Danmeter CSM 2 User Manual

Cerebral State Monitor

Model CSM 2

User Manual

Rx only

Danmeter A/S
Kildemosevej 13, DK-5000 Odense C, Denmark
Tel.: [phone]
Fax: [phone]
e-mail: [e-mail]
www.danmeter.com

Table of Contents

1 About this Manual .............................................................................................................................1

1.1 Device description ..................................................................................................................1

1.2 Indications for Use..................................................................................................................1

1.3 List of Symbols .......................................................................................................................2

2 Installation and Preparation..............................................................................................................2

3 Skin Preparation and Sensor Positioning..........................................................................................3

4 Description of the Device ..................................................................................................................4

4.1 General Overview....................................................................................................................4

4.2 Keys and Controls Overview....................................................................................................5

4.3 Light Indicators.......................................................................................................................6

4.4 Description of Keys.................................................................................................................6

4.5 Operation Display Modes........................................................................................................ 7

4.6 Setup Menu.............................................................................................................................9

4.7 Settings.................................................................................................................................10

4.8 Events...................................................................................................................................11

4.9 CSM Parameters ...................................................................................................................12

5 Principle of Operation .....................................................................................................................14

5.1 High Quality Amplifier............................................................................................................14

5.2 Measurement Principle.........................................................................................................14

5.3 CSI Scale...............................................................................................................................15

5.4 EMG ......................................................................................................................................16

5.5 Burst Suppression Indicator .................................................................................................16

5.6 Artifact and Noise Control.....................................................................................................16

6 CSM Battery / CSM Power Operation...............................................................................................17

6.1 Using CSM Power and CSM Rechargeable Batteries.............................................................17

7 Data Recording via CSM Link...........................................................................................................18

7 Data Recording via CSM Link...........................................................................................................19

7.1 CSM Link Software ................................................................................................................19

7.2 CSM Link ....................................................................................................................... ........19

8 Specifications ..................................................................................................................................21

9 Accessories.....................................................................................................................................22

10 Maintenance....................................................................................................................................22

11 Troubleshooting..............................................................................................................................24

12 System and Error Messages ...........................................................................................................26

13 Safety and Warranty........................................................................................................................26

14 Service and Contacts.......................................................................................................................28

15 Technical description.......................................................................................................................30

This manual is published by Danmeter A/S, who reserves the right to improve and modify the
contents without prior notice. Modifications will, however, be published in future editions. All rights
reserved.

Cerebral State Monitor, CSM & CSI are trademarks of Danmeter A/S
Products manufactured by Danmeter A/S, Kildemosevej 13, DK-5000 Odense C, Denmark

US-English
PN 561105003-04

Declaration of Conformity:

Danmeter A/S hereby declares that the Cerebral State Monitor complies with the following
standards:

 EN (IEC) 60601-1,
 EN (IEC) 60601-1-2,
 EN (IEC) 60601-2-26
 UL 60601-1:2003
 CAN/CSA-C22.2 No. 601.1-M90
 CAN/CSA-C22.2 No. 601.1S1-94
 CSA 601.1 Amendment 2:1998
 CAN/CSA 601-2-26

Cerebral State Monitor - CSM DFU Page 1

1 About this Manual

This manual is intended to assist the user in operating the Cerebral State Monitor (CSM) in a safe
and effective manner.

This version of the manual was originally drafted, approved and supplied by Danmeter A/S in English.

WARNINGS are directions which, if not followed, could cause fatal or serious injury to an

operator, patient or any other person.

CAUTIONS are directions which, if not followed, could cause damage to the equipment

described in this manual and/or any other equipment or goods, and/or cause
environmental pollution.

NOTES are intended to highlight unusual points as an aid to the operator.

1.1

Device description

The Cerebral State Monitor (CSM) is a non-invasive measurement tool for use by trained healthcare
professionals to measure the level of consciousness (LOC) in all areas of the hospital. Based on
EEG, an index (CSI) is calculated, which is used in the estimation of LOC. The CSM displays the CSI
but does not perform any data interpretation (i.e., all data interpretation is performed by a
physician).

1.2

Indications for Use

The monitor is intended for use in monitoring the hypnotic state of the brain by data acquisition of
EEG signals of the anesthetized or sedated patient in all areas of the hospital.

Before operating the monitor read this manual thoroughly, with particular attention to all
warnings and cautions.

Note:
Although the monitor is built and tested to exacting specifications, it is not intended to
replace the supervision of level of consciousness monitoring by medical personnel. The user
should become thoroughly familiar with the features, operations, and accessories of the
monitor and exercise vigilance in its utilization.

Caution:
Federal law (U.S.A.) restricts this device to sale, distribution, and use by or on the order of a

p

hysician.

Cerebral State Monitor - CSM DFU Page 2

1.3 List of Symbols

Type BF equipment

On / Off

Attention, consult accompanying documents

Do not dispose of in refuse collection. Dispose of at a recycling
station or equivalent in accordance with directive 2002-96-EC WEEE.

2 Installation and Preparation

The Cerebral State Monitor system CSM007 includes the following:

Cerebral State Monitor CSM Wireless Link
Patient Cable CSM Software CD
Rechargeable 9V Battery User manual (this document)
Power Adapter (2 pieces) Power Cable (2 pieces)
RS-232 Cable/USB Cable Carrying case
Velcro strip 1.7x0.9” Clip for patient cable

For replacement accessories, refer to chapter 9

Note
The performance of the CSM monitor by EEG acquisition, processing and calculation of the

CSM parameters and waveforms in the CSM monitor are ONLY guaranteed by the

manufacture when using the CSM Procedure Pack, part no. DMX005.

The possibility to use standard ECG electrodes is NOT RECOMMENDED

Cerebral State Monitor - CSM DFU Page 3

3 Skin Preparation and Sensor Positioning

To ensure low sensor impedance, clean skin with mild soap and water is recommended as a skin
cleanser.

The CSM Procedure Pack contains a skin preparation product and 3 neuro sensors.

Dry-abrade the skin gently using the skin prep product or with a dry wash cloth or gauze, to remove
the non-conductive skin layer. See diagram below.

Position of the three sensors from your CSM Procedure Pack according the diagram below

Shown above is a left sided setup; right sided is also acceptable. Place sensors at the side farthest
from the surgical area.

The advanced signal processing of the monitor ensures that a deviation in the positioning of the
sensors up to 2 cm (0.78 in) has no significant influence on the index. However, it is recommended
to place the sensors on an area of the skull where only a few muscle fibers are present in order to
achieve the best quality signal.

Middle of forehead
Left side of forehead
Mastoid left side

Note: Alcohol is not recommended as a skin cleanser; it leaves a film layer that may cause
high sensor impedance. If alcohol is used, ensure 30 second dry time.

Caution:

-

Make sure no part of the sensors is in contact with any other conductive parts including
earth/ground.

-

If skin rash or other unusual symptoms develop, remove sensors from patient.

-

Change sensors every 24 hours to check skin integrity.

Note: Once the sensors have been secured on the skin, attach the color-coded wires on the
patient cable to appropriate sensor.

Note: The performance of the CSM is only guaranteed by the manufacturer when the CSM
Procedure Pack is used.

Cerebral State Monitor - CSM DFU Page 4

4 Description of the Device

4.1 General Overview

Battery lid

Battery
compartment

Patient cable

connection

CSM

power/charge

connection

On/Off

­+

Cerebral State Monitor - CSM DFU Page 5

4.2 Keys and Controls Overview

2
RED Error
light

Error

Charge

Mute

Set

Display

Event

3
GREEN Power
adapter

5
Mute
key

7
Display
key

1
On/Off

4
Display
area

6
Set Event
key

8
Event Type
key

9
Control
key

Cerebral State Monitor - CSM DFU Page 6

4.3 Light Indicators

2 RED Error light
Lights up when neuro sensor error situations are detected

3 Lights when power adapter is connected

4.4 Description of Keys

1 Power On

Press once

1 Power Off

Press and hold until “Power Off” bar disappears

1 Wireless Link connection, disconnection or reconnection

Press twice within 1 second

5 Mute key Mutes alarms

6 Set Event key / Set link

7 Display key

Changes between graphical and information screen

7a - For immediate impedance update. Press down firmly for one second

8 Event key

Select event type / Select link (accessory)

9 Control key

Used for menu selection of parameter settings

9a - Use the Control key to scroll in the menus or set values

9b - Select a submenu or function

9c - Go back one menu level

Cerebral State Monitor - CSM DFU Page 7

4.5 Operation Display Modes

The CSM always starts with display A
Switch between display A, B, C, D and E by pressing the Display key (7).

Display Mode D

CSI trend histogram with 5-minute interval showing average, lowest and highest
CSI values within the interval. EMG% is displayed as a bar in the right panel

Display Mode C

CSI trend curve with event markers and BS curve. EMG% is displayed as a bar in
the right panel. Operation time and numeric value of the actual CSI and BS%. The
time scale for the trend curve is 5.27 minutes and each tag is 60 seconds

Display Mode B

Displays 3 seconds of EEG waveform. Use Event key (8) to scale up and down. EEG
scales are ±200μV, ±100μV (default), ±50μV, ±20μV and ±10μV

Display Mode A

Main information window with CSI, BS%, EMG%, SQI%, clock, operation time and
battery operation.

Display Mode E

.

Sensor impedance, CSI, BS%, clock and operation time. When display E is active,
the sensor impedance is updated every 60 seconds. Press Display key (7a) firmly
for immediate impedance update

10:12:05

0:47:11

10:12:05

0:47:11

Cerebral State Monitor - CSM DFU Page 8

The EEG waveform derives from the signal recorded between the frontal and mastoid electrodes. The
frequency content is 2-35 Hz. If the EEG amplitude is low then in some conditions the ECG might be
detectable in the EEG waveform

EMG% is shown in the display as a bar in the right-hand side. Operating time and numerical value for
current CSI and BS%. The time scale for the histogram graph is 180 min. The interval between each
tag is 60 min. The high-low bar in the current time interval (high-low bar to the far right) is updated
dynamically.

Special display features

Artifact Sensor

alarm

CSI - - -?-

BS% - - -?-

EMG - - -?-

SQI SQI value -?-

Cerebral State Monitor - CSM DFU Page 9

4.6 Setup Menu

General menu structure and menu selections

Top Menu

BS% 0 47 CSI

Menu 1

Alarm

Config
Device information

How to select menu settings from Display Mode

1. Remove battery lid.

2. From any Display Mode, press any arrow on the Control key (9).

3. The top menu appears.

4.

Note:

The last menu used is chosen.

How to set parameter values

1. Press the Control key (9a) to select menu.

2. Press the Control key (9b) to enter submenu.

3. Press the Control key (9a) to select parameter.

4. Press the Control key (9b) to highlight parameter value.

5. Press the Control key (9a) to select parameter value.

6. Press the Control key (9b) to accept setting or (9c) to cancel the selection and return
without any change.

7. Press the Control key (9c) to go back in one menu level steps.

If the Control key has not been activated in 20 sec. the CSM returns to Operation Display Mode and
stores the settings.

Note:
The change of settings will only be stored for future use after returning to Operation
Display Modes.

Cerebral State Monitor - CSM DFU Page 10

4.7 Settings

Parameter Menu Description Values (Default)

High Alarm Alarm Selects the CSI Alarm High Option ON/OFF (OFF)

Low Alarm Alarm Selects the CSI Alarm Low Option ON/OFF (OFF)

High Limit Alarm Selects the CSI High Alarm Level 2-99

(60)

Low Limit Alarm Selects the CSI Low Alarm Level 1-98

(40)

Language Config Selects device language English

Contrast Config Selects display contrast 15-35

(20)

RF interface Config Select radio link active. If turned

OFF the link is completely inactive.

ON/OFF (ON)

Set clock Config Sets clock: Date Format, Year,

Month, Date, Hours, Minutes,
Seconds

Back light Config Sets display light and light

brightness

0 = Off
1 = Normal (1)
2 = Bright

AutoLNK Config Automatically establishes a

wireless link to any CSM link within
approx. 10 feet or to a specified
CSM link.

Inactive/Active/SN
(Inactive) SN is
only displayed if
link is established

The AutoLNK function

When AutoLNK is set to Inactive:

- active CSM Link(s) within range will pop-up in the Link display. Select the CSM Link serial

number you would like to connect to.

When AutoLNK is set to Active:

- active CSM Link within range will automatically be connected to CSM monitor

When AutoLNK is set to SN:

- CSM monitor automatically connects to the dedicated CSM Link if within range.

Cerebral State Monitor - CSM DFU Page 11

Device Information:
Select submenu.

BS% 0 47 CSI

Device information 1

Info

Link
Log

Info:

• Serial number.

• SW version.

• CSI version.

• AD version.

Link:

• - indicates no CSM Link connected.

• If CSM Link connected the CSM Link serial number and software version will be shown.

Log:

• Serial number.

• #1 total no. of CSM sessions.

• #2 total no. running hours.

4.8

Events

Pressing the Set Event key (6) results in a continuously numbered event with no description
displayed.
Pressing the Event Type key brings up the following selection menu:

BS% 0 47 CSI

Event types 1

Induction

Intubation
Maintenance

The following options event descriptions can be selected: Induction, Intubation, Maintenance,
Surgery, Injection, Note, End Maintenance and Movement.
When the desired option has been selected, press the Set Event key (6) to confirm. If no selection is
made within 5 seconds the system returns to the current Display Mode. Only the event numbers are
visible on Display Mode C. Event names will only be displayed when using the CSM Link option.

Events can be set with intervals of 3 seconds.

Cerebral State Monitor - CSM DFU Page 12

4.9 CSM Parameters

BS% Indicator
The amount of Burst Suppression (very low-amplitude or “flat” EEG) is displayed in all Display Modes
at the top left hand side. Please refer to Section 5.5 for further information on the BS%
measurement.

EMG% and EMG bar
The EMG level is displayed either as a numerical percentage (0-100%) value in Display Mode A or
graphically as a bar at the right hand side in Display Mode B. Please refer to Section 5.4 for further
information on the EMG measurement.

Signal Quality Indicator (SQI%)
SQI% measures the quality of the acquired EEG signal. The calculation is based on the number of
artifacts during the last minute. The electrode-to-skin impedance is included in the SQI% calculation.
Higher electrode-to-skin impedances reduces the SQI%. Only electrode-to-skin impedances at 1 and

1 kΩ will result in a SQI% at 100. This quantity is displayed numerically as a percentage (0-100%,
100% equals best signal quality) in Display Mode A.

If the impedance of the white or black sensors exceeds 1kΩ, the SQI will fall gradually. Poor
impedance conditions may cause the SQI to fall to 50%.

Sensor Impedance
The impedance of the white and black sensors is continuously measured and displayed in Display

Mode E. Low sensor impedance values (typically between 1 and 3 kΩ) are essential for good
monitor operation. A “<1kΩ” readout means that sensor impedance is optimal.

Sensor Alarm

The Sensor Alarm signals the interruption of reliable CSI calculation due to corrupted or interrupted
EEG. This is usually caused by the use of diathermia or a faulty sensor connection (high sensor
impedance or disconnection of sensor leads). Should any of these situations occur, the Red Error
light (2) will turn on. The CSI is not calculated during these periods, but is replaced by

-?-.

Alarms (High / Low)
Alarms can be set to signal the moment when the CSI rises above and/or falls below preset limits.
The High and Low Alarms can be turned on or off from the Alarm Menu, where the High and Low
Alarm limits can also be set. The High Alarm is ONLY activated when the current CSI has been lower
than the High Alarm value. This is convenient when the High Alarm is set in the awake patient. If High
Alarm is set to 60 and High Alarm ON, then the CSI must be lower than 60 once before the High
Alarm is activated. If the current CSI goes higher than 60 the CSM monitor alarm sounds.
Same functionality is present for Alarm Low.

Cerebral State Monitor - CSM DFU Page 13

Battery Symbol
An icon labelled “BAT” in Display Mode A indicates the remaining battery capacity. For further
information on battery operation of the CSM, please see section 6.

Battery about 50-percent charged

Battery charging when icon animates

Battery fully charged (if not animated)

LINK Signal Symbol
An icon labelled “LNK” in Display Mode E indicates the state of the data transfer connection via the
CSM Link. For further information on the CSM Link feature, please see section 7.

Acoustic signals
Start-up 3 beeps
Event 1 beep
Alarm (High/Low) 2 beeps per sec. (Mute = mute 60 sec.)
Low Battery 2 beeps per sec. (Mute = mute 60 sec.)

Note:
ONLY CSM Battery (CSMX04) will be charged in CSM Monitor

Cerebral State Monitor - CSM DFU Page 14

5 Principle of Operation

5.1 High Quality Amplifier

An instrumentation amplifier collects ongoing EEG with a high Common Mode Rejection Ratio
ensuring a high-quality EEG acquisition. Special artifact detection algorithms are used to eliminate
their effects on subsequent CSI calculations.

5.2

Measurement Principle

The performance of the CSM is based on the analysis of the frequency content of the EEG signal.

The energy of the EEG is evaluated in specific frequency bands. These are used to define two energy
ratios called alpha (α) and beta (β). Both of these show a shift in energy content from the higher to

the lower frequencies during anesthesia. The relationship between these quantities is also analysed
as a separate parameter (β-α).

Hz

Hz

ratio

E

E

126

5.4230

ln

−

−

=

α

Hz

Hz

ratio

E

E

2111

5.4230

ln

−

−

=

β

The monitor also on-line evaluates the amount of instantaneous burst suppression (BS) in each
thirty-second period of the EEG. This measurement quantifies the amount of “silent” or “flat” EEG
periods characteristic of the deepest levels of hypnosis.

These four parameters are used as input to a fuzzy logic classifier system that calculates the
Cerebral State Index.

FUZZY LOGIC

CLASSIFIER

CSI

β

ratio

BS%

α

ratio

β-α

EEG

Cerebral State Monitor - CSM DFU Page 15

5.3 CSI Scale

The CSI is a unit-less scale from 0 to 100, where 0 indicates a flat EEG and 100 indicates EEG
activity corresponding to the awake state. The range of adequate anesthesia is designed to be
between 40 and 60. All values in the table are approximate values based on the mean values of the
patient behaviour.

The relationship among the CSI, the clinical state and the OAAS

1

score is shown in the table below
CSI Clinical State OAAS
90 – 100 Awake 5
80 – 90 Drowsy 4
60 – 80 Light anesthesia or sedation 3

40 – 60

Range considered as adequate for
surgical anesthesia

2-1

10 – 40

Deep anesthesia, in most cases
accompanied by burst suppression

1

0 – 10

Close to coma, BS (burst suppression)
larger than 75. When CSI is below 3,
the EEG is practically iso-electric.

<1

The prediction probability (Pk) between the CSI and the OAAS was 0.92

The OAAS score correspond to:

OAAS

Clinical State
5 Responds readily to name spoken in normal tone
4 Lethargic response to name spoken in normal tone
3 Responds only after name called loudly and/or repeatedly
2 Does not respond to mild prodding or shaking
1 Does not respond to noxious stimulus

1

Observers Assessment of Alertness and Sedation

Cerebral State Monitor - CSM DFU Page 16

5.4 EMG

High levels of facial muscular or electromyographic (EMG) activity can interfere with the CSI under
certain circumstances. The monitor incorporates an EMG filter that removes most of the potential
interfering EMG activity. The EMG bar shows the energy of the EMG level in the 75–85 Hz frequency
band (0–100 logarithmic). The bar is located on the right side of the display.
EMG activity is expected to be present when the patient is awake. When the patient is asleep, EMG
activity can increase due to:

• Reflex reactions to painful stimuli during surgery.

• Lack of muscular relaxation.

• Muscular rigidity caused by some opioids (analgesics).

• Presence of large external electrical fields, e.g. diathermy.

The EMG bar should be checked frequently, especially in case of a sudden increase in the CSI. If the
increase in CSI is accompanied by an increase in muscular activity, there is a risk that EMG is causing
interference. When this happens, attention must be paid to the stimuli received by the patient during
surgery. In the presence of hypnotically unrelated EMG, administration of a neuromuscular blocking
agent will cause the CSI to decrease. Since patients receiving neuromuscular blocking agents cannot
exhibit movement as a sign of arousal, the CSI is a valuable tool in their anesthetic management.

5.5

Burst Suppression Indicator

The monitor includes a Burst Suppression indicator to show periods when the EEG is iso-electric or
“flat”. The indication appears in the upper left-hand side of the graph window in the display and
shows the percentage of burst suppression over the last 30 seconds of the EEG signal. A BS% = 20
readouts means that the EEG has been iso-electric during 20% of the last 30 seconds.

5.6

Artifact and Noise Control

The artifact rejection algorithm ensures that the incoming EEG is not contaminated with noise. When
excessive noise is detected, the signal quality index is reduced reflecting the disturbance. The
artifact rejection algorithm will be active especially when diathermy and equipment creating external
interference is used.

Cerebral State Monitor - CSM DFU Page 17

6 CSM Battery / CSM Power Operation

6.1 Using CSM Power and CSM Rechargeable Batteries

The CSM can be operated in two different modes

• Battery operated

• CSM Power operated

Warning:
Only standard CSM rechargeable battery CSMX04 or alkaline batteries must be used.

Battery operation (Alkaline batteries)

• Always use new Alkaline batteries to ensure best results

• Insert battery correctly

CSM Power operation and CSM rechargeable batteries

Warning:
Only for use with adapter CSMX05 (Ault Inc., Model MW117)

Note:
There is no alarm if the battery is not connected. If no battery is inserted, the monitor is switched off
when the external CSM Power is removed. There is no internal back-up battery in the monitor.

Note:
The clock is powered by an internal battery with a limited life (minimum 6 years from date of
manufacture). When the battery is used up, the clock will be reset, and the clock will blink on start
up. The monitor should then be sent for service.

Note:
To maintain and fully maximize the rechargeable battery lifetime, always connect the monitor to the
CSM Power when the device is not in use.

Battery Lifetime (Fully charged CSMX04 only at normal operation)

Wireless Link Backlight level Life time (hours)

OFF OFF 10.5
OFF 1 9.0
OFF 2 7.0

ON OFF 10.0
ON 1 8.5
ON 2 6.5

Note:
Using 9V alkaline disposable
batteries the battery life time
indicated in the table can be
multiplied by 2 to 3.

Cerebral State Monitor - CSM DFU Page 18

CSM Power

1. Insert the CSM rechargeable battery as indicated

2. Connect power cable to outlet and turn on power

3. Green indicator (3) lights up

4. Turn on monitor

5. When the CSM is connected to an electrical outlet, and turned on, the CSM can be
operated while the CSM battery is charged. If power is disconnected the CSM will continue
running on the CSM battery.

Electrical Operation Only

The CSM can be operated on mains with the CSM Power, with or without any type of approved
battery inserted.

7

Connect to power cable

Connect to CSM Power connection

Note:

W

hen CSM rechargeable battery (CSMX04) is used, it will charge automatically while the
electrical power is connected. ONLY CSM Battery (CSMX04) will be charged in the CSM
monitor.

Cerebral State Monitor - CSM DFU Page 19

Data Recording via CSM Link

7.1 CSM Link Software

The real-time data capturing software for the Cerebral State Monitor makes it possible to record
online data wireless via the CSM Link. The following data is recorded:

• CSI

• BS

• EMG

• Sensor impedance

• SQI

• EEG

CSM automatically saves the last 18 hours of data and a maximum of 10 cases, independent of the
state of the wireless link (on or off)

7.2

CSM Link

Description of CSM Link Indicators:

Power: Power
Link: Flashing: Link Selected
Constant: Link established

Connector power adapter

Connector for PC/Terminal

Link status indicator
Power indicator

Cerebral State Monitor - CSM DFU Page 20

Connecting CSM Monitor and CSM Link

1. Turn on the CSM Link.

2. Power indicator shows a constant light.

3. Link indicator is off.

4. Turn on the CSM monitor.

5. The CSM monitor shows a list of CSM Links found.

6. Select CSM Link ID (Serial No.) with the Event key (8) and the indicator Link flashes,
or choose skip in order not to establish a connection. (The radio is reactivated by
pressing the Power On key (1) twice or the next time the CSM is switched on.)

7. Accept the CSM Link by pressing the Set Event key (6).

8. When link has been established the indicator Link will show a constant light.

Disconnecting CSM Monitor and CSM Link

1. Press Power On key twice within one second.

2. Highlight release using Event key (8).

3. Press Set Event key (6) to disconnect. CSM radio is inactive. (The radio is reactivated
by pressing the Power On key (1) twice or the next time the CSM is switched on.)

Connecting to CSM Link when the CSM radio is inactive

1. Turn on the CSM Link.

2. Power indicator shows a constant light.

3. LINK indicator is off.

4. Press Power On key twice within one second.

5. The CSM monitor shows a list of CSM Links found.

6. Select CSM Link ID (Serial No.) with the Event key (8) and the indicator Link flashes,
or choose skip in order not to establish a connection.

7. Accept the CSM Link by pressing the Set Event key (6).

8. When link has been established the indicator Link will show a constant

light.

Note:
If wireless has been active for more than five minutes without any connection to CSM-Link,
the radio is inactivated.

Cerebral State Monitor - CSM DFU Page 21

8 Specifications

EEG sensitivity ±400μV
Noise < 2μV

p-p

, < 0.4μV RMS, 1–250 Hz
CMRR >140dB
Input impedance >50Mohm
Sample rate 2000 samples/sec. (14 bits equivalent)
CSI and update 0-100. Filter 6-42 Hz, 1 sec. update
EMG 0-100 logarithmic. Filter 75-85 Hz, 1 sec. update
BS% 0-100%. Filter 2-42 Hz, 1 sec. update
Digital output Wireless to RS232 link or USB (ISM 2.4 GHz)
Wireless range Up to 10 meters
Display size 1.3 x 0.7”
Alarms High / Low with user selectable limit
Artifact rejection Automatic
Sensor impedance range 0-10kOhm / measurement current 0,01μA
Battery Rechargeable NiMH or 9V Alkaline

(6AM6/IEC:6LR61/ANSI:1604A )
Supply current 30mA (typical)
Max. battery lifetime - Alkaline 30h (stand alone)

18h (transmitting wireless)
Max. battery lifetime –
Rechargeable

See table in section 6.1

Recharge time 4 Hours (CSMX04 only)
Weight

4.6 ounces (130 g) with battery

Dimensions 4.6x2.7x1.2”
Classification Internal power supply/ Class II, type BF, continuous use
Sensors Danmeter Neuro Sensors
Cable length 77” with 14” split
Mounting options Velcro strip 1.7x0.9”
Memory Data recording 18 hours
Environment – Operation

Temperature 50–104°F

Rel. humidity 30–75%

Air pressure 700–1060 hPa
Environment – Transport
and storage

Temperature 50–104°F *

Rel. humidity 30–95%

Air pressure 700–1060 hPa
* If transport without sensors: -4–158°F

Cerebral State Monitor - CSM DFU Page 22

9 Accessories

CSMX04 CSM rechargeable battery
CSMX05 CSM Power/Charger
CSMX06 Patient cable
CSMX09 Carrying case
CSMX10 Service manual, English
CSMX11 CSM Link Software
CSMX12 CSM Link RS232
CSMX19 CSM Link USB
CSMX18 CSM Link PHILIPS VOI
CSMX13 Velcro Strip (1.7x0.9”)
DMX004 RS-232 cable
DMX013 USB cable
DMX005 CSM Procedure Pack
DMX007 Clip for patient cable
CSMIUS User Manual

10 Maintenance

Routine Maintenance

To ensure the monitor remains in good operating condition, it is important to keep it clean and carry
out the routine maintenance procedures described below. There are no serviceable parts in this
instrument and all service is to be carried out by the manufacturer.

Interval Routine Maintenance Procedure
As required Clean the external surfaces of the monitor thoroughly before and

after a prolonged period of storage

Every 12 months 1. Inspect power adapter plug and cable for damage.

2.Perform electrical safety checks (including leakage current
measurement)

Note:
If the monitor is dropped, damaged or subjected to excessive moisture or high temperature, it
should immediately be taken out of service for examination by qualified service personnel.

Cerebral State Monitor - CSM DFU Page 23

Cleaning

Clean the monitor periodically by wiping the outer case with a lint-free cloth lightly moistened with
warm water and a mild, non-abrasive cleaning solution or 70% isopropyl alcohol.

Same solutions can be used for cleaning the patient cable.

Storage

If the monitor is to be stored for a longer period, it should first be cleaned and the battery removed.
Store in a clean, dry atmosphere at room temperature and, if available, use the original packaging
for protection.

Fuses

Disposal

The monitor should be disposed of taking into consideration environmental factors, local laws and
regulations. All components can be safely disposed of in the approved manner as per hospital or
locally regulated guidelines.
Remove battery, if any, before disposal.

Test Routines

Refer to guide for biomeds.

Note
The monitor case is resistant to the following cleaning solutions:

• Renu-klenz 16ml/L (Steris corp., USA)

• Vesphene Iise 8ml/L (Steris corp., USA)

• Warm water

• Isopropyl alcohol 99%

• Acetone 10%

• Hydrogen peroxide 3%

Caution:
No user- replaceable fuses in the monitor or CSM power

Cerebral State Monitor - CSM DFU Page 24

11 Troubleshooting

• CSM does not turn on when power key is pressed?

Change to a new battery or a fully recharged battery.
If changing the battery does not help, send the CSM for service.

• Rechargeable Battery seems to have a diminished user time

1. Turn on the monitor without patient cable and no CSM Power attached.

2. Wait until the monitor turns off (rechargeable battery discharged).

3. Connect CSM Power for minimum 4 hours to fully recharge.

• Sensor alarm – Red Error light turns on and CSI, BS and EMG replaced by -?-

Check all neuro sensors and their connections. This alarm can also be caused by
diathermy – see section 5.6.
Check the patient cable.
If not connected, then connect it.
If faulty, replace patient cable.

Check if either of the neuro sensors are disconnected or badly connected.
Replace faulty sensor

• Blanked index – but why?

Sensor impedance too high
If sensor impedance is >5kΩ the CSI, BS and EMG will be blanked (- - displayed).
Check that neuro sensors are not dry.
Check that the skin has been cleaned properly.
Clean and prep skin as described in section 3 and attach new neuro sensors.

Signal Quality Index (SQI) low

If the impedance of the white or black sensors exceeds 1kΩ, the SQI will fall gradually.

Poor impedance conditions may cause the SQI to fall to 50%.
Artifacts can have many causes: diathermy, EMG, etc. are typical causes.
If SQI falls because of extensive use of diathermy, it will rise as soon as the diathermy is
stopped.
Check that all neuro sensors and cable connections are correctly connected.
Has the use of any mechanical device that could generate high frequency activity (e.g.
patient warmer) been initiated or is any such device in close proximity to the CSM neuro
sensors?
If possible move disturbing device away from the neuro sensors.
Check grounding of disturbing device.
Reduce the influence from disturbing device by disconnecting CSM Power to let the CSM
run from the battery.

Cerebral State Monitor - CSM DFU Page 25

• CSI is higher than expected

Check anesthetic delivery systems: IV lines and status of vaporizers.

Some patients require a higher dose of drugs due to interpatient variability.

Adequate dosing for maintenance may not be sufficient for increased stimulation.

• CSI rises along with EMG

High levels of facial muscular or electromyographic (EMG) activity can elevate the CSI
under certain circumstances. When this happens, attention must be paid to the stimuli
received by the patient during surgery. When the patient is asleep, EMG activity can
increase due to reflex reactions to painful stimuli during surgery, lack of muscular
relaxation or muscular rigidity caused by some opioids (analgesics). In the presence of
hypnotically unrelated EMG, administration of a neuromuscular blocking agent may cause
the CSI to decrease.

• Communication

POWER indicator on CSM Link does not turn on when power is connected
Check power connection.
Replace power cable or try alternate outlet. If POWER indicator is still not on, send CSM
Link for service

LINK indicator on CSM Link Does not turn on
Check that this actual CSM Link is chosen on the CSM.
If CSM cannot find the CSM Link:
Relocate CSM Link to obtain better signal quality.
Turn on RF communication in the CSM.

CSM and CSM Link are connected but no data appears on recording terminal
Check that the RS-232 or USB cable is connected.
Check that the recording terminal has the right setup.

Note:
Facial muscles will recover sooner than skeletal muscles.
When these artifacts are present, the CSI should be interpreted with caution.

Cerebral State Monitor - CSM DFU Page 26

12 System and Error Messages

For error codes (1-10 and 14) shown in the display, contact the appropriate service or distribution
center. See section 14.

Together with the error code an audible alarm is activated.

Error codes 11, 12 and 13 can occur if the patient cable or the electrodes are connected while the
CSM is performing the start up check. Take the following action:

1. Turn off the CSM.

2. Disconnect patient cable.

3. Turn on the CSM

4. When the start up check has finished, connect the patient cable for normal operation.

13 Safety and Warranty

Warnings

• Not to be used in the presence of flammable gases; explosion risk.

• When used with High Frequency (HF) surgery please note the positioning of the neuro

sensors (see page 3). In order to reduce the hazard of burns, the neuro sensors should
not be located between the surgical site and the electro-surgical unit return neuro sensor.

• Pay attention if the monitor is connected to a patient connected to other equipment. The
total of leakage current may exceed the allowable limit and cause a possible hazard to the
patient.

• The conductive parts of neuro sensors and their connectors, including the neutral neuro
sensor, should not contact other conductive parts including earth.

Precautions

• The monitor should be used in conjunction with other patient monitoring parameters and
clinical signs. This will ensure the optimum balance of the anesthesia/sedation
administration.

• Do not open the instrument case. There are no user-serviceable parts inside. The case
should only be opened by qualified service personnel using proper grounding techniques.
When the case is opened, an electrical shock hazard exists which can result in serious
injury to persons and instrument component damage.

• Disconnect from battery power when performing maintenance.

• Should an instrument be dropped or severely shaken, it should immediately be taken out

of service and inspected by qualified service personnel to ensure its proper function prior
to use.

Cerebral State Monitor - CSM DFU Page 27

• Operating the monitor close to equipment radiating high-energy radio frequencies
(electrosurgical/cauterizing equipment, portable radios, cellular telephones, etc.) may
cause signal disturbance. If this happens, reposition the monitor away from the source of
interference. See section 5.6 for additional information on artifacts.

• Do not allow fluids to spill or drip on the monitor.

• Do not use the monitor when cardiac defibrillator is used.

• Patient cables are not protected against defibrillation.

Special Patient Populations

 The monitor will not render accurate readings when used on patients with severe

neurological disorders and patients under 2 years of age.

 The use of pacemakers might cause either long periods of artifacts or elevated CSI values

 Exclusion criteria are weight less than 70% or more than 130% of ideal body weight,

neurological disorder, and recent use of psycho-active medication, including alcohol

Warranty

DANMETER warrants that:

• The monitor is free from defects in material and workmanship under normal use and service for
a period of 24 months from the date of delivery by Danmeter to the first purchaser.

• Accessories are free from defects in material and workmanship under normal use and service
for a period of ninety (90) days from the date of delivery by Danmeter to the first purchaser.

If any product requires service during the applicable warranty period, the purchaser should
communicate directly with the local Danmeter service center to determine the appropriate repair
facility. Repair or replacement will be carried out at Danmeter’s expense, subject to the terms of this
warranty. The product requiring service should be returned promptly, properly packed, and postage
prepaid. Loss or damage in return shipment to Danmeter shall be at purchaser's risk.
In no event shall Danmeter be liable for any incidental, indirect or consequential damages in
connection with the purchase or use of any Danmeter product.

This shall apply solely to the original purchaser. This warranty shall not apply to any subsequent
owner or holder of the product. Furthermore, this warranty shall not apply to, and Danmeter shall
not be responsible for any loss arising in connection with the purchase or use of any Danmeter
product that has been:

• repaired by anyone other than an authorized Danmeter service representative

• altered in any way so as, in Danmeter's judgment, to affect its stability or reliability

• subject to misuse or negligence or accident, or which has had the serial or lot number altered,

effaced or removed; or

• improperly maintained or used in any manner other than in accordance with the instructions
furnished by Danmeter

Cerebral State Monitor - CSM DFU Page 28

This warranty is in lieu of all other warranties, expressed or implied, and of all other obligations or

liabilities of Danmeter, and Danmeter does not give or grant, directly or indirectly, the authority to
any representative or other person to assume on behalf of Danmeter any other liability in connection
with the sale of Danmeter products.

DANMETER DISCLAIMS ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING ANY
WARRANTY OF MERCHANTABILITY OR FOR FUNCTION OF FITNESS FOR A PARTICULAR PURPOSE OR
APPLICATION.

14 Service and Contacts

For service, please contact Danmeter or the appropriate service or distribution center to obtain a
unique Service ID number for the CSM.

• Before returning the device for service please carry out the following:

Carefully describe what is wrong with the monitor.
Clean the monitor before shipping it.
Use only original packaging for return shipment.
Include all accessories used when error occurred except used neuro sensors.

Return the Monitor to Danmeter A/S or appropriate service or distribution center.

Head office:
Danmeter A/S
Kildemosevej 13
DK-5000 Odense C
Denmark
Tel. [phone]
Fax: [phone]
Email:

[e-mail]

www.danmeter.dk

Note:
The Cerebral State Monitor (CSM) can only be returned with assigned Service ID number.

Cerebral State Monitor - CSM DFU Page 29

Notes

Cerebral State Monitor - CSM DFU Page 30

15 Technical description

Guidance and manufacturer’s declaration — electromagnetic emissions

The Cerebral State Monitor CSM is intended for use in the electromagnetic environment specified below. The
customer or the user of the CSM should assure that it is used in such an environment.

Emissions test Compliance

Electromagnetic environment —
guidance

RF emission
CISPR 11

Group 1

The Cerebral State Monitor CSM uses
RF energy only for its internal function.
Therefore, its RF emissions are very
low and are not likely to cause any
interference in nearby electronic
equipment.

RF emission
CISPR 11

Class B

Harmonic emission
IEC / EN 61000-3-2

Not Applicable

Voltage fluctuations/
flicker emissions
IEC / EN 61000-3-3

Not Applicable

The Cerebral State Monitor CSM is
suitable for use in all establishments,
including domestic establishments and
those directly connected to the public
low-voltage power supply network that
supplies buildings used for domestic
purposes.

Guidance and manufacturer’s declaration — electromagnetic immunity

The CSM is intended for use in the electromagnetic environment specified below. The customer or the user
of the CSM should assure that it is used in such an environment,

Immunity test IEC / EN 60601

test level

Compliance level

Electromagnetic
environment –
guidance

Electrostatic
discharge (ESD)

IEC / EN 61000-4-2

±6 kV contact
±8 kV air

±6 kV contact
±8 kV air

Floors should be
wood, concrete or
ceramic tile. If floors
are covered with
synthetic material, the
relative humidity
should be at least
30%.

Electrical fast
transient/burst

IEC / EN 61000-4-4

±2 kV for power
supply lines

±1 kV for
input/output lines

Not Applicable

Mains power quality
should be that of a
typical commercial or
hospital environment.

Surge
IEC / EN 61000-4-5

±1 kV differential
mode

Not Applicable

Mains power quality
should be that of a

Cerebral State Monitor - CSM DFU Page 31

±2 kV common
mode

typical commercial or
hospital environment.

Voltage dips, short
interruptions and
voltage variations on
power supply lines

IEC / EN 61000-4­11

<5%

U

T

(>95 % dip in

U

T

)

for 0.5 cycles

40%

U

T

(60 % dip in

U

T

)

for 5 cycles

70%

U

T

(30 % dip in

U

T

)

for 25 cycles

<5%

U

T

(>95 % dip in

U

T

)

for 5 sec.

Not Applicable

Power quality should
be that of a typical
commercial or hospital
environment. If the
user of the CSM
requires continued
operation during
power mains
interruptions, it is
recommended that the
CSM be powered from
an uninterruptible
power supply or a
battery.

Power frequency
(50/60 Hz)
magnetic field
IEC / EN 61000-4-8

3 A/m Not Applicable

Power frequency
magnetic fields should
be at levels
characteristic of a
typical location in a
typical commercial or
hospital environment.

NOTE

U

T

is the a.c. power voltage prior to application of the test level

Guidance and manufacturer’s declaration — electromagnetic immunity

The CSM is intended for use in the electromagnetic environment specified below. The customer or the user
of the CSM should assure that it is used in such an environment,

Immunity test

IEC / EN
60601

test level

Compliance
level

Electromagnetic environment –
guidance

Portable and mobile RF
communications equipment should
be used no closer to any parts of
the Cerebral State Monitor CSM,
including cables, than the
recommended separation distance
calculated from the equation
applicable to the frequency of the
transmitter.

Cerebral State Monitor - CSM DFU Page 32

Conducted RF
IEC / EN 61000-

4-6

Radiated RF
IEC / EN 61000-

4-3

3 Vrms
150kHz to 80

MHz

3 V/m
80 MHz to 2,5

MHz

3 Vrms

3 V/m

Recommended separation distance

Pd 2,1=

Pd 2,1= 80 MHz to 800

MHz

Pd 3,2= 800 MHz to

2,5 GHz

where P is the maximum output
power rating of the transmitter in
watts (W) according to the
transmitter manufacturer and d is
the recommended separation
distance in meters (m).

Field strengths from fixed RF
transmitters, as determined by an
electromagnetic site survey, (a)
should be less than the compliance
level in each frequency range (b)

Interference may occur in the
vicinity of equipment marked with
the following symbol:

NOTE1 At 80 MHz and 800 MHz, the higher frequency range applies

NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by

absorption and reflection from structures, objects and people.

Cerebral State Monitor - CSM DFU Page 33

(a)

Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless)
telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV
broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic
environment due to fixed RF transmitters, an electromagnetic site survey should be considered.
If the measured field strength in the location in which the CSM Is used exceeds the applicable
RF compliance level above, the CSM should be observed to verify normal operation, If abnormal
performance is observed, additional measures may be necessary, such as reorienting or
relocating the CSM.

(b)

Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.

Recommended separation distances between portable and mobile RF communications equipment and the
CSM

The CSM is intended for use in an electromagnetic environment in which radiated RF disturbances are
controlled. The customer or the user of the CSM can help prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF communications equipment (transmitters)
and the CSM as recommended below, according to the maximum output power of the communications

Separation distance according to frequency of transmitter
m

Rated maximum
output power

of transmitter
W

150 kHz to 80 MHz

Pd 2,1=

80 MHz to 800 MHz

Pd 2,1=

800 MHz to 2,5 GHz

Pd 3,2=

0,01 0,12 0,12 0,23

0,1 0,38 0,38 0,73

1 1,2 1,2 2,3

10 3,8 3,8 7,3

100 12 12 23

For transmitters rated at a maximum output power not listed above, the recommended separation distance

d

in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where

P

is the maximum output power rating of the transmitter in watts (W) according to the transmitter
manufacturer.

NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.

NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by

absorption and reflection from structures, objects and people.