GE Medical Systems Information Technologies 2014748-002 Users Manual
Viewing real-time patient data
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Real-time patient views
You can view real-time data for patients located in your care unit, and when
networked with other CIC Pro centers, you may also view real-time data for patients
located outside of your care unit.
The CIC Pro center allows you to view real-time patient data from two different
patient viewers. Each viewer provides a different level of data granularity:
Multi-patient viewer
Single patient viewer
CAUTION
TREATMENT — Do not treat a patient based solely on the alarm
messages and/or numerics presented via the connectivity device to
the monitor. You must verify the accuracy of the alarm message and/
or numerics at the peripheral device itself before initiating treatment.
Treatment should be b a sed o n the information presented at the
peripheral device.
Data synchronization
Multi-patient viewer
Information displayed on the ECG tab sheet is synchronized with the source
(transmitter) every two seconds. If differences are detected, the display is refreshed
with new patient data.
The multi-patient viewer displays a snapshot of real-time parameter data for a
maximum of 16 patients. You can do the following real-time tasks from the multipatient viewer:
View abbreviated real-time patient data.
View a snapshot of real-time Graphic Trends data for a maximum of two
different parameters. See Configuring the real-time trend window on page 7-6.
Print parameter limits or waveform data for all patients in the care unit. See
Printing parameter limits or waveforms for all in-unit patient beds on page 7-9.
View a single patient’s detailed real-time parameter data. See Single patient
viewer on page 7-3.
View a single patient experiencing an alarm condition. See Viewing in-unit
patients experiencing an alarm condition on page 7-5.
Admit or discharge a patient. See Chapter 6.
View beds outside your care unit. See Out-of-unit patient beds on page 7-6.
Silence all alarms. See Silencing alarms on page 5-7.
The multi-patient viewer displays menu bar options similar to the following:
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Multi-patient viewer menu bar options
Option Function
Auto Display When enabled, the Auto Display button is selectable from the
menu bar.
Clicking the Auto Display button while viewing the multi-
patient viewer automatically completes the following tasks:
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Single patient viewer
Removes any un-locked, unoccupied beds.
Adds at least one empty patient window with an Admit
button.
Resizes the remaining patient windows to maximize the
amount of displayed patient data.
View Other View any patient bed on the Unity Network that is inside or
outside of the care unit, floor, or hospital. See In-unit patient
beds on page 7-5. See Out-of-unit patient beds on page 7-6.
CIC Setup
Silence Alarms Silence audible alarm tones for one minute. See Silencing
Graph All Print the parameter limits or the waveform data for all patients
Browser Access stored patient data from the web access server.
The single patient viewer displays detailed real-time parameter data for a selected
patient. You can complete the following tasks from the single patient viewer:
View the
some of the user-level defaults. See Customizing the system
on page 4-4.
alarms on page 5-7.
in the care unit.
CIC Pro center default settings. Y ou can customize
View detailed real-time parameter data.
View, change, or print Alarm Control or parameter control settings for any in-
unit patient. These changes are also adopted by the monitor. See Adjusting alarm
control settings on page 5-8. See Adjusting parameter control settings on page 7-
11.
View Alarm Control or parameter control settings for out-of-unit patient beds on
the Unity Network. See Adjusting alarm control settings on page 5-8. See
Adjusting parameter control settings on page 7-11.
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NOTE
You cannot change the Alarm Control or parameter control settings of an
out-of-unit patient.
Adjust the real-time trend window for any in-unit patient. See Configuring the
real-time trend window on page 7-6.
Print real-time parameter data and waveforms for any in-unit patient. See
Printing real-time data on page 7-8.
The single patient viewer displays menu bar options similar to the following:
Single patient viewer menu bar options
Option Function
Real-Time View Return to the real-time display of patient data.
Admit Display the Admit window.
Monitor Setup... Temporarily adjust a patient’s parameter, alarm, or print
control settings.
Patient Data... Display stored patient data. See Chapter 8.
System Utilities... Access web access server data.
View all ECG Display waveforms for ECG leads I, II, III, V, aVR, aVL, and
aVF.
Sample Record and store a 10-second sample of a patient’s real-time
ECG data. Data samples are stored in Events directory.
Monitor: Parameter numeric data and up to three
waveforms.
Telemetry: ECG waveforms only.
Relearn Relearn the selected patient’s ECG rhythm after changes
occur to heart rate or rhythm. The CIC Pro center uses 14
current complexes to relearn the patient’s ECG pattern.
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The heart rate value appears briefly as Xs during the relearn
process and returns to numerics when the relearn process is
complete.
Configuration Configure the selected patient’s real-time trend window. See
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Configuring the real-time trend window on page 7-6.
Viewing real-time patient data
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In-unit patient beds
You can view any in-unit patient bed that is on the Unity Network.
Viewing in-unit patients experiencing an alarm condition
When an in-unit patient experiences an alarm condition, you can quickly display this
patient’s data by displaying the single patient viewer.
You can use one of the following methods to display the single patient viewer of an
alarming patient bed:
Click in the patient window.
Click the alarm button.
The CIC Pro center can display an alarm button for a maximum of four patients. Th is
row of alarm buttons display across the top of the multi-patient viewer and show the
unit name, bed number, and the cause of the alarm.
The color of the alarm button indicates the severity of the patient alarm condition.
Red indicates a Crisis alarm condition, yellow indicates a Warning alarm conditio n,
and white indicates an Advisory alarm condition.
Another name for this row of alarm buttons is the Alarm Display Unit (ADU) line.
Alarm buttons, also known as Alarm Display Unit (ADU) line
Viewing patient beds from another in-unit CIC Pro center
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When you have more than one CIC Pro center in your care unit, you can view
(monitor) a patient bed from another in-unit CIC Pro center.
Complete the following procedure to view (monitor) in-unit patient beds from another
in-unit CIC Pro center:
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1. Go to the CIC Pro center in your care unit that has room to view additional
admitted patient beds.
2. From the multi-patient viewer, right click in an empty patient window displaying
an Admit button. The right click menu displays.
3. From the right click menu, choose Select Care Unit then Bed Number. A list of
networked care units displays.
4. From the list, choose the care unit and bed name you want to view. The patient
bed is displayed in the multi-patient viewer.
Out-of-unit patient beds
You can view out-of unit patient beds that are not displayed at your CIC Pro center.
The bed you wish to view must be on the Unity Network.
NOTE
You cannot change the Alarm Control or parameter control settings of an out-ofunit patient.
Viewing an out-of-unit patient bed
Complete the following procedure to view networked out-of-unit patient beds:
1. From the multi-patient viewer, click View Other. A list of networked care units,
floors, or hospitals displays.
2. Click the + sign next to the desired unit, floor, or hospital to display the list of
viewable beds.
3. Select the bed you want to view and click OK. The single patient viewer displays
for this patient. The patient bed is displayed in the multi-patient viewer and the
single patient viewer also displays for this patient.
4. To close the single patient viewer, click the (close button) on the top right
side of the window.
Removing viewed out-of-unit patient beds
Complete the following steps to remove out-of-unit patient beds you are viewing
from the multi-patient viewer:
1. From the multi-patient viewer, right click on the patient bed you want to remove.
2. From the right click menu, choose Select Care Unit then Bed Number > None.
Configuring the real-time trend window
Y ou can configure the display of a real-time trend window in the multi-patient viewer.
The real-time trend window displays the recent patient trends for a maximum of two
parameters.
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Complete the following procedure to configure a patient’s real-time trend window:
1. Choose one of the following methods to access the Real-time Trend Graph
configuration window from the multi-patient viewer:
Right-click on the patient you want to configure and select Configuration.
The Real-time Trend Graph window displays.
Click on the patient you want to configure. The single patient viewer
displays. From the single patient viewer, click Real-time View to display the
real-time window.
2. Click Configuration to display the Real-time Trend Graph window.
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3. Change any of the undimmed setting options.
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Real-time Trend Graph control settings
Option Function
Display Real-time Trend
Graph
Display Parameter 1 Display the first real-time parameter trend.
Display Parameter 2 Display the second real-time parameter trend.
Display a real-time trend window with a maximum of two
real-time parameter trends.
To display the Real-time Trend Graph, click in the
empty check box to fill the box with a check mark.
To display one real-time parameter trend, click in the
empty check box to fill the box with a check mark. Then,
click the down arrow to set the display properties:
Parameter Name: Set the displayed parameter.
Scale: Set the size of the displayed waveform
trend.
Color: Set the color of the displayed parameter text
and waveform trend.
To display a second real-time parameter trend, click in
the empty check box to fill the box with a check mark.
Then, click the down arrow to set the display properties:
Parameter Name: Set the displayed parameter.
Scale: Set the size of the displayed waveform
trend.
Color: Set the color of the displayed parameter text
and waveform trend.
4. After making your selections, complete one of the following tasks:
Click OK to apply your changes and close the window.
Click Cancel to cancel your changes and close the window.
Click Apply to apply your changes without closing the window.
See Viewing stored patient data on page 8-1.
Printing real-time data
While viewing the in-unit real-time patient data from the multi-patient viewer, you
can manually print a continuous ECG strip for a single patient bed or print the
parameter limits and waveforms for all displayed patient beds.
Printing a continuous ECG strip
From the multi-patient viewer, you can click in the ECG parameter window of any
displayed in-unit patient bed to print a continuous ECG strip. A print icon appears as
you position the cursor over the ECG parameter window.
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NOTE
When using a digital writer, click in the ECG parameter window of any displayed
in-unit patient bed.
Then, press the (Graph Stop) button on the front of the digital writer to
stop printing a continuous ECG strip.
NOTE
The printing formats are controlled by the data source device (monitor or
telemetry system). This includes printed waveforms, speed, and graph location.
See the operating instructions for the devices you are using.
Printing parameter limits or waveforms for all in-unit patient beds
You can print the parameter waveform data for all in-unit patients displayed at a CIC
Pro center by using the Graph All function. In addition, you can also print the
parameter limits for telemetry beds.
Selecting the Graph All function results in printing a 10-second graph for each
admitted telemetry bed and a 20-second graph for hard-wired beds. The graph speed
of a telemetry graph is 25 millimeters per second and the graph speed of a hard-wired
graph is determined by the monitor.
NOTE
Close any open single patient viewer windows before selecting the Graph All
function. Otherwise, only the single patient viewer data prints.
The following conditions apply when using the Graph All function:
When you press the (Graph Stop) button on the local digital writer, the
current patient’s graph stops and the writer begins to print a 10-second graph for
the next patient.
When a patient’s data is currently graphing or is being saved to graph when a
Graph All function request is started, this patient’s data is not included in the
Graph All Patients graph. This patient’s data graphs independently of the Graph
All Patients graph.
When you click in the ECG parameter window of a patient whose data is saving,
this cancels the Graph All Patients request for that patient.
When an arrhythmia alarm sounds for a patient while a Graph All Patients
request is running, the alarm data replaces the data that was saved for the Graph
All Patients request.
When a telemetry patient initiates a graph from a transmitter while a Graph All
Patients request is running, the Graph All Patients graph for that patient is
replaced by a transmitter graph.
Complete the following procedures to print parameter limits or waveforms for all
patient beds displayed in the multi-patient viewer:
Printing limits
NOTE
The Limits option only prints parameter limits for telemetry beds.
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Stopping a print job
Complete the following procedure to print telemetry bed parameter limits:
1. From the multi-patient viewer, click Graph All. The Graph All Patients window
displays.
2. From the Graph All Patients window, click Limits.
3. Click OK to begin printing.
Printing waveforms
Complete the following procedure to print parameter waveforms for all displayed
patient beds:
1. From the multi-patient viewer, click Graph All. The Graph All Patients window
displays.
2. From the Graph All Patients window, click Waveforms.
3. Click OK to begin printing.
You must stop a print job from the same CIC Pro center you used to send the print job
to the printer.
Stop printing to a laser printer
Complete the following procedure to stop printing all print jobs sent to the laser
printer:
1. From the multi-patient viewer, click CIC Setup > CIC Defaults. The CIC
Defaults window displays.
2. Under Printer/Writer, click Cancel Print Jobs for the printer you want to stop
printing to.
3. After making your selection, complete one of the following tasks from the CIC
Defaults window:
Click OK to apply your changes and close the CIC Defaults window.
Click Cancel to cancel your changes and close the CIC Defaults window.
Click Apply to apply your changes without closing the CIC Defaults
window.
Stop printing to a local digital writer
Complete the following procedure to stop printing all print jobs sent to a local digital
writer:
1. Locate the digital writer.
2. Press the (Graph Stop) button located on the front of the digital writer to
stop the print job.
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Monitored parameters
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The CIC Pro center can display data for many monitoring paramet e rs.
NOTE
For a complete list of supported parameters, refer to the CIC Pro Clinical
Information Center Operator’s Manual.
Adjusting parameter control settings
The following guidelines apply to adjusting parameter control settings at the CIC Pro
center:
You may view and adjust parameter settings for any in-unit patient. Any changes
are temporary and return to the default settings when a patient is discharged.
These changes are also adopted by the monitor.
Y ou may not be able to adjust some of the control settings for non-GE acquisition
devices that are interfaced via the Unity Network Interface Device.
You may view parameter settings for any out-of-unit patient. However, you
cannot adjust these settings.
To permanently change the parameter default settings, see the CIC Pro Clinical
Information Center Bedrock Hardware Platform Service Manual.
This section briefly covers adjusting control settings for the following parameters:
Viewing real-time patient data
ECG
ECG control settings
ECG
SpO
Invasive pressures
Complete the following procedure to adjust the control settings.
1. From the multi-patient viewer, click on the patient you want to view. The single
2. From the single patient viewer, click Monitor Setup.
3. Click ECG to display the control window.
4. Change any of the undimmed setting options. When an option appears dimmed,
2
Non-invasive pressures
patient viewer displays.
you cannot change it unless you enter the service-level password.
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ECG control settings
Option Function
Display Lead Set the top or first lead displayed on the monitor and on the
CIC Pro center. This is the lead data that prints during an
alarm or manual graph.
Relearn button Relearn the selected patient’s ECG rhythm after changes
occur to heart rate or rhythm. The CIC Pro center uses 14
current complexes to relearn the patient’s ECG pattern.
Remove the V Fail message or activate the second V-lead
when changing between a 5-and 6-leadwire set on the
transmitter.
NOTE
The heart rate value appears briefly as Xs during the
relearn process and returns to numerics when the relearn
is complete.
Size Set the waveform size. 1X is standard.
Detect Pace Set the pacemaker detection mode:
Pace 1: Alternate pacemaker detection mode when Pace
2 does not adequately detect pacemaker spikes.
Pace 2: Normal pacemaker detection mode.
For more information, refer to Monitoring pacemaker patients
on page 7-13.
Pace Help button View solutions to common pacemaker detection problems.
Lead Analysis Set the leads for ECG and arrhythmia data processing:
Single-Lead: Use the top Display Lead.
Multi-Lead: Use leads I, II, III and V lead.
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ECG control settings
Option Function
Arrhythmia Set the arrhythmia detection level:
Full: Detect all arrhythmia conditions defined by the
software.
Lethal: Detect lethal arrhythmia conditions.
Off: Turn off arrhythmia detection.
Arrhythmia detection remains off until you choose Full or
Lethal, or the patient is discharged.
NOTE
OFF appears dimmed and is not selectable when
the following option is set: CIC Setup > CIC
Defaults > Allow Alarms OFF on this CIC > No.
The Allow Alarms OFF on this CIC setting is a
service-level default and is protected by the Service
Password.
PVC Limit Turn On to count PVCs per minute. A PVC counter appears in
the ECG parameter window.
ST Turn On to display, store, and enable ST alarms.
V Lead Label the V Lead position.
5. After making your selections, complete one of the following tasks:
Click a different Monitor Setup option to apply your changes without
closing the Monitor Setup window.
Click the (close button) on the top right side of the window to apply
your changes and close the Monitor Setup window.
Monitoring pacemaker patients
Be aware of the following when monitoring a patient with a pacemaker.
WARNING
FALSE CALLS—False low heart rate indicators or false asystole
calls may result with certain pacemakers because of electrical
overshoot.
NOTE
To display the PVC counter, the Arrhythmia detection
level must be set to Full.
WARNING
MONITORING PACEMAKER PATIENTS—Monitoring of
pacemaker patients can only occur with the pace program activated.
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WARNING
PACEMAKER SPIKE—An artificial pacemaker spike is displayed
in place of the actual pacemaker spike. All pacemaker spikes appear
uniform. Do not diagnostically interpret pacemaker spike size and
shape.
WARNING
PATIENT HAZARD—A pacemaker pulse can be counted as a QRS
during asystole in either pace mode. Keep pacemaker patients under
close observation.
WARNING
RATE METERS—Keep pacemaker patients under close
observation. Rate meters may continue to count the pacemaker rate
during cardiac arrest and some arrhythmias. Therefore, do not rely
entirely on rate meter alarms.
CAUTION
FDA POSTMARKET SAFETY ALERT—The United States FDA
Center for Devices and Radiological Health issued a safety bulletin
October 14, 1998. This bulletin states “that minute ventilation rateadaptive 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
U.S.A.
NOTE
ECG monitoring with patients on non-invasive transcutaneous pacemakers may
not be possible due to large amounts of energy produced by these devices.
Monitoring ECG with an external device may be needed.
The Detect Pace option enables/disables the pacemaker detection program. It must be
used whenever the monitored patient has a pacemaker.
There are two pacemaker processing modes, Pace 1 and Pace 2. The modes use
different algorithms for pacemaker artifact rejection. The clinician must be the judge
as to which mode is better for each patient. The pacemaker detection program
defaults OFF, so if you have a patient with a pacemaker, you will have to select a
mode. For more information, refer to ECG control settings on page 7-11.
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The Pace 1 mode allows successful detection of the largest variety of paced QRS
morphologies. As a direct consequence, this mode does have a higher risk of counting
pacemaker artifact as QRS complexes during ASYSTOLE. For this reason, it is
imperative that the user keep patients with pacemakers under close observation. It is
also recommended that the user set the low heart rate limit on the monitor close to the
minimum pacing rate, and that the BRADY arrhythmia alarm level be elevated to a
Warning or Crisis level.
The Pace 2 mode is much more conservative in recognizing paced QRS
morphologies and is recommended for use whenever possible. It is designed to
minimize the possibility of counting pacemaker artifact as QRS complexes during
ASYSTOLE. If the monitor does not adequately detect paced beats in the Pace 2
mode, then the user may wish to try the Pace 1 mode.
When either pace mode is enabled, the software places an artificial spike on the
waveform whenever the pacemaker triggers. When pacemaker detection is on, it is
indicated by a “P” in the patient’s ECG parameter window.
For successful monitoring of pacemaker patients follow these suggestions:
Use recommended electrode placement.
Brady, Pause, and Low Heart Rate are additional alarms available for use when
monitoring pacemaker patients.
Problems you may experience are:
heart rate double counting;
inaccurate alarms for low heart rate or asystole;
pacemaker spikes not recognized by the software.
Possible solutions to above problems are:
relearn arrhythmia;
try an alternate electrode placement;
try Single-Lead analysis;
try switching to the other pace detection mode.
Multi-vector pace detection
The T14 transmitter uses multi-vector pace detection. Here are some additional
guidelines for successful monitoring pacemaker patients when using the T14
transmitter.
When using the 5- or 6-leadwire set with all the electrodes attached, pace
detection occurs on two ECG leads simultaneously.
The default leads used for detection are II and V. If these leads are not available,
multi-vector pace detection switches to available leads.
Pace detection switches to Single-Lead when using a 3-leadwire set.
For more information, refer to “Pacemaker troubleshooting” on page D-3.
Pace help
Clicking on the Pace Help button opens a window that shows common problems and
solutions in regard to pacemaker detection. This window is shown below.
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Lead analysis
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The Lead Analysis control signals the transmitter to process the ECG in Single-Lead
or Multi-Lead mode. Use the mouse to click on your selection. Multi-Lead analysis is
the default setting for Adult.
Multi-Lead analysis
Single-Lead analysis
NOTE
ECG is relearned whenever Lead Analysis is changed.
Multi-Lead analysis simultaneously examines ECG leads I, II, III, and V (whether
they are displayed or not) to help eliminate false alarms and improve the ability of the
system to:
Detect beats which occur isoelectric to a single chest lead.
Discriminate artifact that appears in one lead compared to the other lead vectors.
Provide a smart-lead fail feature, where the failed lead is identified, and if
available, another lead is provided for display.
Continue arrhythmia processing even after a lead change.
Single-Lead analysis uses only the lead displayed on the CIC Pro center screen to
process ECG and arrhythmia information. To change the lead used for Single-Lead
analysis, you must change the displayed lead.
Single-Lead ECG may be acquired using a 3-, 5-, or 6-leadwire set. However, only a
Single-Lead ECG is transmitted or processed.
Single-Lead analysis is beneficial when troubleshooting pacemaker detection and/or
arrhythmia detection. Single-Lead analysis must always be used when monitoring
with a 3-leadwire set. Single-Lead analysis can be set up as a unit default. Refer to
Customizing the system on page 4-4 for more information.
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Single-Lead ECG telemetry data
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NOTE
When acquiring Single-Lead ECG data using a 5- or 6-leadwire set, it is not
necessary to connect the V leads or the right leg lead to the transmitter or to the
patient.
The following constraints apply when using Single-Lead ECG telemetry data.
Viewing real-time patient data
Function Single-Lead Constraints
change the displayed
lead
Lead Analysis Multi-Lead analysis may appear to be selectable at the
select a V lead V leads may appear to be selectable at the CIC Pro
select displayed leads
from a single viewer
select graph waveforms Leads other than the default displayed lead may appear to
The factory default Display Lead is lead II.
Contact your local service representative to change the
default displayed lead.
Display Lead appears to be selectable at the CIC Pro
center. However, your selection is temporary and will
revert back to the transmitter’s default displayed lead.
NOTE
When the clinical situation dictates monitoring a lead
other than the default lead, you can move the leads
and/or electrodes to view a different lead. Be aware
that the label on the display and on the printout will
show the default lead label.
CIC Pro center. However, your selection is temporary and
will revert back to the Single-Lead analysis mode.
center. However, your selection does not change the
transmitter’s default displayed lead.
Leads other than the default displayed lead may appear to
be selectable at the CIC Pro center. However, your
selection is temporary and will revert back to the
transmitter’s default displayed lead.
be selectable at the CIC Pro center. However, you must
select the transmitter’s default displayed lead to obtain a
graph of the waveform.
Arrhythmia
WARNING
INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING
AND CALCULATIONS BASED ON PATIENT AGE — After
manually updating or automatically retrieving patient demographic
information from a network database, always confirm that the
entered patient’s date of birth matches the patient’s actual date of
birth. Otherwise the appropriate age-related algorithms, arrhythmia
detection, and calculations will not be applied.
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WARNING
SUSPENDED ANAL YSIS—Certain conditions suspend arrhythmia
analysis. When suspended, arrhythmia conditions are not detected
and alarms associated with arrhythmias do not occur. The messages
which alert you to the conditions causing suspended arrhythmia
analysis are: ALL ALARMS OFF, ALARM PAUSE, ARR OFF,
ARR SUSPEND, DISCHARGED, LEADS FAIL, and NO
TELEM. Additionally, the alarms off with reason options and
disabling the Alarm Pause Breakthrough feature also suspend
arrhythmia analysis.
WARNING
VENTRICULAR ARRHYTHMIAS—The arrhythmia analysis
program is intended to detect ventricular arrhythmias. It is not
designed to detect atrial or supraventricular arrhythmias, with the
exception of atrial fibrillation. Occasionally it may incorrectly
identify the presence or absence of an arrhythmia. Therefore, a
physician must analyze the arrhythmia information in conjunction
with other clinical findings.
The arrhythmia control signals the CIC Pro center to ignore or accept arrhythmia
calls. To modify arrhythmia settings, use the mouse to click on Full, Lethal, or Off.
NOTE
Full arrhythmia processing is suspended when the level 1 ARTIFACT message is
displayed. Lethal arrhythmia is still active but its accuracy may be hindered by
the artifact.
NOTE
When arrhythmia program is in Full mode, the program counts the number of
PVCs that occur within a minute.
Turning arrhythmia on automatically starts a relearn procedure.
When arrhythmia is turned off, ARR OFF appears in the ECG parameter
window.
No arrhythmia detection with 7015 software level patient monitors
If an ApexPro system patient is admitted to a patient monitor at the 7015 software
level (ECG source is telemetry, not the monitor), the following scenario may occur
when monitoring in Combo or Rover Combo monitoring modes:
Since the 7015 software level does not support arrhythmia processing,
arrhythmia detection for the telemetry patient is reduced from full arrhythmia
detection to no arrhythmia detection (arrhythmia OFF). This occurs because the
software is designed to take on the attributes of the bedside monitor when in
Combo or Rover Combo monitoring modes.
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Full arrhythmia conditions
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Viewing real-time patient data
CAUTION
Under these conditions, arrhythmia detection is OFF. There is NO
INDICATION of this at the bedside monitor, central station or CIC
Pro center.
If the patient is later discharged from the monitor, and monitoring continues from
telemetry, the message ARR OFF will then appear at the central station or CIC
Pro center. Arrhythmia monitoring remains OFF.
NOTE
Solar 7000 monitors, Solar 8000 monitors, Dash monitors, and Eagle
monitors may include the 7015 software level.
The following is an alphabetical list of the Arrhythmia messages that are displayed
when full arrhythmia is selected and the condition occurs. Definitions of each
condition are included. The CIC Pro center’s response to each condition is determined
by the alarm level to which the arrhythmia has been assigned.
ACC VENT Adult—Accelerated ventricular occurs when six or more ventricular
Atrial FIB Atrial fibrillation identification occurs when random. chaotic, low-amplitude
ASYSTOLE V entricular asystole occurs whenever the displayed heart rate drops to zero.
BIGEMINY Occurs when three or more bigeminal cycles (a ventricular beat followed by
BRADY Bradycardia is the average of the most recent eight R-to-R intervals at a
beats are detected with an average heart rate for the ventricular beat
between 50 and 100 beats per minute.
0-2 years—Occurs when six or more ventricular beats are detected
with an average heart rate for the ventricular beat between 60 and 160
beats per minute.
3-10 years—Occurs when six or more ventricular beats are detected
with an average heart rate for the ventricular beat between 60 and 140
beats per minute.
11-13 years—Occurs when six or more ventricular beats are detected
with an average heart rate for the ventricular beat between 60 and 130
beats per minute.
deflections of the supraventricular component of the ECG waveform. This
results in irregular timing of QRS complexes and the absence of uniform P
waves proceeding the QRS complex.
NOTE
AFIB alarms can take up to 90 seconds to display while the algorithm
verifies the event.
a non-ventricular beat) are detected.
heart rate less than the set LOW heart rate limit.
NOTE
The Brady limit matches the low heart rate limit. If the low heart rate
limit is changed, the Brady limit changes.
COUPLET Occurs when two ventricular beats are detected and have non-ventricular
beats before and after the couplet. The coupling interval must be less than
600 milliseconds.
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IRREGULAR Occurs when six consecutive normal R-to-R intervals vary by 100
PAUSE Occurs when a 3-second interval without a QRS complex is detected.
PVC Isolated premature ventricular complexes occur when a premature
PVC limit When on, the PVC Limit control displays a PVC counter in the ECG
R ON T Occurs when a ventricular complex is detected within the repolarization
TACHY Tachycardia is four R-to-R intervals at a heart rate greater than the set HIGH
TRIGEMINY Occurs when three or more trigeminal cycles (a ventricular beat followed by
milliseconds or more.
NOTE
Some bedside monitors allow the Pause time interval to be adjusted.
For more information, refer to the appropriate bedside monitor’s
operator’s manual.
ventricular beat is detected and has non-ventricular beats before and after.
parameter window. When off, the PVC counter is not displayed. Use the
mouse to turn the PVC Limit control On or Off. The PVC limits are preset in
Alarm Control defaults.
period of a non-ventricular beat.
heart rate limit.
NOTE
The Tachy limit matches the high heart rate limit. If the high heart rate
limit is changed, the Tachy limit changes.
two non-ventricular beats) are detected.
V BRADY Adult—Ventricular bradycardia occurs when a run of three or more
ventricular beats is detected with an average heart rate that is less than or
equal to 50 beats per minute.
0-2, 3-10, and 11-13 years—Occurs when a run of three or more ventricular
beats is detected with an average heart rate that is less than or equal to 60
beats per minute.
VFIB/ VTAC Ventricular fibrillation occurs when the ECG waveform indicates a chaotic
ventricular rhythm.
WARNING
VFIB/VTAC should not be considered a substitute for the V TACH
arrhythmia call. Efforts to lower the V T ACH alarm level can result in missed
ventricular tachycardia alarms.
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V TACH Adult—Ventricular tachycardia occurs when a run of six or more
VT > 2 Adult—Ventricular tachycardia >2 occurs when a run of ventricular
ventricular beats is detected with an average heart rate greater than or
equal to 100 beats per minute.
0-2 years—Occurs when a run of six or more ventricular beats is
detected with an average heart rate greater than or equal to 160 beats
per minute.
3-10 years—Occurs when a run of six or more ventricular beats is
detected with an average heart rate greater than or equal to 140 beats
per minute.
11-13 years—Occurs when a run of six or more ventricular beats is
detected with an average heart rate greater than or equal to 130 beats
per minute.
beats is detected with a duration of less than six beats but longer than
two beats and with an average heart rate that is greater than or equal
to 100 beats per minute.
0-2 years—Occurs when a run of ventricular beats is detected with a
duration of less than six beats but longer than two beats and with an
average heart rate that is greater than or equal to 160 beats per
minute.
3-10 years—Occurs when a run of ventricular beats is detected with a
duration of less than six beats but longer than two beats and with an
average heart rate that is greater than or equal to 140 beats per
minute.
11-13 years—Occurs when a run of ventricular beats is detected with
a duration of less than six beats but longer than two beats and with an
average heart rate that is greater than or equal to 130 beats per
minute.
Lethal arrhythmia conditions
When Lethal arrhythmia is selected, the following conditions (as defined for Full
arrhythmia) are detected:
ASYSTOLE
VFIB/VTAC
V TACH (defaults to the Crisis level, but can be moved to a different level)
BRADY (if the Patient Age range selected is 0-2 years or 3-10 years)
AFIB identification
NOTE
AFIB trending is only available when the bedside monitor supports this feature.
If your bedside monitor does not support AFIB trending, this feature is not
available. Contact your sales/service representative for more information.
Atrial fibrillation (AFIB) is characterized by random, chaotic, low-amplitude
deflections of the supraventricular component of the ECG waveform, resulting in
irregular timing of QRS complexes and an absence of uniform P waves preceding the
QRS complex.
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Alarms
The AFIB algorithm feature identifies atrial fibrillation arrhythmias for the
transmitter. When an AFIB event is detected, the ATRIAL FIB alarm text replaces
the IRREGULAR arrhythmia alarm text.
AFIB event patient data is stored for review in the Graphic Trends and Vital Signs
tab sheets.
A patient status alarm is triggered when an AFIB arrhythmia is detected. The message
ATRIAL FIB is displayed in the message area of the display.
NOTE
There is approximately a 90 second delay while the AFIB algorithm verifies the
AFIB arrhythmia condition.
The AFIB alarm defaults to a Message alarm level but can be changed under
Arrhythmia Alarm Level, in the Telemetry Alarm Control Defaults tab sheet on the
CIC Pro center. How the monitor responds to each condition is determined by the
alarm level to which the AFIB arrhythmia detection has been assigned. When set for
Advisory or greater, AFIB alarms will be recorded and displayed in the alarm area on
the CIC Pro center.
ST analysis
NOTE
AFIB alarms can only be adjusted at the CIC Pro center. If AFIB is not available/
enabled at a bedside monitor in Combo mode, you will not be able to
immediately adjust the alarm. You must discharge the patient from the bedside
monitor, ad ju st the alarm setting at the CIC Pro center and then admit the patient
at the bedside monitor.
The patient’s most dominant, normal beat is used for ST measurement. This beat is
identified by the arrhythmia analysis program. Turn ST ON to display the numerics
calculated for ST at the CIC Pro center.
GE identifies the ST segment of the QRS complex as beginning at the J point and
ending 60 milliseconds following the J point in Adult mode. The ST measurement
factory defaults are:
Adult— J+ 60ms
0–2 years— J+ 30ms
3–10 years— J+ 40ms
11–13 years— J+ 50ms
The ST numeric displayed (millimeters) indicates either a positive or negative
elevation in relation to the isoelectric reference point (which is also determined by the
arrhythmia program and the patient’s age).
When ST is on, numerics are displayed under each ECG lead label on the screen. (A
negative deflection is preceded by a minus sign.) These numerics are updated about
every 15 seconds.
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The ST value shown in the ECG parameter window is the lead with the greatest ST
deviation. This may or may not be the lead that is in alarm, since a lead with a lesser
deviation from the isoelectric line may have changed more than the lead with the
greatest deviation.
NOTE
ST numerics are always calculated with reference to 1X size. Displaying the
ECG waveform at a different size does not affect the ST values.
NOTE
When a new dominant beat is detected or a relearn occurs, the arrhythmia
program calculates ST based on the new beat. This could affect the ST values
displayed. This may not necessarily represent a change in the patient’s condition.
The clinician needs to assess the patient any time there is an ST change.
NOTE
Adjustable ST alarms are only available when using a CIC Pro center running
software version 5 or later. If your CIC Pro center is running an earlier version of
software, this feature is not available. Contact your sales/service representative
for more information.
ST deviation alarm
Adjusting ST limits
When any individual ST value is beyond the limit, an ST deviation alarm occurs. It is
considered a parameter alarm, and the default alarm level is Warning. This can be
modified in the parameter alarm level setup.
When the ST program is turned on, or a relearn is done with ST on, the ST
deviation values are set for all leads of ST.
The current ST value is determined in all eight leads.
The ST value in the ECG parameter window turns red to indicate an alarm.
ST limits can also be adjusted individually in the patient’s Alarm Control tab.
NOTE
ST limits can also be adjusted at the CIC Pro center from Monitor Setup > ECG.
ST alarm limits and levels for telemetry patients are typically controlled by the
default ST alarm levels from the CIC Pro center. Some bedside monitors allow users
to adjust ST alarm limits and levels at the bedside when the patient is admitted in
combination monitoring mode. For more information on adjusti ng ST limits, refer to
the bedside monitor operator’s manual.
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SpO2
Introduction
NOTE
SpO2 and SPO2 are used interchangeably throughout this manual to refer to
pulse oximetry.
The transmitter supports the Apex oximeter and the Xpod oximeter. Unless specified,
oximeter refers to both units.
The Xpod oximeter connects to the transmitter and provides the following oximetry
vital signs for display at the CIC Pro center:
arterial oxygen saturation (SpO2)
peripheral pulse rate (PPR)
perfusion quality indicator
The Apex oximeter functions as a stand-alone device, and displays digital values for
SpO2 and pulse rate. When the Apex oximeter is connected to the transmitter, digital
values for SpO2 and pulse rate are also displayed at the CIC Pro center.
NOTE
When monitoring SpO2 using an transmitter, an SpO2 waveform is neither
generated nor displayed on the Apex oximeter or CIC Pro center. Additionally,
no alarm histories are generated or stored.
SpO2 in the multi-patient viewer
In the multi-patient viewer, the bed window for a telemetry patient being monitored
for SpO2 displays the current SpO2 value; one, two, or three asterisks indicating
signal strength; and, if turned on, the derived pulse rate for the patient. Below is an
example of a telemetry patient’s bed window in the multi-patient viewer.
SpO2 control settings
SpO2 Value
Signal Strength
Indicator
Pulse Rate Value
346B
Complete the following procedure to adjust the control settings.
1. From the multi-patient viewer, click on the patient you want to view. The single
patient viewer displays.
2. From the single patient viewer, click Monitor Setup.
7-24 ApexPro™ 2001989-301A- draft 1
3. Click SPO2/Resp to display the control window.
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NOTE
The SpO2 tab is labeled SpO2/Respiration because respiration monitoring
settings are available on this tab sheet for bedside monitored patients only.
Respiration monitoring is not an option for telemetry patients. Therefore
only SpO2 information appears on this tab sheet when monitoring a
telemetry patient.
4. Change any of the undimmed setting options.
Viewing real-time patient data
SpO2 probe safety
064A
SpO2 control settings
Option Function
Rate Turn On to display the SpO
Size Set the waveform size. No waveform is displayed for
telemetry patients. This option will appear dimmed.
5. After making your selections, complete one of the following tasks:
Click a different Monitor Setup option to apply your changes without
closing the Monitor Setup window.
Click the (close button) on the top right side of the window to apply
your changes and close the Monitor Setup window.
Be sure to read all literature accompanying probes for specific safety information. Be
aware of the following safety precautions when using SpO2 probes.
heart rate.
2
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WARNING
DATA VALIDITY—Do not expose probe detector to strong ambient
light while monitoring a patient. A poor signal may result.
Do not allow tape to block the probe light detector.
WARNING
PATIENT SAFETY—Prolonged monitoring may require changing
the probe site periodically. Move the probe if there is any sign of
skin irritation or impaired circulation. Change the probe site AT
LEAST every four hours to prevent ischemic skin necrosis. If
required, reduce the application periods to HALF the times
recommended above.
If a probe is damaged in any way, discontinue use immediately.
CAUTION
Use only Nonin SpO2 probes with the Apex oximeter and Xpod
oximeter. The reliability of SpO2 data obtained with any other probe
has not been verified.
Infants and pulse oximetry
Precautions
We recommend the application of the following criteria when using the pulse
oximetry function on infants:
1. The peripheral pulse rate (PPR) as determined by the SpO2 function must be
within 10% of the heart rate, and
2. the SpO2 signal strength indicator must have 2 or 3 asterisks displayed, and
3. stable SpO2 values are displayed for six seconds.
WARNING
The display of inaccurate pulse oximetry (SpO2) values has been
linked to the presence of poor signal strength or artifact due to
patient motion during signal analysis. This condition is most likely
to be encountered when the equipment is used on infants. These
same conditions in adults do not impact the SpO2 values to the same
extent.
When using pulse oximetry on infants, always observe the following
precautions.
7-26 ApexPro™ 2001989-301A- draft 1
Procedures or devices previously applied in your facility for SpO2 monitoring should
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be used in the event that the SpO2 value from the equipment cannot be validated by
the above criteria.
Signal and data validity
It is extremely important to determine that the probe is attached to the patient
correctly and the data is verifiable. To make this determination, the signal strength
indicators on the Apex oximeter and the CIC Pro center are of assistance.
Signal strength indicator
A signal strength (perfusion) indicator is displayed on the Apex oximeter display and
at the CIC Pro center in the appropriate patient window.
Viewing real-time patient data
CAUTION
Do not use the Apex oximeter on neonatal patients. It is not designed
for use on neonates.
Error messages
On the Apex oximeter, this indicator is a perfusion LED that blinks with each SpO2
pulse detected. The LED blinks green for each acceptable strength pulse. It blinks
yellow for SpO2 signals of marginal quality, and blinks red when the SpO2 signal is
too weak or the quality is very poor. When the perfusion LED blinks red, the numeric
data displayed on the Apex oximeter will be replaced by dashes within 10 seconds.
At the CIC Pro center, the signal strength indicator consists of 0, 1, 2, or 3 (strongest)
asterisks, depending on the strength of the signal.
Proper environmental conditions and probe attachment help ensure a strong signal .
WARNING
In the monitoring of patients the coincidence of adverse conditions
may lead to a disturbed signal going unnoticed. In this situation
artifacts are capable of simulating a plausible parameter reading, so
that the monitor fails to sound an alarm. In order to ensure reliable
patient monitoring, the proper application of the probe and the signal
quality must be checked at regular intervals.
If the probe is not correctly attached to the patient and data is not verifiable, one of the
following error messages may appear in the patient’s bed window at the CIC Pro
center:
SPO2 PROBE OFF
SPO2 PROBE
If either of the above messages appears, check the position of the probe or replace the
probe. If the problem persists, call GE Service or contact your sales/service
representative.
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Pressures
The Pressures tab sheet allows you to view and modify settings specific to the viewed
telemetry patient’s NBP display. Settings may be viewed fo r any pat ient. However,
you can only modify settings for patients who are admitted to a bed in your unit.
NOTE
The NBP tab is labeled Pressures because other invasive pressures settings are
available on this tab sheet for bedside monitored patients only.
Invasive pressure monitoring is not an option for telemetry patients. Therefore,
only NBP information appears on this tab sheet when monitoring a telemetry
patient.
Non-invasive blood pressure control settings
Complete the following procedure to adjust the control settings.
1. From the multi-patient viewer, click on the patient you want to view. The single
patient viewer displays.
2. From the single patient viewer, click Monitor Setup.
3. Click Pressures to display the control window.
4. Change any of the undimmed setting options.
065A
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Non-invasive blood pressure control settings
Option Function
Auto Turn Off automatic NBP measurements.
When turned On at the monitor, NBP measurements are
acquired automatically at regular intervals.
NOTE
This option does not apply to telemetry beds and
cannot be turned on from the CIC Pro center.
Cuff Size Set the inflation pressure used during the first NBP
measurement and for calculating the NBP pressure:
NOTE
For more information, refer to the appropriate
bedside monitor’s operator’s manual.
Clear Message button Clear the display of inflation messages and current NBP
5. After making your selections, complete one of the following tasks:
Click a different Monitor Setup option to apply your changes without
closing the Monitor Setup window.
Click the (close button) on the top right side of the window to apply
your changes and close the Monitor Setup window.
NBP monitoring with telemetry
NBP monitoring via telemetry is done with an Accutracker DX or Dinamap Pro blood
pressure monitor connected to the transmitter. The blood pressure cuff is connected to
the blood pressure monitor, which measures and displays systolic and diastolic blood
pressures using the auscultatory method. When the blood pressure monitor is
connected to an transmitter, digital values are also displayed at the CIC Pro center.
WARNING
The following conditions may affect the accuracy of noninvasive
blood pressure readings: seizures, tremors, extreme hypotension or
hypertension, arrhythmias, or extremely high or low heart rate.
readings.
Patient preparation
Blood pressure cuff selection and application are important. Inappropriate selection or
improper application of the cuff will result in erroneous measurements.
Most people use their non-dominant arm for acquiring ambulatory noninvasive blood
pressure readings.
Follow these steps to prepare the patient for NBP monitoring:
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1. Place the K-sound microphone in the microphone pad (or blood pressure cuff).
For more information on microphone placement, refer to Microphone placement
on page 7-30.
2. Locate the patient’s brachial artery on the inside of the arm, jus t above the elbow.
Mark the location with a pen for easy microphone placement.
3. Remove the backing from the microphone pad and adhere it in the location
marked on the patient’s arm. Do not bend or squeeze the microphone. Route the
microphone cable up, toward the patient’s shoulder.
4. Wrap the blood pressure cuff around the arm. Be sure that the artery marker is
aligned over the brachial artery.
5. Drape the cuff hose over the patient’s shoulder and attach an adhesive cuff
anchor to the snap on the cuff hose. Do not adhere the cuff anchor to the patient
at this time.
6. Place the blood pressure monitor in its pouch and attach it to the patient using the
belt or shoulder strap provided.
7. Adhere the cuff anchor to the patient’s upper arm by removing the adhesive
backing and pressing firmly.
When attached, the blood pressure cuff and hoses should be positioned like those in
the following illustration.
Hoses Routed Over
Shoulder
Cuff Anchor Clip
Cuff/Microphone
Connections
408A
Microphone placement
A microphone is used to hear the Korotkoff sounds (K-sounds) that the blood
pressure monitor uses to determine the systolic and diastolic pressure readings. The
microphone can be placed in a microphone pad and adhered to the patient’s arm under
7-30 ApexPro™ 2001989-301A- draft 1
the blood pressure cuff, or alternatively, it can be placed directly into the microphone
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pocket inside the blood pressure cuff.
Placement in the microphone pad
Using a microphone pad is recommended. Place the microphone in the pad as
illustrated below. Do not bend or squeeze the microphone when placing it in the pad,
or when adhering the pad to the patient’s arm.
Microphone Cable
K-sound Microphone
Microphone Pad
Viewing real-time patient data
410A
Placement in the blood pressure cuff
As already stated, using the microphone pad is recommended, especially in the case
of ambulatory patients or patients with weak K-sounds. However, as an alternative,
the microphone can also be placed directly in the blood pressure cuff. Follow the
directions below.
NOTE
Blood pressure readings taken with the microphone in the blood pressure cuff
may not be as accurate as readings obtained when using the microphone pad.
1. Remove the bladder from the cuff.
2. Turn the cuff bladder pouch inside out to expose the microphone pocket.
3. Open the Velcro pocket flap and gently insert the microphone into th e pocket.
4. When the microphone is completely inserted, close the Velcro flap over the
microphone cable and turn the cuff right side out.
5. Replace the bladder and exit the bladder hose and microphone cable out of the
same exit site, either right arm or left arm, as marked on the cuff.
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