GE Cardioserv User manual

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CardioServ

Version 4.2

Operator’s Manual

227 446 32 Revision I

The product CardioServ bears the marking

-0459

(notified body GMED)

The authorized representative for GE Medical Systems Infor-

mation Technologies Inc. in Europe is:

indicating its conformity with the provisions of the Council

Directive 93/42/EEC concerning medical devices and fulfills

the essential requirements of Annex I of this directive.

The product complies with the electromagnetic immunity

requirements of standard IEC 60601-1-2/EN 60601-1-2

“Electromagnetic Compatibility – Medical Electrical Equip-

ment”.

The device is in radio-interference protection class B in

accordance with CISPR11/EN 55011.

The CE marking covers only the accessories listed in section

“Order Information and Accessories”.

This manual describes CardioServ with all options included

and reflects software version 4.13.

Revision History

This document is subject to the GE Medical Systems Information Technologies GmbH change order system.

The revision code, a letter that follows the document part number, changes with every update of the manual.

GE Medical Systems

Information Technologies GmbH

Munzinger Str. 3

D-79111 Freiburg, Germany

Tel. +49 (0) 7 61 45 43-0

Fax: +49 (0) 7 61 45 43-233

The country of manufacture appears on the device label.

Part No./Revision Code Date Comment

227 446 32 29 April 1997 Initial Release

227 446 32-A 14 May 1997 SW version 4.1

227 446 32-B 1 July 1997 ECO 202998

227 446 32-C 9 July 1998 ECO 060477

227 446 32-D 6 August 1999 ECO 062982

227 446 32-E 11 June 2001 ECO 066990

227 446 32-F 15 October 2003 ECO 074738

227 446 32-G 13 January 2004 ECO 075566

227 446 32-H 20 December 2004 ECO 079412

227 446 32-I 28 July 2005 ECO 080432

2 CardioServ V 4.2 227 446 32-I

Contents

1. Introduction to CardioServ

2. Controls and Indicators

3. Setup and Performance Test

4. Non-Synchronized Defibrillation

5 Cardioversion (Synchronized Defibrillation)

6. Displaying and Monitoring the ECG

7. The Memories of CardioServ

8. Recording

9. Oxygen Saturation SpO

10. Pacing

11. Configuring the Defibrillator Settings

12. Error Indications and Messages

13. Cleaning, Maintenance and Disposal

14. Technical Specifications

15. Order Information and Accessories

Appendix

Index

227 446 32-I CardioServ V 4.2 3

General Information

* This manual is an integral part of the instrument and

describes its normal use. It should always be kept close to

the equipment. Observance of the manual is a prerequi-

site for proper instrument performance and correct

operation and ensures patient and operator safety.

* The symbol

It serves as an indicator for important facts to be noted

when operating the instrument.

* Information which refers only to certain versions of the

instrument is accompanied by the part number(s) of the

instrument(s) concerned. The part number is given on

the instrument nameplate.

* Patient safety, specified measuring accuracy, and interfer-

ence-free operation can be guaranteed only if original

GEMS IT devices are interconnected (e.g. basic units

and plug-in modules).

* Only use accessories which are listed in this manual or

which have been tested in combination with the device

(e.g. patient cables, electrodes, transducers, sensors,

consumables, etc.). If you use accessories or consumables

from other manufacturers, GEMS IT does not guarantee

safe operation or functioning of the device.

denotes: Refer to Operator’s Manual!



* GEMS IT considers itself responsible for the effects on

safety, reliability, and performance of the equipment,

only if

– assembly operations, extensions, readjustments,

modifications, or repairs are carried out by

GEMS IT or by persons authorized by GEMS IT

– the instrument is used in accordance with the

instructions for use.

* All publications are in conformity with the instrument

specifications and IEC publications on safety of electro-

medical equipment valid at the time of printing. All

rights are reserved for instruments, circuits, techniques,

software programs and names appearing in the manual.

* On request GEMS IT will provide a service manual.

* The GEMS IT quality management system complies

with the standards DIN EN ISO 9001 and EN 46001.

* The warranty does not cover damage resulting from the

use of accessories and consumables from other manufac-

turers.

4 CardioServ V 4.2 227 446 32-I

Introduction to CardioServ

1. Introduction to CardioServ

This section describes

– The capabilities and applications of the CardioServ

defibrillator

– points to note when operating CardioServ

– general points to note when handling a defibrillator

227 446 32-I CardioServ V 4.2 5

Introduction to CardioServ

1.1 General Information

CardioServ is a high-voltage electrotherapy unit

which should be handled only by specially trained

Danger

personnel. Even though the defibrillator is

equipped with various safety features, such as

internal safety discharging, its operation by

unqualified staff could be hazardous to the

patient, the operator, and any assisting personnel.

The user instructions given in this manual refer to a

☞

CardioServ unit equipped with pacemaker and

SpO2 measuring system.

CardioServ is a light-weight, portable defibrillator with ECG

monitor and built-in recorder.

The device is designed for external and internal defibrillation.

It can be used both for semi-automatic and for manual defi-

brillation. Furthermore CardioServ is capable of monitoring

the heart rate with adjustable alarm limits.

CardioServ can be expanded with a transcutaneous pacemaker

and/or SpO2 measuring system which also monitors the

measured SpO2 values.

The device is easy and convenient to operate. Three operating

steps are sufficient to deliver the defibrillation shock. The

display can be turned 180° to allow the user to view the

information when the device is standing upright.

Defibrillation can be performed with standard defibrillation

paddles, defibrillation pads and internal electrodes.

In addition to line power operation, the defibrillator operates

on battery power from a slot-in rechargeable battery, and on

12-Volt power supplied from an emergency vehicle.

6 CardioServ V 4.2 227 446 32-I

Introduction to CardioServ

I/A

120

100

-20 0 2 4 6 8 10 12

Ra = 50 Ohm Ra = 100 Ohm Ra = 25 Ohm

L = 26 mH

C = 32 μF

R = 6,5 Ω

Figure 1-1. CardioServ current-discharge curve (360 J)

t/ms

CardioServ comes with three memories whose contents can

be documented individually:

– text memory (code summary documentation)

– event memory (16-s ECG)

– trend memory (trend plots of HR, SpO2, 45 min,

9 hours)

The built-in recorder is initiated automatically or manually.

Extensive safety precautions have been taken to protect the

patient and the user from inadvertent delivery of defibrillation

shocks.

The current-discharge curve corresponds to an approximate

sinusoidal halfwave with aperiodic decay. Figure 1-1 shows

the discharge curve for various external resistances.

227 446 32-I CardioServ V 4.2 7

1.2 For your Safety

Introduction to CardioServ

The safety information given below is divided into the catego-

ries “Danger”, “Warning” and “Caution”.

indicates an imminently hazardous situation

which, if not avoided, will result in death or

Danger

serious injury.

indicates a potentially hazardous situation which,

Warnin

if not avoided, could result in death or serious

injury.

indicates a potentially hazardous situation which,

if not avoided, may result in minor or moderate

Caution

injury and/or damage to the equipment.

provides application tips or other useful information

☞

to assure that you get the most from your equipment.

CardioServ is designed to comply with IEC 60601/

☞

EN60601 requirements. It is Class I equipment and

has an internal power source.

CardioServ operates on line voltages between 95

Warnin

and 240 Volts, 49 to 65 Hz. The mains plug

must be connected to an appropriate power supply

with a non-fused earthed wire. The use of exten-

sion cords is not permitted.

Before putting the device into operation, visually

Warnin

check all connecting cables and electrodes for signs

of damage. Damaged cables and electrodes must

be replaced immediately, before use.

When disconnecting the device from the power

Warnin

line, first remove the plug from the wall outlet.

Disconnect the device from the power line and

Warnin

operate it on battery power, if the integrity of the

protective earth conductor is in doubt.

Set up the device in a location which affords

sufficient ventilation. The ventilation openings of

Caution

the device must not be obstructed. The ambient

conditions specified in the “Technical Specifica-

tions” section must be ensured at all times.

8 CardioServ V 4.2 227 446 32-I

Introduction to CardioServ

Warnin

Danger

Warnin

Danger

Warnin

Caution

Devices intended for emergency application must

not be exposed to low temperatures during storage

and transport to avoid moisture condensation at

the application site. Wait until all moisture has

vaporized before using the device. Avoid using the

defibrillator under conditions where prolonged

exposure to or excessive contact with moisture can

occur.

Before putting the defibrillator into operation,

make sure that the paddles and all connection

cables are dry.

CardioServ is an emergency device and must be

ready for operation at any time. For this reason,

the defibrillator battery must always be charged.

This can be achieved by leaving the defibrillator

connected to the power line when it is not needed

in an environment where only battery operation

is possible.

Possible explosion hazard if used in the presence

of concentrated oxygen.

CardioServ is suitable for application in a humid

environment provided the regulations concerning

drip-proof equipment of IEC 60601 are strictly

observed. However, avoid defibrillation in a very

moist or wet environment, unless absolutely

necessary.

Use only the original GEMS IT batteries, as

these are designed for an extended temperature

range.

Magnetic and electrical fields are capable of

Warnin

interfering with the proper performance of the

device. For this reason make sure that all external

devices operated in the vicinity of the defibrillator

comply with the relevant EMC requirements. X-

ray equipment, MRI devices and radio systems

are a possible source of interference as they may

emit higher levels of electromagnetic radiation.

The defibrillator is designed for intracardiac appli-

☞

cation.

Devices may be connected to other devices or to

Warnin

parts of systems only when it has been made

certain that there is no danger to the patient, the

operators, or the environment as a result. In those

instances where there is any element of doubt

concerning the safety of connected devices, the

user must contact the manufacturers concerned or

other informed experts as to whether there is any

possible danger to the patient, the operator, or the

environment as a result of the proposed combina-

tion of devices. Standards IEC 60601-1-1/

EN 60601-1-1 must be complied with in all

cases.

Set up the device so that the operator has a clear,

☞

unobstructed view of the front panel.

Liquids must not be allowed to enter the device.

Warnin

Devices into which liquids have penetrated must

be immediately cleaned and checked by a service

technician.

227 446 32-I CardioServ V 4.2 9

Introduction to CardioServ

Danger

Caution

Warnin

Caution

Use only the original GEMS IT patient cables.

Do not connect other signal sources to the cables.

Patient signal inputs labelled with the

symbol are protected against damage resulting

from defibrillation and electrocautery voltages.

Nevertheless extreme care must be taken when

devices which are directly connected to the patient

remain applied during electrocautery or defibril-

lation. The distance between ECG electrodes

should be at least 15 cm. If in doubt, disconnect

the patient cable from the device while applying

the defibrillation pulse or performing

electrocautery.

For defibrillation of children use only the special

clip-on electrodes for children listed in section 15

“Order Information and Accessories”.

The full responsibility for the use of accessories

from other manufacturers lies with the user.

Check the device performance at regular intervals

(once a month), strictly following the instructions

given in section 3.2. Do not select high energy

levels for test discharges with defibrillation elec-

trodes shorted together.

At the end of its service life, CardioServ and its

accessories must be disposed of in compliance with

Caution

the special waste control regulations for electronic

parts. If you have any questions in this matter,

please contact GEMS IT GmbH.

Dispose of the packaging material, observing the

Warnin

applicable waste-control regulations and keeping

it out of children’s reach.

Literature

Medical Device Directive

EN 60601-1/1990 + A 1: 1993 + A2: 1995: Medical electrical

equipment. General requirements for safety

EN 60601-1-1/9.1994 + A1 12/1995: General requirements

for safety. Requirements for the safety of medical electrical

systems.

IEC Publication 513/1994: Fundamental aspects of safety

standards for medical equipment.

ROY, O.Z.: Summary of cardiac fibrillation thresholds for

60-Hz currents and voltages applied directly to the heart.

Med. & Biol. Engn. & Computing 18: 657...659 (1980).

For each defibrillation, verify that the selected

and the displayed/charged energy are identical.

Caution

CardioServ also operates on line power when the

☞

battery is depleted or missing.

10 CardioServ V 4.2 227 446 32-I

Introduction to CardioServ

General points to note when handling a defibrillator

Electromedical equipment such as the CardioServ

Warnin

defibrillator must only be handled by persons who

are trained in the use of such equipment and are

capable of applying it properly.

Before using the equipment, the operator must

Warnin

ascertain that it is in correct working order and

operating condition.

The defibrillator paddles must be clean and dry.

Danger

The person carrying out the defibrillation should

☞

have at least one assistant.

The operator must be trained in the use of the

Warnin

defibrillator.

All assistants must be briefed regarding the

Warnin

preparations for and execution of defibrillation.

All tasks must be assigned clearly.

Warnin

Defibrillating a patient with normal heart

rhythm may induce ventricular fibrillation.

Danger

Position the patient flat on a hard, dry surface

where the patient is electrically insulated. The

Caution

patient must not be allowed to come into contact

with metal parts, e.g., bed or litter, in order to

prevent unwanted pathways for the defibrillation

current which endanger the assistants. For the

same reason, do not place the patient on wet

ground (rain, accident in swimming pool).

Have a pacemaker at hand, if possible.

☞

Should cardiac arrest occur or be imminent during

☞

preparations for defibrillation, administer heart

massage and artificial respiration (CPR).

Do not allow the defibrillator paddles to come

into contact with other electrodes or metal parts

Danger

which are in contact with the patient.

Transducers and instruments that are not defi-

brillation-proof must be disconnected from the

Caution

patient.

Interrupt heart massage and artificial respiration

immediately before triggering the shock.

Danger

Immediately before triggering the shock discon-

nect tubes and have assistants step back.

Caution

227 446 32-I CardioServ V 4.2 11

Introduction to CardioServ

Caution

Danger

Warnin

Caution

The patient’s chest must be dry, as moisture causes

unwanted pathways for the defibrillation current.

Therefore, when using flammable skin cleansing

agents, wait until they have completely dried.

Possible explosion hazard if used in the presence

of concentrated oxygen, flammable substances

(gasoline) or anesthetic agents. Oxygenation in

the vicinity of the defibrillation paddles must be

strictly avoided; if necessary, interrupt oxygen

supply while defibrillating the patient.

To prevent sparking

– the electrodes should make full contact with

the body

– the electrodes should be pressed firmly onto

the thorax.

Do not deliver shocks into open air. High voltage

may briefly be present at the unprotected paddle

surfaces as a result and endanger the persons

present.

Warnin

Defibrillating a patient who has an implanted

pacemaker is likely to impair the pacemaker

function or cause damage to the pacemaker.

Therefore, the following should be observed:

– Select the smallest energy level possible for the

application.

– Do not apply the defibrillation paddles in the

vicinity of the pacemaker electrodes.

– The availability of an external pacemaker is

of utmost importance in this case.

– After the defibrillation the working order of

the implanted pacemaker should be checked

immediately.

Also be aware that children require less energy for

a successful defibrillation than adults. For the

first defibrillation pulse delivered to babies and

toddlers, select an energy level of 2 joules/kg body

weight. For subsequent shocks, increase the energy

up to 4 joules/kg.

When defibrillating children it is especially

important to verify that the paddles make full

Caution

contact with the body surface. This is to be ob-

served also when using the clip-on electrodes for

children (Part No. 303 439 95).

12 CardioServ V 4.2 227 446 32-I

Controls and Indicators

2. Controls and Indicators

This section describes the CardioServ operating controls and

indicators and explains their function.

When operating elements in this manual are identified with

a reference number in parentheses, this number refers to

Figure 2-1 in this section.

You will also find an explanation of all signs and symbols

used on the CardioServ defibrillator.

227 446 32-I CardioServ V 4.2 13

Controls and Indicators

Shock

STERNUM

J (50 )

102030

Autosequence

P/min

–

Dem

Fix

100

300

360

150

200

Shock

Charge

Shock

Sync

13 8 975

1 Select energy

Apply electrode cream to both paddles

Charge defibrillator

Press charge button on apex paddle (on the device, when using adhesive or internal electrodes)

Deliver shock3

Press buttons on both paddles simultaneously (on the device, when using adhesive or internal electrodes)

APEX

Charge

Shock

APEX

1418 17 16 15

Option

Figure 2-1. Controls and indicators of CardioServ

14 CardioServ V 4.2 227 446 32-I

SpO

EKG





Controls and Indicators

1 Defibrillator paddles

Shock

button to trigger the defibrillation shock – together

with button (8)

3 keys to adjust the LCD contrast. Press both

keys simultaneously to obtain a screen copy.

4 Energy selector, on/off switch

Charge

key to charge the unit (manual mode) and to

Shock

trigger the defibrillation shock – together with key (6). This key assumes the function of button (8) when internal paddles or adhesive electrodes are used.

Shock

key to trigger the defibrillation shock – together

with key (5). This key assumes the function of button (2) when internal paddles or adhesive electrodes are used.

7 Five selection keys F1 to F5 whose functions change

with the menu displayed. The respective key functions are indicated by symbols or labels in the bottom line on the LCD. From the main menu, that appears on power up, you can access submenus which, in turn, allow the selection of further options. The back function returns you to the next higher menu level. The main menu reappears automatically if you do not depress any of the keys for about 30 seconds.

button to charge the unit (manual mode) and

Charge

Shock

trigger the defibrillation shock – together with button (2)

11 key to start and stop the recorder. This key assumes

the function of button (9) when internal paddles or adhesive electrodes are used.

12 Green indicator is lit when the defibrillator operates

on line power.

13 Yellow indicator

is lit when the defibrillator battery

is being charged.

14 Connection for defibrillator paddles

(controls 15 to 18 only on models with pacemaker)

15 Keys

16 Keys

17 Pacing mode selection key

P/min

to adjust the pacer output

P/min

to adjust pacer rate

Dem

Fix

(demand/fixed rate)

18 Key to enable and disable the pacemaker

19 Aperture to open the paper compartment

20 Connector for power cord

21 Unassigned

22 1-Volt ECG output

23 Connector for SpO2 sensor

9 button to start and stop the recorder.

Sync

key to switch to the synchronized operating mode

24 Connector for patient cable (ECG signal input)

(section 5 “Cardioversion”)

227 446 32-I CardioServ V 4.2 15

Controls and Indicators

Explanation of the signs and symbols used on the defibrillator

Type CF equipment with highly insulated patient

connections, suitable for intracardiac application,

connections defibrillation-proof.

Type CF equipment with highly insulated patient

connections, suitable for intracardiac application,

connections not defibrillation-proof.

Standby mode (for line-power operation)

Power off

Battery charging

Recorder start

ECG signal

Contrast

Standby or preparatory state only for a part of the

equipment

On, only for a part of the equipment



Hardcopy of screen image

This symbol indicates that the waste of electrical

Refer to Operator’s Manual

and electronic equipment must not be disposed as

unsorted municipal waste and must be collected

separately. Please contact an authorized representa-

tive of the manufacturer for information concern-

ing the decommissioning of your equipment.

Direction indicator

Signal output

Audible alarm on/off

High voltage

16 CardioServ V 4.2 227 446 32-I

Setting Up CardioServ and Testing Its Performance

3. Setting Up CardioServ and Testing Its Performance

In this section you will find information about

– putting CardioServ into operation

– connecting CardioServ to the 12-Volt power supply of

an ambulance vehicle

– customizing the CardioServ settings to suit your per-

sonal requirements

– testing the CardioServ performance before using it on a

patient

227 446 32-I CardioServ V 4.2 17

Setting Up CardioServ and Testing Its Performance

3.1 Setting Up CardioServ

The defibrillator is a high-voltage electrotherapy

device and must be handled by qualified person-

Danger

nel only. Improper use of this device can endanger

life. Do not fail to observe the information given

in this manual and only entrust the device to the

hands of trained persons.

Check the electrodes and their leads for signs of

damage every time before you use the defibrilla-

tor. In particular, make a close visual inspection

of the insulation. Replace internal electrodes or

the contact inserts when you detect signs of me-

chanical damage.

CardioServ operates on:

– line power (95 to 240 V, 49 to 65 Hz)

– battery power (rechargeable batteries), i.e., independent

of the power line

– 12-Volt power supplied from the emergency vehicle

(with optional defibrillator mounting system)

* Use the power cord to connect the defibrillator to the

power line (Figure 3-1).

Figure 3-1. Power input

18 CardioServ V 4.2 227 446 32-I

Setting Up CardioServ and Testing Its Performance

360

Shock

Charge

P/min

Shock

Sync

Figure 3-2. Green indicator (indicating that defibrillator is

supplied from the power line)

Figure 3-3. Inserting the battery

* Check that the green indicator is lit (Figure 3-2).

* Check that the battery is in place (Figure 3-3).

Pull back the catch on the underside of the device to remove

the battery. When inserting it, make sure that it clicks prop-

erly into place.

When a battery is inserted, the yellow indicator

starts

flashing as soon as the defibrillator is connected to the power

line (to indicate that the battery is charging). The battery is

fully charged after 16 hours and the indicator is continuously

lit.

* Check that the supply of chart paper is sufficient (Figure

3-4). A stripe marks the last 3 meters of the roll.

Figure 3-4. Recording strip

227 446 32-I CardioServ V 4.2 19

Setting Up CardioServ and Testing Its Performance

Power Supply From Emergency Vehicles

A qualified technician can be called in to connect the

CardioServ to the 12-Volt supply of an emergency vehicle.

The following points must be noted:

– The negative terminal of the ambulance power supply

system must be connected to the ambulance chassis for

grounding.

– The positive lead of the ambulance power supply system

intended to supply the current must be protected with a

10-A fuse.

– Use only the defibrillator mounting system listed in

section 15 “Order Information and Accessories” or the

external charging unit, if your CardioServ has been

modified accordingly.

Check that the contacts for power supply from the



Figure 3-5. Accu Service Unit

defibrillator mounting system on the underside of

CardioServ (next to battery) are clean. Do not damage

We recommend our Accu Service Unit for optimal

☞

them in any way.

care of the batteries. It prolongs the batteries’ service

life and guarantees their operational readiness at all

Important Information on Battery-Power Operation

times.

Rechargeable batteries require special maintenance and con-

A NiCd battery should not be charged while

Warnin

located in direct sunlight, over a radiator, in cold

storage, or in other temperature extremes (not

below 5 °C). When the instrument is charging,

ambient temperatures exceeding 40 °C may

adversely affect battery capacity and life.

20 CardioServ V 4.2 227 446 32-I

tinued checks to assure they function in emergency situations.

It is normal for batteries of this type to selfdischarge when not

in use.

The battery charges automatically when CardioServ is con-

nected to the power line (yellow indicator (13) flashes).

Setting Up CardioServ and Testing Its Performance

In order to ensure its functioning as an emergency device, the

defibrillator should not be disconnected from the power line

for more than 48 hours.

A fully charged battery supplies power for 35 defibrillation

shocks of 360 joules or 2 hours of monitoring (or 1.2 hours of

monitoring if the CardioServ unit has pacemaker and SpO

option). It takes 16 hours to charge a depleted battery.

Proceed as follows to test the battery charge level:

☞

– Disconnect CardioServ from the power line.

– Trigger a test discharge of 360 joules (see

section 3.2 “Testing the Defibrillator Perform-

ance”).

– If you are not prompted to charge the battery,

the charge level should be sufficient for at least

5 more 360-joule shocks.

Monthly battery maintenance and checks:

☞

1. Disconnect CardioServ from the power line and

discharge fully charged battery in the monitoring

mode. To do so, set energy selector switch to ,

(SpO2 sensor not connected) and wait until device

switches off.

Inserting CardioServ In Its Softcase

* Open both zips on the CardioServ softcase.

* Undo the two Velcro strips on the front of the softcase.

* Open the Velcro flap located in front of the CardioServ

printer.

* Place the softcase on the small base, so that the softcase is

positioned as though you were carrying it.

* Disconnect the paddles on the CardioServ and remove

them.

* Hold all the opened up parts of the softcase to the side

and put the CardioServ into the softcase.

* Pull the softcase by the two Velcro strips on the black

base into position, ensuring that the feet of the

CardioServ are in the cut-out openings provided.

* Close the two front Velcro strips as well as the flap in

front of the printer at the side.

2. Check how long it takes before battery is depleted.

If the time is less than 1.8 hours, the battery is too

old or improperly maintained and must be

replaced.

3. Recharge the battery. This will take 16 hours.

For easy, convenient care and maintenance of the

batteries, use our “Accu Service Unit”.

227 446 32-I CardioServ V 4.2 21

* Close the zips.

* If the individual cut-out openings for the external con-

nections, paddles or feet are not correctly positioned,

pull the material at this point into the right shape.

* Reconnect the paddles and put them back into the

CardioServ recesses.

Customizing the defibrillator settings

Setting Up CardioServ and Testing Its Performance

Further steps that can be taken while setting up the defibrilla-

tor include customizing the device functions. This allows you

to select defibrillator default settings which suit your personal

preferences. CardioServ saves these configured settings and

reactivates them automatically every time you switch the

Refer to section 11 “The Defaults Menu” for a detailed

explanation of how to customize the CardioServ, including

the language selection (available languages are English,

French, German, Italian, Portuguese, Russian, Spanish and

Swedish).

defibrillator on. The following chart shows the factory settings

of all parameters and the optional adjustments.

retemaraP noitpircseD gnitteSyrotcaF egnartnemtsujdA sgnittesdezimotsuC

stimiLRH stimilmralaRH 061/04 ffo003ot51ffo

ytivitisneS ezislangisGCE 1 Vm/mc2,1,5.

daeL 1 selddap+sdaeldradnatslla

.qesotuA slevelygrenegnicneuqesotua J063,J002,J002 ,J063,J003,J002,J051

OpS

stimiL stimilmrala ffo/09 ffo001ot51ffo

kcoL-C OpSdezinorhcnys-GCE

OpS

resU )sretcarahc04(emanrotxeteerf

emiT.tnI OpS

mralAliaFdaeL ffo s03/ffo

peeBSRQ ffo ffo/no

enoTmralA ffo ffo/no

tuotnirPmralA tratsredrocer.motua ffo ffo/no

tuotnirPkcohS tratsredrocer.motua no ffo/no

tuotnirP.tnoC tratslaunamnopupotsredrocer ffo ffo/no

rekamecaP etareslup MPB06 nim/P051ot51

yalpsiD lamron desrever/lamron

yalpsiD seerged0 seerged081/seerged0

emuloV slangisoiduallafoemulov duol wol/duol

retliFCA zH05 ffo/zH06/zH05

retliFelcsuM tcafitranoitomfonoitanimile no ffo/no

emiT/etaD

tamroFetaD YYYY:MM:DD YYYY:DD:MM/YYYY:MM:DD

egaugnaL namreG ,namreG,hcnerF,hsilgnE

tluafedyrotcaF sgnittesyrotcafhsilbatseer ffo ffo/no

emitnoitargetni s8 )dednemmocerton(s21,s8,s4

tnemerusaem ffo ffo/no

,naissuR,eseugutroP,nailatI

hsidewS,hsinapS

Table 1

22 CardioServ V 4.2 227 446 32-I

Setting Up CardioServ and Testing Its Performance

J (50 Ω)

Autosequence

Figure 3-6. Switching on CardioServ

a b

Paddle

160 BPM

140 ECG

HR Alarm

3.2 Testing the Defibrillator

100

150

200

300

360

Charge

Shock

Sync

Performance

On power up CardioServ runs an automatic selftest. Any

malfunctions identified during this test result in an error

message displayed on the LCD (refer to section 12 “Error

Indications and Messages”). As a further performance test a

trial defibrillation can be triggered.

The energy selector is used to switch CardioServ on and off.

Once you have become familiar with CardioServ you can thus

switch on the defibrillator and select the required energy in

one single operation.

* Set the energy selector to the position. No energy

will be stored in this position of the switch.

The defibrillator beeps and displays a checkered pattern

(LCD performance test). Next the main display appears

(Figure 3-7).

The “Paddle” message (b, Figure 3-7) indicates that no pa-

tient cable is connected and that the ECG signal is acquired

via the defib paddles. Upon connection of the patient cable

FreezeSpO2ECG

the selected ECG lead is displayed here. CardioServ is now

ready for operation.

Figure 3-7. CardioServ main display

a heart/pulse-rate reading with alarm limits b ECG signal source c 1-mV calibration pulse d alarm message, QRS blip e signal trace, channel 1 f signal trace, channel 2 g menu

227 446 32-I CardioServ V 4.2 23

Setting Up CardioServ and Testing Its Performance

Do not trigger more than 5 consecutive test

discharges (or internal safety discharges) within

Caution

15 minutes at max. energy setting.

Paddle

160 BPM

140 ECG

HR Alarm

Figure 3-8. Display of selected energy

360 J

MenuFreezeSpO2ECG

Test Discharge

A test discharge can be triggered to check the defibrillator

discharge circuit. For this test the stored energy is discharged

into the device via two contacts in the paddle compartments.

* Set the energy selector to 360 joules (50 joules, if inter-

nal electrodes are connected). The display first shows the

selected energy (Figure 3-8).

Charge

* Press the

(Press the

Shock

button on the paddle to charge the unit.

Charge

key on the defibrillator, when using

Shock

internal electrodes.)

You may now watch the defibrillator charging.

* When the selected energy level has been reached,

CardioServ beeps and the stored energy is displayed

(Figure 3-9).

Do not deliver shocks into open air. High voltage

may briefly be present at the unprotected paddle

Caution

surfaces as a result and endanger the persons

onds. To do so, simultaneously press the buttons on

Charge

both paddles (or press the two

Shock

keys on the

defibrillator, when using internal electrodes).

present.

If more than 5% of the available energy are lost before the

defibrillation pulse is triggered, CardioServ recharges until the

required energy level is reached.

24 CardioServ V 4.2 227 446 32-I

* Trigger the defibrillation pulse within the next 30 sec-

Setting Up CardioServ and Testing Its Performance

Paddle

160 BPM

140 ECG

HR Alarm

Energy available

Figure 3-9. Display of available energy

If you do not trigger the defibrillation pulse within

☞

30 seconds, an internal safety discharge is initiated

automatically.

360 J

MenuFreezeSpO2ECG

After defibrillation, the beeping sound stops, and the energy

actually delivered into a 50-ohm resistance is displayed for

10 seconds in place of the stored energy (Figure 3-9). The

delivered energy must not deviate more than ±15% or

±4 joules (whichever is greater) from the selected value. A

recording is initiated at the same time (16-second strip).

Should the discharge circuit be interrupted (paddles not

properly placed on contacts in the compartments, defective

lead), an internal safety discharge is initiated 200 ms after the

defibrillation shock has been triggered. In this case the “deliv-

ered energy” is “0”.

If the defibrillator cannot store the selected energy so that

selected and stored energy values differ, the LCD shows the

message “Energy high” or “Energy low”. The defibrillation

pulse can be triggeed all the same.

* Switch off CardioServ (set energy selector to ).

The message “Energy high” or “Energy low”

indicates that CardioServ needs to be repaired.

Caution

If, in spite of this energy storage problem, the

device has to be employed, it will display the

message “Self-test failed. Charge Energy Error”

Testing the Pacemaker Performance

The performance of the pacemaker can be tested with a

commercially available pacemaker tester (e.g. CS300 Simula-

tor from GEMS IT, part no. 417 983-001).

upon power up. In this situation press one of the

function keys and proceed as usual.

Performance Test

Caution

Test the defibrillator performance once a week:

test 1 – defibrillator connected to mains, battery

removed,

test 2 – defibrillator disconnected from mains,

battery inserted

227 446 32-I CardioServ V 4.2 25

For your notes

Setting Up CardioServ and Testing Its Performance

26 CardioServ V 4.2 227 446 32-I

Non-Synchronized Defibrillation

4. Non-Synchronized Defibrillation

This section describes first how to perform a non-synchro-

nized defibrillation, using the standard defibrillation

paddles. The subsequent explanations refer to the use of

internal and disposable adhesive electrodes.

At the end of this section you will find a summary of all

necessary operating steps (brief operating instructions).

227 446 32-I CardioServ V 4.2 27

Non-Synchronized Defibrillation

4.1 Defibrillation with Standard

Electrodes

The information given in section 1.2 must be

Warnin

observed without fail to ensure safe and reliable

application of the device.

Always switch off CardioServ before exchanging

the defibrillation paddles.

Danger

Paddle

160 BPM

140 ECG

HR Alarm

200 J

SpO2ECG

Figure 4-1. Main display, indication of ECG lead, manual

operation and selected energy

MenuFreeze

The energy selector can be set to the autosequence position,

where the defibrillator automatically sequences the preset

energy levels. The preset factory default setting is the sequence

recommended by AHA/ERC (200 J, 200 J, 360 J). The

factory default values can be changed from the defaults menu.

You can choose among 150 J, 200 J, 300 J and 360 J.

* Set the energy selector (4) to “Autosequence” or to the

required energy value (this turns on CardioServ).

The defibrillator beeps and displays a checkered pattern (LCD

performance test). Next the main display appears (Figure

4-1). When a patient cable is connected the selected ECG

lead is displayed (selectable).

* Check that the energy selector locks in on the correct

position and that the display shows the selected energy

(Figure 4-1).

The energy depends on the defibrillation mode, on the

patient’s age and constitution. In external application the

thickness of the tissue is also a factor which influences the

amount of energy required.

The energy necessary for successful ventricular defibrillation

without damaging the myocardium has for many years been a

matter of scientific controversy. The manufacturer is therefore

not able to give any recommendations.

28 CardioServ V 4.2 227 446 32-I

Figure 4-2. Removing the paddles

Do not apply the paddles over

Warnin

– sternum or clavicle

– nipples

– implanted pacemaker or defibrillator.

Non-Synchronized Defibrillation

In emergency situations AHA recommends for adult patients

1. defibrillation with 200 joules; if unsuccessful, repeat

2. defibrillation with 200 joules; if unsuccessful, repeat

3. defibrillation with max. energy setting (360 joules).

Please note that children require less energy for successful

ventricular defibrillation than adults. For the first defibrilla-

tion pulse delivered to babies and small children, select an

energy level of 2 joules/kg body weight. For subsequent

shocks, the energy may be increased to 4 joules/kg.

In compliance with IEC requirements the energy adjusted on

this defibrillator is not the stored energy, but the energy

released into an external resistance of 50 ohms (patient resist-

ance + electrode-to-skin contact resistance). The energy

selector is labelled accordingly.

* Remove the paddles from their compartments (as shown

in Figure 4-2). Carefully dry the electrodes, if they are

wet. The handles, in particular, must be completely dry.

Apply an ample amount of electrode cream to each

paddle.

STERNUM

* Apply the electrodes to the patient’s thorax so that the

greatest possible amount of energy flows through the

myocardium (the imaginary connecting line between the

Charge

APEX

two electrode centers should be identical with the cardiac

median line; Figure 4-3).

* Press paddles firmly down onto the patient’s thorax..

Figure 4-3. Paddle application points

227 446 32-I CardioServ V 4.2 29

Non-Synchronized Defibrillation

Charge

Shock

STERNUM

Charge

Shock

APEX

Figure 4-4. Buttons to initiate energy storage and to trigger the

defibrillation shock

Paddle

160 BPM

140 ECG

HR Alarm

The ECG signal trace appears on the monitor.

* Do not touch the patient any more and warn all those

present.

Charge

* Press the

Shock

button (8) on the apex paddle to initiate

charging (Figure 4-4). When using internal electrodes or

defibrillation pads, press

Charge

on the device.

Shock

When the selected energy level has been reached (message

“Energy available”), CardioServ beeps and the stored energy is

displayed (Figure 4-5).

* Trigger the defibrillation shock within the next 30 sec-

onds by simultaneously pressing the buttons on both

paddles (Figure 4-4). When using internal electrodes or

defibrillation pads, press

Charge

Shock

and

Shock

on the device.

If more than 5% of the available energy are lost before the

defibrillation shock is triggered, CardioServ recharges until

the required energy level is reached.

Energy available

FreezeSpO2ECG

200 J

Figure 4-5. Display of available energy

☞

When the defibrillator is already charged you can

increase the energy level simply by turning the energy

selector to the new setting. To decrease the energy

level, set the selector to the lower value and initiate

charging again.

30 CardioServ V 4.2 227 446 32-I

Non-Synchronized Defibrillation

Paddle

160 BPM

140 ECG

HR Alarm

Energy delivered

Figure 4-6. Display of delivered energy

The “Check Electrode” message refers to the defibril-

☞

lation paddles only when no patient cable is con-

nected. It refers to the ECG electrodes when the

patient cable is plugged in.

If you do not trigger the defibrillation pulse within

☞

30 seconds, an internal safety discharge is initiated

automatically. You will then have to recharge the

defibrillator.

The defibrillation energy (high voltage!) remains

Warnin

applied to the defibrillation paddles until fully

discharged. Do not touch the paddle surface! The

internal safety discharge is completed when the

selected energy is displayed again.

198 J

MenuFreezeSpO2ECG

– After defibrillation, the beeping sound stops, and the

energy actually delivered is displayed for 10 seconds in

place of the stored energy (Figure 4-6). At the same time

the recorder writes a 16-second ECG (including a his-

tory of 4 seconds) (adjustable, Figure 4-7). CardioServ

saves this recording (4 s history, 5 s blanked, 10 s after

release of shock), and it can be printed off again at any

time. Also refer to section 7 “The Memories of

CardioServ”.

– When the electrodes are not applied at all or they are not

properly applied to the skin, the message “Check Elec-

trode” is displayed. The defibrillation shock can be

triggered all the same. Nevertheless it is recommended to

reduce skin impedance (risk of skin burns!), for instance,

by applying more electrode cream to the paddles or by

pressing them down firmly.

– When there is a break in the discharge circuit (paddles

not properly applied, leads or paddles defective), an

internal safety discharge is initiated 200 ms after the

defibrillation shock has been triggered. In this case the

“delivered energy” is “0”.

_ If the defibrillator cannot store the selected energy so

that selected and stored energy values differ, the LCD

displays a warning. The defibrillation pulse can be

triggered anyway (notify service).

* Once therapy has ended, set the selector switch to

for monitoring of the patient’s ECG.

227 446 32-I CardioServ V 4.2 31

Non-Synchronized Defibrillation

DEFIB 09. 07 .1997 09 : 16 : 12 50 Hz 35 Hz 360 JOULES HR : O BPM

SHOCK

PADDLE

1 CM/MV

25 MM/S ST. JOHN’S 97

<5s>

Figure 4-7. Example of a recording initiated by a defibrillation pulse

a initiation e delivered energy i paper speed

b date f heart rate k name of hospital/practise

c time g ECG lead

d active filters h sensitivity

PATIENT

DATE OF BIRTH.............

USER........................

COMMENTS.................

SELECTED ENERGY.........

DELIVERED ENERGY........

ALARM LIMIT HR...........

ALARM LIMIT SPO2 .......

PACEMAKER................

DATE/TIME

* After use, switch off CardioServ (set selector switch to

* Clean the paddles and the device as described in section

13.

* After cleaning, return the paddles to their compartments

as shown in Figure 4-8.

Figure 4-8. Returning the paddles to their compartments

32 CardioServ V 4.2 227 446 32-I

Non-Synchronized Defibrillation

4.2 Defibrillation with Internal

Electrodes or Single-Use Pads

Internal Electrodes

When using CardioServ with internal or adhesive

☞

electrodes, charging is initiated with

Charge

Shock

and defi-

brillation is triggered by simultaneously pressing the

Charge

Shock

and

Shock

(Figure 4-9). Only sterile electrodes

may be used for internal defibrillation!

J (50 Ω)

utosequence

360

300

100

200

150

Charge

Shock

Sync

Figure 4-9. Panel keys to initiate charging and to trigger the

defibrillation shock

When electrodes for internal defibrillation are connected to

CardioServ, it is not posssible to store energy above 50 joules.

If you set the selector to values higher than 50 joules, release

of the defibrillation pulse is blocked for reasons of patient

safety (“Energy high” will be displayed!). Simply turn the dial

back and initiate charging again, this time selecting not more

than 50 joules.

Spoon-shaped electrodes are used for internal defibrillation.

Their contact surface must match the dimensions of the heart,

as the spoons should make full contact with the tissue.

You can choose from 3 different spoon sizes (section 15

“Order Information, Accessories”). As the spoons are in direct

contact with the heart – hence the term “direct defibrillation”

– energy levels considerably lower than those for transthoracic

(external) defibrillation are sufficient.

Please note that internal electrodes must be sterilized before

use (section 13 “Cleaning and Disinfection”).

227 446 32-I CardioServ V 4.2 33

Non-Synchronized Defibrillation

STERNUM

electrode + connector

Figure 4-10. Anterior – anterior placement

front back

APEX

Single-Use Defibrillation Pads

* Use pads before their expiration date.

* A pair of defibrillation pads may remain attached to

the patient for up to 24 hours. They withstand up to

50 shocks of 360 joules each.

* Apply the pads (part no. 919 202 94 adult pads, part no.

919 202 95 pediatric pads) as shown in Figure 4-10 for

an anterior-anterior placement, and as shown in Figure

4-11 for an anterior-posterior placement:

– Shave any hair from each site. This improves conduc-

tivity and makes removal of the pad easier.

– Place the pads on the patient so that the connectors

point to either side of the patient. In this position the

connecting cables will not hinder CPR measures.

– The electrodes are pregelled; therefore do not use

APEX STERNUM

additional contact cream or paste.

Figure 4-11. Anterior – posterior placement

– Do not use pads, if the gel has dried out.

– Peel off the backing from each pad and place the pad

carefully on the appropriate site.

34 CardioServ V 4.2 227 446 32-I

223 383 01

Non-Synchronized Defibrillation

* Then press the connector of cable 223 383 01 on to the

electrode contact pin until you hear it click into place.

Observe the connector lables: “A” = apex, “S” = sternum.

Figure 4-12. Connecting the cables

223 346 01

919 202 94 919 202 95 (K)

919 201 89 919 202 75 (K)

The round adhesive electrodes (part no. 919 201 89) can be

used with adapter lead 223 346 01. When connecting the

electrode to the lead, take care that they engage properly. To

disconnect them, simply press on the rear part of the catch

(Figure 4-13).

* Before defibrillating the patient, verify the position and

adhesion of the pads.

* Defibrillate the patient as described in section “Defibril-

lation with Standard Electrodes”. Note, however, that

energy storage and defibrillation pulse will have to be

triggered with the panel keys.

* After use, carefully peel off the electrodes from the

patient’s skin (Figure 4-14) and discard them immedi-

ately.

Figure 4-13. Connecting the defib pads to the adapter cable

When monitoring the patient with the adhesive

defib pads, make sure that the energy selector is in

the monitoring position .

incorrect

correct

Warnin

Discard disposable defibrillation pads immedi-

Warnin

ately after use. Do no reuse them!

Figure 4-14. Removing defibrillation pads

227 446 32-I CardioServ V 4.2 35

Non-Synchronized Defibrillation

4.3 Brief Operating Instructions (non-synchronized)

External Electrodes/Paddles

* Set energy selector to “Autosequence” or select

the required energy

* Remove paddles from compartments and apply

electrode cream

* Apply electrodes to thorax

Charge

* Initiate defibrillator charging

Shock

* Wait for beep to sound and for stored energy to

be displayed

* Warn bystanders, do not touch the patient any

more and trigger shock; to do this, simultane-

Charge

Shock

ously press

Shock

on both paddles

* Watch ECG, repeat defibrillation if necessary or

set energy selector to , if defibrillation was

successful

* Switch off CardioServ after use (set energy

selector to )

* Clean paddles and defibrillator

Internal Electrodes or Pads

* Connect internal electrodes or pads to

CardioServ

* Apply pads

* Set energy selector to “Autosequence” or select

the required energy (50 joules max. for internal

defibrillation)

* Initiate defibrillator charging

* Wait for beep to sound and for stored energy to

be displayed

* Warn bystanders, do not touch the patient any

more and trigger shock; to do this, simultane-

Charge

ously press the

Shock

* Watch ECG, repeat defibrillation if necessary or

set energy selector to , if defibrillation was

successful

* Switch off CardioServ after use (set energy

selector to )

* Dispose of single-use electrodes, clean defibrilla-

tor

Charge

Shock

keys on the panel

* Clean/sterilize internal electrodes

36 CardioServ V 4.2 227 446 32-I

Cardioversion (Synchronized Defibrillation)

5. Cardioversion (Synchronized Defibrillation)

This section describes first how to perform a synchronized

defibrillation (cardioversion). For this purpose, the ECG is

picked up either via the paddles or via separate ECG elec-

trodes.

At the end of this section you will find a summary of all

necessary operating steps (brief operating instructions).

227 446 32-I CardioServ V 4.2 37

Cardioversion (Synchronized Defibrillation)

5.1 General Information

The information given in section 1.2 must be

Warnin

observed without fail to ensure safe and reliable

application of the device. Also read section 6.1

“Displaying the ECG”.

False Triggering – If ventricular fibrillation

Warnin

occurs during the intervention, you must switch to

the non-synchronized mode to be able to trigger a

defibrillation pulse, because it is not possible to

detect a QRS complex in the presence of ventricu-

lar fibrillation and the QRS complex is necessary

to derive the trigger pulse.

Do not use a pacemaker ECG for triggering,

because the trigger pulses derived from pacemaker

ECGs may be incorrect and synchronized delivery

of the defibrillation shock may not be possible.

Following each synchronized defibrillation,

☞

CardioServ reverts to the non-synchronized mode.

Please note that the synchronized mode must be

deliberately activated with

Sync

every time you

want to perform cardioversion. This measure is to

ensure that in emergencies the defibrillator is always

ready to deliver nonsynchronized shocks.

For cardioversion, the defibrillation shock is delivered in

synchronization with the heart action (on the R-wave), as the

heart is still working. As a prerequisite the patient’s ECG

signal must be supplied to the defibrillator. After the defibril-

lator has received the “defibrillation command” from the

operator who pressed the appropriate keys, the defibrillator

will wait for the next R-wave to derive the trigger signal.

It is strongly recommended to acquire the ECG via separate

ECG electrodes. However, you may also use adhesive defibril-

lation pads and simultaneously acquire the ECG via these

pads.

38 CardioServ V 4.2 227 446 32-I

Cardioversion (Synchronized Defibrillation)

5.2 Performing Cardioversion

red

R L

white

black

N F

Figure 5-1. ECG electrode placement

yellow

green

ECG Acquisition via ECG Electrodes and Patient Cable

Use only siver/silver chloride electrodes if you intend to

acquire the ECG signal via the patient cable. This type of

electrodes prevents polarization voltages which may be caused

by the defibrillation shock, resulting in an ECG trace simulat-

ing cardiac arrest.

* Apply the electrodes as shown in Figure 5-1 and connect

them to CardioServ via the patient cable (Figure 5-2).

For further information on ECG signal acquisition, please

refer to our application note on electrocardiography and to

the relevant literature.

ECG Acquisition via Defibrillation Pads

* Apply the pads as described in section 4.2.

* Check that no patient cable is connected to ECG signal

input (Figure 5-2).

Option

SpO

EKG

The ECG will now be acquired via the defibrillation pads.

Perform cardioversion as described below.





Figure 5-2. ECG signal input

227 446 32-I CardioServ V 4.2 39

Cardioversion (Synchronized Defibrillation)

100

150

200

300

360

Charge

Shock

Sync

Figure 5-3. Key to select synchronized defibrillation

APEX

Charge

Shock

Cardioversion

* Set the energy selector to (this turns on

CardioServ) and check the ECG trace.

The defibrillator beeps and displays a checkered pattern (LCD

performance test). Next the main display and the label of the

selected lead are shown (when patient cable is connected).

CardioServ is now ready for operation.

The defibrillator selects the following settings:

APEX

– lead I (selectable)

– AC line filter on (selectable)

– sensitivity of 1 mV/cm (selectable)

If you wish to select another lead or sensitivity, proceed as

follows (these are only temporary changes which will not be

saved):

* Press the

* Use the

ECG

softkey to call up the ECG submenu.

I...III

aV...V

softkey to select a suitable ECG lead

Paddle

(shown at a, Figure 5-4).

* Use the

* Press

cm/mV

Sync

(Figure 5-3).

softkey to select the sensitivity.

The “Sync” mode is indicated on the LCD (c, Figure 5-4).

40 CardioServ V 4.2 227 446 32-I

Cardioversion (Synchronized Defibrillation)

160 BPM

140 ECG

Figure 5-4. Screen display

a selected lead

b Sync mark

c Sync mode on

d heart symbol

On the recording strip each sync pulse is identified

☞

with a dash above and below the ECG trace.

If no SYNC marks are displayed, do not trigger a

defibrillation shock, because the shock might be

Danger

delivered unsynchronized with the QRS complexes.

MenuFreezeSpO2ECG

Sync

Verify that the heart symbol flashes regularly on the LCD and

that the sync mark appears at regular intervals along the upper

LCD margin (b, Figure 5-4). Otherwise select another lead

using softkey

It is important that the ECG exhibit the following characteris-

tics

– the R-wave amplitude should be greater than 0.5 mV,

1 mV or more are recommended

– the T-wave amplitude should be small in relation to the

R-wave amplitude

– the SYNC mark should be located above the leading

edge or peak of the R-wave

When the synchronized defibrillation mode is selected, each

QRS complex is identified with a SYNC mark (b, Figure

5-4). If these SYNC marks are missing, synchronized defibril-

lation will not be possible. Reasons for missing SYNC marks

include poor ECG signal quality. Select another ECG lead,

check electrode contact or disable and re-enable the SYNC

mode.

For an accurate estimation of the phase in which the defibril-

lation shock will occur, you can mark the latest point in time

on the printed ECG: the defibrillation shock will be triggered

not later than 60 ms after the SYNC mark.

I...III

aV...V

of the ECG submenu.

Paddle

* Remove the paddles from their compartments. Carefully

dry the electrodes, if they are wet. The handles, in

particular, must be completely dry. Apply an ample

amount of electrode cream to each paddle.

* Set the energy selector to the required energy level

(“Autosequence” is not suitable for cardioversion).

227 446 32-I CardioServ V 4.2 41

Caution

STERNUM

Cardioversion (Synchronized Defibrillation)

The energy depends on the defibrillation mode, on the pa-

tient’s age and constitution. In external application the thick-

ness of the tissue is also a factor which influences the amount

of energy required.

The energy necessary for successful ventricular defibrillation

without damaging the myocardium has for many years been a

matter of scientific controversy. The manufacturer is therefore

not able to give any recommendations.

Charge

APEX

Figure 5-5. Paddle placement

Do not apply the paddles over

Warnin

– sternum or clavicle

– nipples

– implanted pacemaker or defibrillator.

Charge

Shock

STERNUM

Charge

Shock

APEX

Figure 5-6. Buttons to inititate energy storage and to trigger the

defibrillation shock

The American Heart Asociation AHA recom-

mends the following energy levels for cardio-

version: 50 J, 100 J, 200 J, 300 j, 360 J.

* Apply the electrodes to the patient’s thorax so that the

greatest possible amount of energy flows through the

myocardium (the imaginary connecting line between the

two electrode centers should be identical with the cardiac

median line; Figure 5-5).

* Press paddles firmly down onto the patient’s thorax.

* Do not touch the patient any more and warn all those

present.

Charge

* Press the

Shock

button (8) on the apex paddle to initiate

charging (Figure 5-6). When using defibrillation pads,

press the

Charge

key on the CardioServ control panel.

Shock

When the selected energy level has been reached, CardioServ

beeps and the stored energy is displayed (Figure 5-7). It

should be identical with the selected value (±15% or

±4 joules, whichever is greater)

42 CardioServ V 4.2 227 446 32-I

Cardioversion (Synchronized Defibrillation)

Shock

160 BPM

140 ECG

Energy available

Figure 5-7. Display of the stored energy

The “Check Electrode” message refers to the defibril-

☞

lation paddles only when no patient cable is con-

nected. It refers to ECG electrodes when the patient

cable is plugged in.

The defibrillation energy (high voltage!) remains

Warnin

applied to the defibrillation paddles until fully

discharged. Do not touch the paddle surface! The

internal safety discharge is completed when the

selected energy is displayed again.

100 J

MenuFreezeSpO2ECG

Sync

* Simultaneously press the butttons on both paddles

(Figure 5-6) within 30 seconds. The next synchroniza-

tion pulse will release the defibrillation shock. When

using internal electrodes, press the panel keys

Charge

Shock

and

to deliver the shock.

– After defibrillation, the defibrillator stops beeping, and

the energy actually delivered to the patient is displayed

for 10 seconds in place of the stored energy. At the same

time the recorder writes a 16-second ECG, including a

history of 4 seconds (adjustable, Figure 5-8). CardioServ

saves the ECG (4-s history, 5 s blanked, 10 s after release

of shock). On the recording the blanked period of time

is marked with a spike (Figure 5-8). Refer to section 7

“The Memories of CardioServ”.

– When the electrodes are not applied at all or they are not

properly applied to the skin, the message “Check Elec-

trode” is displayed. The defibrillation pulse can be

triggered all the same. Nevertheless it is recommended to

reduce skin impedance, for instance, by applying more

electrode cream to the paddles or by pressing them down

firmly.

– When there is a break in the discharge circuit (paddles

not properly applied, leads or paddles defective), an

internal safety discharge is initiated 200 ms after the

defibrillation shock has been triggered. In this case the

delivered energy is not indicated.

– If the defibrillator cannot store the selected energy so

that selected and stored energy values differ, the LCD

shows he message “Energy high” or “Energy low”. The

defibrillation pulse can be triggered all the same.

227 446 32-I CardioServ V 4.2 43

Cardioversion (Synchronized Defibrillation)

DEFI 09. 04 .1997 09 : 16 : 12 SYNC 100 JOULES HR : 59 BPM

SHOCK

1 CM/MV

25 MM/S ST. JOHN’S DGH 97

Figure 5-8. Example of a recording initiated by a defibrillation pulse

a initiation

b date

c time

d SYNC mode

e delivered energy

f heart rate

g ECG lead (here: EINTHOVEN I)

h sensitivity

i paper speed

k name of hospital/practice

b d

<5s>

44 CardioServ V 4.2 227 446 32-I

Cardioversion (Synchronized Defibrillation)

Warnin

Always switch off Cardio Serv before exchanging

the defibrillation paddles.

* Once therapy has ended, set the selector switch to

for monitoring of the patient’s ECG.

* After use, switch off CardioServ (Set selector switch to

* Clean electrodes and the defibrillator as described in

section 13.

* After cleaning, return the paddles to their compartments.

* When using CardioServ with internal electrodes or pads,

please refer to section 4.2 “Defibrillation with Internal

Electrodes or Single-Use Pads”.

227 446 32-I CardioServ V 4.2 45

Cardioversion (Synchronized Defibrillation)

5.3 Brief Operating Instructions (cardioversion)

ECG Acquisition with ECG Electrodes

(this is the preferred method)

* Apply ECG electrodes and connect them to

CardioServ, using the patient cable

* Turn on CardioServ (4) and set energy selector

to required energy

* Select synchronized operating mode (

Sync

) and

check LCD for regular trigger pulses; if they do

not appear, select another lead (F1

ECG

)

* Remove paddles from their compartments and

apply electrode cream

* Apply paddles to patient and initiate defibrillator

Charge

charging

Shock

* Wait for beep to sound and for available energy

to be displayed

* Warn bystanders, do not touch the patient any

more and trigger pulse; to do this, simultaneously

Charge

Shock

press the buttons

Shock

on both paddles; wait

for shock to be delivered

* Watch ECG, repeat defibrillation if necessary or

set energy selector to , if defibrillation was

successful

* Switch off CardioServ after use (energy selector

at )

* Discard disposable electrodes, clean paddles and

defibrillator

ECG Acquisition with Defib Pads

* Apply pads to patient and connect them to

CardioServ; a patient cable must not be con-

nected to the unit (24)!

* Turn on CardioServ (4) and set energy selector

to required energy

* Select synchronized operating mode (

check LCD for regular trigger pulses; if they do

Sync

) and

not appear, acquire ECG with ECG electrodes

* Initiate defibrillator charging

Charge

Shock

* Wait for beep to sound and for available energy

to be displayed

* Warn bystanders, do not touch the patient any

more and trigger pulse; to do this, simultaneously

press

Charge

Shock

on the device; wait for shock to

be delivered

* Watch ECG, repeat defibrillation if necessary or

set energy selector to , if defibrillation was

successful

* Switch off CardioServ after use (energy selector

at )

* Discard disposable electrodes, clean paddles and

defibrillator

46 CardioServ V 4.2 227 446 32-I

Displaying and Monitoring the ECG

6. Displaying and Monitoring the ECG

This section describes how to apply the ECG electrodes in

order to display all 12 standard leads, and how to monitor

the heart rate (adjusting alarm tone, QRS beep and alarm

limits).

At the end of this section you will find a summary of all

nesessary operating steps (brief operating instructions).

227 446 32-I CardioServ V 4.2 47

Displaying and Monitoring the ECG

red

yellow

white

IEC

red

configuration

black green

white

black

brown

AHA

white

configuration

green red

Figure 6-1. Electrode application points

5-lead cable (left)

3-lead cable (right)

With a 3-lead cable only ECG leads I,II and III can

☞

be displayed.

When monitoring the patient via the adhesive

defib pads, make sure that the energy selector is in

Caution

the monitoring position .

yellow

6.1 Displaying the ECG

For a quick diagnosis the ECG signal can be sensed via the

defibrillation paddles (see below). For more accurate examina-

tions and heart-rate monitoring, however, ECG electrodes

black

must be applied.

Either 3 or 5 electrodes can be used for ECG acquisition. In

emergencies, 3 electrodes are sufficient. Use only silver/silver

chloride electrodes. This type of electrodes prevents polariza-

tion voltages which may be caused by the defibrillation pulse,

resulting in an ECG trace simulating cardiac arrest.

red

For detailed information on ECG signal acquisition, please

refer to our application note on electrocardiography and to

the relevant literature.

* Apply the electrodes as shown in Figure 6-1.

* Connect the patient cable to the electrodes and to the

ECG signal input (Figure 6-2).

– If you prefer to use 5 ECG electrodes, apply 4 limb-lead

electrodes, for instance, and one precordial electrode.

Option

SpO



EKG



Figure 6-2. ECG signal input

48 CardioServ V 4.2 227 446 32-I

Displaying and Monitoring the ECG

– To obtain a recording of all 12 standard leads, attach the

The C-electrodes of the IEC system shown here are

☞

the V-electrodes of the AHA system.

4 limb-lead electrodes and apply suction electrode

217 144 01 to the thorax. This electrode is easy to move

from one pick-up point to the next (C1 through C6,

Figure 6-3). Use electrode lead 223 404 10 to connect

the suction electrode to the patient cable. While record-

I...III

ing the chest leads, leave softkey

aV...V

Paddle

set to V and

simply move the chest electrode to application points C1

through C6 (C8).

C2C3

Figure 6-3. Chest electrode application points

C1 in the 4th intercostal space at the right sternal

edge

C2 in the 4th intercostal space at the left sternal edge

C3 at the level of the 5th rib midway between C2

and C4

C4 in the 5th intercostal space on the left midclavi-

cular line

C5 between C4 and C6 on the left anterior axillary

line

C6 on the mid-axillary line at the level of C4

C7 in the 5th intercostal space on the left posterior

axillary line

C8 in the 5th intercostal space on the left scapular

line

– As an alternative, you can connect the 3-lead monitoring

cable, Part No. 223 287 01 or Part No. 223 288 01

(with HF protection).

In this case only leads I,II and III can be displayed.

☞

* Set the energy selector (4) to : This turns on

CardioServ.

227 446 32-I CardioServ V 4.2 49

Displaying and Monitoring the ECG

160 BPM

140 ECG

HR Alarm

- % 90 SpO2

Figure 6-4. Main display

a heart/pulse-rate reading with alarm limits

b lead

c 1-mV calibration pulse

d alarm message, QRS blip

e channel 1: ECG

f channel 2: plethysmogram

g menu

performance test). Next the software version is displayed,

followed by the main display (Figure 6-4).

A field is reserved for technical alarms and messages above the

heart and pulse rate reading.

The defibrillator beeps and displays a checkered pattern (LCD

FreezeSpO2ECG

The defibrillator selects the following default settings:

– EINTOVEN lead I (selectable)

– AC filter on/ muscle filter on (selectable)

– sensitivity of 1 cm/mV (selectable)

If you wish to select another lead or sensitivity, proceed as

follows (these are only temporary changes which will not be

saved):

* Press the

* Use the

ECG

softkey to call up the ECG submenu.

I...III

aV...V

softkey to select a suitable ECG lead

Paddle

(shown at b, Figure 6-4).

* Use the

softkey to select the sensitivity.

cm/mV

Filters (AC line filter / muscle filter) enabled during signal

acquisition render the ECG display insensitive to signal noise

arising from the mains or from muscle tremor or motion. The

Warnin

Filters will falsify the ECG signal. For diagnostic

purposes, all filters should be disabled.

filters, however, falsify the ECG signal, making it unsuitable

for diagnostic purposes. The heart rate is always calculated

from the unfiltered ECG. An artifactual ECG signal may thus

lead to a wrong heart rate reading, even though the displayed,

filtered ECG is “clean”.

50 CardioServ V 4.2 227 446 32-I

Displaying and Monitoring the ECG

Freeze

The Freeze function may mask messages on the

☞

display.

* For a more detailed assessment of the ECG, you can

freeze the trace with the

Freeze

softkey.

The current ECG continues to be displayed in the upper

section of the LCD for monitoring, while the frozen segment

appears in the bottom section. The monitoring function is

still on.

When you press

Freeze

the erase bar moves to the right-hand

screen edge, i.e., the entire display shows the period of time

immediately prior to depression of

Freeze

The frozen ECG segment can be:

Freeze

– printed out with the

key (incl. a history of

4 seconds)

Store

– stored with the

– released with the

Freeze

Un-

key

key.

Rotating the display (temporary)

The screen display can be rotated 180°.

* Press

to display the submenu.

Display

Flip

to rotate the display.

Pressing the same key again restores the original orientation.

227 446 32-I CardioServ V 4.2 51

Displaying and Monitoring the ECG

6.2 Monitoring the Heart Rate

CardioServ can be set up (Section 11 “Configuring

☞

the Defibrillator Settings”) to automatically enable

the audible alarm on power-up. The default alarm

limits can also be preset.

160 BPM

140 ECG

HR Alarm

- % 90 SpO2

Figure 6-5. Main display

a heart/pulse-rate reading with alarm limits

b lead

c 1-mV calibration pulse

d alarm message, QRS blip

e channel 1: ECG

f channel 2: plethysmogram

g menu

FreezeSpO2ECG

With the factory settings unchanged, there will be no audible

alarm upon power up (F4 ). You enable the alarm

tone by pressing F4 once.

If the device sounds an alarm, you can press to silence

the alarm tone. Should the alarm cause persist, the alarm will

recur after 120 s (the remaining time is displayed in the

softkey). To permanently disable the audible alarm, press the

key longer than 2 seconds. As a result the crossed-out bell

symbol will appear.

The alarm limits can be modified either permanently via the

defaults menu (section 11 “The Defaults Menu”) or tempo-

rarily (see below).

If the heart rate violates one of the set limits for more than

5 seconds CardioServ gives alarm:

– the alarm tone sounds (selectable)

– the alarm cause is shown in the display (d, Figure 6-5)

– the violated limit value flashes

– the alarm recorder is started (selectable)

– the ECG is saved (4-s history, 6 seconds after alarm

release). See section 7 “The Memories of CardioServ”.

* Press to silence the alarm.

If the alarm cause has been eliminated, the alarm is cleared; if

it persists, the alarm recurs after 120 seconds.

52 CardioServ V 4.2 227 446 32-I

Displaying and Monitoring the ECG

Do not rotate the screen display (“Display Flip”

Warnin

function) within 2 minutes of silencing the alarm

tone. Otherwise the audio alarm would not be

reactivated and the device would not emit an

alarm tone for future alarms.

I...III

aV...V

Paddle

cm/mV

Alarm

Limits

Alarm

Printout back

Figure 6-6. Next menu

High Alarm

- + ECG

Low Alarm

- + ECG

Figure 6-7. Alarm menu

You can disable the alarm limits by selecting a value

☞

outside the adjustment range.

back

When an electrode required for the selected ECG lead drops

off, an alarm sounds and the “Check Electrode” message

appears on the display.

Modifying Device Settings

Using keys F1 to F5 you can change the settings for ECG

monitoring. In this case, however, the settings are only tem-

porary and will not be saved. Permanent adjustments are only

possible via the defaults menu (section 11 “Configuring the

Defibrillator Settings”).

Adjusting Alarm Limits

* Press the

ECG

softkey to display the ECG menu

(Figure 6-6).

Alarm

* Press

Limits

to change the alarm limits. The alarm

menu will be displayed (Figure 6-7).

* The + keys increase the values, the - keys decrease them

in steps of 5 BPM. If you hold the key depressed, the

digits change at a higher rate.

227 446 32-I CardioServ V 4.2 53

Displaying and Monitoring the ECG

Selecting the HR Source

CardioServ automatically returns to the main menu

☞

when no function keys are pressed for more than

30 s.

Source

ECG

QRSPulse

Beep

OFF

Memory

Display

Flip

Figure 6-8. The submenu

With the C-LOCK ECG synchronization function

☞

enabled, the QRS beep is triggered by the ECG

signal even when the selected heart rate source is the

pulse signal.

back

CardioServ devices with SpO2 measuring system allow the

selection of the heart/pulse-rate source (heart rate from ECG

or pulse rate from the SpO2 signal). The source is indicated by

“ECG” or “Pulse” below the parameter reading.

* Display the submenu with the

key.

Figure 6-8 will appear.

* Select “ECG” or “SpO2” with the

Source

ECG

key.

Enabling/Disabling the QRS Beep

* Display the submenu (Figure 6-8) with the

key.

* Enable or disable the QRS or pulse beep with the

QRSPulse

Beep

key, as required.

OFF

54 CardioServ V 4.2 227 446 32-I

Displaying and Monitoring the ECG

6.3 Monitoring Pacemaker Patients

Warnin

If several adverse conditions exist at once, the

possibility that pacing pulses are interpreted as

QRS complexes should be considered. For safety,

always watch pacemaker patients closely.

The device does not recognize pacing pulses with

an amplitude below 20 mV.

When monitoring pacemaker patients, it is important that the

device counts only the QRS complexes and not the pacing

pulses from the pacemaker. For this reason, CardioServ comes

with an electronic circuit that filters out pacemaker pulses.

However, in exceptional cases, depending on the pacemaker

model involved and the electrode placement, the compensa-

tion algorithm following every pacing pulse may simulate a

QRS complex. Every pacemaker must provide an oppositely

charged current (reverse current) after delivering a pacing

pulse. Ineffective stimulation (absence of QRS complexes) can

lead to misinterpretation, so that alarm is not released in cases

of bradycardia (slow heart rate) or cardiac arrest.

For this reason we recommend the plethysmogram (SpO2) for

monitoring of pacemaker patients. Also, set the HR source to

“Pulse”.

You should disable the C-LOCK synchronization to prevent

that frustraneous pacing pulses are counted as QRS com-

plexes.

Whether or not the device interprets the pacemaker compen-

sation algorithm as a QRS complex depends on the pace-

maker pulse parameters (See section 14 “Technical Specifica-

tions”).

For pacemaker patients, the ECG amplitude should be greater

than 1 mV.

227 446 32-I CardioServ V 4.2 55

Displaying and Monitoring the ECG

6.4 Brief Operating Instructions

Displaying the ECG

* Apply ECG electrodes and connect them to CardioServ.

* Set energy selector to .

* Display the ECG menu (key F1

ECG

) and select ECG

lead (F1).

* Adjust amplitude (F2).

* Freeze and release the ECG, if desired, with F3 (main

menu).

Monitoring the Heart Rate

* Display the ECG as described above.

* Enable alarm tone with F4.

Modifying the Heart-Rate Alarm Limits

* Press F1

ECG

to display the ECG menu.

* Press F3 to display the alarm limits menu.

* Decrease the values with F1 and F3, increase them with

F2 and F4.

* Silence alarm with F4, if alarm cause persists, the alarm

recurs after 120 seconds (or disable the audible alarm

permanently by pressing F4 longer than 2 s).

56 CardioServ V 4.2 227 446 32-I

The Memories of CardioServ

7. The Memories of CardioServ

This section of the manual informs you

– about the memories of CardioServ

– how to print out the stored information

– how to clear the memories

227 446 32-I CardioServ V 4.2 57

Source

ECG

QRSPulse

Beep

OFF

Figure 7-1. Submenu

Text

Event

Figure 7.2. Memory menu

Memory

Trend

Display

Flip

Memory

Clear

The Memories of CardioServ

CardioServ comes with 3 different memories:

– a text memory

– an event memory

– a trend memory

All information concerning device operation goes into the text

memory where it is saved with the time of day (e.g., device

on, device off, alarms, shocks, etc.). CardioServ can save up to

80 such events. When the memory is full, the device updates

the information automatically by saving new events and

deleting old ones. Moreover, all three memories can be cleared

in one action (see below).

To print out the stored information, proceed as follows:

back

* Press

back

* Press

text memory (Figure 7-3).

to display the submenu (Figure 7-1).

Memory

to display the memory menu (Figure 7-2).

Text

to print out the information stored in the

DEVICE OFF . . . . . . : 17:15:02 28.06.1997

DEVICE ON . . . . . . : 17:15:08 28.06.1997

HR ALARM 335BPM : 17:15:09 28.06.1997 SHOCK 349JOULES : 17:15:25 28.06.1997 HR ALARM 61BPM : 17:16:20 28.06.1997 HR ALARM 60BPM : 17:17:44 28.06.1997 HR ALARM 61BPM : 17:19:31 28.06.1997 SHOCK 205JOULES : 17:20:12 28.06.1997

DEVICE OFF . . . . . . : 17:38:17 28.06.1997

DEVICE ON . . . . . . : 17:52:09 28.06.1997

Figure 7-3. Printout from text memory

58 CardioServ V 4.2 227 446 32-I

The Memories of CardioServ

Event

160 BPM 40 ECG

Event SHOCK #6 30.03.1998 11:41

all

Figure 7-4. “Print Event” menu

Select

Event

The event memory contains up to 40 ECG strips of 16 sec-

onds duration, each with a history of 4 seconds. The event

strips are recorded either automatically (upon violation of a

heart-rate limit, delivery of the shock and modification of the

pacemaker settings, provided the pacemaker is turned on) or

Store

device updates the information automatically by saving new

manually with the

Freeze

key. When the memory is full, the

events and deleting old ones. Moreover, all three memories

can be cleared in one action (see below). Recordings initiated

by a defibrillation shock are blanked for 5 seconds after the

200 J

Event

back

4-second strip before the shock. After the blank, the recording

continues for another 10 seconds.

To print out the stored events, proceed as follows:

* Press

to display the submenu (Figure 7-1).

Memory

to display the memory menu (Figure 7-2).

Event

to display the print-event menu (Figure

7-4).

Now you can

* select an event with the + and - keys (The event is dis-

played at a in Figure 7-4) and initiate the printout with

* print all stored events with

all

(starting with the

event displayed at a, Figure 7-4) or

* press

227 446 32-I CardioServ V 4.2 59

back

to return to the memory menu.

The Memories of CardioServ

Source

ECG

QRSPulse

Beep

OFF

Memory

Figure 7-1. Submenu (repeated)

Text

Event

Trend

Figure 7-2. Memory menu (repeated)

45 min

9 h

45 min

SpO2

Figure 7-5. “Print trend” menu

Display

Flip

Memory

Clear

9 h

SpO2

back

The CardioServ trend memory contains the HR and SpO

readings of the past 45 minutes and 9 hours. This memory,

too, is updated automatically. The stored trends can be

printed out as follows:

* Press

to display the submenu (Figure 7-1).

Memory

to display the memory menu (Figure 7-2).

Trend

to display the print-trend menu (Figure

7-5).

Now you can

45 min

* print the 45-min HR trend with

* print the 9-hour HR trend with

* print the 45-min SpO2 trend with

9 h HR

45 min

SpO2 Print

9 h

* print the 9-hour SpO2 trend with

* press

back

to return to the memory menu.

SpO2

Clearing the Memories

* Press

to display the submenu (Figure 7-1).

Memory

to display the memory menu (Figure 7-2).

Memory

Clear

for 2 seconds to clear all three memories in

one action.

60 CardioServ V 4.2 227 446 32-I

Recording

8. Recording

This section describes

– how to initiate a manual recording

– in which situations the recorder operates automatically

– how to load chart paper

227 446 32-I CardioServ V 4.2 61

Recording

100

8.1 Manual Recordings

The keys are used to start and stop manual record-

ings. When “Cont. Printout” in the defaults menu is “off”

(Default), CardioServ will record the ECG shown on the

display for 16 seconds. The recorder can be stopped before

that with . When “Cont. Printout” is “on”,

CardioServ will record the ECG until stopped with

360

300

150

200

Charge

Shock

APEX

Shock

Sync

Charge

Shock

recorded first (Figure 8-2). The following information is

annotated in the margin of the recording strip:

a text indicating that this

Figure 8-1. Keys to initiate a recording

b date

c time

d active filters

e delivered energy

MANUAL 09. 04 .1997 09 : 16 : 12 50 Hz 35 Hz 0 JOULES HR:

1 CM/MV

25 MM/S ST. JOHN’S DGH 97

. The paper speed is 25 mm/s. A calibration pulse is

f heart rate

is a manual recording

g ECG lead

h sensitivity

i paper speed

k hospital/department name

PATIENT

DATE OF BIRTH.............

USER........................

COMMENTS.................

SELECTED ENERGY.........

DELIVERED ENERGY........

ALARM LIMIT HR...........

ALARM LIMIT SPO2 .......

PACEMAKER................

DATE/TIME..................

Figure 8-2. Manual recording

62 CardioServ V 4.2 227 446 32-I

Recording

8.2 Automatic Recordings

It is important that the chart paper exit is unob-

Warnin

structed. If this is not ensured, the paper may be

pulled back into the device and wrap around the

transport roller. When this happens, remove the

paper jam as follows:

– open the paper compartment

– carefully pull out the tangled paper and tear

it off the strip

– re-load the chart paper (section 8.3).

You can obtain a copy of the displayed image by

☞

simultaneously pressing the two contrast adjust-

ment keys.

A recording is initiated automatically with each delivered

defibrillation shock. Via the defaults menu (section 11) you

can select automatic recordings to be triggered by each viola-

tion of an alarm limit. An automatic recording covers a period

of 16 seconds, including a history of 4 seconds. The following

information is annotated in the margin of the recording strip

(Figure 8-2):

a Message indicating the reason for the recording

b Date

c Time

d Active filters

e Delivered energy

f Heart rate

g ECG lead

h Sensitivity

i Paper speed

k Hospital/department name

227 446 32-I CardioServ V 4.2 63

Figure 8-3. Opening the paper compartment

Recording

8.3 Loading Chart Paper

To prevent damage to the printhead use the original

GEMS IT CONTRAST® chart paper only (Part No.

226 130 02).

* Push the cover of the paper compartment upward and

fold it out (Figure 8-3).

* Remove the empty sleeve of the old paper roll by pulling

on the white plastic tab.

* Insert the new roll as shown in Figure 8-4.

Figure 8-4. Inserting the paper roll

64 CardioServ V 4.2 227 446 32-I

Figure 8-5. Inserting the leading edge

Recording

* Feed the leading edge of the paper under the paper

transport roller (Figure 8-5) and keep pushing it forward

until it appears above the roller.

* Feed the leading edge of the paper through the exit in

the cover as shown in Figure 8-6.

Figure 8-6. Feeding the leading edge through the aperture

227 446 32-I CardioServ V 4.2 65

Figure 8-7. Closing the cover

Thermorecordings should only be stored in transpar-

☞

ent envelopes made of polyethylene, since PVC

bleaches the text and traces (if in doubt, insert a

sheet of tissue paper in between).

Recording

* Close the cover. While doing so, pull firmly on the paper

strip to ensure that it does not get caught behind the

cover (Figure 8-7).

The last 3 meters of the roll are marked with a red stripe.

Insert a new roll in time to ensure that all alarm recordings are

documented.

66 CardioServ V 4.2 227 446 32-I

Oxygen Saturation SpO

9. Oxygen Saturation SpO

This section of the manual explains

– the oxygen saturation measuring method

– how to apply the sensors

– points to note during SpO2 measurement

227 446 32-I CardioServ V 4.2 67

Oxygen Saturation SpO

9.1 General Information

160 BPM

140 ECG

SpO2 Alarm

100 % 90 SpO2

MenuFreezeSpO2ECG

Figure 9-1. Display of the SpO2 reading and the plethysmogram

Pulse oximetry is not suitable for oxygen monitor-

ing in fetuses before or during birth. Moreover, it

Caution

is not suitable for use on patients with carbon-

monoxide poisoning.

SpO2 measurement is employed to determine the oxygen

saturation of hemoglobin in the arterial blood. Alarm limits

can be adjusted to monitor levels of oxygen saturation. A

plethysmographic waveform is displayed in channel 2 (Figure

9-1).

Arterial oxygen saturation is measured by a method called

pulse oximetry. It is a continuous, non-invasive method based

on the different absorption spectra of reduced hemoglobin

and oxyhemoglobin.

Therefore the sensors consist of a light source (two LEDs in

most cases) and a photodetector on the opposite side which

collects the incident light. The light (red and infrared range

between 660 nm and 940 nm) from the LEDs is transmitted

through the blood and tissue components of the finger, ear

lobe or foot. The photodiode in the sensor measures the light

that passes through and converts it into an electrical signal.

The pulsatile component of the signal is used to build the

plethysmogram.

Elevated levels of CO-Hb and Met-Hb can

influence the SpO2 readings. Also dyes in the

Caution

blood (e.g. Cardiogreen) can impair the measur-

ing accuracy of the system.

Literature

WUKITSCH, M.W.; PETTERSON, M.T.; TOBLER, D.R.;POLOGE,

J.A.: Pulse Oximetry: Analysis of Theory, Technology, and

Practice, J. Clin. Monit. 4: 290– 301 (1988)

CECIL, W.T.; THORPE, K.J.; FIBUCH E.E.; TUOHY, G.F.: A

Clinical Evaluation of the Accuracy of the Nellcor N-100 and

Ohmeda 3700 Pulse Oximeters, J. Clin. Monit. 4: 31–36

(1988)

68 CardioServ V 4.2 227 446 32-I

Oxygen Saturation SpO

C-LOCK ECG Synchronization

The C-LOCK ECG synchronization feature enables the

monitor to use an ECG signal as a reference point for identi-

fying the pulse and synchronizing saturation measurements.

This enhances the performance of the monitor in the presence

of patient movement and when the patient’s perfusion is

poor.

When an ECG signal is present during SpO2 measurement,

the monitor is receiving two separate signals that reflect

cardiac activity: an optical signal from the sensor and an

electrical signal from the ECG. The time that elapses between

the ECG R-wave and the optical pulse detected at the sensor

site depends on the patient’s physiology, the heart rate and the

location of the sensor. However, for a given patient the length

of the delay is relatively stable. Through C-LOCK ECG

synchronization, the monitor uses that time relationship to

identify good pulses and reject nonsynchronized artifacts.

Application Hints

– Use only the sensors listed in section 15 “Order Informa-

tion and Accessories”. Apply the sensors as described in

their instructions for use. Carefully observe all informa-

tion and cautions given in these instructions.

– Take care that the sensor does not exert too much pres-

sure on the tissue, as this would result in wrong readings

and blistering. The blisters are not caused by overheating

but by lack of ventilation.

– Exercise extreme care to assure continued circulation

distal to the sensor site after application.

– Change the application site at least every 24 hours to

allow the skin to breathe.

– Excessive ambient light impairs signal quality. This can

be prevented by covering the sensor site with a cloth.

– Simultaneously determining the cardiac output by means

of dye dilution may prevent SpO2 measurement.

– When circulation of blood is impaired (blood-pressure

cuff or extreme vascular resistance), it may not be possi-

ble to determine SpO2 values or the pulse rate.

– Remove nail polish and artificial fingernails before

applying the sensor, as these may affect the reading.

– Do not apply the finger sensor to the same arm as a

blood-pressure cuff.

227 446 32-I CardioServ V 4.2 69

Oxygen Saturation SpO

In order to minimize motion artifact:

– take care to provide an ECG of good quality (C-LOCK

ECG synchronization)

– use a new sensor with fresh adhesive backing

– move the sensor to a less active site

– select a slow integration time.

When monitoring SpO2 during electrosurgical intervention,

take care that:

– CardioServ is powered from the built-in battery or from

a different power circuit than the electrosurgical unit

– the ground pad is close to the surgical site

– the sensor is applied as far from the surgical site, the

ground pad and the electrosurgical unit as possible.

In the presence of AC line interference

– When interference signals from the power line are

present, square waves may be displayed instead of the

plethysmogram. In this situation we recommend to

disconnect the device from the power line and operate it

on battery power.

70 CardioServ V 4.2 227 446 32-I

Oxygen Saturation SpO

The ECG signal (section 6.1 “Displaying the ECG”)

☞

is a prerequisite for the proper functioning of the

C-LOCK ECG synchronization feature.

Option

SpO



EKG



Figure 9-2. SpO2 sensor connection

160 BPM

140 ECG

9.2 Measuring and Monitoring Oxygen Saturation

* Turn on CardioServ (switch position ).

* Apply the sensor as described in the instructions for use

enclosed with the sensor.

* Connect the sensor to CardioServ (SpO2 connection,

Figure 9-2).

Within a few seconds the SpO2 reading and the plethysmo-

gram will be displayed (Figure 9-3).

Please note: The following adjustments are temporary and,

contrary to the settings of the default menu (Section 11

“Configuring the Defibrillator Settings”), will not be saved.

--- % 90 SpO2

I...III

aV...V

Paddle

cm/mV

Figure 9-3. SpO2 value and plethysmogram

a SpO2 value

b plethysmogram

c SpO2 alarm limits (upper limit disabled)

227 446 32-I CardioServ V 4.2 71

Alarm

Limits

back

Oxygen Saturation SpO

Enabling/Disabling the C-LOCK ECG Synchronization

Disable the C-LOCK ECG synchronization func-

☞

tion for monitoring of pacemaker patients (section

6.3)

C-Lock

Integ.

Time

12 s

Alarm

Limits

Figure 9-4. SpO2 menu

If, in monitoring the patient, several adverse

conditions exist at once, a disturbed signal may go

Caution

unnoticed. Artifacts could then be capable of

simulating a plausible reading, and no alarm

would be released. To assure reliable monitoring,

the sensor application and signal quality should

be verified from time to time.

When monitoring the pulse rate derived from the

SpO2 signal instead of the heart rate, select an

Caution

integration time of 4 s or 8 s. Do not select 12 s.

back

With the factory settings unchanged, the C-LOCK ECG

synchronization feature is inactive when the CardioServ is

switched on. If an ECG signal is available, enable the synchro-

nization feature as follows:

* Press the

SpO2

softkey to display the SpO2 menu

(Figure 9-4) (only available when SpO2 sensor is con-

nected to the unit).

C-Lock

* Press the

OFF

softkey to enable (ON) the C-LOCK

feature (or disable the feature by pressing the key again).

Selecting the Integration Time

The integration time is the time over which the SpO2 readings

are averaged. Selectable times are 4, 8 (default) and 12 sec-

onds. The integration time of 12 seconds should only be

selected in exceptional cases.

* Press the

SpO2

softkey to display the SpO2 menu

(Figure 9-4).

Integ.

* Press

Time

to select an integration time.

12 s

72 CardioServ V 4.2 227 446 32-I

Oxygen Saturation SpO

Adjusting SpO2 Limits

C-Lock

Integ.

Time

12 s

Alarm

Limits

Figure 9-4. SpO2 menu (repeated)

High

Alarm

SpO2 SpO2

Low

Alarm

Figure 9-5. Alarm limits menu

SpO2 alarms are similar to HR alarms. Please refer

☞

to section 6.2 “Monitoring the ECG”.

MANUAL 29.06.1997 09:16:12 50 Hz 35 H

back

* Press

SpO2

to display the SpO2 menu (Figure 9-4).

Alarm

Limits

to display the alarm limits menu (Figure

9-5).

* The + key increases the limit value, the - key decreases

it.

SpO2 alarms neither initiate an alarm recording nor are they

saved to the event memory.

Printing the Plethysmogram

The recordings, no matter whether they are initiated manually

or automatically, always display the plethysmorgram in chan-

nel 2.

1 CM/MV

25 MM/S CARDIOSERV PACEMAKER SPO2

Figure 9-6. ECG and plethysmogram

227 446 32-I CardioServ V 4.2 73

For your notes

Oxygen Saturation SpO

74 CardioServ V 4.2 227 446 32-I

Pacing

10. Pacing

This section of the manual explains

– the pacemaker uses

– the points to note during pacing

– pacemaker operation

227 446 32-I CardioServ V 4.2 75

10.1 General Information

Pacing

Application and Functional Description

The transcutaneous pacemaker of CardioServ is applied in

emergencies for external (transcutaneous) cardiac stimulation.

It is also used as a temporary aid in cases of acute arrhythmias

or Stokes-Adams attacks. Some forms of bradycardia and

tachycardia can be treated as well.

The pacemaker offers two modes of operation: demand and

fixed-rate pacing.

The pacing pulses are delivered through the defibrillation

pads.

Rules for Application of External Pacemakers

These rules are valid for all pacemakers, regardless of model

and manufacturer.

All electrical devices that deliver energy to patients in any

form or that have an electrically conductive connection to the

patient present a possible hazard.

The safe application of the device lies in the hands of the user;

thus, it is very important to observe the following rules:

* Pacemakers may only be used under the supervision of

qualified medical staff.

* The safe application necessitates expert knowledge, good

organization, special care in selecting the technical

equipment and regular maintenance.

* Medical-technical devices such as the CardioServ must

only be applied by persons who are adequately trained in

the use of such equipment.

* Before application, the user must check the unit for

functional safety.

* The patient’s ECG must be monitored to allow the user

to determine capture. Furthermore, at least one of the

persons present must be familiar with the application of

the defibrillator.

76 CardioServ V 4.2 227 446 32-I

Pacing

Due to their functional requirements pacemakers

operate with high voltages and are thus equipped

Caution

with special non-accessible outputs. Nevertheless,

it is important not to come into contact with the

voltage-conducting contacts via conductive metal

objects, such as tweezers, as long as the pacemaker

is operating. Currents passing through the heart

which exceed 10 μA may induce ventricular

fibrillation.

Switch the pacemaker on and off as follows:

Caution

Switching the pacemaker on:

1. Apply the pace pads

2. Connect pads to CardioServ via the adapter

lead

3. Switch on CardioServ

4. Switch on the pacemaker

Switching the pacemaker off:

1. Switch off the pacemaker

2. Switch off CardioServ

3. Disconnect adapter lead from CardioServ

4. Remove pace pads

Each of the following rules must be observed:

* Check the performance of the defibrillator at hand.

* When positioning the patient ensure that no electrically

conductive connections are created between the patient

and earthed metal parts (also beware of puddles, etc.).

Although the pacemaker pulse current output is re-

quired to be electrically isolated (floating), this is an

additional safety precaution to ensure that the pacemaker

current pulse only flows between the pacemaker elec-

trodes.

* Apply electrodes, arrange electrode leads and connect

them to CardioServ. Use only the electrodes and leads

listed in section 15 “Order Information and Accessories”.

* Operate the pacemaker as described in this manual.

Determine capture by measuring the pulse rate,

not the heart rate.

Caution

227 446 32-I CardioServ V 4.2 77

Pacing

10.2 Application of Single-Use

Defibrillation Pads

STERNUM

electrode + connector

Figure 10-1. Defibrillation pad placement

223 383 01

The single-use defibrillation pads (part no. 919 202 94 adult

pads, part no. 919 202 95 pediatric pads) can be used for

– defibrillation/cardioversion (refer to section 4.2 “Defi-

brillation with Internal Electrodes or Defibrillation Pads”)

– ECG monitoring

– transcutaneous pacing.

APEX

Below we will explain the correct pad application for

transcutaneous pacing

* Use pads before their expiration date.

* Apply the pads as follows:

– Shave each site. This improves conductivity and makes

removal of the pad easier.

– Place the pads on the patient so that the connectors

point to either side of the patient and that the cables are

not hindering patient treatment.

919 202 94 919 202 95 (K)

Figure 10-2. Connecting the pad to the cable

– The electrodes are pregelled; therefore do not use addi-

tional contact cream or paste.

– Do not use pads, if the gel has dried out.

– Peel off the backing from each pad and place the pad

carefully on the appropriate site.

78 CardioServ V 4.2 227 446 32-I

Warning

223 346 01

919 201 89 919 202 75 (K)

Figure 10-3. Connecting the defib pads to the adapter cable

Pacing

* Then press the connector of cable 223 383 01 on to the

electrode contact pin until you hear it click into place.

Observe the connector labels: “A” =apex, “S” = sternum.

The round adhesive electrodes (part. no. 919 201 89) can be

used with adapter lead 223 346 01. When connecting the

electrode to the lead, take care that they engage properly. To

disconnect them, simply press on the rear part of the catch

(Figure 10-3).

* After use, carefully peel off the pads from the patient’s

skin (Figure 10-4) and discard them immediately.

Should a patient require defibrillation during

transcutaneous pacing, immediately select the

Caution

required energy with the energy selector, and push

Charge

the

button. The pacemaker automatically

Shock

selects a current of 0 mA in this situation. The

shock is delivered by pressing the

described in section 4.2).

Should the patient require further pacing, resume

pacing by following the instructions in sections

10.3 (Demand Mode) or 10.4 (Fixed-Rate

Mode).

incorrect

Figure 10.4. Removing defibrillation pads

Shock

buttons (as

correct

Discard disposable defibrillation pads immedi-

ately after use. Do not reuse them!

If the ECG signal is extremely noisy and the AC line

☞

filter is not sufficient to provide a clean signal, the

demand mode operation of the CardioServ may be

disturbed. In this situation the message “Check pace

pads” will be displayed. To reduce the interference

signal, reapply the pads, carefully observing the

application instructions.

227 446 32-I CardioServ V 4.2 79

Pacing

10.3 Demand Mode

Warnin

Observance of the pacemaker application rules

stated in section 10.1 is an absolute must to

ensure the safe and successful use of the pace-

maker.

During pacing, always set the energy selector to

the position. This prevents that a defibrilla-

tion pulse is triggered inadvertently.

Caution: The pacing pulses are delivered via the defibrillation

pads. These must be applied to the patient as explained in

section 10.2.

The pacemaker can be switched on only when the pace pads

are connected (otherwise a message will be displayed to in-

form the user of missing electrodes).

In the demand mode the pacemaker does not deliver a pacing

pulse as long as the patient’s intrinsic heart rate exceeds the set

pacer rate. When the heart rate drops below the pacer rate, the

pacemaker starts delivering pacing pulses. For this reasons the

ECG must be continuously monitored. The necessary syn-

chronization pulses are automatically transmitted to the

pacemaker.

Demand mode is the method of choice when bradycardia or

asystole is expected to develop after critical events. Control-

ling the pacemaker in this manner precludes the possible

competition between intrinsic excitation and external pacing

pulses which could result in ventricular fibrillation.

* Acquire the ECG signal as described in section 6.1

“Displaying the ECG”.

* Verify that the pads are properly applied and connected

to CardioServ.

80 CardioServ V 4.2 227 446 32-I

Defib

P/min

–

Dem

Fix

STERNUM

18 17 16 15

Figure 10-5. Pacemaker operating controls

15 Buttons for selection of the pacer output

16 Buttons for selection of the pacer rate

17 Pacing mode selection button (Fix/Demand)

18 toggles the pacemaker on and off (press button

longer than 2 seconds to turn the pacemaker

off)

The default pacer rate can be preset (Defaults

☞

menu).

Pacing

* Press the button to switch on the pacemaker (Fig-

ure 10-5). The pacemaker defaults to the demand mode

and to a pacer rate of 60 BPM (selectable).

–

* Using the

button, select a low pacer output (e.g.

20 mA)

* Increase the pacer rate with the

P/min

button until the

asterisk (a, Figure 10-6) just begins to flash: The pacer

rate is now identical with or just above the intrinsic heart

rate.

* Press the

button to slowly increase the pacer output

to a level which ensures consistent responses from the

heart.

* Now select the required pacer rate with buttons

P/min

and

P/min

* Increase the pacer output by another 5 mA to achieve

reliable stimulation.

* To verify the success of the treatment, watch the ECG

on the screen. You can press the

Sync

button to view the

trigger marks on the display.

227 446 32-I CardioServ V 4.2 81

160 BPM

140 ECG

Pacing

* At the end of the intervention, first turn off the pace-

maker, then remove the pads carefully.

In order to turn off the pacemaker, button must be

held down for at least 2 seconds. This safety precaution

has been taken to prevent the pacemaker being turned

off inadvertently. For this reason it is not possible to

switch off CardioServ while the pacemaker is still on.

Pacemaker Demand 60 BPM 65 mA

Figure 10-6. Screen display with pacemaker switched on

a asterisk, flashing with every delivered pacing

pulse

b pacing rate

c pacing current

d pacing mode

If the defibrillator is put into operation during

☞

pacing, the pacemaker automatically selects an

output of 0 mA

MenuFreezeSpO2ECG

82 CardioServ V 4.2 227 446 32-I

Pacing

Defib

10.4 Fixed-Rate Mode

Observance of the pacemaker application rules

Warnin

stated in section 10.1 is an absolute must to

ensure the safe and successful use of the pace-

maker.

P/min

–

Dem

Fix

STERNUM

18 17 16 15

Figure 10-7. Pacemaker operating controls

15 Buttons for selection of the pacer output

16 Buttons for selection of the pacer rate

17 Pacing mode selection button (Fix/Demand)

18 toggles the pacemaker on and off (press button

longer than 2 seconds to turn the pacemaker

off)

Caution: The pacing pulses are delivered via the defibrillation

pads. These must be applied to the patient as explained in

section 10.2.

The pacemaker can be turned on only when the pace pads are

connected (otherwise a message will be displayed to warn the

–

user of missing electrodes).

In the fixed-rate mode the pacemaker delivers pacing pulses at

a selectable rate and output setting. The selected rate is

“fixed”, i.e., it does not take into account intrinsic action of

the heart. This mode of operation should be selected in cases

of asystole. Some forms of bradycardia and tachycardia can be

corrected with fixed-rate pacing, but transcutaneous emer-

gency pacing is not the therapy of choice in these instances.

* Verify that the electrodes are properly applied and

connected to CardioServ.

* Press the button, to switch on the pacemaker

(Figure 10-7). The pacemaker defaults to the demand

mode and to a pacing rate of 60 BPM (selectable).

During pacing, always set the energy selector to

Warnin

the , position. This prevents that a defibril-

lation pulse is triggered inadvertently.

227 446 32-I CardioServ V 4.2 83

Pacing

160 BPM

140 ECG

Pacemaker Fix 60 BPM

65 mA

Figure 10-8. Screen display with pacemaker switched on

a asterisk, flashing with every delivered pacing

b pacing rate

c pacing current

d pacing mode

The default pacer rate can be preset (Defaults

☞

menu).

pulse

MenuFreezeSpO2ECG

* Press the

Dem

button for 3 seconds to select the fixed-

Fix

rate mode (“Demand” is replaced with “Fix” at d in

Figure 10-8).

The asterisk (a; Figure 10-8) flashes each time a pacing pulse

is delivered.

* Select the pacing rate with the buttons

* Press the

button to slowly increase the pacer output

P/min

and

P/min

to a level which ensures consistent reponses from the

heart.

* To verify the success of the treatment, watch the ECG

on the screen.

* Increase the current by another 5 mA to ensure reliable

pacing.

* At the end of the intervention, first turn off the pace-

maker, then remove the pads carefully.

In order to turn off the pacemaker, button must be

held down for at least 2 seconds. This safety precaution

has been taken to prevent the pacemaker being turned

off inadvertently. For this reason it is not possible to

switch off CardioServ while the pacemaker is still on.

84 CardioServ V 4.2 227 446 32-I

Configuring the Defibrillator Settings

11. Configuring the Defibrillator

Settings

This section describes the instrument settings that can be

modified to suit your personal needs and preferences, and

how this is done.

227 446 32-I CardioServ V 4.2 85

Configuring the Defibrillator Settings

Defaults

HR Limits Sensitivity Lead

Autosequence SPO2 Limits C-LOCK SPO2-Int. Time Lead Fail Alarm QRS Beep Alarm Tone Alarm Printout Shock Printout Cont. Printout

Defaults

Cont. Printout Pacemaker Display Display Volume AC Filter Muscle Filter Date Format Date/Time Language

User Factory Setting

Figure 11-1. The menu

low : 40 high : 160

0.5 1 2 cm/mV

I II III aVR aVL aVF V

Paddle 200J 200J 360J low : 40 high : OFF

OFF ON

4s 8s 12s

OFF ON OFF ON OFF ON OFF ON

OFF ON

EXIT

OFF ON

60 BPM

normal reverse 0 deg. 180 deg. high low 50Hz 60Hz OFF

OFF ON DD:MM:YYYY MM:DD:YYYY

06.01.1998 11:35:47

deutsch English français

усск espanol italiano Svenska Portugues

OFF ON

Next MenuEXIT

The defaults menu allows you to customize device settings,

which means that they are retained in memory and are acti-

vated automatically on power up.

* Simultaneously press F1 and F5 to display the defaults

menu.

Page 1 of the menu appears (Figure 11-1 top).

The cursor keys F1, F2 (up/down) and F4 (right) are used to

move the cursor to the parameter whose setting is to be

modified. Then you can change the setting with function keys

F1 through F5. The functions and labels of these keys change

with each parameter.

With F5

Confirm each selection with F5

you scroll to the next page of the menu.

EXIT

. This will also take

you back to the main menu.

Defaults

HR Limits

Sensitivity Lead

Autosequence SPO2 Limits C-LOCK SPO2-Int. Time Lead Fail Alarm QRS Beep Alarm Tone Alarm Printout Shock Printout Cont. Printout

low : 40 high : 160

0.5 1 2 cm/mV

I II III aVR aVL aVF V

Paddle 200J 200J 360J low : 40 high : OFF

OFF ON

4s 8s 12s

OFF ON OFF ON OFF ON OFF ON

OFF ON

F1 F2 F3 F4 F5

–

Enter

Figure 11-2. The configuration menu

86 CardioServ V 4.2 227 446 32-I

Configuring the Defibrillator Settings

With F3

EXIT

you leave the configuration menu and save

the changes.

The new settings are saved only if you quit the

☞

defaults menu with F3

EXIT

ECG monitoring is suspended during configura-

Warnin

☞

tion.

It is not possible to call up the defaults menu, while

the defibrillator is charged, during ECG analysis

Analyse

(

button) or while the pacemaker operates.

When you display the defaults menu, the values

preset in this menu will overwrite the temporary

Caution

device settings (alarm limits, leads, etc.).

HR Alarm Limits

The limit values for heart-rate monitoring selected here are

automatically activated on power up.

* Using F4, move the cursor to the right.

* Adjust the low limit with F1 and F2 (if you keep the

keys depressed, the digits change at a higher rate) (Figure

11-2). Alarm limits can be disabled by selecting a value

outside the adjustment range.

* Using F4, move the cursor to the high limit and adjust it

in the same way as the low limit.

* Confirm the new limit values with F5.

Sensitivity

The setting selected here (.5,1,2 cm/mV) is the CardioServ

default sensitivity.

* Using F4, move the cursor to the right.

* Select the desired setting with F3 or F4 and confirm the

selection with F5.

227 446 32-I CardioServ V 4.2 87

Configuring the Defibrillator Settings

Lead

The setting selected here is the CardioServ default ECG lead.

* Using F4, move the cursor to the right.

* Select the desired lead with F3 or F4 and confirm the

selection with F5.

Autosequence

This menu item defines the energy levels for the 1st, 2nd and

3rd defibrillation shock in autosequence mode (default: 200 J,

200 J, 360 J).

You can choose a different energy level (150 J, 200 J, 300 J,

360 J) for each shock.

When the cursor highlights a value, this value can be in-

creased with F1 and decreased with F2.

SpO2 Int. Time

Here you select the default integration time for averaging of

the SpO2 values. The 12 second integration time should only

be selected in exceptional cases.

Lead Fail Alarm

Do you wish the alarm to sound after 30 s when an ECG

electrode drops off?

QRS Beep

Do you wish to have the QRS beep enabled or disabled on

power up?

Alarm Tone

Do you wish to have the audible alarm enabled or disabled on

power up?

SpO2 Limits

Here you adjust the default alarm limits for monitoring of

SpO2.

C-LOCK

Do you wish to have the C-LOCK ECG Synchronization

feature enabled or disabled on power up?

88 CardioServ V 4.2 227 446 32-I

Alarm Printout

Do you want the recorder to start automatically in an alarm

situation (violation of HR limits)?

Shock Printout

Do you want the recorder to start automatically when a

defibrillation shock is delivered?

Configuring the Defibrillator Settings

Continuous Printout

When the function is disabled, the recorder will stop auto-

matically after 16 seconds. When it is enabled, the recorder

must be stopped manually.

Pacemaker

This is to select the default pacing rate.

Display

Normal (black on white) or reverse (white on black) display

on the LCD screen.

Normal or flipped display (rotating the display 180° may

prove useful for CardioServ units operated in the defibrillator

mounting system).

Volume

For selection of the volume of all audio signals emitted by the

unit (prompts, alarms).

AC Filter

for elimination of signal noise from the power line. Default

setting for 50 Hz (Europe) or 60 Hz (USA) or no filter

(OFF).

Muscle Filter

For elimination of motion artifact and muscle action

potentials (35 Hz).

Date Format

DD.MM.YYYY (European format) or

MM.DD.YYYY (US format).

Date / Time

For adjustment of date and time.

* Using F4, move the cursor to the right (day).

* Using F1 and F2, adjust the day.

* Using F4, move the cursor to the right (month).

* Using F1 and F2, adjust the month.

* Proceed in the same manner to adjust year, hours,

minutes and seconds.

* Confirm the entries with F5.

Depending on the CardioServ model purchased, not

☞

all menu items may be available.

227 446 32-I CardioServ V 4.2 89

Configuring the Defibrillator Settings

Language

This menu item is used to select the language for the screen

texts and printed documents.

* Using F4, move the cursor to the right.

* Select the desired language with F3 or F4.

* Confirm your selection with F5.

User

Via this menu item you can enter a text or a name which will

be printed in the margin of the recording strip.

* Using F4, move the cursor to the right.

You can now use F1 and F2 to select the first numeral, sym-

bol or letter from a character set for the name or text to be

entered. With F1 you scroll forward through the set, with F2,

backward. F4 moves the cursor to the right, allowing you to

enter the second character, etc. The first character is a blank.

Factory Settings

You can restore the factory settings by selecting ON (language

and operating mode will not be changed).

Restoring the factory settings will delete the informa-

☞

tion entered with menu item “User”.

* Confirm entries with F5.

90 CardioServ V 4.2 227 446 32-I

Error Indications and Messages

12. Error Indications and Messages

In this section of the manual you will find

– the error indications and messages which CardioServ

may display after the power-on self-test

– the error indications and messages which CardioServ

may display while in use

– an explanation of the meaning of each message, and

troubleshooting tips

227 446 32-I CardioServ V 4.2 91

Error Indications and Messages

Error Messages during power-on self-test (POST)

egasseMtceffEnoitanalpxEydemeR

rorrEMARehtesutonod,tcefedecived

ecived

rorrEMORehtesutonod

ecived

rorrEMARyalpsiD

yekynasserp

yromemdexifnirorrE

yekynasserp

fed,ylno

rorrEesaBemiT

yekynasserp

yek”kcohS“kcehC

yekynasserp

,tcefedecived

itallirbifed,ylno

(snottubrehtie 2 (ro/dna) 8)

w;evitcefed)s(nottubro

ecived,evitcefednottub

rofdesuebtonnac

roftubsnoitallirbifed

ylnognirotinom

eciffoecivresyfitoN

seicnegremerofesudetcirtser

elbissopno

llatadaer

seicnegremerofesudetcirtser

elbissopnoitallirbi

)devasebtonnac

seicnegremerofesudetcirtser

elbissopnoitallirbifed,ylno

siyalpsideht,tcefedyalpsid

ebtonnacrodaerottluciffid

(syek 7 ecivresyfitondna)

eciffo

tcefednoitarugifnocresu

snoitarugifnocmotsuc,.g.e(

(syek 7 ecivresyfitondna)

eciffo

sah

cus(ataddetaler-emitlla

ebyam)etartraeheht

(syek 7 rorrefi;emittsujda,)

suoenorre

,purewopnodesserpederew

(syek 7 ,ecivedffohctiws,)

neh

noitcnufehtfoenosserP

fehtfoenosserP

noitcnu

(syeksserptonod 2 (dna) 8)

eciffoecivresyfiton,stsisrep

.niaganoecivedhctiwsdna

refI

,sruceregassemror

.eciffoecivresyfiton

yekEGRAHCkcehC

)evobayek”kcohS“ees()evobayek”kco

hS“ees()evobayek”kcohS“ees(

yekynasserp

)evobayek”kcohS“ees(

rorrEygrenEegrahC

yekynasserp

92 CardioServ V 4.2 227 446 32-I

morfsreffidygrenederots

niecivedesu,ygrenedetcel

!ylnoseicnegreme

devas

ehtemittsalderruccororre

tierofeb(desusawecived

(syek 7 -sidtsetreviled,)

sawdna)ffodenrutsaw

noitcnufehtfoenosserP

dnaffoecivedhctiws,egrahc

egassemrorrefI.niagano

ucer

.eciffoecivresyfiton,sr

Messages/problems during operation

egasseMnoitanalpxEydemeR

yrettabwoLdetelpedtsomlayrettabsniamotecivedtcennoc

Error Indications and Messages

mralaRHro,timilRHwolrohgihfonoi

taloiv

edortcelekcehCelddaproedortceleGCEhgih

ecnadepmi

degrahcbifeDs0

rotceleskcehC;ylreporpgnixednitonsirotcelesygrene

hgihygrenEneve,seluoj05sdee

cxeygrenedetceles

ed;ygrene

wolygrenE;ygrenedetceleswolebygrenederots

elbissopnoitallirbifed

edortcelEgnirotinomedortceleroelddapbifed

kcehc,cilotsysatonsitneitapnehw

s4rofdeifitnedievaw-Ron

otsiedutilpmalangis

llamso

ehtnehwdaelrehtonatceles;sedortcele

euqinhcetedortcelekcehc

3rofderotsygrenenoitallirbifed

;noitisoptcaxeehtotrotcelesygrenetes

elbissoptonnoitallirbif

ecivresyfiton,sruceregassemnehw

eciffo

,)selddaplanretni(eulavrewolatceles

;detcennoceraselddaplanretnihguoht

detcelesnahtrehgihygrenederots

eciffoecivresyfiton,sruce

egassemnehw;egrahcsidtsetesaeler

elbissopnoitallirbif

egassemnehw;egrahcsidtsetesaeler

eciffo

ecivresyfiton,srucer

ecived(niaganodnaffoecivedhctiws

ecivedhtiwselddapfoegnahcxe,tcefed

ptonnoitallirbifed,nodenrut

elbisso

elddaprofffodehctiwsebtsum

yfiton,sruceregassemnehw;)egnahcxe

eciffoecivres

yltcerrocnoitcnuftonseodeciveDecnabrutsiderawtfosniaganodnaffoecivedhcti

sdapecapkcehCecnerefretnienilCAevissecxe,retlifenilCAehtelbane

noitacilppaedortcelekcehc

litonseodDELneerG

gnirudetanimul

tinuylppusrewopevitcefedecivresyfiton

noitareporewopenil

gnirudetanimullitonseodDELwoll

tinuylppusrewoproyrettabevitcefedecivresyfiton

noitareporewopenil

227 446 32-I CardioServ V 4.2 93

For your notes

Error Indications and Messages

94 CardioServ V 4.2 227 446 32-I

Cleaning, Maintenance and Disposal

13. Cleaning, Maintenance and Disposal

This section of the manual describes

– how to clean and disinfect the device and the electrodes

– how to sterilize the internal electrodes

– how to clean and disinfect the suction electrodes

– how to perform routine maintenance on the device

227 446 32-I CardioServ V 4.2 95

Cleaning, Maintenance and Disposal

13.1 Cleaning, Disinfection and

Sterilization

Before cleaning the device, disconnect it from the

power line. Turn off the device before touching

Danger

the contact susfaces of the paddles, and be careful

not to switch it on again while cleaning it. Dan-

ger to life! As a safety precaution, remove the

battery and disconnect the paddles from the

defibrillator.

Do not use hot air to sterilize the internal defi-

brillation electrodes.

Caution

The defibrillation electrodes and handles must be

disconnected from the cable before autoclaving

Caution

(arrow, Figure 13-2).

Device and Paddles

* Discard all disposable electrodes immediately after use to

prevent inadvertent reuse.

* The paddles and their leads can be cleaned and disin-

fected by wiping them down with a gauze pad moistened

in a cleaning solution. Before applying the paddles again,

check that they have thoroughly dried.

* Clean the instrument surface with a cloth moistened in a

cleaning solution. Take care that the solution does not

enter the defibrillator enclosure.

Any hospital-grade cleaning solution and disinfectant contain-

ing up to 70% alcohol is suitable.

* The internal defibrillation electrodes are initially cleaned

in the same way as external paddles. For electrodes and

connection cables, low-temperature plasma sterilization

is the recommended method. Alternative methods are

ETO sterilization, water vapor (autoclave at 134 °C) or

ionizing radiation. Internal electrodes must be sterilized

after each resuscitation code.

96 CardioServ V 4.2 227 446 32-I

Cleaning, Maintenance and Disposal

1 2 3

Figure 13-1. Inserting the contact paddle

Having loosened the counter nut, you can easily alter

☞

the position of the contact paddle.

➙

To insert the contact paddles, proceed as follows:

* Screw the counter nut (2, Figure 13-1) onto the elec-

trode as far as it will go.

* Screw the contact paddle (1) into the handle as far as it

will go, then bring it into the appropriate position.

* Now fix the contact paddle by screwing the counter nut

(2) tight against the handle (3).

External Counter Electrode for Internal Defibrillation

* Disconnect the electrode from its lead before cleaning or

sterilizing it (Figure 13-2).

* Clean the electrode by rubbing it down with a cloth

moistened in soap water. Use a disinfectant for disinfec-

tion. Do not immerse the electrode in the liquid.

* Low-temperature plasma sterilization is the recom-

mended sterilization method. Alternative methods are

ETO sterilization and ionizing radiation. (Please note:

Figure 13-2. Counter electrode for internal defibrillation

227 446 32-I CardioServ V 4.2 97

Frequently sterilizing the electrodes with ethylene oxide

reduces the life of the plastic material!) Do not autoclave

the electrodes!

Cleaning, Maintenance and Disposal

Exchanging the Defibrillation Electrode Cable

* Switch off CardioServ.

* Grasp the plug and remove it from the socket (do not

pull on the cable).

* When inserting the plug, observe the orientation

(beveled edges) and click it into place.

Cleaning and Disinfecting Suction Electrodes

Do not use pointed metal objects to remove solid

particles of dirt from the electrodes as this would

Caution

destroy the silver/silver-chloride layer. Use a

commercially available fiberglass eraser instead.

* Clean the electrodes with water and a detergent. Use a

small brush to remove grime.

* All commercially available cleaning agents used for

surgical instruments are suitable for cleaning of the

electrodes. Follow the manufacturer’s instructions to mix

the preparation. Do not use metal dishes and take care

not to immerse plugs and metal sockets in the solution.

* To disinfect the electrodes, wipe them down with a cloth

moistened in 70% alcohol.

98 CardioServ V 4.2 227 446 32-I

13.2 Maintenance

Cleaning, Maintenance and Disposal

Before each application

* visually check the device and all accessories (leads, elec-

trodes, etc.) for signs of damage

* test the device performance (refer to section 3).

If you detect damages or impaired functions so that the safety

of the patient and user are no longer guaranteed, CardioServ

must be repaired before it can be applied again.

Checks at regular intervals

CardioServ defibrillators are emergency medical devices

designed to save and preserve life; they must be ready for use

at all times. Operational readiness must also be ensured for

battery power operation. Therefore, the devices must be

subjected to the following checks at regular intervals:

Every month

If batteries are repeatedly partially discharged, the resulting

“memory effect” may dramatically reduce the battery capacity.

This effect can be efficiently minimized by regular condition-

ing. If the capacity of a relatively new battery is drastically

reduced, the battery may be reconditioned by repeated charg-

ing and discharging. Proper maintenance of NiCd batteries is

essential and considerably promotes their proper performance.

Routine preventive maintenance should be carried out by

qualified service technicians on a regular basis (recommended

interval: 30 days).

It is the user’s decision whether or not to recondition the

battery at regular intervals. Batteries which are not recondi-

tioned have a shorter service life and will have to be replaced

more frequently.

We recommend our Accu Service Unit (Figure 3-5)

☞

for optimal care of the batteries. It prolongs the

batteries’ service life and guarantees their opera-

tional readiness at all times.

* visually inspect the device and accessories

* test the device performance as described in section 3.

Battery Maintenance

Rechargeable batteries require special maintenance and con-

tinued checks to assure they function in emergency situations.

It is normal for batteries of this type to self-discharge when

not in use.

227 446 32-I CardioServ V 4.2 99

If you decide not to use the Accu Service Unit, the battery can

be checked and reconditioned as described below. With this

method, however, the continued operational readiness of

CardioServ on battery power is not guaranteed.

1. Disconnect CardioServ from the power line and dis-

charge fully charged battery in the monitoring mode. To

do so, set energy selector switch to (SpO2 sensor not

connected) and wait until device switches off.

Cleaning, Maintenance and Disposal

2. Check how long it takes before battery is depleted. If the

time is less than 1.8 hours, the battery is too old or

improperly maintained and should be replaced.

3. Recharge the battery. This will take 16 hours.

Technical Inspections

For safety, the devices require regular maintenance. To ensure

functional and operational safety of the CardioServ Technical

Inspections should be carried out annually.

The following checks can be carried out within the framework

of a service contract. Otherwise it should be assured that the

person inspecting the device is adequately trained and experi-

enced.

* The device and accessories should be visually inspected

for signs of mechanical damage which may impair the

device functions.

* All safety-related labels and instructions printed on the

device must be inspected for legibility.

* The electrode leads of defibrillators and pacemakers

must be carefully checked for signs of mechanical dam-

age, short-circuits and breaks.

* After 2 years, replace all defibrillator and pacemaker

batteries that were not maintained and reconditioned in

our Accu Service Unit for CardioServ. Battery mainte-

nance and reconditioning in the Accu Service Unit

extends the battery life for about 1 year.

* The warning system of the defibrillator must be checked.

Testing the Pacemaker Performance

The performance of the pacemaker can be tested with a

commercially available pacemaker tester (e.g. CS300 Simula-

tor from GEMS IT, part no. 417 983-001).

* Devices which are not in perfect working order or the

use of which is unsafe must be immediately repaired or

labelled accordingly to prevent their use.

The device does not require any other maintenace.

* A performance test as described in section 3 is to be

performed. The hardware and software functions are to

be tested by means of the power-on self-test. All seg-

ments of the LCD must be visible.

* On the defibrillator the energy delivered into a 50-ohm

resistance must be measured.

100 CardioServ V 4.2 227 446 32-I

13.3 Disposal of the Product

Do not dispose the product described in this

Operator Manual with the normal, unsorted

household waste. It requires separate treatment.

Please contact an authorized representative of the

manufacturer for information on disposal of the

product.

GE Cardioserv User manual

Specifications and Main Features

Frequently Asked Questions

User Manual