Agilent M1165, M1166, M1167, M1175, M1176 User reference manual (Vol.2)

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Agilent M1165/66/67/75/76/77A Component Monitoring System and Agilent M1205A V24 & V26

User’s Reference Manual Volume 2 Parameter Information

Part Number M1046-900 1L Printed 06/2000 First Edition

Notice

This document contains proprietary information which is protected by copyright. All Rights Reserved. Reproduction, adaptation, or translation without prior w rit ten permission is prohibited, except as a llowed under the copyright laws.

Agilent Technologies 3000 Minuteman Road Andover, MA 01810-1085 (978) 687-1501

Publication number M1046-9001L

Warranty

The information contained in this document is subject to change without n otice. Agilent Technologies ma kes no warranty of any kind with regard to this material, including,

but not limited to, the implied warranties or merchantability and fitness for a particular purpose.

Agilent Technologies shall no t be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material.

Printing History

0366

0123

New editions of this document will incorporate all material updated since the previous edition. Update packages may be issued bet ween editions and contain replac ement and additional pages to be merged by a re vision date at the bottom of the pa ge. Note that pages which are rearranged due to ch anges on a previous page are not considered revised.

The documentation printing date and part number indicate its current edition. The printing date changes when a new edition is printed. (Minor corrections and updates which are incorporated at reprint do not cause the date to change.) The document part number changes when extensive technical ch anges are incorporated.

First Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . June 2000

Important

United States federal law restricts these devices to sale by or on the order of a physician. The M1165/66/75/76A Systems comply with UL544, CSA 22.2-125, IEC 601-1, EN 60601-1, and

EN 60601-1-2 and car r ies Marking to Counci l Dir ec ti ve 93/ 4 2/ EEC, E ur opean Medical Device Directive (MDD).

The M1167/77A Systems comply with UL2601-1, CSA 22.2 No. 601.1-M90, IEC 601-1, EN 60601-1, and EN 60601-1-2 and carries Marking to Council Directive 93/42/EEC,

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European Medical Device Directive (MDD). The M1205A Systems comply with UL2601, IEC 601-1, CSA C22.2 no. 601-1, EN60601-1, and

EN60601-1-2 and carries Marking to Council Directive 93/42/EEC, European Medical Device Directive (MDD).

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Electromagnetic Interference

Anomalies due to electromagnetic interference are not unique to the M1165/66/67/75/76/77A or the M1205A but are chara cteristic of patient monitors in use today. This performance is due to the very sensitive high gain front end amplifiers used to display the physiological signals. Among the many similarly performing monitors already in use by customers, interference from electromagnetic sources is rarely a problem in actual use.

Avoiding Electromagnetic Interference

When electromagnetic interference (EMI) is encountered there are a number of actions that can be taken to mitigate the problem.

• Eliminate the source. Possible sources of EMI can be turned off or moved away to reduce their strength.

• Attenuate the coupling. If the coupling path is through the patient leads, the interference may be reduced by moving and/or rearranging the leads. If the coupling is through the power cord, plugging the monitor into a dif ferent circuit may help.

• Reduce the sensitivity of th e syst em . In all o f th e EM C t esti n g the m oni to r wa s adju ste d to maximum sensitivity. For the ECG amplifier the gain was four times what is normally required. By reducing the gain of the system receiving the EMI, the interference can often be eliminated.

• Add external attenuat ors. I f E MI becomes an unusually difficult problem external devices such as an isolation transf ormer or a transient suppressor ma y be of help. An Agilent Customer Engineer can be of help in determining the need for external devices.

Intended Use

Description

The Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 Monitors are ne tw ork connectable bedside patient monitoring devices.

The Agilent M1205A Models V24CT and V26 CT may powered by either AC line power or by battery power.

Purpose

The Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors measure and display multiple ph ysiological parameters and w aves, and generate alarms and recordings. They exchange information with compatible devices. The Agilent M1165/66/67 /75/76/77A Component Monitoring System and the Agile nt M1205A V24 and V26 monitors are not therapeutic devices.

Patient Population

The Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors are intended to be used on adult, pediatric, an d neonatal patients.

Environment

The Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors are intended to be used in a clinical environment by trained healthcare professionals. They are not intended for home use.

They communicate with de vices such as a central station through network interface ports and a serial I/O port.

The Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A

V24 and V26 Monitors are pres cription devices and will carry the following label, “United States Federal law restricts this device to sale by or on the order of a physic ian.”

Indications for Use

Condition

The Agilent M1165/66/6 7/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 Monitors are generally indicated when the clinician decides there is a need to measure and display multiple physiological parameters and waves, to generate alarms and recordings of adult, pediatric, or neonatal patie nts.

Part of Body or Type of Tissue with Which the Device Interacts

The Agilent M1165/66/6 7/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors do no t c ontact the body or tissue of the patient. Signals are obtain ed from accessory electrode, transducer, and sensor devices.

Frequency of Use

The Agilent M1165/66/6 7/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors ar e indicated for use when presc ribed by a clinician.

Physiological Purpose

The Agilent M1165/66/6 7/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 Monitors are indicated when the purpose is to gain information for treatment, to assess adequacy of treatment, or to rule out causes of symptoms. The Agilent M1165/66/67/ 75/76/77A Compon e nt Mo n it or i n g Syste m an d the Agi le n t M120 5A V24 an d V26 mo n itors are well suited for patient m onitoring.

Patient Population

Adult, pediatric, and neonatal non-ambulatory patients.

Indications for Use

Prescription Versus Over-the-Counter

The Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 Monitors are prescription devices.

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Indications for Use

Warnings, Cautions, and Notes

Warnings, cautions, and notes are us ed throughout this User’s Manual to give you additional information about the Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors. The warnings and cautions included in this safety section refer to the equipment in general.

WarningWarning

A “warning” calls attention to the user of imminent hazard to people if proper procedures are not followed.

• For continued safe use of this equipment, it is necessary that the listed instructions are followed. Instructions in this manual in no way supersede established medical procedures.

• Explosion Hazard- Do n ot u se th i s equipment in the pre s en ce o f fl am ma bl e an esth etics.

• Alarms - Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monit oring may result in patient jeopardy. Remember that the most relia ble method of patient monitoring combines close persona l surveillance with correct operation of m onitoring equipment.

• This equipment is only intende d fo r use in healthcare facilities by trained healthcare professionals.

• The product is not intended for outside hospital use such as a helicopt ers or ambulances.

• This product is not intended for home use.

• To reduce the risk of elect ric al shock, do NOT remove any cover. Refer servicing to qualified personnel.

• This equipment may interfere with ultrasound imaging equipment by causi ng interference on the ultrasound display. Try to keep the instruments as far apart as possible.

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Indications for Use

• Exposure of electrical contacts or connections to saline or other liquids and gels is dangerous. Electrical contacts and connections such as cable connectors, power supplies, parameter module plu g-in connections and rack connec tions must be kept clean and dry. Thoroughly dry any electrical connections that become contaminated with liquids. If additional decontamination is required please contact your biomedical department or Agilent Tech nologies Response Center.

• Although this equipment is shielded against Electromagnetic Interference (EMI), it is recommended to avoid the use of electrically radiating devices in close proximity to this equipment.

• Connecting the Agilent monitoring network (SDN) cable when the product is powered on is not supported. Error c odes and Agilent monitoring network (SDN) interface lockup may occur. Power cycling the product will recover the product. No permanent damage will result. To prevent unintentional disruption in monitoring, be sure th e SDN interface cable is properly secured at both ends when c onnecting to the Agilent monitoring network (SDN).

• Do not connect a second rack by a cable when using a module rack docked to the back of the Agilent V24CT or V26CT. Using a second rack connected by a cable may disrupt module communication.

Caution

A “caution” calls attention to a c ondition or possible situation that co uld cause injury to the user.

• Ventilation Requirements - Failure to meet ventilation requirements may cause equipment failure an d, in turn, jeopardize the functions of automated monitoring. Do not locate equipment in an enclosed ar ea which could restrict heat dissipation.

• Maintenance - Failure on the part of the responsible individual, hospital, or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible healt h hazards.

• Do not spray cleaning solut ions directly onto the monitor. Moisture droplets may enter the internal components and cause equipment mal function or failure. Cleaning solutions should be applied to a cloth and the cloth used to wipe the monitor clea n. The monitor should be turned off during cleaning.

Indications for Use

• Replacement Parts - It is highly recommended that only Agilent Technologies recommended parts and a ccessories be used with this equipment. Failure to do so may result in the degradation of performance. Accessorie s and parts for individual modules and components are listed at the back of the appropriate section in th is manual.

Note—

A note gives special instructions to highlight an operating procedure or practice. Notes

may precede or follow the applicable text. At this time, Agilent Technologies will ma ke available on request, and in E nglish only, such

circuit diagrams, component part lists, descriptions, calibration instructions, or other information which wil l assist the user’s appropriate qualified technical pers onnel to repair those parts of the equipment which are classified by Agilent Technologies to be repairable. A list of Agilent Sales and Support Of fices is provided at the end of this manual.

Indications for Use

Using This Manual

To enable you to find information easily, there is a contents list at the front of the guide and a comprehensive index at the back.

The User’s Reference Manual is separated into two parts; the core document and the parameter module guides.

The Core Document

This section of the guide contains al l the general information about the sy stem. It is a good place for new users to start because it gives an introd uction to the system and the way it works, and shows you how to get start ed. Here is a list of the major sections:

• Introducing the Agilent M1165/66/67/75/76/77A Component Monitoring System and the Agilent M1205A V24 and V2 6 monitors

• Getting Started

• Configuring the System

• Other Patients

• Alarm Functions

• Recording Functions

• Trends and Data Management

• Installation and Patient Safety

• Care and Cleaning

Indications for Use

Monitor Setup

Parameter Module Sections

These sections each contain information for one parameter module. This covers setting-up, monitoring, and problem solving if you encounter difficulty. Each section is separ at ed with a white tab which has the title of the section.

Note—

The User’s Reference Manual contains information for all the parameter modules available for the system. This means, of course, that depending on the model and number of modules you have ordered, the screens w ill not always apply to your system. However, the information for the param eters and functions is valid for all the system s.

Note—

The screenshots displayed in this manual were generated in demo mode and may therefore differ from what actually appears on your screen during patient monitoring.

Notice to the User

Although there may be products in your area that look similar to the Agilent M1165/66/67/75/ 76/77A Component Monitoring System and the Agilent M1205A V24 and V26 monitors, their functionality may not be the same. This User’s Reference Manual is intende d t o be used with the Agilent M1165 / 66/67/75/76/77A Component Monitoring System, the M1026A Anest hetic Gas Module and the Agilent M1205A V24 and V26 monitors only.

This Manual is only applicable for Release C.0 versions of the monitors listed above. A Release C.0 monitor can be identified by:

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a. the Release C.0 label on the monitor, or b. the suffix of the EPROMpack part number. To view this number, press

→ → .

Monitor Revision Show SW Rev

The suffix of the EPROMpack part number on a Release C.0 Agilent CMS is A. The Software R evision of a Releas e C.0 Agilent V24 or V26 monitor is L.xx.xx

Responsibility of the Manufacturer

Agilent Technologies only considers itself responsible for any effects on safety, reliability and performance of the equipment if:

assembly operations, extensions, re-adjustments, modifications or repairs are carried out by persons authorized by Agilent , and

the electrical installation of t he relevant room complies with nationa l standards, and the instrument is used in accordance with the instructions for use.

To ensure optimum usage, we recommend that Agilent parts and accessories are used in conjunction with the Agilent M1165/66/67/75/76/77A Co mponent Monitoring System, the Agilent M1026A Anesthetic Gas Module and the Agilent M120 5A V24 and V26 Monitors, wherever available. If non-Agilent parts are used, Agilent Technologies is not liable for any damage that these parts may cause to the Agilent equipment.

Manufacturer´s Address

For South America, North America and Canada:

Agilent Technologies, Inc. 3000 Minuteman Road Andover MA 01810-1099

For all other countries:

Agilent Technologies GmbH Herrenberger Str. 130

71034 Böblingen Germany

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Responsibility of the Manufacturer

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Contents

Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Warranty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Printing History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Important . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Electromagnetic Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Avoiding Electromagnetic Interference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Description. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Part of Body or Type of Tissue with Which the Device Interacts. . . . . . . . . . . . . . . . . . . . . . vi

Frequency of Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Physiological Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Prescription Versus Over-the-Counter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Warnings, Cautions, and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Using This Manual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

The Core Document. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Parameter Module Sections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

Notice to the User. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

Responsibility of the Manufacturer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Manufacturer´s Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

ECG and ECG/Respiration Module Section 14-1

Introduction to ECG Parameter Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2

What does it Measure?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2

How the ECG/RESP Parameter Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-2

RESP Parameter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-6

Considerations When Monitoring ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-7

ECG Monitoring Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-9

Placing the Electrodes for ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10

Respiratory Monitoring Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18

How Respiration is Measured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-18

Contents-1

Checklist for Respiratory Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18

Placing the Electrodes for Respiratory Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-19

ECG/RESP with Analog Respiration Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-20

ECG Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-21

Changing the Lead. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 4-21

Adjusting the Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-23

Changing the Filter Bandwidth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-25

Changing the QRS Detection Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-26

Adjusting the QRS Detection Level Manually . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-28

Correct Positioning of the QRS Detection Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 - 28

Changing Alarm Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-29

Adjusting the Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-29

Switching ECG Parameter Alarms On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-29

Changing Brady Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-30

Tone Modulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-31

Multilead ECG Display and Recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-32

EASI™ 12-lead ECG Display, Printing and Recording . . . . . . . . . . . . . . . . . . . . . . . . . .14-33

Respiration Adjustments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-39

Changing the Respiration Detection Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-39

Adjusting the Respiration Detection Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-39

ECG and RESP Alarm and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-41

ECG Alarm Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-41

RESP Alarm Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-44

Parameter Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-46

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-47

ECG/RESP Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-50

ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-50

RESP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-55

ECG/RESP with Analog Respiration Ou tput Performance Specifications

(CMS Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-56

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-57

ST Segment Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-58

ST Segment Monitoring with EASI™. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-58

Introduction to ST Segment Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-59

Operation Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-60

Data Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-61

ST Segment Monitoring Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 4-62

ST Segment Measure-ment Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-64

Waveform Storage/Recall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-65

Contents-2

Adjusting the Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-65

Adjusting the Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-66

ST Alarm and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-67

Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-70

Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-71

ST Segment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-71

Noninvasive Blood Pressure Module Section 15-1

Introduction to the Noninvasive Blood Pressure Parameter Module. . . . . . . . . . . . . . . . . . . . . .15-2

NBP Measurement Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-5

Notes on NBP Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-7

Venous Puncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-11

NBP Setup Task Window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-11

Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-13

NBP Alarm and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-14

Measurement Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-18

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-19

Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-22

NBP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-22

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-25

SpO2/PLETH Module Section 16-1

Introduction to the SpO2/PLETH Parameter Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-2

What does it Measure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-2

How the SpO2/PLETH Parameter Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-3

Dual SpO2/PLETH Measure-ments (Agilent CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . .16-5

SpO2/PLETH Measurement Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-6

Tone Modulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-8

SpO2 Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-10

Escalating SpO2 Situations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-11

NBP Alarm Suppression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-14

Testing the Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-14

Adjustment of the PLETH wave. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-15

SpO2/PLETH Alarm and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-20

Technical Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-22

Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-25

Measurement Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-26

SpO2/PLETH Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-28

Contents-3

SpO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-28

PLETH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-30

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-30

Temperature Module Section 17-1

Introduction to the Temperature Parameter Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-2

Temperature Measurement Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-4

Temperature Module Labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-5

Labeling with Parameter Settings Transfer ON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6

Labeling with Parameter Settings Transfer OFF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-6

Temperature Labels Available. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-7

Measuring Temperature Differences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-9

Getting into the Diff Temperature Task Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-10

Selecting Labels for Diff Temperatures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-10

Parameter Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-11

Temperature Alarm and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-12

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-14

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-16

Temperature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-16

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-17

CO2 Module and Sidestream Module Section 18-1

Introduction to the CO2 and Sidestream Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-2

Sidestream and Mainstream CO2 Measure-ment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-2

CO2 Module Setup Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-4

CO2 and Sidestream CO2 Measurement Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-6

Mainstream Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-8

Sidestream Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-9

Sidestream Pump Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-12

N2O, O2 and Environmental Corrections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-13

Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-16

Accuracy Check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-17

Calibration Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-18

CO2 Alarm and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-21

Parameter Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-26

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-27

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-28

CO2/ssCO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-28

Contents-4

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18-33

FIO2 Module Section

(Agilent CMS only) 19-1

Introduction to the FIO2 Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-2

What does it Measure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-2

How the FIO FIO

Measurement Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-4

FIO

Calibration Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-7

Calibration in 21% O

Calibration in 100% O

Parameter Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-2

2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-7

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-8

FIO2 Alarm and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-10

Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-13

Accessories and Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-14

Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-15

FIO

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-15

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-16

Pressure Module Section 20-1

Introduction to the Pressure Plug-in Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-2

Intra-Aortic Balloon Pump Pressure Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-3

Pressure Measurement Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-5

Zeroing the Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-6

Changing the Wave Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-8

Pressure Module Labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-9

Labeling with Parameter Settings Transfer ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-10

Labeling with Parameter Settings Transfer OFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-11

Pressure Labels Available. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-12

Pulmonary Artery Wedge Pressure Measurement (CMS only). . . . . . . . . . . . . . . . . . . . . . . . .20-14

Measuring Wedge Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-15

Starting the Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-17

Finishing the Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-18

Situations to Avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-19

Cerebral Perfusion Pressure Measurements (CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-21

Application Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-21

Pressure Alarm and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-23

Flush/Sample Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-23

Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-23

Contents-5

Parameter Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-27

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-28

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-29

Invasive Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-29

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-32

Cardiac Output Module Section 21-1

Introduction to Cardiac Output Parameter Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-2

Right Heart Thermo-

dilution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-2

Transpulmonary Thermodilution

(Agilent CMS only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-3

Cardiac Output Measurement - Right Heart Thermodilution . . . . . . . . . . . . . . . . . . . . . . . . . .21-5

Adjusting the Compu-tation Constant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 1-8

Getting into the C.O. Measure-ment Task Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-9

Measuring the Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-10

Curve Alert Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-12

Task Window Prompt Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-13

Warning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-13

Measuring the Blood Temp-erature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-14

Editing the Cardiac Output Measure-ment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-15

Cardiac Output Measurement - The PiCCO Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-17

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-17

Adjusting the Arterial Catheter Constant and the Injectate Volume . . . . . . . . . . . . . . . . .21-20

Injectate Temperature

and Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-21

Getting into the C.O. Measurement Task Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-23

Measuring the Cardiac Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-24

Curve Alert Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-27

Task Window Prompt Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-28

Warning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-28

Measuring the Blood Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-29

Editing the Cardiac Output

Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-30

Continuous Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-34

Contents-6

C.O. Alarm and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-37

Errors in Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-41

Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-43

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-44

Right Heart Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-44

Transpulmonary Thermo

dilution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-44

Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-46

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21-49

VueLink Module Section 22-1

Introduction to the VueLink module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-2

Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-3

VueLink Module Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-6

Adjustments to VueLink Module Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-7

VueLink Module Task Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-7

VueLink Module Softkeys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-7

Selecting a Different Device. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-8

General Wave and Numeric Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-10

Viewing Waves and Numerics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-12

Selecting Waves and Numerics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-15

Changing Wave Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-17

VueLink Module Alarm and INOP Reporting from the External Device. . . . . . . . . . . . . . . . .22-19

Alarms Ignored. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-19

Alarms Accepted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-19

Notes on Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-19

Notes on Inops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-19

Alarm symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-20

VueLink Module Alarm and INOP Reporting from the System. . . . . . . . . . . . . . . . . . . . . . . .22-21

Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-21

INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-21

SvO2 Module Section

(Agilent CMS only) 23-1

Introduction to the SvO2 Plug-in Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-2

What does the Module Measure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-2

How Does the SvO

SvO

Main Task Window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-4

Measurement Work?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-2

Contents-7

Setting up the SvO2 Equipment for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-5

Data Storage and Recall in the Optical Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-11

Alarms and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 3-12

Technical Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-12

Parameter Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-15

Accessories and Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-16

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-17

SvO

Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-17

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-18

Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-18

Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-18

tcpO2/tcpCO2 Module Section 24-1

Introduction to the tcpO2/tcpCO2 Parameter Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-2

What does it Measure?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-2

How the tcpO2/tcpCO2 Measurement Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-2

Correlation of Transcutaneous with Arterial Blood Gas Values . . . . . . . . . . . . . . . . . . . . . 24-2

Setting up the Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-3

Activating the Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-6

Preparing the transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 4-7

1. Remembrane the tcpO2/tcpCO2 Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-7

2. Calibrating the tcpO2/tcpCO2 System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-11

3. Applying the Transducer to the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-16

tcpO2/tcpCO2 Alarms and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-20

Technical Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-21

Parameter Settings Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-23

Accessories and Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-24

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-25

tcpO2 and tcpCO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 4-25

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-27

Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-27

Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-28

Disposal of Empty Calibration Gas Cylinders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-29

Ventilator Interfaces and Respiratory Loops (Agilent CMS only) 25-1 Ohmeda Ventilator Interface Section - 7800/7810 25-3

Introduction to the 7800/7810 Ohmeda Ventilator Interface . . . . . . . . . . . . . . . . . . . . . . . . . . .25-4

Contents-8

Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-5

Ohmeda Ventilator Parameters and Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-6

Operating Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-7

Ohmeda Ventilator Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-7

Ohmeda Ventilator Signals and Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-8

Ohmeda Ventilator Alarm Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-10

Alarms Accepted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-10

Alarms Ignored. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-11

Ohmeda Ventilator Alarm and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-12

Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-12

INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-12

Ohmeda Ventilator Interface Section - 7900 25-15

Introduction to the 7900 Ohmeda Ventilator Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-16

Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-17

Ohmeda Ventilator Parameters and Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-18

Operating Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-19

Ohmeda Ventilator Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-19

Ohmeda Ventilator Signals and Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-20

Ohmeda Ventilator Alarm Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-23

Respiratory Loops 25-25

Introduction to Respiratory Loops. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-26

Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-27

Respiratory Loops Parameters and Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-28

Loop Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-29

Color Coding of Loops. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-30

Operating Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-30

Anesthetic Gas Module Section 26-1 Section I:

The Anesthetic Gas Module – Option A01 26-3

Introduction to the Anesthetic Gas Module (Nafion Version). . . . . . . . . . . . . . . . . . . . . . . . . . .26-4

What does it measure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-4

How the Gas Measure-ment Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-5

How fluids are removed from the gas sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-5

Front Panel of the Anesthetic Gas Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-6

Contents-9

Rear Panel of the Anesthetic Gas Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-8

Anesthetic Gas Module Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-9

What you need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-9

Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-10

Detecting and Preventing Leaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-16

Anesthetic Gas Exhaust. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-17

What you need to return the gas sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-17

Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-18

What you need to remove the gas sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-19

Anesthetic Gas Module Standby Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-20

Automatic Switch to Standby Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-21

Using the Anesthetic Gas Module during a Cardiopulmonary Bypass. . . . . . . . . . . . . . . . . . .26-22

Screen Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-23

Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-23

Automatic Parameter Switch Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-23

The Overview Task Window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-24

The Airway Gas Task Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-25

Automatic Agent Identification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-26

Selecting an Anesthetic Agent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-26

Exchanging Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-27

Oxygen (O2) Measurement (Optional). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-29

Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-30

Zero Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-30

Span Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-33

Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-34

Accessories and Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-42

Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-42

Anesthetic Gas Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-42

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-48

Anesthetic Gas Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-48

Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-48

Section II:

The Anesthetic Gas Module – Option A02 & A05 26-55

Introduction to the Anesthetic Gas Module (Watertrap Version). . . . . . . . . . . . . . . . . . . . . . .26-56

What does it measure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-56

How the Gas Measurement Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-57

How fluids are removed from the gas sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-57

Contents-10

Front Panel of the Anesthetic Gas Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-58

Rear Panel of the Anesthetic Gas Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-60

Anesthetic Gas Module Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-61

What you need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-61

Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-63

Detecting and Preventing Leaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-67

Anesthetic Gas Exhaust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-68

What you need to return the gas sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-68

Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-69

What you need to remove the gas sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-70

Anesthetic Gas Module Standby Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-71

Automatic Switch to Standby Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-72

Using the Anesthetic Gas Module during a Cardiopulmonary Bypass . . . . . . . . . . . . . . . . . . .26-73

Screen Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-74

Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-74

Automatic Parameter Switch Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-74

The Overview Task Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-75

The Airway Gas Task Windows. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-76

Automatic Agent Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-77

Selecting an Anesthetic Agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-78

Exchanging Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-78

Emergence from Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-79

Oxygen (O2) Measurement (Optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-80

Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-81

Zero Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-81

Span Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-84

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-85

Accessories and Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-93

Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-94

Anesthetic Gas Module Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-94

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-101

Anesthetic Gas Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-101

Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-101

Blood Analysis 27-1

Introduction to the Blood Analysis Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-2

Blood Analysis Module Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-3

Obtaining Blood Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-5

Suitable Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-5

Contents-11

Criteria For Specimen Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-5

Circum-stances to Avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 7-6

Procedure for Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-7

Preparing Cartridges for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-7

Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-7

Blood Analysis Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-9

Selecting an Operator ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-10

Selecting the Blood Sample Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-11

Selecting a Patient Tem-perature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-11

Entering an O2 Value. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-11

Entering Information into the Free-Entry Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-12

Blood Analysis Results Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-12

Blood Analysis Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-14

Transmitting Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-15

Procedure for Trans-mitting Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-17

Recording Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-17

Alternative Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-18

Blood Analysis Alarm and INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-19

Technical Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-19

Accessory Ordering Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-20

Cartridges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-20

System Control and Verification Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-21

Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-22

EEG Module Section (Agilent CMS only) 28-1

Introduction to EEG Parameter Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-2

How the EEG Parameter Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-3

Considerations When Monitoring EEG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-5

EEG Monitoring Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-6

Placing the Electrodes for EEG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-7

EEG Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-11

Changing the Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-12

Selecting the Numerics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-13

Changing the CSA Epoch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-15

Low & High Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-16

Changing the Impedance Range Limit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-17

Print-Out. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-19

Switching CSA Screen On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-22

Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-22

Contents-12

EEG INOP Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-23

Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-25

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-26

EEG Performance Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28-27

A. Summary of Formulas Used in Calculations A-1

Hemodynamics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Oxygenation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-6

Abbreviations and Unit Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-12

B. Analog Output Section

(Agilent CMS Only) B-1

Introduction to the Analog Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-2

Technical Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3

Gain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3

Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3

Application Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-4

Scaled Waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-4

Absolute Waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-4

Numeric Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B- 4

Configuring Scaled Wave Outputs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-5

Selecting the channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-5

Assigning the\Scaled Wave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-6

Adjusting the Gain and Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7

Configuring Absolute Wave Outputs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-9

Selecting the Channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-9

Assigning the Absolute Wave. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-10

Adjusting the Gain and Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-11

Configuring Numeric Trend Outputs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-12

Selecting the Channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-12

Assigning the Numeric Trend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-13

Adjusting the Gain and Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-14

C. Calibrating the Pressure System C-1

Methods of Calibrating the Pressure System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-2

Zeroing the Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3

Contents-13

Procedure for Zeroing the Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-4

Mercury Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-6

Procedure for Mercury Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-8

Mercury Calibration Task Window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-9

D. SpO2 Transducer Information D-1

Description of Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Transducers and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-3

Transducer Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-5

Application Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-6

Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-14

E. Supported Device Information E-1 F. Main Sales and Support Offices F-1

Contents-14

ECG and ECG/Respiration Module

Section

This chapter describes the ECG module and the ECG/RESP module. You will find information on ECG and respiratory monitoring, troubleshooting, and ST Segment monitoring. It includes the following sections:

• Introduction to ECG Parameter Module. . . . . . . . . . . . . . . . . . . . 14-2

• Considerations When Monitoring ECG . . . . . . . . . . . . . . . . . . . . . 14-7

• ECG Monitoring Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9

• Respiratory Monitoring Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18

• ECG Adjustments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-21

• Respiration Adjustments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-39

• ECG and RESP Alarm and INOP Messages . . . . . . . . . . . . . . . . 14-41

• Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-46

• Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . 14-47

• ECG/RESP Performance Specifications . . . . . . . . . . . . . . . . . . . 14-50

• Care and Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-57

• ST Segment Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-58

• ST Alarm and INOP Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-67

• Parameter Settings Transfer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-70

• Performance Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-71

Note—

EASI™ is a trademark of Zymed Inc.

ECG and ECG/Respiration Module Section 14-1

Introduction to ECG Parameter Module

ECG and ECG/

Respiration Module

What does it Measure?

How the ECG/RESP Parameter Works

Monitoring the ECG produc es a continuous waveform of the patient’s cardiac electrical activity to enable an accurate assessment of his current physical state.

• The system displays the average Heart Rate (HR), this can be derived from the ECG or a remote arrhythmia computer.

• You can select HR or PULSE (PULSE can only be selected if you are monitoring invasive pressure or pleth) as the alarm parameter both share the same alarm limits.

The EASI™ option all o ws yo u to de ri ve a ll 12 standard ECG leads, us in g a 5-electrode ECG cable and a special electrode placement. This is described on “EASI™ 12-lead ECG Display, Printing and Recording” on page 14-33

With the ECG or the ECG/RESP modules listed below, you can use a 5or a 3-electrode ECG cable set to derive up to 8 selectable ECG leads which can be displayed in up to 3 channels.

Note—

EASI™: With any of the ECG modules listed below and the

EASI™ option switched on, you can use a 5-electrode ECG cable set to derive the 12 standard ECG leads of which up to 3 can be displayed on the monitor.

Modules

– M1001A/B ECG Module – M1002A/B ECG/RESP Module – CMS Only: M1002A Option C01 ECG/RESP Module with

Analog Respiration Output

• If you are monitoring with a 3-lead set you can select one lead out of I, II or III to be displayed in 1 channel.

• If you are monitoring with a 5-lead set you can select any two leads from I, II, III, aVR, aVL, aVF, V or MCL

14-2 ECG and ECG/Respiration Module Section

to be displayed in

Introduction to ECG Parameter Module

channel 1 and channel 2. Channel 3 (CH3) will only monitor the V lead.

• EASI™: With a 5-lead set and EASI™, you can select any lead you want to monitor in all three channels.

Automatic 3-lead versus 5-lead Detection

• If the monitor is turned on with a 3-lead cable connected to the ECG module and your monitor is configured for 2 or 3 ECG channels, a limb lead will automatically be monitored in channel 1, even if you have configured a different lead (for example aVR or aVF). After 1 minute, channels 2 and 3 will be automatically turned off.

• If you unplug the 3-lea d cable and plug in the 5-lead cable, the Monitor automatically recovers its configured state, as long as a lead has not been changed, or a channel has not been switched ON or OFF manually in the meantime.

a. If you are using a 5-lead set (without using EASI™ software

and placement) and the RL electrode falls off, then the Monitor automatically switches to a limb lead and monitors a 3-lead set in channel 1. You can recover the Monitor's original 5-lead state as follows:

1. Reattach the RL elec trode within 1 minute.

2. unplug and plug in the cable again, or unplug and plug in the frontend module again.

ECG and ECG/

Respiration Module

b. If you are using a 5-lead set with EASI™ and the RL (N) or A

electrode falls off, the Mon itor cannot switch to a limb lead so an INOP will result.

The Patient Cable

The patient cable is either single-piece or consists of 2 sections:

1. The trunk cable which connects to the monitor.

2. The lead set which connects to the patient.

The Module

• The front of the module has the key(s): – The ECG key for parameter setup, a light will appear above the

key when you are in the setup.

ECG and ECG/Respiration Module Section

14-3

Introduction to ECG Parameter Module

ECG and ECG/

Respiration Module

– (M1002A/B only) The RESP key for parameter setup, a light

will appear above the key when you are in the setup.

14-4 ECG and ECG/Respiration Module Section

Introduction to ECG Parameter Module

ECG

M1001A

80x90

ECG/RESP M1002A

ECG

RESP

The settings are transferred with ECG and ECG/RESP modules that have a T on the front. For more information on Parameter Settings Transfer, refer to “Parameter Settings Transf er” on page 14-46

ECG

M1001B

Defib

T P

ECG/RESP M1002B

Defib

T P

ECG and ECG/

Respiration Module

ECG

80x90

RESP

ECG and ECG/Respiration Module Section

14-5

Introduction to ECG Parameter Module

Note—

signal delay of <20ms

ECG and ECG/

Respiration Module

All ECG and ECG/RESP modules with a P on the front have a signal delay of <30ms

waves from a high lead ECG signal. According to the specifications defined by AAMI the peak of the synchronized defibrillator di scharge should be deliv ered within 60msec of the peak of the R wave. The Agilent M1001A/B and M1002A/B ECG modules meet the AAMI specifications, however your biomedical engineer should verify that your ECG/Defibrillator combination does not exceed the recommended maximum delay of 60msec.

All ECG and ECG/RESP modules without a P on the front have a

WarningWarning

Your ECG/Defibrillator combina tion is conf igured to detec t R

Defib

RESP Parameter

If you want to monitor respira tion this can be done from the ECG electrodes. See “Respiratory Monitoring Setup” on page 14-18.

14-6 ECG and ECG/Respiration Module Section

Considerations When Monitoring ECG

Listed below are important considerations to remember when monitoring ECG.

• Interference from a non-grounded instrument near the patient, and

ESU interference can cause problems with the waveform. Refer to Recommended ECG Lead Placement for Surgical Patients in this section for more details.

• Radiated field strengths above 0.7V/m may cause noise on the ECG

and respiration waves at various frequencies, though this noise does not influence the accuracy of the Heart Rate or Respiration Rate. If operating under conditions according to the EMC-standard 60601-12 (Radiated Immunity 3 V/m), field strengths above 1 V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to ECG/r esp i ra ti on meas ur em en ts.

• If an ECG module is inserted into the System and ECG monitoring

commenced when the patient is in as ystole, the asystole alarm will be generated about 15 seconds later.

• If you get an INOP caused by pacemaker activity, reduce the size of

ECG-CH1 until the status message is removed, or select a lead that produces a smaller pace pulse. (This INOP does not occur if you are using the EASI™ option).

ECG and ECG/

Respiration Module

• After defibrillation, the screen display will recover within 10

seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions.

ECG and ECG/Respiration Module Section

14-7

Considerations When Monitoring ECG

ECG and ECG/

Respiration Module

WarningWarning

DO NOT TOUCH THE PATIENT, OR TABLE OR INSTRUMENTS DURING DEFIBRILLATION

When connecting electrodes a nd/or patient cables, ensure that the ECG leads and connectors do not come into contact with other conductive parts or earth.

14-8 ECG and ECG/Respiration Module Section

ECG Monitoring Setup

1. Check that the ECG or ECG/RESP module is inserted in the rack.

2. Plug in the patient cable to the ECG module.

3. Prepare the patient’s skin prior to placing the electrodes. The skin is a poor conductor of e lectricity, therefore preparation of

the patient’s skin is important to facilitate good electrode to skin contact. Recommendations:

– Shave hair from sites, if necessary. – Wash sites thoroughly with soap and water. (Never use ether

or pure alcohol, because this increases skin resistance).

– Dry briskly to increase capillary blood flow in the tissues and

remove skin cells and oil.

– Attach clip or snap to electrode prior to placement.

4. Place the electrodes on the patient. Use electrode gel prior to placement if pre-gelle d electrodes are not used.

Remember to select a site where th e signal will not be interfered with by either movement or bone s.

ECG and ECG/

Respiration Module

5. Attach the electrode leads to the patient cable.

6. Switch on the monitor (if it was not on before) using power ON/OFF switch.

Note—

In both auto and manual modes, if the lead of the first chan nel is in INOP for at least 10 seconds, the leads in channel one and two are automatically exchanged. This means that the lead of channel two is displayed in channel one so that the heart rate counter can continue to count. If the situation which caused the INOP is rectified, and the user selected lead is out of INOP for at least 10 seconds, the leads w ill be swapped back again. The automatic swapping of the leads can be configured on or off during

ECG and ECG/Respiration Module Section

14-9

ECG Monitoring Setup

ECG and ECG/

Respiration Module

the installation of the monitor. If automatic swapping is set to off, the lead in channel one is only displayed when a signal is available.

Note—

EASI™: If the E, S or I electrodes fall off, the monitor shows a

non-standard lead (that is, one of the 3 EASI™ vectors) labelled "ECG"

until the electrode is reattached. There is no automatic lead swapping for EASI™.

Placing the Electrodes for ECG Monitoring

Note—

When EASI™ lead placement has been configured, “EASI” is shown beside the 1mV calib ration bar on the ECG wave in c hannel 1. For EASI™ lead placement, see “Electrode Placement with a 5-Lead Set for EASI™ 12-lead.” on page 14-33. You can switch from EASI to standard lead placement in the Change Lead Task Window of each channel. See “Switching between EASI and Standard leads” on page 14-22 for details.

Note—

Electrode labels and colors are given for U.S. norm and in square brackets [-] for European norm.

Standard Electrode Placement with a 5-Lead Set.

Angle of

Lewis

BLACK

[YELLOW]

WHITE

[RED]

BROWN [WHITE]

GREEN [BLACK]

14-10 ECG and ECG/Respiration Module Section

80x80

RED

[GREEN]

COLOR CODING

ECG Monitoring Setup

Label

AAMI Color

Coding

IEC Color

Coding

RA WHITE (RED) place directly below the clavic le

and near the right shoulder.

LA BLACK (YELLOW) place direct ly below the clavicle

and near the left shoulder.

C BROWN (WHITE) place on the chest as illustrated on

following page. RL GREEN (BLACK) place in right lower abdomen. LL RED (GREEN) place in left lower abdomen.

Note—

To ensure patient safety, all leads must be attached to the patient.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-11

ECG Monitoring Setup

ECG and ECG/

Respiration Module

For 5-Lead configuration. Place the V electrode at one of the locations shown below, so as to get the best quality signal:

V3R

V4R

Note—

For accurate V lead placement and monitoring it is important to

80x80

locate the 4th intercostal space. The 4th intercostal space is determined by first locating the first intercostal space. Because patients vary with respect to body shape, it is difficult to palpate the 1st intercostal space with accuracy. Thus, locate the 2nd intercostal space by first palpating the little bony prominence, called the Angle of Lewis, where the body of the sternum joins the manubrium. This rise in the sternum identifies where the second rib is attach ed, and the space just below it is the second intercostal space . Palpate and count down the chest until you locate the 4th intercostal space.

• V1 on the 4th intercostal space at the right sternal border.

• V2 on the 4th intercostal space at the left sternal border.

• V3 midway between V2 and V4 electrodes.

14-12 ECG and ECG/Respiration Module Section

ECG Monitoring Setup

• V4 on the 5th intercostal space at the left midclavicular line.

• V5 on the left anterior axillary line, horizontal with V4 electrode.

• V6 on the left midaxillary line, horizontal with V4 electrode.

• V3R-V6R on the right side of the chest in positio ns corre spon ding to those on the left.

• VE over the xiphoid pr ocess.

For posterior V lead placement, place the V electrode at one of the following locations.

• V7 on posterior chest at the left posterior axillary line in the 5t h intercostal space.

• V7R on posterior chest at the right po sterior axillary line in the 5th intercostal space.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-13

ECG Monitoring Setup

ECG and ECG/

Respiration Module

Electrode Placement with 3-Lead Sets (Standard Configuration)

Note—

Not for simultaneous monitoring of more than one ECG lead. For

more than one simultaneou s cha nnel of ECG, use 5-lead electrode set.

WHITE

[RED]

aVL

aVF

III

aVR

80x80

BLACK

[YELLOW]

RED

[GREEN]

• White(RA) electrode - place directly below the clavicle and near the right shoulder.

• Black(LA) electrode - place directly below the clavicle and near the left shoulder.

• RED(LL) electrode - place in left lower abdomen.

Lead Position

(-) (+) Reference

1 (I) RA LA LL 2 (II) RA LL LA 3 (III) LA LL RA

14-14 ECG and ECG/Respiration Module Section

Electrode Placement with 3-Lead Sets! (MCL

and MCL6 Configurations)

ECG Monitoring Setup

ECG and ECG/

Respiration Module

WHITE

[RED]

BLACK

[YELLOW]

Select Lead I for mon itoring the MCL

80x80

RED

[GREEN]

configuration. Electrodes need to

be moved or switched according to the following instructions. As you will notice, you must attach lead wires to areas of the chest that do not coincide with the electrode labels (that is, that do not coincide with the RA, LA and LL labels).

• White(RA) electrode - place directly below the clavicle and near the left shoulder.

• Black(LA) electrode - place on the 4th intercostal space at the right sternal border.

• RED(LL) electrode - place on the left midaxillary line at the 5th intercostal space.

Note—

This modified lead placeme nt allows monitoring of the MCL6 lead.

Simply select Lead II on the monitor for MCL

ECG and ECG/Respiration Module Section

14-15

ECG Monitoring Setup

Recommended ECG Lead Placement for Surgical Patients

ECG and ECG/

Respiration Module

The placing of the ECG leads will depend on the type of surgery that is being performed. For example, with open heart surgery the electrodes may be placed laterally on the chest or on the back. In this case you will no longer be monitoring the standard leads.

In the operating room artifacts can sometimes affect the ECG waveform due to the use of ES (electro-surgical) equipment. To help reduce this you can place the electrodes on the right and left shoulders, the right and left sides near the stomach, and the chest lead on the left side at mid-chest. Avoi d p l aci n g the electrodes on th e up p er ar ms o t h er wi s e th e ECG waveform will be too small.

WarningWarning

• To protect against the hazard of burns when using high frequency surgical equipment in the OR, only the OR orange lead sets should be used (part numbers can be found in the Accessories section of this chapter). With this lead set, respiration cannot be measured. To avoid triggering unnecessary RESP alarms in this situation, it is possible to configure the RESP parameter to be Off when the system is switched on. This setting is made in the special Configuration Mode.

• All specified patient lead cables are protected against the effects of the discharge of a defibrillator.

14-16 ECG and ECG/Respiration Module Section

ECG Monitoring Setup

Caution

• When using ES equipment, never place an electrode near the grounding pla te of the ES devi ce, as sign ifi cant inte rfere nce wi th the ECG signal occurs.

The electrodes should be approximately equidistant from an axis joining the ES knife and t he ES grounding plate.

• Do not apply leads directly to the external wall of the heart.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-17

Respiratory Monitoring Setup

ECG and ECG/

Respiration Module

How Respiration is Measured

Checklist for Respiratory Monitoring

The system measures respiration from the amount of thoracic impedance between t wo ECG electrodes. The change of impedence between the two electrodes, (due to the thoracic mo vement), produces a respiratory waveform on the screen.

For respiratory monitoring you do not need additional electrodes but the placing of electrodes is important. If the patient is using the thoracic muscles you can use the electrode placement as shown on page 14-19.

Some patients, due to their clinical condition, expand their chest laterally causing a negative intrathoracic pressure. In these cases it is best to place the two respiratory electrodes laterally in the right midaxillary and left lateral chest areas at the m ax imum point of breathing movement to optimize the respiratory waveform.

Note—

Respiratory monitoring is not recommended for patients who are

very active as this can cause false alarms to occur.

Note—

Implantable pacemakers which are minute ventilation rateadaptive can occasionally interact with the impedance measurement of cardiac monitors causing the pacemakers to pace at their maximum programmed rate.

1. Plug the patient cable into the ECG/RESP module.

2. Prepare the patient’s skin prior to placing the electrodes.

3. Attach snap or clip to the electrodes and attach the electrodes to the patient as describe d above.

4. Switch on the monitor (if not already switched on).

14-18 ECG and ECG/Respiration Module Section

Respiratory Monitoring Setup

Placing the Electrodes for Respiratory Monitoring

Note—

Position the White (Red) and Red (Green) electrodes diagonally to optimize the respiration waveform. Avoid th e liver area and the vent ricles of the heart in the line between the respiratory electrodes so as to avoid cardiac overlay or artifacts from pulsating blood flow. This is particularly important for neonates.

Note—

EASI™: Respiratory monitoring is also possible with the the

EASI™ placement shown in “Electrode Placement with a 5-Lead Set for EASI™ 12-lead.” on page 14-33.

Electrode Placement with a 5-Lead Set

WHITE

[RED]

GREEN

[BLACK]

Angle of

Lewis

80x80

BLACK

[YELLOW]

BROWN

[WHITE]

RED

[GREEN]

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-19

Respiratory Monitoring Setup

Electrode Placement with a 3-lead Set

ECG and ECG/

Respiration Module

ECG/RESP with Analog Respiration Output

Angle of

Lewis

WHITE

[RED]

80x80

Note—

Respiration can only be monitored with an ICU ECG cable set, not

BLACK

[YELLOW]

RED

[GREEN]

with an OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electro-surgery is being performed.

Option C01 of the M1002A/B ECG/RESP Module provides an analog respiration output signal for us e with external devices. A standard BNC cable is required to connect the device to the output socket situated at the top left of the module.

Note—

Avoid accidental disconnection of the BNC cable by locking it

into the socket. Always turn the connector clockwi se.

Note—

The BNC Cable must not exceed 4 meters (13 feet) in length.

Note—

Always keep the cable away from working space.

Caution

The module provides an output signal only. Do not attempt to input any other signal or data into the BNC out put socket.

14-20 ECG and ECG/Respiration Module Section

ECG Adjustments

Information about the following ECG adjustments is provided on the proceeding pages:

• Changing the lead

• Adjusting the waveform size

• ECG waveform settings

• Changing the filter bandwidth

• Changing the QRS detection mode

• Adjusting the QRS detection level

• Adjusting the alarm li mits

• Changing the alarm parameter

Changing the Lead

A 5-lead set is option al for th e S yste m. Th is gives you a choice of leads for the first 2 channels: I, II, III, aVR, aVL, aVF, V, MCL1. The third channel displays one of the V leads, V

Note—

channels : I, II, III, aVR,aVL, aVF, V

, V2, V3, V4, V5, or V6.

EASI™: The EASI™ software gives you a choice of leads for all 3

, V2, V3, V4, V5, V6.

ECG and ECG/

Respiration Module

With a 3-lead set, (1 channel only), a ll th e lead labels are displayed on the screen but only leads I, II, or III can be processed.

If you choose one of the other leads it will cause an INOP.

You cannot use a 3-lead set with the EASI™ option. If you try to use a 3-lead set with the EASI™ opti on, the prompt “EASI ECG requires 5 electrodes” will be issued.

If you are not receiving a good ECG waveform and the electrodes are securely placed, you should try changing the lead in which you are monitoring.

ECG and ECG/Respiration Module Section

14-21

ECG Adjustments

Confirm

Characteristics of a Good Signal

ECG and ECG/

Normal QRS complex

Respiration Module

• Tall and narrow with no notches (for a good HR me asurement).

• R-wave should be tall.

• Pacer pulses should be smaller than the R-wave height.

• T-wave should be less than the R-wave height (for a good HR measurement)

• P-wave should be much smaller t han the T-wave.

Switching

between EASI

In the Change Lead Task Window of each channel you can also switch between EASI and Standard lead placement:

and Standard

leads

Procedure

1. Press to change to standard lead placement (if EASI is active) or to EASI lead placement (if standard is active). To cancel the procedure, press

Change Lead

2. You will be prompted to change the electrode placement. After performing the change, press .

3. Monitoring will be interrupted for 15 seconds and will then resume with the new setting.

14-22 ECG and ECG/Respiration Module Section

Confirm

ECG Adjustments

Adjusting the Waveform Size

If either autoadjust or autosize ECG wave settings is selected (in Configuration mode), a n automatic size adjustment will be performed in the following situations:

• after power on

• after the module has been plugged in, or a lead has been off for longer than 60 seconds

• between 7 and 15 seconds after lead change.

When the ECG wave has been ad justed, the gain i s frozen. You can also manually change the siz e of the ECG wave form by entering

Adjust Size Task Window.

the This Task Window also enables you to set the waveform to a specific size

in order to get a calibrated ECG wave recording of 10 mm/mV. Two wave sizes, x1 or x2, are available. Select the wave size shown in the table for your recorder and its sec tor size in order to get a calibrated 10 mm/mV recording.:

Recorder Sector size Wave Size

M1116A/B Module Recorder

M1117A Bedside Recorder (CMS

Only)

40 mm 20 mm

50 mm 25 mm

x1 x2

ECG and ECG/

Respiration Module

Central Recorder 40 mm and 50 mm x1

Note—

Pressing the key changes the si ze of thi s indivi dual

channel. Pressing the key changes the size of all three channels simultaneously. For viewing and recording mult ilead ECG, the size and filter of channel 1 is used for all leads of the multilead ECG.

Note—

EASI™: If you are using EASI™, you cannot adjust the gain at the

ECG Out using the key.

Note—

On touch-operated monitors, you can use the arrow buttons below

the size bar to adjust the size of the ECG waveform.

Adjust Size

Confirm

Adjust Size

ECG and ECG/Respiration Module Section

14-23

ECG Adjustments

ECG and ECG/

Respiration Module

Indication for Adjusting the Size

If the system is in manual mode and the pace pul se is t he same size or larger than the R-wave, you can select a lead that produces a smaller pace pulse, or you will need to change the size of the QRS complex so that the R-wave is larger than the pace pulse otherwise the pace pulse could also be counted and this will double the heart ra te count.

Notes—

• If you get an INOP caused by pacemaker activity the message

Pace pulses too large - reduce size of ECG-CH1

is displayed in the status line. Reduce the size of ECG-CH1 slowly until the status message is removed or select a lead that produces a smaller pace pulse.

ECG Waveform Settings

There are four possible configuration settings which control the size and the position of the ECG wave. The settings must be selected in a special Configuration Mode by your biomedical engineering department, or the Agilent Service Engineer.

Autoadjust

This is the factory default. The size o f t he wav e is au tomatically ad justed to fit inside the channel. The position of th e wave is optimized so that the middle of the wave occupies the middle of the channel, unless ST monitoring is switched on. In this case the wave is not centered.

Autosize

The size of the wave is automatically adjusted to fit inside the channel, without changing position.

Gain x 1

The size of the wa ve is not automatically adjusted. It is always displayed with a gain of x1. (The amplitud e of the wave is magnified by 1000.)

Gain x 2

The size of the wave is always displayed with a gain of x 2. (The amplitude of the wave is magnified by 2000.).

14-24 ECG and ECG/Respiration Module Section

ECG Adjustments

Changing the Filter Bandwidth

The filter bandwidth refers to a measure of electrical frequencies contained wi thin an electrical signal. Depending on the meas urement conditions, you may wa nt to change the ECG’s filter to remove some of these electric al frequencies. The System offers a choice of filter bandwidth settings:

• Filter

• Monitor

•Diag

These settings can be selected by pressing the key.

Indications for Changing the Filter Bandwidths

• Filter - use if signal is distorted. The filter bandwidth reduces interference to the signal. In the operating room the filter reduces the artifact and interference from electrosurgical units. In normal monitoring situations the filter may suppress the QRS c omplexes too much. It is important to remember that using the filter bandwidth is not a replac ement for good skin prep.

If the monitor is configured for th e O.R. and it is in monitor or diagnostic mode, it will automatically switch to filt er mode during episodes of electro-surgical interference (ESU). It will return to its original setting once the interfer ence stops.

• Monitor - use in normal monitoring situation. The monitoring bandwidth filters out artifac ts which may cause fal se al ar ms.

Filter/Mon/Diag

ECG and ECG/

Respiration Module

• Diag - use when diagnostic quality is required. The diagnostic bandwidth allows the monitor to display an unfiltered ECG wave. This enables the clinician to detect changes in the ECG, for example, R-wave notching and ST segments.

A letter indicating the filter bandwidth is shown next to the HR numeric. is filter,

When ST monitoring is ON, the low end bandwidth for diag, monitor and filter always defaults to a lower value of 0.05 Hz. This enables the clinician to detect changes in the ECG, for example, discrete elevation or depression of S-T segments. When ST monitoring is switched OFF, the bandwidth automatically returns to the previously selected filter, monitoring or diagnostic bandwidth.

M is monitoring, and D is diagnostic.

ECG and ECG/Respiration Module Section

14-25

ECG Adjustments

ECG and ECG/

Respiration Module

Note—

For viewing or recording multilead ECG, the bandwidth setting

for channel 1 is used for all leads of the multilead ECG.

Note—

EASI™: For EASI™ 12-lead ECG, the same bandwidth setting is

used for all leads of the ECG.

Changing the QRS Detection Mode

You have a choice of auto or manual modes:

•In auto mode the QRS complexes are detected automatically.

•In manual mode the QRS detecti on level appears on the screen a s a horizontal line across the ECG wave. This enables you to see exactly what is causing the heart rate counter to count.

These two detection modes are available for adult, pediatric and neonatal non-paced a nd paced patients.

Indications for Changing Mode

Auto Mode - use in n ormal monitoring situation. Manual Mode - use in exceptional cases if the monit or miscounts the

heartrate. If arrhythmia monitoring is assigned, the monitor automatically switches to Auto mode.

WarningWarning

In manual mode you may have to readjust the QRS detection level if the waveform size or the shape of the QRS complex has changed.

Paced Patients vs Non-Paced Patients

In the non-paced patient mode no pace pulses are expected and no pace pulse rejection occurs.

In paced patient mode the pace pulses are annotated with a small dash on the screen, as shown in the figure below:

D HR

1mV

14-26 ECG and ECG/Respiration Module Section

ECG Adjustments

Auto/Manual pacing cannot be adjusted when arrhythmia channels are assigned or an arrhythmia computer is being used. The arrhythmia function cannot recognize which paced mode has been selected in the Monitor. For this reason, whenever arrhythmia is assigned you have to reselect paced mode. If you are using the Ag ilent Information Cent er (M3150A/M3153A), you select paced mode in the Admit Window. If you are using CCM (M2300), you have to select the paced mode in the arrhyth functns Task Window at either the monitor or the Central Station. After arrhythmia has been assigned during the use of an arrhythmia computer, the Monitor stays in “Paced Patient” mode.

If heartrate is counte d irregularly or there are too many (unaccountable) pacer marks on a paced pa tient monitored in “Paced Patient” mode, do not use the instrument for further patient monitoring. Contact the hospital biomedical engineer.

WarningWarning

• Beats with a pacer spike within the QRS complex may not be detected by the System's QRS detector.

• The paced/non-paced selection should be based on your specific patient situation - “paced mode” should be used for paced patients, and “non-paced mode” used for non-paced patients. Using the non paced mode with pace d patients may result in pace pulses being counted as regular QRS complexes which could prevent an asystole alarm from being activated.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-27

ECG Adjustments

Adjusting the QRS

ECG and ECG/

Detection

Respiration Module

Level Manually

Correct Positioning of the QRS Detection Level

The QRS detection level only needs to be adjusted if the monitor is in manual mode - If the monitor is in a ut o mode, the QRS complexes are detected au tomatically.

Note—

Ventricular fibrillation alarms will function in both automatic and

manual modes.

Non-Paced Patients

Set the QRS detection level at a location where it is guaranteed to cross the QRS complex.

Paced Patients

The pace pulse in manual mode is set to a fixed size on the display. This enables you to increase the size of the ECG wave independently and thus set the QRS detection level above the pace pulses so that only the QRS complex is causing the heart rate counter to count. An example of incorrect and correct positioning of the QRS Detection Level is shown in the diagram below.

QRS DETECTION LEVEL

PACING

PULSE

14-28 ECG and ECG/Respiration Module Section

ECG Adjustments

Changing Alarm Parameter

Adjusting the Alarm Limits

In some situations it may be impossib le t o derive an accurate HR from an ECG, for instance because of excessive ECG artifact or because of inability to place el ectr odes on a pa tient wit h burns. If a pulsati le pressu re is being monitored (pressure or pleth), you can choose PULSE as the alarm parameter.

You can set the heart rate alarm limits according to the individual patient’s clinical condition.

The high rate al ar m set ti n g i s also important in QR S detection. You sh ou l d not set the upper limit too high otherwise it may cause the heart rate counter to miscount. Set the limit no higher than 20 bea ts per minute higher than the heart rate, taking into account the variability.

The alarm limits that you set are shared by the HR/PULSE parameters, but only one of these parameters can be in active alarm function.

WarningWarning

Red alarms for Asystole, V. Fib. and Brady will not occur with Pulse selected as the active alarm function. If Pulse is selected, the following status message is displayed on the Agilent CMS:

“ECG Alarms Off. To switch on, select HR.”

ECG and ECG/

Respiration Module

Switching ECG Parameter Alarms On/ Off

As both numerics are displayed on the screen, the parameter that has not been chosen as the alarm parameter will have a sign next to th e parameter label.

ECG parameter alarms can be switched on/off, like any ot her parameter. If, however, arrhythmia is assigned to the bedside and all alarms are switched off (the key has been pressed), then if you go into the ECG Task Window, the softkey is hollow and there is a sign beside the ECG alarm bar and HR reading.

Suspend

On/Off Alarms

ECG and ECG/Respiration Module Section

14-29

ECG Adjustments

Changing Brady Limit

ECG and ECG/

Respiration Module

If the alarm source for HR is ECG, you can set a red brady alarm for neonates and pediatrics. When the patient’s HR falls below the low alarm limit, a yellow alarm is activated. If it then falls below the brady limit a red alarm is activated.

When you go into the HR Alarm Adjust Task Window, in neonatal or pediatric mode, you will see the brady alarm limit displayed above the HR low alarm limit. F or ex am ple , the l o w al a rm l imi t m ay be 100 and the brady limit 80. If the HR falls below 100, a yellow alarm is activated. If it then continues to fall below 80, a red alarm is activated.

The difference between the HR lower alarm limit and the brady alarm limit can be set in a special Configuration Mode by your biomedical engineering de pa rtm en t . For exam p l e, yo u m ay wan t a lo we r al ar m li mit of 80 with a brady alarm limit of 70 (Brady Limit Diff =10). You can even set the brady alarm limit to be the same as the lower alarm limit. In this case, you would always see a red low he art rate alarm.

A brady alarm delay time can also be set in this special configuration mode. This defines the amount of time the HR needs to be below the brady limit, before a red alarm is activated. For example, if the delay time is set to 3 seconds, the HR has to r em ain below the brady limit for 3 seconds before a red alarm is activated. Choosing a short brady delay time (for example, less t han 3 seconds) may increase the probability of issuing false brady alarms.

14-30 ECG and ECG/Respiration Module Section

ECG Adjustments

Tone Modulation

If tone modulation is configured, the pitch of the QRS tone is related to the SpO

level. If the SpO2 level drops, the QRS tone becomes low er.

The QRS tone is derived from the alarming parameter, which can be configured as either HR or pulse in the “Adjust A larms” Task Window. If

the numerics for the alarming parameter are set to “Off” when the monitor is switched on, the re will be no QRS tone and therefore no tone modulation is possible.

If the alarm parameter source goes into INOP, the modulated QRS tone does not stop. Instead, it is derived from PLETH, if the PLET H parameter is on.

Note—

Tone modulation is selected in a spe cia l Configuration Mode, by

your biomedical engineering depart ment. You can have tone modulation

configured as either “Off”, “Standard” or “Enhanced”:

Standard: The tone decreases by a small amount for each drop in

the SpO

level. (This is equivalent to that used in

NELLCOR® equipment.)

Enhanced: The tone decreases more dramatically for each drop in

the SpO

level, and is therefore easier to recognize.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-31

ECG Adjustments

Multilead ECG Display

ECG and ECG/

and

Respiration Module

Recording

The Multilead ECG capability allows you to view and recor d a snapshot of 8 ECG leads.

For multilead ECG viewing and recording, you will need to use a 5-lead ECG cable.

The size and filter bandwidth of channel 1 (ECG-CH1) is used by the system as a reference if the remaining channels have differing size and filter bandwidth settings. For ex ample, if the size or filter bandwidth for channels 2 and 3 are different to that of channel 1, the system will change the size or filter bandwidth of channels 2 and 3 to correspond to channel 1 for the multile ad procedure. After the mult ilead procedure, the original settings will be returned

14-32 ECG and ECG/Respiration Module Section

ECG Adjustments

EASI™ 12lead ECG Display, Printing and Recording

Note—

In the USA, EASI™ 12-lead ECG is only for use on adult and

pediatric patients. The optional EASI™ 12-lead ECG capability allows yo u to view and

record or record a snapshot of 12 ECG leads. For EASI™ 12-lead ECG viewing and recording, you will need to use a 5-

lead ECG cable. The electrode placement for EASI™ is given below.

Note—

You must select the EASI™ lead placement in the ECG Configuration Task window for th is placement to work. When EASI™ lead placement is selected, "EASI" is shown beside the 1mV calibration bar on the ECG wave in channel 1.

Electrode Placement with a 5-Lead Set for EASI™ 12-lead.

ECG and ECG/

Respiration Module

[WHITE]

Note—

Great care must be taken to place the electrodes as accurately as

possible for the best qu ality EASI™ measurements.

• S - Black [IEC: Yellow] (LA) e lectrode - place on the upper sternum.

• E - Brown [IEC:White ] (V) electrode - place on the lower sternum at the level of the fifth intercostal space.

ECG and ECG/Respiration Module Section

14-33

ECG Adjustments

12-Lead ECG

View ECG

ECG and ECG/

Respiration Module

• I - White [IEC: Red] (RA) electrode - place on the right midaxillary line at the same level as the E electrode.

• A - Red [IEC: Green] (LL ) electrode - place on the lef t midaxillary line at the same level as the E electrode.

• Green [IEC: Black] (REF) electrode - place anywhere.

If the electrode plac ement shown is not possible on your patient (because of plasters or therapeutic equipment), the E and S electrodes can be moved in parallel to the patient’s right, but this move should be kept as small as possible.

If the electrode plac ement shown is not possible due to pulmonary problems, the A and I electrodes can be moved up or down in parallel. Moving the electrodes down produces better measurements than moving them up.

Note—

Respiratory monitoring is also possible with the the EASI™

placement. Respiration is measured between the I and A electrodes.

T o View a 12-

1. Press in the Procedures task window,

Capture 12-Lead

Lead ECG

1. in the ECG Main Task window (channel 1 ).

2. Press to view/preview the 12-lead snippets.

14-34 ECG and ECG/Respiration Module Section

Example of a 12-lead E CG display

Print ECG

Record ECG

ECG Adjustments

ECG and ECG/

Respiration Module

3. You can change the size using the softkey or the up

Adjust Size

and down arrows. (Pressing t h e key changes t h e size of the 1mV calibration bar f or the first channel . T he wa ves change size 1 sec ond after you have finish ed adjusting the calibration bar.)

Press in the 12-lead Task window to print the 12-lead snippets to the local or central pr inter.

Press in the 12-lead Task window to record the 12-lead snippets on a central or local recorder.

Note—

Use diagnostic bandwidth for the opt imal signal definition. Due to network transmission restrictions, the bandwidth printed on a central recorder is of reduced resolution.

The same filter bandwidth is used by the system for all channels. The 12 lead snippets are all the same size. The initial size is set in the

EASI™ ECG Configuration Task Window in Configuration Mode. Adjust the size to "x2" to get 1cm/mV on the printout.

ECG and ECG/Respiration Module Section

14-35

ECG Adjustments

ECG and ECG/

Respiration Module

You cannot adjust the size of the waves after you have printed them. If you need to change the size of the waves, you should capture the 12leads again.

Scheduled or Triggered 12Lead Reports

EASI™

Configuration

Press in the 12-lead Task window.

Auto Reports

The type of alarm that trig gers a report as well as the kind of report

(printer or recorder) can be set up in the EASI™ Configuration Task Window in Configuration Mode. You can select between

• No Reports.

• Reports On Alarm, triggered by ST alarms, or ST & HR alarms. The type of alarm that triggers a report can be set in the EASI™ ECG Configuration Task Window. Reports generated by an ST & HR alarm have a symbol, reports for an ST alarm have an symbol. Arrhythmia alarms will also generate a 12-lead printout if you select ST & HR alarms.

• Scheduled reports, which can be at any multiple of half an hour between a half an hour and 48 hours (0.5, 1.0, 1.5, 2.0,...48). Scheduled reports are ma rked with a symbol.

• All, which selects the scheduled reports you have set and any reports triggered by an ST or S T&HR alarm.

In the ECG configuration in configuration mode, you must firs t select

EASI™ lead placement. Then, in addition to the normal parameters for the ECG, there are a number of para meters just for the 12-lead.

• The 12-lead sequenc e lets you choose between nor mal and Cabrera order fo r the display, printing and recordi n g o f th e 1 2- l ead snippets. Normal order displays the lead snippets as follows:

II V

III V

14-36 ECG and ECG/Respiration Module Section

ECG Adjustments

aVR V aVL V aVF V

Cabrera order displays the lead snippets as follows::

aVL V

-aVR V II V

aVF V

III V

Note—

The 12-lead snippets on the recorder are paired so that you

can cut the strip up and stic k them on a sheet to get the Normal or Cabrera order given above.

• You can select the size of the 12-lead window as large or normal. The large window will cover all of the real-time traces on the screen. The normal window leaves space for 1 full trace above the task window.

ECG and ECG/

Respiration Module

• The next settings are for the automatic EASI™ reports, as described in “Scheduled or Triggered 12-Lead Reports” on page 14-36. Here you can select

– Whether th e rep o rt is gener ated for alarms, at scheduled times,

for alarms and on schedule, or no reports at all.

– Whether the alarm reports are triggered by ST or ST & HR

alarms. HR alarms are sele cted auto mati call y for mo nitor s with no ST functionality.

– The time interval between scheduled reports.

ECG and ECG/Respiration Module Section

14-37

ECG Adjustments

– Whether alarm reports are output to the printer or recorder.

ECG and ECG/

Respiration Module

– Whether scheduled reports are out put to the printer or

recorder.

• 12-lead on SDN is set to "Off". This parameter is for future use.

Note—

Only one precordial-lea d can be transmitted on SDN.

• Set the initial size for the 12-lead snippets to – AutoAdj for a best fit.

– GainCH1 to use the gain for channel 1 for all snippets. – Gain x1 sets all snippets to 0.5cm/mV. – Gain x2 sets all snippets to 1cm/mV.

Note—

The same gain applies to all 12 le ads.

14-38 ECG and ECG/Respiration Module Section

Respiration Adjustments

Changing the Respiration Detection Mode

The monitor counts the respiration using one of two modes, auto or manual.

In auto mode the moni tor counts the respiratio n an d ad ju sts th e de tection level automatically de pending on waveform height , presence of cardiac artifact and absence of valid breaths. The auto mode is used in the following situations:

• When breathing is spontaneous with or without Continuous Positive Airway Pressure (CPAP).

• With ventilated patients, (except Intermitten t Mandatory Ven tilation

- IMV).

• When the Respiration Rate (RR) does not approach t he Heart Rate (HR).

In manual mode you set the de tection level for counting the respiration. It is important to remember that if the depth of breathing changes the detection level may require adjustment. The manua l mode should be selected in th e following situations:

• When the RR approximately equals the HR.

ECG and ECG/

Respiration Module

Adjusting the Respiration Detection Level

• When the respiration is weak, heart activity, or movements of the chest wall caus ed by the heart, can cau se artifacts. (In this situation, adjust electrode placement to improve the signal. Take special care when adjusting EASI ™ pl aceme nt - see “Elec trod e Plac ement wi th a 5-Lead Set for E ASI™ 12-lead.” on p age 14-33).

In manual mode the Respiration Detection Level is shown as a horizontal line across the respiratory waveform. Each downward stroke of the waveform which crosses the detection line is counted as a respiration.

The manual mode is more sensitive than the auto mode to any impedance changes, including artifact. You should check the waveform on the screen to ensure that it represents the patient's breathing pattern.

ECG and ECG/Respiration Module Section

14-39

Respiration Adjustments

ECG and ECG/

Respiration Module

Caution

• If you move the detection level towards the waveform's baseline, the monitor is more likely to detect impedance chan ges due to cardiac activity. If apnea oc cu rs i n thi s sit ua ti on th e mon ito r migh t falsely interpret cardiac activity as respiratory activity and not detect the apnea.

The apnea alarm would not be activated.

You would remain unaware of this critical patient condition.

• Switching the RESP alarms OFF, also has the effect of switching the apnea alarms OFF.

14-40 ECG and ECG/Respiration Module Section

ECG and RESP Alarm and INOP Messages

ECG Alarm Messages

The Heart Rate alarm messages are rated in order of severity: *** Red

** Yellow

INOP message

Alarm tone = a single chime repeated every second. INOP tone = a single beep repeated every 2 seconds. Alarm limits are dependent on patient’s condition.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-41

ECG and RESP Alarm and INOP Messages

Physiological Alarms

ECG and ECG/

Alarm Message Condition Visual Indication

Respiration Module

***ASYSTOLE

The interval between two QRS complex es has

HR numeric (=0) blinks. Red alarm lamp.

exceeded 4 seconds.

***VENT FIB

The heart is fibrillating. Only in adult

HR numeric blinks. Red alarm lamp.

configurations.

***BRADY

1, 2

60<80

HR has dropped below the selected Brady limit.

**HR 160>150 HR has exceeded the high

alarm limit.

**HR 90<100 HR has dropped below the

low alarm limit.

If PULSE is the HR numeric source, there is no ASYSTOLE, VENT FIB

HR numeric blinks. Red alarm lamp.

HR numeric blinks. Yellow alarm lamp.

or BRADY red alarm.

Brady alarms will on ly be generated in neonatal or pediatric mode.

Technical Alarms

INOP messages appear when the monitor cannot measure or process signals properly. This could be du e to patient-related or equipment related problems but you must always check the patient’s condition first. The INOP message is accompanied by an audible alarm which can be silenced with the key.

Silence/Reset

Audible Indication

Alarm tone

14-42 ECG and ECG/Respiration Module Section

Equipment-Related INOPS

ECG and RESP Alarm and INOP Messages

INOP Message Condition Visual Indication

LEADS OFF Not all the required leads

HR numeric displays -?-. INOP tone are attached or electrodes have been displaced.

LEADS OFF XX Single electrode fro m lead

XX detached.

If INOP occurs in

channel 1, HR numeric

displayed as -?-. After 10

seconds lead in channel

2 switches to channel 1

so that heart rate

counter can operate. HR

numeric displayed as

normal.

LEADS OFF (EL.X)

Single electrode from lead E, S, or I is detached (EASI™ lead set).

A non-standard ECG

signal

is shown in channel 1,

the HR numeric is

derived.

Channels 2 and 3 show

baseline.

ST is disabled.

Audible Indication

INOP tone

INOP tone at beginning.

ECG and ECG/

Respiration Module

ECG/RESP UN PLUGGED

ECG EQUIP MALF

ECG/RESP module switched on and has been un-plugged from the rack.

Malfunction in the ECG hardware.

HR numeric displays -?-. INOP tone

ECG and ECG/Respiration Module Section

14-43

ECG and RESP Alarm and INOP Messages

RESP Alarm Messages

ECG and ECG/

Respiration Module

Alarm Message Condition Visual Indication

***APNEA RESP has exceeded the

**RESP 25>20 RESP has exceeded the

**RESP 6<8 RESP has dropped

INOP Messages Condition Visual Indication

RESP ERRATIC Poor contact between

Physiological Alarms

preset apnea alarm limit.

high alarm limit.

below the low alarm limit.

Patient-Related INOPS

the electrode and skin or excessive patient movement.

RESP numeric (=0) blinks. Red alarm lamp.

RESP numeric blinks. Yellow alarm lamp.

? next to RESP label. None

Audible Indication

Alarm tone

Audible Indication

14-44 ECG and ECG/Respiration Module Section

Equipment-Related INOPS

ECG and RESP Alarm and INOP Messages

INOP Message Condition Visual Indication

ECG/RESP UN PLUGGED

ECG/RESP module switched on and un-

RESP numeric displays -?-. INOP tone

plugged from the rack.

RESP LEAD OFF RESP lead fallen off,

RESP numeric displays -?-. INOP tone or electrode detached, or patient cable unplugged.

RESP EQUIP MALF

Malfunction in the RESP hardware .

RESP numeric displays -?-. INOP tone

Audible Indication

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-45

Parameter Settings Transfer

ECG and ECG/

Respiration Module

WarningWarning

Make sure that the ECG placement (Standard or EASI™) selected on the monitor to which you are transferring, and your patient’s electrode pl acement are the same.

The following settings can be transferred with ECG and ECG/RESP modules that have a T on the front. For more information on Parameter Settings Transfer, refer to “Parameter Settings Transfer” in Chapter 3.

Setting Name Meaning

Standard Lead on CH1 / CH2

EASI™ Lead on CH1 / CH2 / CH3

Paced Mode Patient paced / non pace d Alarm parameter Heart rate or pulse rate alarm source Alarm limits Heart / Pulse and respiration rate alarm limits Apnea time Apnea delay time

Note—

EASI™: Both the EASI™ settings and the standard settings are

transferred.

Selected ECG lead

14-46 ECG and ECG/Respiration Module Section

Accessories and Ordering Information

Note—

All Agilent patient lead cables are protected against the effects of

the discharge of a defibrillator.

Trunk Cables

Note—

You cannot use 3-lead cab les with the EASI™ option.

3-lead

AAMI: M1500A - Trunk cable (2.7m)

M1540C - Trunk cable (0.4m)

IEC: M1510A - Trunk cable (2.7m)

M1550C - Trunk cable (0.4m)

3-lead One Piece Cables

AAMI: M1970A - OR (1.9m)

M1972A - ICU (Sna p, 1.9m)

IEC: M1980A - OR (1.9m)

M1981A - ICU (Grabber, 1.9m)

5-lead

ECG and ECG/

Respiration Module

AAMI: M1520A - Trunk cable (2.7m)

M1560A - Trunk cable (0.4m)

IEC: M1530A - Trunk cable (2.7m)

M1570A - Trunk cable (0.4m)

5-lead One Piece Cable

AAMI: M1975A - OR (2.5m)

M1977A - ICU (Sna p, 2.5m)

IEC: M1985A - OR (2.5m)

M1986A - ICU (Grabber, 2.5m)

If you are using EASI™ lead placement, replace the standard leadplacement label on the cable with the appropriate EASI™ Label.

ECG and ECG/Respiration Module Section

14-47

Accessories and Ordering Information

ECG and ECG/

Respiration Module

Since these Agilent cables were designed specifically for your Agilent V24 and V26 Monitor, we re commend the use of only A gile nt cables and leadsets for optimum monitor pe rformance.

Note—

The following listed accessories are not shipped with every

instrument. Contact your Agilent sales representative for details.

Accessories

3 lead 5 lead

combiner block M1501A M1502A cable organizer (standard and OR

M1503A M1504A

cables) cable organizer (unshielded cables) M1505A M1506A bedsheet clip M1509A M1509A

OR Lead Sets

Note—

You cannot u se 3-lead cables with the EASI™ o p tion.

Lead Sets (Orange)

Grabber OR 0.7m

3-lead U.S. M1601A 3-lead Europe M1611A 5-lead U.S. M1621A 5-lead Europe M1631A

14-48 ECG and ECG/Respiration Module Section

Accessories and Ordering Information

Shielded Lead Sets

Note—

You cannot use 3-lead cab les with the EASI™ option.

Lead Sets (Grey) Snap Std 0.7m Grabber Std 0.7m

3-lead U.S. M1605A M1603A 3-lead Europe M1615A M1613A

ECG and ECG/

Respiration Module

5-lead U.S. 5-lead Europe

The limb lead on 5-lead sets are 1.6m.

M1625A M1623A

M1635A M1633A

Radioluscent Lead Sets

Lead Sets (Black) Miniclip 0.91m

5-lead M1649A

With color rings for AAMI and Europe

Electrodes

Neonatal Pediatric Adult

40476 13950 40489 40478 13951 40493 13952 13941 13953 13942 M2202A

ECG and ECG/Respiration Module Section

14-49

ECG/RESP Performance Specifications

ECG and ECG/

Respiration Module

For safety an d environmental specifications, please refer to the Mo nit or Installation and Patient Safety Chapter 10.

ECG Cardiotach

Adult Range 15 to 300 bpm Pedi/Neo Range 15 to 350 bpm Accuracy + Resolution 1 bpm Sensitivity >= 200 µV peak

Pace Pulse Detection:

• 100 µs pulse width amp litude greater than 3 mV

• 50 µs pulse width amplitude greater than 5 mV

Pace Pulse Rejection:

• Meets the requirements for AAMI EC 13-1993 Standards for cardiac monitors (automode).

1% of range

14-50 ECG and ECG/Respiration Module Section

ECG/RESP Performance Specifications

Filter Bandwidths

Mode Adult Pediatric / Neonatal

Diagnostic Mode 0.05 to 130 Hz

0.5 to 130 Hz

Monitoring Mode 0.5 to 40 Hz 0.5 to 60 Hz Filter Mode 0.5 to 20 Hz 0.5 to 20 Hz

a. The M1001B and M1002B have a bandwidth of 0.05Hz to 150Hz.

ECG Output

Signal Gain: 640 to 6400 depending upon display gain

ECG and ECG/

Respiration Module

Full Scale Display: 6.4V

Gain Error Constant deviation <20% Baseline Offset <180mV + ECG offset Signal Delay: <30ms

a. ECG Output Signal Delay range for ECG and ECG/RESP modules:

All ECG and ECG/RESP modules without a P on the front have a signal delay of <20ms All ECG and ECG/RESP modules with a P on the fron t have a sign al delay of <30ms

WarningWarning

EASI™ 12-Lead: If you are using EASI™, the signal gain is fixed at

3400. You cannot adjust the gain at the ECG Out using the

Adjust Size

. Certain defibrillators may double trigger on the R-wave and Twave, depending on the size and shape of the signal. Use an alternative lead which does not double trigger, or change to non-EASI mode for cardioversion procedures.

ECG and ECG/Respiration Module Section

14-51

ECG/RESP Performance Specifications

ECG and ECG/

Respiration Module

Defib

WarningWarning

Your ECG/Defibrillator combina tion is conf igured to detec t R

14-52 ECG and ECG/Respiration Module Section

ECG Output Impedance

ECG/RESP Performance Specifications

Tip (ECG & Marker) 2.6kΩ (typically) Ring (ECG only) 2.2kΩ (typically)

Marker Input Requirements

Signal Type 0 to -12V (source < 7kΩ) Current 1mA Falltime <100µs Duration >4ms

Alarms

Adult Pediatric Neonatal

HR Alarm 15 to 250 bpm 15 to 300 bpm 15 to 300 bpm Limit Range Bradycardia

not applicable 20 to 295 bpm 40 to 295 bpm

Alarm Limit Range

ECG and ECG/

Respiration Module

Adjustment: Steps of 5bpm High/Low delay: 10 seconds according to AAMI EC 13-1993

standards.

Asystole: • no detected beat within 4 seconds

• alarm within 3 seconds after this criterion is met according to AAMI EC 13-1993 standards.

INOP Alarms: Triggered if the offset potential rises above

500mV or leads off.

ECG and ECG/Respiration Module Section

14-53

ECG/RESP Performance Specifications

ECG and ECG/

Miscellaneous

Respiration Module

Baseline Recovery Less than 1 second after defibrillation Display Update 2 seconds nominal.

14-54 ECG and ECG/Respiration Module Section

RESP Respiration Rate

ECG/RESP Performance Specifications

Adult/Pedi Range: 0 to 120 rpm Neonatal Range 0 to 180 rpm Accuracy + Resolution 1 rpm

Alarm

Adult/Pedi Neonatal

High Alarm Limit 10 to 100 bpm 30 to 150 bpm Low Alarm Limit 0 to 95 bpm 0 to 145 bpm

Adjustment Steps of 1 under 20 rpm

RESP Alarm Delay If limit is between 0 and 20 rpm:

1 rpm at 60 rpm

Steps of 5 above 20 rpm.

As soon as value goes below limit setting. If limit is above 20 rpm: 10 seconds after limit exceeds limit setting.

ECG and ECG/

Respiration Module

Apnea Alarm Delay • Range of 10 to 40 seconds .

• Adjustment in Steps of 5 seconds.

• No detected breath within the adjusted apnea delay time.

Alarm 2 seconds after this criterio n is met. INOP Alarms: Triggered if the impedance rises above 2 kΩ

or leads off.

Miscellaneous

Bandwidth 0.3 to 2.5 Hz (- 6 dB)

ECG and ECG/Respiration Module Section

14-55

ECG/RESP Performance Specifications

Noise Less than 25 mΩ (input reference).

ECG and ECG/

Respiration Module

ECG/RESP with Analog Respiration Output Performance Specifications (CMS Only)

Output Range -3.5V to +3.5V Amplitude 1.0V/Ω change of transthoracic impedance Offset 0.0V ±1V Delay <90ms Polarity Rising (positive) edge at inspiration Load Capacitance <100nF Load Resistance >1k Ground Floating, isolated Connector BNC

Output Delay

Actual delay of the respiration output signal depends upon the respiration rate. When used with a critical timing device, careful

evaluation of the device’s compatibility is essential.

Cable Specification

Proper operation of the analog output is only guaranteed if the interface cable meets the following specifications:

BNC Cable Length <4m Impedance <60mΩ/m Capacitance <400pF/m

Ω

14-56 ECG and ECG/Respiration Module Section

Care and Cleaning

Patient Cables and Leads

Clean cables after each use as follows:

1. Remove any adhesive used to secure the electrodes to the patient

2. Sponge cables with warm water and soap, or another suitable

3. Check each cable for corrosion, cracks and deterioration.

Do not autoclave cables or electrodes or heat them above 75°C (167°F). If the metal surfaces become tarnished, they may be cleaned with any cleaner which does not leave a residue. Do not use any metallic abrasive such as steel wool. The cables should be stored in an environmental temperature between -2 0°C to 75°C (-68°F to 167°F). They should be hung up or laid flat to prevent damage to the cable.

ECG and ECG/

Respiration Module

and wipe off any remaining electrolyte fr om the electrodes. (If adhesive tape residue has t o be removed, use a plaster remover solution or the Scholl Mfg. Co. Double seal tape remover. Acetone, alcohol, ammonia, chl oroform or other strong solvent s are not recommended, becau se th ey will even tu all y da mage the vinyl cabling.)

cleaning solution, and dry. Do not immerse them in water.

ECG and ECG/Respiration Module Section

14-57

ST Segment Monitoring

ECG and ECG/

Respiration Module

In this section you will find information on setting up ST segment monitoring, adjusting alarm limits, and troubleshooting.

If you have problems with the monitoring (for example, an INOP message appears on the screen), you will find information on alarms and INOPs on page 12-53.

For a list of the parameter settings related to ST segment monitoring that are stored inside the ECG and ECG/RESP modules with a T on front, turn to page 12-55.

To find specific information check either the contents list at the front of the user guide or the alphabetical index at the back.

This application provides ST level change information; the clinical significance of this ST level change information should be determined by a physician.

WarningWarning

ST Segment

Using EASI™, ST monitoring can be done on multiple V-leads.

Monitoring

Note—

with EASI™

14-58 ECG and ECG/Respiration Module Section

If an electrode falls off, the monitor shows a non-standard lead

(that is, one of the 3 EASI™ vectors) labelled "ECG" until the electrode is reattached. No ST analysis is possible in this time, and ST analysis is switched off automatically.

1. Assessment of EASI derived 12-Lead ST measurements is recommended for patients that meet the following requirements:

Ages: 33 to 82 Heights: 147 to 185 cm (58 to 73 in) Weights: 53 to 118 kg (117 to 261 lb) Height-to-Weight Ratios: 1.41 to 2.99 cm/kg (0.25 to 0.54 in/lb)

Introduction to ST Segment Monitoring

Procedures

Introduction to ST Segment Monitoring

The ST segment monitoring for System measures the elevation or depression of the ST segment on up to three leads of a patient’s ECG.

The corresponding ST measurements:

• are presented as numeri cs o n t he Standard Display. These ST v al ues are as follows:

ST 1 is the ST measurement from the channel 1 ECG lead. ST 2 is the ST measurement from the channel 2 ECG lead. ST 3 is the ST measurement from the channel 3 ECG lead.

• are shown graphically in the ST Analysis Task Win dow, an integrated display of current ST values and waveforms, HR a nd ST trends, reference ST values and waveforms, and net change

• are available in Vital Signs and Graph Trends displays and reports in Patient Data

• can be recorded with reference beats at the bedside or at a central recorder. Recordings made at the Patient Information Center do not include referenc e beats.

ST Analysis is accessed through the ECG Channel 1 Task Window, or through . The ST Analysis Task Window provides quick access to information needed to make an initial assessment of the significance of ST changes.

ECG and ECG/

Respiration Module

In the left side of the window, up to three ST trends are shown, with the HR trend graphed in the ST1 plot area. Trends can be scaled at +

5.0, or +10.00 mm; the current scale is displayed in the box above the

Change Scale

softkey label. The trend time span choices are 1, 3, 6 or

1.0, +2.0,

12 hours for the standard database, 1 or 3 hours with high resolution storage; the span for the c urrent trends is noted in the box above the

Change Time

label. The bar cursor provides a mechanism for retrieving stor ed values for disp lay in the cursor spot on the right side of the window.

ECG and ECG/Respiration Module Section

14-59

Introduc tion to ST Segment Monitoring

ECG and ECG/

Respiration Module

In the right side of the window, the current or recalled ST complexes are displayed in the cursor spot at the right. To their left in the reference spot the reference set of complexes for use in analysis is displayed. Up to 242 sets of realtime algorithm outputs (ST values, beats and measurement points) can be trended and recalled. The default reference beat can be updated to any of the stored values.

The net change between the current and reference values is listed at the extreme right of the Task Window.

The arrow keys can be used to move the cursor to different time columns within the trend area. On touch-operated systems, the arrow buttons below the trends can be used to perform the task of the arrow keys. Alternatively, the trend area can be directly selected by touch or mouseclick. This will bring u p th e ST st rored for the selected time.

Operation Notes

14-60 ECG and ECG/Respiration Module Section

• ST measurements a re not performed on ventricular or A-V sequential paced beats. ST measurements are performed on atrially paced beats.

• Arrhythmia and pulse monitoring are fully compatible with ST segment monitoring.

Introduction to ST Segment Monitoring

• Usually VPBs do not affect the accuracy of the ST segment measurement. However, rhythms that are primarily ventricular can cause incorrect ST measurements.

• If you are using a touchscreen, selecting the trend area will bring up the ST segment stored for that particular time.

Note—

The System automatically marks the following ST-related

adjustments as events in Patient Data:

• Whenever an ECG lead is changed.

• Whenever ST parameter measurement points are changed.

You can review the ST adjustment markers on the Graphs Display. The label is “ST” or, if part of a graphs group, “ST Adjust”. See “Marking and

Reviewing Events” in Chapter 8 for more information.

ECG and ECG/

Respiration Module

Data Transfer

ST Analysis functions are available during transfers to the M1235A Data Transfer Module, but they are deactivated during a transfer to the monitor.

ST trends of transferred data can be viewed in the ST Analysis Task Window and in the Vital Signs and Graphs Trends screens accessible

under the key. Transferred values are indicated by a “T” on the trend time line. However, ST waveforms are not transferred; thus transferred measurements cannot be used as the reference beat.

Trends/Calcs

ECG and ECG/Respiration Module Section

14-61

ST Segment Monitoring Setup

ECG and ECG/

Respiration Module

• Standard Lead placement: – ECG channel 1 should display a good cardiotach lead. This is

– ECG channel 2 should display a good lead f or monitoring the

typically lead II.

ST level. This is typically aVF.

– ECG channel 3 is always lead V, which is typically V

for

monitoring the ST level.

• EASI™ Lead placement: – ECG channel 1 should display a good cardiotach lead. This is

typically lead II.

– ECG channel 2 should display a good lead f or monitoring the

ST level. This is typically V

– ECG channel 3 is always lead V, which is typically V

for

monitoring the ST level.

Notes—

• If monitoring with only one lead, choose the lead wh ere both beat

detection and ST segment evaluation are possible. If monitoring with two leads, leads II and V

are typically chosen. Reme mb er ,

the number of ECG channels that you monitor is independent of the number that you display. For example, you can tur n on ECGCH1, CH2, and CH3 (and thus monitor three ST parameters) but display only ECG-CH1.

• When you turn an ST parameter on, the monitor automatically

adjusts the low end of the bandwidth (filter, monitor, or diagnostic) to 0.05 Hz, the diagnos tic quality need ed for ST monitoring. There is no change to the high end of the bandwidth. When you turn ST monitoring off, the monitor automatically returns to the original low end of the selected bandwidth.

14-62 ECG and ECG/Respiration Module Section

ST Segment Monitoring Setup

• If the monitor is configured to switch to the filter bandwidth during ESU interference, you will get an ST INOP (Cannot A nalyze STx) during ESU interference. When the ESU interference stops, the low end of the bandwidth range automatically changes back to.05 and ST monitoring resumes.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-63

ST Segment Monitoring Setup

ST Segment Measure-

ECG and ECG/

ment Points

Respiration Module

The ST measurement for each QRS complex is the vertical difference between where two measurement points on the wave:

The isoelectric point provides the baseline for the measurement. The ST point provides the othe r measurement point.

R-WAVE PEAK

AT 0 MSEC

J POINT

ISOELECTRIC

POINT

DEFAULT =

- 80 MSEC

ST MEASUREMENT

POINT

DEFAULT =

+ 108 MSEC

DIFFERENCE =

}

ST VALUE

You can adjust both measurement points. Your monitor is configured so that you set the ST Point in reference to:

the R-wave peak.

the J Point, which is the transition between the QRS and the ST segment.

Note—

The ST measurement point may need to be adjusted if the patient’s heart rate or ECG morphology changes significantly. As you move the cursor, the ST values at the right of the ST Measurement Points Task Window are updated to show the effects of moving the cursors. These values may differ from those in the Standard Display, since the Standard Display S T va l ues are onl y u pdated every 15 seconds.

14-64 ECG and ECG/Respiration Module Section

ST Segment Monitoring Setup

Waveform Storage/ Recall

Adjusting the Reference

Up to 242 sets of ST beats can be stored, each with up to three channels of data. After 242 sets of data are stored, the database rep l aces the oldest entry with new data. The dura tion and frequency of stor age is dependent on the frequency of parameter storage in Patient Data. If patient data is being collected every 12 seconds, ST wave storage occurs at 1 minute intervals. If p a tien t data is collected on ce p er mi n ut e, S T st or ag e occurs at 5 minute intervals. During an ST alarm, wave storage is once per mi nut e. All stored waves are cleared after a discharge procedure, when the monitor is turned off for more tha n 3 hours, or when monitoring mode is reset.

Setting the reference values enables you to select new or temporary reference beats. When ST analysis is begun, the second valid beat is selected as the default reference beat and is displayed in the reference spot. Any trended beat can then be compared with the reference. You can change the reference in the Adjust Reference Task Window.

In addition, any trended beat can be used as a temporary reference, without affecting the saved reference. A temporary reference remains in effect until you change it or you leave the Task Window. A temporary reference can be retained as the saved reference.

If the monitor is turned off for more than 3 hours, the saved reference will be reset to the second valid ST beat after restart. The reference is also reset whenever the ST or ISO point is changed.

ECG and ECG/

Respiration Module

Saved Reference the stored reference beat (This may be the

default beat, or a trended beat selected by the user.)

Temp Reference a trended beat selected by the user and

displayed in the reference spot on a temporary basis for analysi s

Change Reference a way for the user to replace the defa ul t

reference wit h a temporary reference complex

ECG and ECG/Respiration Module Section

14-65

ST Segment Monitoring Setup

ECG and ECG/

Respiration Module

Adjusting the Alarm Limits

Each ST parameter has its own alarm limit. The alarm is triggered when the value of the ST parameter exceeds its alarm limit for more than 1 minute. The alarm will be a yellow alarm.

Turning ST alarms on or off affects all of the ST parameters. (If you need to disable alarms for an indiv idual parameter, adjust the alar m limits so that reaching an alarm condition is virtually impossible.)

Caution

When more than one ST parameter is in alarm, only one alarm message is displayed.

Note—

The displayed scales for ST alarm limits (in the Adjust ST Alarms and Alarm Limits Task Windows, and in Vital Signs and Graph Trends) are pre-configured to + you can set ST alarms within is -9.8 to +9.8 mm.

1, +2, +5, or +10 mm. However, the actual range

14-66 ECG and ECG/Respiration Module Section

ST Alarm and INOP Messages

The ST alarm messages are rated in order of severity: ** Yellow

INOP Alarm tone = a single chime repeated every second. INOP tone = a single beep repeated every 2 seconds. Alarm limits are

dependent on patient’s condit ion.

The alarm and INOP messages are listed below, with the “x” representing ST1, ST2, or ST3.

ECG and ECG/

Respiration Module

ECG and ECG/Respiration Module Section

14-67

ST Alarm and INOP Messages

Physiological Alarms

ECG and ECG/

Alarm Message Condition

Respiration Module

Visual Indication

**STx -1.2<-1.0 ST below the low alarm limit ST numeric

Audible Indication

Alarm tone blinks. Yellow alarm lamp.

**STx 1.3>1.0 ST above the high alarm limit ST numeric

Alarm tone blinks. Yellow alarm lamp.

ST Alarm Limit Ranges

-9.8mm to +9.8mm

Technical Alarms

INOP messages appear when the monitor cannot measure or process signals properly. This could be du e to patient- related or equipment related problems but you must always check the patient’s condition first. Some INOP messages are accompanied by an audible alarm which can be silenced with the

Silence/Reset

key.

14-68 ECG and ECG/Respiration Module Section

Patient-Related INOPS

ST Alarm and INOP Messages

INOP Message Condition Visual Indication

ERRATIC STx The variation between

STx numeric displays -? - None measured ST values exceeded the limits for valid data.

ST PACED BEATS The algorithm recognizes

STx numeric displays -? - None an unacceptable number of paced beats. This could be caused by an exceptionally noisy ECG signal.

CANNOT ANALYZE STx

The algorithm cannot generate a valid value

STx numeric displays -? - None (e.g., noisy ECG) and

none of the above conditions apply.

Equipment-Related INOPS

INOP Message Condition Visual Indication

Audible Indication

ECG and ECG/

Respiration Module

NO STx SOURCE The channel of ECG

corresponding to this ST parameter is off.

STx OVERRANGE The alg orithm calculated

a value >

25 mm or < -25

*If the Unit Type for the Configuration Set is OR, there is no I NOP to ne.

ECG and ECG/Respiration Module Section

STx numeric displays -? - INOP tone *

14-69

Parameter Settings Transfer

ECG and ECG/

Respiration Module

The following settings related to ST Segment Monitoring can be transferred with ECG and ECG/ RESP modules that have a T on the front. For more inform ation on Parameter Settings Tr ansfer, refer to

“Parameter Setting Transfer,” Chapter 3.

Setting Name Meaning

Alarm limits Heart/Pulse and respiration rate alarm limits ISO points Isoel ect ri c measurement poi n t ST points ST measurement point

14-70 ECG and ECG/Respiration Module Section

Performance Specifications

ST Segment Measurement Range

Measurement Range -25.0 mm to 25 mm Resolution Range + Intermediate

Resolutions

Leads First and second channels select able from I,

Measurement Points

Measurement Points Referenced to peak of QRS complex or set

Measurement Resolution

Isoelectric Point Rang e -460 ms to 460 ms from QRS peak

0.1 mm at highest ECG gain (50 mm/mV)

0.1 mm at 40 mm/mV

0.1 mm at 20 mm/mV

0.3 mm at 10 mm/mV

II, III, aVR, aVF, aVL, MCL1, V. Third cha nnel is V.

60/80 ms from the user-selected J-point 4 ms

ECG and ECG/

Respiration Module

ST Point Range -380 ms to 460 ms from QRS peak J-Point Range -460 ms to 460 ms from QRS peak.

ECG and ECG/Respiration Module Section

14-71

Performance Specifications

Alarms

ECG and ECG/

Range -9.8 mm to 9.8 mm

Respiration Module

Adjustment Steps of 0.2 mm Alarm delay 1 minute af ter th e val ue exce eds the se t li mit

value

INOP Alarms Refer to Patient and Equipment related

INOP tables.

Miscellaneous

Median Value Updated every 15 seconds Automatic Annotation Measurement point changes and lead

changes

Manual Annotation Available to user using Events A to D.

14-72 ECG and ECG/Respiration Module Section

Agilent M1165, M1166, M1167, M1175, M1176 User reference manual (Vol.2)

Specifications and Main Features

Frequently Asked Questions

User Manual

ECG and ECG/Respiration Module Section 14-1