Philips Medical Alarms Mp20 30 Users Manual M80009001g

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2015-02-05

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Patient Monitoring

INSTRUCTIONS FOR USE

IntelliVue MP20/30, MP40/50 and MP60/70/80/90

IntelliVue Patient Monitor

MP20/30, MP40/50, MP60/70/80/90

Release D.0 with Software Revision D.00.xx

Part Number M8000-9001G

Printed in Germany 02/06

4512 610 13551

*M8000-9001G*

1Table Of Contents

M8000-9001G

1Basic Operation 1

Introducing the IntelliVue Family 1

IntelliVue MP20/MP30 2

MP20/MP30 Major Parts and Keys 3

IntelliVue MP40/MP50 4

MP40/MP50 Major Parts and Keys 4

IntelliVue MP60/MP70 5

MP60/MP70 Major Parts and Keys 6

IntelliVue MP80/MP90 6

MP80/MP90 Major Parts and Keys 7

D80 Intelligent Display 7

Remote Alarm Device 7

Docking Station 8

Related Products 1 Basic Operation

M3012A Hemodynamic Measurement Server Extension

The M3012A Hemodynamic

Measurement Server Extension

(HMSE) can be connected to the

M3001A Multi-Measurement Server to

provide the following additional

measurements: Temperature, Pressure,

an additional Pressure or Temperature,

and C.O. and CCO measurements.

Temperature connectors (brown)

Cardiac Output (orange;

optional)

Pressure connectors

(red)

Connection to MMS

1 Basic Operation Operating and Navigating

Operating and Navigating

Everything you need to operate the monitor is contained on its screen. Almost every element on the

screen is interactive. Screen elements include measurement numerics, waveforms, screen keys,

information fields, alarms fields and menus.

The configurability of the monitor means that often you can access the same element in different ways.

For example, you might be able to access an item through its on-screen setup menu, via a hard key, or

via a SmartKey. These Instructions for Use always describe how to access items via an on-screen menu.

You may use whichever way you find most convenient.

1234567 8 9

18 16

ABP Zero done at 11 Nov 02 7:31 am

Monitor information line Other screen elements

1network connection indicator

(documented in Information

Center Instructions for Use)

10 alarm status area - shows active alarm messages

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

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

4patient category 13 enter Main Setup menu

5paced status 14 scroll right to display more SmartKeys

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

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

8current screen name/enter

change screen menu

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

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

immediately re-enable alarm indicators.

9adjust alarm volume/level

indicator

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

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

Operating and Navigating 1 Basic Operation

Selecting Screen Elements

Select a screen element to tell the monitor to carry out the actions linked to the element. For example,

select the Patient Identification element to call up the Patient Demographics window, or

select the HR numeric to call up the Setup ECG menu. Select the ECG wave segment to call up the

ECG lead menu.

Note that the space between each line of a menu may be configured to wide or narrow to facilitate your

most common method of operation, either touch, Speedpoint or navigation point, or mouse.

Using the Setup Menu

MP20/MP30/

MP40/MP50

Only

For the MP20/MP30 and MP40/MP50 monitors, the

elements at the top of the Screen are grouped together for

ease of navigation. Select any item at the top of the Screen

to open the Setup menu; scroll down the menu to

highlight the element you want then press the navigation

point to select the element.

Using the Touchscreen

Select screen elements by pressing them directly on the monitor’s screen.

Disabling Touchscreen Operation

♦To temporarily disable touchscreen operation of the monitor, press and hold the Main

Screen permanent key. A padlock will appear on the Main Screen permanent key.

♦Press and hold the Main Screen permanent key again to re-enable the touchscreen operation.

Setup

Alarm Messages

Alarm Limits

Alarm Volume

My Care Group

Change Screens

Profiles

Admit/Dischrg

Paced No

Network

Bed Information

Date, Time

1 Basic Operation Operating and Navigating

Using the SpeedPoint

Rotate the SpeedPoint knob left or right. With each click, the highlight jumps to the neighboring

screen element. Alternatively, tilt the knob to move it in the direction of a screen element. A cursor

moves across the screen, following the direction of the knob. Any screen element under the cursor is

highlighted. When you reach the screen element you want, press the knob to select the element.

Using the remote SpeedPoint, you can operate the monitor from a distant location such as at the foot

of the bed. The remote SpeedPoint can be used with all monitors.

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

follows the Silence permanent key configuration.

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

configuration.

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

4Back - go back one step to the previous menu.

5SpeedPoint knob - rotate and tilt to highlight elements. Press to select.

6Function keys on remote SpeedPoint - function identical to the first five SmartKeys configured for a

screen.

7On/standby key

integrated SpeedPoint

(MP60/MP70 only)

Remote SpeedPoint

(all monitors)

Operating and Navigating 1 Basic Operation

Using the Navigation Point

MP20/MP30/

MP40/MP50

Only

To use the navigation point, rotate it left or right. With each click, the highlight jumps to the

neighboring screen element. The element under the cursor is highlighted. When you reach the screen

element you want, press the knob to select the element.

Using a Mouse or Trackball

If you are using a mouse or trackball, select screen elements by clicking on them (press and release the

left mouse button). While you are moving the mouse, a cursor appears and a highlight shows your

current position.

Using Keys

The monitor has four different types of keys.

Permanent Keys

A permanent key is a graphical key that remains on the screen all the time to give you fast access to

functions.

1Silence - acknowledges all active alarms by

switching off audible alarm indicators and

lamps. Exact behavior depends on permanent

key configuration

2Alarms Off/Pause Alarms - pauses alarm

indicators. Exact behavior depends on Pause

Alarms permanent key configuration

3 Main Screen - closes all open menus and

windows and return to the main screen.

4Back - takes you back one step to the previous

menu.

5Navigation Point knob

Pause Alarms - pauses alarm indicators. Pause duration depends on monitor

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

Select again to immediately re-enable alarm indicators.

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

lamps.

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

Main Setup - enter main setup menu.

1 Basic Operation Operating and Navigating

SmartKeys

A SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast

access to functions. The selection of SmartKeys available on your monitor depends on your monitor

configuration and on the options purchased.

enter profile menu, or

revert to default profile

change Screen, or

revert to default screen

show BIS Sensor previous Screen

freeze waves quick admit a patient

set alarm limits enter patient identification menu to

admit/discharge/transfer

change alarm volume end case to discharge a patient

change QRS volume view information for patients in other

beds

enter standby mode - suspends patient

monitoring. All waves and numerics

disappear from the display. All settings

and patient data information are

retained.

change screen brightness (not for

independent displays)

review beat labels (annotate

arrhythmia wave) re-learn arrhythmia

change amplitude (size) of ECG wave enter cardiac output procedure

- start/stop manual NBP measurement

- start auto series

- stop current automatic measurement

within series

start NBP STAT measurement

stop automatic or STAT NBP

measurement and measurement series

start veni puncture (inflate cuff to

subdiastolic pressure)

set the NBP repeat time

access patient reports zero invasive pressure transducer

Operating and Navigating 1 Basic Operation

Hardkeys

A hardkey is a physical key on a monitoring device, such as the zero pressure key on the MMS or a

setup key on a module.

Pop-Up Keys

Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when

required. For example, the confirm pop-up key appears only when you need to confirm a change.

start a delayed recording Realtime Record SmartKey to access pop-

up recording keys

set wide automatic alarm limits set narrow automatic alarm limits

access wedge procedure window access the Loops window

review vital signs trend review graph trend

access event surveillance access calculations

access the calculator access the Drug Calculator

gas analyzer - exit standby mode suppress zero for all gas measurements

unpair equipment access ST Map application

start 12-Lead Capture (only available

if Information Center is connected)

access remote applications (if Application

Server is connected)

access EEG CSA access the EEG montage

display VueLink information access timers

access the spirometry data window switch CO2 pump off

1 Basic Operation Operating and Navigating

Using the On-Screen Keyboard

Use this as you would a conventional keyboard. Enter the information by selecting one character after

another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete

single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have

entered and close the on-screen keyboard.

If a conventional keyboard is connected to the monitor, you can use this instead of or in combination

with the on-screen keyboard.

Using the On-Screen Calculator

You can use the on-screen calculator to perform any of

the standard operations for which you would normally

use a handheld calculator.

♦To access the on-screen calculator, select the

Calculator SmartKey, or select Main Setup

-> Calculations -> Calculator.

Calculator

MC MR M+ Back

√C/CE

Operating Modes 1 Basic Operation

Operating Modes

When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:

1Select the Main Setup menu.

2Select Operating Modes and choose the mode you require.

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

•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 in the bottom right-hand corner. Select this field to

change to a different mode.

Standby Mode

Standby mode can be used when you want to temporarily interrupt monitoring.

To enter Standby mode,

♦select the Monitor Standby SmartKey or

♦select Main Setup, followed by Monitor Standby.

The monitor enters Standby mode automatically after the End Case function is used to discharge a

patient.

Standby suspends patient monitoring. All waves and numerics disappear from the display but all

settings and patient data information are retained. A special Standby screen is displayed. If a patient

location is entered at the Information Center, this will also be displayed on the Standby screen

(availability depends on Information Center revision).

To resume monitoring,

♦Select anything on the screen or press any key.

Config

1 Basic Operation Understanding Screens

Understanding Screens

Your monitor comes with a set of preconfigured 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 SmartKeys on the monitor screen when you switch on. You can easily switch between

different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so

forth.

When you switch from a complex to a less complex Screen layout, some measurements may not be

visible but are still monitored in the background. If you switch to a more complex Screen with, for

example, four invasive pressure waves but you have only two pressures connected to the monitor, the

“missing” two pressures are either left blank or the available space is filled by another measurement.

Switching to a Different Screen

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

or select the Change Screen SmartKey.

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

Changing a Screen’s Content

If you do not want to change the entire Screen content, but only some parts of it, you can substitute

individual waves, numerics, high-res waves, or trends. Be aware that these changes cannot be stored

permanently in Monitoring Mode.

To change the selection of elements on a Screen,

1Select the element you want to change.

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

Change HiResTrend, and then select the wave or numeric you want, or select the high-

resolution trend wave you want from the list of available waves.

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

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

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

Using Additional Displays 1 Basic Operation

In the Change Screen menu, the changed Screen is

shown linked to the original Screen and marked with an

asterisk.

Up to three modified Screens can be accessed via the

Change Screen menu.

To recall Screens, either

♦select the name of the Screen in the

Change Screen menu

♦use the previous/next arrows at the top of the

Change Screen menu to move back and forth in the

Screen history. The ten most recently-used Screens

including up to three modified Screens can be

accessed.

After a patient discharge, the monitor’s default Screen is

shown. Modified Screens are still available in the

Change Screen menu.

If the monitor is switched off and then on again, modified Screens are erased from the monitor’s

memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was

switched off, it is retained (unless Automat. Default is configured to Yes).

Using Additional Displays

A second display, showing the same Screen as the main display, can be connected to any of the

monitors, for viewing only.

The MP90 can have two main displays and additionally, as a third main display, the D80 Intelligent

Display connected. All main displays can be configured and operated individually using standard input

devices.

For MP90 monitors with multiple displays and multiple input devices, the usage and behavior can be

configured according to specific requirements at installation (for example, use for two independent

operators or tracking of mouse input across two displays). For details refer to the Service Guide.

When two operators are using two displays, the scope of an action depends on the type of operation:

• Patient monitoring operations such as Silence or Pause alarms take effect for the monitor as a

whole, the results will be seen on both displays.

• Display operations such as the Main Screen key and Back hardkey will take effect only on the

display being operated.

If you are operating two displays with one remote SpeedPoint, to navigate from one display to another:

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

The highlighting moves to a special “jump” field at the edge of the Screen

2Press the knob on the SpeedPoint to confirm; the highlighting will automatically move to the other

display.

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

operating two or three displays, you can choose Screens for all displays from one location:

Change Screen

6 Waves A

Split Screen A

Loops

Cardiac Output

Vital Signs A

Vital Signs A*

1 Basic Operation Understanding Profiles

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

2Select Display 1, Display 2, or Display 3 then select the Screen you want to display

on the that display from the list of available Screens.

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

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

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

special Tall Screen or Wide Screen symbol.

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

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

blank grey window with a cross through it.

Using the Visitor Screen

If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and

numerics but continue to monitor the patient with active alarms and trend storage at the bedside and

Information Center. You can change the name of the visitor Screen in Configuration Mode.

♦To activate this Screen, select the Screen name in the monitor info line to open the Screen

menu, then select the name of the visitor Screen configured for your monitor from the list of

available Screens.

♦Select any element on the Screen to open the Screen menu and select a different Screen to show

waves and numerics again.

Understanding Profiles

Profiles are predefined monitor configurations. They let you change the configuration of the whole

monitor so you can adapt it to different monitoring situations. The changes that occur when you

change a complete profile are more far reaching than those made when you change a Screen. Screens

affect only what is shown on the display. Profiles affect all monitor and measurement settings.

The settings that are defined by Profiles are grouped into three categories. Each category offers a choice

of ‘settings blocks’ customized for specific monitoring situations. These categories are:

• Display (screens)

– Each profile can have a choice of many different predefined screens. If you are using a second

display, each display can have its own individual screen selection. When you change the profile,

the screen selection configured for the new profile becomes active.

• Measurement Settings

– Each profile can have a choice of different predefined measurement settings. These relate directly

to individual measurements, for example, measurement on/off, measurement color, alarms limits,

NBP alarm source, NBP repeat time, temperature unit (oF or oC) 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.

Understanding Profiles 1 Basic Operation

You can change from one complete profile to another or swap individual settings blocks (display

screen/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.

You might find it helpful to think of the three categories in terms of a restaurant menu. The Screens

are like the first course, offering you a choice of “starters” (many different screen configurations from

which you can choose the one that best suits your requirements). The Monitor Settings category is like

the main course, offering a choice of different “main dishes” from which you can pick one. The

Measurement Settings are like the dessert course. From these you build your meal. You can choose one

from the “starters”, one from the main course, then one from the dessert or simply pick one or two

courses without having a full meal.

Depending on your monitor configuration, when you switch on or discharge a patient the monitor

either continues with the previous profile, or resets to the default profile configured for that monitor.

WARNING If you switch to a different profile, the patient category and paced status normally change to the setting

specified in the new profile. However some profiles may be setup to leave the patient category and

paced status unchanged. Always check the patient category, paced status, and all alarms and settings,

when you change profiles.

When you leave Demonstration Mode, the monitor uses the default profile.

Swapping a Complete Profile

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

2In the Profiles menu, select Profile.

3Chose a profile from the pop-up list.

4Confirm your selection.

Profiles

Measurement B

Measurement C

Measurement D

Profiles Menu, showing current settings Available choices in measurement

Profile : Profile A

Patient Category: Adult

Paced : No

Display : S-014

Monitor Settings: Monitor A

Meas Settings: Measurement A

Measurement A

1 Basic Operation Understanding Settings

Swapping a Settings Block

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

2In the Profiles menu, select Display or Measmnt. Settings or

Monitor Settings to call up a list of the settings blocks in each category.

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

4Confirm your selection.

Default Profile

Your monitor has a default profile that it uses when you leave Demonstration, or Service modes, or

when you discharge a patient. This profile is indicated by a diamond .

Locked Profiles

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

indicated by this lock symbol.

Understanding Settings

Each aspect of how the monitor works and looks is defined by a setting. There are a number of

different categories of settings, including,

Screen Settings, to define the selection and appearance of elements on each individual Screen

Measurement settings, to define settings unique to each measurement, for example, high and low

alarm limits

Monitor settings, including settings that affect more than one measurement or Screen and define

general aspects of how the monitor works, for example, alarm volume, reports and recordings, and

display brightness.

You must be aware that, although many settings can be changed in Monitoring Mode, permanent

changes to settings can only be done in the monitor’s Configuration Mode. All settings are reset to the

stored defaults:

• when you discharge a patient

•when you load a Profile

• when the monitor is switched off for more than one minute (if Automat. Default is set to

Yes).

Changing Measurement Settings

Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup

menu:

• via the measurement numeric - select the measurement numeric to enter its setup menu. For

example, to enter the Setup ECG menu, select the HR (heart rate) numeric.

• via the Setup hardkey (on plug-in modules) - press the Setup hardkey on the module front.

Changing Wave Speeds 1 Basic Operation

•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 popup list. With this SmartKey you can access any setup menu in the

monitor.

• via the Measurement Selection key.

This guide always describes the entry method using the setup menu. But you can use any method you

prefer.

Switching a Measurement On and Off

When a measurement is off, its waves and numerics are removed from the monitor’s screen. The

monitor stops data acquisition and alarming for this measurement. A measurement automatically

switches off if you disconnect its module or measurement server. If you disconnect a transducer, the

monitor replaces the measurement numeric with question marks.

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

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

setting.

Switching Numerics On and Off

For some measurements, such as EEG, you can choose which numerics to view on the screen.

♦In the measurement’s setup menu, select the numeric name to toggle between on and off.

For example in the Setup EEG menu, select the EEG numeric name to toggle between on and

off.

Adjusting a Measurement Wave

♦To quickly adjust wave-related measurement settings (such as speed or size), select the

measurement wave itself. This displays the measurement Wave menu, which has only wave-

related measurement settings.

Changing Wave Speeds

Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the

speed expands the waveform, giving you a more detailed view.

The monitor distinguishes three groups of wave speed settings,

•RespiratorySpeed, for all respiratory waves: CO2, Resp. anesthetic agents and O2

•EEG Speed, for all EEG and BIS waves

•Global Speed, for all waves not included in the other two groups.

Changing the Wave Group Speed

The wave speed group setting defines the speed of all the waves in the group.

To change the wave speed of a wave speed group,

1Select Main Setup -> User Interface

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

1 Basic Operation Freezing Waves

3Select a value from the list of available speeds.

Changing Wave Speed for a Channel

To change the wave speed of an individual wave channel,

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

2Select Change Speed.

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

Global Speed.

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

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

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

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

Freezing Waves

You can freeze waves on the screen and measure parts of the wave using cursors. The waves are frozen

with a history of 20 seconds so that you can go back and measure what you have seen.

Freezing An Individual Wave

To freeze a wave,

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

2Select Freeze Wave.

The realtime wave is replaced with the frozen wave.

Freezing All Waves

To freeze all waves on the screen,

1Select the Freeze Waves SmartKey.

All realtime waves are replaced with frozen waves.

Measuring Frozen Waves

To measure a frozen wave,

1Select the frozen wave.

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

repositioned by touching the required point on the wave, or

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

the vertical cursor.

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

cursor.

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

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

Using Labels 1 Basic Operation

Changing The Wave Speed

Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the

speed expands the waveform, giving you a more detailed view.

To change the wave speed:

1Select the frozen wave.

2Select Change Speed.

3Select a speed from the list.

Updating The Frozen Wave

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

1Select the frozen wave.

2Select Freeze Again.

Releasing Frozen Waves

To release frozen waves,

1Select a frozen wave.

2Select Unfreeze Waves.

All frozen waves are released.

Using Labels

You can measure multiple invasive pressures, temperatures, and SpO2 simultaneously. The monitor

uses labels to distinguish between them. The default settings defined in the profile (such as

measurement color, wave scale, and alarm settings) are stored within each label. When you assign a

label to a measurement, the monitor automatically applies these default settings to the measurement.

The labels assigned are used throughout the monitor, in reports, recordings, and in trends.

About Label Sets

Your monitor may be configured to use a Restricted or Full label set. The Full label set

provides extra labels for Pressure and Temp. See the sections in this Instructions for Use on Pressure

and Temp for more information.

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

using a Restricted label set or an M3/M4 monitor, any additional labels switch to labels available

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

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

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

the Information Center. See the Information Center documentation and your monitor’s

Configuration Guide for information on label set compatibility.

Changing Measurement Labels (e.g. Pressure)

To change a measurement label of a measurement with multiple labels (invasive pressure, temperature,

or SpO2),

1 Basic Operation Using Labels

1Enter the Wave menu of the measurement.

2Select Label.

3Choose a label from the list.

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

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

monitor’s Configuration Mode.

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

Give me an example Let’s imagine you used a Press module to monitor your previous patient’s CVP.

Now you want to use the same module to measure ABP with a new patient. You’ve set up your arterial

line. When you connect the pressure transducer to the module, the pressure shown on the screen still

uses the CVP color and wave scale and is labeled CVP. To rectify this, just change the pressure label to

ABP. Now the pressure has the correct color, the wave is shown in the correct scale, and the

appropriate alarm limits for ABP are active.

Resolving Label Conflicts

Each label must be unique, that is, it can only be assigned once. You cannot monitor two pressures

labelled “ICP” at the same time. If you need to use two identical pressures, you must assign different

labels to them, for example, P and ICP.

Measurement labels are stored in the measurement device (module or measurement server). If you try

to use two measurement devices that have identical labels, this causes a label conflict in the monitor.

Depending on your configuration, the monitor will either

• resolve the conflict automatically, by assigning a new, generic label

to the most recently connected conflicting label (e.g. a second FAP

label could be changed to ABP)

•display the Measurement Selection window automatically

for you to resolve the conflict

• take no action, you must enter the Measurement

Selection window and resolve the conflict

All the currently available measurement devices are depicted in the Measurement Selection

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

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

device is shown “grayed-out”.

To resolve a label conflict,

1Select the measurement selection key or select Main Setup -> Measurement Selection

to display the Measurement Selection window.

measurement selection key

with question marks

indicating a label conflict

Measurement Selection

SpO2 BIS SpO2

Tskin C.O. EcgRsp NBP ABP

CO2 Temp

Conflicting measurement

labels are shown in red

De-activated labels are

grayed-out

Changing Monitor Settings 1 Basic Operation

2Select the device whose label you want to correct.

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

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

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

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

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

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

the conflicting device’s label to a different label.

–Modify Driver (VueLink only) - change the VueLink device driver.

Changing Monitor Settings

♦To change monitor settings such as date and time, brightness, or QRS tone volume, select the

Main Setup SmartKey and then select the setting you want to change, or select User

Interface to enter a submenu where you can change user interface settings.

Adjusting the Screen Brightness

1Select the Brightness SmartKey.

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

bright.

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

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

monitor’s Configuration Mode.

If you are using an MP80 or MP90 with an external display, the Brightness SmartKey does not

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

instructions.

Adjusting Touch Tone Volume

The touch tone volume is the tone you hear when you select any field on the monitor screen. To adjust

the touch tone volume,

1In the Main Setup menu, select User Interface

2Select TouchToneVolume, then select the appropriate setting for the touch tone volume: 10 is

the loudest and 1 is the quietest. Selecting zero switches the touch tone volume off.

Setting the Date and Time

If your monitor is connected to an Information Center, the date and time are automatically taken from

this. Once it is set, the internal clock retains the setting even when you switch off the monitor.

WARNING Changing the date or time will affect the storage of trends and events.

1Select the Date, Time screen element from the monitor’s info line to enter the Date, Time

menu.

1 Basic Operation Checking Your Monitor Revision

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

necessary. Select the correct values from the pop-up list.

3Select Store Date, Time to change the date and time.

Checking Your Monitor Revision

1Select Main Setup -> Revision to open the Monitor Revision menu.

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

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

revision information.

Getting Started

Once you understand the basic operation principles, you can get ready for monitoring.

Inspecting the Monitor

WARNING If the monitor is mechanically damaged, or if it is not working properly, do not use it for any

monitoring procedure on a patient. Contact your service personnel.

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

all connected Measurement Servers, modules, or measurement server extensions.

– Check for any mechanical damage.

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

2Plug the power cord into the AC power source. 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.

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

instrument is in good working order.

Switching On

♦Press the on/off switch on the monitor for one second. The monitor performs a self test and is then

ready to use. If you see a message such as CO2 Sensor Warmup wait until it disappears before

starting monitoring that measurement. Connected devices usually take their power from the

monitor. External devices such as gas monitors and those connected via VueLink have their own

power switches.

CAUTION When using an MP90 monitor with a D80 Intelligent Display, always switch power on directly at the

MP90 or at a remote SpeedPoint or remote alarm device directly connected to the MP90.

Setting up the Measurement Servers and Modules

1Decide which measurements you want to make.

Disconnecting from Power 1 Basic Operation

2Connect the required modules, Measurement Servers, or measurement server extensions.

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

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

Starting Monitoring

After you switch on the monitor,

1Admit your patient to the monitor.

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

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

3Refer to the appropriate measurement section for details of how to perform the measurements you

require.

Disconnecting from Power

The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect,

unplug the power cable.

Monitoring After a Power Failure

If the monitor is without power for less than one minute, monitoring will resume with all active

settings unchanged. If the monitor is without power for more than one minute, the behavior depends

on your configuration. If Automat. Default is set to Yes, the default profile will be loaded

when power is restored. If Automat. Default is set to No, all active settings are retained, if power

is restored within 48 hours. The Automat. Default setting is made in Configuration Mode.

Networked Monitoring

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

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

information about the network,

♦MP20/MP30/MP40/MP50 - select the monitor info line to enter the Setup menu, then select

Bed Information.

♦MP60/MP70/MP80/MP90 - in the monitor info line, select the bed label.

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

comparison to those on wired networks.

Using Remote Applications

If your monitor is connected to a Philips Application Server, you can access applications hosted

remotely on the Application Server and display and operate them on the bedside monitor screen. The

Application Server provides portal technology to allow information access through a web browser,

terminal emulation, or served applications. The applications available depend on the Application

Server configuration: see the device documentation for details. A Remote Application window can also

be embedded in a monitoring Screen.

To display remote applications on the monitor,

1 Basic Operation Using Remote Applications

1In the Main Setup menu, select Remote Applics, or select the

Remote Applications SmartKey.

2Select the required application from the pop-up list of available applications.

3Operate the application with your preferred monitor input device: touchscreen, SpeedPoint,

navigation point, keyboard or mouse.

Remote Application Popup Keys

The Remote Application window occupies a pre-defined area on the monitor Screen. The maximum

size of the area depends on the resolution of your display. If the pre-defined area for the Remote

Application covers the full monitor Screen (on independent second displays only), the pop-up keys are

not displayed. In this case a small window appears with two keys: one (with the Remote Application

symbol) to display the pop-up keys and another to move the small window if it is obstructing viewing.

If you change the monitor Screen while a Remote Application is running, and the pre-defined area on

the second Screen is smaller, the Remote Application cannot be shown at full size. You must select a

suitable monitor Screen to display the Remote Application again.

Pop-Up Keys Selecting this pop-up key lets you....

Minimize minimize the Remote Application window; the session continues running in the

background. Select the Remote Application symbol to show the window at full size

again.

Keyboard start a keyboard application to show a keyboard on the display. This key is not available

if the keyboard application is not installed or not supported on the Philips Application

Server.

Refresh update the content of the Remote Application window.

Close close the Remote Application session.

2What’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 configuration purchased by your

hospital.

What’s New in Release D.0?

M1014A Spirometry Module

The spirometry module produces a real time wave for flow, volume and pressure of respiratory gases

together with numerics for analysis of ventilatory mechanics. It is designed to be used in combination

with Philips-branded airway flow sensors and combined CO2/airway flow sensors.

M3014A Capnography Extension

The M3014A Capnography Extension offers an additional measurement method - sidestream CO2

with the M2741A sensor.

M8016A D80 Intelligent Display

The D80 Intelligent Display can be used as a third main display with the MP90 monitor. You then

have three displays able to be configured individually and to be operated independently.

IntelliVue 802.11 Bedside Adapter

The 802.11 Bedside Adapter is a wireless ethernet adapter which can be built in to the patient monitor

(option J35). It provides wireless connectivity to standard IEEE 802.11a/b/g wireless networks.

Improved Multiple Display Support

• Wide and Tall screen layouts are supported which allow screen content to be spread over two screens

next to each other (wide acreen) or one above the other (tall screen).

• An additional main display used for a surgeon can be configured not to show alarm information.

The permanent keys and SmartKeys can also be configured not to display.

• Input devices can be assigned to an operator, independent of physical connector location.

New SmartKeys

For the new spirometry module there is a SmartKey to provide direct access to the spirometry data

window. For microstream and sidestream CO2, sampling can now be suppressed directly with the

SmartKey CO2 Pump Off.

2What’s New? What’s New in Release C.0?

What’s New in Release C.0?

IntelliVue MP80

The MP80 patient monitor is a new addition to the IntelliVue patient monitor family. The

functionality is similar to that of the MP70 but with the flexibility of component modularity as in the

MP90.

M3014A Capnography Extension

The M3014A Capnography Extension offers a new measurement combination - mainstream CO2,

cardiac output, invasive pressure and invasive pressure/temperature.

M8045A Docking Station

The docking station provides quick mounting and connections for the MP20/MP30/MP40/MP50 in

a one-step operation. By placing the monitor on the docking station and closing the lever you can

make the connection to AC power and to a network, if present.

BIS Interface Board

This interface board allows use of Bispectral Index monitoring with the MP20 and MP30.

Timers Application

The new Timers application allows you to set timers to notify you when a specific time period has

expired. The timers can have varying characteristics and can be located on the Main screen for easy

viewing.

IntelliVue Instrument Telemetry (USA only)

Wireless network capabilities via the IntelliVue Instrument Telemetry network using a built-in

interface (MP20/MP30) or an external adapter (MP40/MP50).

Remote Applications

Remote applications can now be embedded in a monitoring Screen. The display colors for remote

applications have been enhanced.

Basic Operation

• Selection and order of SmartKeys can now be configured in the monitor’s Configuration mode.

• A new SmartKey exits Standby mode at the gas monitor.

• Direct operation of a second independent display with the MP90, using standard input devices.

• Networked monitors can now show Telemetry information for the “Own Bed” in an overview

window or embedded in a Screen.

• Overview bed information can be configured to display in the colors used at the Information Center

(with Information Center System G or higher).

• Support for Unit-based Care Group model for up to 64 beds (with Information Center System G or

higher).

• Battery status information on the main screen now includes estimated monitoring time available

during battery charging.

• Barcode reader support during patient admission.

• Direct entry to graphical trends when a limit alarm is selected in alarm review and to the event

episode window when an event alarm is selected.

• MP90: screen trends can now also be viewed on the second display.

What’s New in Release B.1? 2What’s New?

Trends

• In graphical trends, a segment menu allows direct adjustment of trend scales, automatic scale

optimization, expanded view for an individual segment.

• In graphical and horizon Screen Trends a cursor is available.

• In the Vital Signs window, the values can be shown with the parameter color.

Events

• Events can be configured to be signaled as alarms (advanced event surveillance only).

• Deviation triggers can be set which trigger an event when measured values change by a defined

amount over a set time (advanced event surveillance only).

• Up to six event groups can be active simultaneously (advanced event surveillance only).

Measurements

• Pulse Pressure Variation is a new derived measurement calculated from beat-to-beat arterial pressure

values.

• MAC value calculations

Applications

• Improved Drug Calculator meeting JCAHO requirements.

• The ST Map application shows ST changes over time in two multi-axis spider diagrams.

• Freeze and measure waves on the Main Screen.

What’s New in Release B.1?

IntelliVue MP20/MP30

The MP20/MP30 patient monitor is a new addition to the IntelliVue patient monitor family. It is

smaller and lighter than the MP40/MP50 monitors and can be powered by battery. It can be used with

the measurement server and server extensions and has a built-in recorder.

Basic Operation

• New Measurement Selection window makes it easier to resolve measurement label conflicts

• New Previous/Next Screen function provides access to the ten most recently modified Screens

• Wave speeds can now be set for individual wave channels

Trends

• Cursor in graphical trend window improves navigation in the trends database

• Vital Signs and Graphical Trend screen elements can be embedded on a Screen

• New band style format for displaying trends of measurements with multiple numerics

• Horizon trend is a new format for screen trends, showing the deviation from a stored baseline

• Aperiodic measurements now stored with a timestamp in Vital Signs

• New symbol representing NBP measurements in Graphical Trends

Measurements

• ST numerics in the Alarm Limits window can be shown and hidden

2What’s New? What’s New in Release B.0?

• ST Point can be set directly by selecting a numeric value

• New NBP countdown timer shows the time remaining until the next NBP measurement in a series

• Networked monitors can now show Other Bed information embedded on Screen

• Additional labels available for Pressure and Temp

• Additional options for SpO2, support for an extended list of accessories

• Suppress Zero function for Microstream CO2

Applications

• Drug Calculator can now be configured to include a list of commonly-used drugs

• Cursor in the Loops window improves navigation through the stored loops

• Volume-flow loops added to the list of respiratory loops types

• Loops Report for documentation of stored loops

• EEG CSA can now be called up and viewed in a window over the currently displayed Screen

What’s New in Release B.0?

IntelliVue MP40/MP50 The MP40/MP50 patient monitor is a new addition to the IntelliVue

patient monitor family. It uses the same measurement devices as the MP60/MP70/MP90 monitors

and shares the same technological platform and user interface, but is more compact in size and can be

operated by battery.

M3012A Measurement Server Extension The new Hemodynamic Measurement Server Extension

extends measurement capability by adding two additional pressures and Cardiac Output.

M1020B SpO2 Module New SpO2 measurement module, M1020B, enables dual SpO2

measurement without the need to use the VueLink module. Two options are available:

– Option A01 for use with Philips reusable and disposable sensors and Nellcor “R-Cal” disposable

sensors.

– Option A02 for use with Nellcor OxiMax sensors, including the MAX-FAST forehead sensor.

M1020B Option A02 for use with Nellcor OxiMax sensors may not be available in all countries.

PV Loops: compares graphic representations of airway waves to help detect changes in the patient

airway condition.

High-resolution waves per Screen: the number of high-resolution waves that can be shown on a

Screen is increased, limited only by the Axx Option purchased.

Alarms symbols: New alarm symbols are introduced, and “short” yellow alarms were renamed “one-

star” yellow alarms (yellow arrhythmia alarms).

Aperiodic measurements available as Screen Trends: patient trend information for NBP, C.O., C.I.,

and Wedge can now be permanently displayed on the Screen in tabular and graphical form.

What’s New in Release A.2? 2What’s New?

What’s New in Release A.2?

12-Lead ECG recordings: 12-Lead ECG waves and numerics can be sent to a connected recorder

High-Resolution Trend Report: high-resolution trend report can be sent to a connected printer

ST Snippets ST snippets, showing a one second wave segment for each measured ST lead, can be

permanently displayed on the Screen or called up as required.

EEG Wave Speed: new EEG-specific wave speeds have been added to the list of wave speeds available

Drug Calculator: this new feature helps you to calculate drug dosages for your patients

On-Screen Calculator: a mathematics calculator can be used on the Screen

Visitor Screen: this new Screen is designed to hide sensitive patient information from the Screen.

Monitoring and alarm generation function as usual.

Touch selection volume control: The volume of the audio prompt given when a screen element is

selected is now adjustable

VueLink interface: the VueLink on-screen appearance and controls are improved

M3001A: Trend upload from the Multi-Measurement Server (M3001A) improved

Screen Trends: lets you display patient trend information in graphic form permanently on the Screen

Alarm Limits Page: lets you view and control alarm settings for all measurements in one window

New Option for Event Surveillance: a new neonatal event review option #C04 is introduced

Second display To simultaneously show two different Screens, a second display can be connected to

the MP90. The second display is for viewing only.

2What’s New? What’s New in Release A.2?

3Alarms

The alarm information here applies to all measurements. Measurement-specific alarm information is

discussed in the sections on individual measurements.

The monitor has three alarm levels: red, yellow, and INOP.

Red and yellow alarms are patient 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). Yellow arrhythmia alarms are specific to

arrhythmia-related patient conditions (for example, ventricular bigeminy).

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 a problem with the

reliability of the data, but that monitoring is not interrupted.

Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the

trigger delay time for the individual measurement. See the specifications section for details.

If more than one alarm is active, the alarm messages are shown in the

alarm status area in succession. An arrow symbol next to the alarm

message informs you that more than one message is active.

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.

↑ ** HR HIGH

3Alarms Visual Alarm Indicators

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. If more than one measurement is in an alarm condition, the message

changes every two seconds, and has an arrow ( ) at the side. The background color of the alarm

message matches the alarm priority: red for red alarms, yellow for yellow alarms, and light blue for

INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms,

** for yellow alarms, * for yellow arrhythmia alarms. INOPs are displayed without asterisks.

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 “**SpO2 94<96”, where the first number shows the maximum

deviation from the alarm limit, and the second number shows the currently set limit.

Flashing numeric: The numeric of the measurement in alarm flashes.

Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm

limit on the monitor screen is shown more brightly.

Alarm lamp: A lamp on the monitor’s front panel flashes. This has the same color as the alarm

priority.

Nurse call systems: Alarm conditions are indicated on any device connected to the nurse call relay, if

configured to do so.

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 9703-2 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.

Audible Alarm Indicators 3Alarms

Traditional Audible Alarms (HP/Agilent/Philips/Carenet)

• Red alarms: A high pitched sound is repeated once a second.

• Two-star yellow alarms: A lower pitched sound is repeated every two seconds.

• One-star yellow alarms (arrhythmia alarms): The audible indicator is the same as for yellow alarms,

but of shorter duration.

• INOPs: an INOP tone is repeated every two seconds.

ISO/IEC Standard 9703-2 Audible Alarms

• Red alarms: A high pitched tone is repeated five times, followed by a pause.

• Two-star yellow alarms: A lower pitched tone is repeated three times, followed by a pause.

• One-star yellow alarms (arrhythmia alarms): The audible indicator is the same as for yellow alarms,

but of shorter duration.

• INOPs: a lower pitched tone is repeated twice, followed by a pause.

Changing the Alarm Tone Volume

♦The alarm volume symbol at the top right of the monitor screen gives you an

indication of the current volume. To change the volume, select the volume symbol

and then select the required volume from the pop-up selection.

♦If you want to see a numerical indication of the current alarm volume on a scale

from zero to 10, 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.

Alarm

3Alarms Acknowledging Alarms

Acknowledging Alarms

To acknowledge all active alarms and INOPs, select the Silence permanent

key. This switches off the audible alarm indicators and alarm lamps. Alternatively,

you can acknowledge alarms by pressing the Silence hardkey on the MMS or

on the SpeedPoint. The hardkeys follow the behavior configured for the

permanent key.

A check mark beside the alarm message indicates that the alarm has been

acknowledged. If the monitor is configured to re-alarm, a dashed check mark will

be shown.

If the condition that triggered the alarm is still present

after the alarm has been acknowledged, the alarm message

stays on the screen with a check mark symbol beside it.

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.

Unplugging an MMS or a plug-in module automatically switches off its measurements.

Alarm Reminder (ReAlarm)

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). There is no alarm reminder for INOPs.

In Configuration Mode, you can set the interval between silencing the alarm and sounding the

reminder tone to one, two, or three minutes.

Pausing or Switching Off Alarms

If you want to temporarily prevent alarms from sounding, for example while you are moving a patient,

you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or

three minutes, or infinitely.

To view the alarm pause setting chosen for your unit,

1Select Main Setup -> Alarm Settings

2Check the Alarms Off setting.

This setting can only be changed in Configuration Mode.

Silence

APNEA

Pausing or Switching Off Alarms 3Alarms

To Pause All Alarms

♦Select the Pause Alarms permanent key. If your monitor is configured to

infinite pause time, the permanent key is labelled Alarms Off, and selecting it

switches alarms off.

♦Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey

follows the behavior configured for the permanent key.

To Switch All Alarms Off

You can only switch alarms off permanently if your monitor is configured to allow infinite alarms

pause and the permanent key is labelled Alarms Off.

♦Select the Alarms Off permanent key.

♦Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The

hardkey follows the behavior configured for the permanent key.

Pausing alarms infinitely is the same as switching them off.

To Switch Individual Measurement Alarms On or Off

1Select the measurement numeric to enter its setup menu.

2Select Alarms to toggle between On and Off.

The alarms off symbol is shown beside the measurement numeric.

While Alarms are Paused or Off

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

•In the alarm field, the monitor displays the message

Alarms Paused or Alarms Off, together with

the alarms paused symbol and the remaining pause

time in minutes and seconds, or alarms off symbol.

• No alarms are sounded and no alarm messages are

shown.

• INOP messages are shown but no INOP tones are

sounded.

The only exceptions are the INOPs Battery/Batteries Empty, Battery/

Batteries Malfunction, Batt 1/2 Missing, and NBP Cuff Overpressure.

These INOPs are sounded even if alarms are paused or off.

• The nurse call relay is not active.

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

switched off.

Pause

Alarms

Off

ALARMS PAUSED 1:28

ALARMS OFF

3Alarms Alarm Limits

Restarting Paused Alarms

♦To manually switch on alarm indication again after a pause, select the permanent key

Pause Alarms (or Alarms Off) again.

Alarm indication starts again automatically after the pause period expires. If the monitor is configured

to stay paused infinitely, you must select Alarms Off again to restart alarm indication.

Resetting Arrhythmia Alarm Timeouts

♦To reset the arrhythmia alarm timeout period, select the Alarms Off or Pause Alarms

permanent key and then reselect it.

Extending the Alarm Pause Time

If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to

prevent alarms being indicated, for example, while you are washing a patient or carrying out a

procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to

monitor the patient’s condition closely.

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

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

2Select either the pop-up key Pause Al. 5 min or the pop-up key Pause Al. 10 min.

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

minutes.

Alarm Limits

The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some

measurements (for example, BIS and SpO2), where the value ranges from 100 to 0, setting the high

alarm limit to 100 switches the high alarm off, and setting the low alarm limit to 0 switches it off. In

these cases, the alarms off symbol is not displayed.

WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different

patients. Always check that the alarm settings are appropriate for your patient before you start

monitoring.

Viewing Individual Alarm Limits

You can usually see the alarm limits set for each measurement next to the

measurement numeric on the main screen.

If your monitor is not configured to show the alarm limits next to the numeric,

you can see them in the appropriate measurement setup menu. Select the

measurement numeric to enter the menu and check the limits.

120

Alarm limits

Alarm Limits 3Alarms

Viewing All Alarm Limits

The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an

Apnea alarm delay time is set, this is also shown. The Alarms Off symbol is shown beside the

measurement label of any measurement whose alarm switched off.

To open the Alarm Limits window, either select any alarm field to open the Alarm

Messages window, then select the Alarm Limits pop-up key, or select the Alarm

Limits SmartKey, if configured.

♦Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits.

Selecting Hide ST Limits hides the list again.

You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:

–All Al. On/All Al. Off,

–All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all

measurements.

–Print Limits/Record Limits to print a list of all current alarm limit settings on a

connected printer or recorder.

Measurement labels, with alarms

off symbol where appropriate

Current alarm limits

Graphic view of current

yellow and red alarm

limits and currently

monitored measurement

value

Off indicates the

measurement is switched

off

Alarm Limits

ST-V4

ST-V5

ST-V6

SpO2

Pulse (SpO2)

ABPs

PAPd

awRR

NBPs

Apnea Time

Off

sec

3Alarms Alarm Limits

These pop-up keys are not available in the window for changing individual alarm limits which you

access by selecting the measurement label in the Alarm Limits window.

Changing Alarm Limits

To change individual measurement alarm limits using the measurement’s Setup Menu,

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

available values for the alarm limit.

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

Alternatively, you can use the keys in the measurement Change Limits window, which you access by

selecting the measurement label in the Alarm Limits window.

To change alarm limits,

1In the Change Limits window,

– if you are using touch, select the up or down arrow buttons to adjust the high and low alarm

limits as required.

– if you are using a SpeedPoint or Navigation Point, position the cursor in the high yellow alarm

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

the knob again to set the displayed limit.

2Repeat to set the low yellow alarm limit.

15-min trend, showing alarm

limits and monitored

measurement values

(MP40/50/60/70/90 only)

Preview Alarm AutoLimits for a

measurement before applying

Select to apply wide AutoLimits

Select to apply narrow

AutoLimits

High yellow alarm field

Low yellow alarm field

High red alarm (view only)

Up/down arrow keys for

changing high yellow alarm

limits

Alarms

On/Off

Alarms On/Off key - select to

toggle between alarms on or off

Low red alarm (view only)

Up/down arrow keys for

changing low yellow alarm limits

Graphic view of alarm limits

with currently measured value

Alarm Limits 3Alarms

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 Change 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 (AutoLimits)

The monitor can automatically set alarm limits suited to your individual patient, using the Automatic

Alarm Limits function. 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 defined safe limits never exceed the non-pathological range.

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

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

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

changes are not so critical.

♦Use the keys in the Change 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 Change 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

The alarm limits pop-up keys appear with the Alarm Limits and Change Limits windows.

♦Select the Print Limits pop-up key to print an overview of all alarm limits on a connected

printer.

♦Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder.

High alarm limit, wide

High alarm limit, narrow

Low alarm limit, narrow

Low alarm limit, wide

Measurement value

Alarm

limits

Upper limit

clamps

Lower limit

clamps

3Alarms Reviewing Alarms

Reviewing Alarms

To review the currently active alarms and INOPs, select any of the alarm status areas on the monitor

screen. The Alarm Messages window pops up. All alarms and INOPs are erased from the

monitor’s alarm history when you discharge a patient, or if you change to Demonstration Mode.

Alarm Messages Window

The Alarm Messages window shows all the currently active alarms and INOPs in chronological

order, beginning at the top with the most recent. INOPs are shown on the left hand side and patient

alarms are shown on the right hand side. Any active red alarms are shown first, followed by yellow

alarms. Acknowledged alarms or INOPs are shown with the check mark symbol.

The Alarm Messages window pop-up keys appear when the window is opened. If alarm pause

extension is disabled, the pause pop-up keys are inactive (“grayed-out”). Selecting the Review

Alarms pop-up key opens the Review Alarms window.

Review Alarms Window

The Review Alarms window

contains a list of up to 100 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 any changes made to

the Alarms On/Off or Silence status.

If you select a high or low limit alarm in

the list, the Graphical Trends

window will open to provide further

data. If you select an alarm resulting

from an event alarm notification, the Event Episode window for that event will open. 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, when the

monitor is switched off for longer than one minute, and when you leave Demonstration Mode.

The Review Alarms window pop-up keys appear when the window is opened. If alarm pause

extension is disabled, the pause pop-up keys are inactive. Selecting the Active Alarms pop-up key

opens the Alarm Messages window.

Alarm

Limits

Review

Alarms

Pause Al.

5 Min.

Pause Al.

10 Min.

Alarm

Limits

Active

Alarms

Pause Al.

5 Min.

Pause Al.

10 Min.

5 Apr 16:55:18 ** ABPs HIGH (120 >95)

5 Apr 16:55:18 Alarms On

5 Apr 16:45:15 ** SpO2 NON-PULSAT.

5 Apr 16:44:57 Alarms Off

5 Apr 16:44:46 ** awRR LOW (14<15)

5 Apr 16:44:39 ** SpO2 LOW (95<99)

5 Apr 16:44:28 ** ABPs HIGH

5 Apr 16:55:18 *** Apnea

Review Alarms

Understanding Alarm Messages 3Alarms

Understanding Alarm Messages

If you do not immediately understand an INOP or alarm message, refer to its help text.

♦In the Alarm Messages window, select the INOP message. This calls up a help window with

an explanation of the INOP message and, where appropriate, a suggested solution for the problem.

Latching Alarms

The alarm latching setting for your monitor defines how the alarm indicators behave when you do not

acknowledge them. When alarms are set to non-latching, their indicators end when the alarm

condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still

displayed or announced by the monitor after the alarm condition ends. The indication lasts until you

acknowledge the alarm.

Viewing the Alarm Latching Settings

To see the alarm latching setting for your monitor

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

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

settings.

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

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

Yellow, and Off. These choices can be combined to give the following settings:

R = red alarms, Y = yellow alarms

The lead LL has become detached from the

patient or the lead set has been changed.

Attach the missing electrode or select <New

Lead Setup> to confirm the new lead set

Alarm Messages

Resp LEADS OFF

LL LEAD OFF

** awRR LOW

Visual Latching R&Y R&Y R&Y RROff

Audible latching R&Y ROffROffOff

3Alarms Testing Alarms

Alarm Latching Behavior

All INOPs except DISCONNECT and UNPLUGGED INOPs from measurement servers and modules

are non-latching. See “Yellow Arrhythmia Alarms” on page 113 for information on short yellow

arrhythmia 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 indidual 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 On/Off

When you switch alarms on, the settings defined in the currently active Profile are used.

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 either the alarm settings from the monitor's configured default Profile, or the most recently

used alarm settings. After any of these situations, you should check that the alarm settings are

appropriate for your patient, and if necessary, select the correct Profile and patient category.

If power is lost for less than one minute, the alarm settings prior to the power loss are restored.

Red and Yellow Measurement

Alarms

Non-latching

alarms

Visual and audible

latching

Visual latching,

audible non-latching

Alarm has not been

acknowledged.

Alarm condition

still present.

Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.

Alarm condition

no longer present.

All audible and visual

alarm indicators

automatically stop.

Alarm tone on.

Alarm lamp on.

Alarm message.

Flashing numerics.

Alarm message. Flashing

numerics.

Audible alarm indicators

automatically stop.

Alarm has been

acknowledged.

Alarm condition

still present.

Audible alarm acknowledged. Alarm lamp off. Alarm message. Flashing

numerics. Audible alarm reminder (if configured).

Alarm condition

no longer present.

Audible and visual alarm indicators automatically stop.

4Patient Alarms and INOPs

This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their

priority. INOPs start on page 59.

For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for

Use.

Patient Alarm Messages

The measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent

alarms are explained in the individual chapters.

Some alarms may be shown at the Information Center in shortened form, when transferred through

IntelliVue Instrument Telemetry (USA only). These shortened alarm texts are included in the list and

identified with the note “at Information Center”.

Note that yellow arrhythmia alarms (“short yellow alarms”) may be shown with one or with two stars,

depending on your monitor configuration and the Information Center revision you are using.

Refer to your Gas Module Instructions for Use for patient alarms and INOPs from the gas modules.

Alarm Message From Condition Indication

***APNEA or

***APNEA xxx sec

CO2, Resp,

AGM

Respiration has stopped for longer than

the preset apnea time. “xxx” denotes the

Apnea duration.

numeric flashes, red alarm

lamp, alarm tone.

***ASYSTOLE ECG No QRS detected for a period greater

than the asystole threshold (in the

absence of Vfib or chaotic ECG).

numeric flashes, red alarm

lamp, alarm tone.

**awRR HIGH CO2, Resp,

AGM

The airway respiration rate has exceeded

the high alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**awRR LOW CO2, Resp,

AGM

The airway respiration rate has dropped

below the low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

**BIS HIGH BIS The Bispectral Index value has exceeded

the high alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**BIS LOW BIS The Bispectral Index value has dropped

below the low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

4 Patient Alarms and INOPs Patient Alarm Messages

***BRADY (Pulse)

***BRADY xxx<yyy

Press, SpO2The heart rate from the Pulse signal has

fallen below the bradycardia limit. xxx

denotes the lowest measured value; yyy

is the bradycardia limit.

numeric flashes and alarm

limit is highlighted, red alarm

lamp, alarm tone.

**CCO/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/CCI LOW CCO Continuous Cardiac Output or CC

Index is below the low alarm limit.

numeric flashes and low alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

**CPP HIGH CPP The CPP value has exceeded the high

alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone

**CPP LOW CPP The CPP value has fallen below the low

alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

***DESAT or

***DESAT xxx<yyy

SpO2The SpO2 value has fallen below the

desaturation alarm limit. xxx denotes

the lowest measured value, and yyy is

the desaturation limit.

numeric flashes, red alarm

lamp, alarm tone.

**et <Agent label>

HIGH

AGM The end tidal agent high alarm limit has

been exceeded.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**et <Agent label>

LOW

AGM The end tidal agent value has fallen

below the low alarm limit.

numeric flashes and low alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

**etCO2 HIGH CO2, Resp,

AGM

The end tidal CO2 high alarm limit has

been exceeded.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**etCO2 LOW CO2, Resp,

AGM

The end tidal CO2 value has fallen

below the low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

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

been exceeded.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

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

the low alarm limit.

numeric flashes, and low limit

is highlighted, yellow alarm

lamp, alarm tone.

*/**/***

EVENT:<GRP>

Event

surveillance

An event has occurred and the event

notification is configured to alarm.

<GRP> is the event group

event group name flashes,

yellow or red alarm lamp and

alarm tone

*/**/*** EVENT

at Information center

Event

surveillance

An event has occurred and the event

notification is configured to alarm.

Check on the monitor for more details

on event group.

(on monitor) event group

name flashes, yellow or red

alarm lamp and alarm tone

***EXTREME BRADY ECG The bradycardia limit has been

exceeded.

numeric flashes and alarm

limit is highlighted, red alarm

lamp, alarm tone.

***EXTREME TACHY ECG The tachycardia limit has been

exceeded.

numeric flashes and alarm

limit is highlighted, red alarm

lamp, alarm tone.

Alarm Message From Condition Indication

Patient Alarm Messages 4 Patient Alarms and INOPs

**HR HIGH ECG The heart rate high alarm limit has been

exceeded.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone. The sound

switches off after 5 seconds if

Arrhythmia is On.

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

alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone. The sound

switches off after 5 seconds if

Arrhythmia is On.

**imCO2 HIGH CO2, Resp,

AGM

The inspired minimum CO2 high alarm

limit has been exceeded.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**in <Agent label>

HIGH

AGM The inspired agent high alarm limit has

been exceeded.

numeric flashes, high limit is

highlighted, yellow alarm

lamp, alarm tone.

**in <Agent label>

LOW

AGM 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 N2O, AGM The inspired N2O high alarm limit has

been exceeded.

numeric flashes, high limit is

highlighted, yellow alarm

lamp, alarm tone.

**inO2 HIGH O2, AGM The inspired O2 high alarm limit has

been exceeded.

numeric flashes, high limit is

highlighted, yellow alarm

lamp, alarm tone.

**inO2 LOW O2, AGM The inspired O2 value has fallen below

the low alarm limit.

numeric flashes, low limit is

highlighted, yellow alarm

lamp, alarm tone.

***inO2 LOW OXYGEN O2, AGM The inspired O2 value has fallen below

18 vol.%.

numeric flashes, low limit is

highlighted, red alarm lamp,

alarm tone.

*/**IRREGULAR HR ECG/

Arrhythmia

Consistently irregular heart rhythm. numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**MISSED BEAT ECG/

Arrhythmia

No beat detected for 1.75*R-R interval,

or if HR>120bpm no beat detected for

one second (non-paced patients only).

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**MULTIFORM PVCs ECG/

Arrhythmia

Two differently shaped Vs detected,

each occurring at least twice within the

last 300 beats and at least once within

the last 60 beats.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

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

high alarm limit.

s, d, or m after the label indicates

whether the systolic, diastolic or mean

pressure has crossed the limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

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

low alarm limit.

s, d, or m after the label indicates

whether the systolic, diastolic or mean

pressure has crossed the limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

Alarm Message From Condition Indication

4 Patient Alarms and INOPs Patient Alarm Messages

*/**NON-SUSTAIN VT ECG/

Arrhythmia

A run of Vs having a ventricular HR>V-

Tach HR limit, but lasting for less than

the V-Tach Run limit has been detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**PACER NOT CAPT ECG/

Arrhythmia

(paced

patients only)

A missed beat with a pace pulse was

detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**PACER NT

PACING

ECG/

Arrhythmia

(paced

patients only)

A missed beat without a pace pulse was

detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**PAIR PVCs ECG/

Arrhythmia

A non-ventricular contraction, followed

by two ventricular contractions,

followed by a non-ventricular

contraction has been detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**PAUSE ECG/

Arrhythmia

No beat detected for a period greater

than the pause threshold.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

***<Pressure>

DISCONNECT

PRESS The pressure is non-pulsatile and the

mean pressure is continuously less than

10mmHg (1.3kPa). This alarm occurs

only with arterial pressures (P, ABP,

ART, Ao, BAP, FAP, PAP, UAP).

numeric flashes, red alarm

lamp, alarm tone.

**<Pressure> HIGH PRESS The measured pressure value is above

the high alarm limit. s, d, or m after the

label indicates whether the systolic,

diastolic or mean pressure has crossed

the limit.

numeric flashes, high limit is

highlighted, yellow alarm

lamp, alarm tone.

**<Pressure> LOW PRESS The measured pressure value is below

the low alarm limit. s, d, or m after the

label indicates whether the systolic,

diastolic or mean pressure has crossed

the limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

**PULSE HIGH PRESS

SpO2

The pulse rate has exceeded the high

alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**PULSE LOW PRESS

SpO2

The pulse rate has dropped below the

low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

*/**PVCs/min HIGH ECG/

Arrhythmia

More premature ventricular

contractions have been detected in a

minute than the limit.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**R-ON-T PVCs ECG/

Arrhythmia

For HR <100, a PVC with R-R interval

< 1/3 the average interval followed by a

compensatory pause of 1.25 x average

R-R interval or two such Vs without

compensatory pause occurring within 5

minutes of each other. (When HR

>100, 1/3 R-R interval is too short for

detection.).

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

Alarm Message From Condition Indication

Patient Alarm Messages 4 Patient Alarms and INOPs

**RR HIGH RESP The respiration rate has exceeded the

high alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**RR LOW RESP The respiration rate has dropped below

the low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

*/**RUN PVCs HIGH ECG/

Arrhythmia

A run of PVCs greater than 2 was

detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

**<SpO2 label>

HIGH

SpO2The arterial oxygen saturation has

exceeded the high alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**<SpO2 label> LOW SpO2The arterial oxygen saturation has fallen

below the low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

**ST<n> HIGH ECG/

Arrhythmia

The ST elevation in lead <n> is higher

than the limit.

numeric flashes and high alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

**ST<n> LOW ECG/

Arrhythmia

The ST depression in lead <n> is lower

than the limit.

numeric flashes and low alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

**ST MULTI <n>,<n> ECG/

Arrhythmia

The ST depression or elevation is

outside of the limit in two or more leads

numeric flashes, yellow alarm

lamp, alarm tone

**ST MULTI

at Information Center

ECG/

Arrhythmia

The ST depression or elevation is

outside of the limit in two or more

leads. Check on the monitor for more

details about which leads are affected.

(on monitor) numeric flashes,

yellow alarm lamp, alarm tone

**SvO2 HIGH SvO2The SvO2 value has exceeded the high

limit.

numeric flashes and high alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

**SvO2 LOW SvO2The SvO2 value has fallen below the low

limit.

numeric flashes and low alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

*/**SVT ECG/

Arrhythmia

A run of supraventricular beats greater

than the SVT run limit has been

detected and the HR has exceeded the

SVT HR limit.

numeric flashes, yellow alarm

lamp, alarm tone.

***TACHY (Pulse)

***TACHY xxx>yyy

Press, SpO2The heart rate from the Pulse signal has

exceeded the tachycardia limit. xxx

denotes the highest measured value; yyy

is the tachycardia limit.

numeric flashes, alarm limit is

highlighted, red alarm lamp,

alarm tone.

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

exceeded the high alarm limit.

numeric flashes, high alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

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

below the low alarm limit.

numeric flashes, low alarm

limit is highlighted, yellow

alarm lamp, alarm tone.

**tcpO2 HIGH/

**tcpCO2 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.

Alarm Message From Condition Indication

4 Patient Alarms and INOPs Patient Alarm Messages

**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.

**<Temperature

label> HIGH

TEMP The temperature has exceeded the high

alarm limit.

numeric flashes and high limit

is highlighted, yellow alarm

lamp, alarm tone.

**<Temperature

label> LOW

TEMP The temperature has fallen below the

low alarm limit.

numeric flashes and low limit

is highlighted, yellow alarm

lamp, alarm tone.

*/**VENT BIGEMINY ECG/

Arrhythmia

A dominant rhythm of N, V, N, V (N =

supraventricular beat, V = ventricular

beat) was detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

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

consecutive seconds was detected.

numeric flashes, red alarm

lamp, alarm tone.

*/**VENT RHYTHM ECG/

Arrhythmia

A dominant rhythm of adjacent Vs >

vent rhythm limit and ventricular HR <

VTach HR limit was detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

*/**VENT TRIGEMINY ECG/

Arrhythmia

A dominant rhythm of N, N, V, N, N,

V (N = supraventricular beat, V =

ventricular beat) was detected.

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

***VTACH ECG,

Arrhythmia

Ventricular tachycardia has been

detected (Consecutive PVCs exceed V-

Tach Run limit and HR exceeds V-Tach

HR limit).

numeric flashes, yellow alarm

lamp, short yellow audible

alarm.

**/***VueLink

ALARM

at Information Center

VueLink A yellow (**) or red (***) patient alarm

is present on the VueLink module.

Check the monitor display for more

detailed alarm information.

(on monitor) yellow or red

alarm lamp, alarm tone

Alarm Message From Condition Indication

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

The measurement labels and abbreviations for pressure, temperature, SpO2, anesthetic agent, and

VueLink INOP messages are explained in the individual chapters.

INOP Message, Indication Source What to do

ABP INOPS PRESS See <Pressure label> INOPS (under Pressure).

ALL ECG ALARMS OFF ECG/

Arrhythmia

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 alarms source.

Ao INOPS PRESS See <Pressure label> INOPS (under Pressure).

ART INOPS PRESS See <Pressure label> INOPS (under Pressure).

AWF CHANGE SCALE Spirometry Airway flow signal exceeds range of selected scale. Adjust scale

to display complete wave.

AWP CHANGE SCALE Spirometry Airway pressure signal exceeds range of selected scale. Adjust

scale to display complete wave

AWV CHANGE SCALE Spirometry Airway volume signal exceeds range of selected scale. Adjust

scale to display complete wave.

Bad Serverlink

INOP tone

Monitor 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.

BAP INOPS PRESS See <Pressure label> INOPS (under Pressure).

BATTERIES EMPTY or BATT 1/

BATT 2 EMPTY

INOP tone, battery LED flashes

During this INOP, alarms cannot be

paused or switched off.

Batteries The estimated remaining battery-powered operating time of

the indicated battery or batteries is less than 10 minutes.

Replace the batteries immediately.

If the condition persists and the monitor is not connected to

mains power, this INOP is re-issued two minutes after you

acknowledge it.

BATTERIES INCOMPAT or BATT

1/BATT 2 INCOMPAT

INOP tone

Batteries The indicated battery or batteries cannot be used with this

monitor. Replace with the correct batteries (M4605A).

BATTERIES LOW or BATT 1/

BATT 2 LOW

INOP tone

Batteries The estimated battery-powered operating time remaining is less

than 20 minutes.

BATTERIES MALF or BATT 1/

BATT 2 MALFUNCTION

INOP tone, battery LED flashes

During this INOP, alarms cannot be

paused or switched off unless the

monitor is connected to mains power.

Batteries The monitor cannot determine the battery status. If this INOP

persists, replace the faulty battery or batteries. If the condition

persists and the monitor is not connected to mains power, this

INOP is re-issued two minutes after you acknowledge it.

Place the batteries in a different monitor or in a battery charger.

If the same INOP is shown, contact your service personnel.

BATT 1/BATT 2 MISSING

INOP tone.

During this INOP, alarms cannot be

paused or switched off.

Batteries The monitor requires two batteries but can detect only one

battery. Insert the missing battery immediately.

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

BIS CABLE INCOMPAT

INOP tone.

BIS The semi-reusable sensor cable connected is unknown or not

supported by your software revision. Replace it with a Philips-

supported sensor cable.

BIS CABLE USAGE

INOP tone.

BIS The semi-reusable sensor cable has exceeded the maximum

number of uses. Replace the cable.

BIS DSC DISCONN

INOP tone

BIS DSC is not properly connected OR either DSC or BIS engine

may be faulty.

Make sure that the DSC is properly connected to the BIS

Engine. If INOP persists, replace DSC with a known good one

of the same type.

If INOP persists replace BIS engine.

Silencing this INOP switches the measurement off.

BIS DSC INCOMPT

INOP tone

BIS DSC is not supported by the BIS engine or new DSC

connected to an old BIS engine. A software upgrade may be

required. Contact your service personnel.

BIS DSC MALFUNC BIS Electrocautery used during self-test OR malfunction in the

DSC hardware.

Make sure not to use electrocautery during the self-test

procedure. Disconnect and reconnect the DSC to the BIS

engine. If the INOP persists, replace the DSC or contact your

service personnel.

BIS DSC UPDATE

INOP tone

BIS DSC update currently being carried out. This INOP will

disappear when the DSC update is finished. Do not disconnect

the DSC during the update. No action is needed.

BIS ELECTR. DISC

INOP tone.

BIS One or more electrodes are not connected to the semi-reusable

sensor cable. Check all electrode connections.

BIS ENGINE DISC.

INOP tone

BIS BIS engine not connected OR Module Cable defective.

Make sure that the Module Cable is properly connected. If

INOP persists, replace the Module Cable.

Silencing this INOP switches the measurement off.

BIS ENGINE INCOMPT

INOP tone

BIS BIS engine software is not supported. A software upgrade may

be required. Contact your service personnel.

MP20/30 - BIS engine not supported.

BIS ENGINE MALFUNC

INOP tone

BIS Malfunction in the BIS engine hardware. Disconnect and

reconnect the BIS engine. If the INOP persists, replace BIS

engine.

BIS EQUIP MALF

INOP tone

BIS There is a malfunction in the BIS hardware. Unplug and replug

the BIS module. If the INOP persists, contact your service

personnel.

BIS HIGH IMPEDANCE

INOP tone may sound

BIS Impedance of one or more electrode(s) is above the valid range,

most often caused by bad skin preparation. Check the sensor

montage and press the electrode pads firmly. If this INOP

persists, replace the sensor(s) in question using correct skin

preparation.

If INOP persists, contact your service personnel.

BIS IMPEDANCE CHCK

INOP tone may sound

BIS The Cyclic Impedance check is running. It will stop

automatically if all impedances are within the valid range. If

any electrodes do not pass the impedance test, check the sensor

montage and press the electrode pads firmly.

To manually stop the Cyclic Impedance Check, select

Cyclic Check Off in the Setup BIS menu.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

BIS ISOELECTRC EEG BIS No discernible EEG activity is detected for longer than one

minute.

Check the patient. Check that the electrodes are properly

connected.

BIS LEAD OFF

INOP tone may sound

BIS One or more electrodes have no skin contact and therefore

impedances cannot be measured. Check the sensor montage

and press the electrode pads firmly.

If this INOP persists, replace the sensor(s) in question, using

correct skin preparation.

BIS OVERCURRENT

INOP tone

BIS Unplug and replug the BIS module or, f or the MP20/MP30,

disconnect and reconnect the BISx from the Interface board. If

the INOP persists, contact your service personnel.

BIS SENSOR DISCONN

INOP tone

BIS The sensor is not properly connected to the patient interface

cable (PIC) and/or the PIC is not properly connected to the

DSC or BISx, or the sensor or PIC or DSC or BISx may be

faulty.

Check all the connections.

Disconnect and reconnect the sensor, PIC, DSC, BISx.

If the INOP persists, replace the sensor.

If the INOP persists, replace PIC. If INOP persists, contact

your service personnel.

Silencing this INOP switches the measurement off.

BIS SENSOR INCOMPAT

INOP tone

BIS Unsupported sensor connected or sensor type unknown or not

supported by your software revision. Replace the sensor, using

only Philips supported sensors.

BIS SENSOR MALFUNC

INOP tone

BIS Malfunction in the sensor hardware, most often caused by

liquids permeating into the connectors OR patient interface

cable (PIC) or DSC or BISx may be faulty.

Replace the sensor. Manually initiate a Cyclic Impedance

Check. Make sure all electrodes pass the test. Make sure that

the both sides of the PIC connector (between PIC and sensor)

are dry. If you are not sure that the connector is dry, replace the

PIC until it has dried. If this INOP persists, contact your

service personnel.

BIS SENSOR USAGE

INOP tone

BIS Excessive sensor usage. Replace sensor.

A Cyclic Impedance Check will start automatically.

BIS SQI < 15% (INOP tone)

BIS SQI < 50% (no INOP tone)

BIS If the signal quality is below 50%, BIS numerics cannot be

reliably derived.

If the signal quality is below 15%, no BIS numerics can be

derived.

This may occur as a result of artifacts such as those generated

from motion or the presence of electrocautery devices. Make

sure the sensor is properly attached to the patient. Manually

initiate a Cyclic Impedance Check. Make sure all electrodes

pass the test. Make sure the patient is completely relaxed (even

small motions of the facial muscles affect the signal quality).

BIS UNPLUGGED

INOP tone

BIS Plug in the BIS module. Silencing this INOP switches off the

measurement.

BISx DISCONNECTED

INOP tone

BIS The BISx is not connected to the BIS module or the BIS

interface board. Silencing this INOP switches the measurement

off.

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

BISx INCOMPATIBLE

INOP tone

BIS The BISx software is not compatible with the BIS module or

with the MP20/MP30 monitor software. A software upgrade

may be required. Contact your service personnel.

BISx MALFUNCTION

INOP tone

BIS The BISx is faulty. Disconnect and reconnect it to the module

or BIS interface board. If the INOP persists, replace the BISx.

MP20/MP30 - Malfunction on interface board. If the INOP

persists, contact your service personnel.

CANNOT ANALYZE ECG ECG/

Arrhythmia

The arrhythmia algorithm cannot reliably analyze the ECG

data. Check the ECG signal quality of the selected primary and

secondary leads. If necessary, improve lead position or reduce

patient motion.

If you have arrhythmia analysis on, and you are not getting a

reliable HR because the signal is below a minimum amplitude,

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

system performance by choosing another lead and changing

electrodes, you should consider turning arrhythmia analysis off.

CANNOT ANALYZE ST 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.

CCI NO BSA

CCI numeric unavailable

INOP tone

C.O. CCI cannot be calculated because the patient's body surface

area is unknown. Enter the patient weight and height to

provide the BSA for CCI calculation.

CCO BAD PRESS SIGN

numeric is replaced by -?-

INOP tone

C.O. 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 <Pressure label>

numeric is replaced by -?-

INOP tone may sound

C.O. 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 VueLink pressure cannot be used. Select

a n o t h e r p r e s s u r e l a b e l , e i t h e r A B P, A o , A R T, B A P, F A P, o r U A P.

CCO NO CALIBRATION

numeric is replaced by -?-

C.O. The CCO measurement is currently not calibrated.

CCO NO PRESS

at Information Center

C.O. 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 VueLink pressure cannot be used. Select

a n o t h e r p r e s s u r e l a b e l , e i t h e r A B P, A o , A R T, B A P, F A P, o r U A P.

CCO NOT SUPPORTED

numeric is replaced by -?-

INOP tone

C.O. 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/CCI OVERRANGE

numeric is replaced by -?-

INOP tone

C.O. The measured CCO or CCI value is not within the specified

range for CCO/CCI measurement.

CCO <Pressure label>

INVALID

numeric is replaced by -?-

INOP tone may sound

C.O. 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.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

CCO PRESS INVALID

at Information Center

C.O. The arterial pressure selected for pulse contour calculation for

CCO is available but currently invalid. Make sure the pressure

transducer is connected and the zero calibration is valid.

CCO PRESS OVERRANG

numeric is replaced by -?-

INOP tone

C.O. The mean value of the arterial pressure values used for pulse

contour calculation for CCO is below 0 mmHg or above 300

mmHg.

CCO PULSE OVERRANG

numeric is replaced by -?-

INOP tone

C.O. The pulse rate of the pressure used for pulse contour

calculation for CCO is below 30 bpm or above 240 bpm.

CCO/Tbl NO TRANSD

Numeric is replaced by -?-

INOP tone

C.O. No transducer attached to the module or catheter

disconnected.

CCO RECALIBRATE

numeric is replaced by -?-

C.O. The most recent CCO or CCI calibration was made over 8

hours ago. 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.

Charge BATT1/BATT2 now

INOP tone

Batteries Battery must be charged. Connect the monitor to mains power

or exchange the battery.

CHARGER MALFUNCT

INOP tone, battery LED may flash

Batteries There is a problem with the battery charger in the monitor.

Connect the monitor to mains power and contact your service

personnel.

Check Alarm Lamps

INOP tone.

Monitor 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 BATT TEMP

INOP tone

Battery The temperature of one or both batteries is too high. Check

that ventilation openings are not blocked and monitor is not

exposed to heat.

Check Flex Texts

INOP tone

Monitor 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.

CheckInternVoltage

at Information Center

Monitor Potential problem with alarm lamps, display or interfaces

detected. Contact your service personnel. This INOP will

appear on the monitor as Check Monitor Func.

Check Keyboard

INOP tone

Monitor Perform a visual and functional check of the keyboard. Contact

your service personnel.

Check Main Board 2

INOP tone.

Monitor There is a problem with the second main board in the monitor.

Contact your service personnel.

Check MCC Monitor The monitor cannot communicate with the D80 Intelligent

Display. Check the MSL coupling cable. The end with the grey

connector must be connected to the Intelligent Display.

Check Monitor Func

INOP tone.

Monitor Potential problem with alarm lamps, display or interfaces

detected. Contact your service personnel. This INOP may

appear on the Information Center as

CheckInternVoltage.

Check Monitor Temp

INOP tone

Monitor The temperature inside the monitor is too high. Check that the

monitor ventilation is not obstructed. If the situation

continues, contact your service personnel.

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

Check Mouse Device

INOP tone.

Monitor Perform a visual and functional check of the mouse input

device. Contact your service personnel.

Check MSL Voltage

INOP tone

Monitor/

Measuremt

Server

There is a problem with the voltage of the Measurement Server

Link (MSL). Contact your service personnel.

Check Network Conf

INOP tone

Monitor 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 Nurse Relay

INOP tone

Monitor There is a problem with the connection to the nurse relay.

Contact your service personnel.

Check Screen Res

INOP tone

Monitor The Screen you have selected uses a resolution which is not

supported by the display. The monitor will show a generic

Screen instead until you select a different Screen.

Contact your service personnel if you want the Screen deleted

from the Profile(s) to avoid this in future.

Check Settings

INOP tone

Monitor If this INOP appears, check the monitor and patient settings

before you resume monitoring. If the settings are unexpected,

there may be a problem with the monitor software. Contact

your service personnel.

Check Speedpoint

INOP tone.

Monitor Perform a visual and functional check of the SpeedPoint input

device. Contact your service personnel.

Check Touch Input Monitor Perform a visual and functional check of the touch input

device. Contact your service personnel.

Check Waves

INOP tone

Monitor The options purchased with this monitor may not support the

number of waves required to show the selected Screen, so some

waves or high resolution trends are missing from the Screen.

Select a different Screen with fewer waves.

Contact your service personnel if you want the Screen deleted

from the Profile(s) to avoid this in future.

Chk IndepDsp Cable Monitor The monitor cannot communicate with the D80 Intelligent

Display. Check the MSL coupling cable. The end with the grey

connector must be connected to the Intelligent Display.

C LEAD OFF

HR Numeric is replaced by -?- for 10

seconds. INOP tone.

ECG The C electrode (AAMI: V electrode) has become detached

from the patient or the lead set has been changed. Reattach the

electrode or select New Lead Setup in the Setup ECG

menu to confirm the new lead set.

CO2 AUTO ZERO

Numeric is replaced by a - ? -

if the Autozero lasts >15 sec, INOP

tone sounds.

CO2The automatic zero calibration is in progress. This typically

takes 10 seconds. During this time the CO2 values may not be

updated, or they may be replaced by -?-. Wait until the zero

calibration is complete to resume monitoring.

CO2 CAL MODE

CO2 numeric displays current CO2

value for accuracy check

CO2Currently no calibration is running. Accuracy can be checked

by placing the transducer on the two cells of the calstick and

starting calibration. To start monitoring, leave Cal. Mode.

CO2 CAL RUNNING

Numeric is replaced by a - ? -

CO2Wait until calibration is finished.

CO2 CHANGE SCALE CO2The CO2 wave is clipped. Select a more appropriate wave scale

to display the whole wave.

CO2 CHECK ADAPTER

Numeric is replaced by a - ? -

INOP tone.

CO2Check 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.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

CO2 CHECK CAL

Numeric is replaced by a - ? -

INOP tone.

CO2The CO2 value is outside the measurement range. Perform an

accuracy check for both calstick cells and, if necessary,

recalibrate the transducer.

C.O. EQUIP MALF

Numeric is replaced by a - ? -

INOP tone.

C.O. There is a problem with the C.O. hardware. Contact your

service personnel.

CO2 EQUIP MALF

Numeric is replaced by - ? -

INOP tone.

CO2The Measurement Server Extension is faulty. Unplug and

replug the Measurement Server with Extension. If you are using

the mainstream method, unplug and replug the transducer or

try another transducer. If the INOP persists, contact your

service personnel.

CO2 FAILED CAL

Numeric is replaced by -?-

INOP tone.

CO2Make sure that the Cal cell was changed between CAL1 and

CAL2. Repeat the calibration. If the INOP reappears, try

another transducer. If the INOP persists, contact your service

personnel.

CO2 NO SENSOR

Numeric is replaced by - ? -

INOP tone.

CO2There is no CO2 sensor connected. If you silence this INOP

the CO2 measurement will be switched off.

CO2 NO TRANSDUC

Numeric is replaced by - ? -

INOP tone.

CO2There is no CO2 transducer connected. If you replace the

transducer, the new transducer must be calibrated. If you

silence this INOP the CO2 measurement will be switched off.

CO2 NO TUBING

Numeric is replaced by - ? -

INOP tone.

CO2Either the FilterLine is disconnected, or an incorrect line is

attached. Check the connection. If necessary, connect another

Microstream Filterline (only Microstream accessories can be

used).

If you silence this INOP, the measurement will be switched off.

CO2 OCCLUSION

Numeric is replaced by a - ? -

INOP tone.

CO2The FilterLine or exhaust tube is blocked. Check the FilterLine

and exhaust tube, then disconnect and reconnect the

FilterLine. If the INOP persists, connect a new FilterLine.

CO2 OVERRANGE

Numeric is replaced by - ? -

INOP tone.

CO2The CO2 value is higher than the measurement range. If you

suspect a false high value, contact your service personnel.

CO2 PUMP OFF

Numeric is replaced by a - ? -.

CO2The pump has been switched off for fifteen minutes. To switch

it on again, select Pump On in the Setup CO2 menu.

CO2 PURGING

Numeric is replaced by a - ? -

INOP tone.

CO2The 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 SENSOR WARMUP

Numeric is displayed with a - ? -

Microstream CO2: INOP tone.

Mainstream CO2: no INOP tone

CO2Wait until the sensor reaches operating temperature and the

INOP disappears.

C.O. UNPLUGGED

numeric is replaced by -?-

INOP tone.

C.O. Plug in the C.O. module. Silencing this INOP switches off the

measurement.

CO2 UPDATE FW

Numeric is replaced by a - ? -

INOP tone.

CO2The software in the Measurement Server Extension does not

match the software in the MMS. Contact your service

personnel.

CO2 WAIT CAL2

Numeric is replaced by a - ? -

CO2Calibration on the first calstick cell is complete. Place the

transducer on the other calstick cell and start the CAL2

calibration cycle.

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

CO2 ZERO FAILED

Numeric is replaced by a - ? -

INOP tone.

CO2An error occurred during the last zero calibration. Check the

airway adapter and clean, if necessary. Perform another zero

calibration. If the INOP persists, contact your service

personnel.

CO2 ZERO REQUIRED

Numeric is replaced by a - ? -

INOP tone

CO2Perform zero calibration for the CO2 sensor. If the INOP

persists, contact your service personnel.

CO2 ZERO RUNNING CO2Wait until zero calibration is finished.

CPP CHK SOURCES

Numeric is replaced by a - ? -

CPP Not all measurements or values required to perform the

calculation are available. Check the measurement sources.

CPP CHK UNITS

Numeric is replaced by a - ? -

CPP The monitor has detected a conflict in the units used for this

calculation. Check the unit settings.

CUFF NOT DEFLATED

Numeric is displayed with a - ? -

INOP tone.

During this INOP, alarms cannot be

paused or switched off.

NBP Remove the cuff from the patient. Make sure that the tubing is

not kinked or twisted and that the correct patient category is

selected. Try repeating the measurement.

You can silence the INOP, but the INOP message remains

visible until the next NBP measurement is started or the Stop

All SmartKey is selected.

[Adult or pediatric patients: The NBP cuff pressure has exceeded

15mmHg (2kPa) for more than 3 minutes.

Neonatal patients: The NBP cuff pressure has exceeded 5mmHg

(0.7kPa) for more than 90 seconds.]

CVP INOPS PRESS See <Pressure label> INOPS (under Pressure).

ECG EQUIP MALF

Numeric is displayed with a - ? -

INOP tone.

ECG Contact your service personnel.

The ECG hardware is faulty.

<ECG LEAD> LEAD OFF

Numeric is displayed with a - ? -

INOP tone.

ECG Not all the required leads for ECG monitoring are connected.

Check the ECG connections and make sure that the electrode

indicated by <ECG lead> [RA, LA, LL, RL, V or C] electrodes

is attached. In EASI mode, all 5 electrodes must be connected.

ECG EL. NOISY <ECG LEAD> ECG 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 SIGN.

INOP tone.

ECG 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.

EcgOut EQUIP MALF

INOP tone

ECG Check that the ECG out cable is securely connected. Contact

your service personnel.

EEG EQUIP MALFUNC

INOP tone

EEG The EEG hardware is faulty. Contact your service personnel.

EEG IMPEDANCE HIGH or

EEG1 and/or EEG2 IMPED.

HIGH

EEG The signal electrode in one or both channels exceeds the user-

selected impedance limit, or the impedance of a single electrode

exceeds the limit. Check the impedance. If the impedance is

too high, reconnect the electrodes according to the EEG

monitoring setup guidelines.If the INOP persists, contact your

service personnel.

EEG<X> LEAD OFF <n>

[X = channel, n = electrode]

EEG Reconnect specified electrode.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

EEG<X> LEAD OFF

[X = channel]

at Information Center

EEG One or more electrodes are not connected. Check in the EEG

Impedance/Montage window on the monitor which

electrode(s) are affected and reconnect the electrodes.

EEG<X> LEADS OFF

[X = channel]

EEG Two or more electrodes are not connected. Check in the EEG

Impedance/Montage window which electrodes are

affected and reconnect the electrodes.

EEG LINE NOISE

EEG 1 or 2 LINE NOISE

EEG Excessive line noise has been detected in either channel EEG1

or EEG2, or in both EEG channels.

Keep all cables together and away from metallic bodies, other

cables & radiated fields.

EEG MUSCLE NOISE

EEG 1 or 2 MUSCLE NOISE

EEG Too much power above 30 Hz has been detected in channel

EEG1 or EEG2, or both.

Check the Electrode-to-Skin Impedance and reposition the

electrode away from possible muscle activity, if necessary.

EEG NO TRANSDUCER

INOP tone

EEG The trunk cable is disconnected from the EEG plug-in module.

Reconnect the trunk cable.Silencing this INOP switches the

measurement off.

EEG UNPLUGGED

INOP tone

EEG Plug in module. Silencing this INOP switches off the

measurement.

EEG OVERRANGE, or

EEG<X> OVERRANGE

EEG Input signal is too high in one or both channels. This is usually

caused by interfering signals such as line noise or electrosurgery.

X denotes the EEG channel.

FAP INOPS PRESS See <Pressure label> INOPS (under Pressure).

FMS UNPLUGGED

INOP tone.

FMS Make sure that the Flexible Module Server is connected to the

monitor. All FMS measurements are off while the FMS is

unplugged.

FMS UNSUPPORTED

INOP tone.

FMS The Flexible Module Server is not supported by your monitor.

Contact your service personnel.

IC1/IC2INOPS PRESS See <Pressure label> INOPS (under Pressure).

ICP INOPs PRESS See <Pressure label> INOPS (under Pressure).

Indep.Dsp Malfunc. Display A problem has occurred with the second main display. Contact

your service personnel.

Indep.Dsp NotSupp. Display The monitor does not support a second main display. The

monitor software is incompatible. Contact your service

personnel.

Intell.Dsp Malf.

INOP tone

Display There is a problem with the Intelligent Display. Check the

MSL coupling cable then contact your service personnel.

Intell.Dsp Missing Display The monitor has lost contact with the connected Intelligent

Display. Contact your service personnel.

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

Display. The monitor software is incompatible.

Internal.Comm.Malf

INOP tone

Monitor There is a problem with I2C Bus communication in the

monitor. Contact your service personnel.

LA LEAD OFF

Numeric is replaced by -?- for 10

seconds; INOP tone.

ECG The LA electrode has become detached from the patient or the

lead set has been changed. Reattach the electrode or select New

Lead Setup in the Setup ECG menu to confirm the

new lead set.

LAP INOPs PRESS See <Pressure label> INOPS (under Pressure).

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

LEADS OFF

Numeric is replaced by -?- for 10

seconds; INOP tone.

ECG Check that all of the required ECG leads are attached, and that

none of the electrodes have been displaced.

LL LEAD OFF

Numeric is replaced by -?- for 10

seconds; INOP tone.

ECG The LL electrode has become detached from the patient or the

lead set has been changed. Reattach the electrode or select New

Lead Setup in the Setup ECG menu to confirm the

new lead set.

MCC Reversed Monitor The MSL coupling cable is reversed. Connect the end with the

grey connector to the Intelligent Display.

MCC Unsupported Monitor An MSL coupling cable has been connected to a device which

does not support MSL coupling.

Measserv Unsupportd Monitor The measurement server is not supported by the monitor.

Contact your service personnel.

MMS UNPLUGGED

INOP tone.

MMS Make sure that the Multi-Measurement Server is connected to

the monitor. All MMS measurements are off while the MMS is

unplugged.

MMS UNSUPPORTED

INOP tone.

MMS The Multi-measurement Server is not supported by your

monitor. Contact your service personnel.

MSL Power High Monitor The power consumption of the devices connected to the

Measurement Server Link (MSL) cable is too high. If this

situation continues, the MSL will be switched off. Contact

your service personnel.

MSL Power Off

INOP tone.

Monitor The power consumption of the devices connected to the

Measurement Server Link (MSL) cable was too high for too

long and the MSL has been switched off. Contact your service

personnel.

MSL Power Overload

INOP tone.

Monitor The power consumption of the devices connected to the

Measurement Server Link (MSL) cable is much too high or

there has been a short circuit. The MSL has been switched off.

Contact your service personnel.

NBP CUFF OVERPRESS

Numeric displayed with -?- ; INOP

tone.

During this INOP, alarms cannot be

paused or switched off.

NBP The NBP cuff pressure exceeds the overpressure safety limits.

Remove the cuff from the patient. Make sure that the tubing is

not kinked or twisted and that the correct patient category is

selected. Try restarting the measurement.

You can silence this INOP, but the INOP message remains

visible until the next measurement is started or the Stop All

SmartKey is selected.

NBP EQUIP MALF

Numeric is replaced by -?-

INOP tone.

NBP 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.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

NBP INTERRUPTED

Numeric is replaced by -?-

INOP tone.

NBP Check the tubing and cuff for leakages or kinks. Check that

you are using the correct cuff size and placement, and that the

correct patient category is selected. Try restarting the

measurement.

If the INOP occurs repeatedly, contact your service personnel.

You can silence this INOP, but the INOP message remains

visible until the next measurement is started or the Stop All

SmartKey is selected.

This INOP arises when the measurement needed longer than

the maximum time for inflation, deflation or the total

measurement.

NBP MEASURE FAILED

Numeric may be displayed with a -?-

INOP tone.

NBP Check that you are using the correct cuff size and placement,

and that the correct patient category is selected. Try restarting

the measurement.

If numerics are displayed, the monitor is able to measure mean

only and the alarm source is set to S, D or S&D.

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.

No Central Monit.

INOP tone

Monitor There is a problem with the communication to the network.

Central monitoring is currently not possible (no patient alarms

or information). Check the connection. Contact your service

personnel.

NO PPV FROM MeasSrv

at Information Center

MMS or

FMS

The measurement server does not supply a beat-to-beat arterial

pressure value. Contact your service personnel.

NO PPV FROM <Server> MMS or

FMS

The measurement server does not supply a beat-to-beat arterial

pressure value. Contact your service personnel.

P/P1/P2/P3/P4 INOPS PRESS See <Pressure label> INOPS (under Pressure).

PAP INOPS PRESS See <Pressure label> INOPS (under Pressure).

PPV BAD <Pressure Label>

SIGNAL

PRESS The arterial pressure source selected for PPV is not providing a

pulsatile signal.

PPV BAD SIGNAL

at Information Center

PRESS The arterial pressure source selected for PPV is not providing a

pulsatile signal.

PPV CHK SOURCES PRESS 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.

<Pressure label> ARTIFACT

Numeric displayed with -?-

PRESS A non-physiological event is detected (for example, a flush or

blood sample). A resulting high limit alarm will be suppressed.

DEACTIVATED

INOP tone

PRESS A Pressure measurement label in the measurement server or

extension has been deactivated, either by connecting a Temp

transducer in the shared Press/Temp socket, or by deactivating

the label in the Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either reconnect a

Pressure transducer or reactivate the measurement label in the

Measurement Selection window.

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

<Pressure label> EQUIP

MALF

Numeric displayed with -?-

INOP tone.

PRESS Contact your service personnel.

The pressure hardware is faulty.

<Pressure label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone.

PRESS Make sure that the pressure transducer is connected to the

measurement server or module server.

If you silence this INOP, the measurement will be switched off.

<Pressure label> NOISY

SIGNAL

Pulse numeric is replaced by -?-

INOP tone.

PRESS This INOP can only arise when a pressure is selected as the

pulse source. It occurs when the pulse detector finds a pulse

rate above 350bpm. This is usually caused by movement

artifact or electrical interference.

<Pressure label> NON-

PULSATILE

Pulse numeric is replaced by -?-

INOP tone.

PRESS This INOP can only arise when a pressure is selected as the

pulse source. It occurs when the pulse rate being measured is

less than 25 beats per minute or the amplitude is less than three

mmHg.

Check the catheter and connections to the patient.

OVERRANGE

Numeric is replaced by -?-

INOP tone.

PRESS 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.

<Pressure label> REDUCE

SIZE

PRESS Increase the scale for the pressure wave.

<Pressure label> TRANSDUC

MALF

Numeric is replaced by -?-

INOP tone.

PRESS Contact your service personnel.

The transducer is faulty.

UNPLUGGED

PRESS A Pressure measurement label has been deactivated, either by

unplugging a module, or by deactivating the label in the

Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module

or reactivate the measurement label in the Measurement

Selection window.

ZERO+CHECK CAL

Numeric is replaced by -?-

PRESS Perform a zero and check the calibration of the transducer.

RA LEAD OFF

Numeric is replaced by -?-

INOP tone.

ECG The RA electrode has become detached from the patient or the

lead set has been changed. Reattach the electrode or select New

Lead Setup in the Setup ECG menu to confirm the

new lead set.

RAP INOPS PRESS See <Pressure label> INOPS (under Pressure).

Rem.Alarmdev.Malf

INOP tone

Monitor There is a problem with the connection to the remote alert

device. Contact your service personnel to check the remote

alert device and its connections.

RESP EQUIP MALF

Numeric is replaced by -?-

INOP tone.

RESP Contact your service personnel. The RESP hardware is faulty.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

RESP ERRATIC

Numeric is replaced by -?-

RESP The monitor has detected too many artifacts in the measured

Resp signal. Check that the RA and LL electrodes are correctly

attached and have not dried out.

RESP LEADS OFF

Numeric is replaced by -?-

INOP tone.

RESP Not all the required leads for Resp monitoring are attached.

Make sure that the RA and LL leads are attached.

RL LEAD OFF

Numeric is replaced by -?- for 10

seconds; INOP tone.

ECG The RL electrode has become detached from the patient or the

lead set has been changed. Reattach the electrode or select New

Lead Setup in the Setup ECG menu to confirm the

new lead set.

Settings Malfunc.

INOP tone.

Monitor The monitor cannot use the predefined settings for

monitoring. Contact your service personnel.

SOME ECG ALARMS OFF Arrhythmia This message appears (if configured to do so) when the on/off

settings of the yellow arrhythmia alarms differ from the current

Profile.

Speaker Malfunct.

INOP tone

Monitor Contact your service personnel to check the speaker and the

connection to the speaker.

SPIRO MALFUNCTION Spirometry Module failure detected. Contact your service personnel.

SPIRO INCOMPATIBLE Spirometry Module revision not compatible with the host monitor

software revision. Contact your service personnel.

SPIRO UPGRADE Spirometry The module is running a firmware upgrade. Wait until upgrade

is completed before resuming monitoring.

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

SPIRO PURGE FAILED Spirometry The purge operation could not be completed successfully.

Check for kinked sensor tubings, hard occlusions and make

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

SPIRO UNKN. SENSOR Spirometry An unknown sensor ID code was detected. Use only the sensors

listed in the Accessories chapter.

SPIRO ALARMS SUPPR Spirometry Alarming is suppressed for the spirometry module.

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

Wait until purge is complete.

SPIRO NO SENSOR Spirometry No sensor detected. Make sure the correct sensor is attached to

the breathing circuit.

SPIRO NO BREATH Spirometry No breath was detected for more than 25 seconds. Breath

derived numerics are not available.

SPIRO GAS COMPENS? Spirometry Gas compensation is set to “gas analyzer” but not all gases

necessary for compensation are measured by a gas monitor.

Some of the fall-back values provided by the user are used.

Measurement accuracy might be reduced.

SPIRO PATIENT CAT. Spirometry Mismatch of patient size configured in the host monitor and

sensor type plugged into the module. Check the instructions

on selecting the correct sensor in the Spirometry chapter.

∆SpO2 CHK SOURCES

Numeric is replaced by -?-

SpO2

Difference

Not all measurements or values required to perform the

calculation are available. Check measurement sources.

∆SpO2 CHK UNITS

Numeric is replaced by -?-

SpO2

Difference

The monitor has detected a conflict in the units used for this

calculation. Check the unit settings.

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

<SpO2 label> DEACTIVATED

INOP tone

SpO2You have connected a measurement server that uses a label the

monitor has already assigned to a different source. To activate

the new source, choose a new label in the Measurement

Selection window.

<SpO2 label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

SpO2The MMS is faulty. Unplug and replug the MMS. If the INOP

persists, contact your service personnel.

<SpO2 label> ERRATIC

Numeric is replaced by -?-

INOP tone.

SpO2Check the sensor placement. Try another adapter cable and

sensor. If the INOP persists, contact your service personnel.

<SpO2 label> EXTD. UPDATE

Label is displayed with a -?-

(questionable numeric)

SpO2The update period of displayed values is extended due to an

NBP measurement on the same limb or an excessively noisy

signal.

<SpO2 label> INTERFERNCE

Numeric is replaced by -?-

INOP tone.

SpO2There is too much interference, caused by a high level of

ambient light and/or electrical interference. Cover the sensor to

minimize ambient light. If the INOP persists, make sure that

the sensor cable is not damaged or positioned too close to

power cables.

<SpO2 label> LOW PERF

Label is displayed with a -?-

(questionable numeric)

SpO2Accuracy may be compromised due to very low perfusion.

Stimulate circulation at sensor site. If INOP persists, change

the measurement site.

<SpO2 label> NOISY SIGN.

Numeric is replaced by -?-

INOP tone.

SpO2Excessive patient movement or electrical interference is causing

irregular pulse patterns. Try to reduce patient movement or to

relieve the cable strain on the sensor.

<SpO2 label> NON-PULSAT.

Numeric is replaced by -?-

INOP tone.

SpO2Check the perfusion at measurement site. If necessary,

stimulate circulation or change measurement site. If the INOP

is due to NBP measurement on the same limb, wait until the

NBP measurement is finished.

<SpO2 label> NO SENSOR

Numeric is replaced by -?-

INOP tone.

SpO2Make sure the SpO2 sensor is connected. If the INOP persists,

try another adapter cable and sensor. If you silence this INOP,

the measurement will be switched off.

<SpO2 LABEL> POOR SIGNAL

Label is displayed with a - ? -

(questionable numeric)

SpO2The signal condition of the SpO2 measurement is poor and

measurement accuracy may be compromised.

<SpO2 LABEL> PULSE?

Numeric is replaced by -?-

INOP tone

SpO2The detectable pulsations of the SpO2 signal are outside the

specified pulse rate range.

<SpO2 LABEL> SEARCHING

Numeric unavailable

SpO2SpO2 is analyzing the patient signal to derive Pulse, SpO2 and

Perf values. Please wait until the search analysis is complete.

<SpO2 label> SENSOR MALF

Numeric is replaced by -?-

INOP tone.

SpO2The SpO2 sensor or adapter cable is faulty. Try another adapter

cable and sensor. If the INOP persists, contact your service

personnel.

<SpO2 LABEL> SENSOR OFF

Numeric is replaced by -?-

INOP tone

SpO2The SpO2 sensor is not properly applied to the patient. Apply

the sensor following the instructions supplied by the

manufacturer.

<SpO2 LABEL> UNKN.SENSOR

Numeric is replaced by a - ? -

SpO2The connected sensor or adapter cable is not supported by the

SpO2 measurement. Use only specified sensors and cables.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

<SpO2 LABEL> UPGRADE

Label is displayed with a -?-, numeric is

unavailable

SpO2The SpO2 measurement is currently in UPGRADE mode.

Monitoring is not possible in this mode.

Sp - vO2 CHK SOURCES

Numeric is replaced by -?-

Sp - vO2Not all measurements or values required to perform the

calculation are available. Check measurement sources.

Sp - vO2 CHK UNITS

Numeric is replaced by -?-

Sp - vO2The monitor has detected a conflict in the units used for this

calculation. Check the unit settings.

SvO2 CAL FAILED

SvO2 numeric is displayed with ?

SvO2The calibration failed. Check the catheter-to-Optical-Module

connection. Manually restart the calibration. Try another

catheter and Optical Module. If the catheter is already inserted,

perform an in-vivo calibration.

SvO2 CAL MODE

SvO2 numeric is replaced by -?-

SvO2Pre-insertion calibration is complete, but the catheter tip is still

inside the optical reference. The catheter is now ready for

insertion.

SvO2 CAL REQUIRED

SvO2 numeric is replaced by -?-.

INOP tone may sound

SvO2There is no valid calibration data in the Optical Module.

Perform either a pre-insertion or an in-vivo calibration.

SvO2 CONFIGURATION

SvO2 numeric is replaced by -?-.

INOP tone

SvO2The Optical Module has been configured to SaO2 Mode. Use

Change to SvO2 in the Setup SvO2 menu to

reconfigure to SvO2 Mode.

SvO2 CONNCT OPTMOD

SvO2 numeric is replaced by -?-.

INOP tone

SvO2The Optical Module was disconnected during data storage.

Reconnect the Optical Module for at least 20 seconds.

SvO2 EQUIP MALF

SvO2 numeric is replaced by -?-.

INOP tone

SvO2The SvO2 Module or Optical Module is faulty. Unplug and

replug the Optical Module and SvO2 module. Exchange the

modules. If the INOP persists, contact your service personnel.

SvO2 IN-VIVO CALIB

SvO2 numeric is replaced by -?-.

SvO2The in-vivo calibration is not yet complete. Lab values must be

stored to the Optical Module to complete the calibration.

Either continue with the next steps of the current calibration or

recall the previous calibration.

SvO2 LIGHT INTENS

SvO2 numeric is replaced by -?- or

numeric is displayed with ?

INOP tone with -?- display

SvO2The intensity changed considerably since the last light intensity

calibration. This may indicate that the catheter tip is positioned

against a blood vessel wall or that there is low blood flow.

Reposition the catheter and perform a light intensity

calibration.

SvO2 LOW LIGHT

SvO2 numeric is replaced by -?- or

numeric is displayed with ?

INOP tone may sound

SvO2The optical signal levels are too low. Check that the catheter is

either in the optical reference or inserted into the patient.

Check the catheter-to-Optical Module connection. If INOP

persists, try another catheter and Optical Module.

SvO2 NO OPTMOD

SvO2 numeric is replaced by -?-.

INOP tone

SvO2Connect the Optical Module. If the INOP persists, try another

Optical Module. Silencing this INOP switches the

measurement off.

SvO2 OPTMOD DEFECT SvO2The Optical Module memory is faulty, and calibration data

cannot be stored for transport or during power failure. If this

feature is needed, use another Optical Module.

SvO2 OPTMOD WARMUP

SvO2 numeric is displayed with ?

SvO2The Optical Module has not yet reached the operating

temperature. Wait a few minutes until warm-up is finished.

SvO2 PRE-INS CALIB

SvO2 numeric is replaced by -?-

INOP tone

SvO2The pre-insertion calibration is running. This typically takes

one minute. During this time SvO2 alarms are switched off.

Wait until the calibration is complete.

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

SvO2 UNABL TO MEAS

SvO2 numeric is replaced by -?-.

INOP tone

SvO2The signal is out of the normal range, and no SvO2 value can

be derived. Perform an in-vivo calibration. If the INOP

persists, try another Optical Module and catheter.

SvO2 UNPLUGGED

SvO2 numeric is replaced by -?-.

INOP tone

SvO2Measurement switched on and SvO2 module unplugged from

the rack.

The measurement automatically disappears from the display.

Silencing this INOP switches off the measurement.

SVR/SVRI CHK SOURCES

Numeric is replaced by -?-

SVR/SVRI Not all measurements or values required to perform the

calculation are available. Check measurement sources.

SVR/SVRI CHK UNITS

Numeric is replaced by -?-

SVR/SVRI The monitor has detected a conflict in the units used for this

calculation. Check the unit settings.

SVR/SVRI SET CVP USED

Numeric is replaced by -?-

SVR/SVRI A CVP value is required for this calculation, but is not

currently being measured. The monitor is using the CVP value

preset in the Setup SVR menu.

T/T1/T2/T3/T4 INOPs TEMP See <Temp label> INOPs (under Temp)

Tamb INOPs TEMP See <Temp label> INOPs (under Temp)

Tart INOPs TEMP See <Temp label> INOPs (under Temp)

Tblood NO TRANSDUC

Numeric is replaced by -?-

INOP tone

C.O. No transducer attached to the module or catheter

disconnected.

Tblood OVERRANGE

Numeric is replaced by -?-

C.O. Tblood out of range 17°C - 43°C.

Tcereb INOPS TEMP See <Temp label> INOPs (under Temp)

Tcore INOPs TEMP See <Temp label> INOPs (under Temp).

tcpO2 (or tcpCO2

or tcGas)

CAL FAILED

Numeric is replaced by -?-

INOP tone.

tcGas A calibration failed. Check the cal. unit, gas pressure, and

tubing connections, then restart the cal. If the cal. has failed

more than once, remembrane the transducer and restart the

calibration. If this INOP persists, contact your service

personnel.

tcpO2 (or tcpCO2

or tcGas)

CAL REQUIRD

Numeric is replaced by -?-

INOP tone.

tcGas Calibration is required before applying the transducer to the

patient.

Insert a membraned transducer into the cal. chamber on the

module, connect the cal. unit to the cal. chamber, open the gas

valve and start the calibration. If this INOP occurs during a

calibration, there may be a module or transducer malfunction:

contact your service personnel.

tcpO2 (or tcpCO2

or tcGas)

CAL RUNNING

Numeric displays first -?- , then

numeric is displayed with a ?

tcGas Wait until the tcpO2/tcpCO2 calibration is finished.

tcpO2 (or tcpCO2

or tcGas)

CHECK TIME

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

tcpO2 (or tcpCO2

or tcGas)

CHANGE SITE

If Heat Switch Off is configured to Yes,

numeric is replaced by -?-

INOP tone.

tcGas Site Timer has timed out. Change the application site to avoid

skin burns. To reset the Site Timer, either calibrate and change

the measurement site, or change the measurement site and reset

the Site Timer manually by selecting the appropriate site time

from the Setup TCGas menu.

INOP Message, Indication Source What to do

Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

tcpO2 (or tcpCO2

or tcGas)

EQUIP MALF

Numeric is replaced by -?-

INOP tone.

tcGas There is a malfunction in the transducer or module. Connect

another transducer. If this INOP persists, contact your service

personnel.

tcpO2 (or tcpCO2

or tcGas)

NO TRANSDUC

Numeric is replaced by -?-

INOP tone.

tcGas No transducer is connected to the tcpO2/tcpCO2 module.

Silencing the alarm switches off the measurement.

tcpO2 (or tcpCO2

or tcGas)

STABILIZING

Numeric is displayed with a ?

tcGas The transducer has not yet reached the selected temperature

and/or skin hyperemization is not yet finished. This INOP will

disappear within three minutes.

tcpO2 (or tcpCO2

or tcGas)

UNPLUGGED

Numeric is replaced by -?-

INOP tone.

tcGas The measurement is switched on but the module is unplugged.

The measurement automatically disappears from the display.

Silencing this INOP switches off the measurement.

<∆Temp> CHK SOURCES

Numeric is replaced by -?-

TEMP

Difference

Not all measurements or values required to perform the

calculation are available. Check measurement sources.

<∆Temp> CHK UNITS

Numeric is replaced by -?-

TEMP

Difference

The monitor has detected a conflict in the units used for this

calculation. Check the unit settings.

<Temp label> DEACTIVATED

INOP tone

TEMP A Temp measurement label in the measurement server or

extension has been deactivated, either by connecting a Pressure

transducer in the shared Press/Temp socket, or by deactivating

the label in the Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either reconnect a Temp

transducer or reactivate the measurement label in the

Measurement Selection window.

<Temp label> EQUIP MALF

Numeric is replaced by -?-

INOP tone.

TEMP Contact your service personnel.

The temperature hardware is faulty.

<Temp label> NO

TRANSDUCER

Numeric is replaced by -?-

INOP tone.

TEMP Make sure the TEMP probe is connected to the MMS or

module.

If you silence this INOP, the measurement will be switched off.

<Temp label> UNPLUGGED

INOP tone

TEMP 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.

<Temp label> OVERRANGE

Numeric is replaced by -?-

INOP tone.

TEMP Try changing the application site of the transducer.

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

Tesoph INOPS TEMP See <Temp label> INOPs (under Temp).

TimeExpired:<timer label>

INOP tone

Monitor The time has expired for the timer indicated in the INOP text.

Clearing the timer clears the INOP.

Tnaso INOPS TEMP See <Temp label> INOPs (under Temp).

Trect INOPS TEMP See <Temp label> INOPs (under Temp).

Tskin INOPS TEMP See <Temp label> INOPs (under Temp).

INOP Message, Indication Source What to do

4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

Ttymp INOPS TEMP See <Temp label> INOPs (under Temp)

Tven INOPS TEMP See <Temp label> INOPs (under Temp).

Tvesic INOPS TEMP See <Temp label> INOPs (under Temp)

UAP INOPS PRESS See <Pressure label> INOPS (under Pressure).

Unsupported LAN

INOP tone

Monitor There is a problem with the communication to the network

and central monitoring is currently not possible. Check the

connection.If the INOP persists, switch off the monitor and

contact your service personnel.

User I/F Malfunct.

INOP tone.

Monitor Perform a visual and functional check of all the monitor input

devices. Contact your service personnel.

UVP INOPS PRESS See <Pressure label> INOPS (under Pressure).

V LEAD OFF

Numeric is replaced by -?- for 10

seconds; INOP tone.

ECG The V electrode (IEC: C electrode) has become detached from

the patient or the lead set has been changed. Reattach the

electrode or select New Lead Setup in the Setup ECG

menu to confirm the new lead set.

<VueLink option> CHK

CABLE

INOP tone.

VueLink No cable or the wrong cable connected to the VueLink module,

or incorrect device selected. Silencing this INOP switches the

measurement off.

VueLink INOP abbreviations may differ slightly depending on

the device category.

<VueLink option> CHK

CONF.

INOP tone.

VueLink The wrong external device has been selected on the VueLink

module, or the external device has not been correctly setup, or

the wrong cable has been used to connect the device to the

VueLi nk module.

VueLink INOP abbreviations may differ slightly depending on

the device category.

<VueLink option> CHECK

SETUP

INOP tone.

VueLink No information was received from the external device. The

device may be switched off or disconnected.

VueLink INOP abbreviations may differ slightly depending on

the device category.

VueLnk EQUIP MALF

INOP tone.

VueLink Malfunction in the VueLink module. If this message appears

repeatedly, the module must be replaced. Contact your service

personnel.

VueLink INOP abbreviations may differ slightly depending on

the device category.

VueLnk NO CONFIG

INOP tone.

VueLink The VueLink module has not been configured during

installation. The installation process should be completed by

either your biomedical engineering department or the Philips

service engineer.

VueLink INOP abbreviations may differ slightly depending on

the device category.

VueLnk UNPLUGGED

INOP tone.

VueLink The VueLink module has been unplugged from the rack, or the

whole rack has been disconnected. The measurement

automatically disappears from the display. Silencing this INOP

switches off the measurement.

VueLink INOP abbreviations may differ slightly depending on

the device category.

INOP Message, Indication Source What to do

5Managing Patients

Use the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer

(ADT) patients.

All patient demographic and ADT information is shared between the patient monitor and the

Information Center, for example, patients admitted to the monitor are automatically admitted to a

connected Information Center.

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.

To admit a patient,

1Select the patient name field or select the

Admit/Dischrge SmartKey to open the

Patient Demographics window.

2Clear any previous patient data by selecting

the Dischrge Patient or End Case

pop-up key and then Confirm.

If you do not discharge the previous patient,

you will not be able to distinguish data from

the previous and current patients, for

example, in the trend database.

3Select Admit Patient.

4Enter the patient information: select each

field and use the on-screen keyboard or

choose from the pop-up list of alternatives to

input information. If a conventional

keyboard or a barcode scanner is connected to the monitor you can use this to enter patient

information.

–Last name: Enter the patient’s last name (family name), for example Smith.

Last Name

First Name

MRN

Patient Cat.

Paced

Height

Weight

BSA (D)

Date of Birth

Age

Gender

Notes (1):

Notes (2):

Adult

Patient Demographics

5 Managing Patients Quick Admitting a Patient

–First name: Enter the patient’s first name, for example Joseph.

–MRN: Enter the patient’s medical record number (MRN), for example 12345678.

–Patient Cat: Choose the patient category, either Adult, Pediatric, or Neonatal.

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

–Height: Enter the patient’s height.

–Weight: Enter the patient’s weight.

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

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

–Age: The monitor calculates the patient age automatically.

–Gender: Choose Male or Female.

–Notes: Enter any extra information about the patient or treatment.

5Select Confirm. The patient status changes to admitted.

Patient Category and Paced Status

The patient category setting determines the algorithm the monitor uses to process and calculate some

measurements, the safety limits that apply for some measurements, and the alarm limit ranges.

The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is

set to No, pace pulses are filtered and therefore do not show in the ECG wave.

WARNING Patient Category and Paced status will always contain a value, regardless of whether the

patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the

default settings from the current profile, which might not be correct for your patient.

Patient category Changing the patient category may change the arrhythmia and NBP alarm limits.

Always check alarm limits to make sure that they are appropriate for your patient.

Paced status For paced patients, you must set Paced to Yes. If it is incorrectly set to No, the monitor

could mistake a pace pulse for a QRS and fail to alarm during asystole.

Admitting a Centrally-Monitored Patient

You can admit a patient at either the bedside or the Information Center. When you admit a patient,

the patient’s name appears on the bedside monitor and the Information Center.

If you do not fill in all patient information required by the Information Center, the Information

Center may reject the admission. Complete all the required fields and try again to admit the patient.

Quick Admitting a Patient

Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete

the rest of the patient demographic details later. If you do not, the patient name will not be written on

reports and on information stored in the database or sent to an Information Center.

1Select the Quick Admit SmartKey.

2Enter the required data (MRN or Last Name depending on configuration) with the keyboard or a

barcode scanner.

Editing Patient Information 5 Managing Patients

3Select Enter.

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

configured).

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

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

is set to - - - . The patient name field on the monitor shows Not Admitted and the patient name

space on printed reports is blank. To fully admit this patient, select Admit Patient again and

complete all required fields.

Editing Patient Information

To edit the patient information after a patient has been admitted, select the patient name field on the

Main Screen to open the Patient Demographics window, and make the required changes.

Discharging a Patient

You should always perform a discharge even if your previous patient was not admitted. A discharge:

– clears the information in the Patient Demographics window

– erases all patient data (such as trend, event, and calculation data) from the monitor, measurement

servers and Information Center. This ensures that data from a previous patient are not mixed

with data from the new patient.

– resets patient category and paced settings to the settings defined in the default Profile

– resets all monitor and measurement settings as well as the active Screen to the settings defined in

the default Profile

– discharges the patient from the Information Center.

When a patient is discharged from the monitor or from an Information Center, all patient data is

deleted. Make sure that you have printed out any required reports before discharging. Check that a

functioning local or central printer is available before you use End Case.

To discharge a patient,

1Select the patient name field to display the Patient Demographics window and associated

pop-up keys.

2Select the pop-up key for either:

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

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

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

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

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 the section on AutoReports for information on

setting up end case reports.

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

5 Managing Patients Transferring Patients

Transferring Patients

To save you from having to enter the same patient data multiple times and enable patient transfer

without loss of data, information can be shared between measurement servers, patient monitors, and

Information Centers.

– patient demographic information is shared between connected measurement servers, patient

monitors, and Information Centers

– measurement settings and calibration data can be uploaded from an MMS to a patient monitor, if

configured

– trend information can be uploaded from an MMS to a patient monitor, if configured.

Different sets of patient- and measurement-related data are stored in the monitor and the Multi-

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

when you transfer patients.

WARNING If the monitor is not battery-powered, you cannot monitor during transport.

Transferring a Centrally-Monitored Patient

Scenario: A centrally-monitored patient is moved to another monitoring location on the same

Information Center database server without interrupting the collection of patient trend information.

1Before you disconnect the MMS from the monitor, select the patient name in the monitor info line

to enter the Patient Demographics window, then select the Transfer pop-up key. If

the patient is not admitted or not monitored by an Information Center, the Transfer key is

inactive (“grayed-out”).

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

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

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

Patient Information Stored in Monitor Stored in MMS and extensions

Patient demographics (name,

DOB, MRN)

yes yes

Monitor settings (alarm pause

time, alarm volume)

yes no

Measurement settings for all

measurements (alarm limits,

measurement on/off, etc.)

yes yes, for all MMS and extensions

measurements

Trend data yes, for all MMS and extensions

measurements (up to a maximum

of 16 or 32, depending on your

database configuration)

most recent 8 hours of

information, for all MMS and

extensions measurements

Calculation data (HemoCalc

data)

yes no

Events data yes no

Data Upload from an MMS 5 Managing Patients

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

the patient selection window will be displayed.

5Select Continue MMS and Confirm your selection. This re-admits the patient from the

transfer list to the new monitor, completing the transfer. This will upload the patient

demographics, and, if configured, the measurement settings and trend data stored in the MMS to

the receiving monitor.

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

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

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

patient data remains in the monitor.

Transferring a Patient with an MMS (no Central Station)

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

admitted at the new monitor.

1Disconnect the MMS from the original monitor and silence the resulting MMS UNPLUGGED

INOP.

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

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

your current patient’s data.

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

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

the new monitor.

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

select Continue MMS to retain the data in the MMS. This will upload the patient

demographics, and, if configured, the measurement settings and trend data stored in the MMS to

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

Data Upload from an MMS

The Multi-Measurement Server stores eight hours of patient trend data at one-minute resolution. It

also stores patient demographic information and the measurement settings and calibration data for the

measurements carried out by the MMS and any connected extensions. This data can be uploaded to an

IntelliVue patient monitor, if your monitor is configured to do so and if at least five minutes of trend

information is stored in the MMS.

Your monitor’s data upload settings are defined in Configuration Mode to suit your patient transfer

use model.

How data is uploaded to the host monitor depends on the configuration mode settings

MMS Trend Upload and MMS Settings Upload.

If there is a patient conflict and you select Continue Monitor, no data will be uploaded from the

MMS.

5 Managing Patients Data Exchange Between 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.

Resolving Patient Information Mismatch

When you connect an MMS to a monitor, or a monitor to the network, the monitor compares patient

category, paced status, and a unique patient identification number that is internally stored in both the

MMS and the monitor. The monitor indicates a mismatch if the information is not identical.

Depending on your monitor’s configuration, this mismatch may be automatically resolved or you may

have to resolve it manually. If your monitor is configured to resolve mismatches automatically,

depending on the configuration, either the monitor or the Multi-Measurement Server data is

automatically retained.

WARNING USA only 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.

Manually Resolving Patient Mismatch

The patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor

Info Line and in the Patient Demographics window. The monitor displays a message such as

Different patients in Central and Monitor. The Patient Selection window

automatically opens so you can decide which patient data to use. You do not have to resolve the

mismatch immediately, however, the indicators remain until you do. There can be up to three columns

of data in the Patient Selection window if the patient is different in the Information Center,

monitor, and MMS.

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

consequences of your choice, telling you where the patient will be continued/discontinued. Confirm

your choice. The monitor automatically displays the Patient Demographics window after

confirmation. Verify that the settings shown are correct for the patient.

Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are

different on different devices, the monitor resolves them itself. For example, it may take date of birth

from the Information Center, whilst taking gender from the MMS. Always check the Patient

Demographics after combining patients, to ensure that you are satisfied with the results. Change them

if necessary.

WARNING After resolving a patient mismatch, check that the monitor settings (especially patient category, paced

status and alarm limits) are correct for the patient.

Resolving Patient Information Mismatch 5 Managing Patients

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,

either:

Continue Central: to continue with

the patient demographics from the

Information Center, discharge the

patient in the monitor, and use the

default monitor profile.

Continue Monitor: to continue with

the patient in the monitor and

discharge the patient in the

Information Center, permanently

deleting all data in the Information

Center.

♦If there is a mismatch between a

monitor and a measurement server,

choose the data set you want to

continue using for this patient,

either:

Continue Monitor: to continue with

the patient demographics, trend

data, and settings in the monitor.

This discharges the patient in the

measurement server, and resets all

MMS settings to the defaults

currently active for the monitor.

Continue MMS: to upload the data

- patient demographics, trend data

(if configured), and measurement

settings (if configured) - stored in the MMS to the monitor. This clears all data in the monitor,

resets the monitor to the default Profile, and discharges the patient in the monitor.

Patient Mismatch - If Neither Patient Data Set is Correct

A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS

to a monitor in order to prepare for a new patient, before you actually start measuring.

♦Select New Patient if you are sure that none of the information is correct. This discharges all

patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and

lets you admit a new patient.

Patient Selection

Central Monitor

Last name DOE MILLER

First name JOHN

MRN 1234HG9556

Patient Cat Adult Neo

Paced No Yes

Continue

Central

Continue

Monitor

New

Patient

Same

Patient

Patient Selection

Monitor MeasServ

Last name MILLER ADAMS

First name PETER

MRN

Patient Cat Neo Neo

Paced Yes No

Continue

Monitor

Continue

MMS

New

Patient

Same

Patient

5 Managing Patients Care Groups

Patient Mismatch - If Both Patient Data Sets Are Correct

A patient mismatch where both sets of patient data are correct might occur if you admit a new patient

at the monitor (or Information Center) before the patient arrives at your unit and then connect the

MMS that was used during the patient transport to the monitor.

♦Select Same Patient if the patient information is different, but you are sure it is the same

patient. This merges the demographics and updates them in the Information Center, monitor, and

MMS, according to this table. Be aware that your monitor may be configured to merge trend data

from the MMS and the monitor, and to upload measurement settings from the MMS to the

monitor.

Automatically Resolving Patient Mismatch

Your monitor can be configured to automatically resolve mismatches in one of two ways.

• continue using the patient in the MMS, and delete the old data in the monitor. This is suitable for

transport monitors.

• continue with the patient in the monitor, and delete the data in the MMS.

Care Groups

If your monitor is connected to an Information Center, you can group bedside monitors into Care

Groups. This lets you:

• view information on the monitor screen from another bed in the same or in a different Care Group.

• be notified of yellow or red alarm conditions at the other beds in the Care Group.

• see the alarm status of all the beds in the Care Group on each monitor screen.

There are two main types of Care Groups:

• standard care group (Bed-based Care Group) - up to 12 patients monitored by up to 4

Information Centers

•unit group (Unit-based Care Group) - for a complete unit with up to 64 patients

monitored by up to 4 Information Centers

Patient Information This information is taken from...

Patient name the monitor, if the patient was admitted there. For centrally-admitted

patients, this information is taken from the Information Center.

MRN

Screen Notes

Patient Category the Multi-Measurement Server. if connected, otherwise the data is

taken from the monitor.

Date of Birth

Height

Weight

Gender

Paced Status Paced status is always set to Yes where there is a conflict in patient

information.

Trend data if there is newer trend data stored in the MMS, it is uploaded to the

monitor.

Care Groups 5 Managing Patients

Monitors must be assigned to these Care Groups at the Information Center. There is a third care group

which can be assigned locally at the bedside. This is the My Central care group which includes all beds

(up to 16) from the Information Center your bed is connected to. This care group setting is typically

used in facilities with only one Information center. The selection of beds is automatic and cannot be

changed.

The functions available with Care Groups depend on the Information Center revision your monitors

are connected to. See your Information Center Instructions for Use for further details.

Understanding the Care Group Overview Bar

The Care Group monitors’ status is shown in symbol form in the Care Group overview bar. Flashing

symbols indicate active alarms, symbols that are not flashing indicate alarms that have been

acknowledged. Selecting a bed symbol calls up the Other Patient window for that bed.

The Care Group overview bar must be configured to display on the monitor Screen. If it is not visible

on your monitor, select a Screen which has been configured to show the bar.

Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed 7 Bed 8 Bed 9 Bed11 Bed 12 Bed 13 Bed 14

Care Group Symbols (four alternative display possibilities

depending on space available)

No data from this bed

The alarms are on but there are no

currently active alarms at this monitor

The highest priority alarm at this

monitor is an INOP condition

The highest priority alarm at this

monitor is a yellow alarm

The highest priority alarm at this

monitor is a red alarm

The alarms at this monitor are

suspended

The monitor is in standby mode

The monitor is in Demonstration

mode

The current monitor

Bed 8 Bed 8

Bed 5 Bed 5

Bed 14 Bed 14

Bed 9 Bed 9

Bed 7 Bed 7

Bed 11 Bed 11

5 Managing Patients Care Groups

Viewing the My Care Group Window

This window shows the alarm status, bed name,

and patient name for every bed in the Care

Group.

The window for the Unit group (shown here)

shows first the beds of the Information Center

this bed is connected to. By selecting the

Information Center name you can display a list

of all Information Centers associated with the

Unit group, and select another Information

Center to view.

To enter the My Care Group window,

♦select the Other Patients SmartKey, if

configured, or

♦in the Main Setup menu, select My Care

Group.

Use the My Care Group pop-up keys to navigate

through the Care Groups:

My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information

Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient

window for that bed.

Other Units lets you view a list of all the Care Units in your Care Domain. Select any Care Unit

to view a list of the Information Centers connected to it. Select an Information Center to see a list of

the monitors connected to it. Select any monitor to see the Other Patient window for that bed.

Alarming Beds lets you view a list of all beds in your care group with an unacknowledged

alarm. The beds are listed in order of alarm severity.

Care Group Symbols (used in the Care Group overview bar

and the My Care Group window)

This is a telemetry bed

This bed is on a wireless network

This bed is on a wired network

This is a “paired” bed, with a bedside

monitor and a telemetry transmitter

assigned.

Beds From:

Room 2

Room 4

Bed 2

Bed 4

Bed 8

Room 1

Room 3

Room 5

Smith, Mary

Jones, Paul

Murphy, Sarah

Miller, John

Baker, Jane

Green, Liza

Scott, James

Black, Harald

My Care Group

Care Groups 5 Managing Patients

Viewing the Other Bed Window

The Other Bed window lets you view a subset of the waveform and numeric information from another

bed on the same network. Waves and numeric information from another bed are delayed. If

configured, Other Bed information is displayed in color, using the colors defined by the Information

Center.

To open the Other Bed window,

♦MP60/MP70/MP80/MP90: select the required bed label or patient name in the Care Group

Overview Bar. If you are in a Unit Group with many beds, the My Care Group window may open

for you to select the bed.

MP20/MP30/MP40/MP50: select any field in the monitor info line to enter the Setup menu,

then select My CareGroup and select the required bed, or

♦Select the Other Patients SmartKey, if configured, and select the required bed.

The Other Bed window may be configured to display embedded in a specially designed Screen.

♦To d i s p l a y th e

embedded Other Bed

screen element, in the

Change Screen menu,

select a Screen designed

to show the Other Bed

information

permanently.

Note that a Screen with an

embedded Other Bed screen

element cannot be displayed

on the D80 Intelligent

Display.

Wave More

Vitals Next

Bed My Care

Group

NO TRANSDUC ** HR HIGH

Bed Label, Patient Name

110 99

SpO2

Silence

Bed

Bed Label Patient Name

VTACH

5 Managing Patients Care Groups

Note that changing the Screen may automatically change the bed shown in the other bed window. If

you switch to a different Screen, you should check if the correct other bed is displayed.

Other Bed Pop-Up Keys

Select the Other Patients SmartKey or the Other Bed window or embedded screen element to

access the associated pop-up keys:

Next Wave lets you view waveforms not currently shown in the other bed window.

More Vitals lets you view more numerics not currently shown in the other bed window.

Next Bed lets you view waveforms and numerics from the next available bed in the Care Group.

My Care Group lets you call up the Care Group window to select another bed.

Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm.

The beds are listed in order of alarm severity.

Silence Bed lets you silence active alarms at the other bed. (Whether you see this key depends

on the revision and configuration of the Information Center your monitors are connected to.)

WARNING The Silence Bed pop-up key in the Other Bed window silences alarms at a remote bed. Be aware

that accidental use of this key could silence alarms for the wrong patient.

To silence own bed alarms use the Silence permanent key on screen or the Silence hardkey.

Visual Alarm Status Information in the Other Bed Window

• If individual alarms are switched off at the other bed, this is indicated by the crossed alarm symbol

beside the measurement numeric.

• If alarms are switched off at the other bed, the message Alarms Off is shown in the other bed

window.

• In the embedded Other Bed window, the crossed speaker symbol in the upper right hand indicates

that the volume of the audible alarm status change notification for the other beds in the care group

is set to zero at the overview monitor.

Care Group Alarms

Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other

beds in the same Care Group. The visual and audible indicators used depend on the monitor and

Information Center configuration.

When an alarm is detected at another bed in the Care Group,

• the alarm status is shown in the Care Group overview bar as an icon.

• a message informing you about the care group alarm is shown in the monitor status line.

• if configured, the Other Bed window, the Alarming Beds window or the My Care Group window

may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at

the Information Center). The automatic alarm notification is suppressed when a window, menu or

pop-up keys are active.

• if configured, an audible status change notification is issued. The tone type and volume can be

configured.

Care Groups 5 Managing Patients

Automatic alarm notification can be switched off permanently in the monitor’s Configuration Mode

or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the

bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode:

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

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

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

the Auto Window as soon as possible.

Telemetry Data Overview

You can assign a monitor and a telemetry device to the same patient. This is called “pairing” and is

done at the Information Center. In paired mode, the telemetry data can be displayed as a permanent

overview session on the monitor. To do this, one of the available Screens must have the Telemetry

Data Overview screen element embedded. If configured, this Screen will automatically display when

the monitor is paired with a telemetry device at the Information Center. Be aware that the data from a

paired telemetry device is stored at the Information Center and not in the monitor.

Unpairing a Telemetry Device

To disconnect the patient from the telemetry device and reconnect them to the monitor

(for example, to see realtime waves),

♦select the Unpair Equipment SmartKey to have the Information Center receive

the ECG data from the monitor again. In this case data from the telemetry device will

no longer be monitored at the Information Center. (Behavior depends on the revision of your

Information Center.)

♦use the Unpair function at the Information Center. In this case you can decide whether the

Information Center will continue to monitor data from the telemetry device.

5 Managing Patients Care Groups

Telemetry Data Overview Screen Element

WARNING Waves and numeric information on the telemetry screen element are delayed for several seconds. If you

need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry.

Silencing Telemetry Alarms from the Bedside

When a telemetry device is paired with the monitor, an audible status change notification is issued for

new telemetry alarms. The volume can be configured.

If configured, alarms generated from a paired telemetry device can be silenced at the bedside.

To silence telemetry alarms from the bedside,

1select the telemetry screen element

2select the Silence Bed pop-up key

Depending on your configuration, the Silence Bed key may silence both telemetry alarms and

bedside alarms.

Suspending Telemetry Alarms

When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for

the bedside measurements.

Refer to the Information Center Instructions for Use for the Suspend/Pause alarms behavior of the

Information Center and telemetry device.

Using Standby

When you select Standby mode at the monitor, the bedside goes into Standby mode.

Refer to the Information Center Instructions for Use for the Standby behavior of the Information

Center and telemetry device.

Te l em e t r y

data overview

screen element

Bed1 Bed4 Bed5 Bed9 Room1

Bed7 Room3 Room1 Room4

TelemetryProfiles

23Feb 17:51Mayer, John AdultRoom3

Tele 3

NBP mmHg

PVC

MCL 1mV

1mV Delayed

Pleth

CO2

Pulse

Perf

etCO2 mmHg

Temp

awRR rpm

6ECG, Arrhythmia, and ST

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

page 107) and ST monitoring (see page 117).

Skin Preparation for Electrode Placement

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

electricity.

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

2Clip or shave hair from sites as necessary.

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

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

resistance.

4Dry skin thoroughly.

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

conductivity of the electrode site.

Connecting ECG Cables

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

electrodes, apply electrode gel to the electrodes before placement.

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

3Attach the electrode cable to the patient cable.

4Plug the patient cable into the white ECG

connector on the measurement server. An ECG

waveform and numeric appears on the monitor

display.

ECG Connector

6 ECG, Arrhythmia, and ST Monitoring Selecting the Primary and Secondary ECG Leads

CAUTION To protect the monitor from damage during defibrillation, for accurate ECG information and to

protect against noise and other interference, use only ECG electrodes and cables specified by Philips.

Selecting the Primary and Secondary ECG Leads

The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac

arrhythmias. They are also available for recordings and for display on the Information Center.

The secondary lead setting is used only if your monitor is configured for multi-lead (instead of single-

lead) arrhythmia analysis. It determines which additional lead will be used for arrhythmia analysis.

To select a lead as primary or secondary lead:

♦In the Setup ECG menu, select Primary Lead or Secondary Lead, then select the

appropriate lead. You can assign any available lead whether it is currently displayed or not.

Checking Paced Status

It is important to set the paced status correctly when you start monitoring ECG.

♦To change the paced status in the Setup ECG menu, select Paced, then select Yes or No.

WARNING Pace pulse rejection must be switched on for paced patients by setting “Paced” to Yes. Switching pace

pulse rejection off for paced patients may result in pace pulses being counted as regular QRS

complexes, which could prevent an asystole alarm from being detected. When changing profiles, and at

admission/discharge, always check that paced status is correct for the patient.

Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS

complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias.

Keep pacemaker patients under close observation.

You should choose a lead as primary or secondary lead

that has the following characteristics:

• the QRS should be either completely above or below

the baseline and it should not be biphasic

• the QRS should be tall and narrow

• the P-waves and T-waves should be less than 0.2 mV

Understanding the ECG Display 6 ECG, Arrhythmia, and ST Monitoring

Understanding the ECG Display

Your display may be configured to look slightly different.

ECG numeric: This is derived from the monitored ECG.

Pace pulse markers: These are shown if the Paced status has been set to Yes and the patient has a

paced signal.

Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the

synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave.

ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on

the bottom left.

Monitoring Paced Patients

An ECG optimized for monitoring a paced patient should look like this:

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

• the normal QRS should be either completely above or below the baseline and it should not be

biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.

• the QRS should be tall and narrow

• the P-waves and the T-waves should be less than 0.2 mV.

EASI

Pace pulse marks

1 mV calibration bar

ECG Filter

label

Lead

label of

the

displayed

wave

Current heart rate alarm limits Current heart rate

Defibrillator synchronization marks

EASI lead placement label

Pacer spikes

Pace Pulses/Beats

Normal Beats

6 ECG, Arrhythmia, and ST Monitoring Changing the Size of the ECG Wave

Setting the Paced Status (Pace Pulse Rejection)

Avoiding Pace Pulse Repolarization Tails

Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as

QRSs in the event of cardiac arrest or other arrhythmias.

If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.

Changing the Size of the ECG Wave

If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the

ECG waves on the screen.

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 AutoSize, the calibration bar may

be a different size for each wave.

To Change the Size of an Individual ECG Wave

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

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

Selecting AutoSize lets the monitor choose the optimal adjustment factor for all displayed ECG

waves.

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

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

When Paced is set to Yes:

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

not counted as extra QRS complexes.

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

– the paced symbol is displayed on the main screen.

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

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

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

asystole alarm from being detected.

Paced

Non-Paced

Repolarization tail

(note width)

Changing the Volume of the QRS Tone 6 ECG, Arrhythmia, and ST Monitoring

To Change the Size of all the ECG Waves

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

1In the Setup ECG Lead menu, select Adjust Size.

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

–Size x0.5 to halve the wave size

–Size x1 to display the wave without zoom

–Size x2 to double the wave size

–Size x4: to multiply the wave size by four

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

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

Changing the Volume of the QRS Tone

The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the

alarm source. The QRS volume can be set from 0 to 10 (0 means off).

♦To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the

appropriate volume from the pop-up list.

Changing the ECG Filter Settings

The ECG filter setting defines how ECG waves are smoothed. A letter indicating the filter type is

shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.

12-Lead ECG captures are analyzed in the PIC using the diagnostic filter and displayed on the

Information Center using the filter setting from the bedside monitor. Any changes you make to the

filter setting at the bedside monitor may take up to a minute to be reflected at a connected Information

Center. For this reason, you should wait one minute between changing the filter setting and sending a

12-lead capture to an Information Center.

♦To change the filter setting, in the Setup ECG menu, select Filter and then select the

appropriate setting.

–Monitor: Use under normal measurement conditions.

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

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.

6 ECG, Arrhythmia, and ST Monitoring Choosing EASI or Standard Lead Placement

–Diag (Diagnostic): 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 and 0.5 to 150 Hz for the 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.

Choosing EASI or Standard Lead Placement

If EASI™ monitoring is available on your monitor, you must enable either standard lead placement or

EASI lead placement.

♦In the Setup ECG menu, select Lead Placement and then Standard or EASI.

EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked

on any recorder strips and printouts.

See the section on EASI ECG Lead Placement for electrode placement diagrams.

About ECG Leads

To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in

standardized positions, forming so-called “leads.” To obtain ECG signals optimized for use in

diagnosis and patient management in different care environments, different lead sets in varying lead

placements can be used. You can use either standard lead placements or EASI lead placements with this

monitor.

When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with

by either movement or bones. Correct lead placement is always important for accurate diagnosis.

Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered

if an electrode is moved away from its correct location.

ECG Leads Monitored

Changing Lead Sets

To change the ECG lead set,

1Remove the electrodes and then replace them as required.

2If the new lead set has more leads than the previous, the monitor automatically recognizes the new

lead placement. If the new lead set has fewer leads, then you must select New Lead Setup in the

Setup ECG menu. If you remove electrodes and do not select New Lead Setup, the monitor

If you are using these leads are available: Resp is measured

between electrodes:

a 3-electrode set I, II, III RA and LL

a 5-electrode set I, II, III, aVR, aVL, aVF, V and MCL RA and LL

a 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL

an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A

ECG Lead Fallback 6 ECG, Arrhythmia, and ST Monitoring

will issue a Lead Off INOP message. Select New Lead Setup and the INOP message will

disappear.

ECG Lead Fallback

If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary

lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is

available, this available lead automatically becomes the primary lead. This is known as lead fallback.

When the Leads Off condition is corrected, the leads are automatically switched back.

This setting can only be changed in Configuration Mode.

ECG Lead Placements

The labels and colors of the ECG electrodes differ according to the standards that apply for your

hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.

Electrode labels Electrode colors

AAMI EASI IEC AAMI IEC

RA I RWhite Red

LA S LBlack Yellow

LL A FRed Green

RL N N Green Black

V E CBrown White

V1 C1 Brown/Red White/Red

V2 C2 Brown/Yellow White/Yellow

V3 C3 Brown/Green White/Green

V4 C4 Brown/Blue White/Brown

V5 C5 Brown/Orange White/Black

V6 C6 Brown/Violet White/Violet

6 ECG, Arrhythmia, and ST Monitoring ECG Lead Placements

Standard 3-Lead Placement

Standard 5-Lead Placement

RA placement: directly below the clavicle and

near the right shoulder

LA placement: directly below the clavicle and

near the left shoulder

LL placement: on the left lower abdomen

RA LA

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

III

aVR

aVL

aVF

ECG Lead Placements 6 ECG, Arrhythmia, and ST Monitoring

Chest Electrode Placement

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

intercostal space.

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

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

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

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

V1 placement: on the fourth

intercostal space at the right sternal

border

V2 placement: on the fourth

intercostal space at the left sternal

border

V3 placement: midway between the

V2 and V4 electrode positions

V4 placement: on the fifth

intercostal space at the left

midclavicular line

V5 placement: on the left anterior

axillary line, horizontal with the V4

electrode position

V6 placement: on the left midaxillary line, horizontal with the V4 electrode position

V3R to V6R placement: on the right side of the chest in positions corresponding to those on the left

VE placement: over the xiphoid process

V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal space

V7R placement: on posterior chest at the right posterior axillary line in the fifth intercostal space

V1 V2 V3 V4 V5 V6

V3R

V4R

Angle of

Lewis

6 ECG, Arrhythmia, and ST Monitoring ECG Lead Placements

100

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.

Conventional 12-Lead ECG

In conventional 12-Lead ECG using 10

electrodes, an electrode is placed on the right

arm, left arm, right leg, and left leg. Six V-

electrodes are placed on the chest. The right leg

electrode is the reference electrode.

Limb electrodes:

– Place arm electrodes on the inside of each

arm, between the wrist and the elbow.

– Place leg electrodes inside of each calf,

between the knee and the ankle.

Chest electrodes:

V1 - on the 4th intercostal space at the right

sternal border

V2 - on the 4th intercostal space at the left

sternal border

V3 - midway between the V2 and V4 electrode

positions

V4 - on the 5th intercostal space at the left

midclavicular line

V5 - on the left anterior axillary line, horizontal

with the V4 electrode position

V6 - on the left midaxillary line, horizontal with

the V4 electrode position

V1 - V6

RL LL

ECG Lead Placements 6 ECG, Arrhythmia, and ST Monitoring

101

Modified 12-Lead ECG

Choosing Standard or Modified Electrode Placement

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System),

you must switch Mod. Lead Placment to On in the monitor. To do this,

♦in the Setup ECG menu, select Mod. LeadPlacement to toggle between On and Off.

–When Mod. Lead Placment is set to On, 12 Lead ECG Reports will be labelled 12 Lead

ECG Report (Mason-Likar), and captured 12-lead ECGs will be labelled Mason-

Likar to the right of the bandwidth annotation at the Information Center.

–When Mod. LeadPlacment is set to Off, 12 Lead ECG Reports will be labelled 12

Lead ECG Report, and captured 12-lead ECGs will not be annotated at the Information

Center.

WARNING Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained

using the modified (Mason-Likar) limb electrode placement.This may lead to misdiagnosis since the

modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead

ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and

ST slope.

Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.

Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from

the Information Center are not annotated with the Mason-Likar label.

Labelling 12-Lead ECG Reports

To label 12-lead ECG monitor reports and Captured 12-lead ECGs reports:

♦In the Setup ECG menu, select Mod. LeadPlacement to toggle between On and Off.

When Mod LeadPlacement is set to On:

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.

Angle of Lewis

V1 - V6

6 ECG, Arrhythmia, and ST Monitoring Capture 12-Lead

102

– 12 Lead ECG Reports will be labelled 12 Lead ECG Report (Mason-Likar).

– Captured 12-lead ECGs will be labelled Mason-Likar to the right of the bandwidth annotation at

the Information Center.

When Mod. LeadPlacement is set to Off,

– 12 Lead ECG Reports will be labelled 12 Lead ECG Report.

– Captured 12-lead ECGs will have no annotation next to the bandwidth annotation at the

Information Center.

Capture 12-Lead

If the monitor is connected to an Information Center via a wired network, the Capture 12-Lead

SmartKey may be configured to show on the screen. Selecting this exports 12-Lead ECG information

to the Information Center for analysis. For details see the Instructions for Use supplied with the

Information Center.

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. EASI-derived 12-lead ECGs and

their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived

with EASI is not exactly identical to the 12-lead conventional ECG obtained from an

electrocardiograph, it should not be used for diagnostic interpretations.

Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I

and A electrodes.

Place the electrodes as accurately as possible to obtain the best quality EASI measurements.

When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG

wave on the display, and EASI is marked on any recorder strips and printouts.

EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP

condition (for example, LEAD OFF), a flat line is displayed. After 10 seconds, the directly acquired

EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead

label. This causes an arrhythmia relearn.

EASI ECG Lead Placement 6 ECG, Arrhythmia, and ST Monitoring

103

EASI Electrode Placement

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

the fifth intercostal space

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

same level as the E electrode

3S (LA) on the upper sternum

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

same level as the E electrode

5Nreference electrode - can be anywhere,

usually below the sixth rib on the

right hip

6 ECG, Arrhythmia, and ST Monitoring ECG, Arrhythmia, and ST Alarm Overview

104

ECG, Arrhythmia, and ST Alarm Overview

The ECG, arrhythmia, and ST 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

• Basic arrhythmia alarms are available when Arrhythmia is switched on

• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced

Arrhythmia option has been enabled for your monitor

• ST alarms are available when ST analysis is switched on and ST leads are selected for analysis.

Cardiotach Alarms Alarms with Basic

Arrhythmia Option

Alarms with Enhanced

Arrhythmia Option

ST Alarms

***Asystole

***Ventricular

Fibrillation/Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**High heart rate

**Low heart rate

***Ventricular Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**Frequent PVCs (PVC >

limit/min)

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Nonsustained V-Tach

**Multiform PVCs

**ST <Lead> High

**ST <Lead> Low

Using ECG Alarms 6 ECG, Arrhythmia, and ST Monitoring

105

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 section. Special alarm features which apply only to

ECG are described here.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source,

either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm

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

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

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

∆ExtrTachy and ∆ExtrBrady.

ECG Alarms Off Disabled

Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in

the monitor’s Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring

Mode. If you try to switch off the HR alarms, you will see the message To activate enter

Config and enable Alarms Off.

HR Alarms When Arrhythmia Analysis is Switched Off

When arrhythmia analysis is switched off, only these HR-related alarms will be detected:

• the asystole alarm

• the ventricular fibrillation/ventricular tachycardia alarm

• the extreme tachycardia/extreme bradycardia alarms

• the high heart rate/low heart rate alarms.

HR Alarms When Arrhythmia Analysis is Switched On

WARNING When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This

means that the yellow alarm lamp and the tones are active for a configured number of seconds only,

after which the flashing numeric and the alarm message remain for up to three minutes. Alarm

reminders are not provided for yellow arrhythmia alarms. Red alarms behave as usual.

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.

6 ECG, Arrhythmia, and ST Monitoring ECG Safety Information

106

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.

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 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. These cables cannot be used for measuring respiration.

Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves

(greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting

in missed detection of cardiac arrest.

Patients exhibiting intrinsic rhythm: When monitoring paced patients who exhibit only intrinsic

rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first

encounters them, resulting in missed detection of cardiac arrest.

The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit

at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the

patient’s heart rate drops to a level where pacing is needed. Proper detection and classification of the

paced rhythm can then be determined.

Filtered ECG signal from external instruments: Instruments such as defibrillators or telemetry units

produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered

again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to

fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient

monitoring performance.

External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a

patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse.

This may result in the arrhythmia algorithm’s failure to detect pacemaker noncapture or asystole.

Fusion beat pacemakers: Pacemakers that create fusion beats (pace pulse on top of the QRS complex)

cannot be detected by the monitor’s QRS detector.

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may

occasionally react on the Impedance measurement used by patient monitors for the determination of

the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp

measurement can prevent this.

About Arrhythmia Monitoring 6 ECG, Arrhythmia, and ST Monitoring

107

About Arrhythmia Monitoring

Arrhythmia analysis provides information on your patient’s condition, including heart rate, PVC rate,

rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-

lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously

• 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 labelling. 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, Arrhythmia, and ST Alarm Overview” on page 104, the rhythm

and ectopic messages detected are listed in “Arrhythmia Status Messages” on page 110.

Where Can I Find More Information?

See the Application Notes on ST and Arrhythmia supplied on your documentation CD-Rom for

detailed information on the arrhythmia algorithm and its clinical application.

6 ECG, Arrhythmia, and ST Monitoring Switching Arrhythmia Analysis On and Off

108

Switching Arrhythmia Analysis On and Off

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

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

Be aware that when arrhythmia analysis is switched off,

–the message Arrythmia OFF appears beside the ECG wave, if configured to do so

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

tachycardia alarm, the extreme tachycardia/extreme bradycardia alarms, the high heart rate/ 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 should be tall and narrow (recommended amplitude > 0.5 mV)

– R-Wave should be above or below the baseline (but not bi-phasic)

– T-wave should be smaller than 1/3 R-wave height

– the P-wave should be smaller than 1/5 R-wave height.

For paced patients, in addition to the above, the pace pulse should be:

– not wider than the normal QRS

– the QRS complexes should be at least twice the height of pace pulses

– large enough to be detected, with no re-polarization.

To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for

QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave

size on the monitor display (gain adjustment) does not affect the ECG signal which is used for

arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.

Aberrantly-Conducted Beats

As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish

between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat

resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the

aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.

Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads

with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia

monitoring. Extra vigilance is required by the clinician for this type of patient.

Atrial Fibrillation and Flutter

Since P-waves are not analyzed, it is not possible to discriminate atrial rhythms. If there is constant

variance in the R-R interval, the rhythm is classified as Irregular. It is extremely important for accurate

analysis of the rhythm to have p-waves with an amplitude of less than 1/5 the height of the R-wave or

< 0.15 mV. If the p-waves are larger than this, they may be counted as QRS complexes.

Understanding the Arrhythmia Display 6 ECG, Arrhythmia, and ST Monitoring

109

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.

Viewing Arrhythmia Waves

♦To review arrhythmia beat labels, in the Setup Arrhythmia menu, select Annotate Arrhy.

The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey

background. Beat labels will be annotated above the ECG wave and Delayed will be written

beside it.

♦To return to the normal ECG primary lead display, select Annotate Arrhy again.

Arrhythmia Beat Labels

Arrhythmia beat labels tell you how the monitor is classifying beats.

N = Normal

V = Ventricular Ectopic

S = Supra-ventricular Premature

P = Paced

' = Pacer spike

L = Learning patient's ECG

A = Artifact (noisy episode)

? = Insufficient information to classify beats

I = Inoperative condition (e.g., LEADS OFF)

M = Pause or missed beat

PP P

Delayed 1mV

PVC Numeric HR Numeric

Delayed arrhythmia wave

Beat label Rhythm status message

Pair PVCs

Ectopic status message

Paced Rhythm

PVC

Pace pulse marks

6 ECG, Arrhythmia, and ST Monitoring Understanding the Arrhythmia Display

110

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 B or E

ASYSTOLE No QRS for 4 consecutive seconds in absence of vent fib or chaotic

signal

B, E

VENT FIB/TACH A fibrillatory wave for 4 consecutive seconds B, E

V-TACH A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart

Rate Limit

B, E

SUST V-TACH Ventricular tachycardia rhythm for more than 15 seconds E

VENT RHYTHM A dominant rhythm of adjacent PVCs and a HR ≤ the V-Tach HR

Limit

VENT BIGEMINY A dominant rhythm of N, V, N, V E

VENT TRIGEMINY A dominant rhythm of N, N, V, N, N, V E

PACED RHYTHM A dominant rhythm of paced beats B, E

IRREGULAR HR Consistently irregular rhythm E

SINUS BRADY

SINUS RHYTHM

SINUS TACHY

A dominant rhythm of SV beats preceded by P-waves B, E

SV BRADY

SV RHYTHM

SV TACHY

A dominant rhythm of SV beats not preceded by P-waves B, E

UNKNOWN ECG

RHYTHM

Rhythm cannot be determined B, E

LEARNING ECG Algorithm is learning the ECG beat morphology B, E

LEARNING RHYTHM Algorithm is learning the rhythm of the classified beats B, E

CANNOT ANALYZE

ECG

ECG signal is predominantly invalid and therefore cannot be

analyzed

B, E

Arrhythmia Relearning 6 ECG, Arrhythmia, and ST Monitoring

111

Ectopic Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

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

1To initiate relearning manually, in the Setup Arrhythmia menu, select Relearn Arrhy.

– While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the

rhythm status message LEARNING ECG.

– Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm

status message changes to LEARNING RHYTHM.

2After relearning is complete, you should check the delayed arrhythmia wave to ensure that the

algorithm is labeling the beats correctly.

3If beats are still not classified correctly, check that the ECG is optimized for arrhythmia

monitoring. You may need to select a different lead or change the electrodes or electrode positions

if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves.

Ectopic Status Message Explanation B or E

(No message displayed) No ectopic activity within the last minute

RUN PVCs More than 2 consecutive PVCs within the last minute E

PAIR PVCs Pair PVCs within the last minute E

PACER NOT CAPT Pause with pace pulse (paced patient only) within the last minute B, E

PACER NOT PACE Pause without pace pulse (paced patient only) within the last minute B, E

PAUSE No beat detected for 1.75 x average R-R interval for HR <120, 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 E

MULTIFORM PVCs Multiform PVCs detected within the last minute E

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

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

SV BEATS SV count within last minute and rhythm status is PACED B, E

PACED BEATS Paced beat count within last minute and rhythm status is NOT

PACED

B, E

6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms

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Automatic Arrhythmia Relearn

Arrhythmia relearning is initiated automatically whenever:

• ECG monitoring is switched on

• The ECG Lead or Lead Label is changed manually, or when fallback occurs

•A

Leads Off INOP condition (that has been active for > 60 seconds) ends.

If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens

only in the affected lead. During this learning phase, the system will continue monitoring using the

other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no LEARNING ECG

rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia

templates are maintained for the operative lead, and all alarms switched on are active.

Arrhythmia Relearn and Lead Fallback

Lead fallback triggers an automatic arrhythmia relearn.

WARNING If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as

the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-

Fib.

For this reason you should:

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

when the ECG signal is relatively noise-free

• be aware that arrhythmia relearning can happen automatically

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

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

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

Arrhythmia Alarms

Arrhythmia alarms can be switched on and off and the 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).

Arrhythmia Alarms 6 ECG, Arrhythmia, and ST Monitoring

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Yellow Arrhythmia Alarms

Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions.

Depending on your monitor and Information Center revision, they may be shown with one or two

stars.

WARNING When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This

means that the yellow alarm lamp and the tones are active for a configured number of seconds only,

after which the blinking numeric and the alarm message remain for up to three minutes. Red alarms

behave as usual.

Arrhythmia Alarms and Latching

When using arrhythmia analysis, Visual Latching and Audible Latching should be on

for red alarms, or at least Visual Latching should be on. Because of the transient nature of

arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting

can only be changed in Configuration Mode.

Switching Individual Arrhythmia Alarms On and Off

Some arrhythmia alarms can be individually switched on or off. They are:

Pacer not capture, Pacer not pace, Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T

PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, Irregular HR, Missed Beat, PVCs/min.

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

the list to toggle between On and Off. The monitor displays the INOP message SOME ECG

ALRMS OFF.

Switching All Yellow Arrhythmia Alarms On or Off

All yellow arrhythmia alarms can be switched on and off together. To do this,

♦In the Setup Arrhythmia menu, select All Yellow Off or All Yellow On.

Adjusting the Arrhythmia Alarm Limits

Some arrhythmia alarms have limits which can be individually adjusted. They are:

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

Threshold.

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

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

Arrhythmia Alarm Timeout Periods

Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are

certain situations that can inhibit the audible and visible indications of the alarm even though the

alarm condition was detected. These include:

• 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.

6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms

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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 115).

This setting can only be changed in Configuration Mode.

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

see the menu items TimeOut 1st and TimeOut 2nd.

♦To reset the timeout period, select the Alarms Off or Pause Alarms permanent key and

then reselect it.

Resetting the Timeout Period

Switching alarms off and then on again cancels all visual and audible indicators and resets the timeout

periods.

Silencing an alarm cancels all visual and audible indicators, if the alarm condition is no longer present.

How are Yellow Arrhythmia Alarms Indicated?

When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators.

Behavior of Unsilenced Arrhythmia Alarms

Yellow arrhythmia alarms are always set to latch visually for three minutes.

Yellow arrhythmia alarms that have not been silenced behave as explained in this table:

Behavior of Silenced Arrhythmia Alarms

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

continue until the condition stops. You will not get a realarm for the same condition or another

condition lower down on the same chain until the alarm condition has stopped and reoccurred, and

the 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 time out period, so you will not get a

realarm for the same condition or lower on the chain until the time out expires.

Alarm condition Example Configured time

out period

Short yellow alarm

tone sounds ...

Alarm message

displayed ...

Single alarm instance Non-sustained

V-tach

All settings when alarm condition is

initially detected

for 3 minutes (latching

time)

Continuous alarm condition HR LOW All settings until the alarm condition

stops, plus a maximum of

3 minutes latching time

Same intermittent alarm

condition, occurring

frequently (more than once

per minute)

Pair of PVCs 2 minutes or less

3 minutes or more each time the alarm

condition is detected,

provided that the timeout

period has expired and the

alarm message has cleared

Arrhythmia Alarms 6 ECG, Arrhythmia, and ST Monitoring

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Arrhythmia Alarm Chaining

When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of

the detected alarm conditions would be confusing, and might hide a more serious condition. For this

reason, arrhythmia alarms are prioritized in three alarm “chains”: PVC Alarms; Beat Detection Alarms,

and Rate Alarms.

Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the

same chain will not be announced while an alarm is active or during the configured timeout period. If

alarm conditions of equal severity from different chains are detected, the alarm condition that occurred

most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are

occurring.

See “ECG, Arrhythmia, and ST Alarm Overview” on page 104 for information on which alarms are

included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 113

for an explanation of how alarm timeouts work.

– 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.

Red Arrhythmia Alarms

Asystole

Ven t Fib /Ta ch

V-Tach

Extreme Tachy/Extreme Brady

Yellow Arrhythmia Alarm s

PVC Alarms Chain Beat Detection Alarms Chain Rate Alarms Chain

Pacer Not Captured/

Pacer Not Pacing/

Missed Beat

HR High/ HR Low

PVCs > xx/min

Non-sustain VT/

Ven t R hyt hm

Run PVCs

R-on-T PVCs

Pause SVT

Multiform PVCs

Vent Bigeminy

Vent Trigeminy Irregular HR

(occurs only if no other

arrhythmia alarms are

present)

First level

timeout

period

(TimeOut

1st)

Second level

timeout

period

(TimeOut

2nd)

Pair PVCs

lower priority higher priority

6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms

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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). Changing one alarm limit automatically changes

linked alarm limits.

Example: This diagram illustrates the conditions under which PVC alarms would be generated if the

Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to eight, 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.

Ventricular Heart Rate

Number of Consecutive PVCs (PVC Run)

**Pair

PVCs

PVC =

** Non-Sustain

PVC Run < 8

HR > 100

***V-Tach

PVC Run ≥ 8

HR > 100

** Run PVCs

PVC Run > 2 but ≤ 12

HR ≤ 100

** Vent Rhythm

PVC Run > 12

HR ≤ 100

V-Tach

Heart Rate

Limit

V-Tach Run Limit

Ventricular Rhythm

Run Limit

1 2 3 4 5 6 7 8 9 10 11 12

100

About ST Monitoring 6 ECG, Arrhythmia, and ST Monitoring

117

About ST Monitoring

The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST

segment elevations and depressions. This information can be displayed in the form of ST numerics and

snippets on the monitor.

All available leads can be monitored continuously. The ECG waveform does not need to be displayed

on the Screen for ST Segment analysis.

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.

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.

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.

Switching ST On and Off

♦To switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis

to toggle between On and Off.

Selecting ST Leads for Analysis

♦To switch ST monitoring for individual leads on or off, in the Setup ST Analysis menu,

select Setup ST Leads. In the pop-up window, the leads in the left column under Choices

are the leads you can choose from, and the leads in the right-hand column Selected are the

leads chosen to be displayed. Select the ST leads on the left and use the arrow keys to move the

leads from one list to the other, then select Done to apply the changes.

6 ECG, Arrhythmia, and ST Monitoring Understanding the ST Display

118

Understanding the ST Display

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

ST Numerics Up to 12 ST numerics plus the

ST index can be displayed on the monitor

screen. They can be configured to show beside

the measurement numerics, beside the ECG

wave, or beside the ST snippet.

A positive ST value indicates ST segment

elevation; a negative value indicates depression.

ST numerics are displayed in the order in

which you select ST leads for analysis. If there

is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the

order in which they appear in the Setup ST Analysis -> Setup ST Leads -> Choices

list. 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 STindx numeric will display a question mark “?”.

♦To switch the ST index numeric on or off for display, in the Setup ST Analysis menu,

select ST-Index to toggle between On and Off.

ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most

recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the

stored baseline snippet, drawn in a different color. The comparison shows any deviation in the

measurement since the baseline snippet was stored, for example as a result of a procedure carried out on

the patient.

The information is updated once per minute.

If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select

a Screen configured to show snippets from the pop-up list of available Screens.

ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid. The current

ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between

these two numerics.

A “?” in front of the difference numeric indicates that the ST measurement points were adjusted since

the baseline snippet was stored.

The Baseline Window opens with the ST pop-up keys Update Baseline, Record ST,

Change ST Lead, Adjust ST Points, ST Map and arrow keys for scrolling through the

available leads.

♦To v ie w t h e ST Baseline window, select any snippet on the Screen.

ST-II 1.2

ST-V 2.5

ST-aVR -3.0

Current heart rate

ST numerics

Current HR

alarm limits

Updating ST Baseline Snippets 6 ECG, Arrhythmia, and ST Monitoring

119

Updating ST Baseline Snippets

ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are

updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST

value to appear.

The first baseline is stored automatically after ST monitoring is started, or when a new patient is

admitted. To update ST baselines,

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

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

baselines. This deletes all previously-stored baselines.

Recording ST Segments

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

the pop-up key Record ST.

ST label and

numeric

ST Baseline stored at 14 Feb 03 9:38

Timestamp of most recently stored baseline snippet

ST Baseline

1mV calibration

bar

Current snippet

ST baseline

Baseline ST numeric

and difference since

baseline was stored

ST-II

-0.8

1.9

?-2.7

6 ECG, Arrhythmia, and ST Monitoring About the ST Measurement Points

120

About the ST Measurement Points

The ST value for each beat complex is the vertical difference between the ISO point and the ST point,

as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the

midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed

distance away from the ST point, it can be useful to help you position the ST point correctly.

CAUTION The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart

rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus

the placement of the ST point. Artifactual ST segment depression or elevation may occur if the

isoelectric point or the ST point is incorrectly set.

Always ensure that ST measurement points are appropriate for your patient.

Adjusting ST Measurement Points

Depending on your monitor’s configuration, the ST point can be positioned either

• relative to the J-point.

In the Adjust ST Points window, the pop-up keys ISO Point, J Point and ST Point are

visible and can be adjusted.

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

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

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

To adjust the ST measurement points,

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

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

Baseline window.

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

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

J point, for example, 48 msec

R-wave peak at 0 msec

Isoelectric point set to -80 msec

Difference = ST value

ST measurement point, for example, J + 60 msec

About the ST Measurement Points 6 ECG, Arrhythmia, and ST Monitoring

121

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

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

highlighted while active.

The ISO-point cursor positions the isoelectric point relative to the R-wave

peak. The relation is shown beside the ISO-point in milliseconds. Position the

ISO-point in the middle of the flattest part of the baseline (between the P and

Q waves or in front of the P wave).

The J-point cursor 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 relative to the J-point:

select either J+60 or J+80. Select J Point and use the arrow keys

to move the J-Point and position the ST-point at the midpoint of the ST

segment.

To position the ST-point directly:

select ST Point and use the left and right arrow keys to position the ST

point at the midpoint of the ST segment.

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

recalculate all ST values.

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

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

monitor.

1mV

calibration

bar

Highlighted ST point

Timestamp of

most recent ST

point adjustment

ST-I

0.0

ST label and the ST

numeric that would

apply using the

current points

Adjust ST Points

ISO Point -80 J Point 48 ST Point J+60

ST Points adjusted at 04 Apr 03 11:38

Cursors for

adjusting ST

points

ISO

6 ECG, Arrhythmia, and ST Monitoring ST Alarms

122

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

key.

ST Alarms

ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST

value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for

all ST leads.

If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST

lead which is currently furthest from its set alarm limits.

Single- or Multi-lead ST Alarming

Be aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead

will be announced.

To choose individual or multi-lead ST alarming,

♦In the Setup ST Analysis menu, select ST Alarm Mode and select either Single ST or

Multi ST.

Changing ST Alarm Limits

The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits

individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST

monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical

condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0

mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.

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

Multi ST.

2Select the alarm to be adjusted.

3Select the appropriate setting.

Viewing ST Maps

The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in

ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each

axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram

correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a

chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the

monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the

ECG parameter.

Current View

In current view, the monitor displays an ST map that corresponds to the current ST values. Three or

more leads per plane are necessary to display a map.

The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the

right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads.

Viewing ST Maps 6 ECG, Arrhythmia, and ST Monitoring

123

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 unplugged), the area formed by the remaining ST leads is left open.

Trend View

In trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You

can configure the time interval between trended samples. The most recent map is shown in the same

color as the parameter itself. Past values change from white through dark gray. In the diagram below,

the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old.

The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values

on the diagrams show the current ST values.

ST map

ST index (for EASI)12-Lead EASI indicator alarm status

indicator

EASI Limb leads EASI Chest Leads

ST label, value and polarity of

corresponding lead

ST Map (Current)

6 ECG, Arrhythmia, and ST Monitoring Viewing ST Maps

124

If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended

values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off 20

seconds ago. The current ST values and the first trended value reflect this change in the lead setup. All

other maps are displayed the way in which they were recorded.

Viewing an ST Map

To display an ST map,

♦In the Setup ST Analysis menu, select ST Map.

Working in the ST Map Task Window

You may need to activate the ST map task window to see all the data, and to access the pop-up keys.

Select the map view on screen to activate its task window. Once you activate it, you can perform the

tasks detailed here.

Switching Between ST Map Views

To switch between views,

♦Select Current View or Trend View to toggle between views.

If your trend view is empty, you need to adjust the priority of this measurement in the trending

priority list. See “Trend Priority” on page 227.

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.

Limb Leads Chest Leads

Interval

12 sec

current ST valuestrending interval

ST Map (Trend)

Viewing ST Maps 6 ECG, Arrhythmia, and ST Monitoring

125

Displaying an ST Reference Baseline

You can display an ST reference baseline for the current view, or for the trended view. The baseline is

shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline

to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia

and also on user request.

♦Select Show Baseline/Hide Baseline to toggle between baseline display on and off.

Updating an ST Map Reference Baseline

To update the baseline,

♦In the Setup ST Analysis menu, select ST Baseline -> 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,

1In Trend view, select Select Interval.

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

Printing an ST Map Report

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

1Select Main Setup - > Reports.

2Select ST Map.

3Press Print.

6 ECG, Arrhythmia, and ST Monitoring Viewing ST Maps

126

127

7Monitoring Pulse Rate

The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in

beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave) or any

arterial pressure (ABP, ART, Ao, BAP, FAP, PAP, UAP, P: see the pressure section for an explanation

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

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

switched on.

Entering the Setup Pulse Menu

If a pulse numeric is displayed on the screen, select it to enter the Setup Pulse (Pulse Source)

menu. If no pulse numeric is visible, in the Setup SpO2 menu or an Setup arterial pressure menu,

select Pulse (Pulse Source).

System Pulse Source

The currently active system pulse source is shown in the setup menus of the pulse source

measurements. The pulse rate chosen as system pulse:

• is monitored as system pulse and generates alarms when you select pulse as the active alarm source

• is sent via the network to the Information Center, if available

• is trended in the HighRes Trends and stored in the monitor’s databases.

To define which pulse rate is used as system pulse,

1In the Setup Pulse menu, select System Pulse.

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

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

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

available.

7 Monitoring Pulse Rate Switching Pulse On and Off

128

Switching Pulse On and Off

To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement

setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or

off,

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

Setup SpO2 menu.

2In the Setup Pulse menu, select Pulse (Pulse source) to toggle between On and

Off.

To switch the system pulse on or off, in any Setup Pulse (Pulse Source) menu, check

which measurement is currently selected as pulse source. Enter the Setup Pulse menu for this

pulse source and then switch off the pulse measurement as described.

Using Pulse Alarms

You can change pulse rate alarm limits in the Setup Pulse menu accessed via any Pulse source, or

in the Setup ECG menu. 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 and a pulse source is set as

system pulse.

Selecting the Active Alarm Source: HR 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 HR or Pulse as its active alarm source. To change the alarm source,

select Alarm Source in the Setup ECG or Setup Pulse menu, then select either

•HR: 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 no ECG

LEADS OFF INOP is active.

The monitor will automatically switch to Pulse as the alarm source if:

– a Pulse source is switched on and available,

and

– the heart rate becomes unavailable and the ECG LEADS OFF inop is active.

The monitor then uses the pulse rate from the measurement currently selected as system pulse.

While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If the HR

becomes available again, the monitor automatically uses this as alarm source.

Using Pulse Alarms 7 Monitoring Pulse Rate

129

WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the

section “ECG, Arrhythmia, and ST Alarm Overview” on page 104, and the heart rate alarms. This is

indicated by the message All ECG Alarms Off (unless this has been configured off for your

monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.

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

Alarm Source Selection Disabled

If Alarm Source Selection is disabled, you cannot change the alarm source. If you try to change the

source, the monitor displays the message To activate enter Config and enable

AlarmSourceSel. 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; for HR 15 bpm, and for

Pressure 25 bpm.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source,

either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm

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

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

♦To see the values added to the high and low limit alarms to create the extreme rate alarms for your

monitor, in the Setup ECG menu, see the menu items ∆ExtrTachy and ∆ExtrBrady.

QRS Tone

The active alarm source is also used as a source for the QRS tone. You can change the tone volume in

the Setup SpO2 and Setup ECG menus and the QRS tone modulation in the Setup SpO2 menu.

7 Monitoring Pulse Rate Using Pulse Alarms

130

131

8Monitoring 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, or 10-lead, using either standard or EASI™

placement - to measure Resp, as long as you use ICU ECG cables.

The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG

electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI™

ECG electrode placement, Resp is measured between the I and A electrodes.

Optimizing Lead Placement for Resp

If you want to measure Resp and you are already measuring ECG, you may need to optimize

placement of the two electrodes between which Resp will be measured for some patients. Repositioning

ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode

placement, results in changes in the ECG waveform and may influence ST and arrhythmia

interpretation.

Cardiac Overlay

Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp

electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement

can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line

between the respiratory electrodes. This is particularly important for neonates.

8 Monitoring Respiration Rate (Resp) Understanding the Resp Display

132

Lateral Chest Expansion

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.

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 Auto/Manual 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,

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.

Resp

1 Ohm

Manually-set Resp detection level

1 Ohm calibration bar Resp numeric

and label

Changing the Size of the Respiration Wave 8 Monitoring Respiration Rate (Resp)

133

• the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If

you are monitoring respiration with only two electrodes, the detection algorithm becomes less

sensitive which may result in reduced breath detection performance.

Use Auto Detection Mode for situations where:

• the respiration rate is not close to the heart rate

• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)

• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).

Manual Detection Mode

In Manual Detection Mode you must set the Resp detection level.

♦In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level

line in the Resp waveform to determine when the desired level is reached.

Once set, the detection level will not adapt automatically to different respiration depths. It is important

to remember that if the depth of breathing changes, you may need to change the detection level.

Use Manual Detection Mode for situations where:

• the respiration rate and the heart rate are close.

• patients have Intermittent Mandatory Ventilation.

• respiration is weak. Try repositioning the electrodes to improve the signal.

Resp Detection Modes and Cardiac Overlay

In Auto Detection Mode: If you are monitoring Resp and the ECG is switched off, the monitor

cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is

automatically set higher to prevent the detection of cardiac overlay as respiration.

In Manual Detection Mode: Cardiac overlay can in certain situations trigger the respiration counter.

This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you

suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the

zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you

may need to optimize the electrode placement as described in the section ”Lateral Chest Expansion”.

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.

8 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave

134

Changing the Speed of the Respiration Wave

Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp

measurement has its own speed control and is not affected by the wave speed settings of the other

measurements.

♦Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the

required speed from the pop-up list. This defines the speed at which the wave is drawn across the

screen in millimeters per second (mm/s).

Using Resp Alarms

Resp alarms can be switched on and off and the high and low alarm limits can be changed just like

other measurement alarms, as described in the Alarms chapter.

Changing the Apnea Alarm Delay

The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines

the time period between the point where the monitor cannot detect any respiration activity and the

indication of the apnea alarm.

1In the Setup Resp menu, select Apnea Time.

2Select the appropriate setting.

Resp Safety Information

WARNING Respiration detection level If you do not set the detection level for the respiration correctly in manual

detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level

too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as

respiratory activity in the case of apnea.

Apnea The respiration measurement does not recognize obstructive and mixed apneas — it only

indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.

The safety and effectiveness of the respiration measurement method in the detection of apnea,

particularly the apnea of prematurity and apnea of infancy, has not been established.

Interference If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated

Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various

frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close

proximity to the respiration measurement unit.

Resp Accessories 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

electro-surgery is being performed.

Resp Safety Information 8 Monitoring Respiration Rate (Resp)

135

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume 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.

8 Monitoring Respiration Rate (Resp) Resp Safety Information

136

137

9Monitoring SpO2

Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact

suppression technology (FAST). It provides four measurements:

• Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the

sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).

• Pleth waveform - visual indication of patient’s pulse.

• Pulse rate (derived from pleth wave) - detected pulsations per minute.

• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by

arterial pulsation.

The monitors are also compatible with SpO2 technologies from other manufacturers. Please refer to the

instructions for use provided with these devices for further information.

SpO2 Sensors

Depending on the purchased SpO2 option, different sensors and adapter cables can be used. The

sensors for the different options are color-coded to match the connectors. See the section on

Accessories for a compatibility table.

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

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

site.

CAUTION Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators

or in the presence of fluids, which may contaminate sensor and electrical connections causing

unreliable or intermittent measurements. Do not use disposable sensors on patients who have allergic

reactions to the adhesive. Always use the MAX-FAST forehead sensor with the foam headband

provided by Nellcor.

Applying the Sensor

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

2Remove colored nail polish from the application site.

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

can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor,

9 Monitoring SpO2Connecting SpO2 Cables

138

select a finger or toe with a diameter of between 7 and 8 mm (0.27” and 0.31”). When applying a

M1193A neonatal sensor do not overtighten the strap.

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

the emitter must pass through the patient’s tissue.

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

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

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

to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a

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

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

four hours.

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

severely obstruct circulation and lead to inaccurate measurements.

Ambient Temperature: Never apply an SpO2 sensor at ambient temperatures from above 37 oC

because this can cause severe burns after prolonged application.

Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular

venous infusion line.

Connecting SpO2 Cables

♦Connect the sensor cable to the color-coded socket on the

measurement device (MMS or module). If you are using a

disposable sensor, plug the sensor into the adapter cable and connect

this to the measurement device. Connect reusable sensors directly to

the measurement device.

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

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

the calculation of the SpO2 and pulse numerics.

2During measurement, ensure that the application site:

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

SpO2

Assessing a Suspicious SpO2 Reading 9Monitoring SpO

139

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

sensor.

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

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

least every four hours.

Using an SpO2 sensor during MR imaging can cause severe burns. Minimize this risk by positioning

the cable so that no inductive loops are formed. If the sensor does not appear to be operating properly,

remove it immediately from the patient.

CAUTION Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and

carboxyhemoglobin may lead to inaccurate measurements.

Interference can be caused by:

• High levels of ambient light. (Hint: cover application site with opaque material.)

• Electromagnetic interference.

• Excessive patient movement and vibration.

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/Pleth 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 pleth wave and perfusion indicator instead to assess the signal

quality.

9 Monitoring SpO2Understanding SpO2 Alarms

140

Understanding SpO2 Alarms

This refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers

high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below

the desat alarm limit.

CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 INOP can occur.

If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in

indicating critical patient status, such as sudden pulse loss or hypoxia.

Alarm Delays

There is a delay between a physiological event at the measurement site and the corresponding alarm at

the monitor. This delay has two components:

• The time between the occurrence of the physiological event and when this event is represented by

the displayed numerical values. This delay depends on the algorithmic processing and the

configured averaging time. The longer the averaging time configured, the longer the time needed

until the numerical values reflect the physiological event.

• The time between the displayed numerical values crossing an alarm limit and the alarm indication

on the monitor. This delay is the combination of the configured alarm delay time plus the general

system delay time (see “Monitor Performance Specifications” on page 342).

Adjusting the Alarm Limits

In the Setup SpO2 menu:

•Select

High Limit then choose the upper alarm limit.

•Select

Low Limit then choose the lower alarm limit.

WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a

consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm

off. Transcutaneous pO2 monitoring is recommended for premature infants receiving supplemental

oxygen.

Adjusting the Desat Limit Alarm

The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in

oxygen saturation.

1In the Setup SpO2 menu, select Desat Limit.

2Adjust the limit.

Pleth Wave

The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality

becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of

change in pulse volume, use the perfusion indicator.

Perfusion (Pleth) Indicator 9Monitoring SpO

141

Perfusion (Pleth) Indicator

The perfusion indicator gives a numerical 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 indicator

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.

Setting SpO2/Pleth as Pulse Source

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

2In the Setup Pulse menu, select System Pulse and select SpO2 from the pop-up list.

Setting Up Tone Modulation

If tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS

tone is derived from either heart rate or pulse depending on which is currently selected as the active

alarm source.

♦In the Setup SpO2 menu, select Tone Modulation to toggle between Yes (for on) and No

(for off).

Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett

Incorporated, a Tyco Healthcare company.

Setting the QRS Volume

♦In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume.

Calculating SpO2 Difference

When a second SpO2 measurement is present (either through the SpO2 module or through VueLink),

the monitor displays both SpO2 values, and calculates the difference between them. The second value

is subtracted from the first.

minimum size for reliable SpO2 value

9 Monitoring SpO2Calculating SpO2 Difference

142

1From the Main Setup menu, select Measurements.

2From the ∆SpO2 Setup menu, select First SpO2.

3Choose the first measurement source.

4Select Second SpO2.

5Choose the second measurement source.

143

10Monitoring 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/EN 60601-2-30.

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

Introducing the Oscillometric NBP Measurement

Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff

deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the

occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude,

reach a maximum (which approximates to the mean pressure), and then diminish.

Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock),

oscillometric devices are more accurate and consistent than devices using other noninvasive measuring

techniques.

WARNING Patient Category: Select the correct patient category setting for your patient. Do not apply the higher

adult inflation, overpressure limits and measurement duration to neonatal patients.

Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial

catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or

blocked during cuff inflation.

Skin Damage: Do not measure NBP on patients with sickle-cell disease or any condition where skin

damage has occurred or is expected.

Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended

blood pressure measurements on patients with severe blood clotting disorders because of the risk of

hematoma in the limb fitted with the cuff.

10 Monitoring NBP Preparing to Measure NBP

144

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 MMS, contact your service personnel.

Measurement Limitations

Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or

if the patient is on a heart-lung machine.

The measurement may be inaccurate or impossible:

• if a regular arterial pressure pulse is hard to detect

• with cardiac arrhythmias

• with excessive and continuous patient movement such as shivering or convulsions

• 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 Methods

There are three methods of measuring NBP:

•Manual - measurement on demand.

•Auto - continually repeated measurements (between one and 120 minute adjustable interval).

•STAT - rapid series of measurements over a five minute period, then the monitor returns to the

previous mode. Use only on supervised patients.

Reference Method

The NBP measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-

arterial). For further information, see the Application Note on NBP supplied on the monitor

documentation CD-ROM.

In Adult and Pediatric mode to check the current setting, select Main Setup -> Measurements

-> NBP, and check whether the Reference setting is set to Auscultatory or Invasive. This

setting can only be changed in Configuration Mode.

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.

Preparing to Measure NBP

1Connect the cuff to the air tubing.

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

Air must pass unrestricted through the tubing.

Preparing to Measure NBP 10 Monitoring NBP

145

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

cover is not folded or twisted.

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

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

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

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

measurement correction formula to correct the measurement.

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

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

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

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

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

frequently when making automatic or stat measurements.

Correcting the Measurement if Limb is not at Heart Level

To correct the measurement if the limb is not at heart level, to the displayed value

Understanding the NBP Numerics

Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured

to display only the systolic and diastolic values.

Alarm Sources if you have parallel alarm sources, the sources are displayed instead of the alarm limits.

NBP Timestamp depending on the configured NBP Time setting, the time shown beside the NBP

numeric can be:

NBP

add 0.75mmHg (0.10kPa) for each centimeter

higher or

deduct 0.75mmHg (0.10kPa) for each centimeter

lower or

add 1.9mmHg (0.25kPa) for each inch higher. deduct 1.9mmHg (0.25kPa) for each inch lower.

NBP mmHg 60min 17:15

Mean

120

Auto

Cuff 151

Auto

Sys.

Measurement Mode

Timestamp/

Timer

Mean pressure

Diastolic

Alarm limits

Alarm source

Systolic

10 Monitoring NBP Starting and Stopping Measurements

146

–Meas Time: the time of the most recent NBP measurement, or

–Next Meas: the time until the next measurement in an

automatic series, displayed with a graphic representation of the

remaining time, as shown here.

During measurements the cuff pressure is displayed instead of the units and the repeat time. An early

systolic value gives you a preliminary indication of the systolic blood pressure during measurement.

Starting and Stopping Measurements

Use the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements.

CAUTION Use clinical judgement to decide whether to perform repeated series of STAT measurements because of

the risk of purpura, ischemia and neuropathy in the limb with the cuff.

Enabling Automatic Mode and Setting Repetition

Time

1In the Setup NBP menu, select Auto/Man.

2Toggle between Auto/Man, if necessary, to pick the measurement method.

3If making an automatic measurement, select Repeat Time and set the time interval between two

measurements.

Action to be performed NBP Setup menu SmartKeys MMS hardkey

Start/Stop manual measurement

Start Auto series

Stop current automatic

measurement

Start/Stop Start/Stop

Stop Automatic, Manual or STAT

measurement AND series

Stop All ---

Start STAT measurement NBP STAT STAT (for MMS

without Pressure/Temp

measurement)

Stop current STAT measurement

and end series

Start/Stop Start/Stop

NBP STAT STAT (for MMS

without Pressure/Temp

measurement)

Choosing the NBP Alarm Source 10 Monitoring NBP

147

Choosing the NBP Alarm Source

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in

parallel. Only one alarm is given, with the priority of mean, systolic, diastolic. In the Setup NBP

menu, select Alarms from and choose from:

Assisting Venous Puncture

You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set

time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.

1In the NBP Setup menu select VeniPuncture.

2Puncture vein and draw blood sample.

3Reselect VeniPuncture to deflate the cuff.

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

in venous puncture mode.

Calibrating NBP

NBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at

least once every two years by a qualified service professional. See the Service Guide for details.

Menu option Pressure value monitored

Sys. systolic

Dia. diastolic

Mean mean

Sys&Dia systolic and diastolic in parallel

Dia&Mean diastolic and mean in parallel

Sys&Mean systolic and mean in parallel

S&D&M all three pressures in parallel

(60)

Cuff pressure

Venous puncture measurement mode

NBP 01:45

Time left in venous

puncture mode

10 Monitoring NBP Calibrating NBP

148

149

11Monitoring Temperature

You can measure temperature using the Multi-Measurement Server (MMS), one of the measurement

server extensions, or the temperature plug-in module. Temp measurement automatically switches on

when you connect a probe. You can switch the measurement off manually.

Making a Temp Measurement

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

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

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

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

5Select an appropriate temperature label.

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

this type of temperature measurement.

WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that

particular label only. Changing the label may change the alarm limits.

Selecting a Temperature for Monitoring

Tell the monitor which temperature you want to monitor by selecting its temperature label. The label

is a unique identifier for each type of temperature. When you choose a label, the monitor uses that

label’s stored color and alarm settings.

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

2Select the appropriate label from the list.

Temp connector socket

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150

Extended Temperature Label Set

The following additional labels are available if Label Set is set to Full. This setting can only be

changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended

label set may not be correctly displayed. See the Configuration Guide for your monitor for more

information.

Calculating Temp Difference

The monitor can calculate and display the difference between two temperature values by subtracting

the second value from the first. The difference is labeled ∆Temp.

1In the Setup Main menu, select Measurements.

2In the Setup ∆Temp menu, select First Temp.

3Label the measurement source as appropriate.

4Select Second Temp.

5Label the measurement source as appropriate.

Temp non-specific temperature label. Trect rectal temperature

Tart arterial temperature Tskin skin tem pera t ure

Tcore core temperature Tven venous temperature

Tesoph esophageal temperature Tnaso nasopharyngeal temperature

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

Tamb ambient temperature

Tcereb cerebral temperature

Ttymp tympanic temperature

Tvesic vesical temperature

151

12Monitoring Invasive Pressure

You can measure pressure using the Multi-Measurement Server (MMS), one of the measurement

server extensions or the pressure plug-in module.

Setting up the Pressure Measurement

1Plug in the pressure cable.

2Prepare the flush solution.

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

free of air bubbles.

WARNING If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air

bubbles may lead to a wrong pressure reading.

4Connect the pressure line to the patient catheter.

5If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid

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

6Position the transducer so that it is level with the heart, approximately at the level of the

midaxillary line.

MMS Module

12 Monitoring Invasive Pressure Zeroing the Pressure Transducer

152

WARNING If measuring intracranial pressure (ICP) with a sitting patient, level the transducer with the top of the

patient’s ear. Incorrect leveling may give incorrect values.

Selecting a Pressure for Monitoring

Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a

unique identifier for each type of pressure. When you chose a label, the monitor uses that label’s stored

color, wave scale and alarm settings.

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

2Select the appropriate label from the list.

Extended Pressure Label Set

The following additional labels are available if Label Set is set to Full. This setting can only be

changed in Configuration Mode.

Note that if your monitor is connected to an Information Center, the additional labels in the extended

label set may not be correctly displayed. See the Configuration Guide for your monitor for more

information.

Zeroing the Pressure Transducer

To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in

accordance with your hospital policy (at least once per day). 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.

Label Description Label Description

ABP Arterial blood pressure PNon-specific pressure label

ART Arterial blood pressure (alternative) PAP Pulmonary artery pressure

Ao Aortic pressure RAP Right atrial pressure

CVP Central venous pressure UAP Umbilical arterial pressure

ICP Intracranial pressure UVP Umbilical venous pressure

LAP Left atrial pressure

Label Description

BAP Brachial arterial pressure

FAP Femoral arterial pressure

IC1, IC2 Alternative intracranial pressures

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

Zeroing the Pressure Transducer 12 Monitoring Invasive Pressure

153

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

measurement server or module while zeroing. Reconnecting the transducer recalls the stored values.

WARNING If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero.

Therefore, make sure you zeroed the transducer correctly in accordance with the transducer

manufacturer’s instructions and your hospital policy. When you use a transducer that you cannot

rezero after placement, ensure that you keep the measuring device with the patient so that you are

certain you have the correct zero data for this patient.

Determining a Pressure’s Most Recent Zero

The monitor displays the most recent zero on the status line. If this has “timed-out” after you have

performed a zero, redisplay the information in the status line by entering the pressure’s setup menu.

Zeroing a Pressure Measurement

WARNING Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily

suppressed until 30 seconds after the transducer finishes zeroing.

1Turn off the stopcock to the patient.

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

exerted on the transducer.

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

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

(for example, ABP zero done at 13 Mar 02 23.35) close the stopcock to atmospheric

pressure, and open the stopcock to the patient.

Using the Zero Hardkey

Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the

pressure currently measured with the module.

Pressing the Zero hardkey for two seconds on the M3001A Multi-Measurement Server zeros the

pressure being measured by the measurement server and the pressures from any connected

measurement extensions.

Zeroing All Pressures Simultaneously

WARNING Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.

12 Monitoring Invasive Pressure Adjusting the Calibration Factor

154

If you are measuring pressures with more than one measuring device, using the Zero 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:

Adjusting the Calibration Factor

Each time you use a reusable transducer, compare the calibration factor written on your transducer

with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the

same.

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

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

list now in accordance with your hospital’s procedure.

2To confirm you want to use the new calibration factor, select the Confirm popup.

Displaying a Mean Pressure Value Only

Use this when you want to see only the mean pressure.

♦In the pressure’s setup menu, select Mean Only. Toggle between On to display mean pressure

value only, and Off to display all pressure values (systolic, diastolic and mean).

Changing the Pressure Wave Scale

1Select the label of the pressure wave whose scale you want to set to enter the Setup menu.

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

Message Corrective Action

unable to zero -

equipment

malfunction

The hardware is faulty. Contact your service personnel.

unable to zero -

excessive offset

Make sure the transducer is vented to air and try again. If this fails, the hardware

may be faulty. Replace the adapter cable and try again. If it fails, replace the

transducer and try again. If it still fails, contact your service personnel.

unable to zero -

unstable signal

unable to zero -

no transducer

Make sure that the transducer is connected and try again. If this fails, exchange

the adapter cable and try again. If this fails, exchange the transducer.

unable to zero -

pulsatile

pressure

Make sure that the transducer is vented to air, not to the patient, and try again.

unable to zero -

timed out

Try pressing the Zero key again. If this fails, replace the transducer and adapter

cable and contact your service personnel.

switch <Press> on

first

Pressure measurement is switched off. To switch it on, in the Setup Pressure

menu, select the pressure’s label.

Optimizing the Waveform 12 Monitoring Invasive Pressure

155

3Select a value from the pop-up list:

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

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

Optimizing the Waveform

♦In the Setup <Press> 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 Suppression is configured to 30, 60, or 90 seconds). During artifact suppression,

the monitor shows the INOP message <Pressure label> ARTIFACT, and a question mark is

shown beside the pressure numerics. Pressure alarms and the Pulse Non-Pulsatile INOP are

suppressed during the configured period. The CPP high alarm is not suppressed.

Choosing the Pressure Alarm Source

WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that

particular label only. Changing the label may change the alarm limits.

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in

parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.

♦In the Setup <Press> menu, select Alarms from and choose the source.

♦Select and set the High Limit and Low Limit for the pressure(s) you have selected.

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

12 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6

156

Calibrating Reusable Transducer CPJ840J6

Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring

mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according

to your hospital policy. You require:

• standard sphygmomanometer.

• sterile 10cc syringe with heparinised solution.

• 3-way stopcock.

• approximately 25cm of tubing.

Making the Pressure Calibration

WARNING Never perform the invasive pressure calibration while a patient is being monitored.

1Zero the transducer.

2Connect the syringe and manometer.

a. Attach the tubing to the manometer.

b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when

you measure a patient.

c. Attach the syringe to one port and the manometer tubing to the other port.

d. Open the port to the manometer.

3Move the syringe barrel in and raise the mercury to 200mmHg (30kPa). 200mmHg is the

recommended calibration pressure.

4In the Setup Pressure menu, select Cal. Press.

M1006A

PRESS

ZERO

tubing to manometer

Syringe with

heparinised

solution

Off

Patient

connection

stoppered

Calculating Cerebral Perfusion 12 Monitoring Invasive Pressure

157

5Select the calibration pressure from the list, for example 200 mmHg.

6Select Confirm to recalculate the calibration factor using the applied pressure.

7When the monitor displays <Press> calibration done at <date and time>, remove

the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer

dome and tubing with sterile ones.

8Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure’s

setup menu.

9Reconnect the patient and start measuring again.

Troubleshooting the Pressure Calibration

The status line lists the probable cause of an unsuccessful calibration.

Calculating Cerebral Perfusion

The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.

The difference is labeled CPP.

1In the Main Setup menu, select Measurements.

2In the Setup CPP menu, select ABP, ART, Ao, BAP or FAP as the arterial pressure source.

Calculating Pulse Pressure Variation

Note: The derived measurement Pulse Pressure Variation is not available in the USA.

Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is

the difference between the systolic and the diastolic pressure values for a single beat. The average

variation in pulse pressure is calculated over periods of 32 seconds.

WARNING • This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The

circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and

reliable must be determined by a physician.

Message Corrective Action

unable to calibrate -

equipment malfunction

Contact your service department. The pressure hardware is faulty.

unable to calibrate -

out of range

Make sure that you have selected the value for Cal. Press that

you are applying to the transducer, and repeat the calibration.

unable to calibrate - no

transducer

Make sure that the transducer is connected and try again.

unable to calibrate -

unstable signal

Make sure there are no disturbances to the transducer, and repeat

the calibration.

unable to calibrate -

perform zero first

No valid zero. Zero the transducer.

12 Monitoring Invasive Pressure Measuring Pulmonary Artery Wedge Pressure

158

• The clinical value of the derived PPV information must be determined by a physician. According to

recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients

receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.

To select an arterial pressure as PPV source:

1In the Main Setup menu, select Measurements.

2In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source.

CAUTION Older measurement servers cannot supply a beat-to-beat arterial pressure value. In this case the

monitor shows a NO PPV FROM <Server> INOP.

At respiration rates below 8 rpm, PPV calculation may lead to inaccurate values.

Measuring Pulmonary Artery Wedge Pressure

Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:

•Fluid status

• Myocardial contractility

• Valve and pulmonary circulation integrity

Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the

pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the inflated balloon

occludes the artery allowing the monitor to record changes in the intrathoraic pressures that occur

throughout the respiration cycle. The pulmonary wedge pressure is the left ventricular end diastolic

pressure (preload).

The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoraic

pressure is fairly constant. Use the ECG waveform to determine the waveform of the wedge pressure.

You can use the respiration waveform as a reference when assessing the PAWP waveform, to ensure

constant measurement timing relative to the respiratory cycle. The monitor displays the PAWP value

for up to 48 hours or until you admit a new patient.

WARNING The pressure receptor in the catheter records pressure changes that occur only in front of the

occlusion. Even though the catheter tip is in the pulmonary artery, the receptor records pressure

changes transmitted back through the pulmonary circulation from the left side of the heart.

While performing the wedge procedure, the monitor switches off the pressure alarms for pulmonary

artery pressure (PAP).

Due to a slight measurement delay, you should not use Microstream (sidestream) CO2 as a direct

reference for determining the end expiratory point in the pressure curve.

To start the Wedge procedure,

1In the Main Setup menu, select Wedge to display the wedge procedures window.

2Prepare and check the pressure line according to your hospital policy. If the PAP waveform scale is

set to Optimum prior to the wedge procedure, it is possible that after wedging the catheter, the

resulting pressure waveform will fall below the lower scale. In this case, the wedge waveform will

Editing the Wedge 12 Monitoring Invasive Pressure

159

not be displayed or recorded properly. To avoid this, switch out of optimum scale before

performing a wedge procedure.

3Use the Reference Wave 1 and 2 popup keys to select any ECG or respiratory wave as

reference waves.

4Select Wave Speed if you want to synchronize all displayed waves to your preferred speed.

5Inflate the balloon when the monitor prompts you: Ready for balloon inflation. The

waveform changes from the PAP to the PAWP wave. The measurement takes approximately 12

seconds. On completion, the monitor stores the PAWP waveform display and prompts you to

deflate the balloon. If the monitor cannot detect a wedging waveform you must use Store

Trace to store the wedge and two reference waves manually.

6Deflate the balloon when the monitor prompts you: Ready for balloon deflation and

verify that the waveform returns to pulmonary artery shape.

7If you need to start a new measurement, select Restart Wedge.

Editing the Wedge

1Select the Edit Wedge pop-up key to see the stored waveforms.

2The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any

previously stored value and the time it was stored.

3Move the cursors up, down, right and left to set them on the correct wedge position.

4Select Store Wedge to store the PAWP value.

5Select Print Wedge to print the PAWP waveform and any reference waves or Record Wedge to

record them. While recording or printing, you cannot perform any more Wedge tasks.

WARNING Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the

minimum time necessary to get an accurate measurement.

If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon, the

pulmonary artery pressure waveform assumes a wedged appearance. Take appropriate action, in accordance

with standard procedures, to correct the situation.

If the PAWP (mean) is greater than the PAP (systolic), deflate the balloon and report the incident in

accordance with hospital policy, because the pulmonary artery could be accidently ruptured, and the wedge

value derived will not reflect the patient’s hemodynamic state, but will merely reflect the pressure in the

catheter or balloon.

12 Monitoring Invasive Pressure Identifying the Pressure Analog Output Connector

160

Identifying the Pressure Analog Output Connector

analog output

(module M1006B,

option C01 only)

161

13Monitoring Cardiac Output

The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic

parameters using a technique called thermodilution. This can be used to determine the flow rate of a

system by introducing a cold solution into the system and measuring the resulting drop in temperature

at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window,

and the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to

the area under the curve. As cardiac output varies continuously, a series of measurements must be

carried out to achieve a reliable C.O. average value. Always use the average of multiple thermodilution

measurements for therapy decisions.

The measurements can be carried out using the right heart thermodilution method or the PiCCO

method (transpulmonary thermodilution).

• The right heart method is available with

– C.O. module M1012A, standard and option #C10

– M3012A Hemodynamic Measurement Server Extension, options #C05 and #C10

– M3014A Capnography Measurement Server Extension, option #C05 and #C10

• The PiCCO method is available with

– C.O. module M1012A, option #C10

– M3012A Hemodynamic Measurement Server Extension. option #C10

– M3014A Capnography Measurement Server Extension, option #C10

The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing

pulse contour analysis on the blood pressure waveform.

13 Monitoring Cardiac Output Hemodynamic Parameters

162

Hemodynamic Parameters

This table illustrates the hemodynamic parameters available with each method, whether they are

measured continuously, and whether they can be shown on the monitor’s resting display or in the

HemoCalc Window.

* currently not available in the U.S.A or in clinical environments under FDA control.

Measured and Calculated Hemodynamic

Parameters and Indexes

PiCCO Method

(Transpulmonary

Thermodilution) Right Heart Thermodilution

Continu

ous?

Resting

Display

HemoCalc

Window

Contin

uous?

Resting

Display

HemoCalc

Window

Blood Temperature (Tblood) Y Y N Y Y N

C.O./C.I.: Cardiac Output N Y Y N Y Y

CCO/CCI: Continuous Cardiac Output Y Y Y (in the

C.O. field)

Not available

SVR/SVRI: Systemic Vascular Resistance N and Y Y Y N N Y

SV/SI: Stroke Volume/SV Index N and Y Y Y N N Y

SVV: Stroke Volume Variation Y Y N Not available

*dPmax: Left Ventricular Contractility Index Y Y N Not available

CFI: Cardiac Function Index N Y N Not available

ITBV/ITBVI: Intrathoracic Blood Volume N Y Y Not available

*EVLW/EVLWI: Extravascular Lung Water N Y Y Not available

*GEDV/GEDVI: Global End-Diastolic Volume N Y Y Not available

PVR/PVRI: Pulmonary Vascular Resistance Not available N N Y

LCW/LCWI: Left Cardiac Work N N Y N N Y

RCW/RCWI: Right Cardiac Work Not available N N Y

RVSW/RVSWI: Right Ventricular Stroke Work Not available N N Y

Using the C.O. Procedure Window 13 Monitoring Cardiac Output

163

Using the C.O. Procedure Window

The C.O. procedure window displays up to six trials (measurement curves) with the trial number and

the C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys

automatically appears to let you carry out C.O.-related tasks. This example shows the procedure

window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly

different on your monitor.

To open the C.O. procedure window,

♦Select Cardiac Output in the Setup C.O. or Setup CCO menu, or

♦Select the Cardiac Output SmartKey on the Screen, if configured, or

♦Press the START hardkey on the front of the C.O. plug-in module, if available, or

♦Press a remote start switch, if you are using one.

♦To change the measurement parameters shown in the results table of the C.O. procedure window,

select the Table Contents pop-up key and choose from the list of available parameters.

♦To view the currently-used temperature unit, see the “grayed-out” setting Temperature Unit

in the Setup C.O. menu. This setting can only be changed in Configuration Mode.

♦The Cardiac Output screen element may be configured to display permanently on a specially

designed Screen. Selecting the screen element opens the cardiac output pop-up keys.

Trial curves Trial curve scale Averaged values

Results table of current trial

Prompt

message field

Thermodilution

curve of current

trial

Curve alert

message field

Setup

information

Current trial

number

Continuously

measured

numeric

Cardiac Output (Transpulmonary)

CathCt InjVol

BSA 1.93

C.I. 4.40 C.O. 8.49

Average Unit

C.O.

CFI

C.I

ITBVI

ETVI

Tinj

InjVol

Tblood

Tblood 37.0

l/min

l/min/m2

ml/m2

Cal

0.3oC

Trial

CCO-CAL

8.51

5.5

4.41

996

8.53

5.5

4.42

996

6.0

2.0

11.4

6.0

5.88

1225

5.0

2.0

8.49

5.5

4.40

998

6.1

2.0

Ready for new measurement

Start

C.O.

Stop

C.O.

Select

Trial

Accept/

Reject

Save C.O.&

Cal CCO

Print/

Record

Table

Contents

Hemo

Calc

Change

Scale

Setup

C.O.

13 Monitoring Cardiac Output Accessing the Setup C.O. and Setup CCO Menus

164

Accessing the Setup C.O. and Setup CCO Menus

C.O. settings can be changed in the Setup C.O. menu. To access this menu,

♦press the C.O. hard key on the C.O. module

♦select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen.

CCO/CCI settings can be changed in the Setup CCO menu. To access this menu,

♦select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen.

Entering the HemoCalc Window

♦From the C.O. procedure window, select the pop-up key HemoCalc to open the HemoCalc

window.

Measuring C. O. Using the PiCCO Method

The PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the

blood pressure waveform. A fluid with a known volume and temperature is injected into the right

atrium through a CVP catheter. The injectate bolus mixes with the blood in the heart and the change

in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in

one of the bigger systemic arteries, for example, the femoral or the axillary artery.

The PiCCO Method requires a pressure measurement made using either the M1006B Pressure

module, or a M3001A MMS, or a measurement server extension M3015A, M3014A, or M3012A. (A

VueLink pressure may not be used.) You will also need a conventional central venous (CVP) line and

an arterial catheter from Pulsion Medical Systems. You must use the approved catheters and puncture

locations.

Measuring Continuous Cardiac Output

Every time C.O. is measured with the PiCCO method, the monitor uses this C.O. value and the result

of the pulse contour analysis to calculate a patient-specific calibration factor. The monitor uses this

value to compute CCO and the other continuous hemodynamic parameters. CCO values are

calculated on a beat-to-beat basis and then averaged over a 12-second time frame. The calculated values

are displayed as numerics on the monitor screen.

Measuring Systemic Vascular Resistance

The monitor uses CCO, an arterial pressure, and CVP to calculate a continuous SVR value. If a

continuously measured CVP value is not available, the monitor uses a preset, static CVP value to

calculate the SVR (you will see the INOP message SVR SET CVP USED). If the BSA is available, the

monitor uses the CCI to calculate the SVRI.

SVR/SVRI settings can be changed in the Setup SVR/SVRI menu. To enter the menu, select ->

Main Setup -> Measurements -> SVR or SVRI.

To display a SVR/SVRI numeric on the Screen, select any numeric, then select Change Numeric

and select SVR or SVRI from the list of available numerics.

Measuring C. O. Using the PiCCO Method 13 Monitoring Cardiac Output

165

Setting Up the PiCCO C.O. Measurement

1Set up the arterial line using the arterial

catheter (transpulmonary catheter) and

the transducer kit from Pulsion Medical

Systems. It must be placed in one of the

bigger systemic arteries, for example, the

femoral or the axillary artery. You must

use the approved catheters and puncture

locations.

2Set up the central venous line.

3Connect the injectate temperature probe

housing to the venous line.

4Plug the C.O. interface cable into the

C.O. module or measurement server

extension and connect the following

devices to the C.O. interface cable:

– Injectate temperature probe

– Thermistor connector

– Remote start switch (if used).

Follow your hospital standards to avoid

unintentional extraction of the C.O.

catheter. Secure the cable using the

mounting clip shipped with each C.O.

interface cable. You may also find it

helpful to loop the C.O. interface cable,

tape the loop, and attach it to the

undersheet of the patient's bed using a

safety pin.

5If you are measuring CCO, set up the

pressure measurement now. The CCO measurement requires a minimally dampened invasive

pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use

only specified accessories.

6Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically

recognizes the method used. If not, in the Setup C.O. menu, select Method and then select

Transpulmonary.

7Check that the Tinj Probe Type setting in the Setup C.O. menu matches the type of

injectate temperature probe used. The probe type is usually printed on the plug of the probe.

To change the probe type, in the Setup C.O. menu, select Tinj Probe Type to call up a list

of available probes.

–23001: it is recommended to use this probe with cold injectate

–M1646: this probe can be used with room temperature injectate or with cold injectate.

C.O. Module Press Module

Pulsion

Pressure

Transducer

Pulsion Arterial

Catheter

Thermistor

Connection

Cable

Injectate

Temperature

Probe

C.O.

Interface

Cable

Injectate

Syringe

CVP

Line

Thermistor

Connection

Remote

Switch

Pressure

Adapter

Cable

Injectate

Temperatur

e Probe

Housing

13 Monitoring Cardiac Output Measuring C. O. Using the PiCCO Method

166

8Check that the correct arterial catheter constant is selected.

If the catheter is recognized by the monitor, the catheter constant is automatically displayed and

cannot be changed manually. If it is not recognized, in the C.O. procedure window, select CathCt

and use the pop-up keypad to enter the correct value. The catheter constant is usually written

either on the catheter or on the catheter packaging.

9Make sure that the injectate volume setting matches the injectate volume you will use. To change

the volume, in the C.O. procedure window, select InjVol and select the correct injectate volume

from the pop-up list.

If there is a problem with the volume or temperature you have chosen, the monitor will issue a curve

alert message to inform you of this.

10 If you are measuring CCO or CCI, check that the correct pressure source is selected in the

Setup CCO menu. The pressure label under CCO from must match the pressure measured with

the arterial catheter. To change the pressure source, select CCO from to call up a list of available

pressure labels and select the correct label.

11 If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item

Alarms From. To change the alarm source, select Alarms From and choose either CCO or CCI.

Performing PiCCO C.O. Measurements

Always wait for the monitor to indicate readiness for the next step before proceeding.

If you are measuring CCO, all measurements should be conducted within 15 minutes. Older

measurements “expire” for CCO calibration.

1Enter the C.O. procedure window.

2When you see the message ...Ready for new measurement, start the measurement by

selecting the pop-up key Start C.O. or pressing the Start hardkey on the C.O. module, or

pressing the remote start switch.

3When you hear the ready tone and see the message ...Stable baseline, inject now!,

inject the solution into the CVP catheter.

At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and

EVLW values and any curve alerts are displayed and a message will appear “...Wait before

starting new measurement”.

4When you see the ...Ready for new measurement message, repeat the procedure until you

have completed the measurements you want to perform. You can perform a maximum of 6

measurements before editing. If you perform more than 6 measurements without rejecting any, the

oldest will automatically be deleted when a 7th curve is stored.

Editing PiCCO C.O. Measurements

It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial

values you do not reject to calculate the averaged cardiac output.

1Review the trials. Irregular trials or trials marked with a “?” should be reviewed carefully. Consider

the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth

peak and returns to the temperature baseline level after the peak.

2Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then

select the Accept Reject pop-up key to accept or reject trials. If you are using a touch screen

Measuring C. O. Using the PiCCO Method 13 Monitoring Cardiac Output

167

you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different

values. The background of rejected trials is red and the background of accepted trials is green. The

monitor recalculates the average values after you reject or accept trials.

If all values are different from each other, there may be true hemodynamic instability caused, for

example, by severe cardiac arrhythmia.

Saving and Calibrating PiCCO C.O. Measurements

When you have finished editing the trials, you must save the results. This closes the measurement

series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged

values in the trends and calculations databases.

Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate

CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the

same direction over 15 minutes, or if there are large or sudden changes in the patient’s condition.

The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO.

To save and calibrate,

♦In the C.O. procedure window, select the pop-up key Save C.O. & Cal CCO to use the

averaged C.O. value to calibrate Continuous Cardiac Output (CCO).

Your monitor may be configured to have two separate pop-up keys, Save C.O. and Cal CCO,

instead of the combined Save C.O. & Cal CCO.

WARNING CCO calibration is patient-specific. When the C.O. module or measurement server extension is

plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in

doubt perform a new CCO calibration first.

CCO Calibration Status Indicators

Each measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting

the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial’s

validity to be used in a CCO calibration.

For a trial to be eligible for calibration, the pressure signal must be continuously available and

undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the

pressure measurement, change the pressure label, or disturb the pressure signal in any other way during

this time.

CAL A pressure signal for CCO was available during the measurement (valid for calibration)

?CAL A disturbed pressure signal for CCO was available during the measurement (valid for

calibration)

N/A No adequate pressure signal for CCO was available during the measurement (no valid

calibration data)

EXP This trial is more than 15 minutes older than the most recent trial and has expired for CCO

calibration (no valid calibration data)

13 Monitoring Cardiac Output Measuring C.O. Using the Right Heart Thermodilution Method

168

Measuring C.O. Using the Right Heart

Thermodilution Method

In the right heart thermodilution method, a fluid of known volume and temperature is injected into

the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter. The

injectate bolus mixes with the blood in the right ventricle and the change in blood temperature is

measured with a thermistor at the distal end of the catheter in the pulmonary artery.

Setting up RH C.O. Measurements

1Set up the PA line using a PA catheter.

2Attach the injectate temperature probe

housing to the PA line.

3Plug the C.O. interface cable into the

C.O. module or measurement server

extension and connect the following

devices into the C.O. interface cable:

– injectate temperature probe

– remote start switch (if used).

Follow your hospital standards to avoid

unintentional extraction of the C.O.

catheter. Secure the cable using the

mounting clip shipped with each C.O.

interface cable. You may also find it

helpful to loop the C.O. interface cable,

tape the loop, and attach it to the

undersheet of the patient's bed using a

safety pin.

4Plug the thermistor connection cable of

the PA catheter into the thermistor

connector.

5Connect the injectate temperature probe

to the injectate temperature probe

housing.

6Check that the correct measurement

method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically

recognizes the method used. If not, in the Setup C.O. menu, select Method and then select

Right Heart.

Ice-Bath Setup for RH Thermodilution C.O. Measurements

If you are using the flow-through method illustrated above, the injectate temperature is measured at

the time of injection by the temperature probe in the injectate temperature probe housing.

C.O. Module

C.O. Interface Cable

Remote Start Switch

Thermistor

Connector

Injectate

Temperature

Probe

Thermistor

Connection

Cable

PA Catheter

Injectate

Syringe

Injectate

Temperature

Probe Housing

Documenting C.O. Measurements 13 Monitoring Cardiac Output

169

If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in

an ice-bath and the probe measures the temperature of the contents of the ice bucket.

Setting the Computation Constant

Check that the correct Computation Constant is entered in the C.O. procedure window. This can

be found in the documentation supplied with the catheter and is based on the injectate volume,

injectate temperature and catheter type. To change the value, in the C.O. procedure window, select

Computation Constant and use the pop-up keypad to enter the correct value.

Performing RH C.O. Measurements

1Enter the C.O. procedure window.

2When you see the message ...Ready for new measurement, select the pop-up key Start

C.O.

3When you hear a ready tone and see the message ...Inject now!, inject the solution into the

right atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second.

At the end of the measurement the thermodilution curve, cardiac output, index values and curve

alerts (if necessary) are displayed and a message will appear ...Wait before starting new

measurement.

4When you see the ...Ready for new measurement message, repeat the procedure until you

have completed the measurements you want to perform. You can perform a maximum of six

measurements before editing. If you perform more than six measurements without rejecting any,

the oldest will automatically be deleted when a seventh curve is stored.

Editing and Saving RH C.O. Measurements

It is important to identify and reject erroneous measurements (called “trials”), as the monitor uses all

the measurement trial values you do not reject to calculate the averaged cardiac output.