GE Healthcare 259cx, 256cx, 250cx User Manual

Download

GE Healthcare

Corometrics™ 250cx Series Monitor

Operator’s Manual

GE Healthcare

Corometrics™ 250cx Series Monitor

Operator’s Manual

GUARANTEE

All equipment sold by GE Medical Systems Information Technologies, is fully guaranteed as to materials and workmanship for a period of 1 year. GE Medical Systems Information Technologies reserves the right to perform guarantee service operations in its own factory, at an authorized repair station, or in the customer’s installation.

Our obligation under this guarantee is limited to repairing, or, at our option, replacing any defective parts of our equipment, except fuses or batteries, without charge, if such defects occur in normal service.

Claims for damage in shipment should be filed promptly with the transportation company. All correspondence covering the instrument should specify the model and serial numbers.

GE MEDICAL SYSTEMS Information Technologies

A GE Healthcare Company

GE Medical Systems Information Technologies will make available on request such circuit diagrams, component diagrams, component parts lists, descriptions, calibration instructions, or other information which will assist the users or appropriately qualified technical personnel to repair those parts of the equipment which are classified by GE Medical Systems Information Technologies as repairable. Refer to the 250/250cx Series Service Manual for further information.

NOTE: In addition to software version 4.50, the information in this manual also applies to previous software

revisions of Corometrics 250cx Series Monitor. There are no user-apparent differences among these software versions. Due to continuing product innovation, specifications in this manual are subject to change without notice.

NOTE: For technical documentation purposes, the abbreviation GE is used for the legal entity name, GE Medical

Systems Information Technologies

Ohmeda Oximetry and other trademarks (OxyTip+®, PIr™, TruSat™, TruSignal™, TruTrak+®, SuperSTAT™) are the property of GE Medical Systems Information Technologies, a division of General Electric Corporation. All other product and company names are the property of their respective owners.

MASIMO SET

is a trademark of Masimo Corporation. Possession or purchase of this device does not convey any express or implied license to use the device with replacement parts which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to the device.

NELLCOR TAT-5000™, Exergen

, OxiMax®, C-LOCK® and SatSeconds™ are trademarks of Nellcor Puritan Bennett.

and TemporalScanner™ are trademarks of Exergen Corporation.

CAUTION: In the United States of America, Federal Law restricts this device to sale by or on the order of a physician.

Corometrics and Marquette are registered trademarks of GE Medical Systems Information Technologies. GE is a registered trademark of General Electric Company. All other product and brand names are trademarks or registered trademarks of their respective companies. ©2005, 2006, 2007 GE Medical Systems Information Technologies. All rights reserved. No part of this manual may be reproduced without the permission of GE Medical Systems Information Technologies.

T-2 Corometrics 250cx Series Monitor Revision C

2036946-001 16-Sept-2007

CE Marking Information

Compliance

A GE brand Corometrics 250cx Series Monitor bears CE mark CE-0086 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 device is manufactured in India; the CE mark is applied under the authority of Notified Body BSI (0086).

The country of manufacture and appropriate Notified Body can be found on the equipment labeling.

The product complies with the requirements of standard EN 60601-1-2 “Electromagnetic Compatibility—Medical Electrical Equipment” and standard EN 60601-1 “General Requirements for Safety.”

0086

Components of the Certified Systems

The IEC electromagnetic compatibility (EN) standards require individual equipment (components and accessories) to be configured as a system for evaluation. For systems that include a number of different equipments that perform a number of functions, one of each type of equipment shall be included in the evaluation.

The equipment listed below is representative of all possible combinations. For individual equipment certification, refer to the appropriate declarations of conformity.

Component Description:

 250cx Series Maternal/Fetal Monitor  Model 146 Fetal Acoustic Stimulator  Intrauterine Pressure Transducer  TOCO Transducer  FECG Cable/Legplate  Ultrasound Transducers (x2)  Blood Pressure Hose and Cuff  MSpO2 Interconnect Cable and Sensor  MECG Cable  FECG/MECG Adapter Cable  Remote Event Marker  RS-232C Interconnect Cables (x3)  Central Nurses Station Interconnect Cable  Model 2116B Keyboard and Interconnect Cable  Model 1563AAO Telemetry Cable  Exergen TemporalScanner

TAT-5000 Assembly 2036641-001

Revision C 250cx Series Maternal/Fetal Monitor CE-1

2036946-001

Exceptions

CE Marking Information

The Monitor System EMC: Immunity Performance

None

Be aware that adding accessories or components, or modifying the medical device or system may degrade the EMI performance. Consult with qualified personnel regarding changes to the system configuration.

CE-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Contents

1 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

General Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Responsibility of the Manufacturer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Responsibility of the User . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Definitions of Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

Monitor Contraindications, Warnings, and Precautions . . . . . . . . . . . . . . . . . . . . 1-5

Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-5

Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-8

Electromagnetic Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-9

Equipment Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10

2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

About the Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3

Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Intended Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Fetal Monitoring Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3

Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Maternal Monitoring Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3

Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Pulse Oximetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

Heart/Pulse Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

Series Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4

The 250cx Series Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

System Parameters (256cx and 259cx) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4

Fetal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-5

Maternal Parameters (259cx only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-6

Adding Fetal Movement Detection and/or Spectra Alerts . . . . . . . . . . . . . . . . . . .2-6

Revision C 250cx Series Maternal/Fetal Monitor i

2036946-001

3 Controls, Indicators, and Connectors . . . . . . . . . . . . . . . 3-1

Front Panel Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3

Front Panel Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Display Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Primary Labor Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

FHR Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-8

UA Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Additional Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10

Maternal NIBP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10

MHR/P Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11

MSpO2 Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12

Waveform Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-12

Time and Waveform Message Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-12

Battery-Backed RAM Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-13

Softkeys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13

Mode Title Softkeys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-13

Waveform Softkeys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-13

Dedicated Softkey Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-14

Rear Panel Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16

4 Setup Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

Loading Strip Chart Recorder Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6

Interruption of Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Self-Test Routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

Setup Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

Using the Trim Knob Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-8

General Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9

Play Song . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Song Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Temp Done Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Brightness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Paper Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

MSpO2 Print Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

FSpO2 Print Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

FSpO2 Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

ii 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Preparing the Monitor for Patient Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11

5 Fetal Heart Rate Monitoring . . . . . . . . . . . . . . . . . . . . . . . 5-1

Ultrasound (External Method) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

US/US2 Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

FECG (Internal Method) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

Artifact Elimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

FECG Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

Audio Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

Fetal Heart Rate Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

FHR Threshold Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6

FHR High Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7

Sample Clinical Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-8

Active Signal Quality Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-8

Resolved Signal Quality Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-8

100% Signal Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9

Silencing an Audio Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10

Single Fetal Heart Rate Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10

Dual Fetal Heart Rate Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10

Heartbeat Coincidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11

Fetal Heart Rate Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11

Activating the Fetal Heart Rate Offset Feature . . . . . . . . . . . . . . . . . . . . . .5-11

De-Activating the Fetal Heart Rate Offset Feature . . . . . . . . . . . . . . . . . . .5-12

6 Uterine Activity Monitoring . . . . . . . . . . . . . . . . . . . . . . . 6-1

Tocotransducer (External Method) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Establishing a Baseline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Initial Referencing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Accounting for Belt Tension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

More About Referencing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Out of Range Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Manually Setting the Baseline at the Default Value . . . . . . . . . . . . . . . . . . . .6-4

Manually Overriding the Baseline Default Value . . . . . . . . . . . . . . . . . . . . . .6-4

Revision C 250cx Series Maternal/Fetal Monitor iii

2036946-001

Automatic Baseline “Zeroing” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Internal Method - Intrauterine Pressure (IUP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 -5

Why You Must Zero the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5

7 Maternal Heart/Pulse Rate Monitoring . . . . . . . . . . . . . . 7-1

MHR/P Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

MHR/P Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-4

HR/PR Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

MECG Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

MECG Pacer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-6

Maternal ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7

Theory and Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-7

Pacemaker Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-7

MECG Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-8

8 Maternal Non-Invasive Blood Pressure Monitoring . . . . 8-1

Blood Pressure Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3

Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4

NIBP Determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5

SuperSTAT NIBP Determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5

Accelerated Determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-6

Systolic Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-6

NIBP Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7

Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-7

Target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-7

NIBP Done Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-8

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-8

Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-8

NIBP Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 -8

Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-8

Blood Pressure Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-9

Hydrostatic Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-10

Manual Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-10

Automatic Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-10

Taking a Manual Reading Between Auto Determinations . . . . . . . . . . . . . .8-11

iv 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Venous Return in Auto Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-11

Adjusting the Interval Time Between Automatic Determinations . . . . . . . . .8-11

NIBP Interval Button Shortcut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-12

Terminating a Determination in Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-13

Smart BP Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13

Enabling/Disabling Smart BP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-13

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-13

9 Maternal Pulse Oximetry Monitoring . . . . . . . . . . . . . . . . 9-1

MSpO2 Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3

Which Module is Installed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-3

Theory of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-4

Ohmeda TruSignal™ Oximetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-4

TruSignal™ Enhanced SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

Signal processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

Masimo SET® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-4

Signal Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

Nellcor OxiMax® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-5

Automatic Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

SatSeconds™ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

SatSeconds “Safety Net” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8

Using SatSeconds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8

MSpO2 Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9

Response Time (Nellcor 506 Technology Only) . . . . . . . . . . . . . . . . . . . . . . . . . .9-9

Response Time (Nellcor NELL-3 Technology Only) . . . . . . . . . . . . . . . . . . . . . . .9-9

Sensitivity (Masimo Technology Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-9

Averaging Time (Masimo Technology Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10

Print Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10

%O2 Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10

Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10

MSpO2 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10

MSpO2 Pulse Beat Audio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-11

The MSpO2 Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-11

Module and Probe Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-11

Modules and Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-12

No Implied License . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-12

Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-12

10 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3

Alarm Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3

Master Alarm Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-3

Revision C 250cx Series Maternal/Fetal Monitor v

2036946-001

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-3

Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-4

Alarm Silence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-4

Alarm Setting Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-5

Maternal Alarm Occurring During Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-5

Alarm Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-5

Fetal Heart Rate Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6

FHR Patient Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-6

Active Patient Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-6

Resolved Patient Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-6

FHR Signal Quality Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-6

Active Signal Quality Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-6

Resolved Signal Quality Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-7

Silencing an FHR Audio Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-7

Maternal Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7

Maternal Patient Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-7

Active Patient Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-7

Resolved Patient Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-7

Signal Quality Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-7

Active Signal Quality Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-8

Resolved Signal Quality Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-8

Silencing a Maternal Audio Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-8

Alarms Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9

11 Recorder Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1

Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3

Off Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3

On Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3

Maternal-Only Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3

What is the Maternal-Only Mode? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-3

Printing Style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-3

Changing Recorder Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

Functionality with a QS System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Paper Versus Electronic Strip Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-5

Fetal Heart Rate Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-6

Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6

Multiple Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-6

SpO2 Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-7

Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7

Standard Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-8

Blood Pressure Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-8

Maternal Pulse Oximetry Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-9

vi 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Annotations from a Central Information System . . . . . . . . . . . . . . . . . . . . . . . . .11-9

Multiple Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-9

Summary of Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-10

Adjustable Recorder Font Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13

Chart Style Vital Signs Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14

Enabling/Disabling Chart-Style Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-14

Examples of Printing Styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-15

Chart-Style Printing Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-15

Real-Time Printing Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-15

Chart-Style 7-Minute Exception for NIBP . . . . . . . . . . . . . . . . . . . . . . . . . .11-15

Strip Chart Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-16

Paper-Low, Paper-Out, and Paper-LoadING Error Conditions . . . . . . . . . . . . . 11-18

12 Maternal Vital Signs History . . . . . . . . . . . . . . . . . . . . . . 12-1

What is the Maternal Vital Signs History Screen? . . . . . . . . . . . . . . . . . . . . . . . . 12-3

Using the Maternal Vital Signs History Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4

Displaying the Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-4

Selecting the HX Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-4

Printing the Maternal Vital Signs History Screen . . . . . . . . . . . . . . . . . . . . . . . . .12-5

Printing the Entire Vital Signs History . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-5

Printing a Page of the Vital Signs History . . . . . . . . . . . . . . . . . . . . . . . . . .12-5

Stopping the Printing of Maternal Vital Signs History . . . . . . . . . . . . . . . . . .12-5

13 Heartbeat Coincidence . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1

Heartbeat Coincidence Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3

Using the Heartbeat Coincidence Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3

Enabling/Disabling Heartbeat Coincidence Detection . . . . . . . . . . . . . . . . . . . . .13-3

Display Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13-3

Strip Chart Annotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13-5

14 Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1

Waveform Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-3

Selecting the Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-3

Waveform Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-3

ECG Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-3

MECG Lead Select . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-3

MECG Pacer Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-3

Moving Gap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-4

Freezing Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-4

Revision C 250cx Series Maternal/Fetal Monitor vii

2036946-001

Printing a Waveform Snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-5

Recorder On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-5

Recorder in Maternal-Only Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-6

Recorder Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-6

Stopping a Print Command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-6

15 Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1

Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3

Monitor Exterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-3

Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-4

Tocotransducer and Ultrasound Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-4

Leg Plates and MECG Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-4

Maternal NIBP Cuffs and Hoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-5

General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-5

Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5

Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5

SpO2 Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-6

Maternal SpO2 Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6

NIBP Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6

Disposal of Product Waste . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7

Patient Applied Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-7

Packaging Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-7

Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-7

16 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1

General Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3

Ultrasound Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4

FECG Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5

External Uterine Activity Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5

Internal UA Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6

MECG Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-7

Blood Pressure Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-7

Maternal Pulse Oximetry Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-8

17 Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . 17-1

General Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-3

Operating Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-4

viii 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Strip Chart Recorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-11

18 Supplies & Accessories . . . . . . . . . . . . . . . . . . . . . . . . . 18-1

General Add-Ons Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3

Paper Supplies Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3

Ultrasound Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3

FECG Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4

Tocotransducer Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4

IUPC Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4

MECG Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5

NIBP Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5

MSpO2 Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6

Peripheral Device Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6

A Factory Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1

Table of Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

B Fetal Movement Detection . . . . . . . . . . . . . . . . . . . . . . . . .B-1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3

Availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-3

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-3

Using Fetal Movement Detection While Monitoring . . . . . . . . . . . . . . . . . . . . . . . . B-3

Enabling/Disabling Fetal Movement Detection . . . . . . . . . . . . . . . . . . . . . . . . . . .B-3

Display Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-4

Strip Chart Annotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-4

Using the FM Remote Marker to Complement the Patient Record . . . . . . . . . . . .B-4

C Spectra Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1

Important Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3

Revision C 250cx Series Maternal/Fetal Monitor ix

2036946-001

Using the Spectra Alert Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4

Enabling/Disabling Spectra Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-4

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-4

Alert Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-6

Active Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-6

Silencing Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-6

Resolved Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-7

Alert Suspension Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-7

Enabling/Disabling the Alert Suspension Feature . . . . . . . . . . . . . . . . . . . . .C-7

Suspending Audio Alerts (and the Nurse Call Interface) . . . . . . . . . . . . . . . .C-7

Restoring Audio Alerts (and the Nurse Call Interface) . . . . . . . . . . . . . . . . . .C-7

Alert Parameters Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-9

Resetting Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-12

False Pattern Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-12

Mode Switching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-12

Trend Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-13

Uterine Contraction Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-13

Enabling/Disabling UC Frequency Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-14

UC Frequency in UA Display Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-14

UC Frequency Histogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-15

Enabling/Disabling UC Chime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-15

Nurse Call Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-16

Alert Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-17

D Frequently Asked

Questions D-1

FAQs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-3

x 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

1 Safety

Revision C 250cx Series Maternal/Fetal Monitor 1-1

2036946-001

For your notes

Safety:

1-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Safety: General Information

General Information

General Use

If the monitor is cold to the touch or below ambient t emperature, allow it to stabilize before use.

To ensure patient safety, use only parts and accessories manufactured or recommended by GE Medical Systems Information Technologies. Parts and accessories used shall meet the requirements of EN60601-1-1.

Disposable devices are intended for single use only. They should not be reused. Test all functions periodically and whenever the integrity of the monitor is in doubt. Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual” for

information concerning the limitations of internal and external feta l heart rate monitoring techniques.

Responsibility of the Manufacturer

GE Medical Systems Information Technologies is responsible for the effects on safety, reliability, and performance if:

 assembly operations, extensions, readjustments, modifications, or repairs are

carried out by persons authorized by GE Medical Systems Information Technologies;

 the electrical installation of the relevant room complies with the requirements of

appropriate regulations; and

 the monitor is used in accordance with the instructions of use.

Responsibility of the User

This device is intended for use by clinical professionals who are expected to know the medical procedures, practices, and terminology required to monitor obstetrical patients. This manual documents all possible parameters available in the 250cx Series monitor. It is the responsibility of each hospital to ensure that the Labor and Delivery staff is trained in all aspects of the selected model.

The 250cx Series monitor is only one clinical indicator of fetal status during labor. The monitor is designed to assist the perinatal staff in assessing the status of a patient. The monitor does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider, who will make diagnoses and decide on treatments or interventions. Visual assessment of the monitor display and strip chart must be combined with knowledge of patient history and risk factors to properly care for the mother and fetus.

Revision C 250cx Series Maternal/Fetal Monitor 1-3

2036946-001

Safety: Definitions of Terminology

Definitions of Terminology

Six types of special notices are used throughout this manual. They are: Danger, Warning, Caution, Contraindication, Important, and Note. The warnings and cautions in this Safety section relate to the equipment in general and apply to all aspects of the monitor. Be sure to read the other chapters because there are additional warnings and cautions which relate to specific features of the monitor.

When grouped, warnings and cautions are listed alphabetically and do not imply any order of importance.

Danger A DANGER notice indicates an imminently

Warning A WARNING indicates a potentially hazardous

Definitions of Terminology

hazardous situation which, if not avoided, will result in death or serious injury.

situation which, if not avoided, could result in death or serious injury.

Caution A CAUTION indicates a potentially hazardous

situation which, if not avoided, may result in minor or moderate injury. Cautions are also used to avoid damage to equipment.

Contraindication A CONTRAINDICATION describes any special

symptom or circumstance that renders the use of a remedy or the carrying out of a procedure inadvisable, usually because of a risk.

Important An IMPORTANT notice indicates an emphasized

note. It is something you should be particularly aware of; something not readily apparent.

Note A NOTE indicates a particular point of information;

something on which to focus your attention.

1-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Safety: Monitor Contraindications, Warnings, and Precautions

Monitor Contraindications, Warnings, and Precautions

Warnings

WARNINGS

ACCIDENTAL SPILLS—In the event that fluids are accidentally spilled onto the monitor, remove the monitor from operation and inspect for damage.

APPLICATION—This monitor is not designed for direct cardiac connection.

CONDUCTIVE CONNECTIONS—Avoid making any conductive connections to applied parts (patient connection) which are likely to degrade safety.

CONDUCTIVE PARTS—Ensure that the conductive parts of the lead electrodes and associated connectors do not contact other conductive parts including earth.

CONNECTIONS—The correct way to connect a patient to the monitor is to plug the electrode leads into the patient cable which in turn connects to the monitor. The monitor is connected to the wall socket by the power cord. Do not plug the electrode leads into the power cord, a wall socket, or an extension cord.

DEFIBRILLATION—During defibrillation, all personnel must avoid contact with the patient and monitor to avoid a dangerous shock hazard. In addition, proper placement of the paddles in relation to the electrodes is required to minimize harm to the patient.

DEFIBRILLATION PROTECTION—When used with the GE Medical Systems Information Technologies-recommended accessories, the monitor is protected against the effects of defibrillator discharge. If monitoring is disrupted by the defibrillation, the monitor will recover.

ELECTRICAL SHOCK—To reduce the risk of electrical shock, do not remove monitor cover. Refer servicing to qualified personnel.

ELECTROMAGNETIC INTERFERENCE—Be aware that strong electromagnetic fields may interfere with monitor operation. Interference prevents the clear reception of signals by the monitor. If the hospital is close to a strong transmitter such as TV , AM or FM radio, police or fire stations, a HAM radio operator, an airport, or cellular phone, their signals could be picked up as monitor signals. If you feel interference is affecting the monitor, contact your Service Representative to check the monitor in your environment. Refer to information.

“Electromagnetic Interference”

on page 1-9 for additional

Revision C 250cx Series Maternal/Fetal Monitor 1-5

2036946-001

Safety: Monitor Contraindications, Warnings, and Precautions

WARNINGS

ELECTROSURGERY—The monitor is not designed for use with high-frequency surgical devices. In addition, measurements may be affected in the presence of strong electromagnetic sources such as electrosurgery equipment.

EQUIPMENT USE—The use of this equipment is restricted to one patient at a time.

EXPLOSION HAZARD—Do not use this equipment in the presence of flammable anesthetics or inside an oxygen tent.

GROUNDING—Do not defeat the three-wire grounding feature of the power cord by means of adaptors, plug modifications, or other methods. A dangerous shock hazard to both patient and operator may result.

INOPERABLE MECG—The MECG trace is not visible during a MECG LEADS OFF condition or an overload (saturation) of the front-

end amplifier during differential input voltage of more than

300mV.

INSTRUCTIONS—For continued and safe use of this equipment, it is necessary to follow all listed instructions. However, the instructions provided in this manual in no way supersede established medical procedures concerning patient care. The monitor does not replace observation and evaluation of the patient, at regular intervals, by a qualified care provider who will make diagnoses and decide on treatments and interventions.

INTERFACING OTHER EQUIPMENT—Monitoring equipment must be interfaced with other types of medical equipment by qualified biomedical engineering personnel. Be certain to consult manufacturers’ specifications to maintain safe operation.

LEAKAGE CURRENT TEST—The interconnection of auxiliary equipment with this device may increase the total leakage current. When interfacing with other equipment, a test for leakage current must be performed by qualified biomedical engineering personnel before using with patients. Serious injury or death could result if the leakage current exceeds applicable standards. The use of accessory equipment not complying with the equivalent safety requirements of this equipment may lead to a reduced level of safety of the resulting system. Consideration relating to the choice shall include: use of the accessory in the patient vicinity; and evidence that the safety certification of the accessory has been performed in accordance with the appropriate EN60601.1 and/or EN60601.1.1 harmonized national standard.

LINE ISOLATION MONITOR TRANSIENTS—Line isolation monitor transients may resemble actual cardiac waveforms, and thus cause incorrect heart rate determinations and alarm activation (or inhibition).

1-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Safety: Monitor Contraindications, Warnings, and Precautions

WARNINGS

MRI USE—Do not use the electrodes during MRI scanning; conducted current could potentially cause burns.

PATIENT CABLES AND LEADWIRES—Do not use patient cables and electrode leads that permit direct connection to electrical sources. Use only “safety” cables and leadwires. Use of non-safety patient cables and lead wires creates risk of inappropriate electrical connection which may cause patient shock or death.

PACEMAKER PATIENTS—Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms. Keep pacemaker patients under close surveillance. Refer to Chapter 16, “Troubleshooting” for disclosure of the pacemaker pulse rejection capability of the 250cx Series Monitor.

RF INTERF ACE—Known RF sources, such as cell phones, radio or TV stations, and two-way radios, may cause unexpected or adverse operation of this device.

SIMULTANEOUS DEVICES—Do not simultaneously connect more than one device that uses electrodes to detect ECG and/or respiration to the same patient. Use of more than one device in this manner may cause improper operation of one or more of the devices.

STRANGULATION—Make sure all patient cables, leadwires, and tubing are positioned away from the patient’s head to minimize the risk of accidental strangulation.

WATER BIRTHS—Do not use the monitor to directly monitor patients during water births, in whirlpool or submersion water baths, during showers, or in any other situation where the mother is immersed in water. Doing so may result in electrical shock hazard.

EXTERNAL VGA CONNECTIONS—Connect only to GE recommended display. ONLY remove cover plate if external display is used.

TELEMETRY CONNECTIONS—Connect only to GE recommended telemetry systems. Contact your GE service representative for more information.

Revision C 250cx Series Maternal/Fetal Monitor 1-7

2036946-001

Safety: Monitor Contraindications, Warnings, and Precautions

WARNINGS

COLOR DISPLAY—Certain colors may have limited visibility at a distance. Color-blind individuals may experience this more often.

Cautions

EXERGEN be field serviced. Do This assembly must be returned to the factory for any repairs. This assembly, as shipped, is important to patient safety.

DISPOSAL—This product consists of devices that may contain mercury, which must be recycled or disposed of in accordance with local, state, or country laws. (Within this system, the backlight lamps in the monitor display contain mercury.)

CAUTIONS

STATIC ELECTRICITY—This assembly is extremely static sensitive and should be handled using electrostatic discharge precautions.

ANNUAL SERVICING—For continued safety and performance of the monitor, it is recommended that the calibration, accuracy, and electrical safety of the monitor be verified on an annual basis by a GE Medical Systems Information Technologies Service Representative.

TAT-5000™ —Cable assembly 2036641-001 cannot

NOT

attempt any repairs to this assembly.

DAILY TESTING—It is essential that the monitor and accessories be inspected every day. It is recommended practice to initiate the monitor’s self-test feature at the beginning of each monitoring session; follow the instructions in Chapter 4,

ENVIRONMENT—The performance of the monitor has not been tested in certain areas, such as x-ray and imaging suites. The monitor is not recommended for use in these environments.

EQUIPMENT CONFIGURATION—The equipment or system should not be used adjacent to, or stacked with, other equipment. If adjacent or stacked use is necessary, the equipment or system should be tested to verify normal operation in the configuration in which it is being used.

PERFORMANCE—Report all problems experienced with the monitor. If the monitor is not working properly, contact your Service Representative for service. The monitor should not be used if it is not working properly.

“Setup Procedures”

1-8 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Safety: Monitor Contraindications, Warnings, and Precautions

Electromagnetic Interference

This device has been tested and found to comply with the Medical Electrical Equipment-General Requirements for Safety-Collateral Standard: Electromagnetic Compatibility, EN60601-1-2:2001, Medical Device Directive 93/42/EEC. These limits are designed to provide reasonable protection against harmful interference in a typical medical installation.

However, because of the proliferation of radio-frequency transmitting equipment and other sources of electrical noise in the health-care and home environments (e.g. cellular phones, mobile two-way radios, electrical appliances), it is possible that high levels of such interference due to proximity or strength of a source, may result in disruption of performance of this device.

Refer to the Electromagnetic Immunity inf ormation in this product’s service manual for EN 60601-1-2 (2001) compliance information and safety information for this product.

This equipment generates, uses, and can radiate radio frequency energy and, if not installed and used in accordance with these instructions, may cause harmful interference with other devices in the vicinity. Disruption or interference may be evidenced by erratic readings, cessation of operation, or incorrect functioning. If this occurs, the use site should be surveyed to determine the source of this disruption, and actions should be taken to eliminate the source.

The user is encouraged to try to correct the interference by one or more of the following measures:

 Turn equipment in the vicinity off and on to isolate the offending

equipment.

 Reorient or relocate the other receiving device.

 Increase the separation between the interfering equipment and this

equipment.

 If assistance is required, contact your GE Medical Systems Service

Representative.

Revision C 250cx Series Maternal/Fetal Monitor 1-9

2036946-001

Equipment Symbols

The following is a list of symbols used on products manufactured by GE Medical Systems Information Technologies. Some symbols may not appear on your unit.

Safety: Equipment Symbols

Equipment Symbols

ATTENTION: Consult accompanying documents.

WASTE OF ELECTRICAL AND ELECTRONIC EQUIPMENT (WEEE): This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately. Please contact an authorized representative of the manufacturer for information concerning the decommissioning of your equipment.

TYPE B EQUIPMENT: Type B equipment is suitable for intentional external and internal application to the patient, excluding direct cardiac application.

TYPE BF EQUIPMENT: suitable for intentional external and internal application to the patient, excluding direct cardiac application. Type BF equipment has an F-type applied part.

DEFIBRILLATOR-PROOF TYPE BF EQUIPMENT: Type BF equipment is suitable for intentional external and internal application to the patient, excluding direct cardiac application. Type BF equipment is type B equipment with an F-type isolated (floating) part. The paddles indicate the equipment is defibrillator proof.

TYPE CF EQUIPMENT: Type CF equipment is suitable for intentional external and internal application to the patient including direct cardiac application. Type CF equipment is F-type applied part that provides a higher degree of protection against electric shock than that provided by Type BF applied parts.

Type BF equipment is

ALTERNATING CURRENT (AC). EQUIPOTENTIALITY.

1-10 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Safety: Equipment Symbols

O POWER OFF: disconnection from the mains.

I POWER ON: connection to the mains.

Equipment Symbols

VGA connection.

Revision C 250cx Series Maternal/Fetal Monitor 1-11

2036946-001

Safety: Equipment Symbols

1-12 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

2 Introduction

Revision C 250cx Series Maternal/Fetal Monitor 2-1

2036946-001

For your notes

Introduction:

2-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

About the Manual

Purpose

Intended Audience

Illustrations

Introduction: About the Manual

This manual documents all possible parameters so that when your equipment is upgraded, new documentation will not be required. Also, the manual provides an opportunity to read about features you may not have, to assist you with your upgrade decisions. Some sections will not apply to your unit’s monitoring capabilities.

This manual is intended for physicians, nurses and midwives. Clinical professionals are expected to know the medical procedures, practices, and terminology required to monitor obstetrical patients.

All illustrations are provided as examples only. Your monitor may not be equipped with the specific feature shown. In addition, unless explicitly stated, the display examples do not represent your equipment setup or displayed data.

Fetal Monitoring Indications for Use

A Corometrics 250cx Series Fetal Monitor is used for fetal surveillance.

Surveillance

A Corometrics 250cx Series monitor can be used for routine non-invasive and invasive fetal monitoring throughout labor and delivery.

Maternal Monitoring Indications for Use

A Corometrics 250cx Series Maternal/Fetal Monitor is intended for monitoring maternal vital signs to help assess maternal well-being. The vital signs which can be measured are summarized below.

NOTE: Maternal vital signs provided by the monitor should only be used

as an adjunct to patient assessment and must be used in conjunction with clinical signs and symptoms.

Blood Pressure

The monitor is intended for use only in the non-invasive monitoring of maternal blood pressure (NIBP). This monitor is not intended for use in neonatal or pediatric blood pressure monitoring.

Revision C 250cx Series Maternal/Fetal Monitor 2-3

2036946-001

Pulse Oximetry

Heart/Pulse Rate

Series Overview

Introduction: Series Overview

The monitor is intended for use in the non-invasive monitoring of the functional oxygen saturation of maternal arterial blood (MSpO

The monitor is intended for use in the non-invasive monitoring of the maternal heart/pulse rate (MHR/P).

NOTE: The Corometrics 250cx Series provides both maternal heart rate

and maternal pulse rate data; the heart rate data is derived from the MECG section of the monitor while the pulse rate data is derived from the NIBP or MSpO

The Corometrics 250cx Series monitor provides one solution for high-risk and lowrisk labors and deliveries. The monitor lets you start with a fetal or maternal/fetal monitor and add the extended features later, as your clinical needs increase and your budget allows. The model of the monitor determines which parameters are in your monitor.

sections of the monitor.

MODEL Fetal Heart

256cx 259cx

The 250cx Series Monitor Features

The 250cx Series monitor offers the following features:

System Parameters (256cx and 259cx)

 The QVGA LCD display, with circularly polarized filter, removes glare; its

wide viewing angle provides sharp viewing at a distance.

 The large display area provides simultaneous display of fetal par a met e rs,

maternal parameters, and maternal waveform s.

 The Brightness softkey permits clear viewing in all lighting conditions.  Frequently used functions are controlled by your choice of front panel monitor

buttons—Volume, UA Reference, Alarm Silence, Mark [Offset], Record, and Paper Advance.

 System setup options are easily accessed via a front panel Trim Knob control.  Automatic mode selection is provided simply by inserting the appropriate

transducer plug into the front panel receptacle.

 Transducer connectors are easy-to-use, color-coded, and durable.

Rate

(Twins) US

FECG TOCO

/IUP

NIBP MSpO2MECG

999

999999

2-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Introduction: Series Overview

 Annotations from an optional Model 2116B Keyboard are printed on the strip

chart recorder paper.

 The strip chart recorder is a quiet, easy-to-load, high-resolution thermal array

printer. The recorder prints continuous trends and alphanumeric data on one strip chart.

 The Chart Light allows the room lights to be dimmed without sacrificing

visibility of the strip chart recorder.

 The system is compatible with Centricity

Perinatal Clinical Information Systems, as well as with other information systems, to streamline capture and archiving of patient data.

Following is a summary of the features.

Fetal Only Monitor (256cx) Maternal/Fetal Monitor (259cx)

 US  US  US2  US2  FECG  FECG

Fetal Parameters

 TOCO  TOCO  IUP  IUP

 NIBP  MSpO

 MECG



Dual ultrasonic heart rate monitoring allows for non-invasive monitoring of twins.

 Independent volume controls facilitate easy transducer placement when

monitoring twins.

 A +20 bpm heart rate offset option is provided for the secondary heart rate

(HR2) trend, when using dual ultrasound, or ultrasound and direct FECG, to separate overlapping FHR trends for easy interpretation.

 A heartbeat coincidence detection feature can be enabled to inform you when

there is the possibility that you may be monitoring a duplicate signal.

 The FECG waveform can be optionally displayed and can be “frozen” on the

screen for review. In addition, a 6-second “snapshot” can be printed on the strip chart paper.

 Fetal parameters are continuously displayed even during configuration of

system setup options.

 The ultrasound mode provides clean, accurate traces with few “dropouts”

because of Corometrics’ patented autocorrelation processing.

 Fetal heart rate alarm limits are user-defined, with pre-set defaults. Signal

quality has no user-defined parameters.

 Alarm limits are easily configured via setup screens.  Alarm silencing is controlled by a brig h tly colored, easily recognizable front

panel monitor button.

Revision C 250cx Series Maternal/Fetal Monitor 2-5

2036946-001

Introduction: Series Overview



Alarm conditions have both audible and visual indications. Only fetal audible alarms can be disabled. Fetal heart rate threshold and signal quality alarms can be cancelled.

 Optional Spectra Alerts™ simultaneously analyzes FHR and UA information

and notifies clinicians of deviations from the norm.

Maternal Parameters (259cx only)

 Built-in maternal vital signs monitoring eliminates the need for separate blood

pressure and maternal pulse oximetry monitors.

 Maternal vital signs storage provides an 8-hour history of the maternal vital

signs in a spreadsheet format. The data can be displayed or printed on-demand.

 A maternal-only recording mode is specifically designed for postpartum

monitoring of the mother.

 The monitor can be interfaced to the most widely used non-invasive blood

pressure monitors and pulse oximeters.

 Maternal non-invasive blood pressure readings can be taken on-demand or at

pre-programmed intervals. The use of unique, patented DINAMAP SuperSTAT blood pressure technology provides blood pressure accuracy and faster, automated readings.

 Smart BP option prevents blood pressure readings from occurring during

contractions.

 Continuous non-invasive MSpO

be reliably monitored using well-known user-preferred pulse oximetry brands. Masimo SET, Nellcor OxiMax, or Ohmeda TruSignal MSpO

at the time of purchase or changed later as determined by hospital needs.

 The MSpO

“frozen” on the screen for review. In addition, a 6-second “snapshot” can be printed on the strip chart paper.

 Continuous display/printing of the maternal pulse rate trend can be enabled.  The MECG waveform can be optionally displayed and can be “frozen” on the

screen for review. In addition, a 6-second snapshot can be printed on the strip chart paper.



Built-in independent MECG monitoring is provided with selection of lead I, II, or III.

 Selectable 3-lead maternal ECG with pacemaker detection and rejection

generates maternal heart rate, QRS waveform display and a 6-second snapshot printout when requested.

 Twins and maternal monitoring can be accomplished simultaneously using dual

ultrasound and MECG, or by using ultrasound, FECG, and MECG.

 Maternal alarm limits are user-defined, with preset defaults; they are easily

configured via setup screens.

 Maternal alarm conditions have audible and visual indications, and can be

silenced for a user-specified time.

 Alarm silencing is controlled by a brig h tly colored, easily recognizable front

panel monitor button.

oxygen saturation and maternal pulse rate can

may be selected

pulsatile waveform can be optionally displayed and can be

Adding Fetal Movement Detection and/or Spectra Alerts

The monitor can be upgraded to include Fetal Movement Detection and/or Spectra Alerts. Contact your local sales representative for upgrade information.

2-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

3 Controls, Indicators, and

Connectors

Revision C 250cx Series Maternal/Fetal Monitor 3-1

2036946-001

For your notes

Controls, Indicators, and Connectors:

3-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Controls, Indicators, and Connectors: Front Panel Description

Front Panel Description

W V

FMD

FECG

165

NIBP

130/ 85

MAP (107)

FECG

Print Freeze Alarms Setup VSHX

172

15:00

03:15

US2

MECG

HBC

TOCO

MSpO2

98%

25 mm/s

II 2x

03:22:45

Monitor Front Panel

Front Panel

# Name Description

A Display The monitor’s display is divided into several sections. The content and layout of the

display can change, depending on which functions are installed in the monitor and the modes of operation in use.

B Trim Knob Control Operation of the monitor is controlled by using the front panel buttons in conjunction

with the Trim Knob control. This control selects softkeys on the display and positions a cursor within a setup screen. Rotate the Trim Knob control left or right to highlight items on the screen with a bar cursor. After highlighting the desired item, press the Trim Knob control to make the selection. In summary: rotate to move cursor; press to select an item.

C NIBP Start/Stop Button This button starts and stops both manual and automatic blood pressure

determinations. It also provides a “shortcut” for changing the auto interval time (see 8-12).

D Test Button Pressing and holding this button for 1 second starts or stops a monitor self-test routine.

Revision C 250cx Series Maternal/Fetal Monitor 3-3

2036946-001

Controls, Indicators, and Connectors: Front Panel Description

Front Panel

# Name Description

E Mark [Offset] Button The Mark [Offset] button is a multi-function button.

 Mark: Pressing this button prints an event mark on strip chart paper (on the

bottom two lines of the top grid).

 Offset: When the Heart Rate Offset mode is enabled, pressing and holding this

button shifts the secondary FHR trend +20 bpm for visibility purposes. Refer to “Fetal Heart Rate Offset” on page 5-11.

F UA Reference Button The UA Reference button sets a baseline for uterine activity pressure monitoring.

Refer to Chapter 6, “Uterine Activity Monitoring”.

G Paper Advance Button Pressing this button advances chart paper at a rate of 40 cm/min for as long as the

button is held down.

H Record Button The Record button selects one of three recorder states: on, maternal-only mode, or

off. Refer to Chapter 11, “Recorder Modes”. Factory default is OFF.

I Power Indicator The indicator lights green when the monitor is turned on.

J Record Indicator Indicator Status Recorder Status

on on off off three short flashes maternal-only mode every 5 sec flashes on and off error condition

K Light Button Illuminates the strip chart paper for night time visibility. Factory default is ON.

L Recorder Door Latch Opens the strip chart recorder door to add, remove, or adjust the paper.

M Power Switch Moving the switch to the on position (I) turns the monitor on; moving the switch to the

off position (O) turns the monitor off.

N Strip Chart Recorder Annotations and trends are printed on the strip chart paper. Two paper styles are

available. Refer to Chapter 4, “Setup Procedures”, for instructions on loading strip chart paper into the recorder. Refer to Chapter 11, “Recorder Modes” for additional information about trends and annotations.

O MATERNAL NIBP Connector Connect a pneumatic hose and blood pressure cuff assembly to this black twin lumen

receptacle.

P MATERNAL SpO

Connector Connect a 250cx Series MSpO2 intermediate cable to this royal blue receptacle. Use

only Nellcor Maternal Oxygen Saturation Sensors if Nellcor technology is installed in your monitor, Masimo Sensors if Masimo technology is installed in your monitor, or Ohmeda Sensors if Ohmeda technology is installed in the monitor.

Q FECG/MECG Connector Connect an FECG cable/legplate or MECG cable plug to the FECG/MECG receptacle.

Cables with rectangular plugs connect directly to the FECG/MECG receptacle. Cables with round plugs require an FECG/MECG adapter. Refer to “MECG Ordering Information” on page 18-5 for the adapter part number. This adapter is used for dual ECG monitoring as well. The adapter branches into two cables, each with a round receptacle at the end: one branch is labeled MECG; the other branch is labeled FECG.

3-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Controls, Indicators, and Connectors: Front Panel Description

Front Panel

# Name Description

R UA Connector Connect a tocotransducer, IUPC, or strain gauge transducer plug to this white

receptacle. Contact your Sales Representative for information about compatibility.

S US2 Connector Connect the secondary ultrasound transducer plug to this light gray receptacle. T US Connector Connect the primary ultrasound transducer plug to this light gray receptacle. U FHR2 Volume Decrease Button V FHR2 Volume Increase Button

W FHR1 Volume Decrease Button

The four Volume buttons raise ( ) and lower ( ) the volume of sound emitted by the rear panel speaker. The upper pair controls the volume for FHR1. The lower pair controls the volume for FHR2. Volume settings have no effect on the processing used to determine heart rate. The Volume buttons work in conjunction with the volume control settings on the US/US2 Setup screen (page 5-3) and on the FECG Setup

X FHR1 Volume Increase Button

screen (page 5-5).

Y Alarm Silence Button Pressing this button removes the audible indication of an individual alarm. (Refer to

Re-Alarm in the “Alarms” Section for more information.)

Revision C 250cx Series Maternal/Fetal Monitor 3-5

2036946-001

Controls, Indicators, and Connectors: Front Panel Displays

Front Panel Displays

The monitor is divided into two main sections: patient information (the left-side of the monitor) and monitor functionality (the right-side of the monitor). Refer to “Monitor Front Panel” on page 3-3. The keys are ordered for user efficiency.The content and layout of the display can change, depending on which functions are installed in the monitor and the modes of operation in use.

Primary Labor Parameters (Fetal)

Additional Parameters (Maternal)

Maternal and Fetal Parameters

Display Summary

Display Section Item Mode

Fetal Heart Rate 1 (FHR1) US, US2, FECG, or INOP

Primary Labor Parameters

(upper portion of monitor)

Fetal Heart Rate 2 (FHR2) US, US2, or INOP Uterine Activity (UA) TOCO, IUP, or INOP Maternal Blood Pressure NIBP

Additional Parameters

(Available in Maternal/Fetal

Monitor only)

Waveform Fetal ECG Waveform, Maternal ECG Waveform, or

Time Current Time, [Label] Frozen Message and Time of

Maternal Heart/Pulse Rate MECG, Pulse or INOP Maternal SpO

MSpO

FECG, MECG, MSpO

Maternal SpO

Pulsatile Waveform

—

Activation

Softkeys System Configuration Softkey Controls —

, or Off

3-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Display Example

Controls, Indicators, and Connectors: Front Panel Displays

From the graphic below, you can determine the following:

 Blood pressure is not active as indicated by the absence of numerics.  Maternal pulse oximetry is active by presence of pulse amplitude indicator.  MECG is selected as the heart rates source as indicated by the MECG mode title

softkey—rather than Pulse.

 The MECG waveform is displayed at 25 mm/sec, at a size of 2x, with lead II

selected.

 Heartbeat coincidence is enabled as indicated by the HBC acronym in the

primary labor parameters area.

 All alarms are enabled as indicated by .

Maternal/Fetal Monitor Display Example

Revision C 250cx Series Maternal/Fetal Monitor 3-7

2036946-001

Controls, Indicators, and Connectors: Primary Labor Parameters

Primary Labor Parameters

The primary labor parameters section displays FHR1, FHR2, and UA data.

FHR Display

The FHR1 and FHR 2 areas are summarized in the following figure and table.

FHR Display

Name Description

FHR Value Up to three digits indicate the fetal heart rate in

FHR Alarm Setting Indicator

beats per minute. This symbol provides information about the FHR

audio alarm and the FHR high/low alarm limit settings. See Chapter 10, “Alarms” for more information.

 : All alarm settings are enabled.

FHR Display

 At least one fetal alarm is disabled.

FHR Mode Title An abbreviation indicates the monitoring mode in

use: FECG, US, US2, or INOP. (FECG only

D FHR Heartbeat Indicator Flashes with each detected valid heartbeat.

3-8 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

displays in the FHR1 area.) Select the mode softkey to access the respective setup screen. See “Connectors vs. Display Modes” Table below for FHR connection options.

Controls, Indicators, and Connectors: UA Display

Connectors vs. Display Modes

UA Display

Active Connectors FECG FECG/US FECG/US2 US US/US2 US2 —

FECG/US/US2

If three FHR transducers are plugged in, the FECG signal overrides the US signal.

FHR1 Area FHR2 Area

FECG INOP FECG US FECG US2 US INOP US US2 US2 INOP INOP INOP FECG US2

The UA area is summarized by the following figure and table.

UA Display

Name Description

UA Value Up to three digits indicate the uterine activity

value—mmHg or kPa. Internal UA monitoring is

absolute and external monitoring (Toco) is relative. The units are consistent in both cases and are user-selectable: mmHg or kPa.

UA Mode Title An abbreviation indicates the monitoring mode in

use: TOCO, IUP, or INOP.

Revision C 250cx Series Maternal/Fetal Monitor 3-9

2036946-001

Controls, Indicators, and Connectors: Additional Parameters

Additional Parameters

The additional parameters area displays NIBP, MHR/P, and MSpO2 data.

Maternal NIBP

The maternal NIBP section is summarized in the following figure and table.

NIBP

11:41

130/ 85

MAP (107)

Name Description

NIBP Time Stamp The time (in 24-hour format) of the last blood

NIBP Values The systolic/diastolic and mean arterial pressures

03:15

NIBP Display

pressure measurement.

(MAP) are each indicated by up to three digits— displayed as XXX mmHg or XX.X kPa. All kPa readings are displayed to 1/10 kPa. During a determination, the instantaneous cuff pressure displays in place of the mean arterial pressure and is denoted by the title Cuff.

NIBP Display

NIBP Alarm Setting Indicator

NIBP Mode Title Select the mode title to access the NIBP Setup

NIBP Countdown Timer The clock symbol represents activation of the auto

3-10 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

This symbol provides information about the NIBP audio alarm and the NIBP high/low alarm limit settings. See Chapter 10, “Alarms” for more information. Maternal alarms cannot be disabled.

screen.

mode. The countdown timer indicates the minutes and seconds until the next automatic reading.

MHR/P Area

Controls, Indicators, and Connectors: MHR/P Area

The MHR/P area is summarized by the following figure and table.

MHR/P Display

Name Description

MHR/P Value Up to three-digits indicate the MHR/P in beats per

MHR/P Alarm Setting Indicator

minute. This symbol provides information about the MHR/P

audio alarm and the MHR/P high/low alarm limit settings. See Chapter 10, “Alarms” for more information. Maternal alarms cannot be disabled.

MHR/P Mode Title The mode title MECG indicates MECG is the

MHR/P source; the mode title Pulse indicates MSpO

or NIBP is used as the source. Select the

mode title softkey to access the MHR/P Setup screen.

Maternal Heartbeat

Indicator

Flashes with each detected valid heartbeat—for MECG only.

Revision C 250cx Series Maternal/Fetal Monitor 3-11

2036946-001

MSpO2 Area

Controls, Indicators, and Connectors: MSpO2 Area

The MSpO2 area is summarized in the following figure and table.

MSpO2

Name Description

Value Up to three digits indicate the percentage of

MSpO

Indicator

Alarm Setting

97%

MSpO

Display

MSpO

Display

oxygen in the mother’s blood. This symbol provides information about the MSpO2

audio alarm and the MSpO settings. See Chapter 10, “Alarms” for more

information. Maternal alarms cannot be disabled.

high/low alarm limit

MSpO

Mode Title Select the mode title to access the MSpO2 Setup

MSpO

Pulse Amplitude

Indicator

Waveform Area

The waveform area displays approximately 4 seconds of waveform data for: FECG, MECG, or MSpO

. Refer to Chapter 14, “Waveforms” for more information.

Time and Waveform Message Area

The current time (in 24-hour format) always displays on the far right. When a waveform is frozen, the message Frozen displays on the far left, bottom corner, along with the time of activation.

screen. This vertical bar qualitatively indicates pulse

amplitude.

3-12 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Controls, Indicators, and Connectors: Softkeys

Battery-Backed RAM Status

Whenever you turn off a 250cx Series Monitor, a battery provides power to the RAM (random access memory) that stores information such as time, date, default settings, etc.

The icon shown above will appear in the upper right-hand section of the monitor under the following circumstances.

Battery-Backed RAM Status

Icon Appearance Reason Solution

Low Battery Icon

Icon appears and then disappears after power cycle.

Icon appears after multiple power cycles.

SET TIME/DA TE message prints on the strip chart paper.

Softkeys

Mode Title Softkeys

Waveform Softkeys

Data corruption. Your monitor has reverted to factory settings.

Battery requires service. Call GE Service to report.

Failure of the battery-backed RAM to retain time and date.

A softkey is an area on the screen that can be selected with the Trim Knob control. When the softkey is activated by pressing the Trim Knob control, it may cycle through available settings or it may display a setup screen.

Most of the mode titles in the display are also softkeys which give access to corresponding setup screens:

US, US2, FECG, NIBP, MECG, Pulse

Access setup screens and configure lastused settings.

Reset the time and date then power cycle the monitor. If message still prints, call GE Service to report.

, and

MSpO2.

The waveform title is a softkey used to select the waveform for display or to disable the area. The ECG Scaling and MECG lead labels are softkeys used to configure the waveform currently displayed.

Revision C 250cx Series Maternal/Fetal Monitor 3-13

2036946-001

Controls, Indicators, and Connectors: Softkeys

Dedicated Softkey Area

Softkeys are located at the bottom of each screen, as shown in “Maternal/Fetal Monitor Display Summary” on page 3-14. Although there are many possible softkeys which may appear in this area, a maximum of five are shown at a time.

165

NIBP

130/ 85

MAP (107)

03:15

MECG 09:21:41 Frozen

Print Freeze Alarms Setup VSHX

02:15

US2

172

MECG

HBC

TOCO

MSpO2

97%

25 mm/s

II Auto

09:22:06

B C

Maternal/Fetal Monitor Display Summary

Display Summary

Name Description

Mode Title Softkeys Selects US, US2, FECG, NIBP, MHR/P, or SpO

B ECG Scale Softkey Selects 0.25x, 0.5x, 1x, 2x, 4x, or Auto.

MECG Lead Select

Softkey VSHX Softkey Displays maternal Vital Signs History screen. (See

E Setup Softkey Displays General Setup screen

F Alarms Softkey Displays Master Alarm Setup screen.

3-14 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Setup screens.

Selects Lead I, II, or III.

illustration below.)

Controls, Indicators, and Connectors: Softkeys

Display Summary

Name Description

Freeze Softkey Freezes waveform for analysis; unfreezes

Print Softkey Prints 6-second snapshot of frozen waveform, real-

waveform to return to real-time display.

time waveform, or maternal vital signs history.

Waveform Softkey Selects FECG, MECG, MSpO

154

Date: 24-Mar 24-Mar 24-Mar 24-Mar 24-Mar Time: 12:00 12:10 12:20 12:30 12:40 NIBP

SYS 120 122 122 125 124 DIA 85 87 90 95 90 MAP 94 95 94 105 98 P7476758177

MSpO2

%02 98 99 99 100 98 P7677758178

MECG 75 74 75 81 78

Print PrintAll ExitView

US2

135

Vital Signs History

HX Interval: 10 min

, or Off.

TOCO

l Maternal Vital Signs History Screen Softkeys

Maternal Vital Signs History Screen Softkeys

Name Description

A Print Softkey Prints one page (screen) of the table. B PrintAll Softkey Prints all pages (screens).

View Softkey Scrolls through the data:

D Exit Softkey Returns to the previous screen.

Revision C 250cx Series Maternal/Fetal Monitor 3-15

2036946-001

 Counterclockwise for newest data  Clockwise for oldest data

Controls, Indicators, and Connectors: Rear Panel Description

J103

J10

J109

J110

J111

J10

J104

00W

0086

Rear Panel Description

240

120

100 -120V ~ 50-60HZ 1

U.S. PATS. 3,982,528 4,533,926 4,573,47

CANADIAN PATS. 1,057,360 1,214,14

GE Medical Systems In

European Representativ

Munzinger Str

e 3-5; D-79111 Freiburg German

RS232

J112

CAUTION: FEDERAL LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN.

RS232

Monitor Rear Panel Connectors (Standard and Optional)

IMPORTANT: The Fetal Acoustic Stimulator and Remote Event Marker connectors are identical in size and shape. Be sure you connect to the proper connector to ensure accurate information.

250cx Series Rear Panel (Standard and Optional Features)

Name Description

Vent Provides ventilation for the monitor’s internal

J101 Telemetry

Connector J103 Data Entry

Connector J104 Nurse Call

Connector

circuitry. Connector for Corometrics telemetry system

interface. Connector for data entry system interface.

Connector for standard Nurse Call System interface. The connector’s maximum output is 50 Vdc at 100 mA; the maximum on resistance is

0.5 Ω.

3-16 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Controls, Indicators, and Connectors: Rear Panel Description

250cx Series Rear Panel (Standard and Optional Features)

Name Description

J102 Central Systems

Connector J112 External VGA

Connector

Connector for analog central station system interface.

Connector for external VGA display. Use of recommended GE external display will allow monitor front panel display video to be replicated remotely.

Speaker The rear panel speaker emits an audible tone for

heart rates, MSpO pitch, and alarms. It also provides the sound for the

pulse with %O2-dependent

song player feature.

J109, J110, and J111 RS-232C

Communications

Three serial RJ-11 connectors are provided for interfacing to peripheral equipment. Contact your GE Service Representative for more information.

Connectors ECG Out Connector External recorder receptacle for MECG signals.

Fetal Acoustic Stimulator Connector

The standard output level is 1 V/mV. Receptacle for Corometrics Model 146 Fetal

Acoustic Stimulator (FAST). A musical note symbol prints on the strip chart paper each time the Model

146 is used:

Remote Event Marker Connector

Receptacle for the Corometrics Remote Event Marker. When activated, one of the following marks prints on the strip chart paper:

 The event marker is commonly used to record

an “event”:

 The fetal movement marker (default setting) is

commonly used as an indication that the mother has perceived fetal movement:

Refer to the “Coro 250/250cx Series Monitor Service Manual” for more information.

Equipotential Lug A binding post terminal is directly connected to the

chassis for use as an equipotentiality connection.

Revision C 250cx Series Maternal/Fetal Monitor 3-17

2036946-001

Controls, Indicators, and Connectors: Rear Panel Description

250cx Series Rear Panel (Standard and Optional Features)

Name Description

AC Voltage Selection Switch

This switch is intended for qualified service personnel to select a voltage range for the AC input:

 120: Accepts an AC input in the range of 100–

120 VAC.

 240: Accepts an AC input in the range of 220–

240 VAC

Power Entry Module AC line power cord receptacle. Refer to the rear

panel markings to verify line voltage and line frequency requirements.

CAUTION

NON-DESTRUCTIVE VOLTAGE—The maximum nondestructive voltage that may be applied to the rear panel connectors is 0 volts. Do not attempt to connect cables to these connectors without contacting your Biomedical Engineering Department or GE Medical Systems Information Technologies Service Representative. This is to ensure the connectors comply with leakage-current requirements of one of the following applicable standards: Underwriters Laboratories UL-2601-1, Canadian Standards Associations CSA 22.2 No. 125, or International Electrotechnical Commission EN60601-1.

3-18 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

4 Setup Procedures

Revision C 250cx Series Maternal/Fetal Monitor 4-1

2036946-001

For your notes

Setup Procedures:

4-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Setup Procedures: Loading Strip Chart Recorder Paper

Loading Strip Chart Recorder Paper

Refer to “Paper Supplies Ordering Information” on page 18-3 to order paper required for use with the 250cx Series Monitor.

 (HR scale of 30–240 bpm); or

 (HR scale of 50–210 bpm).

Refer to Chapter 11, “Recorder Modes” for more information about the different paper styles.

CAUTIONS

LOADING PAPER—The instructions for loading paper into the 250cx Series Monitor are different than the instructions for loading paper into other Corometrics monitors. Im proper loading can cause paper jams. Follow the instructions carefully.

PAPER TYPE—Do not use non-Corometrics paper or paper designed for use with other Corometrics monitors. Using incorrect paper may produce inferior print quality, could result in permanent damage to the recorder’s print head, and may void your warranty . Refer to “Paper Supplies Ordering Information” on page 18-3 for the correct monitor paper part number.

STORAGE/TRANSPORT—Paper should be installed in the monitor’s strip chart recorder at all times. This reduces particle build-up on the printhead and facilitates opening the recorder door.

To install Corometrics chart paper in the 250cx Series Monitor, follow these steps:

1. Press down on the latch on the right side of the strip chart recorder door to open the recorder door.

Opening the Recorder Door

Revision C 250cx Series Maternal/Fetal Monitor 4-3

2036946-001

Setup Procedures: Loading Strip Chart Recorder Paper

2. Fan the pack of Z-fold paper on all sides to loosen any folds and to ensure proper feed of the paper through the recorder.

NOTE: The black squares indicate the end of the recorder paper. When the black

squares appear, the strip chart recorder has approximately 20 minutes of paper remaining, when running at a speed of 3 cm/min.

Fanning the Paper

3. Hold the package of paper so that:

 the black squares are on the bottom of the pack; and  the Corometrics logo and page numbers are on the left side of the pack.

Orienting the Paper

NOTE: The paper is labeled, “This side up for the 120, 2120is, and 170 Series.”

This paper is compatible with and required for the 250cx Series.

4-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Setup Procedures: Loading Strip Chart Recorder Paper

4. Unfold two sheets from the top of the package so that they extend toward you.

5. Place the pack in the drawer so that the pack is laying flat in the recorder.

Creating Paper Leader

Inserting the Paper

6. Close the strip chart recorder door.

Closing the Recorder Door

Revision C 250cx Series Maternal/Fetal Monitor 4-5

2036946-001

Power

Setup Procedures: Power

Refer to Chapter 11, “Recorder Modes” for information about paper-loading errors.

1. Turn the monitor’s power off. The Power button is located in the lower righthand corner of the monitor.

2. Connect the detachable line cord to the rear panel power connector; plug the other end into a hospital grade grounded wall outlet of appropriate voltage. (If you are unsure about the voltage, contact your hospital Biomedical Engineering Department or GE Service Representative.)

Interruption of Power

120

240

Attaching the Power Cord

3. Turn the monitor’s power on. The green indicator light, located near the up per left-hand corner of the Light button, illuminates and a series of tones are heard, indicating that the monitor has been turned on.

When the supply main to the monitor is interrupted for more than 30 seconds, the following behaviors occur.

 Configuration Settings: The configuration settings are restored to the current

user-selected default setting: Factory or Hospital.

 Patient Data: The stored patient data—including vital signs history—are erased.  NIBP: The NIBP parameter reverts to Manual Mode.

4-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Self-Test Routine

Setup Procedures: Self-Test Routine

The 250cx Series Monitor contains a self-test routine which checks the calibration and internal circuitry of the monitor. Initiate the self-test routine at the beginning of each monitoring session to print the results on the patient’s strip chart.

NOTE: To stop a self-test routine that is in progress, press the open the recorder door.

Test Routine Description

Display Test All display pixels extinguish for one second and then illuminate for one second. A green horizontal line

Lamp Test The yellow Record indicator illuminates. Recorder Test The message TEST: ARE ALL DOTS PRINTED? prints followed by two vertical lines and four

Counting Test After the recorder test, the display returns to the main screen. The software generates a 120 bpm rate

Uterine Activity The monitor sets UA value to 50 mmHg and displays in the UA display area; the mode title displays

Test button or

moves down on a red background followed by a blue vertical line moving from left to right.

horizontal lines. The two vertical lines should appear continuous and indicate a fully functional printhead. The four horizontal lines align with the heart rate and uterine activity scales, i.e., 30 and 240 BPM or 50 and 210 BPM, and 0 and 100 mmHg (0.0 and 13.3 kPa).

in the FHR1 area, a 180 bpm rate in the FHR2 area, and both mode titles display Test.

Test.

1. Ensure that strip chart is loaded.

2. Press the

3. Refer to the table below and ensure the test results are produced as expected. At the successful completion of the self-test routine, the monitor is ready for use.

Test button.

Monitor Self-Test Routines

Setup Screens

The 250cx Series Monitor provides a variety of options that are selected using the setup screens shown on the display. (The illustrations in this section are representative of all possible features. Your monitor screens may vary.) All functions are performed easily using the front panel Trim Knob control. Setup screens for

FECG, US/US2,

Revision C 250cx Series Maternal/Fetal Monitor 4-7

Maternal

2036946-001

NIBP, MHR/P, and MSpO

are detailed in Chapter 5.

Setup Procedures: Setup Screens

Using the Trim Knob Control

General instructions for using the Trim Knob control follow:

NOTE: When any setup screen (except the General Setup screen) is displayed, the primary labor parameters remain displayed.

1. To display a parameter setup screen, rotate the Trim Knob control until the bar cursor highlights the title of the parameter (FECG, US, US2, NIBP , MECG, Pulse, or

MSpO

). To access the Master Alarm Setup screen or the General Setup screen,

rotate the Trim Knob control until the bar cursor highlights the Alarms softkey or the Setup softkey, respectively, on the bottom of the screen.

2. Press the Trim Knob control once to display the selected setup screen.

3. While the screen is displayed, rotate the Trim Knob control until the desired field is highlighted.

4. Press the Trim Knob control again to activate the selected field. The cursor flashes to indicate the field is active.

5. Rotate the Trim Knob control in either direction to cycle through the available choices for the field.

6. When the desired selection is made for the field, press the Trim Knob control once to confirm the selection.

7. Repeat Steps 3 through 6 until all desired settings have been made.

8. Rotate the Trim Knob control until the bar cursor highlights the Exit softkey on the bottom of the screen. This returns the monitor to normal operation.

IMPORTANT

EFFECTIVITY—All changes take effect immediately after a selection is enacted in Step 6. Some changes take effect as the values are changed without having to press the Trim Knob.

4-8 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Setup Procedures: General Setup Screen

OFF

Off

FSpO2 Trace:

Off

Song

007

General Setup Screen

Happy Birthda

Brahms' Lullab

Rock-A-Bye Bab

Temp Done Volum

Paper Speed Selection 1, 2, or 3 cm / min

Following is a sample General Setup screen.You can access this screen screen by selecting

Setup

. Using the Trim Knob to go to the field you wish to change.

and select it by pressing the knob. Choose the desired setting.

General Setu

Play Son

Volume

Temp Done Volume

rightness

Paper Speed: 3 cm / mi

1-Jan-2

Tim

2:01:

External Monitor Setu

MSpO2 Print Interval

FSpO2 Print Interval

ervic

mi mi

Exi

10 mi

15 mi

from the main

Play Song

Song Volume

Temp Done Volume

Brightness

General Setup Screen

You can activate a song to be played from the monitor’s speaker to celebrate each birth.

This field sets the volume of the song player.

This field adjusts the temperature completion volume. This field is only available when the Exergen protocol is configured.

This field allows you to adjust the brightness of the backlight of the display. The settings range from

1 to 9

with 9 being the brightest setting.

Revision C 250cx Series Maternal/Fetal Monitor 4-9

2036946-001

Paper Speed

Date

Time

Setup Procedures: General Setup Screen

The monitor offers a choice of paper speeds of the strip chart recorder.

 1 cm/min: paper saving.  2 cm/min: a compromise between the 1 cm/min and 3 cm/min.  3 cm/min: recommended for greater diagnostic capability.

It is very important to set the date on your monitor prior to initial use. The month field has a range from 01–12; the range for the day field varies according to the

selection for month and year battery maintains the date even when the monitor is unplugged from AC power.

It is also very important to set the monitor’s clock prior to initial operation and during daylight-saving time changes. A long-lasting battery maintains the set time even when the monitor is unplugged from AC power.

; the year field has a range of 00–99. A long-lasting

MSpO2 Print Interval

FSpO2 Print Interval

FSpO2 Trace

Service

The time is represented by a 24-hour clock in hours, minutes, and seconds. The hour field has a range of 00–23; the minutes field has a range of 00–59; the seconds field resets when minutes change.

This field sets the time interval for printing MSpO2 values received from an external maternal pulse oximetry monitor.

This field sets the time interval for printing FSpO2 values received from an external fetal pulse oximetry monitor.

This field enables/disables FSpO2 trend trace printing of data received from an external fetal pulse oximetry monitor.

By choosing this option, you can view software revisions, what type of SpO technology your 250cx Monitor contains (i.e., Ohmeda, Nellcor, and Masimo etc.),

and allows service personnel to enter the password-protected Service Mode.

For example, February of 1996 has a day range of 01-29; Februar y of 1997 has a range of 01 -28; August

of 1997 has a day range of 01-31.

4-10 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Setup Procedures: Preparing the Monitor for Patient Use

Preparing the Monitor for Patient Use

The following procedures should be performed before use on each patient:

1. Ensure an adequate supply of paper is in the recorder. The recorder will automatically stop when paper runs out. If the recorder requires paper, refer to “Loading Strip Chart Recorder Paper” on page 4-3.

2. Ensure the monitor

3. Connect the appropriate transducers for monitoring. Read the “Maternal/Fetal Monitoring, Clinical Applications Manual” for instructions on app lying the transducers.

4. Ensure the setup menus are configured appropriately for use on this patient. Refer to “Setup Screens” on page 4-7.

5. Turn the recorder on. Refer to Chapter 11, “Recorder Modes” for more information.

CAUTION

PAPER MOVEMENT—Always ensure that the chart paper is moving properly from the front of the recorder drawer when the Record indicator light is on.

6. Press the

7. Press the Routine” on page 4-7.

8. Check the time and date printed on the strip chart paper. Refer to “General Setup Screen” on page 4-9 if you need to change the time/date setting.

Paper Advance button to create a paper leader. Test button to run the monitor’s self-test routines. Refer to “Self-Test

power is on.

9. Annotate the patient name and ID# using the optional Corometrics Model 2116B Data-Entry/Clinical-Notes Keyboard, if available.

Annotating Patient Information

Revision C 250cx Series Maternal/Fetal Monitor 4-11

2036946-001

Setup Procedures: Preparing the Monitor for Patient Use

4-12 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

5 Fetal Heart Rate

Monitoring

Revision C 250cx Series Maternal/Fetal Monitor 5-1

2036946-001

For your notes

Fetal Heart Rate Monitoring:

5-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Fetal Heart Rate Monitoring: Ultrasound (External Method)

Ultrasound (External Method)

NOTE: Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual”

for patient application information.

Methodology

An ultrasound (US/US2) transducer placed on the maternal abdomen is used to direct an ultrasonic beam toward the fetal heart; the transducer detects Doppler shifted frequency changes in echoes created by moving cardiac structures. An autocorrelation process is used to determine the time interval between successive cardiac cycles.

The fetal heart rate is displayed in bpm and is continuously plotted on the strip chart paper if the recorder is on. (Refer to the “US/US2 Setup Screen” figure below.) The heartbeat indicator flashes for each detected heartbeat.

US/US2 Setup Screen

Applicable Spectra alerts can appear in this area

Select the US or US2 softkey to access the US/US2 Setup screen below. The title of the screen (US vs. US2) is dependent on the mode selected when the screen is activated.

120

FM Detect: Off Volume:

Alert: On

Trend

US2

120

US Setup

Volume 5

IUP

Alert Suspend: Off

Exit

US/US2 Setup Screen

Volume

This field adjusts the volume for the FHR derived from the selected mode, US or US2. This field works in conjunction with the front panel

Revision C 250cx Series Maternal/Fetal Monitor 5-3

2036946-001

Volume buttons.

Fetal Heart Rate Monitoring: FECG (Internal Method)

Alert

This field controls and shows Spectra Alerts. Refer to Appendix C for more information.

Alarm Volume

This field controls the alarm volume for all fetal alarms.

FECG (Internal Method)

Methodology

This method uses an electrode attached directly to the fetal presenting part. The electrode is connected to the cable/legplate secured to the mother. The fetal heart rate is computed based upon the interval between successive R-wave peaks of the fetal QRS complex.

Artifact Elimination

The fetal heart rate is displayed in bpm and is continuously plotted on the strip chart recorder paper if the recorder is on. (Refer to “US/US2 Setup Screen” on page 5-3.) The heartbeat indicator flashes for each detected heartbeat.

An FECG artifact elimination option is available behind the password-protected Service Lock screen on all 250cx Series Monitors.

5-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Fetal Heart Rate Monitoring: FECG Setup Screen

FECG Setup Screen

Select the FECG softkey to access the FECG Setup screen.

Volume

FECG

165

Volume: 5

0 1 2 3 4 5 6

Off

8 9

Alarms

FHR:

Audio Alarms:

On 5

This field controls the volume for the FHR beeps derived from FECG. Thi s field works in conjunction with the front panel

172

FECG Setup

High 160 85 bpm

Volume:

TOCO

Low

Exit

High Low

140-200, Off Off, 60-140

0 1 2 3 4 5 6 7 8 9

FECG Setup Screen With Fetal Alarms Enabled

Volume buttons.

Alarms

These fields adjust the high and low alarm limits. The available ranges are shown in the above figure; the factory default settings are listed in Appendix A, “Factory Defaults”.

NOTE: The FHR1 and FHR2 alarm limits are set independently of each other.

Audio Alarms

This field enables/disables the audio alarm function for FHR when derived from FECG.

 On: Visual and audible indications are provided during an FHR alarm condition.  Off: Only a visual indication is provided during an FHR alarm condition.

Alarm Volume

This field controls the alarm volume for all alarms.

Revision C 250cx Series Maternal/Fetal Monitor 5-5

2036946-001

Fetal Heart Rate Monitoring: Fetal Heart Rate Alarms

Fetal Heart Rate Alarms

FHR Threshold Alarms

A fetal heart rate threshold alarm occurs when any fetal heart rate falls outside of the pre-defined alarm limits—greater than the high limit setting or less than the low limit setting. These alarm limits are configured via the user setup mode; the alarm can be completely disabled as well.

NOTE: The alarm enable/disable setting controls all FHR alarms: high, low, and

signal quality.

A threshold alarm is indicated both visually and audibly. Visual indications are provided by the Alarm indicator and the respective heart rate numerics. The audio alarm is described as alternating high-low tones.

CAUTION

Prior to monitoring each patient, it is recommended that you check the alarm status and alarm limits to ensure they are appropriate for the patient. The alarms are disabled if the Alarm Disable indicator is lit; they are enabled if the indicator is unlit.

Latching Alarms

Fetal heart rate threshold alarms are “latching.” This means that a clinician must acknowledge the alarm using the monitor’s alarm.

 Active Threshold Alarm: Press the Alarm Silence button to cancel the audio

component of an active threshold alarm. The visual indications remains present until the FHR value returns to within the defined acceptable range.

 Unsilenced, Resolved Threshold Alarm: If a threshold alarm condition

resolves, prior to being silenced (clinical acknowledgment), the visual and audible indications both remain present. Press the cancel both the audible and visual indications.

Alarm Silence button in order to clear the

Alarm Silence button to

5-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

FHR High Alarm

Fetal Heart Rate Monitoring: Fetal Heart Rate Alarms

The simplest example of a high FHR alarm occurs when the FHR value is continuously greater than the threshold (high limit) for 5 minutes. When data consistently violates the limit, the time-to-alarm is 5 minutes.

FHR (bpm)

alarm activates

high alarm limit (threshold)

Time (minutes)

High FHR Alarm Example

FHR Low Alarm

The simplest example of a low FHR alarm occurs when the FHR value is continuously less than the threshold (low limit) for 30 seconds. When data consistently violates the limit, the time-to-alarm is 30 seconds.

FHR (bpm)

low alarm limit (threshold)

alarm activates

Time (minutes)

Low FHR Alarm Example

Revision C 250cx Series Maternal/Fetal Monitor 5-7

2036946-001

Fetal Heart Rate Monitoring: Fetal Heart Rate Alarms

Sample Clinical Exceptions

The figure below provides an example of FHR fluctuations above and below the high alarm limit setting.

FHR (bpm)

high alarm limit (threshold)

Time (minutes)

Fluctuations Near High Alarm Limit Example

Whether the pattern shown in the above figure generates an alarm depends on what percentage of the data violates the limit. The monitor evaluates the data on an ongoing basis; the methodology can be simplified as follows:

 An FHR threshold alarm occurs if the FHR violates the alarm limit setting for

more time than it stays within the specified acceptable range.

 The time-to-alarm increases as a greater percentage of data stays within the

specified acceptable range.

Signal Quality Alarms

A fetal heart rate signal quality alarm occurs if the monitor is unable to detect an acceptable FHR signal.

Active Signal Quality Alarm

Signal quality alarms are indicated both visually and audibly. Dashes “– – –” display in the affected fetal heart rate display. The audio alarm is described as alternating high-low tones.

Resolved Signal Quality Alarm

As soon as an alarm condition is resolved, both the visual and audible indications automatically disappear (unlatch).

5-8 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

100% Signal Loss

Fetal Heart Rate Monitoring: Fetal Heart Rate Alarms

In cases where there is a complete absence of signal, the signal quality time-to-alarm is 1.25 minutes.

FHR (bpm)

100% signal loss

1.25 min

alarm activated

Time (minutes)

100% Signal Loss Example

Intermittent Signal Loss

In the clinical environment, a partial loss of signal is seen more frequently than a complete loss of signal. The time-to-alarm will vary related to the percentage of signal loss. Figure below shows an example where there is 70% signal loss resulting in a signal quality alarm after 5 minutes.

FHR (bpm)

Silencing an Audio Alarm

70% signal loss

5 min

end of “good” quality signal

70% Signal Loss Example

alarm activates

Time (minutes)

Press the Alarm Silence button to cancel the audio component of an alarm; the visual indications remain until the alarm condition is resolved.

The silence function works on an alarm-by-alarm basis. An audio alarm will sound if a new alarm condition occurs after the previous condition has been resolved.

Revision C 250cx Series Maternal/Fetal Monitor 5-9

2036946-001

Fetal Heart Rate Monitoring: Single Fetal Heart Rate Monitoring

Summary

The alarm algorithms are intended to assist the perinatal staff in assessing the status of a patient at bedside by recognizing vital signs data that falls outside the userdefined normal range. The monitor does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider, who will make diagnoses and decide on treatments or interventions. A provider shoul d determine the status of the patient by visual assessment of the fetal monitor tracing at the bedside and evaluation of fetal and maternal vital signs and progress in labor. The absence of an alarm does not indicate fetal or maternal well-being.

Frequent assessment of the fetal monitor tracing is necessary to ensure recognition of unusual, undefined, or suspicious patterns that may or may not generate a threshold alarm.

Single Fetal Heart Rate Monitoring

The Corometrics 250cx Series monitor offers three options to monitor a single fetal heart rate (FHR):

 US (external)  US2 (external)  FECG (internal)

Please refer to the “FHR Display and Trend Summary” Table for FHR display and trend summary.

Dual Fetal Heart Rate Monitoring

The Corometrics 250cx Series monitor is capable of monitoring two fetal heart rates. The discussion in this section is limited to methods of monitoring dual fetal heart

rates; however, it is important to note that MECG the monitoring of twins—even when one twin is monitored using FECG. Please refer to the “FHR Display and Trend Summary” Table for FHR display and trend summary.

There are three available options to monitor dual fetal heart rate (FHR).

 US/US2 (dual external)  FECG/US (internal/external)  FECG/US2 (internal/external)

The 250cx Series monitor offers two advanced features to aid in monitoring twins:

 heartbeat coincidence  fetal heart rate offset

monitoring can continue during

5-10 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Fetal Heart Rate Monitoring: Dual Fetal Heart Rate Monitoring

FHR Display and Trend Summary

Heartbeat Coincidence

ACTIVE

CONNECTORS

US US

US2 US2

FECG FECG FECG

US, US2 US US2 US

FECG, US FECG US FECG

FECG, US2 FECG US2 FECG

FECG, US, US2 FECG US2 FECG

NOTE: In the event that three transducers are plugged into the monitor, FECG

overrides the primary ultrasound connector (US).

When the heartbeat coincidence feature is enabled, the monitor alerts you when there is the possibility that you may be monitoring a duplicate signal. Refer to Chapter 13, “Heartbeat Coincidence” for more information.

DISPLAY MODE TREND ANNOTATION

FHR1 FHR2 FHR1 FHR2

US2

US US2 US2

Fetal Heart Rate Offset

When monitoring dual fetal heart rates, overlapping traces on the strip chart may be difficult to interpret. The 250cx Series monitor provides a +20 bpm shift for the secondary FHR trend to alleviate this problem—whether using dual ultrasound or ultrasound and FECG. This field provides an alternative to using the front panel Mark [Offset] button. Refer to the service manual for information on enabling/ disabling fetal HR offset.

Activating the Fetal Heart Rate Offset Feature

To shift the secondary FHR trend +20BPM:

1. Ensure the recorder is on and two HR channels are activated.

2. Press and hold the screen.)

 When you use dual ultrasound or US2 and FECG, the US2 trace is shifted +20

bpm and the symbol prints on the upper portion of the top grid every

4.5 cm.



When you use US and FECG, the US trace is shifted +20 bpm and the

symbol prints on the upper portion of the top grid every 4.5 cm.

Mark [Offset] button for 3 seconds. (Or use the US/US2 Setup

Revision C 250cx Series Maternal/Fetal Monitor 5-11

2036946-001

Fetal Heart Rate Monitoring: Dual Fetal Heart Rate Monitoring

 A right arrow (→) and a vertical dashed line print to draw attention to the start

of the shifted trend.

Refer to “Fetal Heart Rate Offset Example,” on page 5-12 for an example of a shifted trend.

De-Activating the Fetal Heart Rate Offset Feature

After the FHR patterns have been assessed, set the secondary FHR trend back to the

normal (unshifted) position.

1. Ensure the recorder is on.

NOTE: If the auto-revert (10-min) setting is selected on the passwordprotected Install Options screen, the shifted heart rate trace automatically reverts to normal after 10 minutes.

2. Press and hold the

Mark [Offset] button for 3 seconds. (Or use the US/US2 Setup

screen.)

 The trend returns to the unshifted position.  A left arrow (←) and a vertical dashed line print to draw attention to the

change.

Setting the FHR trend to the normal (unshifted) mode does not disable the HR Offset function; it deactivates it. To disable the mode, refer to the 250cx Series Service Manual.

FHR

US2+20 US2+20

FHR

240

210

180

150

120

bpmbpm

5810458103

US HBC TOCO 3CM/MIN US2 FMD US HBC TOCO 3CM/MIN US2 FMD

100

Fetal Heart Rate Offset Example

5-12 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

6 Uterine Activity

Monitoring

Revision C 250cx Series Maternal/Fetal Monitor 6-1

2036946-001

For your notes

Uterine Activity Monitoring:

6-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Uterine Activity Monitoring: Tocotransducer (External Method)

Tocotransducer (External Method)

NOTE: Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual”

for patient application information.

Methodology

A tocotransducer applied to the maternal abdomen records relative changes in abdominal tension caused by uterine contractions. The mode (TOCO) and value are shown in the UA area of the display. During normal operation, the UA value displays from 0–100 in mmHg mode and 0.0 - 13.3 in kPa mode. Uterine activity is continuously plotted on the bottom (or right) grid of the strip chart paper as a plain black line.

IMPORTANT:

FOR TRIMLINE TOCOTRANSDUCERS ONLY—You must wait at least 10 seconds from the time you power the monitor on or connect a tocotransducer before pressing the

UA Reference

button.

Establishing a Baseline

Monitoring uterine activity using a tocotransducer provides relative pressure measurements—compared to a baseline or UA reference. The quality of measurements depends on the following:

 position of the tocotransducer;  belt tension;  size of the patient; and  established baseline.

All 250cx Series Monitors provide a a baseline is established, all pressure measurements are relative to that baseline. The baseline can be set manually by two different methods or automatically, when necessary. Whenever the baseline is set, the bottom line of the bottom strip chart grid is annotated with UA REF.

Initial Referencing

The initial reference occurs automatically. After you plug in a transducer, verify that the display reads less than 30 mmHg (4 kPa). Make a note of the reading.

The purpose of establishing a baseline at this point is necessary for consistency when applying and tightening the belt. You will have to set the baseline again, after tightening the belt.

UA Reference button that sets the baseline. When

Revision C 250cx Series Maternal/Fetal Monitor 6-3

2036946-001

Uterine Activity Monitoring: Tocotransducer (External Method)

Accounting for Belt Tension

When adjusting the belt on the patient, regardless of transducer type, it is important to ensure a comfortable fit; also, ensure that the transducer is held securely in place. GE Medical Systems Information Technologies recommends adjusting the belt tension so that, between contractions, the UA display shows approximately 25 mmHg (3.3 kPa) above the initial baseline.

After the belt is adjusted, it is important to establish a new baseline to prevent belt tension to be counted as uterine pressure; also, pressure readings could tend to go off the scale if belt pressure is not taken into account. Again, the should only be pressed between contractions.

More About Referencing

Out of Range Condition

UA Reference button

After you press the 100 mmHg (13.3 kPa) above the reference level (probably because the belt is too tight), the the tocotransducer from the patient; re-reference with n o pressure applied to the button; reapply the transducer adjusting the belt to approximately 25 mmHg (3.3 kPa) the baseline; then re-reference one more time. If you still receive the message, try a different tocotransducer or contact your GE Service Representative .

UA Reference

display area flashes the message

button, if there is insufficient range to provide at least

Manually Setting the Baseline at the Default Value

Briefly pressing the UA Reference button sets the baseline at the default setting—the default is configured on the password-protected Install Options service screen. The monitor is shipped from the factory with either a default setting of 10 in mmHg mode or 1.3 in kPa mode. Qualified personnel can access the password-protected Install Options service screen to set the baseline default to 5, 10, 15, 20, or 25 relative units in mmHg mode or 0.7, 1.3, 2.0, 2.7, or 3.3 in kPa mode. Refer to the “250/250cx Series Monitor Service Manual” for more information.

Manually Overriding the Baseline Default Value

Pressing and holding the UA Reference button for more than 2 seconds causes the UA reference level and display to override the default setting and cycle through all available selections: 5, 10, 15, 20, or 25 relative units in mmHg mode or 0.7, 1.3, 2.0,

2.7, or in 3.3 kPa mode, starting at the default setting—until the button is released. Once the button is released, the UA trace and UA value take on this new value as a baseline for reference.

CHECK TOCO

. If this happens, remove

above

CHECK TOCO

Briefly pressing the configured via the password-protected Install Options service screen.

UA Reference button reverts back to using the default setting

Automatic Baseline “Zeroing”

If pressure falls below 0 mmHg (0 kPa) (probably because the belt has loosened), automatic UA referencing occurs and a new baseline reference is set at 0 relative units.

6-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Uterine Activity Monitoring: Internal Method - Intrauterine Pressure (IUP)

Internal Method - Intrauterine Pressure (IUP)

NOTE: To secure a strain gauge post for IUP monitoring, refer to the strain gauge

manufacturer’s instructions.

Methodology

An intrauterine pressure catheter (IUPC) inserted transcervically into the uterine cavity measures intrauterine pressure. You can monitor using either a fluid-filled catheter or a transducer-tipped catheter. The mode (IUP) and value are shown in the UA area of the display. The UA value displays from 0–100 in mmHg mode and

0.0 - 13.3 in kPa mode during normal operation. Uterine activity is continuously plotted on the bottom (or right) grid of the strip chart paper as a plain black line. Pressure exceeding 100 mmHg (13.3 kPa) is printed as a straight line at 100 mmHg (13.3 kPa).

Why You Must Zero the System

When you zero the system, you are referencing the pressure to 0 mmHg (0 kPa) while the system is open to air to ensure an absolute pressure measurement. Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual” for more information.

 If you disconnect the patient from the monitor all zeroing information is lost. If

you re-connect the patient to the monitor you must re-zero—regardless of whether you connect to the same monitor or a different monitor.

 If the mother’s position has changed, the baseline may have been altered. If this

is the case, re-zero.

 If the message CHECK IUP flashes in the UA display area, there is insufficient

compensation to provide 100 mmHg (13.3 kPa) above the reference level. Rezeroing should correct the problem.

 If a negative value is displayed (pressure less than 0 mmHg (0 kPa), the

baseline should be re-zeroed. (When a negative value occurs for more than 20 seconds, the message BASELINE PRESSURE OFFSCALE is on the bottom grid on the strip chart paper.)

Revision C 250cx Series Maternal/Fetal Monitor 6-5

2036946-001

Uterine Activity Monitoring: Internal Method - Intrauterine Pressure (IUP)

6-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

7 Maternal Heart/Pulse

Rate Monitoring

Revision C 250cx Series Maternal/Fetal Monitor 7-1

2036946-001

For your notes

Maternal Heart/Pulse Rate Monitoring:

7-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

MHR/P Source

Maternal Heart/Pulse Rate Monitoring: MHR/P Source

The MHR/P can be determined by the MECG, MSpO2, and NIBP sections of the monitor. However, the data from only one parameter is:

 referred to as the MHR/P source  displayed in the MHR/P area;  used to evaluate an MHR/P alarm condition; and

 used to generate the MHR/P trace on the strip chart paper.

The source is:

 selected via the MHR/P Setup screen  may be manually selected or automatically selected by the monitor according to

the following priority order:

 MECG (values updated continuously)  MSpO

 NIBP (NIBP is available only as an Auto selection; the Manual selection is

(values updated continuously)

disabled. Values updated only when NIBP determinations are taken)

IMPORTANT:

MSpO

AS AN MHR/P SOURCE—If MSpO2 is selected as the

MHR/P source, an MHR/P alarm only occurs if the pulse rate value derived from the MSpO

sensor violates an MHR/P alarm

limit. The MHR/P values derived from the MECG and NIBP sections of the monitor are ignored. The heart rate tone varies in pitch to reflect changes in the maternal oxygen saturation reading. The pitch rises as the saturation values increase, and lowers as the saturation values decrease. The pulse rate trend is a grey line annotated by MSpO

P .

If NIBP is selected as the MHR/P source, there is no trending of the data since these are static

measurements.

Revision C 250cx Series Maternal/Fetal Monitor 7-3

2036946-001

Maternal Heart/Pulse Rate Monitoring: MHR/P Setup Screen

MHR/P Setup Screen

Select the mode title softkey—MECG or Pulse—to access the MHR/P Setup screen. (Refer to the following figure.)

NOTES

 The figure below provides an example of MECG selected as the MHR/P

 The Lead source and Pacer fields apply to MECG only.

source, as indicated by the MECG mode title. When either MSpO are selected as the MHR/P source, the mode title changes to Pulse.

or NIBP

Source

Auto MECG

MSpO

On Off

0 1 2 3 4 5 6 7 8 9

1 2 3 4 5 6 7 8 9

FECG

165

Source:

HR/PR Trace:

Volume: 5

Alarms High Low

MHR/P: 120 50 bpm

Auto Off

172

MHR/P Setup

MECG

Alarm Volume 5

100-250

TOCO

MECG

Lead: II

Pacer: Off

I, II, III On

Off

35-120

Exit

MHR/P Setup Screen

This field selects the MHR/P source. When Auto is selected, the monitor checks for parameter availability and use in the following order: MECG, MSpO

, then NIBP. If

a source is not available, the next available source is automatically selected.

IMPORTANT

WAVEFORM—The MHR/P Source field is independent of the waveform selected on the normal operating screen. For example, you can select MECG as the MHR/P source yet display the MSpO

plethysmograph waveform. Or, you can select MSpO2 as

the source and display MECG as the waveform.

7-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

HR/PR Trace

Volume

Alarms

Maternal Heart/Pulse Rate Monitoring: MHR/P Setup Screen

This field enables or disables the printing of the MHR/P trace on the strip chart paper.

 On: The MHR/P trend is printed in grey annotated with MECG or MSpO

P —whichever parameter is selected in the MHR/P Source field. MHR/P

data from NIBP is not trended since blood pressure determinations are static measurements.

 Off: The MHR/P trend is not printed.

This field sets the volume of the “beep” sounded with each detected valid heartbeat—for MECG and MSpO

These fields adjust the high and low alarm limits for MHR/P— in increments of 5 bpm. The selectable values are shown in the MHR/P Setup screen. The factory defaults are listed in Appendix A, “Factory Defaults”.

only.

Alarm Volume

MECG Lead

This field controls alarm volume for all maternal alarms.

This field selects the ECG lead configuration. The lead can also be selected from the MECG Lead Softkey on the normal operating screen.

 Lead I refers to the potential between the left arm and the right arm.  Lead II refers to the potential between the right arm and left leg.  Lead III refers to the potential between the left arm and the left leg.

Revision C 250cx Series Maternal/Fetal Monitor 7-5

2036946-001

Maternal Heart/Pulse Rate Monitoring: MHR/P Setup Screen

The following figure illustrates which electrodes reference the ECG lead obtained.

WHITE (RA)

RED (R)

MECG Pacer

BLACK (LA)

YELLOW (L)

WHITE (RA)

RED (R)

RED (LL)

GREEN (F)

BLACK (LA)

YELLOW (L)

RED (LL)

GREEN (F)

NOTE: AHA label is bolded; IEC label is italicized.

MECG Lead Selection Guide

This field enables/disables pacemaker pulse rejection circuitry.

 Off: Use this setting for a patient without a pacemaker. All ECG events are

monitored; all complexes, including pacer spikes may be displayed

and may be

included in the heart rate calculation.

 On: Use this setting for a patient who has a pacemaker. The monitor rejects the

pacer spike from the heart rate calculation and replaces the actual pacer spike with a pacer event mark; in addition the letter

P is displayed prior to the

waveform speed. Following is an example of an MECG waveform with the MECG pacer On.

P 25 mm/s

II Auto

MECG 09:21:41 Frozen

09:22:06

Print Freeze Alarms Setup VSHX

The bracket situated to the left of the ECG waveform denotes 1 mv. If the ECG waveform size is set to Auto, the bracket will auto-adjust to maximize the QRS display, depending on signal amplitude.

MECG Waveform with Pacer Enabled

If the MECG waveform is enabled for display

7-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Maternal Heart/Pulse Rate Monitoring: Maternal ECG Monitoring

Maternal ECG Monitoring

Theory and Methodology

The maternal heart rate (MHR) is measured via electrodes placed on the maternal chest. When MECG is employed, the maternal heart rate is computed on a beat-tobeat basis using the R-to-R time interval on the maternal QRS complex. When MECG is selected as the MHR/P source, the MHR is displayed on the front panel display in beats per minutes (bpm), denoted by MECG. The heartbeat indicator flashes for each detected heartbeat. The rear panel speaker emits an audible tone for each detected heartbeat. The maternal heart rate trend, when enabled, is continuously plotted in the top (or left) grid of the strip chart paper. The MHR trace is a grey line annotated by MECG . The beat-to-beat MHR signal is used for trending on the strip chart paper and for output to external devices such as a central station system. The averaged MHR values are used for display and for alarm detection.

Pacemaker Safety Information

The following safety information applies to patients with pacemakers.

WARNINGS

ACCESSORIES—Use only electrodes, lead wires, and cables recommended by GE Medical Systems Information Technologies. Failure to use recommended accessories may result in inaccurate readings, damage to equipment, or loss of defibrillator protection.

FALSE ALARMS—False low heart rate alarms or false asystole may result with certain pacemakers because of electrical overshoot.

FALSE COUNTING—Be aware that a pacer spike could be falsely counted as a QRS complex during asystole.

INTERFERENCE—Interference caused by electrosurgical or diathermy instruments will affect the proper operation of the MECG section of 250cx Series Monitors.

PACEMAKER SPIKE—Do not diagnostically interp ret the pacemaker spike size and shape; the spike may be attenuated by the module in order to be displayed or printed.

PATIENT OBSERVATION—Keep pacemaker patients under close observation.

Revision C 250cx Series Maternal/Fetal Monitor 7-7

2036946-001

MECG Waveform

Maternal Heart/Pulse Rate Monitoring: Maternal ECG Monitoring

CAUTION•

FDA POSTMARKET SAFETY ALER T—the United States FDA Center for Devices and Radiological Health issued a safety bulletin October 14, 1998. This bulletin states “that minute ventilation rate-adaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment, causing the pacemakers to pace at their maximum programmed rate.” The FDA further recommends precautions to take into consideration for patients with these types of pacemakers. These precautions include disabling the rate responsive mode and enabling an alternate pace mode. For more information contact: Office of Surveillance and Biometrics, CDRH, FDA 1350 Piccard Drive, Mail Stop HFZ-510 Rockville, MD 20850 USA

When MECG monitoring is employed, the MECG waveform can be displayed and printed—independent of the MHR/P source. Refer to Chapter 14, “Waveforms”.

7-8 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

8 Maternal Non-Invasive

Blood Pressure Monitoring

Revision C 250cx Series Maternal/Fetal Monitor 8-1

2036946-001

For your notes

Maternal Non-Invasive Blood Pressure Monitoring:

8-2 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: Blood Pressure Safety Precautions

Blood Pressure Safety Precautions

NOTES

 This safety information applies to the non-invasive blood pressure (NIBP)

of the monitor.

 A patient’s vital signs may vary dramatically during the use of

cardiovascular agents such as those that raise or lower blood pressure or those that increase or decrease heart rate.

CAUTIONS

Accuracy of NIBP measurement depends on using a cuff of the proper size. It is essential to measure the circumference of the limb and choose the proper cuff size.

ACCURACY—As with any non-invasive oscillometric blood pressure monitor, there are clinical conditions which can affect the accuracy of the measurements obtained. For example, do not use the monitor’s NIBP feature on a patient experiencing convulsions or who is attached to a heart/lung machine. In addition, disregard or stop automatic blood pressure determinations that coincide with maternal contractions. Finally, be aware that the accuracy of measurements can be affected if readings coincide with maternal uterine contractions. Refer to “Smart BP Feature” on page 8-13.

CALIBRATION—Do not operate the monitor unless it has been properly calibrated. Inaccurate blood pressure readings may result. Refer to Chapter 15, “Maintenance” for details.

DISPLA Y INTERV AL—The time period, in minutes, that a blood pressure reading remains displayed before being automatically erased, is selectable via the password-protected Install Options Screen 2. The option can also be set to continuously display the reading until replaced by a new reading. The display of “old” pressure values may cause confusion. If a patient’s condition changes during the time interval between determinations, the monitor will not detect the change or indicate an alarm condition. Blood pressure and pulse can fluctuate greatly between measurements; the monitor does not alert the user (through audio or visual means) to changes in NIBP or NIBP-derived pulse rate occurring between measurement cycles.

EXTERNAL PRESSURE—Do not apply external pressure against the cuff while monitoring. Doing so may cause inaccurate blood pressure values.

Revision C 250cx Series Maternal/Fetal Monitor 8-3

2036946-001

Warnings

Maternal Non-Invasive Blood Pressure Monitoring: Warnings

CAUTIONS

PULSE RATE COMP ARISONS—The pulse rate measured by the monitor’s NIBP circuitry may differ from the heart rate measured by the monitor’s MECG circuitry or another maternal ECG monitor because the monitor’s blood pressure module measures peripheral pulses, not electrical signals or contractions of the heart. Occasionally , the electrical signals at the heart do not produce a peripheral pulse. Similarly, if a patient’s beat-to-beat pulse amplitude varies significantly, blood pressure and pulse rate readings can be erratic and an alternate measuring method should be used for confirmation.

WARNINGS

The NIBP parameter will not measure blood pressure effectively on patients who are experiencing seizures or tremors. Arrhythmias will increase the time required by the NIBP parameter to determine a blood pressure and may extend the time beyond the capabilities of the parameter.

Use care when placing the cuff on an extremity used to monitor other patient parameters.

The monitor is intended only for use in the non-invasive monitoring of maternal blood pressure (NIBP). This monitor is not intended for use in neonatal or pediatric blood pressure monitoring.

Devices that exert pressure on tissue have been associated with purpura, skin avulsion, compartmental syndrome, ischemia, and/ or neuropathy. To minimize these potential probl ems, especially when monitoring at frequent intervals or over extended periods of time, make sure the cuff is applied appropriately and examine the cuff site and the limb distal to the cuff regularly for signs of impeded blood flow.

8-4 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: NIBP Determination

NIBP Determination

A patient’s vital signs may vary dramatically during the use of cardiovascular agents such as those that raise or lower blood pressure or those that increase or decrease heart rate.

Because treatment protocol based on the patient’s blood pressure may rely on specific values and differing measurement methods, clinicians should note a possible variance from values obtained with this unit in planning patient care management. The GE monitor values are based on the oscillometric method of noninvasive blood pressure measurement and correspond to comparisons with intraaortic values within ANSI/ AAMI Standards for accuracy. Most automatic noninvasive blood pressure monitoring uses the oscillometric method of measurement. To understand how this method works, it is compared to the auscultatory method.

Auscultatory – With the auscultatory method, the clinician listens to the blood flow and determines the systolic and diastolic pressures. The mean pressure is then calculated with reference to these pressures (as long as the arterial pressure curve is normal).

Oscillometric – The oscillometric method measures cuff pressure oscillations. Oscillations are small changes in cuff pressure caused by artery motion against the cuff. During a determination, the monitor st ores oscillations along with cuff pressures. At the end of a determination, these stored data are used to determine systolic, mean and diastolic pressures.

Due to the difference in these methods, one cannot be used to check the accuracy of the other.

SuperSTAT NIBP Determination

The oscillometric method of determining SuperSTAT NIBP is accomplished by a sensitive transducer which measures cuff pressure and minute pressure oscillations within the cuff. The first determination initially pumps up to an initial target cuff pressure of about 135 mmHg (18.0 kPa) or to the user-selected initial target pressure. To allow for rapid setting of cuff pressure, the monitor will momentarily inflate to a higher pressure, then immediately deflate to the target pressure.

After inflating the cuff, the monitor begins to deflate, the oscillations versus cuff pressure are measured, and finally, systolic, mean, and diastolic pressure are determined, and the screen is updated. In any subsequent determination, as few as four pressure steps may be necessary to complete the process. When employing fewer pressure steps, the system uses the stored information from the previous blood pressure determination to decide the best pressure steps to take. The monitor measures the consistency of pulse size to tell if the oscillations taken at a step are good and if more steps are needed.

If the current blood pressure reading is similar to the previous reading, the monitor may use some information from the previous blood pressure in the current determination. The monitor constantly evaluates data during a measurement and tries to perform a blood pressure determination in the shortest possible time providing greater comfort to the patient.

Revision C 250cx Series Maternal/Fetal Monitor 8-5

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: SuperSTAT NIBP Determination

Accelerated Determination

Systolic Search

The monitor will try to make an accelerated determination of blood pressure if it has been 16 minutes or less since the last determination and the current blood pressure is similar to the previous reading.

If systolic pressure is not found, the NIBP parameter can search at cuff pressures higher than the initial target pressure. The parameter will inflate the cuff above the initial target pressure to get data in the systolic region. The maximum pressure allowed in systolic search is limited by the normal range for cuff pressures. In any operating mode, if a patient's systolic pressure exceeds the inflation pressure, the parameter will begin normal deflation sequence, detect the absence of a systolic value, stop deflation, reinflate to a higher (than initial) inflation pressure, and resume the normal deflation sequence.

WARNING

Arrhythmias will increase the time required by the NIBP parameter to determine a blood pressure.

8-6 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: NIBP Setup Screen

NIBP Setup Screen

Select the NIBP softkey to access the NIBP Setup screen.

High Low

9.3-32.0

9.3-17.3

9.3-20.0

100-250

High Low 70-240 70-130 70-150

100-250

Mode

kPa mode

6.7-20.0

4.0-16.0

4.0-16.0 35-120

mmHg mode

50-150 30-120 30-120

35-120

FECG

165

NIBP

130/ 85

MAP (107)

03:15

Diastolic: 90 50 mmHg

11:41

Alarms High Low

Systolic: 160 90 mmHg

MAP: 140 50 mmHg

MHR/P: 120 50 bpm

172

NIBP Setup

Mode:

Target:

NIBP Done Vol:

Alarm Volume: 5

Manual 135 5

This field alternates between the manual and automatic monitoring modes for maternal blood pressure. For auto mode, this field also sets the interval time, in minutes, between automatic blood pressure determinations. This interval time is measured from beginning to beginning of determinations. (The monitor is factoryset with the optional 1-minute interval time enabled. For information on disabling the 1-minute interval, refer to the “250/250cx Series Monitor Service Manual”.)

TOCO

Exit

100-250, 5 mmHg

increments

0 1

Manual Auto 1 min Auto 2 min Auto 3 min Auto 4 min Auto 5 min Auto 10 min Auto 15 min Auto 20 min Auto 30 min Auto 40 min Auto 45 min Auto 60 min Auto 90 min Auto 120 min

Maternal NIBP Setup Screen

NOTE: As soon as the auto mode is selected on the setup screen, the countdown

timer begins to decrement. The first automatic determination begins after

expiration of one complete interval time period.

Target

This option lets you choose the initial pressure for cuff inflation. If the NIBP is taken while previous determination is still displayed, and within 16 minutes of the previous determination, the initial target pressures for subsequent determinations are based upon the systolic values of previous determination. The default initial target pressure is 135 mmHg (18.0 kPa). Adjust the pressure between 100 to 250 mmHg (13.3 to 33.3 kPa) in increments of 5 mmHg (0.7 kPa).

NOTE: Selecting a tar get pressure will clear old NIBP values in the vital signs area

and cancel any determination in progress.

Revision C 250cx Series Maternal/Fetal Monitor 8-7

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: NIBP Monitoring

NIBP Done Volume

Alarms

Alarm Volume

NIBP Monitoring

This field sets the volume of the sound emitted at the completion of each blood pressure determination. As you adjust the volume, a sample tone sounds.

These fields adjust the high and low alarm limits for maternal systolic, diastolic, and mean arterial pressures, as well as for MHR/P—in increments of 5 mmHg (0.7 kPa) or 5 bpm. The selectable values are listed in “Maternal NIBP Setup Screen,” on page 8-7. The factory default settings are listed in Appendix A, “Factory Defaults”.

This field controls alarm volume for all maternal alarms.

Checklist

Patient Preparation

1. The NIBP hose is securely inserted into the NIBP connector on the monitor.

2. A cuff appropriate for the limb size has been selected.

3. Cuff is properly placed on patient and connected to the NIBP hose.

4. Tubes between the cuff and the monitor are not kinked or blocked.

Cuff selection and application are important. Inappropriate selection or improper application of the cuff will result in erroneous measurements.

WARNING

The system is designed for use only with dual-hose cuffs and tubing.

Do not place the cuff on a limb being used for A-V fistulas, intravenous infusion or on any area where circulation is compromised or has the potential to be compromised.

1. Connect the air hose to the NIBP port on the front of the monitor. Make sure that

the hose is not kinked or compressed.

2. Choose the appropriate blood pressure measurement site. Because normative values are generally based on this site and as a matter of convenience, the upper arm is preferred. When upper arm size or shape or the patient’s clinical condition or other factors prohibit use of the upper arm, the clinician must plan patient care accordingly, taking into account the patient’s cardiovascular status

8-8 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: NIBP Monitoring

and the effect of an alternative site on blood pressure values, proper cuff size and comfort.

Warning: Do not place the cuff on a limb being used for intravenous infusion or any area where circulation is compromised or has the potential to be compromised.

3. If patient is standing, sitting, or inclined ensure that cuffed limb is supported to maintain cuff at level of patient’s heart. If cuff is not at heart level, the difference in systolic and diastolic values due to hydrostatic effect must be considered. Add 1.80 mmHg (0.24 kPa) to values for every inch (2.54 cm) above heart level. Subtract 1.80 mmHg (0.24 kPa) from values for every inch (2.54 cm) below heart level.

4. Choose appropriate cuff size. Measure patient’s limb and choose appropriately sized cuff according to size marked on cuff or cuff packaging. When cuff sizes overlap for a specified limb circumference, choose the larger size cuff.

Precaution: Accuracy depends on use of proper size cuff.

5. Inspect cuff for damage. Replace cuff when aging, tearing or weak closure is apparent. Do not inflate cuff when unwrapped.

Precaution: Do not use cuff if structural integrity is suspect.

6. Connect the cuff to the air hose.

Warning: It is mandatory that the appropriate hose and cuff combination be used.

7. Inspect patient’s limb prior to application.

Precaution: Do not apply cuff to areas where skin is not intact or tissue is injured.

8. Palpate artery and place cuff so that patient’s artery is aligned with cuff arrow marked “artery.”

9. Squeeze all air from cuff and confirm that connection is secure and unoccluded and that tubing is not kinked.

10. Wrap cuff snugly around the patient’s limb. Cuff index line must fall within range markings. Ensure that hook and loop closures are properly engaged so that pressure is evenly distributed throughout cuff. If upper arm is used, place cuff as far proximally as possible.

11. Proper cuff wrapping should be snug, but should still allow space for a finger between patient and cuff. Cuff should not be so tight as to prevent venous return between determinations.

Warning: Using a cuff that is too tight will cause venous congestion and discoloration of the limb, but using a cuff that is too loose may result in no readings and/or inaccurate readings.

Blood Pressure Methodology

During a determination, the instantaneous cuff pressure is indicated by a numeric value displayed beside the title Cuff. This information is displayed in place of the mean arterial pressure. When a determination is successful, the monitor emits two short tones (high/low) and displays the three pressure readings (and the maternal pulse, if NIBP is enabled as the MHR/P source.) Refer to Chapter 7, “Maternal Heart/Pulse Rate Monitoring”, for information.

Regardless of the mode, auto or manual, the values remain displayed according to the time period specified in the display timer field.

Revision C 250cx Series Maternal/Fetal Monitor 8-9

2036946-001

Maternal Non-Invasive Blood Pressure Monitoring: NIBP Monitoring

Hydrostatic Effect

Manual Mode

The systolic and diastolic pressures are each indicated with two or three digits and separated by a slash (/). The mean arterial pressure is indicated with two or three digits and enclosed in parentheses. All pressure values are displayed in mmHg or kPa.

Systolic, diastolic, MAP, and pulse rate values are printed on the strip chart paper annotated by an outlined diamond ( )which marks the time of the reading.

If patient is standing, sitting, or inclined ensure that cuffed limb is supported to maintain cuff at level of patien t’s heart. If cuff is not at heart level, the difference in systolic and diastolic values due to hydrostatic effect must be considered. Add 1.80 mmHg (0.24 kPa) to values for every inch (2.54 cm) above heart level. Subtract 1.80 mmHg (0.24 kPa) from values for every inch (2.54 cm) below heart level.

In manual mode, press the NIBP Start/Stop button to begin a single determination. The cuff will inflate to the target pressure. If this initial inflation pressure is insufficient, the unit retries with a higher inflation pressure (+40 mmHg; +5.3 kPa). The instantaneous cuff pressure is displayed in place of the mean arterial pressure area and is indicated by the title Cuff.

Automatic Mode

If you have the 256 Monitor–which does not have the NIBP parameter installed–and press the label on the monitor’s screen.

In auto mode an indefinite series of determinations are made at defined time intervals. Upon activation, a clock icon ( ) displays in the NIBP area indicating the

time remaining until the next scheduled automatic determination. NOTE: The first automatic determination begins after the expiration of one

Since the first automatic blood pressure reading will not occur until after a complete interval time, you may wish to take an initial manual reading by pressing the

Start/Stop

previous values are displayed. If previous values are displayed the cuff inflation target pressure is based on the previous values. If this initial inflation pressure is insufficient, the unit retries with a higher inflation pressure. The instantaneous cuff pressure is displayed in place of the mean arterial pressure area and is indicated by the title Cuff.

NIBP Start/Stop button, the message NOT INSTALLED appears under the NIBP

complete interval time period.

NIBP

push button. Automatic determinations inflate to the target pressure if no

WARNING

The NIBP parameter should be set to determine blood pressures only as frequently as is clinically indicated to ensure adequate patient monitoring.

8-10 250cx Series Maternal/Fetal Monitor Revision C

2036946-001

GE Healthcare 259cx, 256cx, 250cx User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual