Getemed VitaGuard 300, VitaGuard 310, VitaGuard 2000, VitaGuard 2100, VitaGuard 3000 Presentation

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getemed
Medizin-und Informationstechnik AG
Oderstrasse 77 14513 Teltow
Customer Training VitaGuard®VG 2100 / VG 3100 / VG 310
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VitaGuard
®
VitaGuard®-Monitors
VG 2100VG 3100VG 310
Pulse Oximeter
Monitor
Heart Rate, Apnea and
Oxygen Saturation
Monitor
Heart Rate and Apnea
Monitor
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Monitored parameters
VitaGuard
Device Family
®
VG 3100
Pulse
Rate
*
--
VG 3100
VG 2100
ApneaVitaGuard
Heart
Rate
*
SpO2
VG 310
* = either heart rate or pulse rate, user selectable
§ Heart rate und respiration measured using 3 electrodes
§ SpO2und pulse rate using an optical LNOP sensor (Low Noise Optical Probe)
--
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VitaGuard
®
VG 3100
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VitaGuard
®
VG 3100
General Requirements (I)
§ User-friendly operation ® increases safety
§ All controls must be clearly marked ® standardised symbols
§ All connectors must be protected against false polarity and connection of wrong
cables
§ Operation must be learned within 20 -30 minutes
§ The monitor must be small, light and easy to transport
§ All settings must reappear when the monitor is switched off
§ Operation from the mains supply and batteries
§ Operation for at least 8 hours from fresh batteries
§ Automatic change-over between mains supply and batteries
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VitaGuard
®
VG 3100
General Requirements (II)
§ Warn signal when power failure occurs
§ Variable alarm settings to suit the particular medical situationof the patient
§ Physiological alarm when the physiological parameter is outside the set limits
§ Technical alarm when an electrode or SpO2 sensor falls off patient
§ Other technical alarms when situations detected that inhibit proper operation
e.g. battery voltage too low
§ Compliance memory i.e. is the monitor being used as expected?
§ Alarm data storage for analysis purposes
§ Silent alarm limits for special situations
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VitaGuard
®
VG 3100
Measured Signals
§ Sensors = Electrodes connected to chest
§ Electrocardiograph (ECG)
§ Heart rate
§ Respiration
§ Basal impedance
§ Sensors = Optical probe on finger, foot, toe or ear
§ Plethysmograph
§ Oxygen saturation (SpO2)
§ Pulse rate
§ Perfusion index
§ Signal IQ
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§ ECG = Electrocardiograph
VitaGuard
ECG Leads
®
VG 3100
EinthovenLeads I YE -RD(yellow -red) IIBK -RD (black -red) IIIBK -YE (black -yellow)
§ The heart rate is calculated from the ECG signal
§ The lead selection menu allows to choose between the Einthoven
leads I, II or III
§ Remember! The respiration signal is always measured between
red and yellow
Lead II Lead III
RA LA
Lead I
LL
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VitaGuard
®
VG 3100
Heart Rate
§ The time interval between two consecutive R waves is
used to calculate the heart rate
§ The displayed heart rate is averaged over the number
of RR intervals selected by the user (between 2 and 16 beats in steps of 2)
§ If the number selected is small (e.g. 2 or 4 beats), then the heart rate is practically beat-to-
beat. The displayed value, however, may jump about a lot
§ If the number selected is large (e.g. 14 or 16 beats), then the displayed value tends to be
smoother. However, the monitor will take longer to detect a bradycardia alarm
§ Average values for the heart rate over fixed intervals of 1 minute, 1, 6 and 12 hours
are displayed in the INFO windows
§ Furthermore, the monitor has a user selectable average interval for deviation alarms.
This average and the current deviation are also displayed in theINFO windows
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VitaGuard
®
VG 3100
Respiration and Basal Impedance
§ Respiration and basal impedance are always measured between the red and
yellow electrodes (Einthovenlead I)
§ Basal impedance: 500 -1000 W, depending on the electrodes used
§ Impedance due to respiration: 0,3 -2 W
§ Impedance resulting from heart beat: 0,025 -0,5 W, main problem with impedance
method!!
§ Further impedance changes due to movement
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VitaGuard
®
VG 3100
Apnea Detection and Respiration Rate
§ Detection of central apneas
§ The respiration rate is calculated and displayed when the signalamplitude is large
enough. The values displayed is averaged over 10s. If the rate cannot be calculated, a question mark is displayed instead
§ Apnea detection is independent of the displayed respiration rate. If the rate cannot
be calculated, then the amplitude is too small. In this case, the electrodes should be repositioned!
§ The setting “minimum respiration rate”4 to 10 per minute determines the maximum
time (15 s to 6 s) to detect the signal
§ Detection of periodic respiration can be switched on or off. However, for proper
detection, the signal amplitude must be large enough and the agegroup “< 2 years“ must be selected
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VitaGuard
®
VG 3100
Open-Lead Detection
§ Open-Lead-Detection
§ The basal impedance between the red and yellow electrodes is measured once
every second
§ If the basal impedance is greater than approx. 2500 Ohm, then a technical alarm
is generated
§ If the black electrode becomes loose, then a technical alarm is only generated
when monitoring is performed using 3 electrodes (menu option)
§ Monitoring can be performed using two electrodes in „electrically clean“
environments
§ Open-lead detection is activated after power-on once plausible signals are
detected. If no cable is connected upon power-on, a remainder tone is generated every 20s until plausible signals are received
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VitaGuard
®
VG 3100
Pulse Oximeter
§ Sufficient supply of all organs and tissueswith oxygen is vital for survival. Death
can occur within minutes if this supply line is broken or damaged. Therefore, it is very important to detect disturbances in the O2supply as fast as possible.
§ Haemoglobin (Hb) in the blood is responsible for approx. 98% of the oxygen
transport within the body. O2attaches to the haemoglobin and changes the light spectrum –the colour of the blood saturated with oxygen turns bright red.Once the oxygen is deposited within the tissue cells, the colour of the blood changes back to dark red.
§ A pulse oximetermeasures these colour changes and, using appropriate
algorithms and calibration tables,determines the oxygen saturation.
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VitaGuard
®
VG 3100
Pulse Oximeter
§ The haemoglobin (Hb) in the blood acts like an optical filter. If one shines white
light through the hand, red light is seen on the other side. Theoptical haemoglobin filter absorbs all other spectral components of the white light and allows only the
red light to pass through.
Whitelight
filtered(red) light
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VitaGuard
®
Oxygen Saturation
VG 3100
§ VitaGuard®displays the functional oxygen saturation SpO
HbO
SaO lefunktionel
SaO lefraktionel
O2Hb = Oxyhaemoglobin MetHb= Methaemoglobin Hb = reduced Haemoglobin COHb = Carboxyhaemoglobin
2
2
frac
func
=
=
2
HbHbO
2
2
+
=
2
SpO
HbO
2
+++
2
COHbMetHbHbHbO
§ The „p“ in SpO2relates to the fact that the measurement is performed
using a pulse oximeter
§ The functional oxygen saturation is always slightly greater than the
fractional saturatione.g. SaO2
of 98% » SaO2
func
of approx. 96%
frac
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VitaGuard
Oxygen Saturation -MasimoSET Technology
§ DST -Discrete Saturation Transform:
§ DST outputs a function with at least on maximum
§ Noise signals result mostly from venous blood
which has a lower SpO2value than arterial blood
§ The peak with the highest SpO2value, i.e. the
®
VG 3100
Conventional
value
right-hand peak, is always the arterial SpO
§ DST needs a lot of computing power
§ DST operates well with small and/or corrupted
signal e.g. low perfusion or movement artefacts
§ DST does not need a „good“ start-up value as
reference
2
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VitaGuard
®
VG 3100
Oxygen Saturation and Plethysmograph
§ An oxygen saturation value is calculated every 0.4s
§ The displayed value is an average over the time selected by the user (between 4s
and 16s)
§ When 4s or 6s are selected, the displayed SpO2is practically beat-to-beat.
Masimo‘s FastSAT® -Algorithm is automaticallyactivated in this case
§ Average values for SpO2over fixed intervals of 1 minute, 1, 6 and 12 hours are
displayed in the INFO windows
§ Furthermore, the monitor has a user selectable average interval for deviation
alarms. This average and the current deviation are also displayed in the INFO windows
§ The displayed plethysmographis an auto-scaled signal derived from the infra-red
signal
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VitaGuard
®
VG 3100
Pulse Rate and Signal IQ
§ The displayed pulse rate is an average calculated over a selectable time (between
4s and 16s in steps of 2s)
§ When 4s or 6s are selected, the displayed pulse rate is practically beat-to-beat
§ Average values for pulse rate over fixed intervals of 1 minute, 1, 6 and 12 hours
are displayed in the INFO windows
§ Furthermore, the monitor has a user selectable average interval for deviation
alarms. This average and the current deviation are also displayed in the INFO windows
§ When a pulse is detected, a „Signal IQ“ value is simultaneously generated. This is
displayed as a vertical line on the monitor. The height of the line corresponds with the quality of the signals from the SpO2sensor –the higher the better
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VitaGuard
Perfusion Index
§ The measured light intensity
pulses with each heart beat due to
®
VG 3100
changes in the blood vessel volume
§ Skin, bones, venous and arterial
blood as well as other tissues cause a constant absorption component
§ The perfusion index is the quotient
of the pulsating component (ac) and the constant component (dc)
§ The displayed value varies
between 0% and 20%
Absorption
Arterial Pulse
Arterial Blood
Venous Blood (Constant)
Tissue, bones (Constant)
t
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VitaGuard
®
VG 3100
The Latest MasimoTechnology
§ Averaging times of 4, 6, 8, 10, 12, 14 and 16 seconds
§ When 4s is set, then averaging is between 2s and max. 4s, depending on the
signal quality
§ When 6s is set, then averaging is between 4s and max. 6s, depending on the
signal quality
§ Masimo‘s FastSAT® -Algorithm can be activated if required
§ 3 sensitivity settings: MAXIMUM (for very low signals, perfusion>0,02%),
STANDARD and MINIMUM
§ When the MINIMUM setting is selected, then the APOD-Algorithm (Adaptive
Probe Off Detection) is activated
§ STANDARD is a compromise between MINIMUM and MAXIMUM. MAXIMUM
has the disadvantage that „Probe Off“ detection is less sensitive
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VitaGuard
®
VG 3100
Alarm Priorities (DIN EN 60601-1-8)
Physiological Alarms –Priority = HIGH
§ Physiological alarm messages are displayed with 3 exclamation marks „!!!
§ SpO
2
§ SpO2too low (Hypoxia) (acoustic and optional as silent alarm)
§ SpO2too high (Hyperoxia) (acoustic and optional as silent alarm)
§ Negative deviation (optional as acoustic alarm)
§ Heart rate or pulse rate
§ No ECG signal (Asystolie) (acoustic alarm)
§ Heart rate too low (Bradycardia) (acoustic and optional as silent alarm)
§ Heart rate too high (Tachycardia) (acoustic and optional as silent alarm)
§ Positive deviation (optional as acoustic alarm)
§ Negative deviation (optional as acoustic alarm)
§ Respiration
§ Central apnoea (acoustic and optional as silent alarm)
§ Periodic respiration (optional as silent alarm)
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VitaGuard
®
VG 3100
Alarm Priorities (per prDINEN 60601-1-8)
Technical Alarms -Priority = MEDIUM
§ Technical alarm messages are displayed with 2 exclamation marks „!!
§ General
§ Recharge or replace batteries
§ Check mains adapter (when voltage below 8V or above 10 V)
§ Incorrect alarm limits
§ Hardware failure detected
§ SpO
2
§ No sensor or defective sensor
§ Interference or too much light
§ Cable not connected
§ Pulse search
§ Hardware failure detected
§ Heart Rate and Respiration
§ Electrode loose
§ No cable connected
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VitaGuard
Tone Sequences
§ Tone sequences from DIN EN 60601-1-8
§ Physiological alarms
break
§ 3 short signals, small pause, 2 short signals, long pause, and repeat
®
VG 3100
§ Technical alarms
§ 3 longer signals, long pause, and repeat
break
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VitaGuard
®
VG 3100
Informative Messages
§ Informative messages are displayed in the status box –no acoustic warning:
§ Heart rate is being calculated
§ Internal battery voltage too low
§ SpO2: Low perfusion
§ SpO2: Low signal IQ
§ Heart rate and pulse rate diverge
§ Status ok
§ Remainder signal generated every 20 when no cables connected after power-on
§ All messages displayed in the status box at top of display
§ Description of all messages and possible causes (trouble shooting) listed in the user
manual
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VitaGuard
®
VG 3100
Memory Functionality
§ Alarm data (up to 200 episodes, depending on selected pre-and post alarm times)
§ Trend memory up to 72 hours
§ Full disclosure memory up to 8 hours
§ Compliance protocol
§ ECG, respiration, SpO2, plethysmograph, pulse and heart rate, respiration rate,
basal impedance, perfusion, signal IQ, average values and deviations, status information, settings, AUX inputs
§ 64 MB Compact-Flash memory card
§ Data transfer via USB port
§ Data transfer < 5 minutesfor all episodes and trend
§ All settings can be downloaded from PC
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VitaGuard
®
VG 3100
Episode data, Trend-and Full-Disclose Memory
§ Episode data (200 pieces with a lead time and wrap up in each case of 1 minute)
§ Storage of all signals during the alarm phase and for up to 180 seconds before and
250 seconds after (user setting)
§ Date and time of alarm
§ All settings at time of alarmandMeasurement values during alarm
§ Trend storage
§ Continual storage up to 72 hours
§ Sampling rate = 1s
§ Heart rate, basal impedance, SpO2, pulse rate, signal IQ, perfusion, status information,
settings
§ Used to determine changes in physiological parameters over a number of days e.g. effects
of medication
§ Full disclosure storage
§ Continual storage of ALL signals up to 8 hours
§ Screening tool e.g. before discharging patient from hospital
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VitaGuard
®
VG 3100
Data tranfser/ Possible uses
§ Data transfer via modem
§ Telephone number and e-mail address stored in monitor (download via VitaWin®3)
§ Online capabilities
§ Changes of the settings over the Web Browser
§ Further possibilities
§ Interval memory e.g. data storage and transfer every hour
§ Data transfer after an alarm
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VitaGuard
®
VG 3100
Further Improvements (I)
§ Extended alarm settings e.g. deviation alarms optional
§ Extended storage capabilities(trend and full-disclosure)
§ More data types ® pulse and heart rate seperat, respiration rate, perfusion, signal
IQ, averages, status, settings, AUX 1&2
§ Improved user interface
§ LCD brightness and contrast settings
§ Language selection, including Turkish
§ Improved user manual
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VitaGuard
Further Improvements (II)
§ Rechargeable battery pack
§ Lighter and more robust power adapter
§ Protected Masimoconnector
§ Improved packaging
§ 2 extra analogue inputs (AUX 1&2)
§ AUX 1: Range 0-2,5 V, 1 Hz, 12 Bit
®
VG 3100
§ AUX 2: Range 0-2,5 V, 32 Hz, 8 Bit
§ Faster data transfer via USB
§ Online output capabilities
§ Data transfer via modem
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§ Telemedicine
VitaGuard
Telemedicine
®
VG 3100
Data transfervia:
ISDN,
analog,
GSM,
Internet
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Connectors:
VitaGuard
Connectors
®
VG 3100
§ MasimoPatient cable for SpO2
sensor
§ BF (body floating) input with
defibrillator protection
§ This opening is not an input !!
§ Opening for safety warn tone
generator
§ Patient cable for ECG and
respiration electrodes
§ CF (cardio floating) input with
defibrillator protection
§ USB connector
§ Interface for VitaWin®3
§ Power adapter NA 3000-2
§ Car Adapter NAK 3000-2
§ 9 Volt DC input
§ RS232 connections for an external
modem
§ 2 analogue inputs
§ Connection for an external alarm
unit
§ Connection for a nurse call unit
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VitaGuard
Device Label Symbols
§ CEmarkper MDD93/42/EWG
§ 0197 = TÜV Rheinland
§ Possible danger if user manual not read and not
®
VG 3100
adhered to
§ Symbol to read the user manual
§ Year of manufacture of device
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VitaGuard
Rechargeable Battery Pack
§ Battery pack is recharged when
external power adapter connected to monitor
§ Green LED lights permanently during
charge-up phase
§ Green LED flashes when battery pack
completely charged (trickle charge to
®
VG 3100
maintain full capacity)
§ NiMH, 4,8V / 2000mAh
§ Operation at least 8 hours
§ Battery pack can be removed if
discharged. Normal LR6 batteries can be used instead
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VitaGuard
Battery Pack / Standard Batteries
§ Remove the battery pack and insert standard LR6 cells instead, if battery pack
discharged and no mains power source available
®
VG 3100
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VitaGuard
®
VG 3100
Controls
§ Large LCD display with high resolution. Backlight activated whenpower adapter
connected
§ 5 LED:
§ Respiration
§ Heart rate
§ Charging
§ Power adapter
§ Alarm
§ 6 keys
§ 4 arrow keys
§ On/Off andEnter
§ Audio pausedandEsc
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VitaGuard
®
VG 3100
DIN EN ISO18778 Infant Monitors
Availability of settings:
§ VitaGuard®implements three protection modes to avoid unwanted changing ofparameters:
§ Settings protection „On“
§ In this case, only 3 displays available to the user:
System, Info und View 1
§ It is not possible to change any alarm settings
§ No waveforms are displayed
§ Settings protection „LIMITED“
§ All displays available
§ Only alarm limits for apnea, heart rate und SpO2can be changed
§ Settings protection „OFF“
§ All displays available, all settings can be changed
§ Caution! If using the operating mode clinic, the protection modestays active even after the
monitor has been switched off.
CODE 0000 (00)
CODE 0009 (09)
CODE 0089 (89)
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§ Status box
VitaGuard
Monitor-Display Status Box
§ Text messages
®
VG 3100
§ External power adapter
§ Battery indicator
§ Acoustic alarm symbol
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VitaGuard
Monitor-Display Menu: System
§ System (Settings protection )
CODE 0000 CODE 0009 CODE 0089
®
VG 3100
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§ Info
VitaGuard
Monitor-Display Menu: Info
®
VG 3100
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§ Info
VitaGuard
Monitor-Display Menu: Info
®
VG 3100
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§ View 1
VitaGuard
®
VG 3100
Monitor-Display View1
§ Name/ Unit
§ Name/ Unit
§ ECG amplitude
§ Actual pulse rate
§ Name/ Unit
§ Amplitude
§ Basal impedance
§ Animation
§ Actual value / SpO
§ Alarm limits/ SpO
§ Actual heart rate
§ Alarm limits / heart rate
§ Alarm limit
§ Actual respiration rate
2
2
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§ View 2
VitaGuard
®
VG 3100
Monitor-Display View2
§ Name/ Unit
§ Plethysmograph
§ Name/ Unit
§ ECG
§ Actual pulse rate
§ Name/ Unit
§ Respiration signal
§ Animation
§ Actual value / SpO
§ Alarm limits/ SpO
§ Actual heart rate
§ Alarm limits / heart rate
§ Alarm limit
§ Actual respiration rate
2
2
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§ View3
VitaGuard
Monitor-Display View3
®
VG 3100
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VitaGuard
Monitor-Display Manual Storage
§ From views 1, 2 and 3 an episode can be stored manually by pressing the
„arrow up“ key and selecting the option. The length of the episode corresponds to the selectedpre and post alarm intervals
®
VG 3100
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VitaGuard
®
VG 3100
Monitor-Display SpO
§ SpO
§ All settings can be changed
only available when settings protection set to LIMITED or OFF“
2 ,
2
CODE 0009 CODE 0089
or or
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VitaGuard
®
VG 3100
Monitor-Display Heart Rate
§ Heart rate, when settings protection set to LIMITED or OFF
§ All settings can be changed
CODE 0009 CODE 0089
or or
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VitaGuard
®
VG 3100
Monitor-Display Respiration
§ Respiration, when settings protection set to LIMITED or OFF
§ All settings can be changed
bei CODE 0009 bei CODE 0089
or or
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VitaGuard
Monitor-Display Alarms
§ View stored alarm events on monitor display
®
VG 3100
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§ Trend data
VitaGuard
Monitor-Display Trend
®
VG 3100
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Thank you for your attention!
Oderstr. 77 14513 Teltow
Tel.: +49 3328 3942–0 Fax: +49 3328 3942–99 Web: www.getemed.de Email: info@getemed.de
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VitaGuard
®
VG 3100
Periodic Respiration
§ Definition
§ 3 parameters can be set:
§ Per. T1 (Pause). The apneaphase must be longer than T1, but shorter than the
set apneaalarm delay
§ Per. T2 (Resp.). The respiration phase must be shorter than T2, otherwise the
periodic respiration phase is ended
§ Number of Periods. When the set number of periods has been detected, the
condition is said to exist. A silent alarm will be started
Firstperiod
Secondperiod
Thirdperiod
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VitaGuard
®
VG 3100
FastSAT®Algorithm
FastSAT®Algorithm
§ If the signal quality is good, then only the most recent values for SpO2are used to
build the current value. In this case, the displayed SpO2is practically a beat-to-beat value.
§ This algorithm makes it possible to follow sudden desaturation phases
§ If the signal quality is bad, then the value displayed is built over the complete
averaging time set on the monitor (e.g. 8s)
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