Sotera Wireless VISI-MOBILE Vital Signs Monitoring system User Manual PWD IFU

Sotera Wireless, Inc. Vital Signs Monitoring system PWD IFU

Contents

User manual

1Monitoring SystemUser manualAugust 2012Part Number: 6-000212-01Reference Number (CD): 95-10100Reference Number (Hardcopy): 95-101019444 Waples Street, Suite 280 San Diego, California 92121 USAPhone: +1 (866) 794-5526 (U.S.)+1 (858) 373-4870 (Intl)Fax: +1 (858) 427-4639Email: support@soterawireless.comEMERGO EUROPEMolenstraat 15, 2513BHThe HagueThe NetherlandsInformation for servicing the ViSi Mobile Monitoring Systems is contained in the ViSi Mobile MonitoringSystem Technical Manual, Reference#: 95-10061 (hardcopy) / 95-10059 (CD). For additional informationor assistance, please contact Sotera Wireless or an authorized Sotera Wireless representative in your area.0297
2CopyrightThis publication is provided for informational purposes only and Sotera Wireless, Inc. makes nowarranties, either express or implied, in this document. Information in this document is subject to changewithout notice. The entire risk of the use or the results of the use of this document remains with the user.Unless otherwise noted, the example companies, organizations, products, domain names, e-mail addresses,logos, people, places, and events depicted herein are fictitious, and no association with any real company,organization, product, domain name, e-mail address, logo, person, place, or event is intended or should beinferred. Complying with all applicable copyright laws is the responsibility of the user. Without limitingthe rights under copyright, no part of this document may be reproduced, stored in or introduced into aretrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying,recording, or otherwise), or for any purpose, without the express written permission of Sotera Wireless,Inc.Sotera Wireless, Inc. may have patents, patent applications, trademarks, copyrights, or other intellectualproperty rights covering subject matter in this document. Except as expressly provided in any writtenlicense agreement from Sotera Wireless, Inc., the furnishing of this document does not give you anylicense to these patents, trademarks, copyrights, or other intellectual property.Information for servicing the ViSi Mobile Monitoring Systems is contained in the ViSi Mobile MonitoringSystem Technical Manual, Part Number: 6-000147. For additional information or assistance, pleasecontact Sotera Wireless or an authorized Sotera Wireless representative in your area.© 2011 Sotera Wireless, Inc. All rights reserved.ViSi Mobile Monitoring System is a trademark of Sotera Wireless, Inc.
3ContentsChapter 1. Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Warnings, Cautions and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Intended Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Chapter 2. General Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Unpacking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Removing and Inserting the Shipping Plug. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22To remove the Shipping Plug. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22To insert the Shipping Plug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22System Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23ViSi Mobile Patient Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23ViSi Mobile Disposable Cuff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24ECG Electrode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24ViSi Mobile Wrist Cradle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25ViSi Mobile Thumb Cradle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25ViSi Mobile Cable Securement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26ViSi Mobile Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26ViSi Mobile Thumb Sensor (SpO2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27ViSi Mobile Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28ViSi Mobile Chest Sensor Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29ViSi Mobile Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30To set up the Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Charging the ViSi Mobile Monitor and Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . 31To charge a Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32To charge a Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Chapter 3. Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Key Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Overview of Clinical Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37ECG Monitoring and Heart Rate (HR) Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Respiration Rate (RESP) Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4Skin Temperature (TEMP) Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Pulse Oximetry (SpO2 and Pulse Rate) Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . 38NIBP Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Display Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39Battery Charge Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Hibernation Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Vital Signs Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Menu Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Monitor Status Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Quiet Monitoring Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Patient View Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Chapter 4. Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Preparing for a New Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Inspecting the Equipment and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Applying Sensors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Selecting Vital Signs to Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Selecting the ViSi Mobile Chest Sensor Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Selecting the ViSi Mobile Patient Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Checking the Battery Charge of the ViSi Mobile Monitor and Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48To check the battery charge of the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48To check the battery charge of the Cuff Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Applying ViSi Mobile Monitoring System / Initiate Monitoring. . . . . . . . . . . . . .50Applying the ViSi Mobile Wrist Cradle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51To apply the Wrist Cradle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Applying Sensors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Applying the ViSi Mobile Thumb Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53To apply the Thumb Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Applying the ViSi Mobile Chest Sensor Cable and ECG Electrodes . . . . . . . . . . . . 56Skin Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563 lead-wire and ECG Electrode Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575 lead-wire and ECG Electrode Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58To apply the Chest Sensor Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Applying the ViSi Mobile Cuff Module and Disposable Cuff . . . . . . . . . . . . . . . . . . 61To apply the Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61Removing ViSi Mobile Monitoring System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63To remove Cuff and Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63To remove the Chest Sensor Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63To remove the Thumb Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63To remove the Wrist Cradle and Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Chapter 5. Patient Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Monitoring the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66Unlocking the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67To unlock the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Locking the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68To lock the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Viewing Vital Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5To view vital signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Viewing Waveforms Associated with Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . 70To view the ECG waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70To view other leads with the 5 lead-wire Chest Sensor Cable. . . . . . . . . . . . . . . . . . . . . . . . 71To view the RESP waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73To view the SpO2 waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Motion Artifact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Taking a NIBP Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75To take a single NIBP measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76To stop an NIBP measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Initiating Automatic NIBP Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79To initiate automatic NIBP measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Viewing Patient’s Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81To Confirm Patient’s Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81To View Patient’s Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Exchanging a Monitor With Low Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83To exchange a monitor with a low battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83Stop Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86To stop monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86To clean and prepare reusable components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87All Sensors Disconnected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Chapter 6. Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89System Alarm Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89General Alarm Management Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89In Network Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90Physiological Alarms (Alarms) / Technical Alarms (Alerts) Summary . . . . . . . 91Responding to Alarms/Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Managing Alarm/Alert Annunciations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92Responding to Physiological Alarms (Alarms) . . . . . . . . . . . . . . . . . . . . . . . . . . 93To Silence/Acknowledge Life Threatening Severity Alarms . . . . . . . . . . . . . . . . . . 93To Silence High Severity Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Responding to Equipment Alarms (Alerts) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97To Silence/Acknowledge Alerts (All Severities) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Managing Alarm Annunciations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99Pause / Resume Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99To pause the alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99To Resume Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100Turn Alarm Annunciation On / Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101To turn all alarms off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101To Turn On Alarm Annunciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102Manage Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104To change alarm limits using Auto Set. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Testing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Chapter 7. User Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Cleaning and Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109To clean the ViSi Mobile Monitoring System components . . . . . . . . . . . . . . . . . . . . . . . . . . 111To disinfect the ViSi Mobile Monitoring System components . . . . . . . . . . . . . . . . . . . . . . . 111
6Inspecting Equipment and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Product Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Chapter 8. Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113ViSi Mobile Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Screen Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114ViSi Mobile Chest Sensor Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115ViSi Mobile Thumb Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118ViSi Mobile Cuff Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119ViSi Mobile Battery Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121General Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Connectivity Lost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Alarms and Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122ViSi Mobile Remote Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Chapter 9. Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Vital Sign Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Heart Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Pulse Oximetry (SpO2, Functional Oxygen Saturation). . . . . . . . . . . . . . . . . . . . . 129Non-Invasive Blood Pressure (NIBP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Physical Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134ViSi Mobile Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134Wireless Communications / Radio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134Mode Plugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135ViSi Mobile Chest Sensor Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136ViSi Mobile Cuff Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137ViSi Mobile Thumb Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138ViSi Mobile Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139ViSi Mobile Appliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140ViSi Mobile Remote Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Customer Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142Alarms / Alerts Annunciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Physiological Alarms (Alarms) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Visual Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Audio Tones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Equipment Alarms (Alerts) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Visual Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Audio Tones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Environmental Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Agency Compliances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Safety and Performance Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149Electromagnetic Compatibility (EMC) Specifications. . . . . . . . . . . . . . . . . . . . . . . 149Accessories Compliant with EMC Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
7Electromagnetic Emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Electromagnetic Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Recommended Separation Distance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152From Portable and Mobile RF Communication Equipment . . . . . . . . . . . . . . . . . . . . . . . . . 153Electrosurgery Interference/Defibrillation/Electrostatic Discharge . . . . . . . . . . . . . . . . . . . . 153Fast Transients/Bursts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Wireless Network Risk Mitigation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Risk Analysis Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Residual Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Sotera Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Responsible Organization Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Appendix A - Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Alarms / Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Alarm / Alert States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Alarm Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Battery States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157General Icons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Navigation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Vital Signs Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Clinical Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159Labelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Appendix B - Model Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163ViSi Mobile System Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Appendix C - Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Sotera Wireless Responsibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
8- Notes -
91. Preface1.1 IntroductionThis User Manual is intended to provide information for the proper operation of the Sotera Wireless ViSiMobile Monitoring System™. A formal knowledge of patient monitoring and an understanding of thefeatures and functions of the system are prerequisites for its proper use.This manual is written for trained clinicians. Although this manual describes guidelines for optimizingmonitoring techniques, clinicians using this system should be trained to take and interpret patient vitalsigns. Automatic vital signs monitoring is an adjunct to clinical assessment; good clinical judgment shouldalways prevail.1.2 Warnings, Cautions and NotesPlease read and adhere to all warnings, cautions and notes listed here and in the associated sectionsthroughout this manual.1.2.1 DefinitionsDo not operate the ViSi Mobile Monitoring System before reading theseinstructions.Warning statements alert the user to conditions or practices that could resultin injury to a person, or serious adverse events associated with the use ormisuse of the ViSi Mobile Monitoring System.Caution statements alert the user to conditions or practices that could resultin problems with the ViSi Mobile Monitoring System associated with its useor misuse.Note: Note statements provide supplemental information to the user.
Warnings, Cautions and Notes 10Warnings Intended UseDo not use the ViSi Mobile Monitoring System outside the intended use described inthis manual. Doing so can result in a delay in or inappropriate therapy.Do not use the ViSi Mobile Monitoring System in neonatal or pediatric patients underthe age of 12 years since the System has not been tested for these patient groups.Do not use the ViSi Mobile Monitor as a primary hypoxia diagnostic tool.SafetyDo not use the ViSi Mobile Monitor in an MRI suite or a hyperbaric chamber.The ViSi Mobile Monitoring System has not been tested in the presence of electro-surgical devices.Avoid electrosurgery burns at the ECG monitoring sites by ensuring the electrosurgery-return circuit is connected properly.Monitoring may be temporarily interrupted during the use of electrocautery in the vicinityof/or on a patient being monitored with a ViSi Mobile Monitoring System. Observe thepatient closely while electrocautery is in use.To ensure patient safety, use only components and accessories recommended orsupplied by Sotera Wireless, Inc. Accessories must always be used in accordance withyour facility’s policies and the manufacturer’s recommendations.Use only the AC adapter recommended for the ViSi Mobile Charger. Use of other ACadapters may result in damage to the unit.There may be a possible hazard caused by the summation of leakage currents whenseveral items of equipment are interconnected.The ViSi Mobile Monitoring System has not been tested in the presence of flammableanesthetics or other flammable agents in combination with air, nitrous oxide, or oxygen-enriched environments.Route the patient cabling to avoid the possibility of patient entanglement orstrangulation.To ensure patient safety, the conductive parts of the ECG electrodes, includingconnectors and other patient-applied components, should not contact other conductiveparts, or earth ground, at any time. Never connect the ViSi Mobile Chest Sensor Cable directly to the AC power outlet.Never connect the ViSi Mobile Cuff Module directly to an AC power outlet. To rechargethe battery, disconnect the Cuff Module from the patient, and then place it in the ViSiMobile Charger.
Warnings, Cautions and Notes11Warnings To prevent possible cross-contamination, properly clean and disinfect all reusablecomponents between patients.The ViSi Mobile Monitor should never be used to measure the NIBP of one patient whilethe Monitor is simultaneously connected to another patient.Do not attempt to take NIBP measurements with the ViSi Mobile Monitor while thepatient is undergoing cardio-pulmonary bypass.Do not attempt to take NIBP measurements with the ViSi Mobile Monitor while thepatient is being treated with an intra-aortic balloon pump or left ventricular assist device.Periodically observe the patient’s arm for signs of impaired circulation, which may be aresult of measurements made too frequently. Loosen or remove the ViSi MobileDisposable Cuff if signs and/or symptoms of prolonged impaired circulation are evident.Never place the ViSi Mobile Monitor or the ViSi Mobile Cuff Module into the ViSi MobileCharger while connected to a patient.Never connect the ViSi Mobile Monitor directly to an AC power outlet. To recharge thebattery, disconnect the Monitor from the patient, and then place it in the ViSi MobileCharger.Do not clean the ViSi Mobile Monitor with detergents while worn by the patient.Do not place the ViSi Mobile Monitoring System on or over an implanted programmablemedical device.Disposable Patient KitAll components of the ViSi Mobile Patient Kit are for single patient use only. To avoidpossible cross contamination, do not reuse any of the items from the Patient Kit on apatient other than the original patient. Dispose of the ViSi Mobile Patient Kit items afteruse per your facility’s policy.All disposable components of the ViSi Mobile Monitoring System are for single patientuse only. To avoid possible cross contamination, do not reuse any disposable items ona patient other than the original patient.Patient MonitoringDo not connect more than one ViSi Mobile Monitor to a patient.Do not connect more than one patient to a single ViSi Mobile Monitor.The ViSi Mobile Monitor, Thumb Sensor, Cuff Module, and the Chest Sensor Cablemust all be connected to the same arm for the System to function correctly.
Warnings, Cautions and Notes 12Warnings The Wrist Strap should securely hold the ViSi Mobile Wrist Cradle in place withoutimpairing circulation. Immediately loosen the Wrist Strap if the patient complains ofpain, tingling, or numbness in the affected hand or wrist.Only use the ViSi Mobile Chest Sensor Cable provided by Sotera Wireless, Inc. for theViSi Mobile Monitoring System. The Chest Sensor Cable is designed to providedefibrillation protection as indicated in the Specifications section of this manual. ViSiMobile is designed to be compatible with the use of external defibrillators.Only use the ViSi Mobile Thumb Sensor provided by Sotera Wireless, Inc. with the ViSiMobile Monitoring System.The ViSi Mobile Thumb Sensor is intended for use on the patient’s thumb only. Do notapply the Thumb Sensor to the patient’s fingers.Inspect patient’s skin at sensor site every 8 hours. If skin surface has beencompromised, reposition the ViSi Mobile Thumb Sensor or move the Thumb Sensor tothe patient’s other thumb.The Thumb Strap should securely hold the ViSi Mobile Thumb Sensor in place withoutimpairing circulation. Immediately loosen the Thumb Strap if the patient complains ofpain, tingling, or numbness in the affected thumb.Only Sotera Wireless, Inc. supplied ViSi Mobile Thumb Sensors should be used. Usingnon-approved Thumb Sensors may result in inaccurate SpO2 readings.Before monitoring a new patient, ensure all the sensors have been removed and thatmonitoring was stopped using the Stop Monitoring procedure.To prevent settings from being inadvertently changed, lock the ViSi Mobile Monitorscreen (if enabled) as soon as tasks are completed.Keep all pacemaker patients under close or constant observation. Pacemaker signalscan differ among pacemakers, ICDs, or CRT devices. The Association for theAdvancement of Medical Instrumentation (AAMI) cautions: “In some devices, ratemeters may continue to count the pacemaker rate during occurrences of cardiac arrestor some arrhythmias. Do not rely entirely upon rate meter alarms”.Other RF radiating devices (such as high powered RFID readers and Bluetoothdevices) that are in close proximity with the ViSi Mobile Monitor may interfer with theMonitor’s wireless communications. During such interference, the Monitor continues tomonitor and will alarm locally. If wireless communication is affected when using theMonitor in close proximity with another RF radiating device, move the other deviceaway from the Monitor or discontinue use of the other device.
Warnings, Cautions and Notes13Warnings All wireless devices are susceptible to radio frequency interference that can disruptconnectivity. If you observe excessive ViSi Mobile Monitoring System disconnections,notify your biomedical engineer. Excessive disconnections can cause interruptedpatient monitoring; disconnections must be investigated and corrected.Locate the ViSi Mobile Remote Viewer so that clinicians can view it without obstruction.Remove any objects that obstruct the display.A qualified clinician must always be in direct view of the ViSi Mobile Remote Viewer. Ifthe Remote Viewer display is blank, contact your Bio Med immediately for service.If a ViSi Mobile Monitor or the ViSi Mobile Remote Viewer display screen is scratchedor damaged, immediately send it for servicing. A scratched or damaged screen caninterfere with patient monitoring.Always consult Sotera Wireless before performing any changes to the ViSi MobileAppliance. Server changes can result in communication failure betweencomponents of the ViSi Mobile Monitoring System. If system communicationstops, monitor patients at the ViSi Mobile Monitors.Perform a risk assessment and verification before you implement a change ormodification to the IT infrastructure. Changes to IT network configurations cancompromise continuous vital signs monitoring and alarm delivery.Vital SignsIf a vital signs measurement is questionable, retake the measurement. If the result isstill questionable, use a different method of measurement.Chest Sensor Cable: ECG, Respiration, Temperature (Skin)Use all of the same type of ECG electrodes on the patient. Mixing ECG electrode typescan adversely affect ECG monitoring.If ECG electrodes need to be replaced, use all of the same type of ECG electrode onthe patient. Mixing ECG electrode types can adversely affect ECG monitoring.Avoid placing the ViSi Mobile Cable Securement and ECG electrodes over areas ofabrasions, irritation, or other sensitive areas. If possible, remove, reposition, andreplace ECG electrodes and Cable Securement if the patient complains of pain/itchingat the sites.
Warnings, Cautions and Notes 14Warnings The ViSi Mobile Monitor does not provide automated arrhythmia analysis. As a result,certain arrhythmias may cause the Monitor to display inaccurate heart rates. If frequentarrhythmias are suspected, their presence should be confirmed by another method,such as a 12-lead ECG or Holter monitoring.The ViSi Mobile Monitor does not have automated ST segment analysis, therefore, if achange in the ST segment of the ECG waveform is suspected, it should be confirmedby another method, such as a 12-lead ECG.Pacemaker signals can differ among pacemakers, ICDs, or CRT devices. TheAssociation for the Advancement of Medical Instrumentation (AAMI) cautions: “In somedevices, rate meters may continue to count the pacemaker rate during occurrences ofcardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms”. Allpacemaker patients should be kept under close or constant observation.External pacemakers or other external electrical stimulators may cause the ViSi MobileMonitor to produce erroneous results.RESP (chest wall motion) can continue in the absence of ventilation (obstructedairway). Do not rely on the RESP alone to determine adequacy of ventilation. Othervital signs, such as HR and SpO2, should be assessed as well.TEMP monitoring with the ViSi Mobile Monitoring System is intended for trendingpurposes only and is not intended to replace core temperature monitoring. Beforemaking clinical decisions based on the skin temperature measurement, verify themeasurement using another clinically acceptable method of core temperaturemeasurement.Impedance pneumography for the determination of respiration (RESP) is notrecommended for use in the presence of mechanically induced, high frequencyventilation.Cuff Module / NIBPViSi Mobile Disposable Cuffs are for single patient use only. To avoid possible crosscontamination, do not reuse a Cuff on a patient other than the original patient.The ViSi Mobile Disposable Cuff should be snug enough to support the Cuff Modulewhile not impairing circulation when deflated.Avoid applying the ViSi Mobile Disposable Cuff over a wound as this can cause furtherinjury.Avoid applying the ViSi Mobile Disposable Cuff on any limb where intravascular accessor therapy, or an arterio-venous (A-V) shunt, is present because of temporaryinterference to blood flow which could result in injury to the patient.
Warnings, Cautions and Notes15Warnings Take care in the application of the ViSi Mobile Disposable Cuff when applying the Cuffto an arm on the same side of a mastectomy.ViSi Mobile NIBP measurements have not been clinically tested in the presence ofactual or ventricular arrhythmias. Use alternative BP methods if these arrythmias arepresent.Inflate the ViSi Mobile Disposable Cuff only after proper application to the patient’s limb.If you are uncertain of the reliability of an NIBP measurement, repeat the measurement.If the reading is still suspect, use another method to measure the blood pressure.SpO2Oxygen saturation measurements using SpO2 are dependent on proper sensorplacement, exposure to ambient light conditions, and general patient conditions. Beforemaking clinical decisions based on SpO2 measurements, verify the measurement usinganother clinically acceptable method, such as arterial blood gas analysis.High ambient light condition, including direct sunlight, may interfer with the performanceof the ViSi Mobile Thumb Sensor.Low perfusion, electro-surgical devices, dysfunctional haemoglobin, the presence ofcertain dyes and inappropriate positioning of the ViSi Mobile Thumb Sensor may resultin erroneous measurements.Alarms / AlertsWhen using the Monitor as a standalone device or the patient is out of network range, aresponsible clinician must be within audible range of the assigned patient wearing theViSi Mobile Monitor at all times.When alarms are paused, there is no notification of a potentially clinically significantchange in the patient's vital signs. Observe the patient by other means when alarms arepaused.When alarms are turned OFF, there is no notification of a potentially clinically significantchange in the patient's vital signs. Observe the patient by other means when alarmlimits are set to OFF.Once new alarm limits are confirmed, they cannot be changed back to the original pre-set limits. Once Auto Set is selected, review the newly calculated alarm limits carefullybefore deciding to confirm or cancel the new alarm limits.
Warnings, Cautions and Notes 16Warnings Line isolation monitor transients may resemble actual cardiac waveforms and inhibitheart rate alarms. Ensure correct electrode placement and cable arrangement tominimize line isolation monitor transients.To avoid possible hearing damage, do not place your ear too close to the ViSi MobileMonitor that is alarming audibly.When the ViSi Mobile Monitor alarms or alerts, check the patient first to confirm thatthere is no immediate danger to the patient.If you test the speaker at the ViSi Mobile Remote Viewer and the tone does not soundor it is not loud enough, immediately contact a biomedical engineer. The test indicateshow alarm and alert tones sound at the Remote Viewer. If the sound is inadequate,clinicians could miss alarms and alerts.User MaintenanceTo avoid contaminating or infecting personnel, the environment or other equipment,make sure you disinfect and decontaminate the ViSi Mobile Monitoring Systemcomponents appropriately before disposing of them in accordance with your country’slaws for equipment containing electrical and electronic parts.Wireless CommunicationsWhen the ViSi Mobile Monitor is not configured or loses wireless connection to the ViSiMobile Appliance, the ViSi Mobile Remote Viewer does not receive patient alarms oralerts from the ViSi Mobile Monitor.If you have any concerns regarding a Cybersecurity breach or vulnerability, contactSotera Wireless or an authorized Sotera Wireless representative in your area.Off-The-Shelf (OTS) SoftwareThe use of any software other than those specified in this manual will violate the safety,effectiveness and design controls of this medical device and such use may result in anincreased risk to users and patients. Customer installed virus protection software willbe permitted on the ViSi Mobile Remote Viewer but not permitted on the ViSi MobileAppliance.
Warnings, Cautions and Notes17Cautions Intended UseFederal (U.S.A.) law restricts the ViSi Mobile Monitoring System to the sale, distribution,or use by, or on the order of a licensed medical practitioner.SafetyThe ViSi Mobile Monitoring System has not been tested in the presence of flammableanesthetics or other flammable agents in combination with air, nitrous oxide, or oxygen-enriched environments.Do not use a ViSi Mobile Monitor, its components, or accessories that appeardamaged. Inspect all reusable components for damage before each use.Do not attempt to connect any patient worn component, ViSi Chest Sensor Cable orViSi Mobile Cuff Module to an electrical outlet of any kind.A component that has been dropped or severely abused should be checked by qualifiedservice personnel before use on a patient.The ViSi Mobile Monitoring System is not indended for home use.Do not use the ViSi Mobile Monitoring System to monitor a patient in a wetenvironment, such as a shower.Explosion Hazard. Do not use in the presence of a flammable anesthetic mixture withair, or with oxygen or nitrous oxide.Use care when using automatic cuff inflation for prolonged periods on unconscious orsemi-conscious patients since the patient may not be able to alert the clinician to anypain he/she may be experiencing. Pressing the “Stop NIBP” button interrupts the NIBPmeasurement and deflates the cuff.Consult your BioMed department or vendors for assistance in identifying EMCcompliance status of other medical devices when using the ViSi Mobile MonitoringSystem.Using accessories other than those specified may result in increased electromagneticemission or decreased electromagnetic immunity of the monitoring equipment.Service / MaintenanceIf the ViSi Mobile Monitor detects an unrecoverable problem, an error messagecontaining the error number is displayed. Remove the Monitor from use and report theerror to Sotera Wireless, Inc.When the ViSi Mobile Monitor is in the Charger and a charging alert occurs, remove theMonitor from service.
Warnings, Cautions and Notes 18Cautions General maintenance of the ViSi Mobile Monitoring System should be conducted at theprescribed intervals.The ViSi Mobile Monitoring System components should only be serviced by SoteraWireless, Inc. technicians or authorized service providers.Equipment / ComponentsIf the ViSi Mobile Monitor is to be stored for an extended period of time, it isrecommended the Monitor be stored with the Shipping Plug inserted to reduce thebattery discharge. The ViSi Mobile Monitor must always have the Shipping Pluginserted when shipped by a common carrier to comply with Federal Regulationsregarding electromagnetic emissions.When inserting the ViSi Mobile Monitor into the Wrist Cradle, ensure proper alignment:flat end to flat end and the round end is pointing down towards the wrist.Selection of the correct ViSi Mobile Disposable Cuff size is necessary to ensureaccurate NIBP measurements. A Cuff that is too small can result in a falsely high NIBPmeasurement. A Cuff that is too large can result in a falsely low NIBP measurement.To avoid damage from dropping the ViSi Mobile Monitor, ensure that the Wrist Strap issnugly wrapped around the wrist.To avoid damage from dropping the ViSi Mobile Monitor, make sure that the Monitor issecurely snapped into the ViSi Mobile Wrist Cradle.The ViSi Mobile Monitoring System does not support printing capability.The performance of the automated sphygmomanometer may be affected by extremesof temperature, humidity and altitude.The ViSi Mobile Monitor may not perform to specification if stored or shipped outsidethe specified temperature range.The ViSi Mobile Monitor may be temporarily interrupted by UHF RFID Systems (860-960MHz).Cleaning / DisinfectingDo not clean the ViSi Mobile Monitor while it is plugged into the ViSi Mobile Charger.Do not clean the ViSi Mobile Cuff Module while it is plugged into the ViSi MobileCharger.Do not apply liquid to the ViSi Mobile Cuff Module. To clean, use a damp cloth.
Warnings, Cautions and Notes19Cautions Ensure the sensor connector contacts are thoroughly dried to prevent possiblemalfunction.Thumb sensors which are saturated with fluid should be allowed to air dry thoroughlybefore re-use.Do not use abrasive cleaning agents or organic solvents on any of the ViSi MobileMonitoring System components.Use only recommended cleaning / disinfecting agents to prevent damage to the deviceand components.Do not autoclave the ViSi Mobile Monitor, its components, or accessories.Do not use excessive amounts of liquid when cleaning the ViSi Mobile Chest SensorCable or the ViSi Mobile Thumb Sensor.After patient use, the disposables from the ViSi Patient Kit may contain bio-hazardmaterials.When the ViSi Mobile Cuff Module is connected to the other ViSi Mobile Components,the entire system has an ingress protection rating of IPX0.NotesNote: Figures in this manual are provided for reference purposes only. Screens may differ based onthe monitoring device configuration, licenses available, parameters selected and patientconfiguration of the ViSi Mobile Monitoring System.Note: All ViSi Mobile Monitoring System alarms and alerts annunciate with icons and colors thatcomply with IEC 60601-1-8.
Intended Use 201.3 Intended UseThe ViSi Mobile Monitoring System is intended for use by clinicians and medically qualified personnel forsingle or multi-parameter vital signs monitoring of adult patients. It is indicated for ECG (3 or 5 lead-wire), respiration rate (RESP), heart rate (HR), non-invasive blood pressure (NIBP), non-invasivemonitoring of functional oxygen saturation of arterial hemoglobin (SpO2), pulse rate (PR), and skintemperature (TEMP) in hospital-based facilities; including general medical-surgical floors, intermediate-care floors, and emergency departments.The ViSi Mobile Monitoring System may be used as standalone devices or networked to a Remote Viewerthrough wireless 802.11 communication.1.3.1 Contraindications• Impedance pneumography for the determination of Respiration Rate (RESP) is not recommendedfor use in the presence of mechanically induced high frequency ventilation.• The ViSi Mobile Monitoring System has not been tested for use on neonatal or pediatric patientsunder the age of 12 years.• Do not use the same ViSi Mobile Monitor System to measure the NIBP of one patient while it isconnected simultaneously to another patient.• Do not use the ViSi Mobile Monitor on a patient with an Intra-Aortic Balloon Pump (IABP), or aLeft Ventricular Assist Device (LVAD). The Monitor requires an unperturbed arterial pulsewaveform for non-invasive blood pressure calculations. IABP and LVAD perturb the arterial pulsewaveform.• Do not use the ViSi Mobile Monitor System on a patient on cardio-pulmonary bypass.• Do not use the ViSi Mobile Cuff Module on a patient’s arm where the use of a blood pressure cuffis contraindicated.• Do not use the ViSi Mobile Monitoring System in an MRI Suite.
212. General Description2.1 IntroductionThe ViSi Mobile Monitoring System is a patient worn, portable, battery operated, physiologicalmonitoring device indicated for the monitoring of ECG (3 lead-wire or 5 lead-wire), Heart Rate (HR),Pulse Rate (PR), Respiration (RESP), Non-Invasive Blood Pressure (NIBP), Pulse Oximetry (SpO2), andSkin Temperature (TEMP). The System comprises the ViSi Mobile Monitor, Thumb Sensor, Chest Sensor Cable (either 3 lead-wire or5 lead-wire), Cuff Module, Charger and Patient Kit.Powered by a rechargeable battery lasting at least 12 hours, the Monitor is a lightweight (weighingapproximately 125 grams) portable patient vital signs monitor featuring a high resolution, full colordisplay touchscreen with visual and audible alarms and alerts.For ease of use, the Monitor features three interchangeable plug-in sites for the Chest Sensor Cable andCuff Module.The industry-standard technique of oscillometry is used for non-invasively taking single measurements ofthe systolic and diastolic blood pressure (NIBP) as well as pulse rate. The method is based on theobservation of oscillations in the sphygmomanometer cuff pressure that are caused by the oscillations ofblood flow, i.e., the pulse in the patient’s upper arm. It uses a sphygmomanometer cuff like the auscultatorymethod, but with an electronic pressure sensor (transducer) to observe cuff pressure oscillations,electronics to automatically interpret them, and automatic inflation and deflation of the Cuff. The CuffModule measures on inflation. The measurement is realized by a Cuff, to which the Cuff Module isattached (pneumatic connection). The electric connection to the Monitor is established through a cable thatconnects to its upper side.
Unpacking 222.2 UnpackingRemove the Monitor and associated components from the shipping cartons and examine them for signs ofshipping damage. Save all packing materials, invoice, and bill of lading. These may be required to processa claim with the carrier. Check all materials against the packing list. Contact the Sotera Wireless Inc.Customer Service Department or the Sotera Wireless representative in your area for prompt assistance inresolving shipping problems.2.2.1 Removing and Inserting the Shipping PlugAll Monitors are shipped in the Wrist Cradle with a Shipping Plug (airplane symbol) inserted. This Plug isfound in the Thumb Sensor connector of the Monitor. The Shipping Plug’s only function is to completelypower off the Monitor. Reinserting the Plug into a Monitor powers down the Monitor in a controlledfashion, and allows internal operations to be completed before completely powering off.To remove the Shipping PlugGrasp the tip of the Plug that extends out from the Wrist Cradle and pull firmly outward. The contact points are disconnected. The Monitor begins a power up phase and the initialinformation screen appears.To insert the Shipping PlugEnsure that the ViSi Mobile Monitor is properly seated in the Wrist Cradle, the Plug is oriented with the connector contacts facing upwards, and push in firmly.The power down process begins. The power down cycle is complete once the screen goes blankand the green LED indicator has stopped blinkingIf the ViSi Mobile Monitor is to be stored for an extended period of time, it isrecommended the Monitor be stored with the Shipping Plug inserted toreduce the battery discharge. The ViSi Mobile Monitor must always havethe Shipping Plug inserted when shipped on a common carrier to complywith Federal Regulations regarding electromagnetic emission.Shipping Plug(with airplane symbol)
System Components232.3 System Components2.3.1 ViSi Mobile Patient KitThe Patient Kit contains the disposable components of the system. The Patient Kit components are forsingle patient use only. The Patient Kits are available in three Adult sizes: Small, Medium, and Large.Choose the Patient Kit that contains the Cuff size best suited for the patient. Cuff sizes follow standardrange of arm circumference. See 4.2.5Selecting the ViSi Mobile Patient Kit on page 47.All components of the ViSi Mobile Patient Kit are for single patient use only.To avoid possible cross contamination, do not reuse any of the items fromthe Patient Kit on a patient other than the original patient. Dispose of theViSi Mobile Patient Kit items after use per your facility’s policy.ViSi Mobile Patient Kit ContentsEquipment QuantityViSi Mobile Disposable Cuff(with pneumatic connector)1ECG Electrode 6ViSi Mobile Wrist Cradle 1ViSi Mobile Thumb Cradle 1ViSi Mobile Setup Guide 1ViSi Mobile Cable Securement 2
System Components 24ViSi Mobile Disposable CuffThe Cuff is available in small, medium and large adult sizes (see 4.2.5Selecting the ViSi Mobile PatientKit on page 47). The Cuff is used to take a NIBP measurement once the Cuff Module is plugged in. SeeViSi Mobile Cuff Module on page 28.Note: Only cuffs designed for use with the ViSi Mobile Cuff Module may be used.ECG ElectrodeECG Electrodes are adhesive pads with conductive gel that are connected to the ECG lead-wires of theChest Sensor Cable to display the ECG waveform and detect the HR. Use only snap-on type electrodes.ArteryReference LineCuff ModuleAttachment
System Components25ViSi Mobile Wrist CradleThe Wrist Cradle holds the Monitor and provides the electrical connectors for the sensors. The WristCradle is held in place on the patient’s wrist with a strap. The Wrist Cradle Strap is available in small,medium and large adult sizes. ViSi Mobile Thumb CradleThe Thumb Cradle holds the Thumb Sensor and secures it to the base of the thumb.When inserting the ViSi Mobile Monitor into the Wrist Cradle, ensure properalignment: flat end to flat end and the round end is pointing towards thewrist.Round EndFlat EndWrist Cradle StrapThumb Cradle ThumbStrapBottom View(with labelling)Top View
System Components 26ViSi Mobile Cable SecurementThere is one large and one small Cable Securement in the Patient Kit. The large Cable Securement securesthe Chest Module of the Chest Sensor Cable to the patient’s torso. The small Cable Securement secures theUpper Arm Module of the Chest Sensor Cable to the upper arm. See ViSi Mobile Chest Sensor Cable onpage 29.2.3.2 ViSi Mobile MonitorThe Monitor is a compact and lightweight device that is worn on the patient’s wrist. The Monitor is held inplace by the Wrist Cradle, which allows sensors to be connected. The Monitor can be removed from theWrist Cradle in order to charge, or swap for another Monitor. The Monitor uses a touchscreen userinterface to access the displays and monitoring functions.Note: The power indicator shows the level of Monitor’s battery charge by flashing green (thebattery has at least 2 hours of monitoring time left), yellow (the battery is low with less than2 hours of monitoring time left), and red (the battery is critically low with less than 30minutes of monitoring time left).SecurementUpper Arm ModuleSecurementPackagingChest ModulePowerTouchscreenSpeakerIndicator3 InterchangeableSensor ConnectionsMicrophone(for speaker self test)
System Components272.3.3 ViSi Mobile Thumb Sensor (SpO2)The Thumb Sensor is applied to the patient’s thumb with the sensor and sensor cradle facing the patient’spalm. The Thumb Sensor is plugged into the rounded end of the Wrist Cradle with the connector contactsfacing upwards.Note: The Thumb Sensor locks the ViSi Mobile Monitor into the Wrist Cradle and must beunplugged to remove the Monitor from the Wrist Cradle.Note: A Locking Plug should be used to lock the Monitor into the Wrist Cradle if the ThumbSensor is not used. Locking Plugs may be ordered separately from Sotera Wireless.Insert with connectorcontacts facing upwards
System Components 282.3.4 ViSi Mobile Cuff ModuleThe Cuff Module is used to take NIBP measurements. The Cuff Module plugs into any one of theconnectors on the flat end of the Wrist Cradle.Note: When the battery status button is pressed, the battery status indicator shows the level of theCuff Module’s battery charge. Green lights indicate the battery has a minimum of 11%charge. More green lights indicate a greater charge level. A yellow light indicates thebattery charge is less than 10%. A red light indicates there is less than 4% battery charge.Note: When a calibration check is required, return the Cuff Module to the Bio Med. It isrecommended a calibration check is performed ever year.Battery StatusButtonBattery StatusIndicator (LEDs)
System Components292.3.5 ViSi Mobile Chest Sensor CableThe Chest Sensor Cable is either a 3 lead-wire or 5 lead-wire and plugs into any one of the connectors onthe flat end of the Wrist Cradle. See Applying the ViSi Mobile Chest Sensor Cable and ECG Electrodes onpage 56 for recommended Chest Sensor Cable placement.The ViSi Mobile Chest Sensor Cable is designed to be fully compatible withexternal defibrillators. No additional precautions are required.Upper Arm ModuleChest ModuleLead(including Skin Temperature Sensor MonitorConnectoron the reverse side)WiresChest Sensor Cable5 LeadChest Sensor Cable3 LeadFront View(Place this side away from the patient’s skin)
System Components 302.3.6 ViSi Mobile ChargerThe Charger is used to charge both Monitors and Cuff Modules, providing eight charging docks forsimultaneously charging multiple units. The Charger consists of a desktop/wall mount charger, power supply and power cable.To set up the Charger1. Connect the power cable to the back side of the desktop/wall mount charger.2. Plug into the AC power outlet.The light on the front of the Charger will display green when the Charger is connected to the ACpower outlet.The Charger will beep once when it is connected to the AC power outlet.Note: When connected to the AC power outlet, if a fault with the ViSi Mobile Charger is detected,the Charger will audibly beep every second.Explosion Hazard. Do not use in the presence of a flammable anestheticmixture with air, or with oxygen or nitrous oxide.Front ViewBack View
System Components312.3.7 Charging the ViSi Mobile Monitor and Cuff ModuleThe ViSi Mobile Charger provided by Sotera Wireless, Inc. is the required Charger for both the Monitorand the Cuff Module. The Charger is capable of charging up to eight of any combination of Monitors andCuff Modules. To charge either the Monitor or the Cuff Module place the flat end into one of the slots withthe front facing outwards. Note: The ViSi Mobile Charger is to be used for ViSi Mobile components only.Note: ViSi Mobile Monitors and Cuff Modules contain sealed batteries that are not replacable bythe user. If a Monitor or Cuff Module has a battery issue, contact the Sotera Wireless Inc.Customer Service Department or the Sotera Wireless representative in your area.The LED on the Charger is used to indicate the charging status of devices that are currently inserted:LED Color Charging StatusSteady Green Everything is normal: • No devices in the Charger.• All devices are charging normally or are fully charged.Flashing Green / Yel lowAt least one device in the Charger is in battery recovery mode with the device not talking to the Charger.Steady Yellow At least one device in the Charger is not being charged due to a fault with the device. The other devices are charging.Steady Red Charger fault. No devices are charging, the Charger has shutdown.
System Components 32To charge a MonitorInsert the Monitor that you want to charge into one of the Charger docks.The Charge Status screen will be displayed briefly. The Monitor’s battery status indicator (in the top righthand of the screen) stops pulsating when the battery is fully chargedNote: When the yellow dot is displayed on the screen, it indicates the Monitor will measure RESPwhen a Chest Sensor is connected to a patient. RESP is not available as part of the defaultset of vital sign measurements and must be purchased separately.Note: If the screen is blank, touch the screen to activate the display and show the battery chargestatus.The power indicator will blink while the Monitor is charging: green indicates there is enough charge tomonitor a patient for at least two hours; yellow indicates the battery charge is low (less than two hours ofmonitoring); and red indicates the battery charge is critically low (less than 30 minutes of monitoring).When the ViSi Mobile Monitor is in the Charger and a charging alert occurs,remove the Monitor from service.In ChargerBattery Charging Indicator(pulsates as battery is charging)RESP measurementoption is available Battery StatusIndicatorPowerIndicator
System Components33To charge a Cuff ModuleInsert the Cuff Module that you want to charge into one of the Charger docks.One of the charging indicator lights will blink while the Cuff Module is charging.When one of the green charging indicators is flashing, the battery in the Cuff Module is charging. Theposition of the green charging indicator represents the level of charge. When the charge indicator furthestaway from the red charging indicator is flashing, the Cuff Module is fully charged.When the yellow charging indicator is flashing, the battery in the Cuff Module is low. No more than acouple of cuff inflations are possible.When the red charging indicator is flashing, the battery in the Cuff Module is empty. No cuff inflations arepossible.Battery is emptyBattery is fully chargedBattery is low(Red LED) (Yellow LED)
System Components 34- Notes -
353. Clinical Features3.1 IntroductionThe ViSi Mobile Monitor is completely body-worn and designed to continuously measure ECG/HR, SpO2,PR, RESP, and TEMP. The ECG, SpO2, and RESP waveforms are viewable on demand. NIBP can bemeasured as a one-time measurement, or it can be measured automatically at predefined intervals.The Chest Sensor Cable measures the ECG/HR, RESP, and TEMP. The illustration on the next page showsa 3 lead-wire placement.
Introduction 36Upper Arm ModuleMonitorThumbChest Module(in Wrist Cradle)Cuff Module(Chest Sensor Cable)(Chest Sensor Cable)SensorViSi Mobile Monitoring System Setup(Flat End)(Round End)Chest ModuleSecurementUpper Arm ModuleSecurement(Cables pointing down)ArterialReference LineFrontTemperature Probe(Place against patient’s skin)(Place away from patient’s skin)
Key Features373.2 Key Features• Battery life > 12 hours • Full charge reached after approximately 2 hours of charging• Chest Sensor Cable options: 3 lead-wire and 5 lead-wire (HR and ECG waveforms)• RESP (measurement and waveform)•SpO2% (measurement and waveform)• TEMP (oC/oF) (Skin Temperature measurement)• NIBP (single measurement and automatic measurements at predefined cycles)• Touchscreen display• Alarms and Alerts generated with visual and audible indication on the Monitor• Self Test3.3 Overview of Clinical FeaturesThe ViSi Mobile Monitoring System is a lightweight portable patient vital signs monitor featuring a highresolution, full color display with visual and audible alarms and alerts. The ViSi Mobile Monitor iscompletely body-worn and designed to continuously measure ECG/HR, SpO2, PR, RESP, and TEMP.ECG, SpO2, and RESP waveforms are viewable on demand. NIBP can be measured as a one-timemeasurement, or it can be measured automatically at programmed intervals.The Monitor is powered by a rechargeable battery. For ease of use, the Monitor features interchangeableplug-in sites for the ViSi Mobile Chest Sensor Cable and ViSi Mobile Cuff Module. The Chest SensorCable measures the ECG/HR (with a 3 lead-wire or 5 lead-wire), RESP, and TEMP.3.3.1 ECG Monitoring and Heart Rate (HR) MonitoringWith the 3 lead-wire Chest Sensor Cable, the Monitor continuously monitors Lead II. With the 5 lead-wire Chest Sensor Cable, the Monitor continuously monitors seven ECG lead viewssimultaneously, Leads I, II, III, aVR, aVL, aVF, and a V lead. The ECG waveform can be displayed onelead at a time.The ability to monitor multiple leads simultaneously improves beat detection to determine the HR andminimizes false detections as a result of muscle artifact. 3.3.2 Respiration Rate (RESP) MonitoringRESP is determined by measuring the AC impedance between the RA and LL ECG electrodes. Chest wallmotion, rise and fall, associated with inspiration and expiration is automatically detected when the RA andLL leads are placed in the standard Lead II configuration on the chest, or in the MCL configuration.
Overview of Clinical Features 38RESP is determined from the frequency of the respiration (chest wall motion). The respiration channel candetect the absence of RESP.3.3.3 Skin Temperature (TEMP) MonitoringTEMP is continuously measured skin surface temperature as measured by the probe located on theunderside of the Chest Module. The probe must be placed directly in contact with the patient’s skin.TEMP can be displayed in °C or °F. See To apply the Chest Sensor Cable on page 59.Note: Skin temperature may not be the same as core body temperature or temperature measuredfrom oral or tympanic methods.Note: Skin temperature representative of skin surface temperature will take approximately 6minutes from the time the Chest Module is applied.3.3.4 Pulse Oximetry (SpO2 and Pulse Rate) MonitoringThe Pulse Oximetry channel non-invasively continuously measures the functional oxygen saturation of thehemoglobin in arterial blood using the transmittance across the base of the thumb. A pulsatile arterialsource at the base of the thumb is required to measure the SpO2. In the absence of a HR source from an ECG, the Pulse Rate (PR) can be measured and displayed from theSpO2 channel.RESP (chest wall motion) can continue in the absence of ventilation(obstructed airway). Do not rely on the RESP alone to determine adequacyof ventilation; other vital signs such as HR and SpO2 should be assessed aswell.TEMP monitoring with the ViSi Mobile Monitoring System is intended fortrending purposes only and is not intended to replace core temperaturemonitoring. Before implementing therapy based on the skin temperaturemeasurement, verify the measurement using another clinically acceptablemethod of core temperature measurement.Oxygen saturation measurements using SpO2 are dependent on propersensor placement, exposure to ambient light conditions, and general patientconditions. Before making clinical decisions based on SpO2 measurements,verify the measurement using another clinically acceptable method, such asarterial blood gas analysis.High ambient light condition, including direct sunlight, may interfer with theperformance of the ViSi Mobile Thumb Sensor.Low perfusion, electro-surgical devices, dysfunctional haemoglobin, thepresence of certain dyes and inappropriate positioning of the ViSi MobileThumb Sensor may result in erroneous measurements.
Display Screens393.3.5 NIBP MonitoringThe ViSi Mobile Cuff Module is intended for measuring arterial blood pressure (systolic and diastolic)using a Cuff. Measurements may be initiated manually (one at a time), or automatically at selectablepredefined intervals of 5, 10, 15, 30, 60, 90 and 120 minutes.The accuracy of NIBP measurements is influenced by several factors:• Correct cuff size• Correct cuff placement on the arm• The position of the upper arm in relation to the heart at the time of the measurement• Motion artifacts3.4 Display ScreensThis section describes various screens displayed on the ViSi Mobile Monitor. Each screen is accessed byinteracting with the touchscreen display.3.4.1 Battery Charge ScreenThe Battery Charge screen displays the battery status while the Monitor is charging in the Charger. Note: When the yellow dot is displayed on the screen, it indicates the Monitor will measure RESPwhen a Chest Sensor is connected to a patient. RESP is not available as part of the defaultset of vital sign measurements and must be purchased separately.Battery StatusBattery Charging Indicator(pulsates as battery is charging)IndicatorRESP measurementoption is available
Display Screens 403.4.2 Hibernation ScreenThe Hibernation screen (blank screen) is the default when no monitoring is currently in progress.The Hibernation screen conserves battery power under the following conditions:• The Shipping Plug is not plugged into the Monitor• The Monitor is not in the Charger• No sensors are connected to the MonitorNote: When in Hibernation, the power indicator blinks approximately every 9 seconds. The powerindicator color is reflective of the battery status: “Green” indicates there is sufficient batterycharge for at least two hours of monitoring; “Yellow” indicates the battery charge is depletedand there is less than 2 hours of monitoring available; and “Red” indicates the batterycharge is depleted and there is less than 30 minutes of monitoring available. When thepower indicator stops blinking, the battery charge is empty.Note: Connecting a sensor to the Monitor displays the Vital Sign screen. There will be a brief delaybefore the Vital Sign screen is displayed to allow the Monitor’s self test to complete.PowerIndicator
Display Screens413.4.3 Vital Signs ScreenThe Vital Signs screen is the default screen that displays automatically (on initial setup) when sensors areplaced on the patient and connected to the Monitor.Use the Vital Signs screen to:• View current vital sign measurements• Vital Signs Measurement: Access the waveforms (see page 70)• Alarm Status: View alarm status• Battery Status Indicator: View the battery status• Menu: Access the Menu screen (see page 42)• Start/Stop NIBP: Start and stop manual NIBP measurement (see page 75)• Alarm Management: Pause alarms/alerts (see page 99)• Alarm Management: Acknowledge (silence) alarms/alerts (see pages 93 and 97)• Lock: Lock the Monitor to prevent unauthorized accessBattery StatusMenuLockRESPSp02TEMPStart/StopNIBP AlarmMessage areaHR/PRIndicatorNIBPAlarm StatusManagementPauseTurn OffResumeTurn OnAlarm AlertAlarms Alarms Alarmin progress In progressOff Paused Acknowledged(Patient’s Primary Id)
Display Screens 423.4.4 Menu ScreenTouch Menu on the Vital Sign screen to view the Menu screen. Use the Menu screen to:• Change the NIBP measurements from Manual to Auto and set auto inflation interval (see page 79)• Stop monitoring (see page 81)• View Monitor status (see page 42)• View and change the alarm limits settings (see page 104)• Silence or enable the HR / PR beep tone3.4.5 Monitor Status ScreenTouch Monitor Status on the Menu screen to access the Monitor Status screen. Use the Monitor Status screen to: • View the battery status• View the version of Monitor’s softwareMonitor StatusNIBP Inflation Settings AlarmQRS/PRStop Monitoring Return to PreviousScreen (Manual/Auto)Beep Tone On/OffManagementBeep OnBeep OffThe yellow dot indicatesRESP is available with this Monitor
Display Screens43• View the Monitor’s serial number• View the Monitor’s MAC address • View features that are available, such as RESP 3.4.6 Quiet Monitoring ScreenThe Quiet Monitoring screen (blank screen) is the default when sensors are connected both to the Monitorand the patient and no user interaction has occurred for a predefined period of time. Continuousmonitoring is in progress during this time.Note: After a predefined period of no direct interaction with the Monitor, the Monitor locksautomatically and enters Quiet Monitoring.The Quiet Monitoring Screen conserves battery power and minimizes patient disturbance. Vital signsalarms and alerts remain active. Touching the screen continuously for 2 seconds resumes the Monitor’sdisplay with the Patient View screen.Note: When in Quiet Monitoring, the power indicator blinks approximately every 3 seconds. Thepower indicator color is reflective of the battery status: “Green” indicates there is sufficientbattery charge for at least two hours of monitoring; “Yellow” indicates the battery charge isdepleted and there is less than 2 hours of monitoring available; and “Red” indicates thebattery charge is depleted and there is less than 30 minutes of monitoring available. Whenthe power indicator stops blinking, the battery charge is empty.PowerTouchscreenSpeakerIndicatorMicrophone
Display Screens 443.4.7 Patient View ScreenThe Patient View screen appears whenever the touchscreen is touched continuously for 2 seconds duringQuiet Monitoring.Use the Patient View screen to: • View the current time• View battery charge level• Unlock the MonitorUUnlock
454. Operation4.1 IntroductionThe ViSi Mobile Monitoring System is a sophisticated multi-parameter vital signs monitor. In order tooptimize the user of ViSi, please adhere to the following instructions related to patient set-up, initiatingmonitoring and the removal of the System.4.2 Preparing for a New PatientIn order to set up the complete ViSi Mobile Monitoring System, you will need the following components: • ViSi Mobile Patient Kit (select size)• ViSi Mobile Monitor• ViSi Mobile Cuff Module• ViSi Mobile Thumb Sensor• ViSi Mobile Chest Sensor Cable (3 lead-wire or 5 lead-wire configuration)Note: Skin preparation equipment (skin preparation pads, scissors and/or razor as needed) notincluded.4.2.1 Inspecting the Equipment and AccessoriesBefore starting patient monitoring, you should visually inspect the ViSi Mobile Monitoring Systemcomponents:1. For each component, examine the exteriors for cleanliness and general physical conditions.Ensure the housings are not cracked or broken, that everything is present, there are no spilledliquids and no signs of abuse.2. Inspect all component cables for damage. Check their strain relief for general condition. Ensurethere are no breaks in the insulation. If any cables show signs of damage, do not use.3. Inspect all disposable accessories (Wrist Cradle, Cuff, Thumb Strap, Securements, etc). If anyshow signs of damage or pre-use, do not use.
Preparing for a New Patient 464.2.2 Applying SensorsApplying the sensors is simple and may be done in any order. At the completion of the setup, thecomponents of the ViSi Mobile Monitoring System will be connected to the patient as shown in thediagram below.Whenever a sensor is connected to the Monitor, a self-test of that sensor is initiated automatically to verifythe sensor is in good working order. If the sensor and Monitor speaker are in good working order, you willhear a double beep. This process takes a few seconds, after which monitoring of the selected vital signcommences as soon as the sensor is connected to the patient.The double beep is also a validation that the Monitor speaker is in good working order and that audio tonesassociated with alarms will be annunciated accordingly.Alarm limits are set automatically according to default settings. See 6.6 Manage Alarm Limits on page104.Successful vital signs monitoring is dependent on several factors:• Determining the vital signs to be monitored• Selecting a Monitor and Cuff Module that are adequately charged for maximum duration ofuninterrupted monitoring• Selecting the 3 lead-wire or 5 lead-wire Chest Sensor Cable• Selecting the appropriately sized Cuff (from the Patient Kit) • Preparing the skin for ECG electrode placement• Correctly applying all sensors used for monitoringMonitorThumb SensorCuff Module (Applied to upper arm)(in Wrist Cradle)Upper Arm Module(on Chest Sensor Cable)Chest Module(on Chest Sensor Cable)(Temperature probe onthe back side of theplaced against the patient’s skin)Chest Module must be
Preparing for a New Patient47Note: The battery in the Monitor will deplete at a faster rate when sensors are connected to theMonitor, even when monitoring has not been started.Note: The Chest Module includes a body surface temperature probe. To ensure proper function,place the temperature sensor on the body with the Chest Module “Front” label facingforward (away from the patient’s skin).4.2.3 Selecting Vital Signs to MonitorThe following vital signs may be monitored:• ECG (one or seven simultaneous leads, using the 3 lead-wire or 5 lead-wire Chest Sensor Cablerespectively)HR (from the ECG)RESP (optional)TEMP (Skin Temperature)•SpO2PR (from the Thumb Sensor)•NIBPSYSDIAPR (from NIBP)4.2.4 Selecting the ViSi Mobile Chest Sensor CableThe Chest Sensor Cable provides the sensors to monitor the ECG, HR, RESP (optional), and TEMP. Note: The skin surface temperature probe is on the underside of the Chest Module. It must beplaced on the skin surface in order to properly measure skin surface temperature.Select the Chest Sensor Cable that best suits the monitoring needs of your patient:• The 3 lead-wire Chest Sensor Cable monitors Lead II, or the MCL configuration. • The 5 lead-wire Chest Sensor Cable monitors seven leads of ECG simultaneously in leadconfigurations I, II, III, aVR, aVL, aVF, and a V lead. The specific V lead depends on theplacement of the V electrode.4.2.5 Selecting the ViSi Mobile Patient KitThe System’s disposable components, including the Cuff are contained in the Patient Kit. The Patient Kitsare designated as S, M, and L based on the Cuff size.Selection of the correct ViSi Mobile Disposable Cuff size is necessary toensure accurate NIBP measurements. A Cuff that is too small can result in afalsely high NIBP measurement. A Cuff that is too large can result in afalsely low NIBP measurement.
Preparing for a New Patient 484.2.6 Checking the Battery Charge of the ViSi Mobile Monitor and Cuff Module Before you start to monitor your patient with the System, you will need to select both a Monitor and a CuffModule that are adequately charged for maximum duration of uninterrupted monitoring.To check the battery charge of the Monitor1. Turn on the display by touching the screen while the Monitor is in the Charger.2. Verify that the large battery icon in the center of the screen is green.A full green battery symbol indicates that the battery is fully charged. A partially green battery symbolindicates the degree to which the battery is charged. The full monitoring period will not be achievedunless the battery is fully chargedA yellow battery symbol indicates the battery is low with less than 2 hours of monitoring time left.A red battery symbol indicates the battery is critically low with less than 30 minutes of monitoring time left.Cuff / Patient Kit Size Arm Circumference (cm)Adult S 20 – 26Adult M 25 – 34Adult L 32 – 43Fully ChargedBattery LowBattery Critically Low
Preparing for a New Patient49To check the battery charge of the Cuff ModulePress Battery Status button on the front of the Cuff Module.There is a row of eight colored lights on the front surface of the Cuff Module. Illuminated green lights indicate that the level of the battery charge is adequate for at least several NIBPmeasurements. When six illuminated green lights are visible on the Cuff Module, the Module is fullycharged.When the yellow light is illuminated, the battery charge is low. At least one NIBP measurement is possible.When the red light is illuminated, the battery charge is too low for any further NIBP measurements.Battery StatusbuttonBattery StatusIndicator (LEDs)
Applying ViSi Mobile Monitoring System / Initiate Monitoring 504.3 Applying ViSi Mobile Monitoring System / Initiate MonitoringThe ViSi Mobile Monitor may be used to monitor one vital sign, such as SpO2, or multiple vital signssimultaneously. Apply the appropriate sensor for each vital sign to be monitored, as described below. Startby selecting the appropriately sized Patient Kit (S, M, L).The Monitor’s ECG channel is capable of monitoring patients with an Implanted Pacemaker (PM),Implantable Cardioverter-Defibrillator (ICD), or Cardiac Resynchronization Therapy (CRT) device. Avertical dashed line before the P wave (atrial pace), and before the QRS (ventricular pace) indicate pacedevents. In the case of biventricular pacing (CRT), two vertical dashed lines occur before the QRS.Note: Stimulus pulses from a pacemaker, as indicated by the vertical dashed lines, are not countedas heartbeats, as defined by the pacer pulse rejection specification. See 9. Specifications onpage 125.Pacemaker signals can differ among pacemakers, ICDs, or CRT devices.The Association for the Advancement of Medical Instrumentation (AAMI)cautions: “In some devices, rate meters may continue to count thepacemaker rate during occurrences of cardiac arrest or some arrhythmias.Do not rely entirely upon rate meter alarms”. All pacemaker patients shouldbe kept under close or constant observation.External pacemakers or other external electrical stimulators may cause theViSi Mobile Monitor to produce erroneous results.Only use the ViSi Mobile Chest Sensor Cable provided by Sotera Wireless,Inc. with the ViSi Mobile Monitoring System. The Chest Sensor Cable isdesigned to provide defibrillation protection as indicated in theSpecifications section of this manual. ViSi Mobile is designed to becompatible with the use of external defibrillators.Only use the ViSi Mobile Thumb Sensor provided by Sotera Wireless, Inc.with the ViSi Mobile Monitoring System.All components of the ViSi Mobile Patient Kit are for single patient use only.To avoid possible cross contamination, do not reuse any of the items fromthe Patient Kit on a patient other than the original patient. Dispose of theViSi Mobile Patient Kit items after use per your facility’s policy.The ViSi Mobile Monitor, Thumb Sensor, Cuff Module, and the Chest SensorCable must all be connected to the same arm for the System to functioncorrectly.
Applying ViSi Mobile Monitoring System / Initiate 514.3.1 Applying the ViSi Mobile Wrist CradleIf there are no contraindications, for patient comfort, apply the Wrist Cradle to the patient’s wrist (eitherleft or right).To apply the Wrist Cradle1. Remove the Wrist Cradle from the Patient Kit.2. Orient the Wrist Cradle with the flat end pointed towards the elbow, slide the patient’s handthrough the Wrist Strap and position the cradle on the top side of the wrist.3. Pull snugly and secure.4. Placing the flat end in first, insert the Monitor into the Wrist Cradle and push down.When the Monitor is pushed down all the way, you will hear a “clicking” sound.Note: The Monitor is not completely secured within the Wrist Cradle until the Thumb Sensor orLocking Plug is inserted into the connector on the rounded end of the Monitor.The Wrist Strap should securely hold the ViSi Mobile Wrist Cradle in placewithout impairing circulation. Immediately loosen the Wrist Strap if thepatient complains of pain, tingling, or numbness in the affected hand orwrist.RoundedEndFlat EndRoundedEndFlat EndWrist Cradle
Applying ViSi Mobile Monitoring System / Initiate Monitoring 525. If you are not performing SpO2 monitoring, secure the Monitor to the cradle by inserting a LockingPlug into the opening on the rounded end of the Monitor.4.3.2 Applying SensorsVital signs monitoring starts automatically as soon as a sensor is connected to the Monitor and attached tothe patient. When performing a patient setup, the alarms pause automatically, allowing you to complete thesetup before the alarms are turned on. Sensors are designed to securely plug into the Monitor so that they cannot fall out unintentionally.You should hear a double-beep sound when a sensor is inserted correctly.When inserting the ViSi Mobile Monitor into the Wrist Cradle, ensure properalignment: flat end to flat end and the round end is pointing down towardsthe wrist.To avoid damage from dropping the ViSi Mobile Monitor, ensure that theWrist Strap is snugly wrapped around the wrist.To avoid damage from dropping the ViSi Mobile Monitor, make sure that theMonitor is securely snapped into the ViSi Mobile Wrist Cradle.The ViSi Mobile Monitor, Thumb Sensor, Cuff Module, and the Chest SensorCable must all be connected to the same arm for the System to functioncorrectly.Locking Plug
Applying ViSi Mobile Monitoring System / Initiate 534.3.3 Applying the ViSi Mobile Thumb SensorTo apply the Thumb Sensor1. Remove the Thumb Cradle from the Patient Kit.2. Insert the Thumb Sensor into the Thumb Cradle such that the sensor optics are pointing away fromthe Thumb Cradle.3. Place the Thumb Sensor at the base of the thumb and secure it with the Thumb Strap. The ViSi Mobile Thumb Sensor is intended for use on the patient’s thumbonly. Do not apply the Thumb Sensor to the patient’s fingers.Thumb CradleThumb SensorOptics
Applying ViSi Mobile Monitoring System / Initiate Monitoring 54The Thumb Cradle is designed to hold the Thumb Sensor in place securely without impairingcirculation.4. Check the patient’s thumb for good color and circulation to ensure that the Thumb Sensor has notrestricted circulation. 5. Connect the Thumb Sensor into the connector on the rounded end of the Monitor with theconnector contacts facing upwards.The monitoring of SpO2 and the PR starts after a few seconds. Alarm limits are set automaticallyaccording to predefined settings. See 6.6 Manage Alarm Limits on page 104. 6. While palpating the pulse in the wrist of the arm opposite the Monitor, watch the pulsatingindicator bar to the right of the SpO2 numeric and ensure that the bar fluctuates with the pulse. The pulsating indicator bar confirms signal adequacy by moving up and down in sync with thedetection of pulsating blood flow. Use the pulsating indicator bar to confirm the Thumb Sensor isoptimally placed. It may take several seconds for the signal to stabilize. Ensure that the ViSi Mobile Thumb Sensor is securely fastened. A ThumbSensor that is wrapped too tight or too loose can adversely affect SpO2measurement.Inspect patient’s skin at sensor site every 8 hours. If skin surface has beencompromised, reposition the ViSi Mobile Thumb Sensor or move the ThumbSensor to the patient’s other thumb.The Thumb Strap should securely hold the ViSi Mobile Thumb Sensor inplace without impairing circulation. Immediately loosen the Thumb Strap ifthe patient complains of pain, tingling, or numbness in the affected thumb.PulsatingIndicator Bar
Applying ViSi Mobile Monitoring System / Initiate 55The indicated PR should match the palpated pulse rate. PR is replaced with HR when measuringECG and SpO2 simultaneously.Note: If sensing of the SpO2 or the PR is erratic, loosen the Thumb Strap from the thumb andreposition the Thumb Sensor until a stable SpO2 and PR are obtained. Re-secure the ThumbSensor with the Thumb Strap.Only Sotera Wireless, Inc. supplied ViSi Mobile Thumb Sensors should beused. Using non-approved Thumb Sensors may result in inaccurate SpO2readings.
Applying ViSi Mobile Monitoring System / Initiate Monitoring 564.3.4 Applying the ViSi Mobile Chest Sensor Cable and ECG Elec-trodesSkin PreparationSkin preparation and ECG electrode placement directly impact the quality of the ECG signal and HRdeterminations. The following steps are recommended for skin preparation:• Select ECG electrode sites on the patient’s chestChoose sites that are flat, avoiding fatty areas and major muscles.For patient comfort, avoid placing ECG electrodes where lying on the side will put pressure on the ECG electrode.Sites just below the middle of the clavicles are good locations for the RA and LA ECG electrodes.• If needed, shave or clip hair in approximately a 1.5 to 2-inch diameter area for each ECG electrodesite.Also, for patient comfort, shave or clip hair from the areas where the Chest Sensor Cable and upper arm sensor are secured.• Thoroughly clean the sites to remove excess skin oils, skin cells, and residue from the ECGelectrode sites.You may use isopropyl alcohol prep pads or another skin preparation pad, or soap and water.Gently rub the site dry with a dry gauze pad or other dry pad.Note: To avoid skin irritation, avoid areas that appear damaged; remove ECG electrodes if thepatient complains of pain/itching; replace ECG electrodes per the electrode manufacturer’sinstructions and place on different sites.Note: Only use snap-on type electrodes.Use all of the same type of high quality ECG electrodes on the patient.Mixing ECG electrode types can adversely affect ECG monitoring.To ensure patient safety, the conductive parts of the ECG electrodes,including connectors and other patient-applied components, should notcontact other conductive parts, or earth ground, at any time.Only use the ViSi Mobile Chest Sensor Cable provided by Sotera Wireless,Inc. with the ViSi Mobile Monitoring System. The Chest Sensor Cable isdesigned to provide defibrillation protection as indicated in theSpecifications section of this manual. ViSi Mobile is designed to becompatible with the use of external defibrillators.Never connect the ViSi Mobile Chest Sensor Cable directly to the AC poweroutlet.
Applying ViSi Mobile Monitoring System / Initiate 573 lead-wire and ECG Electrode PlacementWith the 3 lead-wire Chest Sensor Cable, the ECG channel provides Lead II only. The ECG electrodeplacement shown in the diagram below is recommended for Lead II monitoringLead Wire Color Code - U.S. (AAMI)RA - WhiteLA - BlackLL - Red Lead Wire Color Code - International (IEC)R - RedL - YellowF - Green
Applying ViSi Mobile Monitoring System / Initiate Monitoring 585 lead-wire and ECG Electrode PlacementWith the 5 lead-wire Chest Sensor Cable, the ECG channel is capable of monitoring seven leadssimultaneously (Lead I, II, III, aVR, aVL, aVF, and a V lead). The ability to monitor multiple leadssimultaneously improves beat detection to determine the HR and minimizes false detections as a result ofartifact. The ECG electrode placement shown in the diagram below is recommended.Note: Place the V lead in the position appropriate to your monitoring requirements: V1, V2, V3,V4, V5 or V6.Note: The ECG waveform can be displayed one lead at a time on the ViSi Mobile Monitor.V1 4th intercostal space (just right of sternum)V2 4th intercostal space (just left of sternum)V3 Midway between V2 and V4V4 Mid clavicular line, 5th intercostal spaceV5 Anterior axillary line, between V4 and V6V6 Mid axillary line, horizontal with V4Lead Wire Color Code - U.S. (AAMI)RA - WhiteLA - BlackLL - RedLead Wire Color Code - International (IEC)R - RedL - YellowF - GreenV - BrownRL - Green C - WhiteN - Black
Applying ViSi Mobile Monitoring System / Initiate 59To apply the Chest Sensor Cable1. Remove the ECG electrodes from the Patient Kit.2. Apply the ECG electrodes to the prepared sites on the chest as shown. 3. Remove the large Cable Securement from the Patient Kit.4. Secure the Chest Module of the Chest Sensor Cable between the sternum and the shoulder (sameside as the Monitor) using the large Cable Securement.Note: The Chest Sensor Cable should be oriented vertically. Do not orient the sensor more than 45degrees to the left or right.Note: Ensure the “Front”, “ViSi Mobile” and “Defibrillation” labels on the Chest Module of theChest Sensor Cable are facing outwards away from the patient’s skin.Note: Ensure the “barcode” label and the Temperature sensor on the Chest Modole of the ChestSensor Cable are placed inwards directly against the patient’s skin.Note: For patient comfort, shave or clip the hair in the areas where the Cable Securement come incontact with the chest.5. Apply the lead wires from the Chest Sensor Cable to the ECG electrodes.Note: For patient comfort lead wires may be attached to ECG electrodes prior to applying theelectrodes to the patient’s chest.6. Remove the small Cable Securement from the Patient Kit. Avoid placing the ViSi Mobile Cable Securement and ECG electrodes overareas of abrasions, irritation, or other sensitive areas. If possible, remove,reposition, and replace ECG electrodes and Cable Securement if the patientcomplains of pain/itching at the sites.
Applying ViSi Mobile Monitoring System / Initiate Monitoring 607. Secure the Upper Arm Module of the Chest Sensor Cable on the outside of the upper arm using thesmall Cable Securement.Note: The default ECG configuration is Lead II.8. Plug the Chest Sensor Cable into any of the three ports on the flat end of the Monitor with theconnector contacts facing upwards.Note: Monitoring of ECG, HR, RESP (optional), and TEMP starts automatically. Alarm limits areset automatically according to predefined settings.Note: Only attach one ViSi Mobile Chest Sensor Cable to the patient and ViSi Mobile Monitor.9. While palpating the pulse in the wrist of the arm opposite the Monitor, watch the beating heartsymbol at the top left of the HR numeric to ensure that it fluctuates with the patient’s heart beat. The heart symbol beats with the pulse to confirm that the sensor is optimally placed. It may takeseveral seconds for the signal to stabilize. SmallLargeChest Module (rear view)Chest Module (front view)(Place this side against patient’s skin(Place this side away from the patient’s skin)BlockBlockLead wirespointing downwardsTemperature ProbeInsert with connectorscontacts facing upwards
Applying ViSi Mobile Monitoring System / Initiate 61• The indicated HR should match the palpated pulse rate.• If the indicated HR is erratic or doesn’t match the palpated pulse rate, check to make sure that the ECG electrodes and lead wires are secure.Note: In rare circumstances, the ECG electrodes may need to be placed in different locations toimprove the ECG signal.10. While observing the patient, count the respiration rate and compare it to the RESP rate on theMonitor. It may take several seconds for the signal to stabilize. • The indicated RESP should match the observed rate.• If the indicated RESP is erratic or doesn’t match the observed rate, check to make sure that the ECG electrodes and lead wires are secure.Note: The Temperature sensor takes several minutes to reach a stable temperature reading.4.3.5 Applying the ViSi Mobile Cuff Module and Disposable CuffTo apply the Cuff Module1. Remove the Cuff from the Patient Kit. 2. Squeeze as much air out of the Cuff as possible.3. Ensure that the patient is resting so that the upper arm muscles are relaxed. The level of the middleof the Cuff, while the arm is at rest, should be approximately at heart level.4. Wrap the Cuff around the upper part of the same arm to which the Monitor is attached. • Align the bottom part of the Cuff approximately 1” above the antecubital fossa.• Align the artery marker on the Cuff with the brachial artery.• The connector for the Cuff Module should be to the outside of the arm, away from the body.• Have the patient remain still to avoid the introduction of unnecessary motion artifact.Note: The ViSi Mobile Disposable Cuff is designed to be used on the same arm with the other ViSiMobile sensors. It may temporarily cause the loss of function of other devices (not ViSiMobile) simultaneously used on the same limb.Note: Only attach one ViSi Mobile Cuff Module to the ViSi Mobile Monitor.ViSi Mobile Disposable Cuffs are for single patient use only. To avoidpossible cross contamination, do not reuse a Cuff on a patient other than theoriginal patient.The ViSi Mobile Disposable Cuff should be snug enough to support the CuffModule while not impairing circulation when deflated.Avoid applying the ViSi Mobile Disposable Cuff over a wound as this cancause further injury.
Applying ViSi Mobile Monitoring System / Initiate Monitoring 625. Connect the Cuff Module securely to the Cuff with the cable in the direction of the Monitor.6. Plug the Cuff Module into any of the open ports on the flat end of the Monitor with the connectorcontacts facing upwards.Avoid applying the ViSi Mobile Disposable Cuff on any limb whereintravascular access or therapy, or an arterio-venous (A-V) shunt, is presentbecause of temporary interference to blood flow which could result in injuryto the patient.Take care in the application of the ViSi Mobile Disposable Cuff whenapplying the Cuff to an arm on the same side of a mastectomy.ViSi Mobile arterial measurements have not been clinically tested in thepresence of actual or ventricular arrhythmias. Use alternative BP methods ifthese arrythmias are present.Inflate the ViSi Mobile Disposable Cuff only after proper application to thepatient’s limb.Insert with connectorcontacts facing upwards
Removing ViSi Mobile Monitoring System63The Start symbol on the NIBP Start button blinks, prompting you to start a Cuff inflation. SeeTaking a NIBP Measurement on page 75 for instructions on how to take a NIBP measurement.4.4 Removing ViSi Mobile Monitoring SystemTo remove Cuff and Cuff Module1. Disconnect the Cuff Module from the Monitor: Grasp the Cuff Module cable near the plug and,while holding the Monitor still, pull out the plug.2. Unwrap the Cuff from the arm.3. If the patient will no longer be monitored:• Disconnect the Cuff Module from the Cuff.• Dispose of the Cuff according to your facility’s policy.To remove the Chest Sensor Cable1. Disconnect the Chest Sensor Cable from the Monitor: Grasp the Chest Sensor Cable cable nearthe plug and, while holding the Monitor still, pull out the plug.2. Remove the Cable Securements from the patient’s chest and arm and dispose of them according toyour facility’s policy.3. To prevent placing stress on the lead wires, grasp each lead wire near the connection to the ECGelectrodes. Pull the lead wires from the ECG electrodes.4. Carefully remove the ECG electrodes from the patient and dispose of them according to yourfacility’s policy.To remove the Thumb Sensor1. Disconnect the Thumb Sensor from the Monitor: Grasp the Thumb Sensor cable near the plugand, while holding the Monitor still, pull out the plug.2. Remove the Thumb Sensor from the patient.3. Holding the ends of the Thumb Sensor between your thumb and index finger, gently bend theThumb Sensor backwards until it releases from the Thumb Cradle.4. If the patient will no longer be monitored, dispose of the Thumb Cradle and Thumb Strapaccording to your facility’s policy.To remove the Wrist Cradle and Monitor 1. For ease of removal of the Wrist Cradle and Monitor, ensure all sensors are disconnected from theMonitor.2. Remove the Monitor from the Wrist Cradle. 3. Unwrap the Wrist Strap from the patient’s wrist and remove the Wrist Cradle from the patient’swrist.4. If the patient will no longer be monitored, dispose of the Wrist Cradle and Wrist Strap according toyour facility’s policy.All disposable components of the ViSi Mobile Monitoring System are forsingle patient use only. To avoid possible cross contamination, do not reuseany disposable items on a patient other than the original patient.
Removing ViSi Mobile Monitoring System 64Clean the reusable components of the System: Monitor, Chest Sensor Cable, Thumb Sensor, and CuffModule, in accordance with your facility’s procedures and the cleaning recommendations in this manual.See 7. User Maintenance on page 109.
655. Patient Monitoring5.1 IntroductionThe ability to monitor patients with a patient-worn ViSi Mobile Monitoring System opens up manyopportunities to assess vital signs during all phases and activities involved in a patient’s recovery process.
Monitoring the Patient 665.2 Monitoring the Patient RESP (chest wall motion) can continue in the absence of ventilation(obstructed airway). Do not rely on the RESP alone to determine adequacyof ventilation. Other vital signs, such as HR and SpO2, should be assessedas well.Impedance pneumography for the determination of respiration (RESP) is notrecommended for use in the presence of mechanically induced, highfrequency ventilation.The ViSi Mobile Monitor does not provide automated arrhythmia analysis.As a result, certain arrhythmias may cause the Monitor to display inaccurateheart rates. If frequent arrhythmias are suspected, their presence should beconfirmed by another method, such as a 12-lead ECG or Holter monitoring.The ViSi Mobile Monitor does not have automated ST segment analysis,therefore, if a change in the ST segment of the ECG waveform is suspected,it should be confirmed by another method, such as a 12-lead ECG.Oxygen saturation measurements using SpO2 are dependent on propersensor placement and general patient conditions. Before making clinicaldecisions based on SpO2 measurements, verify the measurement usinganother clinically acceptable method, such as an arterial blood gas analysis.TEMP monitoring with the ViSi Mobile Monitoring System is intended fortrending purposes only and is not intended to replace core temperaturemonitoring. Before making clinical decisions based on the skin temperaturemeasurement, verify the measurement using another clinically acceptablemethod of temperature measurement.To prevent settings from being inadvertently changed, lock the ViSi MobileMonitor screen (if enabled) as soon as tasks are completed.The ViSi Mobile Monitoring System does not support printing capability.
Monitoring the Patient675.2.1 Unlocking the MonitorIf your System is configured to require authorization to view the Vital Signs screen, you must first unlockthe Monitor by entering a PIN code. If you do not have a PIN code, please see your system administrator.If your System is not configured to require authorization, the Enter Pin Code screen does not appear.To unlock the Monitor1. With one finger, touch the Monitor’s screen for two seconds to activate the Monitor’s display. The Patient View screen appears.2. Touch Unlock in the lower left corner of the screen. The Enter PIN Code screen appears. 3. Enter PIN code on the PIN code pad.As PIN digits are entered, a white dot appears in the message area for each digit entered and theReturn to Previous Screen button changes to a Cancel button.4. Touch Confirm to enter the PIN code and confirm authorization. MessageareaReturn topreviousscreen
Monitoring the Patient 68If you touch the Confirm button the system navigates to the Vital Signs screen (when a valid PINcode has been entered). If you touch the Cancel button, the entered PIN code is cleared and theReturn to Previous Screen button appears allowing to return to the Patient View screen.Note: When an invalid PIN code is entered, the outline of the PIN code buttons will flash red andthe entered PIN code is cleared.5.2.2 Locking the MonitorWhen you have finished working with the Monitor, you should lock the Monitor to prevent the patientfrom accidentally accessing clinical settings.To lock the Monitor1. When you are finished interacting with the patient and the Monitor, touch Lock. The Vital Signs screen is locked to prevent settings from being inadvertently changed. The PatientView screen appears.
Monitoring the Patient695.2.3 Viewing Vital SignsVital signs monitoring, with alarms, starts as soon as a sensor is connected to the patient and plugged intothe Monitor. When there has been no interaction with the Monitor for a period of time, the display goesinto Quiet Monitoring.To view vital signs1. With one finger, touch the Monitor screen for two seconds to activate the display. 2. Enter your PIN code if required. See To unlock the Monitor on page 67.The Vital Signs screen appears and displays all currently monitored vital signs.Note: If the Cuff Module is not connected, the Start NIBP button is disabled and the NIBP numericdisplay area is blank.Note: The vital sign measurements are refreshed every 3 seconds.Cuff Module connected Cuff Module not connected
Monitoring the Patient 705.2.4 Viewing Waveforms Associated with Vital SignsWaveforms move across the display from left to right. A sweep bar erases the oldest waveform andreplaces it with the newest waveform as it moves from left to right.The speed of the waveform display (sweep speed) is scaled to 25 mm/sec for ECG and SpO2 waveforms.The sweep speed of the RESP waveform display is scaled to 6.25 mm/sec. The RESP frequency is lessthan the ECG or SpO2. The slower sweep speed for the RESP waveform compensates for the lowerfrequency of activity in order to display several RESP cycles on the display.Note: The NIBP measurement does not have a waveform.To view the ECG waveformsDepending on which Chest Sensor Cable is connected (3 lead-wire or 5 lead-wire), several views (leads) ofthe ECG waveform may be available for view.Note: It is recommended that you step through the available ECG waveform leads to confirm theECG setup is correct. Note: When using a 3 lead-wire Chest Sensor Cable, only a Lead II waveform is available.Note: There is no pacer detection with a 3 lead-wire Chest Sensor Cable.SweepPacerSpikeBar
Monitoring the Patient711. Touch the HR numeric. The top third of the display is replaced with the ECG waveform. The displayed lead is indicated tothe left of the waveform. The square wave indicates the standard calibration of the ECG waveform.To view other leads with the 5 lead-wire Chest Sensor Cable1. Touch ECG Lead Selection or the waveform. The lower part of the display is replaced with Lead Selection buttons.2. Select the lead corresponding to the waveform that you want to view.All available leads can be viewed one at time from this view.Note: Selecting different leads to view has no affect on monitoring. All available leads aremonitored simultaneously and continuously. The lead selection affects only the display.3. Touch Return to Previous Screen to exit this view. The display returns to the previous view of the ECG waveform and vital signs.ECG Leadselection
Monitoring the Patient 724. To return to the main Vital Signs screen, touch the HR numeric. The ECG waveform is no longer displayed.Note: When you touch a vital sign, its corresponding waveform is displayed, even if anotherwaveform is currently displayed.Input Overload / Dynamic RangeThe ViSi Mobile Monitor display indicates an input overload condition (i.e. the input dynamic range of theamplifier associated with the displayed ECG lead has been exceeded) by displaying the trace in red at thetop (or bottom) of the ECG waveform display area.Amplifier is overloaded due to an inputthat exceeds the positive limit of the dynamic range on a continuous basisPositive limit of the dynamic range isbeing exceeded only at the peaks of theQRS complex of the ECG waveformDynamic range of the ECG amplifierhas not been exceeded, but in whichthe peaks of the QRS complex of the ECG waveform extend beyond the upper edge of the display area
Monitoring the Patient73To view the RESP waveform1. Touch the RESP numeric. The top third of the display is replaced with the RESP waveform. 2. To return to the main Vital Signs screen, touch the RESP numeric. The RESP waveform is no longer displayed.To view the SpO2 waveform1. Touch the SpO2 numeric. The top third of the display is replaced with the SpO2 waveform. 2. To return to the main Vital Signs screen, touch the SpO2 numeric. The SpO2 waveform is no longer displayed.
Monitoring the Patient 745.2.5 Motion ArtifactIf a vital sign cannot be measured due to a motion artifact, the word “MOTION” displays below the vitalsign name, and “xx” is displayed in place of the numeric(s).
Monitoring the Patient755.2.6 Taking a NIBP MeasurementThe industry-standard technique of oscillometry is used for non-invasively measuring systolic bloodpressure (SBP) and diastolic blood pressure (DBP). The method is based on the measurement ofoscillations through the occluding cuff which is placed on the patient’s upper arm during an NIBPmeasurement. The pulsatile oscillations are measured using a pressure transducer, and then digitized usinga microprocessor. The NIBP algorithm uses the digitized oscillations and applied cuff pressure as input toan empirical model to calculate SBP and DBP.Blood pressure measurements can be affected by the patient’s position and/or physiological condition:• The cuff should be at the same level as the patient’s heart.• NIBP are not reliable indicators for patients with arterial or frequent premature ventricular beats.• Improper cuff size or application may lead to inaccurate readings.This section describes how to take a single NIBP measurement and how to initiate automatic NIBPmeasurements at various intervals. For patient comfort, when the NIBP is set to manual, remove the Cuffand the Cuff Module from the patient's arm. Once removed, disconnect the Cuff Module from the Monitorbetween measurements. Store the Cuff and Cuff Module in a convenient location. Note: The ViSi Mobile Cuff Module cannot be used with the auscultatory method of measuringNIBP. The ViSi Mobile Monitor should never be used to measure the NIBP of onepatient while the Monitor is simultaneously connected to another patient.Do not attempt to take NIBP measurements with the ViSi Mobile Monitorwhile the patient is undergoing cardio-pulmonary bypass.Do not attempt to take NIBP measurements with the ViSi Mobile Monitorwhile the patient is being treated with an intra-aortic balloon pump or leftventricular assist device.Periodically observe the patient’s arm for signs of impaired circulation, whichmay be a result of measurements made too frequently. Loosen or removethe ViSi Mobile Disposable Cuff if signs and/or symptoms of prolongedimpaired circulation are evident.If you are uncertain of the reliability of an NIBP measurement, repeat themeasurement. If the reading is still suspect, use another method to measurethe blood pressure.The ViSi Mobile Disposable Cuff should be snug enough to support the CuffModule while not impairing circulation when deflated.
Monitoring the Patient 76To take a single NIBP measurement 1. Apply the Cuff and Cuff Module. See Applying the ViSi Mobile Cuff Module and Disposable Cuffon page 61.After the Cuff Module has been connected to the Monitor, the NIBP vital sign numerics (Systolicand Diastolic) display as “xx”, indicating no measurement has been taken.2. Touch Start NIBP to start a measurement. After a few seconds to zero and calibrate the barometric pressure, the Cuff begins inflating. An inflation pressure indicator bar, located to the left of the NIBP numerics, increases/decreases inheight as the pressure increases/decreases in the Cuff. The actual cuff pressure is displayed underthe NIBP label.Once the Cuff begins to inflate, the Start NIBP button changes to Stop NIBP. Note: If unexpected readings are encountered, confirm the correct application of the ViSi MobileDisposable Cuff (see page 61). If unexpected readings persist, have maintenance performedas described in the Technical Reference Manual.The performance of the automated sphygmomanometer may be affected byextremes of temperature, humidity and altitude. See “Specifications” onpage 125.
Monitoring the Patient77Upon completion of a successful measurement, the Systolic and Diastolic measurements are displayed inwhite. The time of the measurement is displayed below the NIBP label. If there is no other heart rate/pulserate source (i.e. Thumb Sensor or Chest Sensor Cable are not connected to the Monitor), then a one-timePR from the NIBP measurement is displayed next to the NIBP measurement for 30 seconds.Note: If the NIBP measurement was unsuccessful, the Cuff Module automatically retries tomeasure the blood pressure. A maximum of 3 attempts will be made. If the failure is due to acuff leak or cuff occlusion, there is no retry and the LEAK or OCCL message appears on thescreen directly below the NIBP label. NIBP numerics fade and shrink in size after 30 seconds to indicate that the reading is not recent.NIBP measurements that are older than 30 minutes are no longer displayed. Time of SystolicDiastolicMeasurementCurrent Reading Older ReadingNote that the numerics for the older reading are faded and shrunk in size
Monitoring the Patient 78To stop an NIBP measurement An NIBP measurement currently in progress may be stopped at any time.Touch Stop NIBP to stop the cuff inflation and NIBP measurement. The cuff will deflate.Inflation PressureIndicator BarInflation Pressure(mmHg)Stop Cuff
Monitoring the Patient795.2.7 Initiating Automatic NIBP Measurements When frequent NIBP measurements are required, the Monitor can be set up to automatically take a bloodpressure measurement every 5, 10, 15, 30, 60, 90 or 120 minutes.To initiate automatic NIBP measurements1. Apply the Cuff and Cuff Module. See Applying the ViSi Mobile Cuff Module and Disposable Cuff on page 61.2. Set the NIBP mode to Automatic.a. Touch Menu on the Vital Signs screen to display the Menu screen. The Menu screen appears.b. Touch NIBP Settings to display the Cuff Management screen. The Cuff Management screen appears.c. Touch Automatic Cuff Inflation. d. Touch the Up or Down arrow to increase or decrease the time interval.The ViSi Mobile Disposable Cuff should be snug enough to support the CuffModule, while not impairing circulation when deflated.Use care when using automatic cuff inflation for prolonged periods onunconscious or semi-conscious patients since the patient may not be able toalert the clinician to any pain he/she may be experiencing. Pressing the“Stop NIBP” button interrupts the NIBP measurement and deflates the cuff. AutomaticCuff InflationManualCuff Inflation
Monitoring the Patient 80e. Touch Confirm to confirm the new settings. - or -Touch Cancel to return to the Menu screen. Once you have touched Confirm, an automatic NIBP measurement is taken immediately, andagain at the set interval. The Automatic setting is saved and the system returns to the Vital Signsscreen. If you touch Cancel, the system discards the changed settings and returns to the Menuscreen.Note: As long as the NIBP Module is plugged in, a manual NIBP measurement can be initiated atany time. If the timing of the manual measurement overlaps with the automaticmeasurement interval, then that automatic measurement is skipped; otherwise the automaticmeasurement occurs as scheduled. Note: Touching the “Stop NIBP” button on the Vital Signs screen interrupts any NIBPmeasurement cycle presently in progress. The next automatic measurement will occur asscheduled.
Monitoring the Patient815.2.8 Viewing Patient’s DemographicsTo Confirm Patient’s DemographicsWhen the patient’s demographics have been changed on the ViSi Remote Viewer or there is an interruptionof monitoring of more than 30 seconds, the demographics must be confirmed (or rejected) directly on theViSi Mobile Monitor.Note: The patient’s primary id will be displayed in blue to indicate the demographics have beenchanged and require confirmation.Note: The primary id is configured to be the patient’s name. The secondary id is configured to bethe patient’s MRN#. The tertiary id is configured to be an alternative id.1. Touch Confirm to confirm the patient’s demographics are correct. - or - Touch Cancel. If cancelled, the patient’s demographics will be removed from the ViSi Mobile Monitor and an alertwill be annunciated on the ViSi Remote Viewer.If confirmed, the patient’s demographics will be displayed in white to indicate they have now beenconfirmed.Patient’s Primary (displayed in blue)Secondary and Tertiary IdsBirth Gender / AgeDate of Birth
Monitoring the Patient 82To View Patient’s Demographics1. Touch Menu on the Vital Signs screen to display the Menu screen. The Menu screen appears.2. Touch Patient Information to display the Patient Information screen. The Patient Information screen is displayed.Note: The primary id is configured to be the patient’s name. The secondary id is configured to bethe patient’s MRN#. The tertiary id is configured to be an alternative id.Note: The patient’s demographics are entered on the ViSi Remote Viewer.Patient’s PrimarySecondary and Tertiary IdsBirth Gender / AgeDate of Birth
Monitoring the Patient835.2.9 Exchanging a Monitor With Low BatteryTo exchange a monitor with a low batteryWhen the ViSi Mobile Monitor’s battery becomes low during monitoring, it may be exchanged with a newMonitor without stopping the patient’s monitoring session.1. Remove the new Monitor from the ViSi Mobile Charger.The Device Status screen will be displayed.2. Touch Device Swap. The Device Swap Instructions screen will be displayed and the Monitor will connect to thenetwork.Note: The Monitor may take a few seconds to connect to the network. Do not attempt to bump thetwo monitors together until the new Monitor has connected to the network.Note: Monitors must be double bumped with long ends in the same direction. See image on theViSi Mobile Monitor instructions screen.Device Swapbutton Button is disabled whenthe battery life of thenew monitor is too low
Monitoring the Patient 843. Double bump the new Monitor with the Monitor on the patient’s wrist.- or - Touch Cancel. If cancelled, the Device Swap will automatically be cancelled.If the monitors are successfully double bumped, the Device Swap process will be initiated. Thenew Monitor will display the Waiting Patient Transfer screen and the patient’s Monitor willdisplay the Confirm Device Swap screen.4. Touch Confirm to replace the existing patient’s Monitor with the new Monitor. - or - Touch Cancel. If cancelled, the Device Swap will automatically be cancelled.If confirmed, the patient’s demographics will be transferred from the patient’s Monitor to the newMonitor. The new Monitor will display the Operation Instructions screen and the patient’sMonitor will display the Disconnect Sensors screen.Waiting Patient Transfer Confirm Device Swap(Instructions on the new Monitor) (Instructions on the patient’s Monitor)
Monitoring the Patient85Note: During the exchange, you will need to confirm the patient’s identification on the patient’sMonitor, if it has not already been confirmed.Note: During the exchange, you will need to enter your pin code on the patient’s Monitor, if it hasnot already been entered.5. To stop monitoring on the patient’s Monitor and complete the exchange, disconnect the sensorsfrom the Monitor within 2 minutes.If the sensors are not disconnected from the patient’s Monitor within 2 minutes, monitoring willcontinue on the patient’s Monitor and the Device Swap process will be cancelled.Once the sensors have been disconnected, the new Monitor may be placed in the cradle and thesensors connected. 6. To restart monitoring, place the new Monitor into the Wrist Cradle (attached to the patient’s wrist)and connect the sensors.Note: When monitoring is restarted, the patient’s demographics will need to be reconfirmed on thenew Monitor.Operation Instructions Disconnect Sensors(Instructions on the new Monitor) (Instructions on the patient’s Monitor)Instructions Device Status(Patient’s New Monitor) (Original Patient’s Monitor)
Monitoring the Patient 865.2.10 Stop MonitoringStop monitoring when ALL vital signs monitoring is no longer required.To stop monitoring1. With one finger, touch the Monitor screen for two seconds to activate the display. The Patient View screen appears.2. Enter your PIN code if required. (See To unlock the Monitor on page 67.)The Vital Signs screen appears. 3. Touch MENU. The Menu screen appears.4. Touch STOP. The Stop Monitoring screen appears. 5. Touch Confirm to confirm that you want to stop monitoring. - or - Touch Cancel. If cancelled, the program returns to the Menu screen and monitoring continues uninterrupted.If confirmed, the Stop-Disconnect Sensors/Clean Monitor screen is displayed showing a 2 minutecountdown timer.
Monitoring the Patient876. Remove all the sensors and the Monitor from the patient.All sensors must be removed from the patient and/or the Monitor to stop monitoring. When thecountdown has elapsed, if vital sign measurements are still being detected (at least one sensor isstill connected to the patient and Monitor), monitoring will continue without interruption.7. To remove the sensors from the Monitor, grasp the sensors near the plug, and while holding theMonitor firmly, pull out the plug. Once all the sensors are disconnected from the Monitor, the Monitor Status screen appears brieflybefore the System transitions into the Hibernate mode.8. Dispose of disposable components per your facility’s procedures.If you want to stop monitoring temporarily or change the Monitor, you will need to stop monitoring on thecurrent Monitor and start monitoring again using the steps outlined in section Applying ViSi MobileMonitoring System / Initiate Monitoring on page 50.To clean and prepare reusable components1. Clean and prepare the reusable components of the System (Monitor, Chest Sensor Cable, ThumbSensor, and Cuff Module) in accordance with your facility’s procedures and the cleaningrecommendations in this manual. See 7.User Maintenance on page 109.2. Place the cleaned Monitor and Cuff Module into the Charger.Never place the ViSi Mobile Monitor or the ViSi Mobile Cuff Module into theViSi Mobile Charger while connected to a patient. Never connect the ViSi Mobile Monitor directly to an AC power outlet. Torecharge the battery, disconnect the Monitor from the patient, and then placeit in the ViSi Mobile Charger.Never connect the ViSi Mobile Cuff Module directly to an AC power outlet.To recharge the battery, disconnect the Cuff Module from the patient, andthen place it in the ViSi Mobile Charger.To prevent possible cross-contamination, properly clean and disinfect allreusable components between patients.
All Sensors Disconnected 885.3 All Sensors DisconnectedThe “All Sensors Disconnected” screen will be displayed when the last sensor is disconnected from theViSi Mobile Monitor without going through the proper “Stop Monitoring” procedure. (see 5.2.8ViewingPatient’s Demographics on 81). An “All Disconnected” alert will be generated.1. To stop monitoring the patient, touch Stop to initiate the Stop Monitoring process. - or - to resume monitoring, connect the sensor(s) to restart monitoring. Monitoring will automatically continue.2. Enter your PIN code if required. (See To unlock the Monitor on page 67.)The Clean Monitor screen appears.
896. Alarms6.1 IntroductionThe ViSi Mobile Monitoring System provides a comprehensive alarm system that alarms on changes to thepatient’s physiologic status (alarms) and technical alarms (alerts). The system provides default alarm limits for physiological alarms. The clinician can manually manage thealarm limits for each patient to provide individualized care. Technical alarms (alerts) are provided to notify the clinician of situations that may impede the ability tomonitor your patient.6.1.1 System Alarm ManagementDuring the installation of the ViSi Mobile Monitoring System, alarm configurations may be modified toconform to the alarm policies set by the clinical care unit. General Alarm Management RulesThe following general alarm management rules pertain to the ViSi Mobile Monitoring System:• All ViSi Mobile Monitoring System alarms conform to IEC 60601-1-8.• Alarms and alerts originate from the ViSi Mobile Monitor (worn by the patient).• Silencing/acknowledging a patient’s alarm or alert suspends the audio tones for up to 2 minutes.When a new alarm/alert occurs during the 2 minute silenced/acknowledged period, the new alarm/alert will be immediately annunciated.Note: When the clinician silences/acknowledges an alarm/alert, all active alarms/alerts in progresswill also be silenced/acknowledged for the 2 minutes. The clinician does not need to silence/acknowledge each alarm/alert individually.• Alarm annunciation may be turned off for an indefinite period of time. This disables theannunciation of alarms and alerts on both the ViSi Mobile Monitor and the Remote Viewer for the“off” duration. Turning the alarms off must be done directly from the ViSi Mobile Monitor (wornby the patient), however, alarms may be turned back on from either the ViSi Mobile Monitor or theRemote Viewer.• Alarm annunciation may be paused for 2 minutes. This disables the annunciation of alarms andalerts on both the ViSi Mobile Monitor (worn by the patient) and the Remote Viewer for thepaused duration. Pausing the alarms must be done directly from the ViSi Mobile Monitor (worn by
Introduction 90the patient), however, alarms may be resumed from either the ViSi Mobile Monitor or the RemoteViewer.Note: When the annunciation of alarms/alerts has been turned off or paused, certain importantalarms and alerts will continue to annunciate (known as break-through alarms and alerts).These are generally equipment alerts that inhibit the ability to monitor the patientappropriately.Note: When alarms/alerts are paused, alarms/alerts currently in progress will no longer beannunciated. The annunciation of any new alarms/alerts will be disabled for the 2 minuteduration.Note: When alarms/alerts are silenced/acknowledged, the audio tone will be silenced. Any newalarms/alerts occurring during the 2 minute silenced/acknowledged duration will beimmediately annunciated.In Network RulesWhen the ViSi Mobile Monitor is in network and connected to the ViSi Mobile Remote Viewer:• When the ViSi Mobile Monitor is connected to the Remote Viewer, the audio alarm and alert toneswill be deferred from the Monitor to the Remote Viewer, for a pre-configured length of time.Note: Audio tones for life threatening alarms will not be delayed.• Alarms/alerts may be silenced/acknowledged from either the ViSi Mobile Monitor or RemoteViewer.Note: Silencing/acknowledging a life threatening alarm directly from the ViSi Remote Viewer willonly silence/acknowledge the alarm on the Remote Viewer. To silence/acknowledge the lifethreatening alarm on the ViSi Mobile Monitor, the clinician must silence/acknowledge thealarm directly from the Mobile Monitor (worn by the patient).• When alarm annunciation has been turned off, alarm annunciation may be turned back on fromeither the ViSi Mobile Monitor or Remote Viewer. Turning alarm annunciation off can only bedone directly from the ViSi Mobile Monitor (worn by the patient).• When alarm annunciation has been temporarily paused, alarm annunciation may be resumed fromeither the ViSi Mobile Monitor or Remote Viewer. Pausing alarm annunciation can only be donedirectly from the ViSi Mobile Monitor (worn by the patient).
Physiological Alarms (Alarms) / Technical Alarms 916.2 Physiological Alarms (Alarms) / Technical Alarms (Alerts) Summary6.2.1 Responding to Alarms/AlertsLatched: The alarm remains in an active state until the clinician silences/acknowledges the alarm onthe ViSi Monitor.Non-Latched: Alarms/alerts can self-correct themselves without any action by the clinician.Silencing Audible Alarms/Alerts from ViSi Remote ViewerPriority Type of Alarm Silence ButtonWhere to Respond to AlarmAudio TonesRemote Viewer(At Clinician’s Station) Mobile Monitor(At Patient)1LATCHEDSilenced at the Remote Viewer for 2 minutes.Continues on Mobile MonitorAudible continues on Mobile Monitor until silenced on Mobile Monitor.BeepBeepBeep- Pause -BeepBeep2Non-LatchedSilence at Remote Viewer or Mobile Monitor.(2 minute audible silenced on both Remote Viewer and Mobile Monitor.)BeepBeepBeep- Pause -BeepBeep3Non-LatchedSilence at Remote Viewer or Mobile Monitor.(2 minute audible silenced on both Remote Viewer and Mobile Monitor.)BeepBeep- Pause -4Non-LatchedVisual Only - No SoundAcknowledge at the Remote Viewer or Mobile Monitor.(Acknowledged for 2 minutes at both the Remote Viewer and Mobile Monitor.)No audio tones.Life ThreateningHigh(High / Medium)Alerts(Low)Alerts
Physiological Alarms (Alarms) / Technical Alarms (Alerts) Summary 926.2.2 Managing Alarm/Alert AnnunciationsAnnunciation: Refers to the audible and visual display of alarms/alerts.Note: When multiple alarms and alerts occur simultaneously, the message text will only displaymessages associated with the highest alarm severity. The vital measurements will display allexisting alarms, regardless of their severity.Action Action Button Duration Allow Where EffectsPause Alarms/AlertsN/A 2 Minutes May only be paused from the ViSi Mobile Monitor.Annunciation disabled at both the ViSi Monitor and Remote Viewer.Resume Alarms/AlertsN/A ViSi Mobile Monitor and Remote Viewer.Annunciation resumed at both the ViSi Mobile Monitor and Remote Viewer.Turn Alarms/Alerts OffN/A Indefinitely May only be turned off from the ViSi Mobile Monitor.Annunciation disabled at both the ViSi Monitor and Remote Viewer.Turn Alarms/Alerts OnN/A ViSi Mobile Monitor and Remote Viewer.Annunciation turned on at both the ViSi Mobile Monitor and Remote Viewer.
Responding to Physiological Alarms (Alarms)936.3 Responding to Physiological Alarms (Alarms)6.3.1 To Silence/Acknowledge Life Threatening Severity AlarmsLife threatening severity alarms require urgent clinician response at the bedside.A responsible clinician must be within audible range of the ViSi MobileMonitor at all times.Symbol Annunciation Color Audio Tone Duration (ms) Spacing (ms)White / Red BBB P BB P BBB P BB...B - Beep / P - Pause100 50Silence/AcknowledgeAlarm
Responding to Physiological Alarms (Alarms) 94To silence/acknowledge the alarm, touch Silence/Acknowledge Alarm button - or - Touch the Alarm Status. The alarm is silenced/acknowledged and the “Silenced/Acknowledged” symbol and countdownwill be displayed. After the 2 minute countdown has expired, the alarm will be re-annunciated.Note: When a Life Threatening alarm occurs and the alarming condition resolves itself before aclinician is able to respond, visual and audio indications of the life threatening alarmcontinue to annunciate until the clinician silences the alarm.Silenced/Acknowledgedsymbol and countdown
Responding to Physiological Alarms (Alarms)956.3.2 To Silence High Severity AlarmsHigh severity alarms require immediate clinician response at the bedside.Symbol Annunciation Color Audio Tone Duration (ms) Spacing (ms)Red BBB P BB P BBB P BB...B - Beep / P - Pause200 100Silence/AcknowledgeAlarm
Responding to Physiological Alarms (Alarms) 96To silence/acknowledge the alarm, touch Silence/Acknowledge Alarm button - or - Touch the Alarm Status. The alarm is silenced/acknowledged and the silenced/acknowledged symbol and countdown willbe displayed.Note: When a high alarm occurs and the alarming condition resolves itself before a clinician is ableto respond, the high alarm message will be displayed (in gray) for up to 5 minutes in themessage area. This serves as a reminder to the clinician that a high alarm has occurred.Silenced/Acknowledgedsymbol and countdown
Responding to Equipment Alarms (Alerts)976.4 Responding to Equipment Alarms (Alerts)6.4.1 To Silence/Acknowledge Alerts (All Severities)Equipment alerts are used when the ability to monitor the patient and detect a patient’s physiologicalalarms may be affected.Symbol Annunciation Color Severity Audio Tone Duration (ms) Spacing (ms)Cyan High B B PB - Beep / P - PauseThere will be a 15 second pause after each sequence.250 250Medium B B PB - Beep / P - PauseThere will be a 15 second pause after each sequence.250 250Low No audio tones. N/A N/ASilence/AcknowledgeAlarm
Responding to Equipment Alarms (Alerts) 98To silence/acknowledge the alert, touch Silence/Acknowledge Alarm button - or - Touch the Alert Status. The alert is silenced/acknowledged and the silenced/acknowledged symbol and countdown will bedisplayed.Note: When an alert condition (of any severity) resolves itself before the clinician is able torespond, the alert condition will no longer be annunciated.Silenced/Acknowledgedsymbol and countdown
Managing Alarm Annunciations996.5 Managing Alarm Annunciations6.5.1 Pause / Resume AlarmsTo pause the alarmsFrom the Vital Signs screen, touch Pause Alarms. The alarms will be paused for 2 minutes.When paused, the words ALARMS PAUSED are displayed at the top of the screen and an ALARMSPAUSED icon is displayed in the lower right corner of the screen.Note: When the clinician logs out of the ViSi Mobile Monitor, the alarms will automatically beresumed.When alarms are paused, there is no notification of a potentially clinicallysignificant change in the patient's vital signs. Observe the patient by othermeans when alarms are paused.Pause Alarms Alarms are pausedRemaining “Paused” duration
Managing Alarm Annunciations 100To Resume Alarms When alarms are paused, the annunciation of any existing and new alarm will be disabled at both the ViSiMobile Monitor and Remote Viewer. Alarms may be resumed from either Mobile Monitor or RemoteViewer.To resume alarm annunciation, touch the Resume button. - or - Touch the AlarmStatus. The alarms are resumed and will annunciate on both the ViSi Mobile Monitor and Remote Viewer.Note: Alarm annunciation will resume at both the ViSi Mobile Monitor and Remote Viewer.Alarms are currently paused.Remaining “Paused” duration.Resume alarms
Managing Alarm Annunciations1016.5.2 Turn Alarm Annunciation On / OffTo turn all alarms off1. Touch Menu on the Vital Signs screen. The Menu screen appears.2. Touch Alarms Settings. The Patient Alarm Limits screen appears. Alarm limit settings are only displayed for the connectedsensors.3. To turn all alarms off, touch Turn Alarms Off. The Turn Alarms Off confirmation screen appears.When alarms are turned OFF, there is no notification of a potentiallyclinically significant change in the patient's vital signs. Observe the patientby other means when alarms are turned OFF.All Sensors ConnectedTurn Alarms OffAuto SetReturn to Previous Screen
Managing Alarm Annunciations 1024. Touch Confirm to confirm that you want to turn all alarms off. -or-Touch Cancel to leave the alarms turned on. If cancelled, the system returns to the Patient Alarm Limits screen and the alarms remain turnedon.If confirmed, the alarms are turned off and the Vital Signs screen appears. The words ALARMSOFF are displayed at the top of the screen and an ALARMS OFF icon is displayed in the lowerright corner of the screen. Note: Alerts that indicate the Monitor is unable to measure a vital sign (such as ECG Lead Fail)can not be turned off.To Turn On Alarm Annunciation When alarms are turned off, the annunciation of any existing and new alarm will be disabled at both theViSi Mobile Monitor and Remote Viewer. Alarms may be turned back on directly from the RemoteViewer.ALARMS OFF Icon(flashes on/off)Alarms are currentlyTurn alarmsturned offback on(flashes on/off)
Managing Alarm Annunciations103To turn the alarm annunciation back on, touch the Turn Alarms On button. - or - Touch the Alarm Status. The alarms will be turned back on.Note: Alarm annunciation will be turned on at both the ViSi Mobile Monitor and Remote Viewer.
Manage Alarm Limits 1046.6 Manage Alarm LimitsAlarm limits for each vital sign parameter are predefined and turned on automatically whenever a sensor isconnected to the patient and to the Monitor. Sometimes it is desirable to adjust the alarm limits to meet apatient’s monitoring requirements.The Auto Set function sets alarm limits based on the current vital signs measurements for all connectedsensors. If the alarms are turned off prior to initiating the Auto Set process, the alarms are turned back onwhen the new alarm limits are confirmed.To change alarm limits using Auto Set1. Touch Menu on the Vital Signs screen. 2. Touch Alarms Settings. The Patient Alarms Settings screen appears.Note: Alarm limit settings are only displayed for the currently monitored vital signs. 3. Touch Auto Set. Alarm limits for all currently monitored vital signs are recalculated based on the current vitalsigns measurements. The Confirm New Alarm Limits screen appears.Once new alarm limits are confirmed, they cannot be changed back to theoriginal pre-set limits. Once Auto Set is selected, review the newlycalculated alarm limits carefully before deciding to confirm or cancel the newalarm limits.
Manage Alarm Limits105Note: Upper and lower alarm limits cannot be set for TEMP.4. Touch Confirm to confirm that you want to accept the new alarm limits. -or-Touch Cancel to return to the Patient Alarm Limits screen. The previous alarm limits are retained.Once confirmed, the system returns to the Vital Signs screen. 5. Navigate to the Patient Alarm Limits screen to review the current alarm limits. When selecting Auto Set, alarm limits are calculated to clinically relevant values based on the patient’spresent condition. Auto Set is not available for SpO2 and temperature. The minimum and maximumvalues to which auto set will adjust the limits are listed in the table below.Note: There is no manual way set individual alarm limits. Auto Set recalculates all alarm limits.Auto Set Alarm LimitsAlarm Limit Default Limits Auto Set Range Auto Set Limit Calculation(based on current reading)Heart Rate (BPM) High 140 90-160 HR x 0-66 + 53.3Low 40 30-80 HR x 0.54 + 13.6Pulse Rate (BPM) High 140 90-160 PR x 0-66 + 53.3Low 40 30-80 PR x 0.54 + 13.6BP Systolic (mmHg) High 190 160-240 BP x 0.75 + 60.0Low 90 60-120 BP x 0.71 + 17.1BP Diastolic (mmHg) High 120 95-150 BP x 0.60 + 60.0Low 40 30-90 BP x 0.72 + 8.3Respiration (BR/M) High 35 12-40 RR x 0.69 + 12.5Low 6 5-8 RR x 0.28 + 3.6
Manage Alarm Limits 106Auto Set Alarm Limits(Heart Rate / Respiration)
Manage Alarm Limits107Auto Set Alarm Limits(Blood Pressure)
Manage Alarm Limits 1086.6.1 Testing AlarmsWhenever a sensor is connected to the Monitor, a self-test of that sensor is initiated automatically to verifythe sensor is in good working order. If the sensor and Monitor speaker are in good working order, you willhear a double beep.Do not cover the microphone of the Monitor during the self-test
1097. User Maintenance7.1 IntroductionThis section of the manual outlines routine maintenance that should be performed by the user. The ViSiMobile Monitoring System is designed for stable operation over long periods of time and, under normalcircumstances, should not require technical maintenance beyond that described in this section. However, itis recommended that routine maintenance (including checking components for damage), calibration, andsafety checks be performed at least once a year as required by your facility administration practice.Routine testing of functionality, alarms and alerts can be verified using standard electronic patientsimulators.In the event any component needs to be returned to Sotera Wireless, Inc; contact the Sotera Wireless Inc.Customer Service Department or the Sotera Wireless representative in your area. Prior to shipping, ensurethe returned components have been properly disinfected.The ViSi Mobile Cuff Module contains an air filter that should be inspected by the Bio Med in accordanceto the service schedule as described in the Technical Reference Manual. The ViSi Mobile Disposable Cuffshould be used on one and only one patient.For more technical information, refer to the ViSi Mobile Monitoring System Technical Manual.7.2 Cleaning and DisinfectionThe ViSi Mobile Monitor, Cuff Module, Chest Sensor Cable and Thumb Sensor require cleaning anddisinfection prior to reuse on a different patient.The ViSi Mobile Monitoring System components should only be serviced bySotera Wireless, Inc. technicians or authorized service providers. To prevent possible cross-contamination, properly clean and disinfect allreusable components between patients.Do not clean the ViSi Mobile Monitor with detergents while worn by thepatient.
Cleaning and Disinfection 110Prior to cleaning and disinfecting:1. Pre-clean at the point of use to remove and prevent drying of soil and contaminants.2. Ensure all components are disconnected, including the ViSi Mobile Monitor from the Wrist Cradleand Thumb Sensor from the Thumb Cradle.After cleaning and disinfection is complete, inspect the System components for wear, damage,discoloration, fraying and cracking. Replace any System components that show evidence any of theseanomalies.Do not clean the ViSi Mobile Monitor while it is plugged into the ViSi MobileCharger.Do not clean the ViSi Mobile Cuff Module while it is plugged into the ViSiMobile Charger.Do not apply liquid to the ViSi Mobile Cuff Module. To clean, use a dampcloth.Ensure the sensor connector contacts are thoroughly dried to preventpossible malfunction.Thumb sensors which are saturated with fluid should be allowed to air drythoroughly before re-use.
Inspecting Equipment and Accessories111To clean the ViSi Mobile Monitoring System components1. Hand wash the System components using mild soap or detergent and water. Use moistened lint-free cloths to remove residual cleaner.A soft-bristled brush may be used for heavily soiled areas, where needed.2. Dry the System components using a lint-free cloth.3. Visually examine each System component to ensure all soil contaminants have been removed.4. Repeat the above cleaning process as required.To disinfect the ViSi Mobile Monitoring System components1. Disinfect all System components by wiping components with a lint-free cloth moistened withisopropyl alcohol.2. Dry thoroughly using a lint-free cloth.7.3 Inspecting Equipment and AccessoriesAfter cleaning and disinfecting, you should visually inspect the ViSi Mobile Monitoring Systemcomponents:1. For each component, examine the exteriors for cleanliness and general physical conditions.Ensure the housings are not cracked or broken, that everything is present, there are no spilledliquids and no signs of abuse.2. Inspect all component cables for damage. Check their strain relief for general condition. Ensurethere are no breaks in the insulation. If any cables show signs of damage, do not use.3. Inspect all disposable accessories (Wrist Cradle, Cuff, Thumb Strap, Securements, etc). If anyshow signs of damage or pre-use, do not use.Do not use abrasive cleaning agents or organic solvents on any of the ViSiMobile Monitoring System components.Use only recommended cleaning / disinfecting agents to prevent damage tothe device and components.Do not autoclave the ViSi Mobile Monitor, its components, or accessories.Do not use excessive amounts of liquid when cleaning the ViSi Mobile ChestSensor Cable or the ViSi Mobile Thumb Sensor.
Product Disposal 1127.4 Product DisposalThe ViSi Mobile Monitoring System components are designated for separate collection at an appropriatecollection point. Do not dispose of as household waste. Refer to your facility’s procedures.Disposables from the ViSi Patient Kit should be disposed of per your facility’s procedures for bio-hazardmaterials.Contact the Sotera Wireless Inc. Customer Service Department or the Sotera Wireless representative inyour area to obtain additional information about cleaning and disinfecting the ViSi Mobile MonitoringSystem components or product disposal.To avoid contaminating or infecting personnel, the environment or otherequipment, make sure you disinfect and decontaminate the ViSi MobileMonitoring System components appropriately before disposing of them inaccordance with your country’s laws for equipment containing electrical andelectronic parts.After patient use, the disposables from the ViSi Patient Kit may contain bio-hazard materials.
1138. Troubleshooting8.1 IntroductionThe ViSi Mobile Monitoring System is designed to alert you to technical issues that may occur whilemonitoring a patient’s vital signs. The following tables provide troubleshooting solutions to potential problems that may be encounteredwhile monitoring a patient
ViSi Mobile Monitor 1148.2 ViSi Mobile Monitor8.2.1 Screen AccessProblem Potential Cause SolutionThe screen is blank The display is in Quiet Monitoring Mode.Touch the screen with one finger for two seconds to activate display.Plug in a sensor to initiate monitoring.The display is in Hibernation Mode.Plug in a sensor to initiate monitoring.The battery charge is too low. Disconnect all sensors from the Monitor, clean the Monitor, and place it in the Charger.Sensors won’t Plug into the MonitorPlug is oriented with the connector contacts facing downwards.Orient the Plug so that the connector contacts are facing upwards.Trying to Plug into wrong end of the Monitor.Only the Thumb Sensor is designed to be Plugged into the rounded end of the Monitor. All other sensors can be Plugged into any port on the flat end of the Monitor.Problem Potential Cause SolutionNo response to touching any buttonsTouching the screen with more than one finger.Touch the button with only a single finger.Button is not an active button. Active buttons are those with borders, and are not dimmed in appearance compared to other buttons.Touching the screen with a pen or stylus.Touch the button with only a single finger.Cannot access the Vital Signs screenScreen is locked. Touch the Unlock button and enter the correct PIN.Access denied due to entering the wrong PIN code.Enter the correct PIN code.
ViSi Mobile Chest Sensor Cable1158.3 ViSi Mobile Chest Sensor CablePatient has accessed the monitoring functionsScreen was not locked after last clinician interaction.• Make sure to lock the screen each time you complete your interactions.• Remind the patient that this is a med-ical device, and that tampering may result in missing important clinical events.Patient guessed PIN correctly. • Define appropriate PIN codes (not 0000 for example).• Remind the patient that this is a med-ical device, and that tampering may result in missing important clinical events.Problem Potential Cause SolutionChest sensor Cable is too short to Plug into the MonitorMonitor is oriented in the wrong direction.Make sure that the flat end of the Monitor is oriented towards the elbow.The Chest Sensor Cable is secured to the side of the chest opposite the arm with the Monitor.Secure the Chest Sensor Cable midway between the sternum and the shoulder of the same arm that the Monitor is on.No HR numeric ECG electrodes not connected to lead wires.Ensure that the lead wires are snapped securely onto the ECG electrodes.ECG electrodes not firmly attached to the patient’s chest.Ensure that the ECG electrodes are securely attached to the chest; ECG electrode sites are clean and free of excess hair.ECG electrode gel is dry. Replace ECG electrodes.Broken/damaged lead wires. Replace damaged Chest Sensor Cable.Chest Sensor Cable not securely Plugged into the Monitor.Make sure that the Chest Sensor Cable is securely Plugged into the Monitor.HR displays “XX” A lead-wire or sensor problem is affecting the measurement.If the problem persists, replace the ECG electrodes and/or Chest Sensor Cable.Problem Potential Cause Solution
ViSi Mobile Chest Sensor Cable 116HR is erratic ECG electrodes are not all the same.Use all the same ECG electrode type, size, materials, and manufacturer.ECG electrode gel is dry. Replace ECG electrodes.ECG electrodes not firmly attached to the patient’s chest.Check the ECG electrodes are securely attached to the chest; ECG electrode sites are clean and free of excess hair.No ECG waveform See No HR numeric above. See No HR numeric above.ECG waveform too small Using a 3-lead Chest Sensor Cable: Lead II has a low amplitude.Lead II only available with a 3-lead Chest Sensor Cable.• Select alternate ECG electrode sites; prepare skin sites; connect lead wires to new ECG electrodes and place on the chest.• Replace 3-lead Chest Sensor Cable with 5-lead Chest Sensor Cable.Using a 5-lead Chest Sensor Cable: Selected lead has low amplitude.5-lead Chest Sensor Cable: select a different lead to view.ECG waveform is noisy; looks like pacer indicators in the waveformECG electrodes not firmly attached to the patient’s chest.Ensure that the ECG electrodes are securely attached to the chest; ECG electrode sites are clean and free of excess hair.ECG electrode gel is dry. Replace ECG electrodes.No RESP numeric See No HR numeric above. See No HR numeric above.The Monitor is not capable of measuring RESP.See Bio Med.RESP displays “XX” A lead-wire or sensor problem is affecting the measurement.If the problem persists, replace the ECG electrodes and/or Chest Sensor Cable.RESP is erratic ECG electrodes not firmly attached to the patient’s chest.Ensure that the ECG electrodes are securely attached to the chest; ECG electrode sites are clean and free of excess hair.ECG electrode gel is dry. Replace ECG electrodes.No TEMP numeric The Chest Module sensor is placed on the patient with the Temperature Sensor facing away from the patient.Place the Chest Module sensor on the patient such that the Temperature Sensor is in direct contact with the patient’s chest.Sensor is not attached to the patient’s chest.Secure the Chest Sensor Cable to the chest. Make sure that a change in position does not affect the sensor’s contact with the skin.TEMP displays “XX” The Temperature Sensor may have failed.If the problem persists, replace the Chest Sensor Cable.Problem Potential Cause Solution
ViSi Mobile Chest Sensor Cable117TEMP is erratic Chest Sensor Cable is not in contact with the skin completely/securely.Secure the Chest Sensor Cable to the chest. Make sure that a change in position does not affect the sensor’s contact with the skin.Skin is not clean and dry. Clean and dry the skin thoroughly and secure the Chest Sensor Cable to the chest.Problem Potential Cause Solution
ViSi Mobile Thumb Sensor 1188.4 ViSi Mobile Thumb SensorProblem Potential Cause SolutionSensor cable too short to Plug into MonitorMonitor is oriented in the wrong direction.Make sure that the rounded end of the Monitor is oriented towards the hand.Thumb sensor is routed wrong. Make sure the cable is routed around the outside of the thumb.No SpO2 numeric Broken/damaged Thumb Sensor. Replace the Thumb SensorSomething is blocking the optics or detector in the Thumb Sensor.Make sure nothing is blocking the optics or detector.Thumb Sensor not secured in the Thumb Sensor Cradle.Place the Thumb Sensor securely in the Thumb Sensor cradle.Thumb Sensor not secured to the base of the thumb.Secure the Thumb Sensor to the base of the thumb.Thumb Sensor not securely Plugged into the Monitor.Make sure that the Thumb Sensor is securely Plugged into the Monitor.SpO2 displays “XX” A sensor problem is affecting the measurement.If the problem persists, replace the Thumb Sensor.SpO2 is erratic Something is partially blocking the optics or detector in the Thumb Sensor.Make sure nothing is blocking the optics or detector.Thumb Sensor not secured to the base of the thumb.Secure the Thumb Sensor to the base of the thumb.Thumb Sensor is not in the correct location.Reorient the Thumb Sensor at the base of the thumb and secure with the Thumb Wrap.Thumb Strap is too tight. Loosen the Thumb Strap making sure that it is still secure.
ViSi Mobile Cuff Module1198.5 ViSi Mobile Cuff ModuleProblem Potential Cause SolutionCuff Module cable is too short to Plug into MonitorMonitor is oriented in the wrong direction.Make sure that the flat end of the Monitor is oriented towards the arm.Cuff Module is on the arm opposite the Monitor.Place the Cuff Module on the same arm that the Monitor is on.No NIBP measurement Battery charge is too low. Replace the Cuff Module.Cuff Module not Plugged securely into the Monitor.Make sure that the Cuff Module is Plugged securely into the Monitor.Not set up for automatic measurements.From the NIBP Settings screen, select an automatic interval.The time from the last measurement exceeds the period of time to display a measurement.Initiate a measurement from the Vital Signs screen.NIBP measurement doesn’t match an auscultatory measurementMeasurements were not taken at the same time.Measurements are taken at the same time.Measurements were taken on different arms.The BP in both arms is the same, sometimes there is a difference between arms.Different size cuffs were used. Ensure the BP cuff size is the same on both arms, and the correct size for the arm.Both arms were not at the same level when the BP was measured.The arms are positioned at the same level relative to the heart.
ViSi Mobile Cuff Module 120LED on Cuff Module displays red when in the Charger.Voltage level has exceeded expectation.• Remove Cuff Module from the Char-ger.• Report the problem to Sotera Wire-less Inc. Customer Service Depart-ment or the Sotera Wireless representative in your area.Current level has exceeded expectation.• Remove Cuff Module from the Char-ger.• Report the problem to Sotera Wire-less Inc. Customer Service Depart-ment or the Sotera Wireless representative in your area.Over temperature protection current temperature has exceeded expectation.• Remove Cuff Module from the Char-ger.• Report the problem to Sotera Wire-less Inc. Customer Service Depart-ment or the Sotera Wireless representative in your area.Problem Potential Cause Solution
ViSi Mobile Battery Charger1218.6 ViSi Mobile Battery ChargerProblem Potential Cause SolutionBatteries in the Monitor and Cuff Module do not chargeThe Monitor and Cuff Module are not securely seated in the Charger.Make sure that the Monitor and Cuff Module are securely seated in the Charger.The monitor and Cuff Module are designed to fit into the Charger in one direction.The Charger is not completely Plugged in to the wall socket.• Make sure that the Plug is securely Plugged into an active wall socket and there is a green light on the Bat-tery Charger.• Make sure that the power cord is not damaged.AC Adapter is not Plugged into the Charger.• Plug the AC Adaptor into the Char-ger.
General Troubleshooting 1228.7 General Troubleshooting8.7.1 Connectivity Lost8.7.2 Alarms and AlertsProblem Potential Cause SolutionOn the ViSi Mobile Remote Viewer, “XX” appears where all vital sign measurements should be displayed.The patient wearing the ViSi Mobile Monitor has moved outside of the wireless network area.Move the patient back into the wireless network area.On the ViSi Mobile Remote Viewer, all patients have disappeared from the Care Unit area.The network cable has been disconnected from the ViSi Mobile Remote Viewer.Reconnect the network cable to the Remote Viewer.If you test the speaker at the ViSi Mobile Remote Viewer and the tone doesnot sound or it is not loud enough, immediately contact a biomedicalengineer. The test indicates how alarm and alert tones sound at the RemoteViewer. If the sound is inadequate, clinicians could miss alarms and alerts.Problem ExplanationI acknowledge an alarm at the ViSi Mobile Remote Viewer, but the audio tone still occurs at the ViSi Mobile Monitor.• Life-Threatening alarms latch at the ViSi Mobile Monitor until they are acknowledged there, even if the alarm condition resolves. • Certain alerts (such as a sensor being discon-nected) continue to sound at the ViSi Mobile Monitor until you acknowledge the alert at the Monitor.An alarm occurs, but the audio tone stops before I acknowledge it.• If an alarm or alert condition resolves before it is acknowledged, the audio tones stops.• If the alarm condition was a high-level severity, the alarm message will remain visible (in gray) for five minutes.I stop monitoring a patient at the ViSi Mobile Monitor, according to procedure, but a MONITOR STOPPED alert still appears on the ViSi Mobile Remote Viewer.The alert informs all clinicians who are remotely monitoring the patient that monitoring has stopped.Acknowledge the alert to remove the patient from the care unit.My patient had a vital sign alarm. I did not acknowledge the alarm, but I removed the sensor from the patient. The vital sign alarm continued.You must acknowledge the vital sign alarm, even if the sensor is removed.
General Troubleshooting123An alert with the icon and PATIENT TAMPERING message occurred. What does it mean?Someone has unsuccessfully tried to log in to the ViSi Mobile Monitor five or more times.The visual indications go away after the alert is acknowledged and after a clinician successfully logs in at the Monitor.When an alarm or alert occurs, the audio annunciation is heard on the ViSi Remote Viewer, but there is no audio on the ViSi Mobile Monitor.Most alarms and alerts will audible annunciate at the ViSi Remote Viewer before they audibly annunciate at the ViSi Mobile Monitor.This is to minimize disturbing the patient.Sometimes if more than one alarm or alert occurs for a patient at the same time, one or more of the messages don’t show.• If the alarms or alerts are the same severity level, the messages will cycle through.• Messages for alarms or alerts that are at a lower severity level will not be displayed.• If alarms and alerts occur simultaneously, only messages associated with the alarms will be dis-played.• Other visual indications usually show for lower level alarms and alerts.Sometimes I acknowledge an alarm or alert, and all alarm or alert indications go away. The audio tone never returns.Some alarms and alerts are acknowledged permanently.At the ViSi Mobile Monitor, I set all alarming to OFF, or I set all alarming to PAUSED. But some alarms and alerts continue to be annunciated.Some important alarms and alerts (such as sensor being disconnected) will continue to annunciate even when all alarms are turned off, or paused.When an alarm or alert occurs, the ViSi Mobile Remote Viewer does not sound an audio tone, or the tone is not loud enough.• Some alerts do not have an audio tone. When an audio tone is associated with an alarm or alert, the Speaker Test button will animate.• When an audio tone is expected, but not present (or not loud enough), immediately contact a Bio Med.• The speaker volume for the ViSi Mobile Remote Viewer can be tested at any time (see section ViSi Remote Viewer Audio Test on page 67).The ViSi Mobile Remote Viewer displays a CONNECTIVITY LOST alert, what does it mean? The ViSi Mobile Monitor is no currently connected to the network.Problem Explanation
ViSi Mobile Remote Viewer 1248.8 ViSi Mobile Remote Viewer8.8.1 Setting Alarm LimitsProblem ExplanationWhen I try to adjust individual limits in the Alarm Settings pane, I cannot go past certain limit values.You cannot set limits beyond the care unit alarm limits.When I adjust an upper limit, the lower limit also changes, or vice versa.If you adjust a vital sign limit to equal the opposite limit, the opposite limit adjusts. Upper and lower limits for a vital sign cannot be the same value.The alarm limits on the ViSi Mobile Monitor and the limits at the ViSi Mobile Remote Viewer do not match.The alarm limits were set on the ViSi Mobile Monitor while the Monitor was not connected to the network. The new limits will not be communicated back to the ViSi Remote Viewer until the Monitor reconnects to the network.The alarms were changed on the ViSi Remote Viewer but before the new alarm limits were communicated to the ViSi Mobile Monitor, the Monitor moved out of network.The limits on the Monitor are the operating limits at all times.
1259. Specifications9.1 IntroductionThis section provides specifications regarding measurement ranges, accuracy levels and environmentaloperating conditions for the ViSi Mobile Monitoring System.Do not use the ViSi Mobile Monitoring System in neonatal or pediatricpatients under the age of 12 years since the System has not been tested forthese patient groups.
Vital Sign Measurements 1269.2 Vital Sign Measurements9.2.1 Heart RateHeart RateDisplay Range 0 to 240 BPMAccuracy Range 30 to 240 BPMAccuracy 3 BPM or ±3% of reading, whichever is greaterResolution 1 BPMPacemaker • The monitor detects and rejects pacemaker impulses in accordance with AAMI EC13:2002• Performs heart rate calculations on a patient with a pacemaker• Will not recognize a pacemaker impulse as a QRS• Displays pacer markers on ECG waveformsPacemaker Pulse Rejection Without OvershootTested per EC13:2002, 4.1.4.1:Pulse Rejection Range: Amplitude from ±2 mV to ±700 mVPulse Width from 0.1 ms to 2 msNote: Amplitude limited to 660mV forpulse widths from 1.5 to 2.0msIndicated Heart Rate:Ventricular Pacing: Case (a): 0 BPMCase (b): 60 BPMCase (c): 30 BPMAtrial / Ventricular Pacing: Case (a): 0 BPMCase (b): 60 BPMCase (c): 30 BPMPacemaker Pulse Rejection With OvershootTested per EC13:2002, 4.1.4.2, Method A:Pulse Rejection Range: Amplitude from ±2 mV to ±700 mVPulse Width from 0.1 ms to 2 msNote: Amplitude limited to 660mV for pulse widths from 1.5 to 2.0msNote: For pulse width > 1.0mS, recovery time limited to 25mS.Indicated Heart Rate:Ventricular Pacing: Case (a): 0 BPMCase (b): 60 BPMCase (c): 30 BPMAtrial / Ventricular Pacing: Case (a): 0 BPMCase (b): 60 BPMCase (c): 30 BPM
Vital Sign Measurements127Pacer Pulse Detector Rejection of Fast ECG SignalsTested per EC13:2002, 4.1.4.3:• Minimum Slew Rate: 25 V/sDefibrillation Response • Defibrillator protected• Displays HR measurement < 30 seconds after a defibrillation event• Displays an ECG waveform < 10 seconds after a defibrillation eventNote: Defibrillation events may be implanted or external.Note: Defibrillation recovery is dependent upon using proper disposable electrodes. Use only Ag-AgCl disposable electrodes.T-Wave Rejection Tested per EC13:2002, 5.1.2.1:• T-waves up to 1.2 mV in amplitude:• T-waves not detected, no change in indicated heart rate.Heart Rate Averaging Tested per EC13:2002, 5.1.2.1 d): • 10 second moving averageHeart Rate Accuracy and Response to Irregular RhythmTested per EC13:2002, 5.1.2.1 e):• Waveform 3a: 80 BPM• Waveform 3b: 30 BPM• Waveform 3c: 120 BPM• Waveform 3d: 60 BPMChange in Heart Rate Tested per EC13:2002, 5.1.2.1 f):• 80 BPM to 120 BPM: < 8 seconds• 80 BPM to 40 BPM: < 8 secondsTime to Alarm for Cardiac StandstillTested per EC13:2002, 4.2.8.4:• < 10 secondsTime to Alarm for TachycardiaTested per EC13:2002, 5.1.2.1 g):Figure 4a:• Gain = 1.0x: 22 secs• Gain = 2.0x: 21 secs• Gain = 0.5x: 10 sec with HR = 0Figure 4b:• Gain = 1.0x: 16 secs• Gain = 2.0x: 18 secs• Gain = 0.5x: 31 sec with HR = 0Input Impedance > 20 MohmsFrequency Response 0.5 to 125HzLead Off Detection Current < 6 nACommon Mode Rejection Ratio> 85 dbHeart Rate
Vital Sign Measurements 1289.2.2 RespirationRespirationMethod Impedance PneumographyDisplay Range 0 to 50 BR/MINAccuracy Range 3 to 50 BR/MINAccuracy ± 3 BR/MIN or 10% of reading, whichever is greaterResolution 1 BR/MINRespiration Drive Voltage: 1.00 V P-P ±5%Frequency: 32.0 KHz ±2%
Vital Sign Measurements1299.2.3 Pulse Oximetry (SpO2, Functional Oxygen Saturation)Pulse Oximetry (SpO2, Functional Oxygen Saturation)Normative Reference ISO 9919: 2005SpO2 Display Range 49 to 100%Accuracy Range 70 to 100%Accuracy ≤ 2% from 70-100% (no motion)aUnspecified from 49-69%a. Bench testing indicates accuracy may be compromised at pulse rates below 50BPM at modulations less than 0.6% and extremely low pulse rates of 30BPM at modulations less than 0.8%.Resolution 1%Pulse Rate Display Range 0 to 240 BPMAccuracy Range 30 to 240 BPMAccuracy(No Motion)± 3 BPM; < 50 BPM @ ≥ 0.6% Pulsatile Modulation± 3 BPM; ≥ 50 BPM @ ≥ 0.4% Pulsatile ModulationAccuracy (RMS Error) ≤ 3 BPMRate Resolution 1 BPMValidation Study Per ISO 9919. The ViSi SpO2 is calibrated to display functional oxygen saturation and validated against human subjects arterial blood sample reference measured with CO-Oximeter (see table below).Note: A functional tester cannot be used to assess the accuracy of apulse oximeter probe or a pulse oximeter monitor.Calculation Rate Every pulseDisplay Refresh Rate Every 3 secondsAveraging 12 beat average following initializationAlarm Range Low - Fixed at 85%Alarm Delay 30 seconds (fixed)Waveform Display • Amplitude is normalized• Sweep speed is scaled to 25mm/sec to match ECGSensor Application Time Sensor should be checked every 8 hoursOptical Wavelengths / powerRed: 660nM / max 6.5mW (±15%)Infra-Red: 905nM / max 5.2mW (±15%)Interference SpO2 can be adversely effected by the presence of dyshaemoglobins, ambient light (including photosynamic therapy); electromagnetic interference; electro-surgical units; dysfunctional hemoglobin; presence of certain dyes; inappropriate positioning of the pulse oximeter probe.Toxicity Thumb sensor uses white silicone which has no known toxicity effects.
Vital Sign Measurements 130The table below shows Arms values measured using the ViSi Mobile Thumb Sensor (Model 92-10020) withthe ViSi Mobile Monitoring System in a clinical study:Validation Data (per ISO 9919)Age of Volunteers 18 - 45SpO2 Accuracy (No Motion)Spo2 Range 70-100% 90-100% 80-90% 70-80%Accuracy (Arms) - No Motion 1.9 1.2 1.9 2.4Bland-Altman: ViSi Mobile Pulse Oximetry
Vital Sign Measurements1319.2.4 Non-Invasive Blood Pressure (NIBP)Non-Invasive Blood Pressure (NIBP)Normative Reference ISO 81060-2: Non-invasive Sphygmomanometers - Part 2: Clinical validation of automated measurement type.Principle of Operation OscillometrySystolic Range: 60 to 240 mmHgAccuracy: Mean error of less than ± 5 mmHg and a std.dev. of ≤ 8 mmHgResolution: 1 mmHgDiastolic Range: 40 to 160 mmHgAccuracy: Mean error of less than ± 5 mmHg and a std.dev. of ≤ 8 mmHgResolution: 1 mmHgPulse Rate Accuracy (NIBP) <3 BPMValidation Study Dual auscultatory observerReference: ISO 81060-2 First Edition 2009-05-01, Section 5.2.4.1, same arm simultaneous method.Number of subjects: 85Subject age range: 18-79 yearsSubject posture during data collection: Seated with feet on ground per ISO 81060-2
Vital Sign Measurements 132Sample Size: 255 data pointsMean: 12.7 mmHgStandard Deviation: 6.6 mmHgLinear Regression (Bland-Altman): Y = -0.06974 x +6.0599Upper 95% Limits of Agreement (+1.96 SD): 10.3 mmHgUpper 95% Limits of Agreement (-1.96 SD): -15.7 mmHgSample Size: 255 data pointsMean: 3.5 mmHgStandard Deviation: 6.3 mmHgLinear Regression (Bland-Altman): Y = -0.05962 x +1.0917Upper 95% Limits of Agreement (+1.96 SD): 15.9 mmHgUpper 95% Limits of Agreement (-1.96 SD): -8.9 mmHgSystolic Bland Altman AnalysisDiastolic Bland Altman Analysis
Vital Sign Measurements1339.2.5 TemperatureTemperatureScale oCoFRange / Accuracy(measurement at approximately 102 kPa / 768 mmHg)Range Accuracy Range Accuracy0o - 19.9o±0.3o 32o - 67.9o±0.5o20o - 24.9o±0.3o68o - 76.9o±0.5o25o - 35.9o±0.2o77o - 96.7o±0.3o36o - 39.9o±0.1o96.8o - 103.9o±0.2o40o - 41.9o±0.2o104o - 107.5o±0.3o42o - 50.0o±0.3o107.6o - 122o±0.5oResolution ± 0.1o± 0.1oTransient Response < 6 min (25o - 37o) < 6 min (77o - 98.6o)
Physical Components 1349.3 Physical Components9.3.1 ViSi Mobile MonitorWireless Communications / RadioViSi Mobile MonitorPhysical Characteristics Dimensions 2.59 cm H x 4.85 cm W x 9.35 cm L 1.02 in. H x 1.91 in. W x 3.68 in. Lexclusive of connectors and Wrist CradleWeight 110 g / 3.92 ozMonitor Display OLED, 160 x 128 pixels, full colorAudio Alarm annunciation, QRS, self-testWaveforms One waveform, user selectableAspect Ratio: 0.4 Sec/mVScaled equivalent to 25 mm/sec sweep speedRespiration waveform scaled equivalent to 6.25 mm/sec sweep speedBattery Operating Time > 12 hoursFuel Charge Display Battery SymbolCharge Level with Full IndicationCharge Time Less than 4 hoursBattery Type Li-Ion, 3.7 V., 2000 mAh, single cellCleaning / Disinfecting Liquid Ingress Rating IPX7During cleaning cycle only, not during monitoringSolutions / Compounds • Isopropyl alcohol (IPA)• Green soapWireless CommunicationsFrequency 2.402 - 2.480 GHzProtocol 802.11bModulation Direct Sequencing Spread SpectrumSecurity WPA2 / PSKPower Output (max) 8 mW (9 dBm)WiFi Alliance Compliant Yes; Reference Protocol: ASD 0478Data Throughput < 20 KBpsIf you have any concerns regarding a Cybersecurity breach or vulnerability, contactSotera Wireless or an authorized Sotera Wireless representative in your area.
Physical Components135Mode PlugsMode PlugsShipping Plug Turns device off completelyBio Med Plug Enables configuration and test functionsLocking Plug Secures Monitor into Wrist Cradle
Physical Components 1369.3.2 ViSi Mobile Chest Sensor CableViSi Mobile Chest Sensor CableMechanical Complies with EC53Length 54 cm (21.25 in)Weight(5 lead-wire / 3 lead-wire)72 g / 62 g (2.54 oz. / 2.19 oz.)Cleaning / Disinfecting Liquid Ingress Rating IPX7During cleaning cycle only, not during monitoringSolutions / Compounds • Isopropyl alcohol (IPA)• Green soap
Physical Components1379.3.3 ViSi Mobile Cuff ModuleViSi Mobile Cuff ModulePhysical Characteristics Dimensions 3.10 cm H x 4.85 cm W x 12.19 cm L(1.22 in. H x 1.91 in. W x 4.80 in. L)exclusive of cableWeight 157 g (5.54 oz)Battery Operating Time > 30 cuff inflations or 24 hrs, whichever occurs firstCharge Display Status Eight LEDs: Six levels of Green, Yellow, RedCharge Time < 4 hoursBattery Type Battery Pack, Li-Ion, 2000 mAhCuff Sizes SmallMediumLargeCleaning / Disinfecting Liquid Ingress Rating IPX0During cleaning cycle only, not during monitoringSolutions / Compounds • Isopropyl alcohol (IPA)• Green soapWhen the ViSi Mobile Cuff Module is connected to the other ViSi MobileComponents, the entire system has an ingress protection rating of IPX0.
Physical Components 1389.3.4 ViSi Mobile Thumb SensorViSi Mobile Thumb SensorCleaning / Disinfecting Liquid Ingress Rating IPX7During cleaning cycle only, not during monitoringSolutions / Compounds • Isopropyl alcohol (IPA)• Green soap
Physical Components1399.3.5 ViSi Mobile ChargerViSi Mobile ChargerPhysical Characteristics Dimensions 7.64 cm. H x 12.7 cm. W x 6.35 cm. L(3 in. H x 5 in. W x 2.5 in. L)Weight 1.59 kg / 3.5 lbsAC Mains Power Supply D.C. Input to Charger: 15VDCAC Line Voltage 90-264 VAC, 47-63 HzPower (while charging) 50 w maxCleaning / Disinfecting Liquid Ingress Rating IPX0 During cleaning cycle only, not during monitoringSolutions / Compounds • Isopropyl alcohol (IPA)• Green soap
Physical Components 1409.3.6 ViSi Mobile ApplianceViSi Mobile ApplianceServer Configuration Single 1u, redundant hardware and internal RAID 10, dedicated hardware.\Processor Single Intel Xeon 56202.4 GHz (or equivalent CPU)8 GB memoryStorage Server contains (4) 500 GB 7200 RPM hard drives in RAID 6 arrayOperating System Note: SUSE Linux Enterprise Server (Version 11, Patch Level 2)Network Requirements Static IP address or DHCP reservation requiredMulticast configuration on network backbone devicesDimensions(Single Appliance, may vary)H: 43.0 cm x W: 43.4 cm x L: 62.7 cm (w/o ear, w/o bezel)H: 1.7 in x W: 17.1 in x L: 24.7 inWeight(Single Appliance)35.02 lbs (15.9 kg)(Maximum configuration weight)Power Requirements(Single Appliance)100-240 VAC, 50-60 Hz, 7 A - 3.5 A w/ redundant power supply Backup Power Requirement(Full System)Customer supplied Uninterruptable Power Supply and Hospital Emergency Power recommended.
Physical Components1419.3.7 ViSi Mobile Remote ViewerNote: Sotera Wireless recommends installation of Trend Micro anti-virus software on Windowsplatforms. Anti-virus software is not installed on the ViSi Mobile Appliance.ViSi Mobile Remote Viewer (Desktop PC with Touchscreen Display)No. of Patients per Remote Viewer Maximum 32Display 23 in display / 1920 x 1080 resolution(screen is touch sensitive to issue commands alternative to mouse/keyboard)Processor Intel i5 2400 CPU 4 Core3.10 GHz4 GB MemoryStorage One 500 GB 7200 RPM SATAOperating Systems Microsoft® Windows® 7 Professional (version 6.1) x64 Bit SP1Network Requirements Ethernet Connection, DHCPDimensions H: 45.0 cm x W: 58.5 cm x D: 10.3 cmH: 17.7 in x W: 23.0 in x D: 4.1 inWeight 26.7 lb (12.1 kg)Power Requirements AC/DC AdapterInput: 100-240 V ~3.5 A, 50-60 HzOutput to Viewer: 19.5 V / 11.8 ABackup Power Requirement Customer supplied Uninterruptable Power Supply and Hospital Emergency Power recommended.
Physical Components 1429.3.8 Customer NetworkWireless NetworkWireless Network Standard IEEE 802.11bRecommended Channels 1, 6, 11Network Latency < 150 msWireless Network Security Support WPA2-PSKMinimum Receiver Sensitivity -65 dBm (edge coverage)Wireless access point cell overlap 15-20%Signal-to-Noise Ratio ≥25 dBPacket loss <8%SSID Dedicated or shared with other medical devicesWired NetworkAppliance (Server) Requires static IP AddressNetwork availability >99.9%
Alarms / Alerts Annunciation1439.4 Alarms / Alerts AnnunciationNote: When the ViSi Mobile Monitor is connected to a network (as indicated by the networksymbol in the top left hand corner of the display), the audio annunciation of non-life-threatening alarms/alerts will be deferred to the Remote Viewer for a pre-configured periodof time. Within the tables below, see column “Deferral Delays” for the pre-defined periods oftime.9.4.1 Physiological Alarms (Alarms)Visual DisplayThe following table outlines the visual display when alarms are in progress:Audio TonesThe following table outlines the audio tones when alarms are in progress:Alarm Limits and Delays (factory default settings)Severity Indicator Attributes Toggle / Flash Speed Duty CycleHigh Priority Red 1.5Hz 50% ONLife-Threatening Priority Red / White 1.5Hz 50% ONSeverity Melodyaa. Melodies are defined as musical notes.Volume[db] Frequency(fo) [Hz] Duration(td) [ms] Spacing(ts) [ms] 5th-6th[s] Inter-Burst(tb) [s]Life Threatening b5.b5.b5..b5.b5 78 987.767 100 50 0.35 2.5High b5.b5.b5..b5.b5 78 987.767 200 100 0.35 5Vital Sign Lower Limit Upper Limit Annunciation Delay Deferral DelayCare Unit Patient Patient Care Unit Patient Care Unitaa. As the vital sign measurement approaches the care unit limit, the annunciation delay will decrease lin-early.Critical Low HR 18 18 N/A N/A N/A N/A N/AHeart Rate 30 40 140 160 N/A N/A 60Pulse Rate 30 40 140 160 30 30 60BP Systolic 70 90 190 240 N/A N/A 60BP Diastolic 40 50 120 150 N/A N/A 60Respiration 5 6 35 40 120 30 60SpO2 N/A N/A 85 85 30 30 60Skin Temp N/A N/A N/A N/A N/A N/A N/A
Alarms / Alerts Annunciation 144No Pulse Detected Alarms Limit DelaysAnnunciation DeferralWhen Thumb Sensor is primary source No Pulse 30 60When Cuff Module is primary source No Pulse N/A 60
Alarms / Alerts Annunciation145Battery AlarmsBattery Alarms Limit Delays (in seconds)Annunciation DeferralMonitorMonitoring Mode 50oC (122oF) N/A N/AIn the Charger 40oC (104oF) N/A N/ANot monitoring / Not in the Charger 40oC (104oF) N/A N/ACuffModuleConnected to the Monitor 50oC (122oF) N/A N/AIn the Charger 40oC (104oF) N/A N/ANot monitoring / Not in the Charger 40oC (104oF) N/A N/A
Alarms / Alerts Annunciation 1469.4.2 Equipment Alarms (Alerts)Visual DisplayThe following table outlines the visual display when alerts are in progress:Audio TonesThe following table outlines the audio tones when alerts are in progress:Note: There are no audio tones associated with low severity alerts.Alarm Limits and Delays (factory default settings)Severity Indicator Attributes Toggle / Flash Speed Duty CycleAll Severities Cyan (Blue) Constant (ON) 100% ONSeverity Melodyaa. Melodies are defined as musical notes.Volume[db] Frequency(fo) [Hz] Duration(td) [ms] Spacing(ts) [ms] Inter-Burst(tb) [s]High e5.c5 68/63 659.255, 523.251 250 250 3Medium e5.c5 68/63 659.255, 523.251 250 250 15Chest Sensor Alerts Limit(if applicable)Delays (in seconds)Annunciation DeferralECG Lead Failure N/A N/A 120All ECG Lead Failure N/A N/A 120Chest Sensor Disconnected N/A N/A 120General Fault Detected N/A N/A 120Multiple Connections N/A N/A N/ATemperature Sensor Fault N/A N/A 120Accelerometer Fault - Chest Module N/A N/A 120Accelerometer Fault - Upper Arm N/A N/A 120Thumb Sensor Alerts Limit(if applicable)Delays (in seconds)Annunciation DeferralSpO2 Signal Lost N/A < 30 120Thumb Sensor Off N/A < 30 120Thumb Sensor Disconnected N/A N/A N/AThumb Sensor Failure N/A 30 120
Alarms / Alerts Annunciation147SpO2 Unobtainable N/A 30 120Cuff Module Alerts Limit(if applicable)Delays (in seconds)Annunciation DeferralLow Battery 4% to 10% N/A 120Battery Empty < 4% N/A 120Cuff Leak N/A N/A 120Cuff Occluded N/A N/A 120NIBP Unobtainable N/A N/A 120Invalid Software Loaded N/A N/A 120Pressure Accuracy Fault N/A N/A 120General Fault Detected N/A N/A 120Pressure Exceeded N/A N/A 120Multiple Connections N/A N/A N/AWrist Monitor Alerts Limit(if applicable)Delays (in seconds)Annunciation DeferralLow Battery 120 minutes N/A N/ACritical Low Battery 30 minutes N/A 120Too Low to Monitor 10 minutes N/A N/AInvalid Plug Connected N/A N/A N/AAudio System Failure N/A N/A 120Wireless Radio Failure N/A N/A N/AAll Sensors Disconnected N/A N/A N/AAccelerometer Failure N/A N/A 120Shock Hazard N/A N/A 120Patient Tampering 5 Attempts N/A N/AMotion Alerts Limit(if applicable)Delays (in seconds)Annunciation DeferralHeart Rate Presence of motion N/A 120Pulse Rate Presence of motion N/A 120Respiration Presence of motion N/A 120SpO2 Presence of motion N/A 120Thumb Sensor Alerts Limit(if applicable)Delays (in seconds)Annunciation Deferral
Environmental Conditions 1489.5 Environmental Conditions9.6 Agency CompliancesEnvironmental Conditions for all ViSi Mobile Components(Monitor, Cuff Module, Chest Sensor Cable, Charger, Cuff, Thumb Sensor)Condition Storage(Packaged / Unpackaged) Operating(Unpackaged)Temperature -20oC to +55oC (50oC for NIBP)-4oF to +131oF (122oF for NIBP)0oC to +50oC32oF to +122oFHumidity 15% to 95% non-condensing(90% for NIBP)10% to 95% non-condensing(90% for NIBP)Atmospheric Pressure Range107 kPa to 50 kPa803 mmHg to 375 mmHg1.06 atm to 0.49 atm107 kPa to 70 kPa803 mmHg to 525 mmHg1.06 atm to 0.69 atmThe ViSi Mobile Monitor may not perform to specification if stored or shippedoutside the specified temperature range. Agency Compliances• ANSI/AAMI EC13, Cardiac monitors, heart rate meters, and alarms• ANSI/AAMI EC53, ECG cables and lead wires.• CAN/CSA C22.2 No 601.1 M90 Part 1: General requirements for basic safety and essential performance• IEC 60601-1 Medical electrical equipment - Part 1: General requirements for safety• IEC 60601-1-2, Med. Elect. Equipment – Part 1-2: General requirements for safety – Collateral standard: EMC – Req. and tests.• IEC 60601-1-4, Medical electrical equipment - Part 1-4: General requirements for safety – Collateral stan-dard: Programmable electrical medical systems• IEC 60601-1-6, Medical electrical equipment – Part 1-6: General requirements – Collateral standard: Usability.• IEC 60601-1-8, Medical electrical equipment – Part 1-8: Gen. req. – Col. Std. Gen. requirements, tests and guidance for alarm systems• IEC 60601-2-27, Medical electrical equipment, Part 2-27: Particular requirements or the safety, including essential performance, of ECG monitoring equipment• IEC 80601-2-30, Medical electrical equipment – Part 2-30: particular requirements for the safety, including essential performance, of auto. cycling non-invasive BP monitoring equipment. • ISO 9919, Medical electrical equipment - Particular requirements for the basic safety and essential perfor-mance of pulse oximeter equipment for medical use. • ISO 81060-2, Non-invasive sphygmomanometers - Part 2: Clinical validation of automated measurement type.• UL 60601-1 Part 1: General requirements for basic safety and essential performance
Safety and Performance Tests1499.7 Safety and Performance TestsYou must observe any national regulations on the qualification of the testing personnel and suitablemeasuring and testing facilities. See User Maintenance on page 109 for a list of required tests.9.7.1 Electromagnetic Compatibility (EMC) SpecificationsTake special precautions regarding electromagnetic compatibility (EMC) when using medical electricalequipment. You must operate your monitoring equipment according to the EMC information provided inthis manual. Portable and mobile radio frequency (RF) communications equipment can affect medicalelectrical equipment.Accessories Compliant with EMC StandardsAll accessories (e.g. ViSi Mobile Charger) comply with either IEC 60601-1-2 or IEC 60950-1.Consult your Bio Med department or vendors for assistance in identifyingEMC compliance status of other medical devices when using the ViSiMobile Monitoring System.Using accessories other than those specified may result in increasedelectromagnetic emission or decreased electromagnetic immunity of themonitoring equipment.
Safety and Performance Tests 1509.7.2 Electromagnetic EmissionsThe ViSi Mobile Monitor is suitable for use in the electromagnetic environment specified in the tablebelow. You must ensure that the Monitor is used in such an environment.Emissions Test Compliance Avoiding Electromagnetic InterferenceRadio Frequency (RF) emissions Group 1 The ViSi Mobile Monitor uses RF energy only for its internal functiona. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.a. The battery operated ViSi Mobile Monitor contains a 2.4 GHz DSSS transmitter for the purpose of wire-less communication. The radio is excluded for the EMC requirements of IEC 60601-1-2, but should be considered when addressing possible interference issues between this and other devices.RF emissions CISPR 11 Class A The ViSi Mobile Monitor is suitable for use in all establishments other than domestic and those directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes.Harmonic emissions IEC 61000-3-2 N/AVoltage fluctuations IEC 61000-3-3 N/A
Safety and Performance Tests1519.7.3 Electromagnetic ImmunityThe ViSi Mobile Monitor is suitable for use in specified electromagnetic environment. The user mustensure that it is used in the appropriate environment as described below.In the above table, UT (Unit in Test) is the ViSi Mobile Monitoring System.Immunity Test IEC 60601-1-2 Electromagnetic Environment GuidanceTest Level Compliance LevelElectrostatic discharge (ESD)IEC 61000-4-2±6 kV contact±8 kV air±6 kV contact±8 kV airFloors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.Electrical fast transient / burstIEC 61000-4-4±2 kV for power supply lines±1 kV for input/output lines±2 kV for power supply lines±1 kV for input/output linesMains power quality should be that of a typical cial and/or hospital environment.SurgeIEC61000-4-5±1 kV differential mode±2 kV common mode±1 kV differential mode±2 kV common modeMains power quality should be that of a typical cial and/or hospital environment.Voltage dips, short interruptions and voltage variations on power supply input linesIEC 61000-4-11<5% UT(>95% dip in UT) for 0.5 cycles<5% UT(>95% dip in UT) for 0.5 cycles40% UT(60% dip in UT) for 5 cycles40% UT(60% dip in UT) for 5 cycles70% UT(30% dip in UT) for 25 cycles70% UT(30% dip in UT) for 25 cycles<5% UT(>95% dip in UT) for 5 sec<5% UT(>95% dip in UT) for 5 secPower frequency (50/60Hz) magnetic fieldIEC 61000-4-83 A/m 3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical cial and/or hospital environment.
Safety and Performance Tests 1529.7.4 Recommended Separation DistancePortable and mobile RF communications equipment should be used no closer to any part of the ViSiMobile Monitor, including cables, than the recommended separation distance calculated from the equationappropriate for the frequency of the transmitter.Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be lessthan the compliance level in each frequency range.In the following table, P is the maximum output power rating of the transmitter in watts (W) according tothe transmitter manufacturer and d is the recommended separation distance in meters (m).Field strengths from fixed transmitters, such as base stations for radio (cellular, cordless) telephones andland mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predictedtheoretically with accuracy. To access the electromagnetic environment due to fixed RF transmitters, anelectromagnetic site survey should be considered. If the measured field strength in the location in whichthe ViSi Mobile Monitor is used exceeds the applicable RF compliance level above, the Monitor should beobserved to verify normal operation. If abnormal performance is observed, additional measures may benecessary, such as reorienting or relocating the Monitor.These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorptionand reflection from structures, objects and people.The ViSi Mobile Monitor may be temporarily interrupted by UHF RFIDSystems (860-960MHz).Interference may occur in the vicinity of equipment marked with this symbol:Immunity Test IEC 60601-1-2Test Level ViSi Mobile Monitoring System Compliance Level Electromagnetic Environment GuidanceConducted RFIEC 61000-4-63 VRMS150 kHz to 80 MHz3 VRMS Recommended separation distance:d = 1.2√PRadiated RFIEC 61000-4-33 V/m80 MHz to 2.5 GHz3 V/m Recommended separation distance:80 MHz to 800 MHz80 MHz to 800 MHzd = 3.5√P800 MHz to 2.5 GHzd = 2.3√P2.0 to 2.3 GHz for short radiod = 7.0√P
Safety and Performance Tests153From Portable and Mobile RF Communication EquipmentThe ViSi Mobile Monitor is intended for use in an electromagnetic environment in which radiated RFdisturbances are controlled. The customer or user of the Monitor can help prevent electromagneticinterference by maintaining a minimum distance between portable and mobile RF communicationsequipment and the Monitor as recommended below, according to the maximum output power of thecommunications equipment.In the following table, P is the maximum power output rating of the transmitter in watts (W) according tothe transmitter manufacturer and d is the recommended separation distance in meters (m).Electrosurgery Interference/Defibrillation/Electrostatic DischargeThe equipment returns to the previous operating mode within 10 seconds without loss of any stored data.Measurement accuracy may be temporarily decreased while performing electrosurgery or defibrillation.This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magneticfields (MRI).Fast Transients/BurstsThe equipment will return to the previous operating mode within 30 seconds without loss of any storeddata.Frequency 150 kHZ to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHzEquation d = 1.2√Pd=1.2√Pd=2.3√PRated max. output power of transmitterSeparation Distance Separation Distance Separation Distance(m) (ft) (m) (ft) (m) (ft)0.01 W 0.1 0.4 0.1 0.4 0.2 0.80.1 W 0.4 1.2 0.4 1.2 0.7 2.41 W 1.3 3.9 1.3 3.9 2.3 7.510 W 3.8 12.4 3.8 12.4 7.3 23.9100 W 12.0 39.4 12.0 39.4 23.0 75.5
Wireless Network Risk Mitigation 1549.8 Wireless Network Risk MitigationReference: ISO 80001-1ViSi Mobile System utilizes the Responsible Organization’s wireless IT network to communicate betweenindividual ViSi Mobile Monitors connected to patients and the ViSi Appliance. Physiologic data andalarms originating from the ViSi Mobile Monitors are transmitted over the IT network to the ViSi RemoteViewer where supplemental alarm notification occurs. Reliability of the IT network is essential inensuring the supplementary alarm notification meets the intended use.9.8.1 Risk Analysis Summary• The ViSi Mobile Monitors are the source of all alarms and alerts. • The ViSi Remote Viewer provides a supplemental alarm notification. When connectivity ispresent audio alarms are deferred to the ViSi Remote Viewer.• In the event that network connectivity is lost, all audio alarms are annunciated at the ViSi MobileMonitors. A connectivity lost alert is annunciated at the ViSi Remote Viewer.9.8.2 Residual RisksLoss of network connectivity will result in failure in supplemental alarm notification to the ViSi Applianceand ViSi Remote Viewer. Management of this risk is the responsibility of the Responsible Organizationfor the IT Network. This risk is minimized with the following mitigations:Sotera Responsibilities• Sotera Inc network assessment prior to installation.• Sotera Inc verification that the Responsible Organization network meets ViSi Mobile Systemconnectivity requirements at the time of installation.Responsible Organization Responsibilities• Conduct a risk assessment of the IT Network prior to installation and mitigate technical risk.• Maintain backup and emergency power resources for ViSi System network components specifiedin the ViSi Installation Manual (Hardcopy: 95-10061 / CD: 95-10059).• Maintain network configuration post installation of the ViSi Mobile System.• Notify Sotera prior to modifications to the network, including any configurations changes thatcould potentially compromise the IT Network as verified at the initial installation of the ViSiSystem. For support contact Sotera Wireless or an authorized Sotera Wireless representative inyour area.Other RF radiating devices (such as high powered RFID readers and Bluetoothdevices) that are in close proximity with the ViSi Mobile Monitor may interfer with theMonitor’s wireless communications. During such interference, the Monitor continuesto monitor and will alarm locally. If wireless communication is affected when using theMonitor in close proximity with another RF radiating device, move the other deviceaway from the Monitor or discontinue use of the other device. Perform a risk assessment and verification before you implement a change ormodification to the IT infrastructure. Changes to IT network configurations cancompromise continuous vital signs monitoring and alarm delivery.
155Appendix A - SymbolsAlarms / AlertsAlarm / Alert StatesAlarm ManagementSymbol DescriptionUnacknowledged life threatening severity alarm in progress.Unacknowledged high severity alarm in progress.Unacknowledged alert in progress (any severity).All alarms in progress have been acknowledged by the clinician.Alarm annunciation (visual and audio) has been paused for 2 minutes.Alarm annunciation (visual and audio) has been turned off.Symbol DescriptionPause alarm annunciation (visual and audible) for 2 minutes.Turn off alarm annunciation (visual and audible).Resume alarm annunciation from a paused state.
Alarms / Alerts 156Turn alarm annunciation back on.Acknowledge an alarm/alert that is in progress.Symbol Description
Battery States157Battery StatesSymbol DescriptionBattery good: the Monitor’s battery is fully charged.Battery Low: the Monitor’s battery voltage is low.Battery Critically Low: the Monitor’s battery voltage is critically low.
General Icons 158General IconsNavigationVital Signs MenuClinical MenuSymbol DescriptionUnlock the ViSi Mobile Monitor to gain access to the clinical features.Lock the ViSi Mobile Monitor to prevent unwanted access to the clinical features.Confirm activity.Cancel activity.Return to the previous screen.Symbol DescriptionAccess to the clinical menu.Start a manual cuff inflation. Cuff inflations are set up to be taken on an ad hoc basis.Start a manual cuff inflation. Cuff inflations are set up to be taken automatically at a selected time interval.Stop a cuff inflation currently in progress.Symbol DescriptionCuff management. Setup the cuff inflation intervals or define as ad-hoc only inflations.Initiate the stop monitoring sequence.
General Icons159OtherAccess information regarding the ViSi Mobile Monitor: Monitor Id, MAC address, Serial #, software version installed and battery status.Alarm management. Review the patient’s current alarm limits, adjust the alarm limits using “Auto Set” or turn off the alarm annunciation.QRS beep is turned on.QRS beep is turned off.Symbol DescriptionChange a patient’s alarm limits using “Auto Set”.Setup cuff inflation to be on an ad hoc basis.Setup cuff inflation such that the cuff will inflate at defined intervals.Symbol Description
Labelling 160LabellingSymbol DescriptionWarning, refer to accompanying documentsCaution, refer to accompanying documentsWiFi Alliance certificationConforms with EEC directivesCatalog numberSerial NumberManufactured ByDefibrillator proof type CF equipmentThis product is designated for separate collection at an appropriate collection point. Do not dispose of as household waste.Lithium Ion batteryIPX0 No special protection.IPX7 Protected against water immersion. Immersion for 30 minutes at a depth of 1 meter.Latex freeDo not reuseFragileContentsCONT
Labelling161MRI UnsafeSymbol Description
Labelling 162- Notes -
163Appendix B - Model NumbersIntroductionIn the event any component needs to be replaced, contact the Sotera Wireless Inc. Customer ServiceDepartment or the Sotera Wireless representative in your area.If a component needs to be returned, prior to shipping ensure the returned components have been properlydisinfected.
ViSi Mobile System Components 164ViSi Mobile System ComponentsModel Number Description92-10010 ViSi Mobile Monitor92-10011 ViSi Mobile Cuff Module92-10012 ViSi Mobile Chest Sensor (5 lead-wire ECG, AAMI)92-10014 ViSi Mobile Chest Sensor (3 lead-wire ECG, AAMI)92-10016 ViSi Mobile Chest Sensor (5 lead-wire ECG, IEC)92-10018 ViSi Mobile Chest Sensor (3 lead-wire ECG, IEC)92-10020 ViSi Mobile Thumb Sensor92-10066 ViSi Mobile Patient Kit (Single-use, adult, S)92-10067 ViSi Mobile Patient Kit (Single-use, adult, M)92-10068 ViSi Mobile Patient Kit (Single-use, adult, L)
Accessories165AccessoriesModel Number Description92-10023 ViSi Charger
Accessories 166- Notes -
167Appendix C - WarrantyWarranty USA, Canada, Mexico, Puerto RicoSotera Wireless Inc. warrants that its products will be free from defects in workmanship and materials for aperiod of one (1) year from the date of purchase except that disposable or one-time use products arewarranted to be free from defects in workmanship and materials up to a date one year from the date ofpurchase or the date of first use, whichever is sooner. This warranty does not cover consumable items suchas, but not limited to, batteries, external cables, sensors, cuffs, hoses, or mounts.Sotera Wireless Inc. shall not be liable for any incidental, special, or consequential loss,damage, or expense directly or indirectly arising from the use of its products, liability under this warrantyand the buyer’s exclusive remedy under this warranty is limited to servicing or replacing at Sotera WirelessInc. option at the factory or at an authorized Sotera Wireless Inc. Distributor, any product which shallunder normal use and service appear to the Company to have been defective in material or workmanship.No agent, employee, or representative of Sotera Wireless Inc. has any authority to bindSotera Wireless Inc. to any affirmation, representation, or warranty concerning its products, and anyaffirmation, representation or warranty made by any agent, employee, or representative shall not beenforceable by buyer.This warranty is expressly in lieu of any other express or implied warranties, including any impliedwarranty or merchantability or fitness, and of any other obligation on the part of the seller. Damage to any product or parts through misuse, neglect, accident, or by affixing any nonstandardaccessory attachments or by any customer modification voids this warranty.Sotera Wireless Inc. makes no warranty whatever in regard to trade accessories, such being subject to thewarranty of their respective manufacturers.A condition of this warranty is that this equipment or any accessories which are claimed to be defective bereturned when authorized by Sotera Wireless, freight prepaid to Sotera Wireless Inc., San Diego,California 92121. Sotera Wireless Inc. shall not have any responsibility in the event of loss or damage intransit.Calibration may be performed without the need to disassemble the instrument. It is the responsibility of thepurchaser to perform calibration as necessary, in accordance with the instructions provided in the technicalmanual.
Sotera Wireless Responsibility 168Sotera Wireless ResponsibilitySotera Wireless Inc. is responsible for the effects on safety, reliability and performance of the equipmentonly if:1. Assembly operations, extensions, readjustments, modifications or repairs are carried out bypersons authorized by Sotera Wireless Inc. and2. The equipment is used in accordance with the instructions for use.
169IndexAAcknowledgealarm doesn’t return after countdown 123alarmsset limits to auto 104Alarms and alertsafter sensor removed 122message remains after resolved 122multiple 123Ccharge battery 32chest sensor cable 29contraindications 20Countdown periodalarm doesn’t return after 123cuff moduledescription 28Ddevice status screen 42displays and views 40battery charge screen 39device status screen 42menu screen 42patient view screen 44quiet monitoring screen 43vital signs screen 41EElectrode Placement on page 19 29Ggeneral description 21, 35Grayalarm and alert messages 122Hhardwaredescription 21, 35hibernation screen 40
170LLife-Threatening alarms 122Mmenu screen 42Messagesgray 122some missing 123monitorcradle 25MONITOR STOPPED alert 122NNIBP monitoring 39PPacemaker patients, observing 12PATIENT TAMPERING alert 123patient view screen 44precautions 17, 66pulse oximetry (SpO2) monitoring 38Qquiet monitoring screen 43Rrespiratory rate monitoring 37SSensor removed, alarming continues 122shipping plugremoving and inserting 22Tthumb sensorcable and connection 27Tones, audioremain at Monitor 122stopped before acknowledged 122VViSi Mobile Monitoraudio tone still occurs 122vital signs screen 41Wwarnings 10, 75

Navigation menu