Welch Allyn FN802FH Propaq 802 LTRN User Manual Users Manal part 5 of 10

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Document Description	Users Manal part 5 of 10
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Document Type	User Manual
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Date Submitted	2005-12-14 00:00:00
Date Available	2005-12-14 00:00:00
Creation Date	2005-10-31 09:25:36
Producing Software	Acrobat Distiller 7.0.5 (Windows)
Document Lastmod	2005-12-14 14:57:41
Document Title	Directions for Use, Welch Allyn Propaq LT Vital Signs Monitor (810-1702-00 Rev A)
Document Creator	FrameMaker 7.1
Document Author:	Welch Allyn

49
Standalone Monitoring
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Preparing for a New Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Continuing to Monitor a Patient on Power-Up . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Monitoring ECG and Resp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Monitoring SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Monitoring Blood Pressure (NIBP). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
To Discontinue Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Overview
The monitor is available as a standalone (model 802LT0N) or wireless model (model
802LTRN).
This chapter describes the operation of the standalone monitor, and of the wireless
monitor when it is not in communication with the Welch Allyn Flexnet® network and an
Acuity® Central Station.
About the Model 802LT0N (Standalone) Monitor
The model 802LT0N monitor operates in standalone mode. It measures and displays vital
signs, stores patient data, and locally indicates alarms and alert conditions.
•
The configuration of the monitor is not affected by Acuity.
•
The vital signs stored by the monitor are not sent to Acuity.
•
Alarms and alerts generated by the monitor do not appear on Acuity.
•
Alarms and alerts generated by Acuity do not appear on the monitor.
•
Acuity does not update the monitor time and date settings.
About the Model 802LTRN (Wireless) Monitor
See “Monitoring in Communication with Acuity” on page 77.
50
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Preparing for a New Patient
To Begin Monitoring a New Patient
1.
If the monitor is on, press
to turn it off.
If prompted to save or delete existing data, highlight Delete and press . The monitor
deletes any saved data and temporary settings, and then shuts down.
2. Press
•
to turn on the monitor.
If the monitor holds stored data from the previously monitored patient, it displays
the “data saved” start-up screen (Figure 43, left):
Figure 43. Start-Up with Saved Data
Portland Westside Hospital
Emergency Department
Note!
There is patient data stored for
Hall, Robert E. ID: 3456187
Select ( ) to delete data
and start a new patient.
Start New Patient Continue Patient
•
Info Demo
If the data from the previously monitored patient was deleted on shut-down, the
“no data saved” start-up screen appears (Figure 44):
Figure 44. Start-Up with No Saved Data
Portland Westside Hospital
Emergency Department
No data saved.
Select ( ) to Start a New Patient.
Start New Patient
Info
Demo
3. Highlight Start New Patient and press
(Figure 45).
. The first configured data display appears
In place of a patient name, ID: is followed by a string that is generated by the monitor
when you select ‘Start New Patient’. This AutoID string, a combination of serial
number, time, and date, is unique to each new patient, and identifies the patient until
you supply the patient identification data.
Directions for Use
Standalone Monitoring
51
Figure 45. Data Display with AutoID
ID: 0101819RO17Q
8:82:56
Adult
Rm
HR/min
Start-up AutoID
SpO2
NIBP mmHg
Resp/min
4. In the primary data display, highlight ID: (upper left) and press
The Patient Information Entry screen appears (Figure 46):
Figure 46. Patient Information Entry
Last
Middle
First
ID#
Rm#
Entry fields
A B C D E F G H I J K L M N O P Q R S T U V
W X Y Z 1 2 3 4 5 6 7 8 9 0 - Backspace
Character field
Select ( ) to enter highlighted character
Confirm
Cancel
5. Enter the ID and name of the new patient.
a.
Press
b. Press
c.
or
to copy it to the green-highlighted location in the entry fields (Figure 46).
Repeat from step a until all characters are entered into the field.
d. Press
e. Press
f.
to highlight (blue) a character in the character field (Figure 47).
until the insertion point in the entry field changes from green to blue.
or
Press
to move the insertion point to another entry field.
to return to the character field.
g. Repeat from step a until all fields are complete.
Note
To correct an error in an entry field: Place the cursor (step d and step e) to the
right of the error location, highlight and enter Backspace in the character field to
delete the erroneous character, and then enter the correct character.
Figure 47. Patient Information Entry (continued)
Last
HALL
Middle First
E RO
ID#
3456187
Rm#
A B C D E F G H I J K L M N O P Q R S T U V
W X Y Z 1 2 3 4 5 6 7 8 9 0 - Backspace
Select ( ) to enter highlighted character
Confirm
Cancel
Next letter highlighted
52
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
6. Highlight Confirm and press
Name alone is not sufficient to confirm a patient ID; thus, you can confirm the
patient name only after you have entered the patient ID.
Note
7.
Verify that the patient mode (adult, pediatric, or neonate) is set correctly for this
patient.
Neonatal
Term birth through 28 days, or up to 44 gestational weeks.
Pediatric
Between 29 days and 12 years.
Adult
13 years and older.
If the current patient mode setting is not correct:
a.
Highlight the current patient mode (Adult, Pediatric, or Neonate) and press
b. From the Patient Mode selection menu (Figure 48), highlight the appropriate
patient mode and press .
Figure 48. Changing Patient Mode
Patient Mode
Adult
Pediatric
Neonate
Patient Mode
Adult
Pediatric
Neonate
c.
A confirmation screen appears:
Figure 49. Confirming a Change of Patient Mode
HALL, ROBERT E.
3456187
Adult
3:00:06P
Rm 239
Note! You are changing the
patient mode from Adult to Pediatric.
This will change settings to default
Pediatric values and delete previous
HR/min
SpO2
patient
data.
If this is correct, highlight “Confirm”
then press Select ( ).
Cancel
Confirm
NIBP mmHg
Resp/min
d. To confirm the change, highlight Confirm and press
Note
When you change the patient mode and confirm the change:
•
All vital-signs data for the patient is lost.
•
All monitor settings revert to the defaults for the new patient mode.
Directions for Use
Standalone Monitoring
53
8. Verify that the displayed time and date are correct.
•
The monitor displays time in either the 12-hour (AM/PM) or 24-hour format, and
displays date in either the mm/dd/yy, dd.mm.yy, or yy/mm/dd format.
•
The date does not appear on the primary display screens. It appears on the
snapshot list and on the snapshot display.
a.
Highlight the time display (in the upper right corner of the screen) and press
The Time/Date screen appears (Figure 50).
Figure 50. Time/Date Screen: 24-Hour Format
HALL, ROBERT E.
3456187
Adult
II
14:49:37
Rm 239
1mV/cm
HR/min
NIBP mmHg
Resp/min
SpO2
Time Format
12 Hour 24 Hour
14
Hour
Minute
45
Month
Day
17
Year
2005
Date Format
mm/dd/yy dd.mm.yy yy/mm/dd
Set
Cancel
24-hour format
b. If the displayed time or date is not correct, press
or
to move the highlight
from one parameter to another, and press or to change the value of the
highlighted parameter. For example, to change the time display format from
24-hour to 12-hour, highlight Time Format and press either or once
(Figure 51).
Figure 51. Time/Date Screen: 12-Hour Format
HALL, ROBERT E.
3456187
Adult
II
14:49:54
Rm 239
1mV/cm
HR/min
NIBP mmHg
Resp/min
SpO2
Time Format
12 Hour 24 Hour
2P
Hour
Minute
45
Month
Day
17
Year
2005
Date Format
mm/dd/yy dd.mm.yy yy/mm/dd
Set
Cancel
c.
Note
12-hour format
When the time and date are correct and formatted appropriately, press
accept the changes and return to the vital-signs display.
to
If you change the time or date settings and then decide not to accept the
changes, press
to cancel the changes and return to the vital-signs display.
54
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Continuing to Monitor a Patient on Power-Up
If a patient’s data was saved before the monitor was last turned off (see “To Turn Off the
Monitor” on page 45), you can resume monitoring that patient when the monitor is turned
on again. (When patient data is saved, the monitor settings are also saved.)
To resume monitoring the same patient:
1.
Turn on the monitor. The “patient data stored” screen appears (Figure 52):
Figure 52. Start-Up with Saved Data
Portland Westside Hospital
Emergency Department
Note!
There is patient data stored for
Hall, Robert E. ID: 3456187
Select ( ) to delete data
and start a new patient.
Start New Patient Continue Patient
Info Demo
2. Verify that the displayed name and ID match that of the current patient.
3. Highlight Continue Patient (Figure 53) and press
Figure 53. Start-Up with Saved Data
Portland Westside Hospital
Emergency Department
Note!
There is patient data stored for
Hall, Robert E. ID: 3456187
Select ( ) to continue
monitoring this patient.
Start New Patient Continue Patient
Info Demo
Directions for Use
Standalone Monitoring
55
Monitoring ECG and Resp
Overview
Note
In this manual, lead refers to an ECG electrode or lead wire, and Lead refers to a
waveform source.
You can monitor heart signs (ECG) and respiration rate (Resp) using either a 3-lead or a
5-lead ECG cable. Using a 3-lead cable, you can display one signal waveform for lead I, II,
or III. Using a 5-lead cable, you can display either one or two signal waveforms (I, II, III, V;
and if enabled in the configuration, aVR, aVL, or aVF). You can also display the SpO2 or
Resp waveform in place of an ECG waveform.
Safety
WARNING Always monitor and set alarms for SpO2 when using impedance
pneumography to monitor respiratory function.
WARNING When monitoring respiration via impedance pneumography, always
select the ECG Lead with the most prominent QRS complex. The monitor rejects
cardiovascular artifact, but this function depends upon accurate ECG R-wave
detection.
WARNING Do not place the monitor near another respiration monitor. Resp
measurement frequencies can cause mutual interference.
WARNING Do not perform impedance pneumography on paced patients.
Pacemaker pulses can sometimes be falsely counted as breaths.
WARNING Always keep patient motion to a minimum. Motion artifact can cause
incorrect breath rate or heart rate readings.
WARNING If a disconnected lead is too close to other electrical devices, it can
cause a false heart rate, a false respiration rate, or a failure to display a “Lead Fail”
message.
WARNING The monitor displays + + + for HR numerics between 301-350 beats
per minute. For heart rates above 350 beats per minute, it might display
incorrectly low heart readings, due to intermittent picking of R-waves.
56
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
WARNING The monitor does not provide internal arrhythmia analysis; therefore,
arrhythmias can cause the monitor to display inaccurate heart rates.
WARNING Motion artifact can cause the monitor to display inaccurate heart
rates. Minimize patient motion whenever possible.
WARNING (1) During a surgical procedure, do not use small ECG electrodes.
(2) Select ECG electrode attachment points remote from the surgical site and
remote from the electrosurgical return electrode. (3) Use electrosurgical return
electrodes with the largest practical contact area. (4) Assure proper application of
the electrosurgical return electrode to the patient.
High-intensity radio-frequency (RF) energy from external sources, such as an
improperly connected electrosurgical unit, can induce heat into electrodes
and cables, which can cause burns on the patient and can lead to
measurement errors.
WARNING Make sure the patient mode is correct. Incorrect patient mode can
result in inaccurate heart rate readings and inappropriate alarm settings.
WARNING Always use the provided garment clips to route ECG cables away
from the patient’s head.
WARNING Use only accessories listed in the Welch Allyn Products and
Accessories guide (810-0409-XX).
WARNING Never use ECG cables with loose or faulty detachable lead wires.
These can cause erratic behavior of the ECG and respiration waveforms due to
intermittent ECG lead wire connections.
WARNING Resp is derived from the same leads as the ECG channel, so the
monitor determines which signals are cardiovascular artifact and which signals are
a result of respiratory effort. If the breath rate is within five per cent of the heart
rate or is a multiple or submultiple of the heart rate, the monitor might ignore
breaths and trigger a respiration alarm.
Caution Never use an ECG cable longer than 10 feet (3 meters) including
extensions. If you use an ECG extension cable with an ECG cable longer than
4 feet, the monitor acts as though no ECG cable is connected.
Caution To protect the monitor from damage during defibrillation or
electrosurgery, for accurate ECG information, and for protection against noise
and other interference, use only ECG electrodes and cables specified or supplied
by Welch Allyn (these cables have the required current-limiting resistors). Follow
recommended application procedures.
Directions for Use
Standalone Monitoring
57
The monitor contains type CF fully isolated patient-connected circuitry, but it is
not intended for direct application on a patient’s heart.
Note
Severe artifact and interference (such as defibrillation interference) can cause the
waveform to move off of the display for a few seconds before it is restored.
Impedance pneumography (Resp) is not recommended for use with
high-frequency ventilation.
The monitor counts as breaths any respiratory efforts larger than twice the
background cardiovascular artifact.
Use only silver/silver chloride electrodes. Other electrodes, such as stainless
steel electrodes, squeeze-bulb electrodes, or electrodes with dissimilar metals,
are subject to large offset potentials due to polarization. Other electrodes can also
have slower recovery time after the application of defibrillator pulses.
Monitoring ECG
Procedure
1.
Inspect the ECG cable. Replace it if it shows any signs of wear, breakage, or fraying.
2. Plug the cable into the monitor.
3. Select electrode sites on the patient (Figure 54), choosing flat areas and avoiding fatty
or bony areas and major muscles.
Figure 54. ECG Leads - Actual Placement
RA
LA
V1
V6
Six possible V lead electrode
placement sites for the C lead.
RL
LL
5-lead, adult and pediatric
RA
RA
LA
LA
LL
LL
3-lead, adult and pediatric
3-lead, neonatal
58
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
4. Shave or clip the hair from the electrode sites.
5. Thoroughly clean the skin, using soap and water, isopropyl alcohol, or skin preparation
pads, and lightly rub it dry.
Caution To protect the patient from allergic reactions to electrodes, refer to the
electrode manufacturer’s directions for use.
6. If you are using gelled electrodes, verify that the electrode expiration date has not
passed and that the gel is intact and not dried out.
If you are not using gelled electrodes, apply a mound of gel (1/4-inch to 1/2-inch, or
0.6-cm to 1.3-cm) to each electrode contact area.
7.
Attach lead wires to the electrodes before applying them to the patient.
8. Apply the electrodes to the patient in the proper locations (Figure 54).
Note
At least three appropriate electrode connections are required for ECG/Resp
monitoring.
Figure 55. ECG Leads - Placement Displays, 5-Lead and 3-Lead
The locations of the circles displayed on the monitor (Figure 55) for each lead are
fixed, and do not indicate the exact placement of the electrodes on the patient.
If the monitor detects that some lead wires are not connected, it displays an “ECG
Fault” equipment alert and a chest diagram (Figure 56) indicating the location of the
disconnected lead or leads. If the disconnected lead(s) invalidate the Lead used for
HR determination, then the monitor reassigns, if possible, the Lead used for HR. If
the reassignment succeeds, the monitor then displays another equipment alert with
the message “ECG Lead changed”.
Directions for Use
Standalone Monitoring
59
Figure 56. ECG Leads - Disconnected Leads
Disconnected leads
9. When all leads are properly connected, confirm that the monitor displays the ECG
waveform, heart rate, and other patient data.
Figure 57. All Vital Signs Being Displayed
HALL, ROBERT E.
3456187
Adult
3:00:06P
Rm 239
II 1mV/cm
SpO2
2x
12 97 %
80 140/78
NIBP mmHg (102) Resp/min SpO2
HR/min
@2:47P Manual
To Change the Waveform Selection
1.
Highlight the current waveform source selection (Lead II, for example) and press
Figure 58. Waveform Source: II
STEWART, ANN
7762940
Adult
Rm 263
II
1mV/cm
Waveform Source
Lead I
Lead II 6 sec
Lead III
aVR
aVL
aVF
Resp
SpO2
Add 2nd Wave
HR/min
NIBP mmHg
Resp/min
80
15:14:28
12 97 %
SpO2
2. Highlight your waveform source choice and press
or
60
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Figure 59. Waveform Source: Resp
STEWART, ANN
7762940
Adult
Rm 263
Resp
4x
Waveform Source
Lead I
Lead II
Lead III
aVR
aVL
aVF
Resp
24 sec
130/74
SpO2
Add 2nd Wave
HR/min
NIBP mmHg (88)
Resp/min
@7:05P Manual
60
15:14:28
20 97 %
SpO2
Note
If you scroll to the bottom selection of the Waveform Source menu—either Add
2nd Wave or Remove 2nd wave—the selection takes effect immediately and the
monitor returns to the primary data display.
Note
In the Waveform Source menu, either the source Lead or the waveform period
can be highlighted. If the waveform period is highlighted, a second trace of the
same source will be cascaded to double the period obtained from a single trace.
To Change the Waveform Size
1.
Highlight the current waveform scale (1mV/cm, for example) and press
Figure 60. Waveform Size Popup Menu
STEWART, ANN
7762940
Adult
II
80
HR/min
12:41:32
Rm 263
1mV/cm
Waveform Size
0.2 mV/cm
0.5 mV/cm
1 mV/cm
24mV/cm
mV/cm
4 mV/cm
8 mV/cm
NIBP mmHg
12 97 %
Resp/min
SpO2
2. Highlight the desired scaling factor and press
QRS-detector sensitivity.)
. (Waveform size does not affect
About Pacemakers and ECG Monitoring
If the patient being monitored has a pacemaker, the monitor detects and can indicate the
occurrence of pacemaker signals. If the Pacer Indicator setting is ON, the monitor displays
and prints vertical dashed lines to indicate detected pacemaker signals. If Pacer Indicator
is OFF, the monitor continues to detect the pacemaker signals but does not display or
print the pacer markers.
Directions for Use
Standalone Monitoring
61
Safety
WARNING Signals differ between pacemakers. The Association for
Advancement of Medical Instrumentation (AAMI) cautions that “in some devices,
rate meters may continue to count the pacemaker rate during occurrences of
cardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms.
All pacemaker patients should be kept under close or constant observation.”
WARNING Use of respiration monitoring by impedance pneumography can
affect the operation of some pacemakers. If pacemaker operation is affected, turn
off respiration pneumography. (See Figure 61 on page 61.)
WARNING Always use fresh ECG electrodes and make sure the ECG cable lead
wires make good connections. The presence of pacer-like noise can cause the
displayed heart rate to be erratic even though the ECG trace might look
undistorted with the pacer indicator off.
Procedure
To enable or disable the display of pacer indicators, follow these steps:
1.
Access the Setup menu. (See “To Access the Setup Menus” on page 38.)
2. Highlight ECG (Figure 61).
Figure 61. Turning the Pacer Indicator Off in the ECG Setup Menu
HALL, ROBERT E.
3456187
Adult
II
3:00:06P
Rm 239
1mV/cm
80
HR/min
140/78
12
NIBP mmHg (102) Resp/min
Setup Alarms
ECG
Resp Monitoring
ECG Bandwidth
Power source filter
Pacer indicator
Exit
Trends
97 %
SpO2
NIBP Timings Service
Off On
Monitor Extended
60Hz 50Hz Off
Off On
Snapshots
Pacer indicator Off
Setup
3. Highlight Pacer indicator and press
or
4. To exit the Setup menu, press
, or highlight Exit and press
Note
or
to highlight Off or On.
If the pacemaker signal is strong enough, the monitor displays it as a waveform
spike. This is true with Pacer indicator ON or OFF.
In accordance with the Pacer Pulse Rejection specification (“Pacer pulse
rejection” on page 165.), pacemaker pulses are not counted as heartbeats
whether Pacer Indicator is On or Off.
Noise on the ECG signal might be detected as pacer signals, causing the pacer
indicator to appear on the display. If you do not need to indicate pacemaker
signals, turn off the pacemaker indicator for a better ECG waveform display.
62
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Improving the Waveform Display
If the power source filter is off, noise from the power source can cause an unclear or
noisy waveform.
To Change the Power Source Filter to Reduce Noise
1.
Access the Setup menu. (See “To Access the Setup Menus” on page 38.)
2. Highlight ECG.
Verify that the setting for Power source filter (Figure 62) is correct for the power
source in your facility. If you do not know what this setting should be, consult a
qualified service person.
3. Highlight Power source filter and press
or Off.
or
as needed to select 60 Hz, 50 Hz,
Figure 62. Turning On the 60 Hz Power Source Filter in the ECG Setup Menu
HALL, ROBERT E.
3456187
Adult
II
3:00:06P
Rm 239
1mV/cm
80
HR/min
140/78
12
NIBP mmHg (102) Resp/min
Setup Alarms
ECG
Resp Monitoring
ECG Bandwidth
Power source filter
Pacer indicator
Exit
Trends
97 %
SpO2
NIBP Timings Service
Off On
Monitor Extended
60Hz 50Hz Off
Off On
Snapshots
Power source filter 60 Hz
Setup
4. Exit the Setup menu by pressing
or
Monitoring Respiration
Resp is based on impedance pneumography, where respirations are sensed from the
ECG electrodes.
Note
All ECG cables listed for the Propaq LT monitor in Products and Accessories
(810-0409-XX) permit respiration monitoring and electrosurgical interference
suppression.
Note
To measure Resp with Lead II selected, the LL lead must be attached to the
patient.
Resp is part of ECG monitoring. The Resp numeric is displayed (in purple) in the lower
right corner. To view the Resp waveform:
Change the waveform source to Resp (Figure 63). (See “To Change the Waveform
Selection” on page 59.)
WARNING Use of respiration monitoring by impedance pneumography can
affect the operation of some pacemakers. If pacemaker operation is affected, turn
off respiration pneumography. (See Figure 61 on page 61.)
Directions for Use
Standalone Monitoring
Figure 63. Resp Waveform, Default Size (2x)
HALL, ROBERT E.
3456187
Adult
Resp
3:08:16
Rm 239
2x
80
HR/min
NIBP mmHg
12 97 %
Resp/min
SpO2
For more detail, change the waveform size to 8x (Figure 64). (See “To Change the
Waveform Size” on page 60.)
Note
Waveform size does not affect breath-detector sensitivity.
Figure 64. Resp Waveform Enlarged for Detail (8x)
HALL, ROBERT E.
3456187
Adult
Resp
80
HR/min
3:08:16
Rm 239
8x
NIBP mmHg
12 97 %
Resp/min
SpO2
63
64
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Monitoring SpO2
Safety
WARNING Accurate measurements of oxygen saturation, when derived from
pulse oximetry, depend to a great extent on patient condition and proper sensor
placement. Patient conditions such as shivering and smoke inhalation can result in
erroneous readings. If you believe a measurement might be inaccurate, verify it
using another clinically accepted measurement method, such as arterial blood gas
measurements using a co-oximeter.
WARNING Use only Nellcor accessories listed in the Welch Allyn Products and
Accessories guide (810-0409-XX). Inspect sensors and cables, and discard any
that are damaged. Do not use a sensor with exposed optical components.
WARNING If you need to increase the length of the sensor cable, use only one
extension. Use of multiple extensions can adversely affect performance. Do not
attach any cable that is intended for computer use to the SpO2 connector at the
monitor.
WARNING Tissue damage and erroneous measurements can be caused by
incorrect application or use of a sensor. (Examples of bad practices: wrapping the
sensor too tightly, applying supplemental tape, failing to periodically inspect the
sensor site, leaving a sensor on too long in one place.) Refer to the
manufacturer’s directions for specific instructions on application and use, and for
description, warnings, cautions, and specifications.
WARNING Do not modify the sensor.
WARNING Do not wet the sensor or immerse it in fluid. Do not attempt to
sterilize a sensor.
WARNING Sensors exposed to ambient light while not applied to a patient can
exhibit seminormal saturation readings. Be sure the sensor is securely placed on
the patient and check its application often to ensure accurate readings.
WARNING Inaccurate measurements might be caused by venous pulsations.
WARNING The pulse oximeter can be used during defibrillation, but the
readings might be inaccurate for a short time.
WARNING Do not use the pulse oximeter as an apnea monitor.
WARNING When using the motion-tolerant pulse oximetry channel, a very
sudden and substantial change in pulse rate can result in erroneous pulse rate
readings. Always validate the patient data and patient condition before effecting
an intervention or a change in patient care.
Directions for Use
Standalone Monitoring
65
WARNING Interfering substances: Carboxyhemoglobin can erroneously
increase readings; the level of increase is approximately equal to the amount of
carboxyhemoglobin present. Methemoglobin and other dysfunctional
hemoglobins can also cause erroneous readings. Further assessment beyond
pulse oximetry is recommended. Intravascular dyes, or any substances
containing dyes, that change usual arterial pigmentation can cause erroneous
readings. Darkly pigmented skin can adversely affect SpO2 readings.
WARNING For a premature infant, high oxygen levels might predispose the
infant to develop retinopathy. Therefore, the upper alarm limit for oxygen
saturation must be carefully selected in accord with accepted clinical standards
and considering the accuracy range of the monitor.
Caution If liquid gets into the SpO2 connector cavity, discontinue SpO2
monitoring until the liquid is removed and the cavity is dry.
Procedure
1.
Inspect the SpO2 cable. Replace it if it shows any signs of wear, breakage, or fraying.
2. Plug the cable into the sensor and the monitor.
Each SpO2 sensor is intended for application to a specific site and site size on the
patient. To obtain optimal performance, use the right sensor and apply it as instructed
by the sensor manufacturer.
3. Clean the application site. Remove anything, such as nail polish, that could interfere
with the operation of the sensor.
4. Attach the SpO2 sensor to the patient according to the manufacturer’s directions for
use, observing all warnings and cautions.
5. Confirm that the monitor displays SpO2 data within a few seconds of being
connected to the patient.
•
If ambient light is too bright, shield the sensor site with opaque material. Failure
to do so can result in inaccurate measurements. Light sources that can affect
performance include the following:
surgical lights (especially those with a xenon light source)
bilirubin lamps
fluorescent lights
infrared heating lamps
direct sunlight.
•
When NIBP and SpO2 are monitored simultaneously, place the NIBP cuff on a
different limb than the SpO2 sensor to help reduce unnecessary SpO2 alarms.
•
Do not attach the SpO2 sensor on the same limb as an arterial catheter or
intravascular line.
66
Standalone Monitoring
•
Welch Allyn Propaq LT Vital Signs Monitor
The pulse signal can disappear if any of the following conditions exists:
the sensor is too tight
ambient light is too bright
an NIBP cuff is inflated on the same limb as the sensor
arterial occlusion occurs near the sensor
the patient is in cardiac arrest or shock
the patient has hypotension, severe vasoconstriction, severe anemia, or
hypothermia.
•
If poor perfusion affects performance for an adult, consider using the adult nasal
sensor.
•
If a sensor is connected and the sensor light does not come on within 3 seconds:
•
Verify that SpO2 is turned on (Figure 65)
Replace the sensor
The SpO2 system is tolerant of normal patient motion. If excessive or prolonged
patient movement interferes with measurements, consider the following possible
solutions:
be sure the sensor is secure and properly applied
use a new sensor with fresh adhesive backing
select a different type of sensor
move the sensor to a less active site
6. Periodically verify that the sensor remains properly positioned on the patient.
About SpO2 Spot Check
Note
The Spot Check feature is available only if it is enabled in the monitor
configuration. Refer to “Configuring the Monitor” on page 126.‘
When SpO2 is turned on, the monitor generates an alarm condition whenever SpO2
readings are interrupted, such as when the sensor is disconnected from the patient after
the monitor begins taking SpO2 readings.
Using the SpO2 Spot Check feature, however, you can take any number of spot SpO2
readings at random intervals, attaching and detaching the sensor repeatedly without
generating alarms.
To Prepare to Take a Spot Check Reading
1.
Highlight SpO2 and press
Directions for Use
Standalone Monitoring
2. Highlight SpO2 Monitoring (Figure 65), press
return to the main screen.
to highlight Off, and press
to
Figure 65. SpO2 Monitoring Turned Off
SpO2
SpO2 Monitoring
Upper Alarm
Upper Limit
Lower Alarm
Lower Limit
HP/PR Tone
Off On Standby
Off On
100
Off On
90
Off Low Med High
Press to move the
highlight to Off.
‘SpO2’ has changed to ‘SpO2 @ (time)’ (Figure 66). Spot checks are now enabled.
Figure 66. SpO2 Monitoring Turned Off
HALL, ROBERT E.
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80
HR/min
SpO2 Monitoring is Off
SpO2 @ 3:03P
NIBP mmHg
Resp/min
To Take an SpO2 Spot Check Reading
1.
Enable spot checks. (See “To Prepare to Take a Spot Check Reading” on page 66.)
2. Attach the sensor to the monitor and the patient.
3. Highlight SpO2 @ XX:XX and press
(Figure 67).
Note
. The SpO2 drop-down menu appears
The SpO2 drop-down menu can be accessed only when SpO2 is set to Off.
Figure 67. SpO2 Drop-Down Menu
SpO2
On
Off
Spot Check
4. Press
•
Enable continuous automatic SpO2 function
Disable automatic SpO2 function (enable Spot Checks)
Take a Spot Check reading
to highlight Spot Check.
The drop-down menu disappears. SEARCH appears above SpO2 Spot Check
(Figure 68) (with pulse rate if SpO2 is the source of pulse rate).
67
68
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Figure 68. SpO2 Spot Check: Waiting for an SpO2 Signal
HALL, ROBERT E.
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SEARCH
PR/min
NIBP mmHg
SEARCH indicates that the monitor
is waiting for pulse oximetry data.
SpO2 Spot Check
Resp/min
•
After a few seconds, the SpO2 heart-beat indicator starts showing heart beats.
•
After about 30 seconds, SEARCH disappears and the pulse oximetry reading
appears (Figure 69).
Figure 69. SpO2 Spot Check: Pulse Rate Reading
HALL, ROBERT E.
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78 98
PR/min
SpO2 @ 3:05P
Pulse rate
NIBP mmHg
Resp/min
•
The spot check ends, and SpO2 monitoring is again turned off.
•
The SpO2 text on the display screen now includes the time of the most recent
SpO2 measurement. For example: SpO2 @ 3:05P.
Note
Spot checks are included in trends displays.
5. Detach the sensor from the patient.
6. To take another spot check later, repeat from step 2.
To Return to Continuous SpO2 Measurements
1.
Highlight SpO2 @ XX:XX and press
2. Press
to turn automatic SpO2 On. The pop-up menu disappears.
To Adjust the SpO2 and ECG Pulse Tone Volume
1.
Highlight SpO2 and press
2. Highlight HR/PR Tone.
3. Highlight the desired volume level (Off, Low, Med, or High) and press
Directions for Use
Standalone Monitoring
69
Monitoring Blood Pressure (NIBP)
Safety
WARNING Always use a properly fitting cuff, placing it carefully on the patient
according to the instructions presented below. Failure to fit and locate the cuff
correctly can lead to inaccurate pressure readings.
WARNING During monitoring, periodically observe the patient’s limb to make
sure that the circulation is not impaired for a prolonged period. Prolonged
impairment of circulation or improper cuff placement can cause bruising.
WARNING Do not use the monitor to simultaneously measure NIBP on one
patient and monitor ECG on another patient.
WARNING If an NIBP measurement is suspect, repeat the measurement. If you
are still uncertain about the reading, verify it using another method.
WARNING Do not take NIBP measurements on patients during
cardiopulmonary bypass.
WARNING When monitoring NIBP, match the monitor patient mode to the NIBP
cuff. For neonates, set the monitor to Neonatal Mode unless the circumference
of the limb is too large for the cuff. In that case, use the Pediatric Mode. Be
aware, however, that the maximum cuff inflation limits are based on the patient
mode, not the cuff; the maximum cuff inflation limits for Pediatric Mode are
greater than for Neonate Mode. (See “NIBP” on page 168 for values.)
Caution Pulse-rate measurements generated through the blood pressure cuff
or through SpO2 are subject to artifact and might not be as accurate as heart-rate
measurements generated through ECG or through manual observation.
Procedure
When the monitor is powered on, the default cuff inflation pressure is based on the
patient mode. (See “Default inflation pressure” on page 169.) After an NIBP
measurement occurs, the monitor adjusts the inflation pressure to optimize subsequent
NIBP measurements.
Note
Always cycle the monitor power before you begin to monitor another patient.
Normal physiological pressure variations affect NIBP measurements from reading
to reading.
If the monitor is in Adult mode and a neonate cuff is connected to the monitor,
the monitor generates an equipment alert.
1.
Select cuff size based on limb circumference. Use only hoses and cuffs listed in the
Welch Allyn Products and Accessories guide.
2. Squeeze all the air from the cuff before placing the cuff on the patient.
3. Place the cuff on the limb, as near heart level as possible (Figure 70 on page 70).
70
Standalone Monitoring
Note
Welch Allyn Propaq LT Vital Signs Monitor
For every inch the cuff is placed above the heart, add 1.9 mmHg (0.253 kPa) to the
displayed NIBP reading. For every inch below the heart, subtract 1.9 mmHg
(0.253 kPa).
•
The cuff must fit snugly without being uncomfortably tight.
•
The hose must be free of kinks and not pinched.
4. Align the point where the tubing connects to the cuff over the brachial or other
appropriate artery.
Note
If you are simultaneously monitoring blood pressure and SpO2, you can reduce or
eliminate unnecessary SpO2 alarms by placing the cuff and the SpO2 sensor on
different limbs.
Figure 70. Cuff Placement
Cuff applied evenly and snugly. The
center of the cuff is at heart level,
and the bottom edge is one inch (2.5
cm) above the antecubital fossa.
Possible cuff placements for neonates
5. Screw the hose connector onto the NIBP air connector on the top of the monitor (see
Figure 4 on page 9).
6. Press
Note
7.
to start a reading.
If the battery charge is low and the monitor is not in the cradle, the battery icon
indicates low battery and NIBP monitoring is disabled.
•
If you need to stop the reading and vent the cuff at any time during the
measurement, press
•
If the monitor cannot get a valid NIBP reading, it displays the message
‘NIBP retry in progress’ in the upper left corner of the screen and attempts
another measurement. Depending on settings and patient mode, the monitor
attempts one or two retries.
If motion artifact, such as shivering or coughing, interferes with NIBP readings, do the
following:
•
Position the patient’s limb away from the body so that the applied cuff is not in
contact with the patient’s body or any other object (such as a bed rail). Keep the
cuff as close to heart level as possible.
Directions for Use
Standalone Monitoring
71
•
Verify that the Smartcuf filter is ON. (See “Improving NIBP Accuracy with
Smartcuf” on page 71.)
•
Verify that the ECG leads are properly connected to the patient and monitor ECG
during NIBP. (ECG monitoring is required for Smartcuf.)
Note
The message ???/???/(???) in an NIBP TREND display or printout indicates that
the monitor could not complete an NIBP measurement during that period.
Note
On-demand NIBP readings (manual or turbo) are delayed by 8 seconds if they are
started while the monitor is in a power-saving mode such as display time-out.
Improving NIBP Accuracy with Smartcuf
Note
Smartcuf will be available in 2006.
Many factors can adversely affect an NIBP measurement: cardiac arrhythmias, sudden
changes in blood pressure, patient motion such as convulsions or shivering, sudden cuff
movement, vibration, vehicle motion, or a weak pulse. The Smartcuf feature increases
NIBP measurement accuracy in the presence of moderate motion artifact or diminished
pulses.
Note
Smartcuf can function only when ECG is being monitored.
To Enable Smartcuf
1.
Simultaneously monitor ECG and NIBP.
2. Access the Setup menu. (See “To Access the Setup Menus” on page 38.)
3. Highlight NIBP, highlight Smartcuf, and enable the Smartcuf filter.
If Smartcuf is enabled and motion artifact is so severe that it still affects measurement
accuracy, the measurement is marked with the symbol on the display and on printouts.
During certain types of arrhythmias and other situations where a good ECG signal cannot
be obtained, consider disabling Smartcuf, as follows:
To Disable Smartcuf
1.
Access the Setup menu. (See “To Access the Setup Menus” on page 38.)
2. Highlight NIBP, highlight Smartcuf, and disable the Smartcuf filter.
72
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Taking Automatic NIBP Readings
In the Auto NIBP mode, for intervals shorter than 5 minutes, the monitor immediately
begins taking NIBP readings at the specified interval. For intervals of 5 minutes or longer,
the readings begin when the time of day is a multiple of the interval. (If the interval is 15
minutes, for example, then the readings begin at 00, 15, 30, or 45 minutes after the hour.)
To Start Automatic NIBP Readings
1.
Select and apply the appropriate NIBP cuff and hose. (“Monitoring Blood Pressure
(NIBP)” on page 69.)
2. Highlight NIBP and press
3. Highlight NIBP Mode and select Auto.
4. Highlight Auto Interval (min) and select an interval.
Note
After you invoke an automatic NIBP, expect a delay before the monitor starts the
first measurement. The delay can be as long as the interval selected.
To Stop Automatic NIBP Readings
1.
Highlight NIBP and press
2. Highlight NIBP Mode and select Manual.
Taking NIBP Readings Using Turbo Mode
In Turbo mode, the monitor starts an NIBP reading and then takes as many more readings
as possible within five minutes.
To Use the Turbo Mode
1.
Select and apply the NIBP cuff and hose. (“Monitoring Blood Pressure (NIBP)” on
page 69.)
2. Highlight NIBP and press
3. Highlight NIBP Mode and select Turbo.
Note
If you cycle the monitor power, NIBP returns to manual mode.
To End the Turbo Mode
Press
or select NIBP Mode Manual. The monitor returns to manual NIBP
measurement mode.
Directions for Use
Standalone Monitoring
73
Taking NIBP Readings Using the Digital Manometer
To Use the Digital Manometer
1.
Attach the appropriate cuff to the patient. (See Step 1 on page 69.)
2. In the NIBP control menu (see “Using Control Menus” on page 34), highlight
Manometer. The manometer menu appears (Figure 71).
Figure 71. NIBP: Manometer Initial View
STEWART, ANN
7762940
Adult
II
3:00:06P
Rm 263
1mV/cm
HR/min
NIBP mmHg
NIBP Manometer
Resp/min
Systolic
Diastolic
SpO2
Mean
NIBP Mode: Manual
50
Exit
100
150
Trends
200
Snapshots
250
300
Setup
3. Press
to start the NIBP measurement cycle. When the cuff is inflated, the
manometer bar dynamically displays the pressure reading (Figure 72).
Figure 72. NIBP: Manometer Reading in Progress
STEWART, ANN
7762940
NIBP in progress.
II
1mV/cm
HR/min
Adult
NIBP mmHg
NIBP Manometer
Resp/min
Systolic
3:00:06P
Rm 263
Diastolic
SpO2
Mean
Manometer pressure indicator bar
NIBP Mode: Manual
145
50
Exit
100
Trends
150
200
Snapshots
250
300
Setup
When the cycle completes, measurement numerics appear below the waveform grid
and the systolic, diastolic, and MAP values are displayed as markers along the
manometer scale (Figure 73).
74
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor
Figure 73. NIBP: Manometer Reading Complete
STEWART, ANN
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3:00:06P
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1mV/cm
79
PR/min
Systolic, diastolic, and MAP
(numeric)
132/83
NIBP mmHg (98)
NIBP Manometer
Systolic
Resp/min
Diastolic
SpO2
Mean
Systolic, diastolic, and MAP
(graphical)
NIBP Mode: Manual
50
Exit
100
Trends
150
200
Snapshots
250
300
Setup
NIBP Measurements in Power-Saving Mode
When a manual or turbo NIBP activity awakens the monitor from power-saving mode
(“Power Saving” on page 45), cuff inflation pressure is reset to default levels and cuff
inflation is delayed for up to 8 seconds.
NIBP Disabled When the Battery is Low
If the battery is low and the monitor is operating on battery power, NIBP functions are
disabled and the monitor displays the message “NIBP off. Low battery.”
If you attempt to start an NIBP measurement during a low-battery condition, the monitor
displays an equipment alert with the message “Low battery. NIBP disabled.”
Note
Inserting a monitor into a powered cradle during a low-battery condition
immediately enables NIBP monitoring.
Directions for Use
Standalone Monitoring
75
To Discontinue Monitoring
1.
Press
. The Power Off screen appears (Figure 74 on page 75).
Figure 74. Power Off
HALL, ROBERT E.
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You have pressed the Power Off button.
There is patient data stored for
Hall, Robert E. ID: 3456187
Select ( ) to delete patient data
and shut down.
Delete & Shut Down Save & Shut Down Cancel Setup
•
If you intend to continue monitoring the same patient when the monitor is turned
on again, and if you want to save the stored vital-signs data and monitor settings
(to print them at a PC), highlight Save & Shut Down and then press . The
monitor saves the patient data and the monitor settings, and then turns off.
•
If you do not intend to continue monitoring the same patient when the monitor is
turned on again, highlight Delete & Shut Down and then press . The monitor
turns off without saving the data and the settings.
2. Disconnect the leads and sensors from the patient.
If you press
and then decide that instead of turning off the monitor you want to resume
monitoring the same patient, do one of the following:
Note
•
Highlight Cancel and press
•
Wait for 30 seconds.
•
Press
When you power down from Demo mode, you cannot save settings and patient
data. In this case, the following screen appears:
ID: SET_DEMMATJP
SIMULATION
12:41:32
Adult
Rm
You have pressed the Power Off button.
Select ( ) to delete patient data
and shut down.
Delete & Shut Down
Cancel
Setup
76
Standalone Monitoring
Welch Allyn Propaq LT Vital Signs Monitor

---

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