Spacelabs Healthcare 76A90341-WMTS 90341-05 User Manual 2 of 3

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User Manual 2 of 3

9-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Arrhythmia DirectoryDirectory of KeysECGECG MENUALARMLIMITS SIZE SETUP LEADCONTROLDISPLAYFORMATSUSPENDPROCESSING REVIEWPRINTRELEARNARRCLASSESSTSEGMENTSALLLEADSPRINTALLCANCELPRINTECG - PRINTCLEARMEMORYSAVEMEMORYECG - RELEARNSTREVIEWARRHYTHMIAREVIEWREPORTREVIEWREAL TIMEST TRENDECG REVIEWTREND TIMEBASE15 MIN/30 MINTREND DISPLAYOFFONRUN1TACHDOM CPL0ABN3PAUSE8PACED8REVIEWMERGE CLASSTRENDLEADIIVIALARMNOYES CLEAR GROUPTRENDPRIORCLASSNEXTCLASS PRINTARRHYTHMIA REVIEWENTIRECLASSLASTEVENTDo you wish to clear the entireclass or the most recent occurrence?MERGECLASSESMERGETRENDSPRIORCLASSNEXTCLASSMerge these classes or select another class.TIMEBASE6 HOURSINCLUDENOYESCURSORRLPRIORCLASSNEXTCLASS PRINTCLASS TRENDTIMEBASE6 HOURSCURSORRLPRIORCLASSNEXTCLASS PRINTGROUP TRENDALARMSOFFONHI=130LO=40ABN INROW=5ABN PERMIN=OFFSINGLEST = 1.00MULTIST = 0.50STLEADSECG - ALARM LIMITS

Contents9-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up Arrhythmia Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Setting and Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Reviewing Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Controlling Arrhythmia Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Clearing a Class or Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Merging Classes/Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Plotting Arrhythmia Trend Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Printing Arrhythmia Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Arrhythmia Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Arrhythmia Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16ArrhythmiaOverviewTwo levels of arrhythmia detection and review are available in Spacelabs Medical monitors.The Multiview I option provides enhanced arrhythmia detection and alarms for ventricular tachycardia, couplets, and single abnormal beats in addition to the detection and alarm capabilities for high and low heart rates, ventricular fibrillation, and asystole.The Multiview II option expands arrhythmia detection to include pauses and tachycardias of a supraventricular origin. This option also offers storage capabilities so that trends of arrhythmia episodes as well as dominant and paced rhythms can be reviewed, edited and printed.!• No arrhythmia detection system can correctly detect and classify all arrhythmias 100% of the time. Use sound clinical judgement when monitoring patients with arrhythmias.• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-5 for further details.

Ultraview Care Network9-4Setting Up Arrhythmia MonitoringWith the Multiview I or II option, the ARR ON/OFF key (located in the Config menu under Setup) can be used to selectively enable or disable arrhythmia detection functions. Arrhythmia detection must be enabled if you wish to establish a new dominant waveform (refer to Relearning the Dominant Waveform on page 9-5 for more details).When you turn arrhythmia detection ON• IN LEARN appears above the ECG tracing in the first zone• the RELEARN key is present in the ECG menu• ABN IN ROW and ABN PER MIN keys are present in the Alarm Limits menu• ECG alarms are momentarily deactivated until the learn sequence completes• Rate and ST alarm limits are initialized• Abnormals in a Row and Abnormals per Minute alarm limits are initializedWhen you turn arrhythmia detection OFF• IN LEARN appears above the ECG tracing in the first zone• no arrhythmia detection features or menus are displayed • ECG alarms are momentarily deactivated until the learn sequence completes• Rate and ST alarm limits are initializedLearning the Dominant WaveformDuring the learn sequence, IN LEARN is displayed on the monitor while the system establishes the heart rate and begins to classify each beat. Rate alarms are set based on this learned heart rate (if they have not been previously set to Fixed in the Module Configuration Manager). The first non-premature beat that occurs ten times is established as the dominant class. When the learn sequence is completed, the IN LEARN message disappears.Examples of actions that initiate a learn sequence are:• Power ON• Module insertion• Changing patient type (adult/infant)• Enabling/disabling arrhythmia detection• Patient admission via the Admit/Discharge menuThe system will not classify a paced beat as the dominant class. If the patient is 100% paced and there is no dominant class at the end of the learn sequence, the first single, non-paced beat detected five times becomes the dominant class.!• The Arrhythmia ON/OFF key is only available in modules with the Multiview I or II options.To set up arrhythmia monitoring:1Set up system and patient for standard ECG monitoring.2Touch ECG.3Touch SETUP.4Touch CONFIG.5Ensure ADULT is selected.6Select ARR ON.To disable arrhythmia detection:1Touch ECG.2Touch SETUP.3Touch CONFIG.4Select ARR OFF.

Arrhythmia9-5 Detecting Abnormal BeatsThe system compares each incoming beat with the dominant class. It examines morphology and the intervals between both the previous and following beats to determine whether the beat does or does not match the dominant. If the system determines the beat is abnormal, it compares the new beat with each of the abnormal shapes categorized since the learn sequence was completed. If the current beat fails to match any of the existing shapes (and after five occurrences), the system classifies it as a new abnormal class.Detecting PausesThe system classifies an R-R interval that is 1.8 times (or 80%) longer than the average R-R interval as a pause.The last beat detected preceding the pause is displayed to the left of center in the pause class. The system does not count two consecutive, long R-R intervals both in the pause class. Instead, it assumes that a sudden rate change occurred and updates the heart rate immediately.Detecting Paced BeatsIf the Paced mode is enabled in the ECG Setup menu and the system does not detect a paced beat during the learn sequence, a paced class will be created once the system detects the first paced beat.The system identifies two different types of paced beats:•paced• AV-pacedThe paced class is created for ventricular-paced beats defined as a QRS complex which is preceded by a single pacemaker pulse.The AV-paced class is created for beats that are preceded by two pacemaker pulses.The QRS complex must follow the pacemaker pulse within 150 msec for the beat to be classified into either paced class. If the pacemaker pulse precedes the QRS complex by more than 150 msec, the beat may be triggered by an atrial pacemaker and is not classified in either paced class.Relearning the Dominant WaveformYou can relearn the dominant rhythm and establish a new dominant at any time during monitoring. After touching the RELEARN key, you can either clear the memory or save the memory. Once a selection is made, the relearn sequence is initiated during which ECG alarms are suspended. The old dominant is labeled as exdominant and stored as an abnormal class.WARNING:• Until the patient’s rate and morphology are learned, ECG alarms for high rate, low rate, run, couplet, abnormal per minute, and tachycardia are not active.To relearn the dominant waveform:1Touch ECG.2Touch RELEARN.3Select SAVE MEMORY or CLEAR MEMORY.

Ultraview Care Network9-6Selecting CLEAR MEMORY clears all arrhythmia and ST segment data and resets the Abnormals per Minute, Abnormals in a Row, and ST segment alarms. Upon completion of the learn sequence, ECG alarms are enabled and rate alarms limits are reset.Selecting SAVE MEMORY saves all previously-acquired arrhythmia and ST segment data. Once the learn sequence is completed, ECG alarms are enabled and rate alarms are reset. The Abnormals per Minute and Abnormals in a Row alarms remain unchanged. If ST segment level alarms were enabled prior to the relearn sequence, they will be reset.Automatic Dominant Class UpdateThe system uses the following rules to update the dominant class:• An abnormal class that occurs more frequently than 50% of all beats in the previous 60-seconds, and occurs three beats more frequently than the current dominant during that period, automatically becomes the new dominant class.• The old dominant is put into an abnormal class and given the status EXDOMINANT. This class can become dominant again and has the same characteristics as any other active class.The message, NEW DOMINANT, is displayed above the ECG trace for 60-seconds after the new dominant is established.Setting and Adjusting AlarmsIn addition to the alarms described in ECG on page 8-3, the Multiview I or II options provide alarms for these additional conditions.Abnormals in a Row AlarmFollowing the learn sequence, the Abnormals in a Row alarm limit is set based on either factory defaults or user-defined settings. You can adjust the alarm limit from two to ten or you can deactivate it.• Setting the Abnormals in a Row alarm limit to three or greater will initiate a RUN ALARM message when three or more consecutive abnormal beats (at a rate greater than 90 BPM) occur.• Setting the Abnormals in a Row alarm limit to two will initiate a COUPLET ALARM message when two consecutive abnormal beats occur.The factory default setting for the Abnormals in a Row limit is five.Abnormals per Minute AlarmFollowing the learn sequence, the Abnormals per Minute alarm limit is set based on either factory defaults or user-defined settings. You can adjust the alarm limit from 1 to 99, or it can be deactivated.To set or adjust alarms for abnormal beats (arrhythmia detection must be enabled):1Touch ECG.2Touch ALARM LIMITS.3Touch ALARMS ON.4Select ABN IN ROW = or ABN PER MIN =.5Use arrow keys to adjust.

Arrhythmia9-7 The factory default setting for the Abnormals per Minute limit is OFF.Table 1 describes the arrhythmias detected with the Multiview I or II options (with arrhythmia detection enabled).* Prematurity is defined as an instantaneous R-R interval that is (1) 15% premature as compared to the average R-R interval and, (2) <666 msec for couplets and runs, and <500 msec for tachycardias of a supraventricular origin.** Template-forming classes.!• If the alarm limit for high rate, low rate, ABN/MIN, or ABN IN ROW is displayed in reverse video, this is an indication that alarm tone, alarm recording, and alarm watch have been disabled for the indicated alarm.Table 1: Classification of EventsType of Class Defining CharacteristicsPrematurity RequiredMax # of Classes AllowedType of Waveform StorageABNORMAL ** 1 beat of abnormal morphology No12Qualifying occurrence (5th) + most recentCOUPLET ** 2 consecutive beats of abnormal morphologyNo for the first beat; Yes for the second beat *Qualifying occurrence (3rd) + most recentRUN3 or more consecutive beats of abnormal morphologyNo for the first beat; Yes for each subsequent beat *32 6-seconds of each occurrence. First in, first out. Saves longest Run and PausePAUSEAn R-R interval that is 1.8 x (or 80%) longer than normalNoASYSTOLE Absence of QRS for 5-seconds or more No NA6-seconds of last occurrence stored as a pause when following normal beatsPACED1 pacemaker flag followed by a QRS (within 150 msec)No 1First paced beat occurrence each minute (PACED key must be set to YES)AV PACED 2 pacemaker flags followed by a QRS No 1First paced beat occurrence each minute(PACED key must be set to YES)TACH (SUPRAVENTRICULAR)≥ 5 or more premature dominant beats in a rowYes * 16-seconds of last occurrenceVFIB NA No 1 6-seconds of last occurrenceDOMINANT ** NA NA 1Qualifying occurrence (10th) + the most recent each minute

Ultraview Care Network9-8Reviewing ArrhythmiasSelecting Arrhythmia ClassesThe numerical value for each arrhythmia key indicates the number of occurrences that the system has stored. If none have been detected, the numerical value inside the key is 0 and the key outline is dotted. For classes that only store the last occurrence of that type of arrhythmia (for example, tachycardias of a supraventricular origin), a value is not displayed. The system updates the menu as new classes are created.Selecting Leads for ReviewWhen you access the Arrhythmia Review menu, the LEAD key text changes to indicate which leads were being monitored the last time the displayed event occurred. The lead associated with the currently displayed waveform is highlighted. You can change the lead selection by touching the LEAD key.Multiple Arrhythmia ClassesThe system distinguishes between classes of the same type that have different morphologies by assigning numbers to each class. The class number is displayed to the right of the class type; for example, ABNORMAL 1.The system will display, in sequence, up to 32 different runs and/or pauses. However, the system always keeps the longest run or pause. If the system detects one more pause and/or run than it can store, it replaces the oldest run or pause with the new one (that is, first in-first out).Updating ClassesThe system updates the review waveform once each minute for the dominant, paced and AV paced classes. Otherwise, it updates with each occurrence.!• Arrhythmia Review and Edit functions are only available in modules with the Multiview II option in the ADULT mode, and with both arrhythmia detection and review enabled.To review arrhythmias:1Touch ECG.2Touch REVIEW.3Select an arrhythmia class type for review.4Select NEXT CLASS or PRIOR CLASS keys to progress through the review.

Arrhythmia9-9 Display DetailThe system stores and displays arrhythmia review data in two categories: non-template forming classes and template-forming classes.The non-template forming class displays a waveform that is 6.25-seconds long and is representative of the most recent occurrence.The template-forming class displays two waveforms. The waveform on the left is 1.25-seconds long; the arrhythmia that originated the class is centered. The waveform on the right is 4.5-seconds in length and the most recent occurrence of the class is centered.The lead, frequency, and time and date of last occurrence appear to the right of each presentation.Figure 9-1: Arrhythmia waveformsNon-template Forming Class ExampleTemplate Forming Class ExampleLead IILast MINUTE: 1Last HOUR: 1Last OCCURRENCE:04:44AM5 Jun 2003Lead VILast MINUTE: 2Last HOUR: 6Last OCCURRENCE:04:40PM5 Jun 2003(Tachycardia)(Couplet)

Ultraview Care Network9-10Controlling Arrhythmia AlarmsTouch ALARM YES or NO to enable or disable alarms for couplets, single abnormals, or tachycardia. Disabling alarms for a specific arrhythmia prevents alarm generation for subsequent detection of that arrhythmia class. At least one episode of the class must be stored before the alarm can be disabled.Clearing a Class or EventWhen you clear a class, the system removes it from memory. Touch the ENTIRE CLASS key to clear the displayed class and template from memory and from the trend buffer. When the system finishes clearing the class, the Arrhythmia Review menu appears and displays the next class.Touch the LAST EVENT key to remove only the most recent occurrence of the displayed class from memory. The LAST EVENT key is only active for abnormal and couplet classes.When you clear the most recent event:• the system removes the most recent occurrence of that class from memory.• the system displays the message The last occurrence of this class was deleted in place of the cleared waveform.• the system updates the frequency and last occurrence totals. The system does not redisplay the updated information until you redisplay the class.Merging Classes/TrendsMerging enables you to take two different classes or trends from the same group and merge them together into a single class, combining the trend history and time of last occurrence. When the module is frequently storing a single morphology as two different classes, merging the classes opens up storage for new classes while saving all arrhythmia data.Merging ClassesTwo classes may be merged when the system interprets two abnormal beats as different classes but the clinician sees them as the same class. This could occur if a patient's dominant beat is experiencing frequent changes in polarity or when the electrodes have been repositioned.At the start of merging two classes, one class appears on the left side of the screen and the second class appears on the right side. The message “Merge these classes or select another class” appears at the bottom of the screen.If the two classes look clinically the same, they can be merged by touching the MERGE CLASSES key. Once merged, the first beat will be displayed as a template on the left side of the screen with the message (M1) following the class title. Any subsequent beat that fits any of the merged templates will then be stored in that class.To control arrhythmia alarms:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select CPL, ABN or TACH.5Select ALARM YES or NO.To clear a class or the most recent event in a class:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class.5Touch CLEAR.6Select ENTIRE CLASS or LAST EVENT.To merge class or trend data:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class.5Touch MERGE.6Use PRIOR CLASS or NEXT CLASS to display the two classes you wish to merge.7Select MERGE CLASSES or MERGE TRENDS.

Arrhythmia9-11 You can merge a maximum of two classes into a third class. The following constraints apply to merging classes:• Two single templates can be merged into a class with one template.• One class of two (previously merged) templates can be merged with one additional template.• If a class has been merged once, then (M1) follows the class number, for example, ABNORMAL 12 (M1).• If a class has been merged twice, then (M2) follows the class number, for example, ABNORMAL 12 (M2).Merging TrendsThere is no limit to the number of trends that you can merge. Merging trends of arrhythmia data deletes the template for the class that has been merged. If an arrhythmia event occurs that matches the merged class, a new class will be created.If you want to combine the data for two routinely recurring arrhythmia classes, merge the classes rather than merge the trends. Merging classes permits the two classes to be stored and trended together on an ongoing basis.If you want to combine an active arrhythmia class with an inactive class, merge the trends. An example of an inactive arrhythmia class is the dominant morphology associated with a previous lead selection.Merge ConstraintsThe following additional constraints apply to merging individual classes or trends:• If the system cannot merge any of the existing classes or trends, the MERGE key is disabled (the key will appear dotted) in menus for those classes/trends. • Only classes/trends that the system can merge are presented.• Single abnormal classes/trends can be merged with each other, or with the dominant, paced, or AV paced classes/trends.• Couplets can only be merged with couplets.• Runs and pauses cannot be merged.

Ultraview Care Network9-12Plotting Arrhythmia Trend GraphsWhen you plot trend graphs the display area consists of:• a 1.5-second segment of the selected class waveform on the left (individual class trends only). • a trend graph of the selected class, or group of classes, on the right. Refer to Figure 9-2: Abnormal class trend.When you select CLASS TREND, the trend graph plots occurrences of events that match that particular class. The total number of events that occurred during the time period between the cursors appears below the trend graph.Figure 9-2: Abnormal class trendWhen you select GROUP TREND, the trend graph plots occurrences of all events in that group of classes along with the average heart rate. For example, the group trend for abnormals plots the occurrences of all single abnormals regardless of the class in which they were stored.• The dominant group trend graph displays the total of all abnormal beats, including beats in runs, over the selected timebase.• A total of all events specific to the selected class over the selected timebase is displayed for all other trended classes.Each trend graph is displayed with two scales:• the scale on the left represents heart rate.• the scale on the right displays the number of arrhythmias over the trended period.Scales are automatically selected, based on the heart rate and arrhythmia values.Selecting a TimebaseYou can also select the time period over which the system trends arrhythmia data. The factory default setting is 6-hours. Resolution for each timebase is shown below. Resolution Timebase1-minute = 6-hour trend graph2-minutes = 12-hour trend graph4-minutes = 24-hour trend graphTo plot a trend graph:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class for review.5Select CLASS TREND or GROUP TREND.1000From 12:18 to 18:17 18:1702050HR1012:17 Total = 612PER1MINABNORMAL 1To select a timebase for class or group trends:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class.5Select CLASS TREND or GROUP TREND.6Select TIMEBASE (6-,12-, or 24-hours).

Arrhythmia9-13 Excluding Classes from TrendsUse this function to exclude specific classes from the group trend for that class as well as from the dominant trend graph (only valid with CPL and ABN classes). This function defaults to YES indicating that all classes will be included. When you select a class, the template for that class displays on the screen. It is followed by a trend graph that plots all of the occurrences of that class over the selected trend graph timebase.Positioning the CursorsThe cursors are small, bright lines that move along the bottom of the trend display and allow you to view the number of trended events that occurred between any two points in time displayed on the trend graph.Initially, the left (L) cursor is located flush with the left edge of the trend graph, and the right (R) cursor is located flush with the right edge of the trend graph. The number of trended events between, and inclusive of, the cursor points appear below the trend graph. If the cursors move past each other, the L cursor becomes the R cursor and vice versa. The highlighted L or R portion of the CURSOR key changes accordingly.Printing Arrhythmia DataAll printouts of ECG or arrhythmia data are annotated with the following data:• Bed identification• Time and date of the printout• Lead designatorYou can print all arrhythmia data for all classes or individually selected classes. You can also print individually selected arrhythmia trend plots.Selecting PRINT ALL prints all ST events and all arrhythmia classes. PRINT ALL also prints all leads.To exclude a class in a group trend:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class.5Touch CLASS TREND.6Select INCLUDE NO.To position the cursors on the trend graph:1Touch the CURSOR to highlight either the L or R portion.2Touch the trend plot to position the cursor near the desired point.3Use the arrow keys for adjustment of the cursor.To print recordings of ALL arrhythmia events:1Touch ECG.2Touch PRINT.-OR-3Touch PRINT ALL.4Touch ARR CLASSES.To print selected arrhythmia classes:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class.5Touch PRINT.To print selected arrhythmia trends:1Touch ECG.2Touch REVIEW.3Touch ARRHYTHMIA REVIEW.4Select an arrhythmia class.5Select CLASS TREND or GROUP TREND.6Touch PRINT.

Ultraview Care Network9-14Arrhythmia Problem SolvingRefer to ECG on page 8-3 for additional monitoring tips.False AlarmsCareful attention to good monitoring techniques, especially during setup, will reduce false alarms. When false alarms occur, check the following:• Multiple classes with atrial fibrillation or flutter waveforms. Either 1) merge these classes with the dominant or another abnormal class, 2) deactivate the alarms for these classes, or 3) consider deactivating the Abnormals per Minute alarm.• Repetitive artifact mimicking QRS complexes. Review the morphology of abnormal classes that are triggering alarms. Either merge these abnormal classes together or deactivate the alarm for these classes.• In some cases VFIB may resemble previously classified abnormal beats which may cause VFIB to be detected as a RUN. If this occurs, use the waveform display as the primary indication of condition.• Some beats may not be recognized as morphologically different from the learned, dominant beat. You may be able to improve performance by changing electrode positions or switching to a lead setting that provides better differentiation between the dominant and abnormal beats.Abnormal Beats Mis-classifiedThere are a number of possible situations that might cause beats to be improperly classified (either too many or too few).• If the message NOISY SIGNAL is displayed, too much noise is present on either one, or both, ECG channels.• If the message ECG VOLTAGE TOO LOW is displayed, the signal level is below the threshold for QRS detection.• Some beats are not recognized as being different from the learned dominant beat.You may be able to improve performance in these cases by changing electrode positions or by switching to a lead setting that provides a better signal or allows abnormal beats to be more clearly differentiated from dominant beats.No Couplet or Run AlarmsIf alarms do not occur as expected, check the following:• Abnormal in a Row alarm limit may be set too high to generate alarm for couplets. When you wish to be alerted for couplets, set Abnormal in a Row alarm limit to 2.• Abnormal beat(s) may not meet the classification criteria of 15% prematurity (for the second beat in a couplet or subsequent beats — at 90 BPM — in a run) and R-R intervals of less than or equal to 666 msec. No action is indicated. An Abnormal in a Row alarm (COUPLET or RUN) will not be generated unless both criteria are met.• Processing may have been suspended or the signal quality may be poor. Resume processing or check electrodes for other causes of a poor signal.

Arrhythmia9-15 Previous Abnormal Classes Missing in Arrhythmia ReviewIf you find that previously classified abnormal beats are no longer stored for review, one of the following conditions have occurred:• The class has been cleared.• Memory was cleared using the RELEARN key or data was purged during the Admit/Discharge function.• A module error recovery reset occurred.Classes FullThe total number of abnormal and couplet classes that can be stored is 12. When the system detects the 13th class, the message CLASSES FULL is displayed with an alert tone (if tone is set to ON). All subsequent alarm events will initiate an alarm, even if classes are full.A “classes full” condition can be cleared by:• Merging one or more classes• Merging one or more trends• Deleting one or more abnormal or couplet classes!• All alarm events occurring when classes are full will initiate an appropriate alarm.

9-16Arrhythmia Troubleshooting GuideClinical Situation Possible Cause SolutionAbnormal beat not detected ■Module receiving inadequate signal; NOISY SIGNAL or ECG VOLTAGE TOO LOW messages appear. Noise level is over allowable range, or signal level is below QRS detection threshold.■Make the necessary adjustments to restore good signal.■Check all leads to determine a better monitoring lead or select another lead.■Remove the cause of the noise.■Some beats not recognized as morphologically different from the learned dominant beat.■No action required; some events that may be diagnosed as abnormal by a skilled clinician may not meet the module’s criteria for abnormality.■System has not seen 5 abnormals or 3 couplets of like morphology to generate a class.■No action is required.■Arrhythmia detection is not enabled. ■Enable arrhythmia detection through the ECG Setup menu.False Alarms NOTE: Careful attention to good monitoring technique, especially setup, will keep false alarms at a low level. If false alarms do occur, however, check the following.■Noise on the signal caused by poor electrode application is the most common cause of false alarms.■Remove the cause of the noise.■Deactivate alarm for the classes that fill up with repetitive artifact; do not clear these classes.■Multiple abnormal classes with atrial fibrillation or flutter waveforms.■Merge the class with the dominant or another abnormal class.■Deactivate alarm for these classes, or consider deactivating the ABN PER MIN alarm.■Atrial fibrillation continually triggering TACH alarm.■Consider deactivating TACH alarm.■Limits set too close to patient’s heart rate.■Check and adjust the alarm limits.■Amplitude of ECG signal has dropped below threshold of R-wave detector.■Reposition electrodes and relearn patient’s rhythm.

10-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.ST Analysis DirectoryDirectory of KeysIIIIII V1 V2 V3 V4 V5 V6 AVFHighlighted leads are included in ST alarms. Touch to include or exclude.AVL AVRECGECG MENUALARMLIMITS SIZE SETUP LEADCONTROLDISPLAYFORMATSUSPENDPROCESSING REVIEWPRINTRELEARNSTREVIEWARRHYTHMIAREVIEWREPORTREVIEWREAL TIMEST TRENDECG REVIEWTREND TIMEBASE15 MIN/30 MINTREND DISPLAYOFFONSTTRENDTIME SAVENOYESCLEAR PRIORSET PRINTNEXTSETSAVESETTIMEBASE6 HOURS PRINTSTSCALEST REVIEW - ST SEGMENT LEVELS at HR:MIN DAY-MONTH-YEARTREND OF ST SEGMENT LEVELDo you wish to clear the displayed ST data?YES NOALARMSOFFONHI=130LO=40ABN INROW=5ABN PERMIN=OFFSINGLEST = 1.00MULTIST = 0.50STLEADSECG - ALARM LIMITS

Contents10-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Setting Up ST Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Selecting Leads for ST Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Reviewing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Clearing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Viewing ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Selecting the ST Trend Timebase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Printing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10ST Analysis Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11ST AnalysisOverviewThe ST analysis function monitors changes to the ST segment level.Since the ST segment is composed of frequencies at the lower end of the frequency range (0.05 Hz), the system automatically analyzes the ST segment at 0.05 Hz regardless of whether the display mode is set to monitor or extended.ST segment analysis starts during the ECG learn sequence. Based on the dominant waveform, the PR (isoelectric), J, and ST points are automatically identified for each beat. The amplitude difference between the ST point and the PR point is referred to as the ST segment level.!• The significance of ST changes can only be determined by a clinician.• The value of ST segment measurements may be affected by:- wide complex QRS’s (for example, bundle branch block).- Wolff-Parkinson-White (WPW) syndrome. - fusion beats classified as dominants.!• You can define your own default settings for alarm limits. Refer to Default Alarm Limits on page 2-3 for further details.

Ultraview Care Network10-4Display DetailThe current ST segment level is displayed for all leads to the right of the ECG parameter key in the split view and the full view modes. Question marks (???) are displayed when the current ST segment level is not available, or as OFF when the lead is not connected.Figure 10-1: ST segment display (full view)Figure 10-2: ST segment display (split view)I 0.16 AVR 0.16II 0.00 AVL 0.24III 1.44 AVR 0.16V1 -1.44 V4 0.16V2 2.88 V5 0.16V3 4.32 V6 0.16ᕡᕤECGII MONA=0A/M 10ROW 41204070AVRAVLAVFV4V5V6V1V2V3IIIIIIᕢᕣECGII MONA=0A/M 10ROW 41204070V4V6V1V2V3V5ᕡᕢᕣᕤECGI 0.16 AVR 0.16II 0.00 AVL 0.24III 1.44 AVR 0.16V1 -1.44 V4 0.16V2 2.88 V5 0.16V3 4.32 V6 0.16

ST Analysis10-5 Figure 10-3: Real-time ST trend displayᕡECG lead designatorᕢAbnormals per minute counterᕣCurrent heart rateᕤST segment levels (updates at 30-second intervals)ᕥST segment level (single lead); asterisk indicates ST alarms are enabledᕦReal-time ST trendᕧAmplitude scale in millivoltsᕨTime scale - either 15- or 30-minutesSetting Up ST MonitoringST analysis is performed on all available ECG leads, even if they are not currently displayed. Setup for ST monitoring is the same as for ECG monitoring. Refer to ECG on page 8-1 for setup details.Adjusting AlarmsYou can adjust alarm limits in increments of 0.25 mm as needed for both single lead ST and multiple lead ST.ST alarms can be activated manually or automatically once the system has acquired an ST segment measurement. Typically, the system acquires this data within 30- to 60-seconds after completion of the learn sequence.!• ST Analysis and Review functions are only available in the adult mode in modules with the ST option.!• Disabling ECG alarms also disables ST alarms.ECGST = X.XX70ᕣᕡV25.0030 MIN0.00ᕦᕧᕨᕥTo set up ST monitoring:1Set up system and patient for standard ECG monitoring.2Touch ECG.3Touch SETUP.4Touch CONFIG.5Select ADULT.To set or adjust ST alarms:1Touch ECG.2Touch ALARM LIMITS.3Select SINGLE ST or MULTI ST.4Use arrow keys to adjust.

Ultraview Care Network10-6The SINGLE ST alarm allows you to monitor for localized changes that may only be detectable in a single lead. An ST alarm for a SINGLE LEAD will activate if the ST level for any one lead exceeds the SINGLE ST alarm limit, with respect to its current reference level.The factory default setting for the single lead ST alarm limit is 1.00 mm.The MULTI ST alarm allows you to monitor for global changes that may be detectable in multiple leads. An ST alarm for MULTIPLE LEADS will activate if the ST level for three or more leads exceeds the MULTI ST alarm limit, with respect to each lead’s current reference level.The factory default setting for the multi-lead ST alarm limit is 0.50 mm.At the time that ST monitoring is initiated, the current reference level for all leads is set to 0.00 mm (isoelectric). A SINGLE ST alarm will activate if any lead has an initial ST level that exceeds the SINGLE ST alarm limit. Or, a MULTI ST alarm will activate if three or more leads have initial ST levels that exceed the MULTI ST alarm limit.Whenever a SINGLE or MULTI ST alarm is activated, the reference level for all leads is automatically reset based on each lead’s current ST level. This allows changes in ST levels to be dynamically tracked throughout the patient’s course of treatment.As shown in Figure 10-4: ST segment alarm function, when the patient’s ST segment trend line rises and violates the first alarm threshold, a new baseline and a new upper alarm threshold are established (the amount of change needed to set off another alarm is denoted by Delta). The lower alarm threshold remains unchanged. Though the patient’s ST segment continues to climb, it does not reach the new alarm threshold, so a new upper limit is not set. When the ST level declines, the alarm threshold also declines until the original alarm thresholds are re-established. As the patient’s ST level continues to decline, a new threshold is established when an alarm condition occurs.Figure 10-4: ST segment alarm function!• The MULTI ST alarm limit cannot be set above the SINGLE ST alarm limit if both alarms are enabled.Thick line is the measured ST level.Solid line is the ST alarm baseline.Dashed line is the alarm threshold.

ST Analysis10-7 As a second example, assume the SINGLE ST alarm is set at 1.00 mm. The initial ST amplitude for a particular lead is +0.60 mm. Based on the initial reference level of 0.00 mm, an alarm would activate if the ST level exceeds +1.00 mm. Therefore, no alarm occurs. Instantaneously, the ST level increases to +1.20 mm. SINGLE ST alarm occurs and the new reference level for the lead is set to +1.20 mm. The next ST alarm for that lead, assuming no changes are made in other leads, would be activated at +2.20 mm.Selecting Leads for ST AlarmsTouching the ST LEADS key allows you to select which leads are to be used to generate ST alarms. Leads that are not clinically relevant for a patient can be disabled to allow tighter limits to be placed on more clinically significant leads.All highlighted leads will be used to generate ST alarms.The factory default setting is all leads included.Displaying Real-Time ST TrendsTo facilitate the assessment of short-term changes in ST-segment levels, measurements for a single lead can be displayed as a real-time trend.The amplitude scale for the trend display is dynamically adjusted to show the maximum and minimum values for the selected time scale.The time scale for the trend display is user-selectable — either 15-minutes or 30-minutes.Trend data is continuously updated at 3-second intervals.To select or deselect leads for ST alarms:1Touch ECG.2Touch ALARM LIMITS.3Touch ST LEADS.4Select or deselect leads.To display a real-time ST trend:1Touch ECG.2Touch REVIEW.3Touch REAL TIME ST TREND.4Select ON.5Select TREND TIMEBASE of 15- or 30-minutes.

Ultraview Care Network10-8Reviewing ST DataUse the ST Review menu to display and review ST segment data. A snapshot of ST segments for all available leads is displayed. The time and date of the ST snapshot is displayed on the menu prompt line. Touch the PRIOR SET or NEXT SET key to display ST data at other time points. Figure 10-5 is an example of a ST segment snapshot.Nine ST snapshots can be stored for display. The oldest ST snapshot, not marked as SAVED, will be deleted to make room to store a new snapshot. To save an ST snapshot, touch the SAVE SET key.ST snapshots are automatically stored whenever an ST alarm occurs or at pre-selected time intervals. To store the ST snapshots at periodic intervals, select TIME SAVE YES. Available intervals are 5-, 10-, 15-, 30- or 60-minutes (only available in the Module Configuration Manager).The factory default setting for the time save interval is 15-minutes.Figure 10-5: ST segment displayClearing ST DataTouching the CLEAR key and then confirming your choice by selecting YES clears the currently displayed data for all leads from memory. Data is also cleared from the trends.To review ST data:1Touch ECG.2Touch REVIEW.3Touch ST REVIEW.AVRAVFV4V6V1V2V3IIIIII-0.16 mm-0.16 mm0.16 mm2.88 mm4.32 mm0.16 mm0.16 mm0.16 mm0.00 mm1.44 mmAVL0.24 mmTo clear the displayed ST data:1Touch ECG.2Touch REVIEW.3Touch ST REVIEW.4Touch CLEAR.5Select YES.

ST Analysis10-9 Viewing ST TrendsTrends showing deviations in ST segment level are displayed for each lead monitored in the past 24-hours. Touching the trend graph or one of the arrow keys in the menu produces a cursor on the baseline of the trend plot. Position this cursor at a point of interest in the trend to determine the ST segment level for all displayed leads at that time. A measurement for each lead is displayed in the table to the right of the trend display.Figure 10-6: ST trend display shows an example of a trend display. The graph plots deviations in ST segment level over time.Figure 10-6: ST trend displaySelecting the ST Trend TimebaseYou can select the time period over which the ST data is displayed in a trended format. Resolution for each timebase is shown below.Available timebases are 1.5-, 3-, 6-, 12-, or 24-hours. The factory default setting for the ST trend timebase is 6-hours.Resolution Timebase30-seconds 1.5-hours1-minute 3-hours2-minutes 6-hours4-minutes 12-hours8-minutes 24-hoursTo view ST trends:1Touch ECG.2Touch REVIEW.3Touch ST REVIEW.4Touch ST TREND.5Touch the trend plot near the desired data point. Then use arrow keys to adjust the cursor position.AVRV4AVLV5AVFV6IV1IIV2IIIV300:00 06:00 00:00 06:00SCALE -2 mm to 2 mmI 0.16 AVR 0.16II 0.00 AVL 0.24III 1.44 AVR 0.16V1 -1.44 V4 0.16V2 2.88 V5 0.16V3 4.32 V6 0.16ST VALUES at 03:38 To select a timebase:1Touch ECG.2Touch REVIEW.3Touch ST REVIEW.4Touch ST TREND.5Select TIMEBASE of 1.5-, 3-, 6-, 12-, or 24-hours.

Ultraview Care Network10-10Printing ST DataPrintouts of ST segment data are annotated with the following:• Bed identification• Time and date of the printout• Lead designatorST segment waveforms can be printed from either the PRINT or ST REVIEW menu.To print all the available ST segment waveforms, use the PRINT menu.To print only selected ST segment waveforms or ST trends, use the ST REVIEW menu.!• ST Segment data cannot be printed with the 90449 printer module.To print all ST segment data:1Touch ECG.2Touch PRINT.3Touch ST SEGMENTS.To print selected ST segments:1Touch ECG.2Touch REVIEW.3Touch ST REVIEW.4Touch PRINT.To print the current trend data:1Touch ECG.2Touch REVIEW.3Touch ST REVIEW.4Touch ST TREND.5Touch PRINT.

10-11 ST Analysis Troubleshooting GuideClinical Situation Possible Cause SolutionNo access to ST analysis functions ■The system must learn the ST segment level before it can provide access to ST analysis functions.■Wait until the system analyzes sufficient QRS complexes to calculate the ST segment level (approximately one minute). ST = ?? is displayed ■Infrequent occurrence of dominant beats.■ST analysis not performed on paced, premature dominant or abnormal beats.■ECG amplitude may be insufficient to detect QRS complexes.■Check QRS amplitude.

11-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.12-Lead Diagnostics DirectoryDirectory of KeysCLEARDo you wish to clear ECG - REVIEWSTREVIEWREPORTREVIEWALARMLIMITS SIZE SETUP LEADCONTROLDISPLAYFORMATSUSPENDPROCESSING RELEARN PRINTECG MENUREVIEWMORETEXTECGARRHYTHMIAREVIEWECG - REPORT REVIEW HR:MN DAY-MONTH-YEAR PRINTSAVESTATREPORTAUTO REPORTXX MINDIRDISPLAYECG - REPORT DIRECTORYAUTO PRINTOFFREAL TIMEST TRENDthe displayed ECG report? TREND DISPLAYON OFFTREND TIMEBASE15 MIN / 30 MIN ONYES NOREPORTSETUPSENDECG**This box will onlydisplay if the ModuleConfiguration ManagerSend ECG Reportsetting is set to manual

Contents11-3 Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Initiating a 12-Lead Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Automatic Scheduling of 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Saving and Clearing 12-Lead Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Sending 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Report Directory Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Patient Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612-Lead DiagnosticsOverviewThe 12-lead report function acquires and displays 12 ECG vectors in the same format as an electrocardiograph.Diagnostic electrocardiographic devices obtain conventional ECG signatures that accurately represent both the detailed waveforms in each cardiac cycle and the beat-to-beat variability to determine cardiac rhythm. Prior to analysis, the ECG data is split into two different paths: one to the module’s monitoring functions and the other to the diagnostic functions. The ANSI/AAMI specifications for diagnostic electrocardiographic devices, as required by the data in the diagnostic path, is acquired at 500 samples per second.The output from both the monitoring and diagnostic functions are combined and transferred to the bedside monitor for display and distribution to the Ultraview Care Network.!• No automated analysis is completely reliable. A physician should read all ECG results.• Special problems exist with pediatric ECGs because of the considerable differences in the signal characteristics of adult and infants and because of the evolution of the ECG patterns from birth to adolescence.• Digital systems produce a noticeable modulating effect from one cycle to the next, particularly in pediatric ECGs. This phenomenon, which is not physiologic, is due to the asynchronism between data acquisition sample rate and the peak of the QRS waveform.

Ultraview Care Network11-4Display DetailThe 12-lead report display shows 2.5-seconds of waveform data per lead. Presentation of the leads may be in a standard format (refer to Figure 11-1) or the Cabrera format. When analysis is complete, measurements and diagnostic statements are displayed above the waveform data (requires option D).Figure 11-1: 12-lead report displayᕡMeasurement and interpretation data (requires Option D)ᕢECG traces for 12 leads (2.5-seconds/lead)Initiating a 12-Lead ReportYou can acquire a 12-lead report by touching STAT REPORT. Initiating a STAT REPORT will not affect the automatic schedule.!• When monitoring paced patients, ECG processing and the pacepulse detection function will be suspended for 10-seconds whenever acquisition of an ECG report is in process. Temporarily suspending these functions allows the actual pacepulse to be displayed/printed in the 12-lead report without interfering with arrhythmia analysis.• If the STAT REPORT key is labeled LEADS OFF, one or more of the 12 leads is disconnected. Check all electrode connections before proceeding.ᕡᕢVent. rate: 60 BPM SINUS BRADYCARDIAPR interval: 162 ms NORMAL ECGQRS duration: 88 msQT/QTc: 360/360 msP-QRS-T axes: 50 44 51I AVR V1 V4II AVL V2 V5III AVF V3 V6To initiate a 12-lead ECG report:1Touch ECG.2Touch REVIEW.3Touch REPORT REVIEW.4Touch STAT REPORT.

12-Lead Diagnostics11-5 Automatic Scheduling of 12-Lead Reports12-lead reports can be acquired automatically by selecting an interval time using the AUTO REPORT key. User-selectable intervals include 30-minutes or 1-, 2-, 4-, 8-, or 24-hours. Selecting OFF will disable this feature.12-lead reports can be printed as they are acquired by selecting AUTO PRINT ON, or saved in memory for review and printing at a later time by selecting AUTO PRINT OFF.Touching the PRINT key at any time will print the displayed diagnostic report.Saving and Clearing 12-Lead ReportsAll 12-lead reports are stored in the module’s memory. The module can store multiple 12-lead reports (the exact number depends upon the ECG waveforms). When the module’s report memory is full, the oldest report that has not been saved is replaced by the newest report.To retain the currently displayed report in memory indefinitely, touch the SAVE key.To clear the currently displayed report from memory, touch the CLEAR key and then confirm your choice by selecting YES.Sending 12-Lead Reports12-lead ECG reports can be manually sent to an ECG Management System as they are acquired. To establish this as the default, use the Send ECG Report feature in the Module Configuration Manager and change the user setting to Manual. Refer to Table 1 ECG Parameter Configuration on page 7-9 for more information.If you select Manual, all reports are sent only to an ECG Management System when you touch SEND ECG.!• Automatic 12-lead reports are inhibited whenever the ECG signal is not of sufficient quality to produce a diagnostic report.!• If your monitoring system is interfaced to an ECG Management System and you are using a single module to acquire 12-lead reports at multiple bedsides, clear the 12-lead report(s) from memory before proceeding to the next patient’s bedside.!• The SEND ECG key is not displayed if the Send ECG Report feature is set to Automatic.• The default setting is Automatic.To schedule 12-lead ECG reports:1Touch ECG.2Touch REVIEW.3Touch REPORT REVIEW.4Touch REPORT SETUP.5Select AUTO REPORT of 30-minutes, 1-hour, 2-hours, 4-hours, 8-hours, or 24-hours.6Touch AUTO PRINT ON or OFF.To save/clear a 12-lead ECG report:1Touch ECG.2Touch REVIEW.3Touch REPORT REVIEW.4a Touch SAVE (while the report is displayed).-OR-4b Touch CLEAR (while the report is displayed).4c Touch YES to confirm (for CLEAR only).To manually send 12-lead ECG reports:1Touch ECG.2Touch REVIEW.3Touch REPORT REVIEW.4Touch SEND ECG.

Ultraview Care Network11-6Report Directory DisplayTouching the DIR key will display a directory of 12-lead reports. The time and date of each report is shown with the summary diagnosis.Use the arrow keys to select the report of interest, then touch the DISPLAY key to display the selected diagnostic report. Reports that have been saved will be marked as YES in column three.Figure 11-2: Report directory displayPatient DemographicsThe patient’s gender, date of birth, height, and weight are required by the diagnostic ECG algorithm. This information is entered via the patient Admit function.If patient demographic information is not entered, the diagnostic ECG algorithm will use the following defaults:!• A summary statement (column 4) is only displayed if option D is present.TIME DATE SAVED DIAGNOSIS1:00 28 AUG YES ABNORMAL ECG1:30 28 AUG NORMAL ECG2:00 28 AUG NORMAL ECG2:30 28 AUG NORMAL ECG3:00 28 AUG YES ABNORMAL ECG3:30 AM 28 AUG YES NORMAL ECGTable 1: Patient Demographic Default ValuesDemographic Default ValueDate of Birth 40 yearsGender MaleHeight 5’10”Weight 180 lbs!•For an accurate diagnosis, the patient’s demographics must be entered correctly.To view directory of 12-lead ECG reports:1Touch ECG.2Touch REVIEW.3Touch REPORT REVIEW.4Touch DIR.

12-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Respiration DirectoryDirectory of Keys - ECGECG MENU SUSPENDPROCESSINGALARM LIMITS SIZE SETUP LEADCONTROLDISPLAYFORMAT PRINTFULL VIEW SPLIT VIEW RESP VARITREND NEXTECG - DISPLAY FORMATRELEARN REVIEWECG Respiration Refer to2 LEAD CASCADERESPVIEWVARIVaritrend 3 Refer toECG - SETUPECG - CONFIGON OFF ON OFF ON OFF ON OFF ON OFF ON OFFSWEEPSPEEDQRSTONEMONITOREXTENDEDPACEDYES NO CONFIG RATESOURCERESTORESETTINGSTRANSFERDATAADULTINFANTARRON OFF

Respiration Directory!• Based on features purchased, more or fewer keys may appear here than on your menu screens.12-2Directory of Keys - RespirationRESP - SWEEP SPEEDRESP - TONERESP - LEAD SELECTRESP - ALARM LIMITSRESP - SIZERESP MENURESPALARM LIMITS SIZE SWEEPSPEEDRESPTONELEADSELECTSHALLOWNORMALCVA FILTERON OFFWAVEFORMON OFFRL - LA RA - LA RA - LL RL - LLTONEON OFF VOLUME VOLUME25mm/sec12.5mm/sec6.25mm/sec1.56mm/secSIZE SIZEHI/LOON OFFHI =20LO =10APNEAON OFFAPNEA =OFF

12-3!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Respiration DirectoryDirectory of Keys - Varitrend 3VARITREND MENUVARISIZE EVENTTREND1.5 MIN3.0 MINSPO2SCALERESP RATERESP WAVE PRINTHRSCALERESP WAVESIZEVARITREND - SIZE MENUDEFINEEVENTCLEAREVENTPRIOREVENTNEXTEVENTTREND PRINTVARITREND - EVENT TREND MENUTIMEBASE6 HOURS PRINTVARITREND - TREND MENUCLEAR THISEVENTVARITREND - CLEAR MENUCLEAR ALLEVENTSONOFF PRINTTACHOFFAPNEA20 secSPO285%VARITREND - DEFINE EVENT MENUBRADYHR 100 ENTER

Contents12-5 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Respiration Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Selecting Adult or Infant Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Setting and Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Turning Respiratory Waveform On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Adjusting Waveform Size. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Adjusting Sweep Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Adjusting Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Selecting Respiration Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Adjusting Respiration Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Using the Cardiovascular Artifact Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Recording Respiration Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Configuring Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Printing Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Respiration Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14RespirationOverviewThe respiration function detects and displays a waveform that:• represents each breath.• provides the respiration rate.• detects and rejects cardiovascular artifact. • initiates alarms when limits are violated for either the respiration rate or apnea.Changes in thoracic impedance during patient inspiration and expiration provide respiration data through the use of the ECG cable. Lead selection for respiration is independent of lead selection for ECG, even though both receive data from the same electrodes.Varitrend 3, an optional feature in some modules, generates a graph that plots heart rate, SpO2, and respiratory rates. You can view this plot on the monitor or print it on a system or bedside printer. The Event Trend feature of Varitrend 3 enables you to screen for apparent life threatening events such as bradycardia, with desaturation, or apnea accompanied by a change in heart rate. This feature plots bradycardia, tachycardia, apnea and desaturation trends for viewing and printing. A 24-hour trend of events is maintained and up to 48 events are stored in memory. Refer to Configuring Varitrend 3 Graphs on page 12-10 for more details.!• You can define your own default settings for alarm limits and the display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further details.

Ultraview Care Network12-6Setting Up Respiration MonitoringRefer to the Directory of Keys - Respiration on page 12-2 for a flow diagram of respiration keys and menus.Display DetailRespiration appears on the monitor in the following format:Figure 12-1: Respiration displayᕡRespiration traceᕢRespiration parameter keyᕣRespiration indicator (flashes once per detected breath)ᕤSelected lead for respirationᕥApnea alarm limit in secondsᕦHigh respiratory rate alarm limitᕧLow respiratory rate alarm limitᕨCurrent respiratory rate!• If the RESP ON/OFF key does not appear in the ECG Display Format menu, your module does not include the respiration option.• The RESP key must be ON in the ECG Display Format menu to display the RESP parameter key.CAUTION:• If you suspend ECG processing using the SUSPEND PROCESSING key in the ECG menu, you also suspend respiration processing.To set up respiration monitoring:1Attach the patient ECG leads.2Plug the ECG cable into the module’s ECG input.3Touch ECG.4Touch DISPLAY FORMAT. 5Select RESP ON.6Touch RESP.7Select additional keys as necessary.RESPAPN 15sRA-LA2015*18 2015ᕡᕢᕣᕤ ᕥᕦᕧᕨ

Respiration12-7 Selecting Adult or Infant ModeThe respiration function provides both adult and infant operational modes to optimize monitoring accuracy.When you select adult or infant, RESP alarm limits and breath detection sensitivity are adjusted based upon your selection.Setting and Adjusting AlarmsThe factory default setting for respiratory rate alarms is OFF in the adult mode and ON in the infant mode. Once respiratory alarms are enabled, the factory default settings are as follows: The factory default setting for apnea alarms is OFF in the adult mode and ON in the infant mode. When active, the factory default setting is 20-seconds in both modes. The apnea alarm setting is adjustable from 5- to 40-seconds, or the alarm can be disabled.Refer to Setting Alarm Limits on page 2-4 for details on system alarm operation.Apnea AlarmsApnea alarm limit is the maximum duration allowed between breaths before the respiration rate is set to zero. The apnea alarm limit may be set from 5- to 40-seconds in 5-second increments.• If the APNEA ALARM is turned ON, the APNEA ALARM will sound after the apnea limit is reached.• If the APNEA ALARM is turned OFF, the respiration rate will be set to zero after 20-seconds or when the apnea alarm limit is reached, whichever is greater. If the low rate alarm is ON, it will sound 10-seconds after the rate is set to zero.CAUTION:• When the system is in the infant mode, respiration alarm activation can be delayed for up to 3-minutes. (The factory default setting for alarm delay is 3-minutes.) Closely observe the patient during this period.High Rate Low RateAdult 150% of learned rate; not below 30 breaths/minute 0 breaths/minuteInfant 100 breaths/minute 10 breaths/minute!• If the alarm limit for high rate or low rate is displayed in reverse video, the alarm tone, alarm recording, and alarm watch have been disabled.To specify the patient type:1Touch ECG.2Touch SETUP.3Touch CONFIG.4Select ADULT or INFANT.To set or adjust rate alarms:1Touch RESP.2Touch ALARM LIMITS.3Select HI/LO ON.4Select HI= or LO=.5Use arrow keys to adjust.To set or adjust apnea alarms:1Touch RESP.2Touch ALARM LIMITS. 3Select APNEA ON.4Touch APNEA=.5Use arrow keys to adjust.

Ultraview Care Network12-8Turning Respiratory Waveform On/OffYou may choose to turn the respiration waveform OFF and display only the respiration numeric values.The factory default setting for respiration waveform is ON.Adjusting Waveform SizeYou can increase or decrease the size of the respiration waveform display. This changes the displayed size only, and does not affect the signal gain or breath detection sensitivity. Adjusting Sweep SpeedThe sweep speed determines the rate at which the respiration waveform moves across the screen. Sweep speed selections are 25, 12.5 (factory default), 6.25, or 1.56 mm/sec.Adjusting Respiration ToneYou can select an audible tone to sound with each respiratory cycle. The tone volume is adjustable or can be disabled.The factory default setting for tone is OFF.Selecting Respiration LeadsRespiration lead selections are RL-LA, RA-LA, RA-LL, and RL-LL.• RA-LA represents the line of maximum respiratory effort in adults and chest-breathing infants.• RA-LL represents the line of maximum respiratory effort in abdominal-breathing infants.• The factory default setting for respiration lead selection is RA-LA.!• When a good respiration signal cannot be attained from the selected lead, the message LOSS OF SIGNAL is displayed and ??? appears in place of the respiratory rate. To turn the respiration waveform display ON or OFF: 1Touch RESP.2Select WAVEFORM ON/OFF.To adjust respiratory waveform size: 1Touch RESP. 2Touch SIZE.3Adjust waveform size using SIZE ↑ or SIZE ↓.To select a respiration sweep speed:1Touch RESP. 2Touch SWEEP SPEED. 3Touch the appropriate mm/sec key.To adjust the respiration tone volume: 1Touch RESP.2Touch RESP TONE.3Select TONE ON.4Adjust tone volume using VOLUME↑ or VOLUME↓.To select respiration leads:1Touch RESP.2Touch LEAD SELECT.3Select the appropriate lead configuration.

Respiration12-9 Figure 12-2: Infant electrode placementAdjusting Respiration SensitivityTwo input sensitivities for respiration monitoring are available. You can set them based on the patient’s respiratory effort; shallow or normal. Use the shallow mode if the monitor has difficulty counting the respiratory rate and/or the waveform is difficult to read. Selecting the SHALLOW mode also lowers the detection sensitivity nearer to the low amplitude waveform of infants.The factory default for sensitivity is NORMAL in the adult mode, and SHALLOW in the infant mode.Using the Cardiovascular Artifact FilterRespiration is monitored based on impedance changes which occur with the expansion and contraction of the chest. However, the physical action of the heart pumping blood and the flow of blood through the vasculature also creates changes in impedance known as cardiovascular artifact (CVA).In the absence of respiration, for example, during episodes of apnea, it is possible for a waveform to appear in the respiration zone which represents CVA rather than true respirations. In such cases, the rate of the CVA would be the same as the heart rate.LARALLAlternate Method:Position RA and LA electrodes at the 2nd intercostal space, midclavicular line.Position LL below the diaphragm, preferably below the umbilicus.RA LALLMaximum Impedance Change:Position RA and LA electrodes at the nipple level, midaxillary line.Position LL below the diaphragm, preferably below the umbilicus.To adjust respiration monitoring sensitivity: 1Touch RESP.2Select SHALLOW or NORMAL.To enable the CVA filter: 1Touch RESP. 2Select CVA FILTER ON.To disable the CVA filter: 1Touch RESP.2Select CVA FILTER OFF.

Ultraview Care Network12-10The Spacelabs Medical CVA detection filter provides a method of discriminating between true respiratory effort and cardiac activity. The filter checks for coincidence between the respiratory and the heart rate. If the rates are the same, the digital display for respiratory rate changes to CVA, a CVA message appears in the waveform zone, and an apnea alarm is triggered if the apnea alarm has been enabled. This minimizes the possibility of apneic episodes being undetected due to CVA. Episodes of CVA will be reflected as a respiratory rate of zero in the trends.If the patient’s respiratory and heart rates are actually identical, you may want to disable the CVA filter.Restoring User-Defined SettingsWith the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-7Recording Respiration WaveformsYou can print Respiration waveforms and values. Refer to Printing on page 4-7 for additional information.Configuring Varitrend 3 GraphsIn Varitrend 3, trends for heart rate and SpO2 are displayed in the upper half of the zone. Either the respiration rate trend or the compressed respiration waveform is displayed in the lower half of the zone.WARNING:• If you disable the CVA detection filter, you will not be alerted to the presence of CVA if it replaces the respiration waveform.!• Module Configuration Manager is an optional feature for some modules. Your module may not contain this option.• RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.• Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.!• If the VARITREND ON/OFF key does not appear in the ECG Display Format menu, your module does not include the Varitrend option.To restore user-defined settings:1Touch ECG.2Touch SETUP.3Touch RESTORE SETTINGS.4Select YES.To print Respiration waveforms:1Touch RECORD.2Touch flashing RESP parameter key.To turn Varitrend 3 ON or OFF:1Touch ECG. 2Touch DISPLAY FORMAT. 3Select VARITREND ON or OFF.

Respiration12-11 Setting the Time ScaleYou can set the time scale for the horizontal axis at either 1.5- or 3.0-minutes.Selecting Respiratory Display TypeThe lower graph displays the trend for either the respiration rate or the compressed respiration waveform.• RESP RATE displays the current respiration rate trend.• RESP WAVE displays a compressed respiration waveform.Selecting Respiratory Rate ScaleYou can adjust the scale for the respiration rate trend. Scale selections include 0-50, 0-100, 0-150, or 0-200 breaths/minute.Selecting Respiratory Waveform SizeYou can trend a compressed respiration waveform. In this mode, the message RESP WAVEFORM appears next to the vertical axis instead of scale values.Selecting Heart Rate ScaleYou can plot heart rate. Scale selections include 0-100, 0-150, 0-200, 0-250, 0-300, 50-150, 100-200, 100-250, and 100-300 beats/minute.Selecting SpO2 ScaleYou can plot SpO2. Scale selections include 0-100, 25-100, 50-100, and 75-100%.To set the horizontal time scale:1Touch VARI.2Select 1.5 MIN or 3.0 MIN.To select the type of respiratory display:1Touch VARI.2Select RESP RATE or RESP WAVE.To select respiration rate scale:1Touch VARI.2Touch RESP RATE.3Touch SIZE.4Touch RESP RATE SCALE.5Use arrow keys to adjust.To select a respiration waveform: 1Touch VARI.2Touch SIZE.3Touch RESP WAVE SIZE.4Use arrow keys to adjust.To select heart rate scale: 1Touch VARI.2Touch SIZE.3Touch HR SCALE. 4Use arrow keys to adjust.To select an SpO2 scale: 1Touch VARI.2Touch SIZE.3Touch SPO2 SCALE. 4Use arrow keys to adjust.

Ultraview Care Network12-12Defining EventsThe Event Trend feature of Varitrend 3 enables you to store events that represent a change in a patient’s condition based on multiple variables. You can define criteria for up to five different events. For example, you may want to store episodes where the heart rate drops to less than 100 bpm, apnea lasts for more than 20-seconds, or the SpO2 value drops to less than 85%.The patient’s status will be continually checked against each event definition. If any of the criteria are violated, a snapshot of the Varitrend 3 display representing this deviation will be stored. The event will also be added to the event trend.Displaying Event TrendsEvents are trended according to their duration and frequency. Regardless of the defining criteria, all events are plotted (grouped) together in the event trend graph. You can select to view these trends in 6-, 12-, or 24-hour time periods. Resolution for each timebase is shown below (15-minutes for a 6-hour trend, 30-minutes for a 12-hour trend, 60-minutes for a 24-hour trend).The top trend displays the duration of the longest event in each time period. The bottom trend displays the number of events that occurred during each time period. Scaling, for the vertical axis for each trend, is automatically adjusted based upon patient data.Figure 12-3: Event trend graphClearing EventsIf you choose to clear a single event the data that represents that episode will be removed from the event trends. You may also clear all events and trends. This will have no effect on the event definitions.!• Events longer than 4-minutes will be reported as 4-minute events.To access Event Trend: 1Touch VARI.2Touch EVENT TREND.To define an event: 1Touch VARI. 2Touch EVENT TREND.3Touch DEFINE EVENT. 4Select event(s) to define.5Use arrow keys to adjust.6Touch ENTER.To display event trends: 1Touch VARI.2Touch EVENT TREND.3Touch TREND.To clear events: 1Touch VARI.2Touch EVENT TREND.3Touch CLEAR EVENT.4Select CLEAR THIS EVENT or CLEAR ALL EVENTS.To print events: 1Touch VARI.2Touch EVENT TREND.3Touch PRINT.To print event trends: 1Touch VARI.2Touch EVENT TREND.3Touch TREND.4Touch PRINT.6030018:30 06:30 18:30Eventbar graph105060-minuteresolutionLongestEVENT(seconds)Number ofEvents

Respiration12-13 Printing Varitrend 3 GraphsYou may produce a recording of the currently displayed Varitrend 3 graph. Refer to Printing on page 4-1 for a complete overview of printer functions.To print a Varitrend 3 graph: 1Touch VARI.2Touch PRINT.

12-14Respiration Troubleshooting GuideClinical Situation Possible Cause SolutionInaccurate respiratory rate or 0 displayed. Question marks displayed instead of rate■Respiration too shallow for normal detection.■Touch the SHALLOW/NORMAL key to highlight SHALLOW.■ECG electrode contact or placement poor.■Apply new electrodes. Make sure to properly prepare the skin; position electrodes on the chest where the chest expansion is the greatest.■Incorrect lead selection for respiration.■Select the appropriate lead. Best lead selection is typically RA-LA for adults and RA-LL for infants.■CVA artifact. ■Assess the patient for apnea. Reselect lead for better signal quality.No respiration waveform. LOSS OF SIGNAL message is displayed■ECG electrodes or patient cable not attached.■Select another lead.■Reconnect the leads or the patient cable.No respiration waveform is displayed■Channels have not been configured to display respiration.■Select RESP ON in the ECG Display Format menu.

13-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.NIBP DirectoryDirectory of KeysADULT NIBP - ALARM LIMITSNIBP - CHANGE CONFIGURATIONTIME INTERVAL for automatic readings = q xx yyyNIBPADULT NIBP - MENUALARMLIMITSTIMEINTRVLCHANGECONFIG.DISPLAY PRON OFFADULTNEONATALALARMSON OFFHI=150LO=100 SYS DIA MEANAUTOON OFF REVIEWPRINT<<>> >><<→←

Contents13-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up NIBP Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting Adult or Neonatal Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Displaying Heart (Pulse) Rate Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Initiating a Manual Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Setting Automatic Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Stopping a Measurement in Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Recording Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Reviewing Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12NIBPOverviewNoninvasive blood pressure (NIBP) uses oscillometric monitoring to measure systolic (S), diastolic (D), and mean (M) arterial blood pressures. The Ultraview Care Network monitor displays these readings and the time the measurement was initiated. You can also display heart rate. The monitor can display up to ten readings at one time and store up to 120 readings.!• Blood pressure measurements determined with this module are equivalent to those obtained by a trained observer using the cuff/stethoscope auscultation method, within the limits prescribed by the American National Standard, Electronic or automated sphygmomanometers.• Use only cuffs specified by Spacelabs Medical. Other cuffs may adversely affect performance and measurement accuracy.• There are no hazards associated with using non-invasive blood pressure equipment during defibrillation or high-frequency electrosurgery because both the cuff and cuff tubing are non-conductive materials.• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further information.

Ultraview Care Network13-4Setting Up NIBP MonitoringProper cuff selection and application is essential in ensuring the accuracy of NIBP readings. To select the proper cuff, first measure the circumference of the limb at its midpoint. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff. When applied, the index line on a correctly sized cuff will fall within the designated range markings on the cuff. If the cuff is too wide for the patient, the reading will be falsely lowered. If too narrow, the reading will be falsely elevated. The cuff results in the greatest chance of error, so a variety of cuff sizes should be available to accommodate your full patient population.The cuff should be snugly applied. When the cuff is properly applied to an adult, you should be able to insert one finger between the cuff and the limb. If you can insert two fingers, the cuff is too loose which may result in falsely elevated readings. Ensure that the inflation tube is not kinked or occluded when the cuff is applied.During blood pressure measurement, the inflated cuff reduces blood flow to the limb to which it is applied. Do not apply a cuff to a limb that has restricted blood flow. Check the patient periodically to ensure cuff application does not impair limb circulation.WARNING:• Cuff tubing connectors may incorporate luer fittings. Exercise caution when used in proximity with intravenous fluid lines.• Inadvertent connection of cuff tubing with luer fittings to intravascular fluid systems could allow air to be pumped into a blood vessel.CAUTION:• Do not use extensions or adapters with the neonatal inflation tube, other than those specified. • Do not apply the cuff to an extremity with restricted or otherwise compromised blood flow.• Do not apply the cuff to a limb being monitored with a pulse oximetry sensor. SpO2 readings will be affected during NIBP monitoring.• Do not apply the cuff to any extremity being used for intravenous infusion or catheterization.• Do not apply the cuff to any area of breached or injured skin.To set up NIBP monitoring:1Attach the cuff tube to the appropriate module front panel connector.2Attach the cuff to the patient.3Touch NIBP.4Touch additional screen keys as needed.

NIBP13-5 Patient Factors Affecting ReadingsExcess patient movement, speech, or muscle contractions (as a result of severe pain or shivering) can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would during manual readings. Avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain.Some arrhythmias may cause beat-to-beat pressure fluctuations that can make obtaining NIBP readings more difficult. Increased variability of readings can result from these pressure variations. If it becomes difficult to obtain readings in the presence of arrhythmia, pressure should be temporarily verified using another method. Pressure also varies cyclically with normal respiration. With deep respirations, or in certain patients, this effect may be enhanced, increasing reading variability.For patients in shock, indirect methods of measuring pressure (auscultatory, oscillometric, doppler) may not be reliable because of peripheral vascular changes. These changes include peripheral vasoconstriction and diminished peripheral circulation resulting from shunting of blood to central organs. In some cases, peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure. In such cases, measuring a cuff pressure may be impossible or give misleading results. Direct (invasive) blood pressure measurements should be considered in patients with signs of shock or any patient who rapidly becomes unstable for unknown reasons.

Ultraview Care Network13-6Display DetailFigure 13-1 and Figure 13-2 illustrate typical NIBP displays. You can view NIBP readings from any Ultraview Care Network bedside or central monitor on a network. The NIBP display on a split-screen central monitor appears in a format slightly different from that of a bedside or full-screen central monitor.Figure 13-1: Bedside monitor displayFigure 13-2: Central monitor, split-screen displayᕡSTAT key initiates an immediate blood pressure measurement. While a measurement is in progress the key label changes to STOP.ᕢNIBP key.ᕣLast systolic and diastolic readings.ᕤNIBP alarm limits. Split-screen central monitors display a bell symbol when alarms are enabled. Bedside monitors display the high and low alarm limits for systole and diastole. The asterisk indicates alarms are enabled for mean pressure.ᕥMean reading.ᕦCurrent interval for automatic readings (q 15 min). q’ in place of q indicates that the reduced delay of 5-seconds between readings is active (refer to Setting Automatic Measurements on page 13-9).ᕧNIBP measurement table.ᕨTime and date of the last reading.08:30 am 128/67 (80)08:45 am 132/67 (83)09:00 am 134/69 (85)09:15 am 140/72 (89)09:30 am 141/72 (91)09:45 am 138/73 (88)10:00 am 140/73 (90)10:15 am 142/76 (92)10:30 am 144/77 (95)10:45 am 165/97 (120)INTERVALq 15 min10:4506/03LAST BP = NIBP16597mmHg(120)SD15010010060*ᕧᕨᕦᕢ ᕣ ᕤ ᕥSTATᕡNIBP165/97 10:4506/03LAST BP = mmHg(120)BED 01 DAVIS, J.ᕣᕥᕨ ᕤᕢ

NIBP13-7 Bedside monitors show an NIBP table displaying a chronological listing of NIBP readings. The oldest data is at the top of the left column. Each reading contains the time of the measurement and the pressure values for systolic, diastolic, and mean. As new measurements are taken, the oldest data moves off the screen. Central monitors display the last NIBP reading only.Setting and Adjusting Alarm LimitsYou can define alarm limits for systolic, diastolic and mean values. The factory default setting for NIBP alarms is OFF. The default alarm limits settings for both the adult and the neonate modes are listed in Table 1.!• If you remove one NIBP module and insert another without purging data (via ADMIT/DISCHARGE), the NIBP table may display data for two patients.Table 1: Alarm LimitsHIGH LOWNeonatal Systolic 85 mmHg (11.5 kPa) 55 mmHg (7.5 kPa)Diastolic 75 mmHg (10.0 kPa) 45 mmHg (6.0 kPa)Mean 80 mmHg (10.5 kPa) 50 mmHg (6.5 kPa)Adult Systolic 150 mmHg (20.0 kPa) 100 mmHg (13.5 kPa)Diastolic 100 mmHg (13.5 kPa) 60 mmHg (8.0 kPa)Mean 110 mmHg (14.5 kPa) 90 mmHg (12.0 kPa)To set or adjust alarms:1Touch NIBP.2Touch ALARM LIMITS.3Select SYS, DIA, or MEAN.4Select ALARM ON.5Select HI= or LO=.6Use arrow keys to adjust.

Ultraview Care Network13-8Selecting Adult or Neonatal ModeIn modules that offer both adult and neonatal modes, you can determine the current mode by observing which key is highlighted or by reading the menu prompt in the NIBP menu. The factory default setting is adult.The following events occur with each change of mode:• The monitor erases current NIBP readings from the display but retains them in memory.• Previous NIBP readings appear immediately if present in memory. If not, readings appear as the measurements are taken.• Alarm limits and state (ON/OFF) are automatically changed for the new mode (adult or neonatal).• Active NIBP alarms reset; alarms in violation terminate and suspended alarms end.Displaying Heart (Pulse) Rate DataNon-invasive pressure measurements may be displayed with or without a pulse rate. If you choose to display pulse rate, only five measurements may be displayed in the NIBP table. Otherwise, ten measurements may be displayed as shown in Figure 13-1: Bedside monitor display. Pulse rate is obtained from ECG, arterial pressure (ART), SpO2, and NIBP (in that order), depending on the availability of these parameters.Initiating a Manual MeasurementYou can start a measurement at any time by touching the STAT key.If an initial measurement attempt is not successful, a single retry will be initiated after a 5-second interval (short-term mode) or 30-second internal (long-term mode). WARNING:• The mode (adult or neonatal) selected must correlate with the hose connected to the module and the patient type.!• New measurements cannot be initiated if another measurement is already in progress.To select the patient type:1Touch NIBP.2Touch CHANGE CONFIG. 3Select ADULT or NEONATAL.To display heart rate on NIBP table:1Touch NIBP.2Touch CHANGE CONFIG.3Select DISPLAY PR ON.To start an immediate measurement: 1Touch STAT.

NIBP13-9 Setting Automatic MeasurementsThe NIBP module always powers ON with automatic measurements set to OFF. The current time interval for automatic measurements is displayed on the message line above the arrow keys.The factory default setting for automatic time interval is 15-minutes. For automatic time intervals of less than 5-minutes, the module makes special allowances for a rapid succession of readings. For the first 15-minutes after you set up a reading (turn AUTO mode ON or select a new time interval), the minimum delay between readings is only 5-seconds. When this five-second delay is active, the interval message will appear with an apostrophe, after the q (q’). After the 15-minute period, the minimum delay between readings becomes 30-seconds.Measurement IntervalsAdult and neonatal measurement intervals are as follows:• between 1- and 10-minutes in 1-minute increments,• between 10- and 60-minutes in 5-minute increments, or• 1-, 2-, 4-, or 8-hours.Automatic Reading TimesTurning automatic mode ON or changing the interval, initiates a new measurement schedule. When the selected interval is a multiple of 5-minutes, automatic readings will always begin at the next five-minute division. Selecting AUTO ON shortly before the desired five-minute division can be used to synchronize measurements to exact clock times.For example, if at 8:03 you select a time interval of 15-minutes, automatic readings will occur at 8:05 and 8:20. If at 8:22 the interval is changed to 7-minutes, the next automatic readings will occur at 8:29 and 8:36.Stopping a Measurement in ProgressTo stop an NIBP measurement currently in progress, press the red Deflate button on the front of the module or the STOP key on the display. The next automatic reading will begin on schedule.WARNING:• During blood pressure readings the inflated cuff reduces blood flow to the limb to which it is applied. Consider this when selecting short time intervals.!• Touching STAT BP will take an immediate reading without affecting scheduled reading times.To determine automatic measurement intervals:1Touch NIBP.2Select AUTO ON.3Touch TIME INTRVL.4Use arrow keys to adjust interval.

Ultraview Care Network13-10Recording MeasurementsYou can choose to print out either the complete NIBP display or only the numeric values of the last reading. Reviewing MeasurementsYou can review a patient’s NIBP measurements by scrolling through the measurement table line-by-line or page-by-page. (A page is limited to five measurements if the pulse rate is displayed. Otherwise, a page is ten measurements.)To scroll line-by-line, touch the single arrow keys: • To review earlier measurements, touch the ← key. • To review later measurements, touch the → key.To scroll page-by-page, touch the double arrow keys:• To review earlier measurements, touch the «key.• To review later measurements, touch the »key.To page to the earliest five (or ten) measurements, touch the |« key.To page to the latest five (or ten) measurements, touch the »|key.Recording WaveformsYou can print NIBP waveforms and values. Refer to Printing on page 4-7 for additional information.Restoring User-Defined SettingsWith the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-7.!• RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.To print the NIBP measurements currently displayed:1Touch NIBP.2Touch REVIEW.3Touch PRINT.To print the most recent measurement (no table):1Touch RECORD (monitor key).2Touch NIBP.To review NIBP measurements: 1Touch NIBP.2Touch REVIEW.To print NIBP waveforms:1Touch RECORD.2Touch flashing NIBP parameter. key.To restore user-defined settings:1Touch ECG.2Touch SETUP.3Touch RESTORE SETTINGS.4Select YES.

NIBP13-11 Status MessagesAt the beginning of a blood pressure measurement:• The mean value of the previous reading disappears.• The message READING IN PROGRESS replaces the diastolic value.• A bleed step replaces the previously displayed systolic pressure.If the system fails to complete an initial measurement reading, the message SECOND READING REQUIRED will be displayed along with a description of the cause of the failure. A second measurement automatically begins either 5- or 30-seconds later, depending on whether the short-term automatic mode is active. If the second attempt fails:• The message NO READING is displayed.• An alarm sounds (if alarms are turned ON).• One of the following messages is displayed:INFLATE ERRORHW ERRORNO DATAIf the Deflate button on the front of the module or the STOP key on the display is pressed during a reading, the reading will end and the messages NO READING and CUFF DEFLATE will be displayed.If the system detects unstable beat-to-beat blood pressures during measurements, one of two messages will be displayed:• In the neonatal mode, MOTION is displayed.• In the adult mode, ARTIFACT is displayed.If an error status message is displayed and the system is unable to proceed with its current operation, you must correct the fault before the system can continue. If you are unable to correct the fault, contact a qualified service person.If NIBP SYSTEM FAILURE ERROR NUMBER = XX (bedside only), or HW ERROR (bedside and remote) displays, it indicates that a hardware problem has caused the NIBP portion of the module to be inoperable. The module must be serviced by a qualified service person before NIBP measurements can be taken. If the error message CUFF CAN NOT BE DEFLATED displays, it indicates that the deflate hardware is blocked and the cuff cannot be deflated. Remove the cuff from the limb immediately and have the module serviced. The module must be serviced by a qualified service person before NIBP measurements can be taken.If either of the above messages are displayed, a RESET NIBP key will be present in the Change Config menu. Touch the RESET NIBP key to re-enable non-invasive blood pressure monitoring. !• If these messages occur repeatedly, discontinue NIBP monitoring and contact a qualified service person.

13-12NIBP Troubleshooting GuideClinical Situation Possible Cause SolutionNo NIBP screen key is displayed■Module not inserted correctly. ■Remove and re-insert the module.No NIBP readings can be obtained■Incorrect or inoperative cuff in use. ■Replace with the cuff known to be operative.■Cuff tubing is attached to an adult outlet, but monitor is configured in the neonatal mode (or vice versa).■Connect tubing to the correct outlet. Correlate monitor mode, cuff and patient type.■Tubing is kinked. ■Locate kink and straighten tubing.■Some arrhythmias (for example, atrial fibrillation and frequent ventricular ectopy) may cause a single or repeated failure to obtain a reading (may be due to true beat-to-beat variations in pressure).■Document arrhythmia if present, verify pressure with another method, then follow hospital procedure for care of this type of patient.■Excessive patient motion or muscle contractions associated with shivering or severe pain.■Ensure that patient is quiet with minimal movement during NIBP readings. Minimize the patient’s shivering.■Blood pressure outside of measurement range.■Verify extremely high or low pressures with another method.Intermittent or complete failure to operate■Hardware error (codes 10, 20, and 30) detected during previous measurement.■Check the presence of the RESET NIBP key in the CHANGE CONFIG menu. Touch RESET NIBP to re-enable monitoring.■Remove the module from service and call a qualified service person if this condition occurs repeatedly.Apparent incorrect value ■Wrong size cuff for patient. ■Measure patient’s limbs at the midpoint. Match limb measurement to the range specified on the cuff (undersizing the cuff results in the greatest degree of error).■Cuff is damaged. ■Replace with a good cuff.■Excessive patient motion, shivering or severe pain.■Ensure the patient is quiet with minimal movement during NIBP readings. Minimize the patient’s shivering.■False high readings may be the result of venous congestion caused by frequent readings.■Reduce the frequency of the readings.■Cuff too loose or positioned incorrectly.■Tighten the cuff or reposition it appropriately.

13-13 Variable readings occur ■Some arrhythmias may cause beat-to-beat pressure and NIBP readings.■Document the arrhythmia, if present. Verify the pressure using another method, then follow hospital procedure for care of this type of patient.■Larger than normal influence of respiratory phases on blood pressure (inspiratory fall in blood pressure; expiratory rise).■NIBP software usually compensates for normal variation.No NIBP readings or questionable values in the presence of shock■Peripheral vascular changes experienced during shock may reduce the reliability of blood pressure readings obtained with any indirect method. Peripheral pulses may be diminished or absent.■Consider invasive pressure measurements in patients with symptoms of shock or in any patient who rapidly becomes unstable for unknown reasons.Clinical Situation Possible Cause Solution

14-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.SpO2 DirectoryDirectory of KeysALARM LIMITS SETUP IABPYES NOPULSE RATEON OFFSPO2SPO2 MENUSIZE WAVEFORMON OFF AVERAGING TONESPO2 - SETUP SPO2 - ALARM LIMITSALARMSON OFFHI =100LO = 85ALM DELAY15sMSG ALARMDELAY 30sMSG ALARM KEY is displayedonly when its value is otherthan 20 seconds.SIZE SIZETONEON OFF VOLUME VOLUMESPO2 - WAVEFORM SIZE SPO2 - DATA AVERAGING TIME XXsSPO2 - TONESUSPENDPROCESSINGYESSPO2 - SUSPEND PROCESSINGNO

Contents14-3 SpO2OverviewPulse oximetry allows continuous noninvasive monitoring of a patient’s hemoglobin oxygen saturation. The oximetry sensor contains two light emitting diodes (LEDs) that transmit specific wavelengths (typically 660 and 940 nanometers) of light that are received by a photo detector.Oxygen saturated blood absorbs light differently compared to unsaturated blood. The amount of light absorbed by the blood can be used to calculate the ratio of oxygenated hemoglobin to total hemoglobin in arterial blood. The monitor displays this ratio as percent SpO2. Normal values range from 95 to 100%.WARNING:• A pulse oximeter should NOT be used as an apnea monitor. • A pulse oximeter should be considered an early warning device. If a trend towards patient deoxygenation is indicated, blood samples should be analyzed by a laboratory co-oximeter to completely understand the patient's condition.• When used according to the manufacturers’ instructions, sensors have no adverse effect on tissues.Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Dual SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Ensuring Accurate Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Using the Sensorwatch Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Selecting Data Averaging Period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Using SpO2 with Intra-Aortic Balloon Pumps . . . . . . . . . . . . . . . . . . . . . . . . . . 7Adjusting Tone Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Modifying Waveform Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Viewing Pulse Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Suspending/Resuming SpO2 Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Recording SpO2 Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12SpO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Ultraview Care Network14-4Setting Up SpO2 MonitoringWhen you connect the adapter cable to the module the SPO2 key will be displayed. Attach the sensor to the patient and then to the adapter cable. An adapter cable is required between the sensor and the module. Do not discard the adapter cable when you have finished using a disposable oximetry sensor. Disconnect the sensor cable from the adapter cable before discarding the sensor.Connect the SpO2 adapter cable to the module or telemetry transmitter by aligning the cable with the notch on the SpO2 connector on the front of the module or telemetry transmitter. Push the cable straight into the connector. To remove the cable, press the latch release on the bottom of the cable and pull the cable straight out.!• Pulse oximetry may interfere with magnetic resonance imaging (MRI) procedures. Refer to your hospital’s protocols for specific instructions.• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further information.• The ECG lead wires of the 90343 telemetry transmitter must be connected to the patient in order to perform ECG and blood oxygen saturation monitoring.CAUTION:• Use only patient sensors specified by Spacelabs Medical. If you use sensors other than those specified, it may degrade performance and could damage the monitor during defibrillation.• Spacelabs Medical recommends the use of sensors repaired or remanufactured by the original manufacturer only.• Check the sensor site frequently. Do not allow the sensor to remain on one site for a prolonged period of time, especially when monitoring neonates. Refer to the sensor manufacturer's instructions.• Never attach an SpO2 sensor on a limb being monitored with a blood pressure cuff or a limb with restricted blood flow.• A poorly applied sensor may give incorrect saturation values. The Sensorwatch signal strength indicator is used to identify a poorly applied sensor or a poorly chosen site. Re-apply the sensor. Refer to Using the Sensorwatch Feature on page 14-6 for further details.• Choose a site with sufficient perfusion to ensure accurate oximetry values.To set up SpO2 monitoring (non-telemetry):1Connect the adapter cable to the module.2Attach the sensor to the patient and connect the sensor cable to the adapter cable.3Touch SPO2.To set up SpO2 monitoring (telemetry):1Connect the SpO2 adapter cable to the transmitter. 2Attach the sensor to the patient and connect the sensor cable to the SpO2 adapter cable. 3Initiate ECG monitoring.4Touch ECG.5Touch CHANNEL FORMAT.6Touch SPO2 ON.

SpO214-5 Dual SpO2 MonitoringSome modules support real-time monitoring of dual SpO2 sites. To employ this option, insert a second Spacelabs Medical SpO2 module into an available slot in the monitor. The new parameter will be displayed below the first SpO2 channel. Affix a label to the monitor’s bezel to indicate the sensor site location (for example, right hand, left foot) for each SpO2 parameter displayed on the monitor.Display DetailThese figures illustrate a typical SpO2 display. You can view oximetry values from any Ultraview Care Network bedside or central monitor on a network.ᕡPulse plethysmographic waveformᕢSPO2 keyᕣSensorwatch signal strength indicatorShaded area (waveform index, WFI) expands up proportionally to signal strength; horizontal line indicates minimum signal level.No shading (lowest waveform index) corresponds to no detected signal strength or a faulty sensor. ᕤSpO2 pulse rate (asterisk flashes when pulse is detected - on bedside monitors only)ᕥCurrent SpO2 value (percent)ᕦHigh and low SpO2 alarm limitsᕧThe bell indicates that alarms are enabled (on split screen central only)!• For telemetry display information refer to Display Detail on page 17-12.99109 bpm%10085*SPO2=99% PULSE RATE = 109 bpmFigure 14-1: Split screen central monitor Figure 14-2: Bedside monitorᕥᕤᕧᕡᕢᕡᕢᕣᕤᕥᕦSPO2SPO2

Ultraview Care Network14-6Ensuring Accurate MonitoringWhile each sensor requires site specific application procedures, the following general points aid in ensuring oximetry monitoring success.• Choose a site that provides proper alignment of the LEDs and receiving photodetector.• Reduce light interference when monitoring a neonate under bright light by using a diaper or other light block over the sensor.• Select a site that has unrestricted blood flow and can remain as immobile as possible to reduce or eliminate movement artifact.• Do not restrict blood flow when securing a sensor with tape.• Do not select a site near potential electrical interference (electrical cords, for example).• The Sensorwatch bar should be above the minimum signal level.Using the Sensorwatch FeatureThe Sensorwatch feature is a graphical presentation of the amplitude of the signal received from the sensor. It can be used to determine the best sensor site and application.Changes in the displayed shaded level signify the changes in the patient’s perfusion or changes in the application of the sensor. The horizontal line near the bottom fourth of the graphic represents the minimum signal level that results in accurate saturation values. When the shading is just below this point, the message LOW SIGNAL STRENGTH - REPOSITION OR REPLACE SENSOR is displayed and SENSORWATCH flashes.When the shading is below the line:• Reposition the sensor to a different site to provide better perfusion.• Reposition the sensor so that better contact is made with the skin and the LEDs and photodetector are aligned better.• Replace a defective sensor.• Wait for the patient to warm and the perfusion to increase.Setting and Adjusting Alarm LimitsPulse oximetry alarm limits and delays are based either on factory default limits or user-defined limits. The factory default settings for alarm limits are 100% for high and 85% for low. For alarm delays, the factory default settings are 15-seconds for alarm limit delay and 20-seconds for message alarm delay. Refer to Alarms on page 2-3 for further information concerning Ultraview Care Network alarm operations.Refer to SpO2 on page 7-31 for SpO2 parameter tables listing available user settings and factory defaults for this parameter. Refer to Table 3 ECG Parameter Configuration (Telemetry Only) on page 7-13 and Table 4 ECG Alarm Attributes (Telemetry Only) on page 7-16 for telemetry information.To set or adjust SpO2 alarms (non-telemetry):1Touch SPO2.2Touch ALARM LIMITS.3Touch ALARMS ON.4Touch HI=, LO=, ALM DELAY, or MSG ALARM DELAY (if present).5Use arrow keys to adjust.

SpO214-7 Additional Information for Telemetry ProductsWhen SpO2 alarms are enabled, a bell symbol is displayed between the SPO2 label and the SpO2 measured saturation value. When an SpO2 alarm is detected, the displayed parameter value blinks yellow if the alarm priority is Low or Medium, and blinks red if the alarm priority is High. Selecting Data Averaging PeriodUse this feature to smooth the oximetry saturation value by averaging patient input values over 4-, 8-, or 16-seconds. The default value is 8-seconds.• For non-telemetry products, the data averaging period is displayed in the menu prompt line of the AVERAGING menu.• For telemetry products, refer to the 90343, 90347, 90478, 90479-A Ultraview Digital Telemetry Service Manual (P/N 070-0744-xx) for setting up the data averaging period.Using SpO2 with Intra-Aortic Balloon PumpsEnabling the intra-aortic balloon pump (IABP) feature informs the SpO2 software that an IABP is in use. The SpO2 software must differentiate between true arterial pulsations and those produced by the IABP. With the IABP feature enabled, the transmitter excludes the IABP-generated pulsations from the calculation for SpO2.The IABP feature also may be useful with patients experiencing irregular heart rhythms. Enabling the IABP feature permits the transmitter to reject irregular pulses, providing a more accurate SpO2 measurement.!• When the IABP feature is enabled, the pulse rate obtained from SpO2 may not match the heart rate obtained from ECG.• In cases of excessive patient motion or artifact, the accuracy of the SpO2 measurement may be compromised when the IABP feature is enabled. • (90343 only) When the IABP operation is selected, the SPO2status key in the Channel Format menu indicates IABP. The Service Manual describes how to configure the telemetry transmitter for use with an IABP.To set or adjust SpO2 alarms (telemetry):1Touch ECG. 2Touch ALARM LIMITS.3Touch SPO2 ALARM LIMITS.4Select SPO2 ALARMS ON. 5Select HI=, LO=, ALM DELAY, and MSG ALARM DELAY.6Use arrow keys to adjust.To specify a data averaging period:1Touch SPO2.2Touch SETUP.3Touch AVERAGING.4Use arrow keys to adjust.To use with balloon pump (non-telemetry):1Touch SPO2.2Touch IABP YES.

Ultraview Care Network14-8Adjusting Tone VolumeUse this function to turn the pulse tone ON or OFF. The pitch varies according to the SpO2 value. The higher the oxygen saturation, the higher the pitch.The default setting for the pulse tone is OFF.Modifying Waveform DisplayUse this function to turn the plethysmographic waveform display ON or OFF. The default setting is ON.Use the SIZE key to change the height of the displayed waveform as necessary for clarity. This changes the displayed size only and does not affect the signal gain.Viewing Pulse RateYou can obtain and view a pulse rate derived from the saturation data. The pulse rate is displayed within the range of 30 to 250 beats per minute ±3 beats per minute.The default setting for the pulse rate display is ON for non-telemetry products.For telemetry products, the heart rate for display is obtained directly from the acquired ECG leads or an alternate rate source. SpO2 can be used as the alternate source if it is set for continuous measurement, but not when SpO2 is set for episodic measurement.!• This feature is not supported in telemetry products.!• Amplitude of the displayed waveform is not proportional to the pulse amplitude.• This feature is not supported in telemetry products.To adjust tone volume (non-telemetry):1Touch SPO2.2Touch SETUP.3Touch TONE.4Touch TONE ON.5Use arrow keys to adjust.To modify display of the waveform (non-telemetry):1Touch SPO2. 2Touch SETUP.3Verify WAVEFORM ON.4Touch SIZE.5Touch SIZE↑ or SIZE↓ to adjust. To modify the pulse rate display (non-telemetry):1Touch SPO2.2Touch PULSE RATE ON/OFF.To display heart rate from SpO2sensor (telemetry):1Touch ECG. 2Touch SETUP.3Touch RATE SOURCE.4Select SpO2 ON.5Select SpO2 as rate source.

SpO214-9 Restoring User-Defined SettingsWith the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-7.Suspending/Resuming SpO2 Processing When you touch YES in the Suspend Processing menu, analysis and display of the SpO2 data is suspended. If you touch NO, the display returns to the SpO2menu without affecting processing.When you suspend SpO2 processing:• The message SPO2 PROCESSING SUSPENDED appears in the SpO2waveform zone.• Question marks replace the SpO2 and pulse rate values.• The message SPO2 ALM OFF replaces the alarm limits.• The keys in the SpO2 Alarm Limits menu display outline to indicate they are disabled.• The SUSPEND PROCESSING key changes to RESUME PROCESSING.Recording SpO2 WaveformsYou can print SpO2 waveforms and values. Refer to Printing on page 4-7 for additional information.!• RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.• Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.!• This feature is not supported in telemetry products.To restore user-defined settings:Configurations with ECG1Touch ECG.2Touch SETUP.3Touch RESTORE SETTINGS.4Touch YES.To restore user-defined settings:Configurations without ECG1Touch TEMP.2Touch RESTORE SETTINGS.3Touch YES.To suspend SpO2 processing: 1Touch SPO2.2Touch SUSPEND PROCESSING.3Touch YES.To resume SpO2 processing:1Touch SPO2.2Touch RESUME PROCESSING.3Touch YES.To print SpO2 waveforms:1Touch RECORD.2Touch flashing SPO2 parameter key.

Ultraview Care Network14-10Error MessagesWhen error messages are displayed, the saturation value and pulse rate immediately change to ??? and an alarm may occur if your module is configured to do so. If it occurs, this alarm does not begin until after the message alarm delay time has elapsed.If your module has been configured for an alarm using the Module Configuration Manager feature, the parameter key will flash red for high priority alarms or yellow for medium and low priority alarms. Refer to Module Configuration Manager on page 7-5 for more information.Telemetry products use different text for their SpO2 error messages than non-telemetry products. Table 1 serves as a key for interpreting the telemetry messages. Telemetry products also display their error messages within ECG’s display zone, so the following ECG alarm messages take priority over other SpO2messages.• LEADS OFF• NOISY SIGNAL• ECG ALARMS SUSPENDED WARNING:• Error messages indicate a problem or condition which may affect accurate monitoring values. Do not ignore these messages. Correct any fault before continuing.Table 1: Telemetry Message EquivalentSpO2 Message Equivalent Telemetry SpO2MessageADAPTER DISCONNECTED – CHECK CONNECTION AT MODULESPO2 UNAVAILABLEFAULTY SENSOR – REPLACE SENSOR SPO2 FAULTY SENSORSENSOR DISCONNECTED – CHECK CONNECTION AT ADAPTER CABLESPO2 SENSOR DISCONNECTEDSENSOR OFF PATIENT – CHECK CONNECTION AT PATIENTSPO2 SENSOR OFF PATIENTINSUFFICIENT SIGNAL – REPOSITION OR REPLACE SENSORSPO2 INSUFFICIENT SIGNALAMBIENT LIGHT INTERFERENCE – COVER SENSOR AREASPO2 AMBIENT LIGHT INTF.NOISY SIGNAL SPO2 NOISY SIGNALLOW SIGNAL STRENGTH – REPOSITION OR REPLACE SENSORSPO2 INSUFFICIENT SIGNAL

SpO214-11 ADAPTER DISCONNECTED — CHECK CONNECTION AT MODULE• The module does not detect an adapter cable connected to the front panel. Check proper adapter cable connection.• If the message persists and the adapter cable is secure, replace the adapter cable.• The channel will drop and the alarm will stop after approximately 10-seconds.• On remote view, there may be no audible alarm on the remote monitor before the channel drops.SENSOR DISCONNECTED — CHECK CONNECTION AT ADAPTER CABLE• The module does not detect a sensor. Check the proper connection of the sensor with adapter cable.• If the message persists, replace the sensor and/or the adapter cable.SENSOR OFF PATIENT — CHECK CONNECTION AT PATIENT• The module does not detect a valid sensor input signal. Check the patient for proper sensor placement.• The tissue between the LED and photodiode is too transmissive. If the sensor placement seems correct and the message persists, try a sensor site with a thicker tissue bed.FAULTY SENSOR — REPLACE SENSOR• The LED and/or photodiode have failed. Replace the sensor.AMBIENT LIGHT INTERFERENCE — COVER SENSOR AREA • The sensor is receiving external light interference from a bright light source near the sensor. Shield the sensor from the external light source.• The sensor photodiode and LEDs are misaligned on flexible sensors thereby allowing light to enter. Realign the sensor photodiode with LEDs.• If the message persists, replace the sensor.INSUFFICIENT SIGNAL — REPOSITION OR REPLACE SENSOR• Insufficient signal for proper operation as evidenced by a low deflection on Sensorwatch signal strength bar.• Poor sensor application or site. Correctly re-apply or reposition to a better perfused site or massage site.• If the message persists, replace the sensor.!• This message is not available with disposable SpO2 sensors or non-clip type sensors.

Ultraview Care Network14-12NOISY SIGNAL• Sensor signal disturbed by motion or other interference. Eliminate sensor movement. Message disappears when the value is obtained.• Sensor placement adjacent to power cords or other electrically noisy devices. Move the noisy device or move the sensor to another site.• If the message persists, replace the sensor.LOW SIGNAL STRENGTH — REPOSITION OR REPLACE SENSORWhen this message appears the saturation and pulse rate continue to be displayed; however, the Sensorwatch flashes as a indication of a possible error condition.• Insufficient blood flow between the sensor light emitter and detector. Move the sensor to an area of higher perfusion.• Poor sensor application. Reposition to place active components closer to skin or locate to a better perfused site.• Sensor site is below the blood pressure cuff. Move to another site.• If the message persists, replace the sensor.SensorsFor further information about biocompatibility or sensor disposal, refer to the Spacelabs Medical Product Specification sheets and to the manufacturer's instructions enclosed with each sensor.

14-13 SpO2 Troubleshooting GuideClinical Situation Possible Cause SolutionNo SpO2 parameter key is displayed■Module not inserted correctly. ■Remove and reinsert the module.■Adapter cable not connected to module properly.■Correctly connect the adapter cable.■Sensor not connected to adapter cable.■Correctly connect the sensor.■SpO2 is not enabled at the 90343 transmitter.■Call a qualified service person to check transmitter DIP switch 1 and 2.■SpO2 is not enabled at the 90478 receiver.■Call a qualified service person to set transmitter DIP switch 8 to OFF.SpO2 value displays ??? ■Sensor not connected to patient. ■Reattach the sensor.■Excessive patient motion. ■Urge patient to remain still while reading is in progress.■Module is in the initialization phase (the first 15-seconds after sensor application).■Wait until the initialization is complete.■Adapter cable not connected to the module properly.■Correctly connect the adapter cable.■Sensor not connected to the adapter cable.■Correctly connect the sensor.■Low battery indicator constantly illuminated.■Call a qualified service person.Low signal strength ■Sensor placement not optimum. ■Move the sensor to a site which has better perfusion.■Align the LED with the sensor photo detector.■Sensor is placed below blood pressure cuff.■Move the sensor to an alternate limb.Intermittent or complete failure to operate■Module error. ■Call a qualified service person.

14-14Factors which cause significant variances in sensor accuracy■Presence of dysfunctional hemoglobins (COHb, MetHb).■Follow hospital procedure for determining oxygenation in these patients.■Presence of intravascular dyes (indocyamine green, methylene blue) depending on their concentration in the blood stream.■Follow hospital procedure for determining oxygenation in these patients.■High ambient light level. ■Reduce light levels near the patient.■Electrosurgical interference. ■Follow hospital procedure for determining oxygenation in these patients.■Patient is significantly anemic (Hb less than 5g/dl) or patient has received large amounts of IV solutions.■Follow hospital procedure for determining oxygenation in these patients.No SpO2 alarms are displayed (telemetry only)■ECG “Leads Off” condition exists. ■Re-attach ECG lead wires to patient and resume ECG monitoring to clear pending ECG alarms.■Higher priority alarm condition is present.■Clear current alarm condition and/or re-prioritize SpO2 alarms of interest in the Module Configuration Manager.■When SpO2 alarms are set ON, all SpO2 alarm conditions will cause the parameter value (or ???) to blink according to the alarm priority set by using the Module Configuration Manager.Clinical Situation Possible Cause Solution

15-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Fetal Monitoring DirectoryDirectory of KeysFETFETAL MAIN MENU TWINSHIFTTOCO FETALECGALFETAL SETUP MENURESET SETUP RECORDER PAPERFEEDAUDIO XXX% UA REFMARKON OFFSENSRESTORESETTINGSPRINTPERIODFETAL - FETAL ECG MENULOWmm/secXMEDIUMFETAL - TOCO SENS MENUSIZE SIZEHIGHAUTO MANUALFETAL - TWIN SHIFT MENUNO SHIFTFETAL - F-ALERT LIMITS MENUF ALERTLIMITSF-ALERTHIDDENKEYWAVEFORMON OFFECG PLOTON OFFECG HR EDITON OFFF-ALERTON OFFHI=XXXLO=XXX

Contents15-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Fetal Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Starting Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Ultrasound Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Uterine Activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Intrauterine Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Fetal Heart Rate Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Bradycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Tachycardia Alert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Recorder Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Module Configuration Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Telemetry Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Mermaid Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Fetal MonitoringOverviewThis chapter describes the fetal monitor functionality of the Spacelabs Medical Maternal Obstetrical Monitor™ (MOM™). For instructions on optional maternal parameters such as ECG, SpO2, temperature, and NIBP refer to the appropriate chapter of this manual.Fetal Display DetailThe fetal module automatically allocates a single display zone when it establishes communication with the Maternal Obstetrical Monitor. This zone consists of numeric values and messages. When an internal fetal ECG electrode is applied to the patient, a second zone displays the fetal ECG waveform from channel 1. This zone does not display when using ultrasound-monitoring technique. For singleton births, this display will appear as follows:Figure 15-1: Singleton birth displayFETAL67FHR1 (US)PATIENT’S NAMEROOM 1003144UC (EXT)ALERT ON♥144FHR1 (US)25UA (EXT)✑✓✑✓TIME and DATEPATIENT’S NAME RM 1003PAPER OUTᕡᕣᕤ ᕦᕨµ¸ᕧᕥᕢ

Ultraview Care Network15-4For a twin pregnancy, the display appears as follows: Figure 15-2: Twin displayᕡHeart beat indicator (flashes once per detected beat)ᕢChannel 1 heart rate (beats per minute)ᕣFHR channel labelᕤSource of heart rate signal (US = ultrasound, ECG = spiral ECG)ᕥSignal indicator (full = good signal; half full = adequate; empty = poor or no signal)ᕦUA channel labelᕧUterine activity measure (units for toco; mmHg or kPa for IUP)ᕨSource (EXT for toco; mmHg, or kPa for IUP) ᕩChannel 2 heart rate (beats per minute)µFetal parameter key¸Status messages (appear when appropriate)¹Time, date, patient name and room numberƸFetal ECG trace from spiral electrodeFETAL67FHR1 (US)PATIENT’S NAMEROOM 1003144UC (EXT)ALERT ON♥FHR1 (ECG)32UA (EXT) ♥125FHR2 (US)136TIME and DATEPATIENT’S NAME RM 1003PAPER OUTᕡᕣ ᕤ ᕦᕨ ᕣᕤµ¸ᕥᕩᕧᕢ¹Ƹ

Fetal Monitoring15-5 Starting OperationPower ONTo prepare the monitor for operation:1. Plug the appropriate end of the power supply cord into the monitor’s right side panel receptacle labeled J1.2. Secure the connector with the screw that is provided.3. Plug the other end of the power cord into a properly grounded three-wire outlet marked Hospital Grade or Hospital Only.4. Press the main power switch ON. The monitor will perform a self-test.Standalone unit (not connected to BirthNet):The patient’s name will flash on the display if all the following conditions are met:• The patient’s name has been admitted through the monitor setup.• The patient was not discharged from the monitor before powering OFF the monitor.• The unit was not powered OFF for a period greater than 3-minutes.If the flashing name is correct, the clinician should confirm the identity of the patient by touching the F-ALERT RESET key. Following confirmation, the patient’s name will print on the fetal strip and will continue to print every 20-minutes.If incorrect, use the MONITOR SETUP/ADMIT DISCHARGE key to admit the new patient.Under standalone conditions, the patient’s name will also flash if no fetal heart rate data has been received for a period of 10-minutes on channel 1. Touch the F-ALERT RESET key to confirm the patient’s name.When connected to BirthNet, the patient’s name will flash the first time the monitor intercepts a name from BirthNet (after power ON) to inform the clinician of the identity of the patient. Touch the F-ALERT RESET key to confirm the information. The patient name will also automatically print on the fetal strip. Subsequent admission through BirthNet will not cause the name to flash if the monitor has not been powered OFF between patients.!• If the MOM unit is powered OFF for a period of 3-minutes, all data, including the patient’s name, is purged from memory.!• The Admit/Discharge feature of the monitor is primarily a standalone feature. Use of this feature when connected to BirthNet might create a situation where the name of the patient entered under ADMIT in Monitor Setup will appear on the maternal strip while the fetal strip is identified with the patient’s name from BirthNet. If the hospital chooses to use the Admit/Discharge function, it is recommend that the monitor be powered OFF for 3-minutes between patients.

Ultraview Care Network15-6Under standalone or BirthNet connections, when the monitor is in fetal heart rate alert status, the clinician will have to first touch the F-ALERT RESET to reset the alert, and again, to confirm the patient’s name.Loading Chart PaperTo load chart paper:1. Press the Recorder Release button and slide the drawer out to reveal the paper bin.2. Pull out one or two sheets of paper from the top of a new packet and place the remaining packet of paper into the recorder drawer. Position the top of the paper (fetal heart rate scale) toward the left of the drawer with the printed side facing up.3. Slide the recorder door back until it snaps securely in place. Make sure that the leading two sheets of paper hang out of the monitor.CalibrationCalibration provides a functional check of the equipment and helps ensure a reliable recording. Calibration should be performed before beginning a recording and can be done at any time during monitoring.To calibrate:1. Touch the FETAL key.2. Touch the PAPER FEED key.3. FHR 1–150, UA –50, and FHR 2–180 will be displayed and the recorder will print corresponding lines on the fetal strip chart.!• For the protection and proper performance of the recorder, use only paper approved by Spacelabs Medical. Failure to use approved paper may result in a malfunction.!• Following calibration, check that the recorder printed a line at 150 and 180 to ensure the paper is the correct scale.To advance and calibrate the fetal recorder paper:1Touch PAPER FEED.

Fetal Monitoring15-7 Ultrasound MonitoringChannel 1The ultrasound transducer sends sound waves into the uterine cavity and detects echoes returning from objects in the path. The monitor uses auto-correlation to analyze these echoes from moving objects, specifically the fetal heart. The rhythm of the motion is used to compute the fetal heart rate. To produce a reliable recording, the transducer must be positioned properly to send sound waves directly at the fetal heart.Ultrasound Transducer Preparation and ApplicationThe transducer connections are color-coded and uniquely keyed.1. Plug the ultrasound transducer (green) connector into the FHR1 (green) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.2. Apply a generous amount of gel over the face of the ultrasound transducer.3. Adjust the volume as necessary to hear the fetal heart sounds while positioning the ultrasound transducer.4. Place the transducer on the mother’s abdomen and gently move it along the abdomen to locate the sharpest and clearest fetal heart sounds.5. The transducer should be held securely in place with the transducer belts without causing discomfort to the patient.6. Check the mother’s pulse. Be sure it does not coincide with the displayed heart rate. If it does, the transducer may be detecting the maternal blood flow, rather than the fetal heart beat. Reposition the transducer toward the fetal heart.!• To obtain consistent, reliable information, proper application of transducers is essential.!• The gel is necessary to ensure that good signals are produced by the transducer. Use enough gel to cover the flat transducer face before it is placed on the mother’s abdomen. Add additional gel, if necessary, to improve the signal.!• Remember to calibrate the monitor each time you begin a monitoring session. Refer to Calibration on page 15-6.!• Keep the transducer face in contact with the abdomen. Tilt the transducer to locate the clearest heart sounds, then reposition it in the direction of the tilt until you hear the best signal while the transducer is flat on the abdomen.

Ultraview Care Network15-8Channel 2The monitor is equipped with a second FHR connector to provide simultaneous monitoring of twins. Both fetuses can be monitored using ultrasound transducers. Ultrasound transducer preparation and application for the second fetus is the same as for a single fetus. Volume controls for both channels are located on screen.Differentiation of Fetal Heart RateTo aid in distinguishing twin fetal heart rates, the operator can select one of three modes for presentation of the fetal heart rate data for the second fetus. The three modes are:• FHR2 prints on the same scale as FHR1• FHR2 prints on a scale 30 bpm below FHR1 (twin shift manual setting)• FHR2 shifts to a scale 30 bpm below FHR1 when the monitor detects the two FHRs to be in proximity to each other (auto setting). To differentiate twin FHRs on the fetal strip chart, the FHR2 trend prints in a light gray compared to the darker FHR1 trend. When twin fetal heart rates intersect, the FHR2 trend prints dots only, rather than a line, to enhance the distinction between the two. Finally, the recorder prints HR2 every 10-minutes with a dotted line pointing to the FHR2 trend. If the 30-bpm offset is activated, the message will read HR2, Add 30.Coincidence RecognitionThe system has a coincidence recognition feature to detect the same heart rates between FHR1 and FHR2 over a period of time. When a coincidence is suspected, the monitor prints a question mark (?) on the strip chart to notify the clinician.!• Make sure that both transducers are not directed at the same fetus. Review the information on Differentiation of Fetal Heart Rate on page 15-8 and Coincidence Recognition on page 15-8.!• Once shifted, FHR2 will remain on this alternate scale until the monitor detects a consistent pattern of baseline separation between the two fetal heart rates. In many cases, this alternate scale may remain in effect throughout the delivery.!• If these marks appear, the FHR1 and FHR2 signals may be from the same fetus. Re-check the ultrasound transducer positions. If necessary, reposition the transducers to capture the fetal heart rates from different fetuses.• This detection may not occur if channel 1 is in ECG mode and channel 2 is ultrasound, because of the difference in signal processing.• This detection may not occur if one or both of the ultrasound channels have a poor signal quality.To set the twin FHR shift:1Touch the SETUP key on the main fetal menu.2Touch the TWIN SHIFT key.3Select MANUAL, AUTO, or NO SHIFT mode.

Fetal Monitoring15-9 Uterine ActivityThe toco transducer detects uterine activity by sensing changes in tension on the abdomen. Although absolute uterine pressure cannot be measured by this method, the toco transducer does provide a reliable indication of the timing and approximate duration of contractions.Toco Transducer Preparation and Application1. Plug the toco transducer (yellow) connector into the UA (yellow) connector on the front of the monitor. The groove on the toco transducer connector must be aligned properly.2. Position the transducer on the maternal abdomen. The best location is usually midline between the fundus and the umbilicus.3. The transducer should be held securely in place with the transducer belts without causing discomfort to the patient.4. To initialize, touch the UA REF key. The UA display will reset to 20 units momentarily.!• Do not use any kind of gel on the toco transducer.!• Toco sensitivity can be set at three different levels enabling you to adjust the sensitivity to meet the specific needs of a particular patient.To initialize uterine activity:1Touch the UA REF key.2Touch YES to confirm.To set the Toco sensitivity:1Touch the SETUP key on the main fetal menu.2Touch the TOCO SENS key.3Select LOW, MEDIUM, or HIGH sensitivity.

Ultraview Care Network15-10ECG MonitoringIn addition to ultrasound, channel 1 is designed to monitor fetal heart rate using an invasive spiral electrode to obtain the fetal ECG and derive the heart rate. The ECG (internal) mode is generally considered the most accurate and reliable method to obtain a fetal heart rate.Fetal ECG Electrode Preparation and Application1. Prepare an area on the patient’s upper thigh or, preferably, on the lower abdomen by cleaning with an alcohol swab. Allow to dry.2. Apply a pre-gelled ECG skin electrode to the prepared area.3. Plug the leg clip (green) connector into the FHR 1 (green) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.4. Apply the fetal spiral electrode according to the instructions on the manufacturer’s packaging.5. Once the spiral electrode has been attached, press the top of each push post on the leg clip to reveal a slot. Insert each wire (two) from the electrode into each slot on the leg clip. There are no color-coded requirements, either wire can be inserted into either post.6. Gently pull the wires to make sure they are firmly attached to the leg clip. They should not disconnect.7. Attach the leg clip to the pre-gelled skin ECG electrode on the patient’s thigh or abdomen.8. Check that the monitor is receiving appropriate signals, and adjust the audio key to hear the tone (R-wave detection), as necessary.WARNING:• Because the tip of the fetal spiral electrode is designed to penetrate the fetal skin, it may present the possibility of trauma, hemorrhage, or infection. Therefore, these electrodes should only be used under aseptic conditions. Refer to contraindications and application instructions on the electrode manufacturer’s packaging.• To apply the fetal ECG spiral electrode, the membranes must be ruptured.!• If both the fetal heart rate and uterine activity are to be monitored using internal techniques, it is generally recommended that the intra-uterine catheter be inserted before the attachment of the spiral electrode.!• To acquire ECG data, the leg clip must be connected to FHRchannel 1.• The leg clip does not work on FHR channel 2.

Fetal Monitoring15-11 Intrauterine Pressure MonitoringActual intrauterine pressure, including contraction frequency, duration, intensity, and uterine tone (pressure between contractions), is measured using an intrauterine catheter and pressure transducer. Application techniques for internal pressure catheters are considered to be beyond the scope of this manual. Consult the manufacturer’s instructions included with the package for proper application techniques.Pressure Transducer Preparation and Application: Reusable Pressure Transducer (Fluid Filled Catheter)1. Follow manufacturer’s instructions on the preparation and insertion of the intrauterine catheter.2. Level the pressure transducer with the maternal xiphoid or the top of the fundus.3. Plug the pressure transducer (yellow) connector into the UA (yellow) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.4. Attach a 3-way stopcock (from the intrauterine catheter kit) to the side port of the pressure transducer (strain gauge). Attach a pressure relief valve or dead-end stopper to the top port.5. Once the intrauterine catheter has been inserted, remove the catheter guide, and attach the catheter to the 3-way stopcock.6. Fill a 20 cc syringe with sterile water and attach it to the 3-way stopcock.7. Turn the handle of the stopcock toward the pressure transducer and flush the catheter with at least 5 cc of sterile water.8. Turn the handle of the stopcock toward the catheter.9. Lift the cap on the pressure relief valve or remove the dead-end stopper on the top of the pressure transducer (strain gauge) dome to vent the dome. Flush the transducer with 1 to 2 cc of sterile water.10. Touch the RECORDER key to turn the recorder ON.11. Touch the UA REF key to initialize.WARNING:• When inserting the intrauterine pressure catheter, the membranes must be ruptured.!• Check to ensure that all of the air bubbles have been removed.• If there are still air bubbles in the dome, repeat the process.CAUTION:• Do not attempt to force water into the transducer dome unless it is vented to the air. Permanent damage to the transducer may result.

Ultraview Care Network15-1212. Press Yes to confirm the initialization. The UA display should read 0 (zero). Release the cap on the pressure relief valve or replace the dead-end stopper to reseal the dome.13. Turn the handle of the stopcock toward the syringe to begin recording uterine activity.If, during monitoring, the UA channel does not appear to be accurately recording contractions or the tracing of the contractions looks jagged or angular, either the catheter has collected debris from the amniotic fluid or it contains air bubbles. If this happens, take the following steps:1. Turn the 3-way stopcock toward the pressure transducer.2. Flush with 5-10 ml of sterile water.3. Turn the handle of the stopcock toward the syringe.4. Check the recording.Transducer-Tipped Catheter  DisposableApplication techniques for internal pressure transducers are considered to be beyond the scope of this manual. Consult the manufacturers instructions included with the package for proper application technique.1. Plug the intrauterine pressure catheter (yellow) connector into the UA (yellow) connectors on the front of the monitor.2. Touch the UA REF key to initialize.3. Press Yes to confirm the initialization. The UA display on the monitor should read 0 (zero) and the strip chart should record 0 (zero).4. Follow manufacturer’s instructions on the preparation and application of the intrauterine pressure catheter.!• Check to see that all of the air bubbles have been removed.• If there are still air bubbles in the dome, repeat the process.!• Between contractions, the UA channel should not return to zero. This is the measure of the uterine resting tone.!• To check that the system is operational, it is often helpful to ask the patient to cough. This should produce an artifact on the fetal strip chart recording.• Utah Medical IPC 400 is the only catheter-tipped transducer recommended for use with this monitor.To initialize uterine activity:1Touch the UA REF key.2Press Yes to confirm.

Fetal Monitoring15-13 Main MenuWhen the FETAL key is touched, the menu will appear at the bottom of the screen. This menu will remain on screen during the monitoring session, unless the operator accesses another menu screen. To return the to Main menu, touch the FETAL key.Fetal Heart Rate AlertsThe fetal module provides two alert conditions for fetal heart rate: operator-set limits and pattern recognition.The fetal heart rate pattern recognition alert function activates if the bradycardia or tachycardia alert limits are violated for a preset period of time or if heart rate patterns described below occur. The alert function serves the purpose of notifying the care giver of a potential condition that might be developing and should not replace any of the care giver’s functions. The monitor will generate an alert when twenty consecutive, one-second samples of fetal heart rate are below the operator-set limit. The factory default is 84 bpm.!• When an alert condition occurs, the monitor provides several indications. Alert reset removes these indications.• A message flashes Heart Rate F-Alert.• The FETAL key will flash.• A tone will sound if tones are enabled.To turn F-Alert ON or OFF:1Touch the SETUP key on the main fetal menu.2Touch the F-ALERT limits key.3Select F-ALERT ON or OFF.To set fetal alert limits:1Touch the SETUP key on the main fetal menu.2Touch the F-ALERT limits key.3Select F-ALERT ON.4Select the HI= or LO= key.5Use the arrow keys to adjust the limits.To silence and reset the alert:1Touch F-ALERT RESET.

Ultraview Care Network15-14Bradycardia AlertType 1The heart rate is divided into eight groups of 20-seconds each. Group Hrepresents the current 20-seconds.An alert will activate if Groups Gand Hare below 90 bpm.Figure 15-3: Type 1 bradycardia alertCAUTION:• Any time the alert activates, the heart rate must return to normal before the Alert can be reactivated. Reset the alert by pressing the F-ALERT RESET key on the screen. • If a group of heart rates is less than 30 bpm, the algorithm considers this condition a loss of signal and a NO ALERT will occur.!• All representations of fetal heart rates in this chapter are computer generated.

Fetal Monitoring15-15 Type 2An alert will activate if:•Group His less than Group F; and•Group Gis less than Group E; and•Group Fis less than Group D; and•Group Eis less than Group C; and•Group His below Group Cby more than 30 bpm.Figure 15-4: Type 2 bradycardia alertType 3An alert will activate if the average of Groups Gand His lower than the average of Groups A,B,C, and Dby more than 40 bpm.Figure 15-5: Type 3 bradycardia alert

Ultraview Care Network15-16Tachycardia AlertThe monitor analyzes the fetal heart rate for tachycardia using the following algorithms. The heart rate is divided into eight groups of 20-seconds each.Type 1An alert will activate if:•Group Cis less than 180 bpm, and•Groups F,G, and Hare each greater than or equal to 190 bpm.Figure 15-6: Type 1 tachycardia alertType 2An alert will activate if Group Ais less than the tachycardia limit set by the operator, and Groups B,C,D,E,F,G, and Hare each greater than or equal to the tachycardia limit set by the operator. The example shown below has the limit set at 180 bpm. Figure 15-7: Type 2 tachycardia alert!• The most recent Heart Rate Group is H; Heart Rate Group Amust not be zero.

Fetal Monitoring15-17 Recorder OperationsThe monitor is automatically programmed to print predetermined data items on the fetal strip chart. The following two strips identify the data items and illustrate how twin FHRs print on the strip. The recorder will also print values from maternal monitoring parameters. When installed with the BirthNet Obstetrical Data Management System, designated data items entered in BirthNet will also print on the strip.Figure 15-8: Twin fetal heart rates on the same scale

Ultraview Care Network15-18Figure 15-9: Twin fetal heart rates on same scale, then shifted to separate scalesThese messages print according to the following schedule:Event Marker FunctionsTo mark an event on the strip chart recorder, touch the MARK key on the screen. The recorder will print a black bar at the top of the heart rate scale. The monitor is also equipped with an external Event Marker. When the external Event Marker is pressed, the recorder prints an arrow at the top of the heart rate scale.Table 1: Print Time IntervalsDATA ITEM TIME INTERVALSᕡ Time and Date Every 5-minutesᕢ Recorder Speed 5-, 20-, 35-, and 50-minutes after the hourᕣ HR Mode 5-, 20-, 35-, and 50-minutes after the hourᕤ Uterine contraction mode 5-, 20-, 35-, and 50-minutes after the hourᕥ Monitor ID # 10-, 25-, 40-, and 55-minutes after the hour Twin Shift (when selected) Every 10-minutes “HR2 add 30” prints ? (for signal coincidence) Upon detectionᕢᕣᕡᕤᕥTo mark an event on the fetal strip:1Touch the MARK key.

Fetal Monitoring15-19 Printing Heart Rates Over 240 bpm (ECG only)When a spiral electrode is in use and the heart rate exceeds 240 bpm, the numeric value (up to 300) is displayed on the screen. On the fetal strip chart, the monitor will automatically plot the scale at half-rate when the heart rate is over 240 bpm (i.e., if the heart rate is 250 bpm, it plots at 125 bpm). A two-dot bar prints on the top of the fetal strip chart to indicate this half-rate scale is in effect. When the heart rate falls below 240 bpm, the monitor resumes normal plotting procedures.Maternal ParametersThe maternal physiological data (such as SpO2, NIBP, etc.) from the Ultraview Command Module or other Spacelabs Medical modules are printed on the fetal strip at designated intervals (1- to 60-minutes). ECG HR EditThe fetal module can recognize and edit fetal heart rate changes between two consecutive heart beats that are greater than 30 beats per minute. If ECG edit is ON, connecting (slew) lines between consecutive heart rates are not plotted. Under these circumstances, the tracing appears to have gaps.ECG PlotsWhen monitoring in the ECG mode (spiral electrode), the monitor can be setup to print short “rhythm strips”. If a change in heart rate greater than 20 bpm between two consecutive fetal ECG complexes is detected, this change triggers the monitor to plot the ECG rhythm strip, representing approximately 4-seconds of data: 2-seconds before and 2-seconds after the triggering event. The ECG rhythm strip feature can also be triggered manually. When the Event Marker is pressed (and the ECG HR is not plotting), a small arrow appears on the strip and the ECG rhythm strip plots.The ECG data is presented at standard 25 mm/sec, although the monitor runs at 3 cm/min. It will take about three and a half minutes at 3 cm/min. for an entire ECG rhythm strip to print.!• Maternal SpO2and heart rate values are printed on the strip as MSpO2 and MHR.!• The monitor does not recognize another triggering event until the rhythm plot is complete. Following completion, the monitor will recognize and plot the next event.• Artifacts may also trigger the monitor to plot the fetal ECG.!• Arrows indicate the triggering event.To set the time interval for SpO2and MHR parameters to print on the fetal strip:1Touch the SETUP key on the main fetal menu.2Touch PRINT PERIOD.3Select numeric value equal to the number of minutes to set the time interval for SpO2 and MHR parameters to print on the fetal strip.To set ECG HR Edit:1Touch the SETUP key on the main fetal menu.2Touch the FETAL ECG key.3Select ECG HR Edit ON or OFF.To set ECG plot:1Touch the SETUP key on the main fetal menu.2Touch the FETAL ECG key.3Select ECG PLOT ON or OFF.

Ultraview Care Network15-20Figure 15-10: ECG rhythm stripFigure 15-11: ECG rhythm stripVariability Trend PlotsWhen operating in ECG mode, a trend of fetal heart rate variability is automatically calculated and plotted. This X-Y graph, printed every 10-minutes, is computed by combining long-term and short-term heart rate variability. One point is plotted for each 128 heart beats.The X-axis corresponds to time, and the Y-axis corresponds to the value of variability for each measurement. The Y-axis is divided into three levels of variability:• above average•average• below averageThe most recent data is represented at the right side of the graph and it takes approximately 100-minutes of monitoring for the variability plot to reach its full capacity.

Fetal Monitoring15-21 Figure 15-12: Above-average variability plotFigure 15-13: Average variability plot

Ultraview Care Network15-22Figure 15-14: Below-average variability plotPaper Out MemoryIf the recorder runs out of chart paper, the screen flashes PAPER OUT in the dedicated status area on the screen.When this condition occurs, the monitor continues to collect and store fetal heart rate and uterine activity data up to one hour (40-minutes if monitoring twins). Once the paper is replaced, the monitor prints the stored data at 12 times real time. A vertical line marks the start and end points, along with the messages MEM START and MEM END. When the stored data has been printed, normal (real-time) recording resumes.!• The Variability Trend Graph is only generated in direct ECG mode from FHR channel 1.• Variability data is not meant to indicate the status or well being of the fetus.• Variability data is a mathematical expression of the variability of the fetal heart rate displayed in a convenient way. !• All collected data is erased when the recorder is powered OFF.• If you wish to print the collected data, do not power OFF the recorder when replacing the paper.• To terminate a print session on the fetal strip chart, select RECORDER OFF.To disable the fetal recorder:1Select RECORDER OFF.

Fetal Monitoring15-23 Module Configuration ManagerThe Module Configuration Manager feature provides the capability to define and store all user-configurable options for the fetal parameter. Once configured, these settings control its operation whenever the monitor is powered ON.Display DetailThe User Settings screens list all user-configurable options. From these screens you can change and store the options in your monitor.Figure 15-15 illustrates the User Settings screen which is used to change and store fetal rate alarm limits. The parameter configuration table in this chapter lists all available options, the available user settings, and the factory defaults for each parameter.Figure 15-15: User settingsᕡCURSOR ↑ and CURSOR ↓ keys scroll through the two columns of parameters on the screen.ᕢ↑ and ↓ keys scroll the list of valid settings for the highlighted parameter.ᕣPREV PAGE key returns to the previous screen.ᕤNEXT PAGE key advances to the next screen.ᕥPRINT PAGE key prints the current screen.ᕦSTORE key stores the currently selected settings as defaults.PARAMETER DESCRIPTION VALUE PARAMETER DESCRIPTION VALUEFETAL RATE ALERT OFF ECG RATE ALARMS (INFANT) NO SHIFT• HIGH RATE 180 TOCO SENSITIVITY MEDIUM• LOW RATE 84 ECG PLOT ONFETAL ECG WAVEFORM ON ECG EDIT OFF• FECG WAVEFORM SIZE 1.00 EXTERNAL DEVICE NONE• FECG SWEEP SPEED 25 PRINT PERIOD 10Enable/Disable Fetal Rate AlertᕦᕥᕢᕣᕡᕤSTORESELECT PARAMETERCURSOR CURSORCHANGE VALUE PAGE X OF XPRINT PAGENEXT PAGEPREV PAGE

Ultraview Care Network15-24Setting User-Defined Default ValuesUse the User Settings screens to change and store settings. If the setting for the selected parameter cannot be changed, the message THIS SETTING CANNOT BE CHANGED will be displayed.The ability to access the Module Configuration Manager screens can either be visible to all users or remain hidden. The factory default setting is INVISIBLE. Adjust the SYSTEM SETUP key to the VISIBLE setting to enable user access to this function.Storing Changed SettingsTouch the STORE key after entering configuration changes for any page. This action stores the currently selected settings for all entries.The Patient Admit/Discharge function allows you to SAVE the changes in the alarm limit settings as the default settings for future patients, or RESTORE the original default settings upon discharge of that patient or admission of a new patient.

Fetal Monitoring15-25 Parameter ConfigurationsTable 2: Fetal Parameter ConfigurationParameter Available User SettingsFactory DefaultsUser SettingsFetal Rate Alert On/Off OffHigh Rate Limit 160-210 bpm 180 bpmLow Rate Limit 70-130 bpm 84 bpmFECG Waveform On/Off OnFECG Waveform Size 0.10-2.00 1.00FECG Sweep Speed 25 or 50 mm/sec 25 mm/secTwin Shift Auto/Manual/No shift No shiftToco Sensitivity High/Medium/Low MediumECG Plot On/Off OnECG Edit On/Off OffExternal Device None/Nellcor FSpO2NonePrint Period 1- to 60-minutes 10-minutesChart Recorder On/Off OnSpeed 1, 2, or 3 cm/minute 3 cm/minuteHeat 1/2/3 2Alignment 0-10 3Scale USA/INTL USAVariability Plot On/Off OnFHR1 Audio Level Off, 50% - 100% 75%FHR2 Audio Level Off, 50% - 100% 75%Patient Name Source Auto/Manual AutoTime/Date Format USA/INTL USACIM Protocol A/B ACIM Baud Rate 9.6k/19.2k 9.6kModem ID 0-255 0Simulator On/Off OffBegin Address 0-127 0End Address 0-127 0Increment 1-63 0System Setup Key Visible/Invisible InvisiblePatient Admit/Discharge Save/Restore RestoreTo review or change settings: 1Touch FETAL.2Touch SETUP.3Touch the hidden key 3 times.4Touch DEFAULT STORAGE.5Touch USER SETTINGS.6Use CURSOR↑ and CURSOR↓to scroll through the parameter description list.7Use ↑ and ↓ to change the settings.8Touch NEXT PAGE to continue to next screen of parameters.9Touch STORE to save the new settings.10 Touch YES when the Yes/No message is displayed.

Ultraview Care Network15-26Telemetry OptionEach fetal monitor can be equipped with a fetal telemetry system to provide continuous monitoring of an ambulatory patient. The patient carries a small transmitting device that transmits signals to the fetal monitor for recording. The fetal telemetry system transmits ultrasound, Toco, and nurse call information to a corresponding receiver connected to the fetal monitor.Fetal Monitor Telemetry Operating Instructions1. Open the battery compartment and install a fresh 9-volt alkaline battery.2. Insert the antenna into the antenna jack on the transmitter.3. Ensure that either the whip antenna or extended range antenna system is attached to the fetal monitor. The whip antenna should be extended at least two sections.4. Power ON the transmitter.5. Apply the ultrasound transducer and toco transducer. (Refer to Ultrasound Transducer Preparation and Application on page 15-7 and Toco Transducer Preparation and Application on page 15-9.) The data from the telemetry unit is transmitted to the fetal monitor for display and printing on the strip chart.6. The unit is supplied with headphones that allow the patient to listen to the fetal heart sounds. The patient should continually hear fetal heart sounds through the earphones. She should be instructed to move the ultrasound transducer slightly if the sound quality diminishes. If unable to reestablish the heart sounds, the patient should notify her clinician.7. When the red Nurse Call button on the transmitter is pressed, an audible tone emits from the fetal monitor. To cancel the tone, touch the F-ALERT RESET key on the Fetal Main menu.Table 3: Fetal Alert AttributesAlarm Type Tone Type Alarm Recording Alarm WatchAvailable User SettingsFactory DefaultsUser SettingsAvailable User SettingsFactory DefaultsUser SettingsAvailable User SettingsFactory DefaultsUser SettingsFetal Heart Rate Alert Medium Medium N N Y/N N

Fetal Monitoring15-27 Mermaid OptionThe Mermaid option is designed to enhance the birthing experience for mothers who require continuous monitoring but would like to relax in a shower or tub, or to move around without being “tethered” to a monitor. The patient wears a small transmit badge that is attached to the waterproof ultrasound and toco transducers by a short cable. Mermaid differs from telemetry in that the transmission of the fetal heart rate and uterine contractions take place through infrared technology rather than radio frequencies. The transducers run on batteries that will operate for 8-hours (typical) before batteries must be changed. Recharge time is about one hour. You may have some minor interference from lights in the patient’s room, or the patient may move beyond the range of the system. If this should happen, either move the receiver to a location with a better view of the patient, or have the patient move closer to the antenna.Monitoring Procedure1. Make sure that the Maternal Obstetrical Monitor is attached to the Mermaid receiver system. The connector is located on the right side panel of the Maternal Obstetrical Monitor.2. Attach a battery pack (a) to the Mermaid toco transducer by aligning the ridge with the transducer cable connector (b). The battery pack should fall into the transducer element with a noticeable movement.!• When the transmitter is powered ON, it should emit a short tone to indicate that the battery is good. If the battery is low, the transmitter emits a steady tone until depleted. Replace the battery if the transmitter is emitting a steady tone or is depleted.• If the patient exceeds the receiving range, the signal may be weak or may drop out. The patient should return to within range of the fetal monitor.• Certain locations may require that the whip antenna be fully extended to enhance reception.• Each telemetry unit (transmitter) operates on a specific radio frequency and is uniquely paired with a receiver internal to the fetal module. These must remain together to operate properly.

Ultraview Care Network15-28Figure 15-16: Wireless transducer  Mermaid system3. Twist the battery pack clockwise slightly to lock it into the Toco transducer. Repeat the procedure for the Mermaid ultrasound transducer.4. Pin the transmit badge (c) to the patient’s clothing (preferably at shoulder level) with the clasp or use the necklace provided. Clothing or blankets must not cover the badge.5. Attach either of the blue connectors (d) on the transmit badge to the Mermaid Toco transducer.6. Position the Mermaid Toco transducer on the patient’s abdomen using the same technique as conventional transducers. Refer to Toco Transducer Preparation and Application on page 15-9 for more information.7. Attach the other blue connector (d) on the transmit badge to the Mermaid ultrasound transducer.8. Position the Mermaid Ultrasound transducer using the same technique as conventional transducers. Refer to Ultrasound Transducer Preparation and Application on page 15-7 for more information.9. When the monitoring session is finished, remove the battery packs and the transmit badge from the transducers. Follow hospital procedures for cleaning the equipment. Refer to Cleaning and Sterilization on page 32-1.10. Store the transducer elements and transmit badge in the compartment in the rear of the recharger unit.11. Store the battery in the charger by following the steps outlined below.CAUTION:• Patients wearing Mermaid transducers should not wander into areas where another Mermaid system is operating. This would interfere with the other patient’s data.bdca

Fetal Monitoring15-29 Recharging Batteries1. The battery packs are enclosed in the top half of the Mermaid ultrasound and Toco transducers (Figure 15-17). To remove the packs (a) from the transducer elements, twist the pack counterclockwise. There will be a noticeable movement. Simply pull the battery pack to disengage.2. Insert a battery pack (a) in the docking station (e) on the recharger by aligning the ridge with the red dot. The battery pack should fall into the docking station with a noticeable movement.Figure 15-17: Wireless transducer  Mermaid system3. Twist the battery pack clockwise slightly to lock it into the docking station. The bottom of the transducers do not need to be charged and should be stored along with the transmit badge in the compartment located in the rear of the recharger unit (f).!• Thoroughly dry the battery pack before inserting it into the charger.• The Mermaid battery charger may be used in the patient vicinity if it is powered by one of the following certified, medical-grade, power supplies:- Ault, Model SW172; Rated Input: 100-240VAC, 0.75-0.35A, 50/60Hz; Rated Output: 12VDC, 2.75A (P/N 010-1554-00)- Ault, Model VM100AMB1203B01; Rated Input: 100-250VAC, 0.3A, 50/60Hz; Rated Output: 12VDC, 0.85A (P/N 1043900-108)• These power supplies are designated Class I by the applicable safety standards. Medical-grade, grounded outlets and power cords are required to ensure patient safety margins.• Three lights indicate a full charge and 8-hours (typical) of operation. Two lights indicate that 2-hours (minimum) of monitoring time is left. One light indicates that less than 2-hours of monitoring time is left. When the one light starts to flash, less than 15-minutes of battery capacity is left.cfehgia

Ultraview Care Network15-304. The amber light (g) on the recharger unit indicates that the battery pack is being charged. A green light (h) indicates that charging is complete. It may take up to one hour to reach a full charge. The battery packs may be left on the charger when the transducers are not in use.5. Each battery pack has three green lights (i) to indicate the remaining charge. The lights automatically power ON whenever the battery pack is attached to the transducer or is being charged.

16-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Temperature DirectoryDirectory of KeysALARMLIMITSHI=OFFLO=OFFHI=OFFLO=OFF TEMP 1 TEMP 2 DELTATEMPOne TemperatureTEMP - ALARM LIMITSTEMP - ALARM LIMITSTEMP MENUALARMSON OFFALARMSON OFFRESTORESETTINGSYES NORESTORESETTINGSHI=OFFLO=OFF TEMP 3 TEMP 4 DELTATEMPALARMSON OFF Alternate key displayYES NOkeys may not be displayedkeys may not be displayedkeys may not be displayedTEMPALARMLIMITSTEMP MENUkeys may not be displayedALARMLIMITSTEMP MENUkeys may not be displayedTEMPTwo Temperatures (same module)

Contents16-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up Temperature Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Setting or Adjusting Temperature Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . 5Recording Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Temperature Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6TemperatureOverviewEither one or two temperature inputs can be monitored. Whenever two temperatures from the same module are monitored, a delta value (temperature difference between the two readings) is calculated.Temperatures are displayed in degrees centigrade only. You can set independent high and low alarm limits for each temperature, and the delta temperature.Setting Up Temperature MonitoringAttach the temperature probe(s) to the patient and then to the module. The TEMP key and temperature values now appear on the monitor screen. Touch TEMP to display the Temperature menu.!• You can define your own default settings for alarm limits. Refer to Setting User-Defined Default Values on page 7-7 for further details.To set up temperature monitoring:1Attach the temperature probe(s) to the patient.2Plug the temperature probe(s) into the module. 3Touch TEMP.4Select additional keys as needed during monitoring.

Ultraview Care Network16-4Display DetailTemperature readings appear on the monitor screen as soon as you plug a temperature probe into the module.Figure 16-1: Temperature displayᕡTemperature parameter keyᕢSingle channel temperature readingᕣTemperature labelᕤHigh and low temperature alarm limitsᕥTwo temperatures (T1/T2 or T3/T4)ᕦDelta temperature (DT)ᕧStatus of temperature alarms!• When alarm limits are set on more than one temperature, the alarm limits for only one temperature will be displayed. To view the alarm limits, touch TEMP, then ALARM LIMITS, then select the TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP key.38.0oC38.537.5TEMPᕢᕡᕣTEMPT1 ONT2 ONDT OFFᕤ ᕥ38.0oC35.1T1T2DT2.9 ᕧT1ᕦ

Temperature16-5 Setting or Adjusting Temperature Alarm LimitsHigh and low alarm limits can be set for T1 (T3), T2 (T4), and the temperature difference (DT) between two temperatures.The factory default settings for high and low temperature alarms are 37.5°C and 36.5°C. Refer to Default Alarm Limits on page 2-3 for details on system alarm operation.Recording TemperaturesYou can send currently displayed temperature readings to a bedside recorder or system printer. Refer to Printing on page 4-5 for an overview of system printing information.Restoring User-Defined SettingsWith the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-7. !• RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.To set or adjust alarm limits1Touch TEMP.2Touch ALARM LIMITS.3Select TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP.4Select ALARMS ON. 5Select HI= or LO=.6Use arrow keys to adjust limit.To print a strip chart of current temperature readings:1Touch RECORD.2Touch TEMP while it flashes.To restore user-defined settings:Configurations with ECG1Touch ECG.2Touch SETUP.3Touch RESTORE SETTINGS.4Select YES.To restore user-defined settings:Configurations without ECG1Touch TEMP.2Touch RESTORE SETTINGS.3Select YES.

16-6Temperature Troubleshooting GuideClinical Situation Possible Cause SolutionIntermittent or no operation ■Module error. ■Call a qualified service person. Temperature not displayed ■Module not inserted correctly. ■Reinsert the module.■Probe not connected to module. ■Reconnect the probe.

17-1Digital Telemetry DirectoryDirectory of KeysSCREENFORMAT TONES MONITORCONFIG.PRIVILEGEDACCESS.MONITORSETUPBRIGHTNESSADMIT CHANGEDATA DISCHARGETIME/DATEREMOTEALARMSALARMWATCHKEYTONECLINICAL LEVEL: Select ParameterMONITOR CONFIGURATIONADMIT/DISCHARGE - Select Function (see Admit/Discharge)MONITOR SETUP - Select type of tone to change (see Alarms)MONITOR SETUP ECGCLEARMEMORYSAVEMEMORYECG - RELEARN2nd LEADON OFFRATESOURCESWEEP SPEEDQRS MONITOR PACEDYES NO CONFIG**TONE EXTENDEDADULTINFANT Select primary heart rate sourceECG - CHANNEL FORMATECG - SETUPECG - CONFIGALARMLIMITS SIZE SETUP LEADSELECTCHANNELFORMAT **SUSPENDPROCESSING PRINTECG MENU - (Multi-Lead) (Multiview II option with Arrhythmia and Review ON - used with 90341/90343/90347 transmitter)REVIEW2nd LEADxx1st LEADxx ON OFFECG ART UA SPO2Enable alternate rate source(s)ARR ON OFFUA ON OFFART ON OFFSPO2 ON OFFTMSETUPRESTORESETTINGS**AUTO LEAD SWITCHASSIGNTM BEDPT RECORDYES NOLO BATON OFFSET TMCHANECG - TM SETUP **Centralonly **Bedsideonly **Bedsidemonitors onlyselect bed(or subnet, then bed)RELEARNSpO2ON OFFNIBPON OFFSpO2(IABP)(NEO)(RATE)(AVG)90343 onlyECG ALMON OFFST LIMITSCH 1ABN INROW=XXABN PERMIN=XXST LIMITSCH 2ABN INROW=XXHI=XXXLO=XXXSPO2 ALMON OFFALM DELAY=XXsMSG ALMDELAY =XXsHI=XXXLO=XXXNIBP ALMON OFFHI=XXXLO=XXXNIBP ACTIVE(NO CABLE)SPO2 ALARMLIMITSNIBP ALARMLIMITSLIMITS90341,90347(and90343withSpO2andNIBPturnedOFF)90343select ECG 1Select zonewaveformselect bed(or subnet, then bed)RECORDERDESTINATIONECG - LEAD SELECTON OFFSINGLE LEAD ALARMECG ALARMCLOCKON OFFACTIVATESCREEN SAVERPRESELECTEDRECORDINGSUNITS OFMEASUREUSER ACCESSENABLEALARMSETUPADMIT/DISCHARGEMPT=ON *90343 only MPT=ON ** Multi-parameter Telemetry (MPT):required settings inModule Configuration ManagerDIA MEANSYS Limit keys will flash on alarm** Not shown in Remote ViewsRECORDERCONFIG.CONTRAST

Contents17-3 Digital TelemetryGeneral Telemetry OverviewThe 90478 digital telemetry receiver module, when used in conjunction with Spacelabs Medical telemetry transmitters, an Ultraview monitor, and 90479-A modular receiver housing, provides continuous monitoring of electrocardiographic signals in order to detect abnormal cardiac rhythms, including asystole, ventricular fibrillation, and ventricular tachycardia. In addition, when used with the 90343 digital telemetry multi-parameter transmitter and the 90217 Ambulatory Blood Pressure (ABP) monitor, monitoring of electrocardiographic signals is augmented by the availability of continuous or episodic SpO2 measurements and episodic noninvasive blood pressure (NIBP) measurements.One operational mode is available with the 90343 and the 90347 multi-lead transmitters. When all electrodes are connected to the patient, leads I, II, III, AVR, AVL, AVF, and Vx are available. When no chest lead is applied, leads I, II, III, AVR, AVL, and AVF are available using the remaining connected electrodes.ECG monitoring in telemetry is identical to hardwired ECG monitoring. Refer to ECG Setup on page 8-4 for more information.For more information on SpO2 and NIBP monitoring refer to Setting Up SpO2 Monitoring on page 14-4 and Multiparameter Telemetry (NIBP) on page 17-17.General Telemetry Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Multiparameter Telemetry Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Transmitters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Selecting Options for the 90341 Lead Display. . . . . . . . . . . . . . . . . . . . . . . . . . 8Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Digital Telemetry Receiver Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Assigning a Telemetry Channel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Tuning a Telemetry Receiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Entering Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Setting or Adjusting Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Acknowledging Signal Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Discharging a Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Setting Battery Status Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Controlling Patient-Initiated Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Telemetry Alarm Message Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Multiparameter Telemetry (NIBP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Setting or Adjusting Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Displaying New or Previous Readings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22NIBP Alarm Message Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Ultraview Care Network17-4!• Spacelabs Medical’s telemetry equipment complies with Part 15 and Part 95 of the FCC Rules and with RSS-210 of Industry Canada and with requirements of other national spectrum management authorities. Repeated here are operational cautions for biomedical telemetry from the FCC Rules (47CFR15.242(f)):“Biomedical telemetry devices must not cause harmful interference to licensed TV broadcast stations or to other authorized radio services, such as operations on the broadcast frequencies under subpart G and H of part 74 of this chapter, land mobile stations operating under part 90 of this chapter in the 470-512 MHz band, and radio astronomy operation in the 608-614 MHz band. (See section 15.5). If harmful interference occurs, the interference must either be corrected or the device must immediately cease operation on the occupied frequency. Further, the operator of the biomedical telemetry device must accept whatever level of intereference is received from other radio operations. The operator, i.e., the health care facility, is responsible for resolving any interference that occurs subsequent to the installation of these devices.” • Medical telemetry equipment is only for installation and use in hospitals and health care facilities. It is not permitted for use in vehicles that operate outside of the medical facility premises. The user of this equipment is not authorized to make any changes or alterations that could compromise the national certifications.• Operation of telemetry equipment in the 608 - 614 MHz, part of the Wireless Medical Telemetry Service (WMTS) and in authorized spectrum of each country, may be geographically restricted by government regulation. Operation of this equipment in U.S. WMTS bands requires coordination and registration with the FCC designated frequency coordinator.• Both the standard and limb lead modes for the 90341 work correctly with or without the right leg electrode attached. However, for optimum performance, the right leg electrode should always be used.• The RA lead wire for the 90343 and the 90347 must be connected to the transmitter at all times. This lead wire also serves as the transmitter’s antenna.WARNING:• Operating television receivers or other CRT displays near the transmitter (within 2 to 3 feet), or operation of some pacemaker programmers may suppress the ECG waveform, preventing QRS detection and rate counting. An erroneous asystole alarm may result.

Digital Telemetry17-5 Multiparameter Telemetry OverviewThe 90343 digital telemetry multiparameter transmitter sends NIBP data acquired by the 90217 ambulatory blood pressure (ABP) monitor to the 90478 digital telemetry receiver. The 90478 displays the patient’s episodic NIBP data and trigger alarms based on thresholds set at the patient monitor. Refer to Setting Up NIBP Monitoring on page 17-17 for information on configuring and using ABP monitors with multiparameter telemetry.The 90217 ABP monitor is a small, lightweight, battery-powered unit designed to take blood pressure measurements. Refer to the 90207/90217 ABP Monitors Operations Manual (P/N 070-0137-xx) and the 90121 ABP Report Management System Operations Manual (P/N 070-0529-xx) for more detailed information on this product, its initialization by a direct PC interface, patient preparation, and event codes. NIBP uses oscillometric monitoring to measure systolic (S), diastolic (D), and mean (M) arterial blood pressures. The pressure readings are sent from the 90217 ABP monitor to the 90343 transmitter by a connecting cable. The 90343 transmitter includes the NIBP readings in the communications to the 90478 receiver using the radio frequency data link. NIBP measurements are checked to eliminate the possibility of erroneous readings and valid measurements are displayed on the monitor and stored for trending. The Ultraview monitor displays valid measurements and the time the measurement was acquired. The most recent reading is displayed by the Ultraview monitor. The most recent 120 readings are stored and may be displayed by the monitor.!• All system connections must be made by Spacelabs Medical personnel only.• Leakage currents are not affected by the high level output in the 90478. The patient is electrically isolated from the patient monitor by the RF link.• The 90217 ABP monitor is intended for use with adult patients only and, when used with the 90343 Digital Telemetry Transmitter, must also involve ECG monitoring.• The ECG lead wires of the 90343 must be connected to the patient in order to perform ECG, SpO2 and NIBP monitoring.• The 90217 ABP monitor, when used with the 90343 Digital Telemetry Transmitter, purges its measurements as they are successfully sent. This operation differs from when the 90217 ABP monitor is used in a stand-alone manner and stores a maximum of 240 NIBP readings and event codes.• NIBP readings which are not successfully transmitted by the 90217 to the 90478 within 24-hours of their measurement are unavailable for display or trending.WARNING:• Changes or modifications not expressly approved by Spacelabs Medical will void the user’s authority to operate the equipment. 90217 ABP Monitor

Ultraview Care Network17-6Intended UseAs an option, on adult patients, additional abnormal cardiac rhythms, such as ventricular runs, tachycardia, and ST segment deviations can be detected. The Ultraview Digital Telemetry System also provides a means for the episodic monitoring of NIBP signals to detect abnormal events such as high and low blood pressure. Finally, it provides a means for both continuous and episodic monitoring of blood oxygen saturation signals in order to detect oxygen desaturation caused by abnormal pulmonary/circulatory functions.The Spacelabs Medical 90341, 90343, and 90347 Ultraview Digital Telemetry Systems are intended for use with either adult or neonatal patients in a hospital environment. When the NIBP option is selected in the 90343 configuration, the NIBP feature is to be used with adult patients only.TransmittersThe transmitter is a small, battery-powered device carried by the patient that monitors ECG activity and SpO2/NIBP (90343 only) data, and transmits this information to the telemetry receiver module. • The 90341 transmits two leads of ECG and uses up to five lead wires. Two leads may be displayed simultaneously.• The 90343 and 90347 transmit four leads of ECG and use up to five lead wires. However, only two leads may be displayed simultaneously.• The 90343 is also capable of transmitting numerical NIBP and SpO2 data. This data is displayed simultaneously with that of the ECG waveform data.Each telemetry channel requires its own transmitter operating on a unique radio frequency. Channel receivers are tuned from the Ultraview monitor touchscreen to receive the available transmitter frequencies.!• Episodic monitoring of NIBP values and continuous and episodic monitoring of blood oxygen saturation values are only supported in conjunction with ECG monitoring. SpO2 and NIBP alarms are inhibited by ECG leads-off condition.WARNING:• The Ultraview Digital Telemetry transmitters are contraindicated for use with other medical instrumentation (e.g., respiration monitors using impedance pneumography, electrocautery, etc.) that source electrical current through the patient. Further, telemetry monitoring is contraindicated for the Operating Room environment. !• Operation of this equipment may be subject to licensing requirements by your local telecommunications authority. Please check with your Spacelabs Field Service Engineer.

Digital Telemetry17-7 Up to five standard disposable silver/silver chloride chest electrodes are connected to the patient. The ECG lead wires are attached to these electrodes and connected to the transmitter. A patient-operated RECORD button initiates an ECG strip at the system printer, if this feature is enabled at the central or bedside monitor.WARNING:• Medical telemetry spectrum allocations may be assigned to frequencies already allotted to other priority users. This means that telemetry operations may be exposed to radio frequency interference that may disrupt or impede telemetry patient monitoring during the life of this equipment. You are urged to regularly consult with applicable local and federal regulatory agencies (e.g., FCC, FDA, etc.) regarding the locations and frequencies of other spectrum users in your geographic area. A Spacelabs Medical field service engineer may be able to assist you in reconfiguring your equipment frequencies to reduce the risk of interference. Spacelabs Medical cannot, and does not, guarantee interference-free telemetry operation. CAUTION:• This device has a limited bandwidth range of .05 to 30 Hz, which may adversely affect the recording of high frequency components in the ECG signal, especially when the morphology of the ECG changes rapidly.• This device has a limited dynamic range of ±4 mV, which may render the device vulnerable to saturation by ECG signals with amplitudes higher than 4 mV.• To clean the transmitter, use only the following solutions per the manufacturer’s labeling: isopropyl alcohol (70%), hydrogen peroxide, Cidex, Betadine, and Clorox. Use of cleaning solutions other than those listed will VOID the warranty of the digital telemetry transmitter cases.• Patients should not use any type of electronic equipment (e.g., portable radios, cellular telephones, pagers, personal computers, etc.) while connected to any medical electronic device without in-situ evaluation by the biomedical engineering staff.• Use of 2-way radio equipment and other personal communication devices must be evaluated in-situ to assess the potential for disruption of monitoring. !• Clean the transmitter after each use. The transmitter does not require any preventive maintenance other than cleaning.

Ultraview Care Network17-8Selecting Options for the 90341 Lead DisplayThere are two operational modes available with the 90341 dual-lead transmitter: (1) the standard mode which offers a choice of one V lead (V1-6), plus lead II, or (2) the limb lead mode which offers choices of the leads I, II, III, AVR, AVL, or AVF. The standard mode is available if the chest lead is applied. The limb lead mode is available when there is not a chest lead applied. Loss of the chest electrode changes the ECG - Lead Select menu to the limb lead mode if the left arm, left leg, and right arm electrodes are intact. Refer to Patient Preparation and Electrode Application on page 8-6 for lead placement illustrations.!• Both modes work correctly with or without the right leg electrode attached. However, for optimum performance, the right leg electrode should always be used.Connected Electrodes (X) Valid Lead VectorsCLA LL RAX X X X V1-6 and II (standard mode)X X X III (standard mode)X X X I (standard mode)XX total lead failure(standard mode)X X X II (standard mode)X X None (lead failure)X X None (lead failure)X None (lead failure)X None (lead failure)X None (lead failure)X None (lead failure)None (lead failure)X X III (limb lead mode)X X I (limb lead mode)X X II (limb lead mode)XX XI, II, III, AVR, AVL, AVF (limb lead mode)!• If one of the leads fails, a lead fault message will display in the upper left corner of the waveform zone. If there is not a valid lead vector, the message LEADS OFF displays and an alarm tone sounds.

Digital Telemetry17-9 Transmitter BatteriesA 9-volt alkaline battery is recommended for standard use in the digital telemetry transmitter. A 9-volt lithium battery may also be used for applications requiring more extended battery service life. Always observe the battery position and polarity as illustrated at the bottom of the battery compartment. After battery installation, close and latch the compartment cover. The transmitter begins transmitting as soon as the battery is in place.Battery DisposalThe 90341, 90343 and 90347 Ultraview Digital Telemetry transmitters are operated by 9-volt, primary (non-rechargeable) batteries that must be properly disposed of when discharged. The batteries specified may be of either alkaline or lithium chemistry. Attempting to recharge these batteries is not recommended and can result in leaking, venting, or explosion.Disposing of used batteries may be subject to national, state/provincial, and/or local regulation, which varies depending on jurisdiction.Follow the battery manufacturer’s recommended handling procedure for both types of batteries: Collect and transport the batteries in a manner that prevents short circuit, compacting, mutilation, or any other physical abuse or electric handling that would destroy their physical integrity. Exposure to high temperatures or fire can cause the batteries to leak, vent, or explode.The recommended disposal procedure for alkaline batteries is to transport them to a hazardous waste landfill. Since these batteries may not be classified as hazardous waste, they may be transported to the disposal facility as non-hazardous waste.The recommended disposal procedure for lithium batteries is to transport them as hazardous waste to a hazardous waste facility. If the batteries are physically sound, disposal of these discharged batteries in a hazardous waste landfill may be permissible. If the batteries are leaking, cracked, opened, vented, or otherwise not physically sound, they must be transported to a qualified hazardous waste facility. !• Whenever the transmitter is not in use, the battery should be removed. Insert a battery only when the transmitter is being used with a patient. • When the battery level falls below approximately 7.0 volts, the low battery LED on the transmitter will flash once every 15-seconds. The LOW BATTERY message may appear after the low battery LED on the transmitter begins to flash. When the battery level falls below 6.0 volts, the low battery LED will flash once every 2-seconds. When the battery level falls below 5.5 volts, the SpO2 and NIBP functions will shut down. • The LOW BATTERY message appears and an alarm tone sounds (if LO BAT is set to ON) when the transmitter battery voltage falls below approximately 7.0 volts. When this message appears, the transmitter has approximately 3-hours of operating time left, depending on transmitter type, selected options, and the type of battery.

Ultraview Care Network17-10CleaningThe transmitter does not require any preventive maintenance other than cleaning but should be cleaned after each use.To clean the transmitter, use only the following agents.• Mild soap and water solution• U.S. Pharmacopoeia (USP) green soap• Sodium hypochlorite solution (1:10 dilution of household bleach in water)• Phenolic germicidal detergent solutions (1% aqueous solutions)• Isopropyl alcohol solution (70%)Digital Telemetry Receiver ModuleThe 90478 telemetry receiver module plugs into a bedside or transport monitor, or into a digital telemetry module housing. The receiver module receives patient vital signs data from the transmitter. This data is reconstructed by the receiver module, displayed on the monitor and analyzed as described in ECG on page 8-3,Arrhythmia on page 9-3, and ST Analysis on page 10-3. Refer also to SpO2 on page 14-3.Digital Telemetry Receiver HousingThe telemetry receiver housing can hold up to eight separate telemetry receiver modules. Except for the ON/OFF switches, there are no operator controls on the module housing. For normal operation with AC mains power applied, the AC WARNING:• Telemetry systems may be more susceptible to interference than hardwired systems, which may impact signal quality.• Operation of hand-held, wireless telephone equipment (cordless telephones, cellular telephones) near telemetry systems may cause interference and should be discouraged. While personal communication devices are turned on, a separation of >6.5 feet (>2 meters) should be maintained between personal communication devices and interior walls, the patient cables, and any electronic medical device to which the patient may be connected. Patients should not use any type of electronic communication equipment while connected to any electronic medical device without an on-site evaluation by the biomedical staff. Two-way radio equipment and other personal communication devices must be evaluated on site to determine if additional space limitations are needed. • Do not install a telemetry receiver module into a bedside that is currently equipped with any other ECG module, hardwired or telemetry (or SpO2module or NIBP module, if the 90343 is operating with that specific receiver module). Doing so may cause inaccurate patient data displays at remote monitors.

Digital Telemetry17-11 mains indicator light on the front panel of the housing must be illuminated. Operating the system without AC mains power is limited to 10-minutes of battery backup time.Figure 17-1: Ultraview digital telemetry systemDiversityAntennaSystemUltraview 1700receiver moduleDigital Telemetry Module HousingSDLC90479-A90478-QECGVIST=0.00A=3 70HELP: Acce ss controls that pertain t o ECGECG MENU ALARMLIMITS SIZE SETUP LEADSELECTCHANNELFORMATSUSPENDPROCESSINGUCW bedside or centralremote module90341/90347SDLCNOTE: The UCW bedside connects tothe remote module housing, and theUCW central connects to the digital te-lemetry module housing.Digital Telemetry Ultraview 1050/1030Ultraview 1500 orECG Transmitter housingshown with flatpanel display ETHERNETHUB10BaseTEthernetOption90343Digital Telemetry Multiparameter Transmitter

Ultraview Care Network17-12Display DetailSignal detection is indicated on your monitor when an ECG signal appears next to the ECG parameter key in the zone assigned to receive the transmitted telemetry channel. The transmitter’s channel number is always identified above the waveform, to the left of the ECG key.Figure 17-2: Display zone — full screenFigure 17-3: Display zone — split screenᕡECG trace for first leadᕢBed nameᕣECG key for first leadᕤQRS indicator (flashes once per detected beat)ᕥECG lead designatorᕦDisplay resolution (monitor or extended)ᕧPaced operation indication (pacemaker detection is enabled)!• Due to the similarity between ECG and Digital Telemetry displays, the items described below are consistently numbered in both chapters. Refer to Display Detail on page 8-9.ECGII MON PACEDST=0.00A=3A/M 10ROW 41204070*****BED 01 DANIELS,RᕢƽƸ¹¸ᕩµᕨ*ᕧᕦƾᕤᕣƺƹᕡNIBP=120/68(94) 15:15 SpO2=98% 15:12CHAN 2241ᕥECGHR= 70 A=3 IINIBP=120/68(94) 15:15 SpO2=98% 15:12CHAN 2241ᕣƺƹƸ ¹BED 01 DANIELS,Rᕢᕥƾƽ¸

Digital Telemetry17-13 ᕨAbnormals per minute alarm limit *ᕩST segment level for first lead** (the asterisk indicates ST alarms are enabled)µAbnormals in a row alarm limit *¸ECG rate alarm limits. Split-screen central monitors display a bell symbol when alarms are enabled; bedside monitors display the rate alarm limits (120/40) ¹Abnormals per minute counter * ƸCurrent heart rateƹTelemetry channel numberƺSensorwatch signal strength indicatorShaded area (waveform index, WFI) expands up proportionally to signal strength; horizontal line indicates minimum signal level.No shading (lowest waveform index) corresponds to no detected signal strength or a faulty sensor.ƻSpO2 levelƼRefer to Display Detail in ECG (not used)ƽNon-invasive blood pressure — systolic/diastolic (mean)Equal sign becomes bell symbol when NIBP alarms are enabledHour and minutes of last readingƾSpO2 reading and time of last readingEqual sign becomes bell symbol when SpO2 alarms are enabledHour and minutes of last reading* Only appears with the Multiview I or II option in the adult mode with Arrhythmia detection enabled.** Only appears in adult mode with the ST segment analysis option.

Ultraview Care Network17-14Assigning a Telemetry ChannelYour central monitor can only display a telemetry channel after that channel has been assigned a specific bed name. Refer to the steps to the left to assign a specific bed name to a telemetry channel. After a bed name is assigned, the central monitor may need to be configured to display data associated with that bed name in a specific display zone. Refer to the steps to the left to assign the bed to a specific display zone, if needed.Tuning a Telemetry ReceiverA telemetry receiver module must be tuned to a transmitter’s assigned frequency before it can receive data from that transmitter. Qualified personnel can use the ECG TM SETUP menu to tune the receiver module.!• Your central monitor may be configured to remember beds that are assigned to individual telemetry channels using the Module Configuration Manager feature. These beds are permanently assigned until you unassign or reassign them. Refer to Module Configuration Manager on page 7-5 for more information.!• Telemetry transmitters have preassigned channel frequencies (or numbers) that cannot be changed. The channel number is identified on the back of the transmitter’s case.• Only qualified personnel should tune telemetry receiver modules to receive data from a telemetry transmitter. Telemetry receiver modules must be used with a transmitter on the same frequency.• Qualified service personnel should set the telemetry transmitter’s frequency band via the Module Configuration Manager feature.• Telemetry channel assignment is not accessible in REMOTE VIEW displays.To initiate telemetry ECG monitoring:1Select a transmitter.2Note its channel number. 3Attach lead wires to transmitter.4Attach lead wires to electrodes.5Apply electrodes to patient.6Install a transmitter battery.7Close the transmitter case.To set up the central for ECG (if bed name not remembered):1Touch key label that matches transmitter’s frequency.2Select bed/room number for transmitter channel.To set up the central for ECG (MPT=OFF):1Touch MONITOR SETUP.2Touch SCREEN FORMAT.3Select subnet and bed/room number.4Select ECG and then desired zone.To tune a receiver module: 1Touch ECG.2Touch SETUP.3Touch TM SETUP.4Access the SET TM CHANNEL menu.5Select the digit to change. Use the ↑↓ keys to select the value for that digit.6Repeat for all digits as necessary.7Touch STORE.

Digital Telemetry17-15 Entering Patient InformationRefer to Admit/Discharge on page 3-3 for information on this subject.Setting or Adjusting Alarm LimitsAlarm limits for multiparameter telemetry are adjusted the same way as the alarm limits in other parameters. The only difference is that the multiparameter telemetry requires you to select a specific parameter to adjust. Once that selection is made, adjustments are made as described in Setting and Adjusting Alarms on page 8-13, Setting and Adjusting Alarm Limits on page 13-7, and Setting and Adjusting Alarm Limits on page 14-6.Acknowledging Signal LossWhen a telemetry signal is lost because the transmitter is out of range or the battery is removed, the receiver indicates this condition by replacing the normal ECG waveform with the triangular squelch waveform. The text SQUELCH is included in the annotation for any strip chart recording initiated during this period. The ECG waveform is automatically displayed if the lost signal returns.After 8-seconds of signal loss, the monitor displays the INTERMITTENT SIGNAL LOSS message in the waveform zone and initiates the signal loss alarm. Select YES to discharge the patient (refer to Discharging a Patient below), or select NO to suspend this alarm.WARNING:•SpO2 and NIBP data cannot be displayed when the INTERMITTENT SIGNAL LOSS message is displayed.• All monitors that display the telemetry channel display the message IS SIGNAL LOSS PERMANENT? in the waveform zone, but only the monitor that is hosting this telemetry channel displays YES and NO keys below this message.To set or adjust multiparameter telemetry alarms: 1Touch ECG. 2Touch ALARM LIMITS. 3a Touch ECG ALARM LIMITS-OR-4a Touch NIBP ALARM LIMITS-OR-5a Touch SPO2 ALARM LIMITS.6a For ECG and NIBP — Touch HI = or LO = key.6b For SpO2 — Touch HI=, LO=, ALM DELAY, or MSG ALARM DELAY (if present).7Use the arrow keys to adjust.To acknowledge signal loss, select NO.

Ultraview Care Network17-16Discharging a PatientThe process of discharging a patient begins by removing the battery from the transmitter. The monitor responds to this as described Acknowledging Signal Loss on page 17-15.The monitor that is hosting this telemetry channel displays keys labeled YES and NO below this message (other monitors do not display these keys). Selecting NO to this message (or any of the following messages) cancels the discharge process, redisplays the IS SIGNAL LOSS PERMANENT? message, and cancels the intermittent signal loss alarm.Selecting YES to this message indicates that the signal loss is permanent and continues the discharge process by changing the message to DISCHARGE THIS PATIENT?. Select YES to continue the discharge process or NO to cancel the discharge process.If YES was selected, the message changes to PURGES DATA - ARE YOU SURE?. Select YES a third time to discharge the patient, erase all patient data from memory, and cancel the intermittent signal loss alarm. Touch NO to cancel the discharge process.Setting Battery Status AlarmsThe telemetry battery alarm tone and a LOW BATTERY message displayed in the ECG zone alert you to a low battery condition in the transmitter. You can disable the low battery alarm tone if your bedside or central is configured to do so.The factory default setting for this alarm is ON. Controlling Patient-Initiated RecordingsIf the Patient Record function is activated (PT RECORD is YES) in the ECG TM SETUP menu, the patient may initiate a recording by pressing the RECORD button on the front of the transmitter. Telemetry Alarm Message SummaryThe following are general telemetry messages and apply to the 90341, 90343 and 90347 transmitters.INTERMITTENT SIGNAL LOSSThe intermittent signal loss message indicates that the patient may be out of antenna range or the battery is depleted. Return the patient into antenna range. Check that the battery is functioning properly. A low priority alarm tone sounds after 10-seconds in this condition. LOW BATTERYA low battery message indicates that the battery is weak. After this message appears, the battery has approximately 3-hours of useful life left (depending on the type of battery used). Install a new battery. A low priority alarm tone sounds if the SETUP menu’s LOW BAT ON/OFF key is set to ON. To discharge a patient: 1Remove battery.2Disconnect the transmitter from the patient.3Touch YES to confirm signal loss permanent. 4Touch YES to discharge.5Touch YES to purge data.To control low battery alarms: 1Touch ECG. 2Touch SETUP. 3Touch TM SETUP.4Select LO BAT ON or OFF.To control transmitter’s Patient Record function:1Touch ECG.2Touch SETUP. 3Touch TM SETUP.4Select PT RECORD YES or NO.

Digital Telemetry17-17 SIGNAL INTERFERENCEThe signal interference message indicates, via the displayed triangle squelch waveform, that an interfering signal has been detected. A signal can no longer be detected because of interference from a stronger signal source lasting more than 0.5-seconds. A low priority alarm tone sounds whenever this message is displayed in the waveform zone.IS SIGNAL LOSS PERMANENT?The permanent signal loss message indicates that no RF signal is being detected.Multiparameter Telemetry (NIBP)Setting Up NIBP MonitoringProper cuff selection and application is critical in ensuring the accuracy of NIBP readings. To ensure proper cuff selection, first measure the circumference of the limb at its midpoint. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff. If the cuff bladder is too wide for the patient, the reading will be falsely lowered; if it is too narrow, the reading will be falsely elevated. Undersizing the cuff results in the greatest chance of error, so a variety of cuff sizes should be available to accommodate your full patient population.Apply the cuff snugly. When the cuff is properly applied to an adult, you should be able to insert one finger between the cuff and the arm. If you can insert two fingers, the cuff is too loose, which may result in falsely elevated readings. Ensure that the hose is not kinked when the cuff is applied.During blood pressure measurement, the inflated cuff reduces blood flow to the limb to which it is applied. Do not apply a cuff to a limb that has restricted blood flow. Check the patient periodically.!• Do not apply a blood pressure cuff to a limb being monitored with a pulse oximetry sensor, because SpO2 is affected during NIBP readings. Avoid applying a cuff to a limb that has an intravenous line in place. Do not apply a cuff to a limb that has restricted blood flow.• Use only single hose cuffs to ensure proper operation. Spacelabs Medical’s hoses are non-conductive with respect to defibrillator discharge effects.

Ultraview Care Network17-18Patient Factors Affecting ReadingsExcess patient movement, speech, or muscle contractions as a result of severe pain or shivering can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would manual readings. The patient must avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain.Some arrhythmias may cause beat-to-beat pressure fluctuations that can make obtaining NIBP readings more difficult. If it becomes difficult to obtain readings in the presence of arrhythmia, pressure should be temporarily verified using another method (i.e., ausculatory, oscillometric, Doppler). Pressure also varies cyclically with normal respiration. With deep respirations or in certain patients this effect may be enhanced, increasing reading variability.For patients in shock, indirect methods of measuring pressure (auscultatory, oscillometric, Doppler) may not be reliable because of peripheral vascular changes. These changes include peripheral vasoconstriction and diminished peripheral circulation resulting from shunting of blood to central organs. In some cases, peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure. In such cases, measuring a cuff pressure may be impossible or give misleading results. Direct blood pressure measurements (invasive) should be considered in patients with signs of shock or any patient who rapidly becomes unstable for unknown reasons.Setting Up the ABP MonitorThe 90217 ABP monitor must be initialized prior to the monitoring of each patient. Initialization is accomplished using the 90121 ABP Report Management System. (Refer to Setting Up the ABP Monitor in the 90207/90217 ABP Monitors Operations Manual, P/N 070-0137-xx.)After the monitor has been initialized, prepare the patient for monitoring as follows:1. Turn on the monitor and wait for the monitor to perform self-tests. When the LCD displays the current time, the monitor is ready for operation. 2. Strap the monitor to the patient on the hip opposite the side on which the cuff is worn. Secure the monitor using the patient’s own belt or the ABP pouch strapped over the opposite shoulder. When using the shoulder strap, use the belt supplied with the monitor, or the patient’s belt, to provide additional security.3. To select the proper cuff, measure the circumference of the limb at the point where the cuff is to be applied. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff (refer to Table 1: Cuff Size by Limb Circumference on page 17-19).CAUTION:• Failure to initialize the ABP monitor as specified may result in the display and storage of measurements that are incorrect or that were acquired from a prior patient. The operator must initialize the ABP monitor before each patient use.To set up NIBP monitoring: 1Initialize the ABP monitor as described in the ABP Operations Manual.2Apply appropriate cuff to patient.3Attach cuff to ABP monitor.4Connect NIBP adapter cable (012-0588-xx) between ABP monitor and 90343 transmitter.5Touch ECG.6Touch CHANNEL FORMAT.7Select NIBP ON.

Digital Telemetry17-19 4. Position the cuff so that the center of the inflatable bladder is directly over the brachial artery. The center of the bladder location is marked on the outside of the cuff. Once the proper position is determined, the cuff must be tightened to ensure that it is equally snug at the top and bottom edges and that it is not kinked. This is especially important on larger arms. Insert a finger between the cuff and the limb to ensure it is not too tight. It may be necessary to wrap the cuff with its tail at an angle to achieve uniform tightness. If the cuff is not equally snug at the top and bottom edges, the number of readings available will be limited and the monitor may indicate that the cuff is improperly applied.5. Once the cuff is applied, the arm should be relaxed at the patient’s side. To avoid reading errors due to hydrostatic pressure differences, the level of the cuff on the arm should be near the level of the heart.6. Lead the hose up the arm with the cuff and place it across the back of the patient. Drape the hose so it does not cause the patient discomfort and is not pinched shut by too tight a radius. Figure 17-4 displays the most common positions for the cuff hose.Table 1: Cuff Size by Limb CircumferenceCuff Size Limb CircumferencePediatric 13 to 20 cmSmall adult 17 to 26 cmAverage adult 24 to 32 cmLarge adult 32 to 42 cmExtra-large adult 38 to 50 cm!• Use only Spacelabs Medical cuffs with this monitor. Using other manufacturer’s cuffs may result in inaccurate readings, even if the manufacturer’s recommended size is observed.• If the cuff is too small, pressure readings may be falsely high; a cuff that is too large produces a falsely low reading. The bladder can be positioned in the cuff for either the left or right arm.CAUTION:• Avoid compression or restriction of pressure in the NIBP patient connector tubes. Check that operation of the equipment does not result in prolonged impairment of circulation. • Do not apply cuff to areas of breached or injured skin.• Cuff hose connections use luer fittings. Be careful not to connect the ABP monitor into an intravenous fluid line when working close to them.• This product contains natural latex rubber components to which some people may be allergic. These components include the bladder and the first four inches of tubing extending from the cuff.

Ultraview Care Network17-20Figure 17-4: Common cuff hose positions7. Connect the hose to the monitor.8. To verify proper monitor operation, take one or more blood pressure readings. Push the START/STOP key to begin a measurement.9. The 90343 transmitter must be configured for use with the 90217 ABP monitor by opening the battery compartment door, removing the battery, and setting DIP switches 5 ON and 8 OFF. Refer to Figure 17-2 on page 17-12.10. The 90478 receiver must be configured for operation with the 90343 transmitter and attached 90217 ABP monitor. Touch the ECG key to display the main menu. Touch CHANNEL FORMAT, then touch NIBP ON. The monitor will display the NIBP measurement in a numeric format in the display zone. The values of the measurement are displayed as ??? until a valid NIBP measurement has been taken. alternative #1alternative #2

Digital Telemetry17-21 11. Interconnect the adapter cable between the communications port on the ABP monitor and the NIBP port on the 90343 as shown in Figure 17-5.Figure 17-5: Transmitter ECG, SpO2, and ABP monitor connectionsFigure 17-2 and Figure 17-3 illustrate typical NIBP displays. You can view NIBP readings from any Ultraview bedside or central monitor on a network. NIBP displays on a split-screen central monitor appear in a format slightly different from that of bedside or full-screen central monitors.SpO2 sensorNIBP adapter cableNIBP cuffSpO2adapter cable90217 & 90343 mount in pouches to patient’s belt.

Ultraview Care Network17-22Setting or Adjusting Alarm LimitsRefer to NIBP on page 13-3.Displaying New or Previous ReadingsThe current (or latest) NIBP reading taken may be displayed when the NIBP parameter is enabled and the 90217 ABP monitor is correctly setup. The current reading is displayed just below the isoelectric line showing systolic, diastolic, and mean values with the time of the reading. The displayed values are replaced by ??? when no valid values have been acquired from the 90217.The previous NIBP readings may be displayed using the Tabular Trend or Graphic Trend monitor functions. The parameter trend information is collected from the module on a minute-by-minute basis and stored in system memory for retrieval. The collected NIBP trend readings may be displayed in the same manner as any other monitored parameter. Refer to Trends on page 26-3 for more information.NIBP Alarm Message SummaryThe 90217 ABP monitor provides an extensive set of result codes that indicate the status of the monitor and the potential causes of an inability to take a valid reading.When any alarm message is displayed, the NIBP parameter value is immediately changed to ??? and an alarm is triggered. If your module has been configured for an alarm using the Module Configuration Manager, the parameter display will blink yellow for Low and Medium priority alarms, and will blink red for High priority alarms. The alarm condition will persist until a new NIBP reading is taken. (Refer to Module Configuration Manager on page 7-5 for more information).The monitor displays the following messages to provide ABP status information to the caregiver. These messages summarize the 90217 event codes. Some of these messages include an event code in parentheses to provide more detailed analysis of the event. A complete list of the event codes can be found in the90207/90217 ABP Monitors Operations Manual,P/N 070-0137-xx.Telemetry products display their error messages within ECG’s display zone, so the following ECG alarm messages take priority over other NIBP messages.• LEADS OFF• NOISY SIGNAL• ECG ALARMS SUSPENDEDNIBP UNAVAILABLE (xx)Displayed when the 90217 ABP monitor has detected an internal condition, defined by the code (xx). Typically, this indicates a hardware or software failure that requires that the transmitter be removed from service. To set or adjust NIBP alarms: 1Touch ECG. 2Touch ALARM LIMITS. 3Touch NIBP ALARM LIMITS.4Select NIBP ALM ON.5Select SYS, DIA, or MEAN.6Select HI= or LO=.7Use arrow keys to adjust.To display the current reading:1Touch ECG.2Touch CHANNEL FORMAT.3Select NIBP ON.

Digital Telemetry17-23 NIBP READING FAILURE (xx)Displayed when the ABP monitor was unable to make a reading. The code (xx) defines the cause of failure. NIBP AIR LEAKDisplayed when an air leak has been detected in the pneumatic system, preventing a reading from being taken.NIBP LOOSE OR NO CUFFDisplayed when the cuff was able to be inflated in a manner indicating that it was not attached to the patient correctly.NIBP PATIENT CANCELLEDDisplayed when the patient has pressed the START/STOP button on the ABP monitor, halting a reading in progress.NIBP LOW BATTERYDisplayed when the primary (3xAA) battery voltage is low. Replace with fresh batteries.NIBP KINKED HOSEDisplayed when the pressure value increased too rapidly indicating a kinked hose or other restriction.NIBP EVENT CODE (xx)Displayed when the event code returned from the ABP monitor is not defined into one of the other messages.

17-24NIBP Troubleshooting GuideClinical Situation Possible Cause SolutionNo NIBP displays ■Adapter cable not inserted correctly.■Remove and re-insert adapter cable.■NIBP not enabled on 90343 or 90478.■Enable NIBP function by setting transmitter DIP switch 5 ON and setting DIP switch 8 OFF.■90217 ABP not properly initialized. ■Re initialize 90217 ABP using 90121.■90343 Low battery indicator constantly illuminated.■Call qualified service person.No NIBP readings can be obtained■Incorrect or inoperative cuff in use. ■Replace with cuff known to be operative. ■Tubing is kinked. ■Locate kink and straighten tubing.■Some arrhythmias (e.g., atrial fibrillation and frequent ventricular ectopy) may cause a single or repeated failure to obtain a reading (may be due to true beat-to-beat variations in pressure).■Document arrhythmia if present, verify pressure with another method, then follow hospital procedure for care of this type of patient.■Excessive patient motion or muscle contractions associated with shivering or severe pain.■Ensure that patient is quiet with minimal movement during NIBP readings; minimize patient’s shivering.■Blood pressure outside of measurement range.■Verify extremely high or low pressure with another method.Intermittent or complete failure to operate■90217 ABP error. ■Remove 90217 ABP from service; record event code; and call qualified service person.Apparent incorrect value■Wrong size cuff for patient. ■Measure patient’s limbs at the midpoint; match limb measurement to range specified on cuff (undersizing the cuff results in the greatest degree of error).■Cuff is damaged. ■Replace with good cuff. ■Excessive patient motion, shivering or severe pain.■Ensure patient is quiet with minimal movement during NIBP readings; minimize patient’s shivering.■False high readings may be the result of venous congestion caused by frequent readings. ■Reduce frequency of readings.■Cuff too loose or positioned incorrectly. ■Tighten cuff or reposition appropriately.

17-25 90217 ABP Display is incorrect■Data not retained. ■Replace backup battery.■Low or no power. ■Check the batteries for a full charge; if needed, replace or recharge the batteries.■May be one of the following: time-out, no reading due to air leak in the system, improper cuff size, cuff size not properly attached to the 90217 ABP.■Isolate cause and correct.No NIBP alarms are displayed■ECG “Leads Off” condition exists.■Higher priority alarm condition is present.■Re-attach ECG lead wires to the patient and resume ECG monitoring to clear pending ECG alarms.■Clear current alarm condition and/or re-prioritize NIBP alarms of interest in the Module Configuration Manager.■When NIBP alarms are set ON, all NIBP alarm conditions will cause the parameter value (or ???) to blink according to the alarm priority set by using the Module Configuration Manager.Variable readings occur ■Some arrhythmias may cause beat-to-beat pressure and NIBP readings.■Document arrhythmia if present, verify pressure using another method, then follow hospital procedure for care of this type of patient.■Larger than normal influence of respiratory phases on blood pressure (inspiratory fall in blood pressure; expiratory rise).■NIBP software usually compensates for normal variation.No NIBP readings or questionable values in the presence of shock■Peripheral vascular changes experienced during shock may reduce the reliability of blood pressure readings obtained with any indirect method; peripheral pulses may be diminished or absent.■Consider invasive pressure measurements in patients with symptoms of shock or in any patient who rapidly becomes unstable for unknown reasons.90217 displays “LLL” and alarm sounds■Low main battery condition. ■Turn off and replace batteries within 60-seconds after removal to continue monitoring.Cuff too tight ■Cuff placed on patient too tightly. ■Reposition the cuff.■Air pump staying on too long. ■Return unit to Spacelabs Medical for service.Cuff too loose ■Cuff placed on patient too loosely. ■Reposition the cuff.■Air pump not staying on long enough.■Return unit to Spacelabs Medical for service.Clinical Situation Possible Cause Solution

18-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Pressure DirectoryDirectory of KeysALARMLIMITSSELECTLABELSIZE SETUP SCALES ZEROSCALESON OFFFREEZEON OFFSCALE0-180SAVESYSSAVEMEAN ZEROSAVEDIAART PA CVP RAP LAP ICP UA UV PRSSWEEP SPEED25 mm/sec.FILTER12 HzART REJON OFFNUMERICSIZE50mm/sec.25mm/sec.12.5mm/sec.6.25mm/sec. SAME AS ECGSYSHI=150SYSLO=90DIAHI=150DIALO=90MEANHI=OFFMEANLO=OFFALARMOFFALLOFF0123456789ENTERPRESSURE MAIN MENUPRESSURE SCALES Menu CURSOR = 95PRESSURE Label Select MenuPRESSURE Setup MenuPRESSURE Waveform Size MenuPRESSURE Alarm Limits MenuThe scale is now 0 - 180. Enter the new scale setting: 0FILTER 12 HZThis keybecomesSAVE PCWPwith PAThe pressure label you select will appear herePRESSURE Sweep Speed MenuSYS/DIALARGEMEANLARGEALLLARGEPRESSURE Numeric Size MenuON

Contents18-3 PressureOverviewA pressure key and waveform will automatically be displayed as soon as you connect a transducer to the module. Immediately after connection, you can relabel the catheter site or zero the system. Pressure labels may be pre-defined (refer to Selecting Alarm Attributes on page 7-7) or you can select from the following:Disconnecting the pressure cable or the transducer will cause the pressure key and waveform to disappear from the display.Pressure Label DescriptionART arterial pressureCVP central venous pressureICP intracranial pressureLAP left atrial pressurePA pulmonary artery pressureRAP right atrial pressurePRS generic pressureUA umbilical artery pressureUV umbilical vein pressureDirectory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up Pressure Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Zeroing the Pressure Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting and Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Adjusting Waveform Size. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Selecting Numeric Display Size. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Adjusting Sweep Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Displaying Waveforms with Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Freezing the Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Changing the Waveform Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting the Waveform Measurement Value . . . . . . . . . . . . . . . . . . . . . . . . . . 7Storing Values for Trending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Setting Artifact Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Selecting a Filter Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Factory Default Pressure Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Invasive Pressure Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Ultraview Care Network18-4Systolic, diastolic, and mean pressure values are displayed for arterial, pulmonary artery, umbilical artery, umbilical vein and generic pressures. Only the mean value is displayed for other pressure types. Refer to the Display Detail on page 18-5 for a sample arterial pressure and intracranial pressure display on the bedside monitor.Setting Up Pressure MonitoringConnect the cable end of either a reusable or disposable transducer to the pressure connector located on the front of the module using a Spacelabs Medical pressure cable.When setting up an invasive pressure system, take all measures to maintain system sterility and to prevent the introduction of air into the system. Air bubbles are the most common cause of inaccurate pressure readings. The transducer, stopcocks, connectors and tubing must be completely free of air to ensure maximum performance. Zeroing the Pressure TransducerBefore you can begin monitoring you must zero the system. Zeroing has two purposes: 1) to establish atmospheric pressure as zero, and 2) to compensate for the hydrostatic effect of fluid in the catheter-tubing system.WARNING:• Systolic and diastolic pressures displayed numerically for patients being treated with an Intra-Aortic Balloon Pump (IABP) therapy may not be accurate. Display the waveform with scales to verify or determine pressures for these patients.!• With the Module Configuration Manager feature, you can define your own default settings for such characteristics as alarm limits and display configuration. Refer to the Module Configuration Manager on page 7-5 for further details.!• Refer to the catheter, tubing, or transducer manufacturer’s instructions or your hospital’s protocol for specific instructions on removing air from the system.• Invasive pressure systems specified by Spacelabs Medical are compatible with high-frequency electrosurgical and defibrillation equipment. No special precautions are required.!• If after you have followed the instructions to zero the pressure transducer and a ZERO REJECTED message appears, you may have a transducer problem. Follow the transducer manufacturer's directions to correct this problem before you continue.To zero the pressure transducer: 1Touch the desired pressure parameter key.2Open stopcock to air/close to patient (at phlebostatic axis).3Touch ZERO.4Close stopcock to air/open to patient.5Begin monitoring after the pressure values appear.

Pressure18-5 Display DetailA pressure display appears once you select a pressure label and zero the transducer. Figure 18-1 shows an example of the display for ART and ICP. The system identifies the specific pressure type in the parameter key and menu title (PA, CVP, LAP, etc.).Figure 18-1: Bedside monitor pressure displayᕡPressure waveformsᕢPressure parameter keysᕣSystolic pressureᕤMean pressureᕥSystolic pressure alarm limitsᕦDiastolic pressure alarm limitsᕧDiastolic pressureᕨCerebral perfusion pressureᕩMean pressure alarm limitsµMean pressure¸CHECK CATHETER key (for UA pressures only)133706CPP= 86(92)150120155ARTMICPSmmHg12060DmmHgCHECK CATHETERᕡᕢ¸µᕣᕤᕥᕦᕧᕨᕩ

Ultraview Care Network18-6Setting and Adjusting AlarmsPressure alarm limits can be defined for systolic, diastolic, and mean values for ART, PA, UA, UV, and PRS. Alarm limits can only be set for the mean value for all other pressures.The Alarm Limits menu for ICP provides a cerebral perfusion pressure key (CPP) used to set CPP alarm limits. CPP is computed as mean arterial pressure minus intracranial pressure (MAP-ICP). The value CPP=xxx displays at the top of the digital zone above the ICP value if ICP and at least one peripheral invasive arterial pressure are being monitored. If the system cannot compute a pressure (for example, no mean arterial pressure is available), then the message CPP=??? displays.Alarms can be independently set for each pressure channel.The CHECK CATHETER alarm may be set when umbilical artery pressure is being monitored. This alarm will sound whenever the pulse rate drops below 60 BPM or the pressure approaches 0 mmHg. Touching the CHECK CATHETER key will silence the alarm.Adjusting Waveform SizeYou can increase or decrease the size of the pressure waveform display. This only changes the displayed size and does not affect the signal gain. The waveform size may not be adjusted while the scales are displayed.Selecting Numeric Display SizeYou can select from three different display formats for pressure numerics (for ART, PA, PRS, UA and UV only). In each of the three display formats, mean pressure is 92, systolic pressure is 133 and diastolic pressure is 70.Figure 18-2: Display formats!• Specific alarm limits are not displayed in the All Large display format.To set or adjust alarm limits:1Touch the desired pressure parameter key.2Touch ALARM LIMITS.3Select desired alarm.4Select ALARM ON.5Use arrow keys to adjust a limit value.To change the waveform size:1Touch the desired pressure parameter key.2Touch SIZE.3Select SIZE ↑ or SIZE ↓.To change the numeric display size:1Touch the desired pressure parameter key.2Touch SETUP.3Touch NUMERIC SIZE.4Select a display size. 13370 92(92)70133 9270133mmHgmmHgmmHgSYSTOLIC/ MEAN LARGE ALL LARGEDIASTOLIC LARGE

Pressure18-7 Adjusting Sweep SpeedThe sweep speed determines the rate at which the pressure waveform moves across the screen. Sweep speed selections are: 50, 25, 12.5, 6.25 mm/second, or the same sweep speed as ECG.Displaying Waveforms with ScalesYou can superimpose a vertical reference scale over pressure waveforms. Up to four pressures can be scaled at one time.Touching a parameter key and then the SCALES key displays scales when the pressure parameter key is activated. Selecting SCALES ON maintains the selected pressure display in scaled format until SCALES OFF is selected.Freezing the Scaled DisplayYou can freeze a pressure waveform display to stabilize the waveform for obtaining measurements.To unfreeze the waveform display, select FREEZE OFF or exit the pressure menu by touching either the PREVIOUS MENU or NORMAL SCREEN keys.Changing the Waveform ScaleYou can increase or decrease the pressure waveform scale. The bottom of the scale is always 0 (zero). You may set the top of the scale to be any value from 10 to 500 mmHg by typing in the desired value and touching ENTER.Selecting the Waveform Measurement ValueYou can obtain a measurement at any part of the pressure waveform by using the horizontal cursor. The measurement value displays as CURSOR = xx in the message line above the Pressure menu. The most common use of this function is to obtain a pulmonary capillary wedge pressure (PCWP) value from the pulmonary artery catheter.To select a pressure waveform sweep speed: 1Touch the desired pressure parameter key.2Touch SETUP.3Touch SWEEP SPEED.4Select a sweep speed.To configure the display of pressure waveforms with a vertical scale:1Touch the desired pressure parameter key.2Touch SCALES.3Select SCALES ON if the pressure is to remain in scales.To freeze the pressure display:1Touch the desired pressure parameter key.2Touch SCALES.3Select FREEZE ON.To change the pressure waveform scale:1Touch the desired pressure parameter key.2Touch SCALES.3Select SCALE 0-xxx.4Type a new scale.5Touch ENTER.To obtain a pulmonary capillary wedge pressure (PCWP):1Touch PA.2Inflate PA catheter balloon.3Touch SCALES.4Touch FREEZE ON.5Deflate PA catheter balloon.6Use arrow keys to position cursor.7Touch SAVE PCWP.

Ultraview Care Network18-8Storing Values for TrendingYou can store values into memory for pressure trend displays for use in clinical calculations.Recording WaveformsYou can print pressure waveforms and values. Refer to Printing on page 4-5 for additional information.Setting Artifact RejectionVariations in intrathoracic pressures during the respiratory cycle can influence invasive pressures; especially PA, PCWP and CVP. The respiratory artifact rejection feature minimizes the impact of such variations by automatically selecting data from waveform peaks that have little change in amplitude from peak to peak. End-expiration is typically the time with the least variation. The artifact rejection feature works equally well in both mechanically-ventilated and spontaneously-breathing patients.In patients with chronic obstructive pulmonary disease, intrathoracic pressures during respiration are different than those in patients with normal lung function. Disable artifact rejection when monitoring these patients.The factory default for artifact rejection is ON for PA pressure only, and OFF for all other pressure labels.!• The pressure scales should not be changed during a recording. This may lead to an annotation on the recorded strip that does not match the actual scale of the recording.To store values in memory:1Touch the desired pressure parameter key.2Touch SCALES.3Use arrow keys to position cursor.For ART, PRS, UA and UV4Select SAVE SYS, SAVE DIA or SAVE MEAN.For CVP, RAP, LAP or ICP 5Touch SAVE MEAN.For PA6Touch SAVE PCWP.To print pressure waveforms:1Touch RECORD.2Touch flashing PRESSURE parameter key.To activate respiration artifact rejection:1Touch the desired pressure parameter key.2Touch SETUP.3Select ART REJ ON.

Pressure18-9 Selecting a Filter FrequencyWhen noise and other interference appears on the pressure waveform, you can adjust the filter frequency to minimize its effect.A higher filter frequency shows greater detail, but can also produce more artifact. A lower filter frequency smooths the waveform and may help diagnose transducer or catheter problems such as under damping or ringing.The filter frequency may be set within the range of 3 to 40 Hz.Restoring User-Defined SettingsWith the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-7.!• RESTORE SETTINGS changes the user-configurable settings for all parameters.• Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.To adjust the filter frequency:1Touch the desired pressure parameter key.2Touch SETUP.3Touch FILTER.4Touch the arrow keys to choose the desired setting.To restore user-defined settings:Configurations with ECG1Touch ECG.2Touch SETUP.3Touch RESTORE SETTINGS.4Select YES.To restore user-defined settings:Configurations without ECG1Touch TEMP.2Touch RESTORE SETTINGS.3Select YES.

Ultraview Care Network18-10Factory Default Pressure Alarm SettingsArterial (ART), Generic Pressure (PRS), Umbilical Artery and Vein (UA and UV), Cerebral Perfusion (CPP-mean only)Systolic *mmHg High Low-50 to 79 +30 -0580 to 109 +30 -10110 to 119 +30 -15120 to 129 +25 -20130 to 139 +20 -20140 to 149 +15 -20150 to 159 +10 -20160 to 169 +10 -25170 to 179 +10 -30180 to 189 +10 -35190 to 300 +10 -40Systolic *kPa High Low-6.7 - 10.5 +4.0 -0.710.6 - 14.5 +4.0 -1.314.6 - 15.9 +4.0 -2.016.0 - 17.2 +3.3 -2.7 17.3 - 18.5 +2.7 -2.7 18.6 - 19.9 +2.0 -2.7 20.0 - 21.2 +1.3 -2.7 21.3 - 22.5 +1.3 -3.3 22.6 - 23.8 +1.3 -4.0 23.9 - 25.1 +1.3 -4.7 25.2 - 40.0 +1.3 -5.3MeanmmHg High Low-50 to 69 +30 -0570 to 79 +30 -1080 to 99 +30 -15100 to 109 +30 -20110 to 119 +30 -25120 to 129 +25 -30130 to 139 +20 -30140 to 149 +15 -30150 to 179 +10 -30180 to 300 +10 -35MeankPa High Low-6.7 - 9.2 +4.0 -0.79.3 - 10.5 +4.0 -1.310.6 - 13.2 +4.0 -2.0013.3 - 14.5 +4.0 -2.714.6 - 15.8 +4.0 -3.315.9 - 17.2 +3.33 -4.017.3 - 18.5 +2.7 -4.018.6 - 19.8 +2.00 -4.019.9 - 23.8 +1.3 -4.023.9 - 40.0 +1.3 -4.7* Example: If systolic is between 80 and 109 mmHg, then HI alarm defaults to 30 mmHg above actual value; LO alarm defaults to 10 mmHg below actual value.DiastolicmmHg High Low-50 to 69 +30 -0570 to 79 +20 -1080 to 89 +20 -1590 to 99 +15 -15100 to 109 +10 -20110 to 119 +05 -25120 to 300 +05 -30DiastolickPa High Low-6.7 - 9.2 +4.0 -0.79.3 - 10.6 +2.7 -1.310.7 - 11.8 +2.7 -1.911.9 - 13.2 +2.00 -1.913.3 - 14.5 +1.3 -2.714.6 - 15.8 +0.7 -3.315.9 - 40.0 +0.7 -4.0Pulmonary Artery (PA), Right Atrial (RAP), Central Venous (CVP), Left Atrial (LAP), and Intracranial (ICP-mean only)Systolic, Diastolic, and MeanmmHg High Low kPa High Low-50 to 25 +05 -05 -6.7 - 3.3 +0.67 -0.6726 to 300 +20% -20% 3.4 to 40.0 +20% -20%

18-11 Invasive Pressure Troubleshooting GuideClinical Situation Possible Cause SolutionIntermittent or no operation ■Module error. ■Call a qualified service person.No pressure key appears ■Module not inserted correctly. ■Reinsert the module.■Transducer not connected. ■Reconnect the transducer.Numeric display does not settle■Respiration artifact too high. ■Select ART REJ ON. Pressure display disappears ■Cable disconnected from the module. ■Reconnect cable.■Cable disconnected from the transducer.■Reconnect cable.Pressure shows NOT ZEROED■Pressure has not been zeroed. ■Zero pressure with the ZERO key after opening transducer to air.Shows constant pressure ■Stopcock(s) are positioned incorrectly.■Reposition stopcock(s) to connect the patient to the transducer (a waveform will appear on the screen).ZERO REJECTED message appears■Stopcock(s) are positioned incorrectly.■Reposition stopcock(s) to open the transducer to air. Zero pressure with the zero key.■Still unable to zero. ■Follow transducer manufacturer’s instructions to correct the problem.CHECK CATHETER key appears on the monitor■Stopcock(s) are positioned incorrectly.■Reposition stopcock(s) to connect the patient to the transducer (a waveform will appear on the screen).■UA catheter has become dislodged or occluded.■Check UA catheter.■Upon completion of the above, touch the CHECK CATHETER key to silence the alarm.