Our company owns all rights to this unpublished work and intends to maintain this work as
confidential. We may also seek to maintain this work as an unpublished copyright. This
publication is to be used solely for the purposes of reference, operation, maintenance, or
repair of our equipment. No part of this can be disseminated for other purposes.
In the event of inadvertent or deliberate publication, our company intends to enforce its
rights to this work under copyright laws as a published work. Those having access to this
work may not copy, use, or disclose the information in this work unless expressly
authorized by us to do so.
All information contained in this publication is believed to be correct. Our company shall
not be liable for errors contained herein nor for incidental or consequential damages in
connection with the furnishing, performance, or use of this material. This publication may
refer to information and protected by copyrights or patents and does not convey any
license under the patent rights of our company, nor the rights of others. Our company does
not assume any liability arising out of any infringements of patents or other rights of third
parties.
Content of this manual is subject to change without prior notice.
Responsibility on the manufacturer party
Our company is responsible for safety, reliability and performance of this equipment only in
the conditions that:
All installation, expansion, change, modification and repair of this equipment are
conducted by our qualified personnel; and,
Applied electrical appliance is in compliance with relevant National Standards; and,
The monitor is operated under strict observance of this manual.
WARNING
This monitor is not a device for treatment purpose.
NOTE:
This equipment is not intended for family usage.
It is important for the hospital or organization that employs this equipment to carry out a
reasonable maintenance schedule. Neglect of this may result in machine breakdown or
injury of human health.
Page 3
- 3 -
Upon request, our company may provide, with compensation, necessary circuit diagrams,
calibration illustration list and other information to help qualified technician to maintain
and repair some parts, which our company may define as user serviceable.
Page 4
- 4 -
Warranty
Workmanship & Materials
Our company guarantees new equipment other than accessories to be free from defects in
workmanship and materials for a period of 18 months (six months for multi-site probes and
SpO
sensor) from date of shipment under normal use and service. Our company's
2
obligation under this warranty is limited to repairing only.
THIS WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESSED OR
IMPLIED, INCLUDING WARRANTIES OF MERCHANT ABILITY OR FITNESS FOR ANY
PAR T I C U LAR PURPOSE.
Exemptions
Our company's obligation or liability under this warranty does not include any
transportation or other charges or liability for direct, indirect or consequential damages or
delay resulting from the improper use or application of parts or accessories of the product
or the substitution upon it not approved by us or repaired by anyone other than a our
company authorized personal. This warranty shall not extend to any instrument which has
been subjected to abnormal use, maintenance negligence or damaged; any instrument
from which our company's original serial number tag or product identification markings
have been altered or removed, or any product of any other manufacturer.
Safety, Reliability and Performance
Our company is not responsible for the effects on safety, reliability and performance of the
Monitor if:
The components are disassembled, stretched or re-adjusted.
The Monitor is not used in accordance with the instructions for use, or the electrical
installation of the relevant room does not comply with NFPA 70: National Electrical
Code or NFPA 99: Standard for Health Care Facilities (Outside the United States, the
relevant room must comply with all electrical installation regulations mandated by
the local and regional bodies of government).
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Return Policy
Return Procedure
In the event that it becomes necessary to return a unit to our company, the following
procedure should be followed:
Obtain return authorization. Contact our Service Department and tell us the product
serial number. The number is marked on the outside of the shipping package. Return
shipments would not be accepted if the number is not clearly visible. Please provide
the model number, serial number, and a brief description of the reason for return.
Freight policy. The customer is responsible for freight charges when equipment is
shipped to our company for service (this includes customs charges).
Preface
This manual gives detailed description to the Monitor concerning its performance,
operation, and other safety information. Please read the user manual carefully before use
in order to operate this product correctly and guarantee the safety of patient and operator.
Keep the user manual near the product for convenient and timely accessed when needed.
Following symbols represent some important facts that you have to pay special attention
to:
Safety warnings indicate the severity of potential hazards.
Warning: prompting potential dangerous or unsafe operations, if not avoided, it may result
in death or severe personal injury or property damage.
Caution: prompting potential dangerous or unsafe operations, if not avoided, it may result
in slight personal injury, product failure or damage, or property damage.
Note: emphasizing important attentions, providing explanations or interpretations for
better use.
NOTE:
The user manual contains descriptions concerning all configurations, so part of the
content may not suitable for the product your purchased. If you have any doubts,
please contact with us.
Refer to the device for its date of manufacture .
Service life
:Valid for 5 years from the date of production.
This manual is intended for persons who are familiar with the functioning measurements
and have experience in operating the monitoring equipment.
19.1 Alarm and Measurement Default Settings ........................................... 110
Appendix A Product Specification .......................................................................... 114
Appendix B System Alarm Prompt ......................................................................... 122
Appendix C Abbreviations ...................................................................................... 127
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Chapter 1 Safety
1.1 Safety information
WARNING
Before using the device, the equipment, patient cable and electrodes etc.
should be checked. Replacement should be taken if there is any evident
defect or signs of aging which may impair the safety or performance.
The Monitor is intended for clinical monitoring application with operation
only granted to appropriate medical staff.
The monitor can be used on only one patient at a time.
EXPLOSION HAZARD-Do not use the device in a flammable atmosphere
where concentrations of flammable anesthetics or other materials may occur.
There could be hazard of electrical shock by opening the monitor casing. All
servicing and future upgrading to this equipment must be carried out by
personnel trained and authorized by our company.
To prevent delayed treatment, sufficient alarm setup should be done
according to individual patient situation and make sure that alarm sound can
be activated when alarm occurs.
Do not touch the patient, table, or the device during defibrillation.
The device is available to connecting with the patient who using cardiac
pacemaker or other electrical stimulation devices, but this may result in risks.
When used with Electro-surgery equipment, the operator (doctor or nurse)
must give top priority to the patient safety.
The monitor and devices connected to it shall form an equipotential system
(protective earthing).
If the protective earthing system is unstable, the monitor should apply
internal power supply.
This device can only be connected to a power socket with protective earthing.
If the power socket is not grounded, do not use the socket and the monitor
should be power supplied by rechargeable batteries. Do not connect the
three-wire cable to a second-wire plug.
The information of physiological waveform, physiological parameters and
alarm, etc., shown on the monitor is for medical reference only, it can not be
regarded as the basis for clinical treatment directly.
Be careful to place the power cord and various cables of accessories to avoid
the patient being wound or suffocated, or the cable entangled together, or
subject to electrical interference.
The disposal of packaging materials should obey the local regulations or the
hospital waste disposal system. The packaging material must be keep out of
the reach of children.
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2
CAUTION
At the end of its service life, the product described in this manual, as well as
its accessories, must be disposed in compliance with related local regulations
or hospital regulations. If you have questions concerning disposal of the
product, please contact our company or representative institution.
When you have questions about the integrity of the external grounding of the
monitor and its arrangement, the internal battery must be used for operation.
Electromagnetic fields can affect the performance of the monitor, so other
equipment used near the monitor must meet the appropriate EMC
requirements. Mobile phones, X-rays, or MRI devices are possible sources of
interference because they could emit high-intensity electromagnetic
radiation.
Before turning on the power to the device, make sure that the supply voltage
and frequency match the device's label or the requirements specified in this
manual.
When the battery is about to exceed its service life, remove the battery
immediately from the monitor.
To ensure patient safety, please use the accessories specified in this manual.
NOTE:
Install the equipment in a location that is easy to observe, operate and
maintain.
If the monitor gets damp accidentally, or the liquid is dumped on the
equipment or accessories, especially if the liquid is likely to enter the monitor,
please contact the service personnel in time.
The software is developed in accordance with IEC62304. The possibility of
risks caused by program error has been minimized.
The pictures and interfaces in this manual are for reference only, please in
kind prevail.
1.2 Precautionary measures
In order to avoid the accumulation of electrostatic charge, it is recommended
to store, maintain and use the equipment at a relative humidity of 30% or more.
The floor should be covered with ESD dissipated carpets or similar materials. In
the use of the components, non-synthetic clothing should be wore.
In order to prevent electrostatic discharging to the ESD-sensitive parts of the
device, the personnel should contact the metal frame of the components or the
large metal objects near the device. When using the device, especially when it
is possible to contact the ESD-sensitive parts of the device, the operator should
wear a grounded bracelet designed for ESD-sensitive devices. For more
information on proper use, please refer to the instructions provided with the
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3
bracelet.
ESD Precautionary procedure training
All potential users are advised to understand the ESD warning symbols and
receive training on ESD precautions.
The most basic content of the ESD precautionary procedure training should
include an introduction to electrostatic charge physics, voltage level in the
conventional case, and damage to the electronic components when the
operator with electrostatic charge contacts them. In addition, the methods for
preventing electrostatic buildup, and the manner and reasons for the release of
human body static electricity to the ground or equipment frame or the use of a
bracelet to connect the human body to the equipment or the ground before
establishing the connection should be described.
1.3 Symbols
Your device may not contain all the following symbols.
Caution: read instructions (warnings) carefully
Follow instructions for use
Alternating current
Direct current
Standby
Manufacturer
Expiration date
This way up
USB port
Fragile, handle with care
Equipotentiality
P/NPart number
Keep in a cool, dry place
Stacking layers limit
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4
Authorized representative
community
Lot number
Date of manufacture
Accesso a Internet
Batteria
Product code
Defibrillation-proof type BF applied part.
Defibrillation-proof type CF applied part.
Atmospheric pressure
limit
Temperature limit
Humidity limit
in the European
Page 14
5
Chapter 2 General
2.1 Introduction
Structure and composing: main unit, accessories (ECG lead cables, SpO
sensor, NIBP
2
extension tube, NIBP cuff, TEMP probe, etc.) and power cord.
The monitor is applicable for the clinical monitoring of cat, dog and other animals.
Physiological parameters including ECG (including ST-segment measurement and
arrhythmia analysis), RESP, SpO
, PR, NIBP and TEMP, can be monitored. The
2
monitoring information could be displayed, reviewed and printed.
WARNING
The monitor should be used by a qualified clinician or under the guidance of a
professional clinician. Personnel who uses this monitor should be adequately
trained. The personnel without authorized or who are not trained, shall not
carry out any operation.
2.2 Contraindications
No contraindications.
2.3 Main unit
Front view
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6
Off: the monitor is disconnected from AC power supply.
Battery indicator: it displays green and flickers under battery-powered
charged.
may set up system information and perform review operation.
NIBP:Press it to inflate the cuff to start a blood pressure measurement.
When measuring, press it to cancel the measurement and deflate the cu ff.
set in "RT REC TIME" item under "RECORD" menu.
1
11
9
10
2
6
12
3 4 5 7 8
AC indicator:
1
On: the monitor is connected to AC power supply;
2
3
4
5
6
condition, it always displays orange in charging state and green after fully
MENU:Press this button to call up the SYSTEM MENU, in which the user
REC/STOP:Press it to start a real time recording. The recording time can be
SILENCE:Push this button to suspend the alarm (with 1 minute and 2
minutes selectable), and a
this button for more than 1 second to mute all kinds of sounds (including
symbol appears in the alarm area. Push
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7
MAIN:Whatever levels of menu the system is in, press the button and the
system will always return to the main screen.
Rotary knob
n operations, such as
entering a menu or processing a command.
ON/OFF
turn off the moni t o r.
y different color and flicking
frequency
12
alarm sound, heart beat, pulse tone, key sound). At the same time, a
symbol appears. Push this button again to restore all kinds of sounds and
the symbol disappears from the screen.
7 FREEZE:Freeze or unfreeze the waveform
8
9
10
Rotating: clockwise or counter-clockwise rotating to move the cursor
Pressing: press the knob to execute certai
ON: press this button to turn on the monitor
OFF: in turning on state, keep pressing this button for 3 seconds can
11 Alarm indicator: indicating alarm level b
handle
Side view
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8
10
1 T1: Socket for channel 1 TEMP probe
2 SpO2: Socket for SpO2 sensor
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9
IBP/CO2: IBP or CO2
interface
Note: [6] and [7] can not be
connection is recognized.
interface
Network interface: standard RJ45 interface, connecting with the central
monitoring system of our company by network cable
Equipotential grounding terminal: when the monitor is used together with
other equipment, use a cable to connect other equipment to the
equipotential terminal of the monitor, which eliminates the ground
2
4
3
1
3 ECG: Socket for ECG cable
4 NIBP: Socket for NIBP cuff
5 T2: Socket for channel 2 TEMP probe
6
7
IBP/CO2: IBP or CO2
8 Option: reserved interface
9 Battery cover
10 Recorder
Rear view
connected to a function at the same
time; if connected, only the earlier
1
2 USB port: connecting with external memory devices
3
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10
5
potential difference between the different devices to ensure safety.
4 AC power port. Fuse: T1.6AL250V
NOTE:
Replacement of fuse: unplug the power cord, then disassemble the screws by
using tools.
The network interface can only connect with the central monitoring system of
our company to form a network monitoring system.
2.4 Display
The monitor adopts high resolution color TFT LCD screen, which clearly displays
all physiological parameters and waveforms of the patient. The following figure is a
standard interface in normal monitoring state.
1
7
6
1.Battery indicator
The battery works normally, the solid part represents battery level.
Battery is low, it needs to be charged immediately, and the monitor
generates low battery alarm.
2
3
4
The monitor does not contain internal battery.
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11
2.Technical alarm area
Displaying technical alarms and prompt messages, cycle display for multiple
pieces of information.
3.Physiological alarm area
Displaying physiological alarms, cycle display for multiple pieces of information.
4.Parameter area
Consisting of several individual areas, displaying the measured value
corresponding to each parameter module. The name of an individual parameter is on
the top left of its area.
5.Patient information area
BED NO.9: Bed number of patient under monitoring
Other: Patient type, three options: Cat, Dog or Other.
M Patient sex, Male or Female.
BLOOD:A Patient blood type.
CUFF L: The cuff applied on the patient (set up in NIBP SETUP menu).
6.Date and Time Indicating current date and time, available to calibrated if necessary.
7.Waveform area
Mainly displaying the waveform of physiological parameters, the name of each
waveform is on the top left.ECG lead is selectable according to the demand. The filter
mode is displayed at the top of screen. Gain of each channel is displayed above its
waveform, at the right side of the waveform, there is a scale of one millivolt.
When a menu pops up in the interface, it always locates a fixed area in the middle of
the waveform area, which will cover parts of the waveform, while the waveform will
appear after exit the menu.The waveform is refreshed at a certain speed, the speed
adjustment please refer to the setup of each parameter.
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Chapter 3 Installation
The portable monitor is designed to comply with relevant safety requirements of IEC
60601-1, IEC 60601-2-27 and IEC 80601-2-30 for medical electrical equipment. The
system has a floating input for defibrillation proof and electrosurgical knife
protection. If the correct electrodes (see the section about ECG Monitoring) are used
and placed according to the manufacturer's instructions, the display will be restored
within 5 seconds after defibrillation.
WARNING
If any sign of damage to the monitor function is detected, or an error message
appears, do not use it on any patient. Contact biomedical engineer in the
hospital or our maintenance engineer immediately.
All analog and digital equipment connected to this device must be certified by
specified IEC standards (e.g. IEC 60950 and IEC 60601-1), and all equipment
shall comply with the requirements of IEC 60601-1-1 (valid versions) for
connection. The person who connects the additional equipment to the
input/output port, is responsible for the compliance with the IEC 60601-1-1
standard. If you have any questions, please contact us.
When this device is connected to other electrical equipment in order to
achieve a specific function, if the hazards of this combination can not be
determined from the specifications of each equipment (for example, the risk
of electric shock due to the accumulation of leakage current), please contact
our company or experts in the hospital related this field to ensure that the
necessary safety of all equipment in this combination will not be damaged.
Please use our designated bracket (optional). When installing the bracket,
please avoid the screws to touch the circuit board inside the machine.
NOTE:
To ensure the monitor works normally, please read this chapter and the
content about patient safety before use, and follow the requirements for
installation.
If the monitor finds any fatal error during self-test, it will alarm.
Keep the package and packing materials for possible future transportation or
storage.
3.1 Open the Package and Check
Before opening the package, please check it carefully. If any damage is found, please
contact the carrier immediately.
Open the package and take out the monitor and accessories carefully. Check the
components according to the packing list to see whether the device has any
mechanical damage or any part is missing. If there is any problem, contact the our
company immediately.
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WARNING
The disposal of packaging materials should obey the local regulations or the
hospital waste disposal system. The packaging material must be keep out of
the reach of children.
The device may get biological contaminated during storage, transport or use.
Please confirm that the package is intact before use, especially the disposable
accessories. If any damage is found, please don't put is into use.
NOTE:
Keep the package and packing materials for possible future transportation or
storage.
3.2 Environmental requirement
Please obey the following instructions to ensure the safety of electrical installation.
The environment for potable monitor using shall properly away from vibration, dust,
corrosive or flammable gas, extreme temperature or humidity and so on. When it is
installed in a cabinet, there should be enough space in front of the device for
convenient operation. When the door of the cabinet is opening, enough space at the
back of the device should be guaranteed for convenient maintenance. Allow at least
2 inches (5 cm) of space around the instrument to ensure air circulation.
WARNING
The environment for use, storage and transport should meets the
requirements described in this manual, otherwise the specifications of this
product stated in this manual may not be able to achieved, or even cause
damage to the device.
Make sure that the device is free from condensation during working, when it is
carried from one room to another room, condensation may appears. This is because
it is exposed under humid air with different temperatures.
3.3 Install the Monitor
If everything goes well, please place the monitor on a flat surface or fix it on the wall.
The installation of wall bracket please refer to its instructions.
3.3.1 Place on a Flat Surface
Place the monitor on a flat surface. The surface should be away from vibration, dust
or corrosive drugs.
3.4 Connect the Power Cables
Please use the power cord equipped for the monitor. Plug the power cord to the
power port on the monitor, and another end to a grounded three-core power socket.
If the monitor is equipped with an adopter, plug one end of the adopter to the power
port on the monitor, and another end to a grounded three-core power socket.
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14
NOTE:
Plug the power cord to the hospital outlet. If necessary, connect it with the
equipotential ground wire.
When the device is equipped with battery, it must be charged after transport
or storage. If turn on the device directly without connecting with AC power
supply, it may not work normally due to lack of electricity. The device can be
charged after connecting with the AC power no matter it is turned on or not.
Ground
In order to protect patients and medical personnel, the enclosure of portable
monitor must be grounded. Therefore, the portable monitor is equipped with a
removable three-wire cable, when it is inserted into a matching three-wire socket,
the device will be grounded through the ground wire in the power cord. If there is no
three-wire socket, consult the hospital's electrical management staff.
WARNING
Do not insert the three-core wire into a two-core socket.
Connect the equipotential grounding terminal on the device to the grounding wire. If
the hazards of a specific combination can not be determined from the specifications
of each equipment (for example, the hazard caused by accumulation of leakage
current), please contact the manufacturer or experts related this field to ensure that
the necessary safety of all equipment in this combination will not be damaged.
Equipotential ground
The room protective grounding system is realized by power plugs grounding, it
already includes the primary protection of the device. For internal examination of the
heart or brain, the portable monitoring system must be individually connected to the
equipotential grounding system. One end of the equipotential grounding wire
(potential equalization wire) is connected to the equipotential grounding terminal on
the rear panel of the device and the other end is connected to a connector of the
equipotential system. If the protective grounding system is damaged, the
equipotential grounding system undertakes the safety function of protecting the
grounding wire. The examination of the heart (or brain) should only be carried out in
a medical room with a protective grounding system. Before each use, check whether
the device is in good working condition. The cable connecting the patient and the
device must be free from electrolyte contamination.
3.5 Power on
3.5.1 Device inspection
1. Appearance inspection
Appearance inspection for the installed monitoring system:
• Carefully check the patient monitor for any mechanical damage.
• make sure the monitor is correctly installed according to the specified
installation program.
• Make sure the cables connecting patient monitor and external equipment are
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15
undamaged, and connected to corresponding interfaces correctly.
• Make sure the external module is connected correctly.
• Make sure the battery cover is installed.
The chapter Maintenance and Cleaning provides detailed information about the
cautions, requirements of cleaning, cleaning procedure and recommended cleaning
agent.
2. Functional inspection
Start
1) Plug the power cord to the AC power port. If the device uses internal
battery for power, please make sure that there is enough battery power
in the battery.
2) Turn on the patient monitor, it should start normally:
• The red and yellow alarm lamp respectively light.
• The system beeps for each time of powering on, and the LED indicator
on control panel or the screen flickers once. If no beep sound or flickering,
please stop using this monitor, and contact out company for maintenance.
• There are no error messages appear on the screen.
3) Check all functions that the patient may need to ensure the device could
work normally.
WARNING
When the monitor is powered on, the system will check whether the alarm
function (audio and light alarms) is normal. If the alarm function works
abnormally, this monitor can not be used for patient monitoring and contact
the manufacturer's maintenance department.
NOTE:
Charge the battery to full for the first time of use. Keep the monitor
connecting with main power supply before the battery is fully charged.
Display
1) Ensure that all text are readable, and all images are clear.
2) Ensure that the device brightness is normal.
Main unit
Check whether the time displayed on screen is correct. If necessary, please
adjust its time and date.
Check the Recorder
If your monitor is equipped with a recorder, open the recorder door to check if
paper is properly installed. If it is out of paper, refer to the chapter Recording for
details.
3.5.2 Start monitoring
1. Check whether the patient cables and sensors are correctly connected.
2. Check whether the settings of the monitor are correct, such as "PAT TYPE"
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16
and "Pacemaker".
3. For the detailed information about the measurement and monitoring of each
parameter, please refer to relevant chapter.
3.6 Power off
Turn off the monitor according to the following steps:
1. Unplug the cables and sensors connecting with the patient.
2. Keep pressing ON/OFF button for 3 seconds to turn off the monitor.
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17
Chapter 4 System Menu
This monitor features flexible configurations. You can customize monitoring content,
waveform sweep speed, sound volume, and output content.Press the MENU button
on the front panel of the monitor, the interface shown in the following figure will
appear:
4.1 Patient Information Setup
Select the "PATIENT SETUP" item in the "SYSTEM MENU", the following patient
information can be set by user:
DEPT.: the department that the patient receives
treatment
PAT NO.: case number of the patient
BED NO.: selectable from 1~100
DOCTOR: name of the attending doctor
NAME: patient's name (Valid characters: a~z, A~Z, 0~9, and
the space, 12 characters can be input at most)
SEX: patient's gender (female, male)
PAT TYPE: Patient type (Available options: CAT, DOG and OTHER)
ADMIT: date of admission (format: year/month/day)
BIRTH: patient date of birth (format: year/month/day)
HEIGHT (cm/inch): patient's height (turning the knob with the
increase/decrease of 0.5 cm/inch each time), the unit
of height in other menus accord with the unit set
here.
WEIGHT (kg/lb): patient's weight (turning the knob with the
increase/decrease of 0.5 kg/lb each time), theunit of
weight in other menus accord with the unit set here.
BLOOD: blood type of the patient ((Available options: A, B, AB,
O, N, "N" means unknownblood type)
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SAVE: to save the changes of patient information,
corresponding information will be displayed in
Patient information area
DELETE: to delete the information of current patient, and to
register a new patient
After clicking the "DELETE" button in this menu, a dialog box "CONFIRM TO DELETE"
will pop up, you could select "YES" or "NO" to decide whether to clear current
patient information.
NOTE:
If you choose "YES", the information of current patient will be deleted.
Please click "SAVE" button if the information of current patient is changed,
otherwise the changes will be invalid.
4.2 Default setup
NOTE:
After selecting any item in this sub-menu, the selected item will replace the
current setup of the system and accordingly become the system default
configuration.
In this sub-menu, you can select both the factory default and the user-defined
default. Also in this sub-menu, you can save the current system configuration as the
user-defined default configuration. But at this time, the system will automatically
save all the setups in the parameter menu, ECG gain and filter way as the
user-defined default configuration according to the patient type. Also, a dialog box
"CONFIRM TO SAVE" will pop up.
Select "YES" to save all configurations of current patient type as user-defined default
configuration.
Select "NO" to give up the modification and the system will keep the previous
configuration.
NOTE:
After selecting any item in the "DEFAU LT" menu and exiting the dialog box,
the "CONFIRM TO SAVE" dialog box will pop up, in which you can select "YES"
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19
to confirm your selection or "NO" to give up your selection.
4.3 Trend Review, Measurement Review and Alarm Event Review
In the "SYSTEM MENU", there are "TREND GRAPH", "TREND TABLE", "NIBP RECALL"
and "ALARM RECALL" items. Please refer to Chapter 8 Recall for detailed information.
4.4 System setup
Select the "SYSTEM SETUP" item in the "SYSTEM MENU", the following menu will
appear:
In the "SYSTEM SETUP" menu, user can set the following items.
4.4.1 Face select
The system provides 5 display modes: "STAND SCREEN", "OxyCRG SCREEN", "TREND
SCREEN", "BIG CHAR" and "VIEWBED SCREEN". You can choose any one of them
according to clinical demand.
Select the "FACE SELECT" item in the "SYSTEM SETUP" menu to enter the following
menu:
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20
1. STAND SCREEN
The "STAND SCREEN" is the default setting. If the current screen is not the standard
screen, you may enter the standard screen by selecting "STANDARD SCREEN" and
then selecting "EXIT" in FACE SELECT menu.
Stand Screen
2. OxyCRG SCREEN
If you want to enter the following interface, select "OxyCRG SCREEN" and then select
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21
"EXIT" in "FACE SELECT" menu.
OxyCRG Screen
OxyCRG screen is located at the lower part of the waveform area, consisting of the
HR trend, the SpO
trend, and the RR (respiration rate) trend or the compressed RESP
2
waveform. Below the RR trend or the compressed RESP waveform is the scale of the
trend time. In addition, three labels are displayed beneath the time scale. The labels
are detailed as below.
①. Trend length
This label allows you to select the time duration of the trend graphs displayed. You can
select either 1 min, 2 min or 4 min.
②. Compressed RESP waveform/RR trend
With this label, you can select to display the compressed respiration waveform or the
RR trend. You can select either RESP WAVE or RR.
③. Recording
You can select the REC label to print out the trend or the waveform displayed in the
oxyCRG screen.
3. TREND SCREEN
If you want to enter the following interface, select "TREND SCREEN" and then select
"EXIT" in "FACE SELECT" menu.
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Trend Screen
Trend graph
In the waveform area, the trend graph is located on the right side of the corresponding
waveform, displaying the trends of one parameter of each module. The parameter
labels, as well as their scales, are displayed on the left of the trend graph.
Trend length
The trend length, located below the trend graph, is 2 hours. In the trend graph, the
scale reading at the right end of X-axis is 0 hour, the reading at the left end is -2
hours.
Selecting a trend parameter
If a module has multiple trend parameters, you can select one from the parameter
label options of the corresponding trend graph. The trend graph of the selected
parameter will be displayed. For example, in the ECG trend graph, you can select
either from the parameter label options: HR, ST, PVCs.
4. BIG CHAR
To view the parameter more clearly in a long distance.
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Big Char
5. VIEWBED SCREEN
This monitor can display one parameter waveform and all measured data from
another patient monitor in the same monitoring network system. To enter the
following screen, open "FACE SELECT" menu, select "VIEWBED SCREEN" item, and
then select "EXIT".
Viewbed Screen
The monitor that used to view the situations of other monitors, is called "host
monitor". The monitor being viewed is called "viewbed monitor". The viewbed
screen is always displayed at the lower part of the host monitor’s waveform area. It
consists of the following parts.
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① Viewbed monitor label
The viewbed monitor label allows you to select the viewbed monitor you want to
view. It displays the bed number and patient's name of the viewbed monitor.
② Viewbed parameter area
All parameter data of the viewbed monitor is displayed in this area.
③ Viewbed waveform label
The viewbed waveform label allows you to select a waveform of the viewbed
monitor.
④ Viewbed waveform area
The viewbed waveform area is located beneath the viewbed waveform label. It
displays the waveform selected through the viewbed waveform label. The scanning
speed is 25 mm/s. In addition, information relating to the viewbed waveform is
shown above the waveform.
4.4.2 Wave setup
1. Select "WAVE SETUP" item in the "SYSTEM SETUP" menu.
2. Adjust the wave type of a channel, the wave corresponding to this channel in
the main interface will change accordingly.
4.4.3 Wave select
1. Select "WAVE SELECT" item in the "SYSTEM SETUP" menu.
2. The waveform in waveform area will show up or disappear accordingly by selecting
corresponding parameter or canceling the selection. The parameter in gray is
unadjustable.
3. If "FULL ECG" is selected, the full-lead ECG waveform will be displayed in the
waveform area in one screen, if "STEP ECG" is selected, the step ECG waveform
will be displayed in the waveform area.
NOTE:
"FULL ECG" and "STEP ECG" are set off as default, and these two functions
can not be turned on at the same time.
4.4.4 Parameter setup
1. Select "PARAM SETUP" item in the "SYSTEM SETUP" menu.
2. You can set the font color in parameter area and the color of waveform. The
color of parameter value activating the alarm is red.
4.4.5 Parameter select
1. Select "PARAM SELECT" item in the "SYSTEM SETUP" menu.
2. The waveform and parameter will show up or disappear accordingly by selecting
corresponding parameter or canceling the selection.
4.4.6 Time setup
1. Select "TIME SETUP" item in the "SYSTEM SETUP" menu.
2. You can set the "Date" and "Time" items. Use cursor to highlight the item that
you want to modify and turn the knob to select time.
3. Then select "SAVE SET" button.
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NOTE:
The system time shall be set when turning on the monitor (if you need to set
the system time); otherwise, when you review the content containing time
information, the system may not display the correct time.
4.4.7 Alarm setup
Please refer to the sections about "Alarm".
4.4.8 Record setup
Select the "RECORD" item in the "SYSTEM SETUP" menu to pop up the following
menu:
REC WAVE1 /REC WAVE2: The recorder could output up to 2 channels of
waveform at a time. You can select the name of the waveform at the right
column for "REC WAVE1" and "REC WAVE 2". If you select "OFF", the waveform
in this channel will not be output. These settings is applicable for real-time
recording and timing recording.
RT REC TIME: This item has two options, CONTINUAL and 8 s. "CONTINUAL"
means once pushing the "REC/STOP" button on the recorder module or the
monitor panel, the recorder will continuously print out the waveform or
parameter until this button is pushed again.
TIMING REC TIME: It represents the time interval between two recordings. Ten
selections are available: "OFF, 10min, 20min, 30min, 40min, 50min, 1HOUR,
2HOURS, 3HOURS and 4HOURS". The system will start the recording process
according to the selected time interval. The recording time is always 8 seconds.
REC RATE: This item has two options, 25.0mm/s and 50.0 mm/s.
REC GRID: It is used to determine output format: OFF is without grid, and ON is
with grid.
CLEAR REC TASK: When too many recording tasks existing, you can use this
function to clear the alarm event that has been generated and is waiting for
outputing.
NOTE:
The setup of "RT REC TIME" takes priority over the "TIMING RECTIMING".
The recorder is a optional component.
If two same waveforms are selected, the system will automatically change
one of the waveform to a different one.
4.4.9 Event setup
In the process of monitoring a patient, the occurrence of some events may have
impacts on the patient, resulting in some changes on the waveform or parameters.
To analyse these effects, you can manually mark some specific events. The event will
be displayed on the trend graph and trend table to assist the analysis of patient's
parameters at the time of the event.
The monitor has four types of events. You can specify their representations by
Select the "MARK EVENT" item in the "SYSTEM SETUP" to modify the events.
How to mark the event:
1. Use the rotary knob to select one from event A, B, C and D.
2. The @ symbol will appear in the front of the event being selected.
3. Once making a wrong selection, you can push the knob on the event again to
give up the selection. Select "EXIT" to exit the menu and consequently the selection
will come into effect.
4.4.10 SD operate
Please refer to the chapter related to SD Recall.
4.5 Machine version
Select the "VERSION" item in the "SYSTEM MENU". In the popping up menu, you can
learn the software version of the monitor.
Naming
standard
4.6 Drug calculation
You can use the drug calculation and titration table function of the monitor to
calculate the concentration of 15 kinds of drugs. Refer to the Chapter Drug Calculation and Titration Table for detailed information.
4.7 Maintain
4.7.1 User maintain
1. You need to select the "MAINTAIN" item in the "SYSTEM MENU", then select
"USER KEY".
2. Input the password to enter the user maintain menu, then you can customize
the maintenance settings. Items shown as below can be set:
LANGUAGE: select the language you need
LEAD NAMING: AHA or EURO
HELP SETUP: ON/OFF
NIBP OBSTRUCT SETUP: 1/2/3/4
This function is used to detect whether the patient moves during the blood
pressure measurement. If the patient moves, the monitor will give an alarm message
and stop the current measuring, or the measurement will be taken as usual.
1) This function is set "1" as default.
2) "1" represents the sensitivity is reduced to the minimum, "4" represents
the sensitivity is increased to the maximum. The higher level the sensitivity is
set and the easier to detect the interference of movement.
"NETWORK CONFIGURATION": see Section 4.7.3 Network Configuration for
details
ALARM SET PASSWORD MODIFICATION: it is used to change the login password
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of "ALARM SETUP".
4.7.2 Factory maintain
1. You need to select the "MAINTAIN" item in the "SYSTEM MENU", then select
"FACTORY KEY".
2. Input the password to enter the factory maintain menu, this function is available
for specific maintenance personnel of our company only.
4.7.3 NET CONFIG
Click "NIT CONFIG" item, the following menu will pop up:
NET TYPE: CMS / CUSTOM
CMS:the Server IP is fixed, "202.114.4.119","LOCAL IP CONFIG" is unavailable.
CUSTOM:when this item is selected, CMS and machine's IP can be changed as you
need.The following is "LOCAL IP SETUP"menu.
LAN CARD SET: 3G / Wireless / Wire
3G
It is strongly required to use the accompanying 3G bracket provided by manufacturer.
CDMA2000 is appointed network, but WCDMA can be ordered.
NOTE:
The monitor supports 3G, wireless and wire .
Wireless
It is strongly required to use the accompanying wireless network card provided by
manufacturer. The router complied with IEEE802.11 (ordinary or household wireless
network router) should be used, and it shall support the authentication method of
WPA, WPA2 or WEP. Wireless network router should access to the Internet by WAN.
Wire
The device has an interface for wire network mode, it accesses to wire LAN complied
with IEEE802.3 by RJ45 connector. Wire network should access to the Internet by
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WAN of the route r.
NET TYPE: CMS or CUSTOM, select the network type according to your need
CMS
The Server IP is fixed "202.114.4.119". Once the monitor specifies the port number,
the program will automatically obtain the local IP address and the port to be
connected.
CUSTOM
In this mode, the IP address and subnet mask of the server, as well as the two items
of this monitor can be set
by user.
LAN CARD SET: 3G/WIRELESS/WIRE
3G
The 3G network is mainly used to connect with the central monitoring system
through the Internet WAN.
After selecting 3G network, restart the device, then the device will automatically
obtain the WAN support (dynamic ip, DNS, etc.) from 3G card and its driver.
NOTE:
The 3G mode is available only when the "NET TYPE" is "CUSTOM". If the
monitor is connected to central station, the central station software need to
be installed on a server with fixed IP address, this address shall be set in the
"SERVER IP".
WIRELESS
After selecting wireless network, click "SELECT ROUTE" in "NET CONFIG" menu, then
click "SEARCH ROUTES". All searched routers will be listed on the screen, you can
select one of them to connect as your need. If you choose a router set with secure
connection, a dialog box will pop up for you to enter the password.
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When the network type is CMS, just make sure the connection between the device
and the wireless router is successful. (The IP address of the server is 202.114.4.119,
the IP address of this monitor and subnet mask are generated by the port number.)
When the network type is CUSTOM, if DHCP service is used, the device will
automatically obtain the network support (dynamic IP of this monitor, gateway, DNS,
etc.) through the DHCP. If specified IP is used, please set the IP address of this
monitor and subnet mask, click "LOCAL IP CONFIG" button, the following menu will
pop up:
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Wire
When the network type is CMS, just make sure the connection between the device
and the central station is successful. (The IP address of the server is 202.114.4.119,
the IP address of this monitor and subnet mask are generated by the port number.)
When the network type is CUSTOM, make sure the monitor is connected to the
router. If DHCP service is used, the device will automatically obtain the network
support (dynamic IP of this monitor, gateway, DNS, etc.) through the DHCP. If
specified IP is used, please set the IP address of this monitor and subnet mask.
LOCAL NET NO: the physical bed number of the monitor
SERVER IP: input the IP address or domain name of the server for central
station software
LOCAL IP CONFIG: when the "NET TYPE" is "CUSTOM", you can set the local IP
address
SELECT ROUTE: when the "LAN CARD SET" is set to "WIRELESS", click this
button to enter the "SELECT ROUTE" menu, and start router searching and
other operations.
4.8 Demo
Select the "DEMO" item in the "SYSTEM MENU" to enter the "DEMO KEY" dialog box.
Input the password "2088", and click "CONFIRM" button, the system will enter DEMO
status.
The demo waveform is an analog waveform set by the manufacturer only to show
the performance of the machine and to train users.
In clinical application, this function is forbidden because it may mislead the medical
staff to treat the DEMO waveform and parameters as the actual data of the patient,
which may result in the delay of treatment or mistreatment. Therefore before
entering this menu, you shall enter the password.
Chapter 5 Alarm
When the patient being monitored appears abnormal changes in vital signs, or the
monitor itself occurs failure and fails to monitor the patient, it will remind the
medical workers through sound, light, etc.
WARNING
In any single area (e.g. intensive care unit or cardiac operating room), there is
a potential hazard that the same or similar devices use different alarm preset.
When the monitor is powered on, the system will check whether the alarm
function (audio and light alarms) is normal.
When turning on the monitor, the system will send a beep sound and the
alarm light flickers once. This function is used to check whether the alarm
function is normal. Therefore, user shall pay attention to these signs when
turning on the device. If the alarm function works abnormally, this monitor
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can not be used for patient monitoring, please contact the manufacturer or
the maintenance service center.
5.1 Alarm classification
The alarm is classified as physiological alarm, technical alarm and prompt message
based on the property of alarms.
1. Physiological alarm
Generally, physiological alarm is activated in the following situations: one of the
patient's physiological parameters exceeds the alarm limits, or the patient appears
physiological abnormal, for example, HR exceeding the set limit. The information of
physiological alarm is displayed in physiological alarm area.
2. Technical alarm
Technical alarm represents the alarms activated by abnormal monitoring or
monitoring result distortion due to system failure, such as lead-off or low battery. The
information of technical alarm is displayed in technical alarm area.
3. Prompt message
Except the physiological alarm and technical alarm, these messages refer to the
displayed information about system status, which are not involved with patient vital
signs. Prompt messages are often displayed in technical alarm area. Besides, some
prompt messages are displayed in parameter area, for example, the messages related
to NIBP are displayed in NIBP area.
5.2 Alarm level
The alarm is classified as high-level alarm, medium-level alarm and low-level alarm
according to its severity.
1. High-level alarm
High-level alarm indicates the patient’s life is in danger or the monitor under using
has serious problem in technical respect. It is the most serious alarm.
2. Medium-level alarm
Medium-level alarm means serious warning.
3. Low-level alarm
Low-level alarm is a general warning.
NOTE:
The level of all technical alarms and prompt messages and some of the
physiological alarms are determined by the system, which can not be
changed by user.
The level of most of the physiological alarms need to be set by user, such as
alarm limits.
5.3 Alarm mode
When alarm occurs, the monitor may draw the user’s attention in three ways as
below:
Audio alarm
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Light alarm
Alarm message
5.3.1 Audio alarm
When alarm occurs, the monitor will make different sound to indicate alarms in
different levels.
High: "beep-beep-beep----beep-beep, beep-beep-beep----beep-beep",
frequency: every 8 seconds
Medium: "beep--beep-beep", frequency: every 8 seconds
Low: "beep", frequency: every 8 seconds
Sound pressure range: 45 dB~85 dB
5.3.2 Light alarm
When alarm occurs, the alarm indicator will prompt different levels of alarms with
different colors and flicker frequencies.
High: alarm indicator flickers in red with high frequency
Medium: alarm indicator flickers in yellow with low frequency
Low: alarm indicator lights in yellow without flickering
5.3.3 Alarm message
When alarm occurs, alarm messages will be displayed in physiological alarm area and
technical alarm area. For physiological alarms, the following marks will be used in
front of the messages to indicate the alarm level.
High: ***
Medium: **
Low: *
The system also adopts different background to indicate the alarm level of
physiological alarm and technical
alarm.
High: red
Medium: yellow
Low: yellow
NOTE:
If one monitoring system has multiple alarm equipment, when an alarm
occurs, the visual and audio prompts generated by all alarm equipment
should keep the same.
The way of alarm prompting is related to its level.
When alarms of different levels occur at the same time, the monitor prompts
the highest level alarm among them.
5.4 Alarm setup
Select "ALARM SETUP" item in the "SYSTEM SETUP" menu, the initial password is
"70808". Under this interface, user could set information about alarm sound and so
on.
ALARM VOL: selective from 1~7, 1 is the minimum volume, 7 is the maximum
volume.
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ALM REC TIME: three options: 8 s, 16 s, 32 s.
ALM PAUSE TIME: two options: 1 min and 2 min.
ALM TYPE: U N L AT C H . . "UNLATCH" refers to the situation that once the causes
of alarm are eliminated, the alarm will disappear automatically.
KEYVOL: selective from 1~7 and OFF.
ALM SOUND: it can be set as "OFF", and the symbol "
" will appear on the
screen.
The system will cancel the "OFF" of alarm sound in the following situations:
The monitor is restarted;
The alarm status is changed, for example, the system enters alarm pause
status, or the alarm sound is forbidden.
WARNING
When the alarm sound is turned off, the monitor will not make any sound
even if a new alarm is triggered. Therefore, user must carefully choose
whether to turn off the alarm sound.
In SILENCE or ALARM PAUSE status, set the alarm sound is as "OFF", then the
system will automatically terminate the status of SILENCE or ALARM PAUSE.
When the alarm sound is "OFF", if the operator selects "SILENCE" or "ALARM
PAUSE", the alarm sound will be restored to the previous volume when it is
turned off, and at this time, the system will enter the status of silence or
pause accordingly.
Do not rely on the sound alarm system only for patient monitoring, user
should pay close attention to the patient's actual clinical situation.
NOTE:
When alarm sound is turned off, a symbol "
" will be displayed in
technical alarm area.
The alarm sound off is only valid when the device keeps turning on, once the
device is restarted, this setup to will be restored to the previous set value.
The symbol "
" means that the alarm sound is turned off, the system
could not make any sound for the alarm, so user must be careful when using
this function. There are two ways to exit this status. Method 1: Set the alarm
sound as "ON" in the "ALARM SETUP". Method 2: Press the "SILENCE" button,
the symbol will become "
", then press the "SILENCE" button one more
time, the system will return to normal alarm status.
Parameter alarm setup
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1. The parameter alarms can be set in "PARAM ALM SETUP", or their individual
parameter menu.
2. When a parameter alarm is off, a symbol "
" displays near the parameter.
3. For the parameter whose alarm is set to "ON", the alarm will be triggered
when at least one of the
parameters exceeds alarm limit. The monitor will take the following actions:
The screen displays the alarm information in a mode as described above;
The monitor beeps in its corresponding alarm level and volume;
Alarm indicator lights or flickers;
Information of all parameter values at the alarm moment, and the
waveform 4/8/16 seconds before and after the alarm are stored.
If alarm recording is on, the recorder starts alarm recording. Refer to the
chapter Recording for details.
4. The following information can be set in parameter alarm setup.
ECG ALM SETUP: HR alarm, alarm level, alarm limits (high/low), ST alarm
setup, ARR alarm setup;
SpO
Except general alarm conditions, you can set the monitor to four different alarm
status as below according to your need. The four alarm status have different symbols:
Alarm pause
Alarm off
Silence
Alarm sound off
5.5.1 Silence
Keep pressing the "SILENCE" button (over 1 second) on the control panel will turn off
all the sounds. In SILENCE status, pressing the "SILENCE" button (no more than 1
second) will switch to the "ALARM PAUSE" status, and the alarm will be suspended
temporarily in accordance with the time set before. In SILENCE status, keep pressing
the "SILENCE" button (over 1 second), the system will exit current status and restore
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the alarm sound correspondingly, and back to normal alarm status. When the system
is in "SILENCE" state, any new triggered alarm can terminate the "SILENCE" state, the
system will return to normal alarm state (sound and light alarm).
5.5.2 Alarm pause
Press "SILENCE" button on the control panel to turn off all alarm sound, light prompt
and physiological alarm information, so that the system will enter the "ALARM
PAU S E " state. The countdown of alarm pause is displayed in the physiological alarm
area and the symbol "" is displayed in this area as well.
Time period of Alarm Pause: 1 min and 2 min.
When the "SILENCE" button is pressed again, the system will restore to its normal
state. In addition, a new triggered alarm can also eliminate the "ALARM PAUSE" state,
and the symbol"" disappears.
NOTE:
After returning to the normal state, the presence of an alarm depends on
whether the alarm condition is appropriate, but after the "SILENCE" button is
pressed, the system will permanently turn off the alarm sound for lead-off or
probe-off.
The alarm pause time can be set in the "ALARM SETUP" menu as required,
the default setting is 2 min.
5.6 Measures for Alarm occurs
The alarm message appears in system information area or system alarm area. It is
needed to identify the alarm and take actions appropriately according to the cause of
the alarm.
1. Check the patient's condition;
2. Confirm the alarming parameter or the type of the alarm;
3. Identify the cause of the alarm;
4. Silence the alarm, if necessary;
5. When cause of alarm has been solved, check that the alarm is working
properly.
You will find the alarm messages and prompts for each parameter in corresponding
chapters related to this parameter in this manual.
5.7 Probe-off alarm
If the system alarms for probe falling off, user can press the "SILENCE" button on the
front panel of the monitor. At this time, the alarm indicator stops flicking and the
monitor enters the ALARM PAUSE state. Press the "SILENCE" button again or wait
until the alarm pause is over, the monitor will no longer generate sound alarm for
probe falling off, and instead remind the user in the form of alarm messages.
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Chapter 6 Freeze
When monitoring a patient, you may freeze the waveform to view it carefully. Up to
34 seconds waveform can be reviewed. Besides, the frozen waveform can be output
by recorder. The Freeze function of this monitor has following features:
Freeze status can be activated under any operating screen.
When entering the Freeze status, the system exits all other operating menus. At
the same time, the system freezes all waveforms in the Waveform area, or
full-lead ECG waveforms and the extra waveform (if available) on the Full-lead
ECG screen. Nevertheless the Parameter area refreshes normally.
The frozen waveforms can be reviewed or recorded.
6.1 Enter/Exit Freeze Status
6.1.1 Enter Freeze Status
In the Non-Freeze status, press the "FREEZE" button on the front panel of the
monitor to let the system exit the Menu being currently displayed (if available), then
enter the Freeze status and display the popup "FREEZE" menu. In the Freeze status,
all waveforms are frozen. In other words, the system will no longer refresh the
waveforms.
6.1.2 Exit Freeze Status
In the Freeze status, executing any of the following operations will command the
system to exit the Freeze status:
Select the "EXIT" option on the "FREEZE" menu;
Press the "FREEZE" button on the front panel again;
Press the non-immediate-to-execute button on the front panel and system
buttons of MAIN and MENU;
Execute any operation that may trigger the adjustment of the screen or display
of a new menu.
After exiting the Freeze status, the system will discharge the Freeze status, clear
screen waveforms and resume to display real-time waveforms.
6.2 FREEZE Menu
Press the "FREEZE" button on the panel, the FREEZE menu will appear on the bottom
part of the screen. At the same time, the system enters the Freeze status.
WAVE 1: to select the first frozen waveform to record. The pull-down list of this
item gives you the names of all frozen waveforms displayed on the screen.
WAVE 2: to select the second frozen waveform to record. The pull-down list of
this item gives you the names of all waveforms displayed on the screen.
RECALL: to review frozen waveforms.
REC: after selected, the system begins recording the frozen waveforms selected
in "WAVE 1" and "WAVE 2".
EXIT: after pressed, the system closes the FREEZE menu and exits the Freeze
status.
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6.3 Reviewing Frozen Waveform
By moving the waveform, you may review a waveform of 34 seconds before the
moment when it is frozen. For a waveform less than 34 seconds, the remaining part is
displayed as a straight line. Use the rotary knob to move the cursor to the "RECALL"
option on the FREEZE menu. Press the knob, the option displays "L-RIGHT". By
turning the knob left or right, the frozen waveform on the screen will move left or
right correspondingly. There is an arrow indicating upward under the right side of the
last waveform. There is also a time scale beside the arrow. "0 s" is used to mark the
moment when waveforms are frozen. With waveforms moving right, this time mark
will turn into "-1 s, -2 s, -3 s…".
6.4 Recording Frozen Waveform
In the Freeze status, you may output displayed frozen waveforms via the recorder.
Maximum 2 waveforms can be output at one time. On the FREEZE menu, the
pull-down lists of both "WAVE 1" and "WAVE 2" give you all names of frozen
waveforms on the screen, from which you may select two waveforms. Select the
"REC" option on the FREEZE menu to output parameters generated upon the freezing
moment and the two selected frozen waveforms. If one of the two selected
waveforms is set off or not available, only parameters and the other waveform are
recorded. If these two selected waveforms are all set off or not available, only
parameters are recorded. As for the function of recording frozen waveforms, you can
only record the waveforms displayed upon the freezing moment. The recording time
length is the same as the length of the waveform displayed on the screen. For
example, if the speed of a waveform is relatively fast, then it needs shorter time to
record it. When recording frozen waveforms, the system is still in the Freeze status.
After completion of this recording, if required, you may select another waveform to
be output, and select "REC" option again to record until the all necessary waveforms
are recorded. You may also record frozen waveforms by pressing the "REC/STOP"
button on the front panel. If selecting "REC" option without installing a recorder, the
system will prompt "RECORDER ERROR" in the status bar. For more detailed
information about recording, please refer to the chapter Recording.
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Chapter 7 Recording
NOTE:
The recorder is an optional component.
7.1 General Information for Recorder
A thermal array recorder is used for the Monitor.
Performance of the Recorder
Recording speed: 25 mm/s or 50 mm/s.
Waveform recording width: 48mm
It can record up to 2 waveforms.
The time and waveform of real-time recording are user-configurable.
Auto recording interval is set by user, the waveform is in accordance with
the real time recording.
The alarm recording waveform is automatically selected by the monitor.
NOTE:
It is recommended to stop the recording when low battery alarm generated.
Otherwise, the device may shutdown for out of power.
7.2 Recording Type
The monitor provides several stripe recording types:
Real-time recording starts as you pressing the "REC/STOP" button on the recorder.
The waveforms for continuous real-time recording and continuous 8 seconds
recording are set in system setup (usually the first two waveforms are displayed on
the screen). You can also configure it through the menu. Refer to related section for
details.
In RECORD SETUP menu, user can choose to print two different waveforms at the
same time, or print only one waveform by setting the other waveform off. If two
waveforms are set off, the real time record will print out measured parameters only.
NOTE:
If certain recording is in process, and another parameter demands alarm
recording, it will only be executed after the earlier recording is finished.
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Auto Recording
The monitor starts a recording for 8 seconds according to interval time set in the
"TIMING REC TIME" of the "RECORD SETUP " menu. Refer to the section "RECORD" in
system setup for details.
Alarm Recording
Parameter Alarm
The monitor records waveforms 4/8/16 seconds before and after the alarm
(totally 8, 16 or 32 seconds) (which can be selected in System Menu).
All parameter values during the alarm will also be recorded.
Two waveforms will be output according to the following rules:
1) If multiple parameter alarms are switched on and triggered simultaneous l y,
the recorder will print out those of the highest level. If parameters have
the same alarm level, the latest alarm will be printed out.
2) If an alarm occurs during the recording of another parameter, it will be
printed out after the current recording is finished.
3) If many alarms occur at the same time, their waveforms will be stored, and
then printed in turn.
ST Segment Alarm
The monitor records 2-channel ECG waveforms 4, 8, or 16 seconds prior to and
after the ST alarm (totally 8, 16, or 32 seconds) (which can be selected in the menu).
All parameter values during the alarm will also be recorded.
Arrhythmia Alarm
The monitor records the waveform 4 seconds prior to and after the alarm
(totally 8 seconds). All measurement results during the alarm will also be recorded.
Freeze Waveform Recording
The monitor prints out the selected waveforms under the FREEZE mode. In this
way you can capture the abnormal waveforms on the screen by freezing and record
it.
Trend Graph/Table Recording
The monitor can print out the trend graph and table in the current trend review
interface.
Arrhythmia Review Recording
The monitor can print out the arrhythmia alarm event in the current ARR
RECALL interface.
Alarm Recall Recording
The monitor can print out the alarm events in the current ALARM RECALL
interface.
NIBP Recall Recording
The monitor can print out all the NIBP review events in NIBP RECALL interface.
SD Recall Recording
The monitor can print out the trend data of the case currently review.
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Continuous real-time
recording
recording
stop after 8 seconds recording.
will automatically stop after 8 seconds recording.
When alarm recording is set ON, it automatically starts a
recording when alarm occurs.
Frozen waveform
After accessing FREEZE menu, use knob to select two
measured parameters in frozen are printed out only.
Titration Table
The monitor can print out the messages in the current TITRATION interface.
Alarm parameters, alarm time and freeze time
Patient bed number, sex, height, weight, date of birth, admission date
Parameter name and value
Recording time
Waveform name
Waveform amplitude (for ECG waveform only)
ECG lead, scale, filter mode (if having ECG waveforms, it will be printed
out within the first second or when changing the lead, gain and filter
mode during real-time recording.)
Date and time
7.3 Recording Start&Stop
Here are the methods for how to start the recording of each type:
Press REC/STOP to start/stop the recording.
8 seconds real-time
Press REC/STOP to start recording. It will automatically
The monitor starts a recording according to interval time
Auto recording
set in the "TIMING REC TIME" of the "RECORD" menu. It
Alarm recording
waveforms to be output. Then press REC button in the
recording
menu to print out the waveforms.
If both "WAVE 1" and "WAVE 2" are set to "OFF", the
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Select "REC" button in the "TREND GRAPH" menu to
print out the currently displayed trend graph.
menu to
printout the currently displayed trend table.
thmia review
Select "REC" button in the "ARR RECALL" menu to print
related parameters.
Alarm review
Access the "ALARM RECALL" interface from "SYSTEM
and related parameters currently displayed.
Access the "NIBP RECALL" interface from "SYSTEM
currently displayed.
Titration table
information currently displayed.
Trend graph recording
Trend table recording
Arrhy
recording
recording
NIBP review recording
Pick "REC" button in the "TREND TAB L E "
out the currently displayed arrhythmia waveform and
MENU", select "REC" button to print out the waveform
MENU", select "REC" button to print out the NIBP values
Access the "TITRATION" interface from "DRUG CALC"
recording
menu, select the "REC" button to print out the titration
Access the "RECORD" menu from the "SYSTEM SETUP" menu. Then select the "CLEAR
REC TASK" button, all recording tasks will be stopped, and all stored alarms will be
cleared.
NOTE:
You can press REC/STOP button on the control panel to stop any current
recording process.
7.4 Recorder Operations and Status Messages
Requirement for Record Paper
Only record paper satisfied the requirement can be used, otherwise the recorder
may not work normally, or the recording quality may be poor, or the thermosensitive
printer head may be damaged.
Proper Functioning
■ When the recorder is working, the record paper goes out steadily. Do not pull
the paper, or the recorder will be damaged.
■ Do not operate the recorder without record paper.
Paper Out
When "RECORDER OUT OF PAPER" alarm is displayed, the recorder cannot start.
Please insert record paper properly.
Inserting Paper
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Alarm
Level
abnormal.
Sw
Record Paper
Recorder Door
itch
Press the switch to open the recorder door.
Insert a new roll of paper into the paper cassette, put the paper correctly and
pay attention to the edges.
Give out the paper from the recorder outlet.
Close the recorder door.
NOTE:
Be careful when inserting paper. Avoid damaging the thermosensitive printer
head. Unless replacing the recorder paper or troubleshooting, do not leave
the recorder door open.
Removing Paper Jam
When the recorder functions or sounds improperly, open the recorder door to check
whether paper jam exists. If yes, re-install the recorder paper.
Recorder Status Message (Technical Alarm)
Message Cause
RECORDER OUT OF
PAP E R
Record paper runs
out.
Low
Solution
Insert a new roll of
record paper.
The
RECORDER ERROR
communication of
recorder is
Low
Tun off the monitor
and restart it.
After restarting the monitor, if error still exists, contact our service engineers please.
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Chapter 8 Recall
The monitor provides 480-hour trend data of all parameters, storage of 4800 groups
of NIBP measurement results and 71 alarm events. All these data can be output
through recorder. By using SD card, the trend data and 72-hour ECG waveform can be
reviewed. This chapter gives detailed instruction for reviewing these data.
8.1 Trend Graph
The latest 1-hour trend is displayed in a resolution of every 1 or 5 seconds;
The latest 480-hour trend is displayed in a resolution of every 1, 5 or 10
minutes;
Pick "TREND GRAPH" in the SYSTEM MENU to call up the following menu:
The y-axis stands for measured value and x-axis stands for time. The symbol "" in
above figure is the cursor of trend graph. The value that the cursor points to, is
displayed under the trend graph, and its corresponding time is displayed above the
trend. Other trends except NIBP trend are displayed in continuous curves. In NIBP
trend graph, the symbol "*" represents the coordinate of the NIBP value.
To select trend graph of a specific parameter:
Pick PARAM SELECT item by using the cursor, and select a requested parameter name
by turning the knob, then the trend graph of this parameter will be displayed.
To select 1-hour or 480-hour trend graph:
Pick RESOLUTION item by using the cursor, choose 1 s/5 s for 1-hour trend graph and
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1min/5 min/10 min for 480-hour trend graph.
To view earlier or later trend curves:
When "
" appears on the right part of the screen, pick "L-RIGHT" button, turn the
knob clockwise to view later trend curves. When "" appears on the left part of
the screen, select the "L-RIGHT" button, turn the knob counterclockwise to view
earlier trend curve.
To change the display scale
Pick the "ZOOM" button to adjust the y-axis scale and thus change the trend curve in
proportion. The value beyond maximum value will be represented by the maximum
value.
To obtain trend data of a specific time
Select "CURSOR" button, and turn the knob to left/right, then the cursor will move
accordingly, and the time to which the cursor points will change too. Parameter at
this time is displayed below the x-axis. When "
" appears on the right part of the
screen, the trend graph pages down for later trend curve as the cursor moves here.
When "" appears on the left part of the screen, the trend graph pages up for
earlier trend curve as the cursor moves here.
To print out the trend curve
Press REC button to print out the trend curve of current selected parameter through
the recorder.
Auto Zoom
The AUTO ZOOM is available only when the PARAM SELECT is set as "NIBP". If the
current measured value exceeds the scale range, click "ATUO ZOOM" button, the
scale will automatically adjust to proper range for current measurement.
Event marks on the trend graph
If an event is marked A, B, C, or D, then on the trend graph, the event type (A, B, C, or
D) will be displayed at the point corresponding to the moment of marking.
Operation example
To view the NIBP trend graph of the lastest 1 hour:
Select the "MENU" button on the front panel, the "SYSTEM MENU" will pop up.
Pick TREND GRAPH item.
Select the "PARAM SELECT" item, switch to "NIBP" by turning the knob.
Adjust the "RESOLUTION" to 1s or 5 s.
Select the "L-RIGHT" button, turn the knob to view the changes of trend graph
time and trend curve.
Stop at requested trend time section for careful review. Pick the ZOOM button
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to adjust the display scale if necessary.
For measurement result of a specific time, pick CURSOR to move the cursor to
this point, corresponding time and value will be displayed above and below the
curve respectively.
For printout of trend graph, pick REC to print the NIBP trend currently
displayed.
Pick EXIT to finish the reviewing.
8.2 Trend Table
The latest 480-trend table data can be displayed at every 1 min, 5 min, 10 min,
30 min, or 60 min.
Pick TREND TABLE in the SYSTEM MENU to call up the following menu:
Time corresponding to each group of trend data is displayed at the leftmost list with
date in brackets. Marked events are listed under the "EVENT" corresponding to the
time of marking. Trend data of all parameter is divided into 6 groups.
HR ,PVCs
ST1,ST2
RR
T1,T2,TD
SpO2,PR
NIBP (S/M/D)
To select trend table of a specific resolution:
Select the "RESOLUTION" item by using the cursor, turn the knob to change the
options under resolution, then the time interval of trend data will be changed.
To vie w earlier or later trend data:
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When a "up arrow" appears on the upper part of the screen, pick "UP/DOWN"
button, turn the knob clockwise to view later trend data. When a "down arrow"
appears on the upper part of the screen, select the same item, turn the knob
counterclockwise to view earlier trend data.
To view trend data of different parameter
Pick L-RIGHT to select one from the 6 groups of parameters. A ">" by the rightmost
item indicates following page available. And "<" by the leftmost item indicates
previous page available.
To print out the trend table
Press REC button to print out the trend data of all parameters currently displayed
through the recorder.
Event marks on the trend data
If an event is marked A, B, C, or D, the event type (A, B, C, or D) will be displayed at
corresponding time in the trend table.
Operation example
To view the NIBP trend table:
Select the "MENU" button on the front panel, the "SYSTEM MENU" will pop up.
Pick TREND TAB LE item.
Select the "L-RIGHT" item, switch to "NIBP" by turning the knob.
Adjust the "RESOLUTION" to the option that you need.
Select the "UP/DOWN" button, turn the knob to view the NIBP trend data at
different time.
If you need to print the NIBP trend table, pick REC button, the recorder will
print the NIBP trend data.
If you need to print all trend tables, select "REC ALL" button, the recorder will
print all trend data of all parameters.
Pick EXIT to finish the reviewing.
8.3 NIBP recall
The monitor can review the latest 4800 groups of NIBP measurement data.
Pick NIBP RECALL in the SYSTEM MENU to invoke the result and time of the latest 9
measurements. Data is listed chronologically from the latest to the earliest. Nine
measurements can be displayed in one screen. Pick UP/DOWN to view the earlier or
later data. Pick REC to print out all measurement data of NIBP RECALL.
8.4 Alarm recall
The alarm recall includes physiological alarm recall and technical alarm recall.
Physiological alarm recall
Select "ALARM RECALL" in the SYSTEM MENU, then select "PHYSIOLOGICAL ALM
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①
②
④
③
RECALL" item. In this menu, user may set the conditions for alarm review, including:
1) Start and End time of review
User may select the start time of review in the "BEGIN TIME" item, and the end time
in the "END TIME". The end time can be set as the current time or the user-defined
time.
2) Alarm recall event
In the pull-down list of ALARM RECALL EVENT, user can select the parameter that
need to be reviewed. The selections include ALL (alarm events of all parameters),
ECG, RESP, SpO2, NIBP, TEMP.
After finishing the setup of all review conditions, press the "ALARM RECALL" button
to access "ALARM RECALL" menu.
The PHYSIOLOGICAL ALARM RECALL interface is shown as below:
⑤
① Time span (Format: year/month/day/hour/minute--year/month/day/hour/minute).
② Event type.
③ Serial number (Format: NO. xx of XX ).
④ The value at the moment of alarming. NIBP result is excluded.
⑤ Two channels waveforms, stored for 8 s/16 s/32 s.
To view all waveforms during the alarming process
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Pick L-RIGHT and turn the knob to view all 8/16/32 seconds waveforms stored.
Recording
Select "REC" button, all review data currently displayed will be output by the
recorder.
Technical alarm recall
1) Select "ALARM RECALL" in the SYSTEM MENU, then select "TECHNICAL ALM
RECALL" item.
2) Technical alarm events are arranged chronologically from the latest to the
earliest. When the number of alarm events exceeds storage range, the latest
events will be displayed. Pick UP/DOWN button, and turn the knob to view the
earlier or later events.
8.5 SD recall
User can review patient data stored in the SD card on the monitor, or on the PC by
using the sync software.
An empty SD card with at least 2G capacity is needed. The SD card mounted on the
monitor could memory trend data (parameters including: HR, PVCs, ST1, SpO
, PR, RR,
2
T1, T2, TD, NIBP) and 72-hour ECG waveform. The trend data is stored per 1 minute.
NOTE:
For the review on PC by using the sync software, only ECG and SpO
related
2
waveforms and parameter values can be reviewed. Refer to the instructions
of sync software for details. This chapter only introduces the reviewing
method on the monitor.
Please first set the patient's information correctly before inserting SD card.
If different patient's data need to be saved in one SD card, you should
unmount the SD card first, and then modify patient's information. Make sure
that the patient number is different.
1. Enter SD OPERATE menu:
Select "MENU"→"SYSTEM SETUP"→"SD OPERATE", then you could enter the SD
OPERATE menu.
2. Insert SD card
If SD card has been inserted and works normally, the prompt "SD device was found,
please mount it by the button above." appears.
NOTE:
If information "SD device wasn't found, please enter SD card" appears, you
should exit "SD OPERATE" menu, check if SD card or USB interface is normal.
If the problem still exists, reboot the monitor.
3. Mount SD card
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If the monitor has found the SD card, select "MOUNT DEVICE" item, the system will
display messages to indicate whether the SD card has been mounted successfully.
NOTE:
Data can be reviewed only after SD card has been mounted successfully for 90
seconds . Otherwise the two buttons "REVIEW TREND" and "REVIEW
ECGWAVE" are invalid.
4. Review trend
Review trend
① Select "REVIEW TREND" item in SD OPERATE menu.
The following menu will pop up. In this menu, you can select any patient you
want to review.
The items from left to right in this menu are No., patient No., patient name,
admission date and birth date. The information is displayed according to the content
set in patient setup. The buttons at the bottom of menu includes:
PAGE UP/PAGE DOWN: observe patient lists of other page.
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UP/DOWN: move the cursor to select a specified patient.
REVIEW: press this button to call up the patient trend information.
② Reading trend data's information
The menu displays the trend data's information according to the selected
patient.
The header, from left to right is:
Patient No.
Patient's name
Admission date
Birth date
The content of list, from left to right is:
The list number
The time that the patient data was reviewed.
The size of data having been saved to the time that the patient data was
reviewed.
③ Review trend data
Select an item in above menu by using the cursor, then press "REVIEW" button,
the trend data will be displayed in a list. The resolution is 1 minute.
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The buttons are:
Page UP/ PAG E DOWN: to view trend data of different time.
LIGHT/ RIGHT: to view trend data of different parameter.
REC: to print current list.
Review ECG waveform
① Select the "REVIEW ECG WAVE" button in SD OPERATE menu, then choose a
specific patient to review.
② Select time span you want to review
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ECG data is saved in many different files. It need save ECG data in a new file per half
an hour. For example, "2014-09-03 14:15" represents ECG file name, it also
indicates the starting time that the file is saved.
Select the time span:
To review the ECG waveform about "2014-09-03 14:15"
By pressing cursor, select the item "1 2014-09-03 14:15"
Press "REVIEW" button.
③ Review ECG waveform
The time span of one window is 5s.
The window can display 3 channels ECG waveform. When the lead type is
"5 LEADS", it displays
ECG I, ECG II and ECG V.
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5-Lead
When the lead type is "3 LEADS", it can displays only one channel
waveform. The ECG lead is the same with the one displayed on the monitor.
5. Unmount SD card
Enter "SD OPERATE" menu, press "UMOUNT DEVICE". You can take out SD card only
when the system displays the prompt "UMOUNT SD CARD SUCCESSFULLY, YOU CAN
TAKE OUT THE CARD NOW."
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Chapter 9 Drug Calculation and Titration Table
This Portable Patient Monitor provides drug calculation and titration table display
functions for fifteen drugs and outputs the content of titration table on the recorder.
9.1 Drug Calculation
The drug calculations that can be performed by the system are AMINOPHYLLINE,
DOBUTAMINE, DOPAMINE, EPINEPHRINE, HEPARIN, ISUPREL, LIDOCAINE, NIPRIDE,
NITROGLYCERIN and PITOCIN. Besides DRUG A, DRUG B, DRUG C, DRUG D and DRUG
E are also provided to flexibly replace any of the drugs.
Select "DRUG CALC" in SYSTEM MENU, the following interface will appear:
The following formulas are applied for dose calculation:
Concentration= Amount / Volume
INF Rate= Dose/Concentration
Duration= Amount / Dose
Dose= Rate × Concentration
Operating method:
In the Drug Calculation window, the operator should first select the name of the drug
to be calculated, and then confirm the patient weight. Afterwards, the operator
should also enter other known values.
Turn the knob to move the cursor to each calculation item in the formula, press the
knob and turn it to select a value. When the calculated value is selected, the result of
other items will be displayed correspondingly. Each calculation item has a range limit,
and if the result is out of range, the system will display "---.--".
NOTE:
For the drug calculation, the prerequisite is that the operator must first of all
enter the patient weight and drug name. Values given by the system at the
beginning are a group of random initial values, which cannot be used as the
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calculation reference. Instead, a new group of values suitable for the patient
should be entered according to doctor’s advice.
Each drug has its fixed unit or unit series. Operator must select the proper
unit following the doctor’s instruction. The unit will automatically adjust
itself in its unit series according to the input value. If the result expressed by
this unit exceeds the range, the system will display "---".
After entering a value, a conspicuous prompt will appear in the menu
warning the operator to confirm the correctness of the entered value. The
correctness of input value is the guarantee for the reliability and safety of the
calculated results.
In neonate mode, Drip Rate and Drop Size items are disabled.
For each entered value, the system will always give a dialog box asking for
user’s confirmation. You must be careful when answering each box. The
calculated result is reliable only when the entered values are correct.
Select the drug name: Turn the knob to pick the DRUG NAME item. Yo u may
select the drug name in the pull-down list, including AMINOPHYLLINE,
DOBUTAMINE, DOPAMINE, EPINEPHRINE, HEPARIN, ISUPREL, LIDOCAINE,
NIPRIDE, NITROGLYCERIN, PITOCIN, Drug A, Drug B, Drug C, Drug D and Drug E.
Calculation for only one type can be generated each time.
NOTE:
Drug A/B/C/D/E are only codes for drugs instead of their real names. The
units for these five drugs are fixed. The operator may select the appropriate
units according to the convention of using these drugs. The rules for
expressing the units are:
"mg" series units are fixedly used for drug A, B and C: g, mg, mcg.
"unit" series units are fixedly used for drug D: unit, k unit, m unit.
"mEq" is fixedly used for drug E.
Patient weight: After accessing the DRUG CALC window, the operator should
enter the patient weight into the first or the second item. The entered weight
will be used as the independent data only for the calculation of drug
concentration.
NOTE:
This drug calculation function acts only as a calculator. Information in this
interface may not related to the patient being currently monitored. That
means the patient weight in Drug Calculation menu and the data in Patient
Information menu are independent from each other. Therefore, if the Weight
in Patient Information changes, the value in Drug Calculation will not be
affected.
9.2 Titration Table
Access titration table:
Select "DRUG NAME" item in DRUG CALC menu, confirm your selection, then
select "TITRATION≫" to enter the titration table interface.
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The interface of titration table is as following:
Method to operate the titration table:
1) In the TITRATION table, turn the knob to pick BASIC item. Press and turn the
knob to select either INF RATE or DOSE or DRIP RATE.
2) Move the cursor to STEP item. Press the knob to select step. The selectable
range is 1 ~ 10.
3) Move the cursor to DOSE TYPE item. Press the knob to select the unit.
4) Move the cursor to UP-DOWN item, press and turn the knob to view the
data in previous or following pages.
5) Move the cursor to REC item. After pressing the knob, the recorder prints
out the data displayed in the current titration table.
6) Move the cursor to EXIT item, press the knob to return to DRUG CALC menu.
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Chapter 10 ECG Monitoring
10.1 Introduction
The ECG monitoring produces a continuous waveform of the patient's cardiac electric
activity to enable an accurate assessment of patient's current physiological state.
Only proper connection of the ECG cables can ensure satisfactory measurement. The
monitor displays 2-channel ECG waveforms at the same time in normal working, and
provides 3/5-lead monitoring, ST segment analysis and arrhythmia analysis.
The patient cable consists of 2 parts;
The cable that connects to the monitor;
The lead set that connects to the patient.
For 5-lead monitoring, the ECG can derive two waveforms from two
different leads. It is available to choose a specified lead to monitor from the
left side of ECG waveform by using the knob.
The monitor displays the Heart Rate (HR), ST segment and Arrhythmia
analysis.
All parameters above can be set as alarm parameters.
NOTE:
In the default settings of the monitor, the ECG waveforms are the top two
waveforms displayed in the waveform area.
10.2 Safety information
WARNING
Do not touch the patient, table nearby, or the equipment during
defibrillation.
Use only the ECG cables and electrodes provided by our company for
monitoring.
When connecting the cables and electrodes, please do make sure that the
cables and electrodes are not in contact with any conductive part or the earth,
especially all the ECG electrodes, including neutral electrodes are securely
attached to the patient. Do not let them contact with any conductive part or
the ground.
Check the skin attached with ECG electrode patches for irritation everyday. If
there is a sign of allergies, replace the electrodes every 24 hours or change
the sites.
Before starting the monitoring, inspect whether the lead works normally.
Unplug the ECG cable from the socket, the screen will display the error
message "ECG LEAD OFF" and the audible alarm will be activated.
NOTE:
Please use defibrillation proof ECG cable during defibrillation.
Interference from a non-grounded instrument near the patient and ESU
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America Stand
Europe Standard
Lead name
Color
Lead name
Color
RA
White
R
Red
LA
Black
L
Yellow
interference can cause inaccuracy of the waveform.
When a ECG device is unable to work, such as "ECG module communication
stopped", "ECG module communication error" or "ECG module initialization
error" appears, the monitor will stop monitoring automatically, and the
prompt system alarm, which is a high-level alarm.
For protecting environment, used electrodes must be recycled or disposed
properly.
10.3 Monitoring Procedure
10.3.1 Preparation
1. Prepare the patient's skin prior to placing the electrodes.
The skin is a poor conductor of electricity, therefore preparation of the
patient's skin is important to facilitate good contact between electrodes and
skin.
Shave hair from the sites where electrode patches attach to, if necessary.
Wash sites thoroughly with soap and water. (Never use ether or pure
alcohol, because this increases skin impedance).
Rub the skin briskly to increase capillary blood flow in the tissues and
remove skin scurf and grease.
Before installing the electrodes, let the skin dry completely.
2. Attach clip or snap to electrodes prior to placement.
3. Install the electrodes on the patient. Before attaching, apply some
conductive paste on the skin if the electrode does not contain conductive paste itse lf.
4. Connect the electrode lead to the patient cable.
5. Make sure the monitor is ready with power supply.
10.3.2 Choose Lead Type
1. Select the ECG parameter area, enter the ECG setup menu.
2. Set the "LESD TYPE" to "3 LEADS" or "5 LEADS" according to the lead type
you applied.
10.3.3 Installing ECG lead
The following description takes America standards as examples.
NOTE:
The following table gives the corresponding lead names used in Europe and
America Standards. (Lead name is represented by R, L, N, F, C respectively in
Europe Standard, while corresponding lead name in America Standard is RA,
LA, RL, LL, V.)
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LL
Red F Green
RL
Green
N
Black
V
Brown
C
White
The 3-lead
The placement of 3-lead electrodes is shown as below:
RA (right arm)lead on the right foreleg
LA (left arm) lead on the left foreleg
LL(left leg)lead on the left hint leg
The 5-lead
The placement of 5-lead electrodes is shown as below:
RA (right arm) lead: on the right foreleg.
LA (left arm) lead: on the left foreleg.
RL (right leg) lead: on the right hind leg.
LL (left leg) lead: on the left hind leg.
V (precordial) lead: exploring lead.
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NOTE:
To ensure patient safety, all leads must be attached to the patient.
Recommended ECG Lead Placement for Surgical Patients
The placing of the ECG leads will depend on the type of surgery that is being
performed. For example, with open chest surgery the electrodes may be placed
laterally on the chest or on the back. In the operating room, artifacts can sometimes
affect the ECG waveform due to the use of ES (Electrosurgery) equipment. To help
reduce this you can place the electrodes on the right and left shoulders, the right and
left sides near the stomach, and the chest lead on the left side of mid-chest. Avoid
placing the electrodes on the upper arms, otherwise the ECG waveform will be too
small.
WARNING
When using electrosurgery equipment, leads should be placed in a position in
equal distance from electrotome and the grounding plate to avoid cauter y.
Electrosurgery equipment wire and ECG cable must not be tangled up.
When using Electrosurgery equipment, never place an electrode near the
grounding of the electrosurgery device, otherwise there will be a great
interference with the ECG signal.
When the monitor is connected to a defibrillator and other high-frequency
devices, it is recommended to use anti-defibrillation ECG leads, otherwise it
may cause burns to the patient.
When the monitor is used with a defibrillator, the operator should avoid
contact with the patient or bed, and the defibrillation electrode should not
touch the electrode of the monitor directly, for doing so may generate sparks
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S
R
P
Q
T
then causing device damage or patient injury.
NOTE:
If a ECG waveform is not accurate, while the electrodes are correctly attached,
try to change the lead.
Interference from a non-grounded instrument near the patient and ESU
interference can cause inaccuracy of the waveform.
A good signal should be:
Tall and narrow with no notches.
With tall R-wave completely above or below the baseline.
With pacemaker signal no higher than R-wave height.
With T-wave less than one-third of the R-wave height.
With P-wave much smaller than the T-wave.
To obtain a 1 mv calibrated ECG wave, the ECG should be calibrated. A message
"when CAL, can't monitor!" prompts on the screen.
Stand ECG Waveform
10.4 ECG Screen Hot Keys
The following figure is an interface of 5-lead monitoring, only for reference.
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③
①
②
④
⑤
ECG Hot Key
① Leads of channel 1:
1) The selectable leads are I, II, III, aVR, aVL, a V F, V.
2) When the ECG is 5-lead, the selectable leads are: I, II, III, aVR, aVL, aVF; V.
When ECG is 3-lead, the selectable leads are: I, II, III.
3) Leads on the ECG waveform must not use the same name. Otherwise, the
system will automatically change the ECG waveform name that has been used
to another one.
② Waveform gain of channel 1: to adjust the amplitude of ECG waveforms
Select gain value for each channel from ×0.25, ×0.5, ×1, ×2 and ×4. A 1mV
scale displays on each ECG channel's one side. The height of the scale is directly
proportional to the waveform amplitude.
③ Filter method: to display clearer and more detailed waveform
There are three filter modes for selection. In DIAGNOSTIC mode, the ECG
waveform is displayed without filter. In MONITOR mode, the artifact that may cause
false alarm is filtered. And the SURGERY mode could reduce artifacts and
interferences from electrosurgery equipment. The filter mode is applicable for both
channels, and it is displayed at the top of screen.
④ Leads of channel 2: refer to ① for detailed information.
⑤ Waveform gain of channel 2: refer to ② for detailed information.
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WARNING
Only in Diagnostic mode, the system can provide non-processed real signals.
In Monitor or Surgery mode, ECG waveforms may have distortion of different
extent. In either of the latter two modes, the system can only show the basic
ECG, the results of ST analysis may also be greatly affected. In Surgery mode,
results of ARR analysis may be somewhat affected. Therefore, it is suggested
that in the environment having relative small interference, you’d better
monitor a patient in Diagnostic mode.
NOTE:
When the input signals are too large, the peak of the waveform may not able
to be displayed. In this case user could manually change the gain setup of ECG
waveform according to the actual waveform so as to avoid the occurrence of
the unfavorable phenomena.
10.5 ECG setup
Turn the knob to move the cursor to the ECG hot key in parameter area, and press
the knob to enter ECG setup menu.
ALM REC: if set to "ON", HR alarm will be recorded once alarm happens.
HR FROM
ECG: Heart rate will be detected by ECG wave.
SpO
: Heart rate will be detected through PLETH, the monitor prompts "PULSE"
2
at the right side of ECG hot key with pulse sound. Only pulse alarm is available.
When the HR FROM is set to "PLETH", the system only carry on the alarm
judgement of pulse rate, while the heart rate alarm will not be judged.
AUTO: The monitor distinguishes heart rate source according to the quality of
signal. ECG source priority is higher than SpO
poor, which can not be analyzed, the system will choose SpO
source. Only when the ECG signal is
2
source, and when the
2
ECG signal quality returns to normal, the heart rate source automatically switch to
the ECG. As long as the presence of ECG module, the heart rate value will be
displayed, only when the ECG module does not exist, the pulse rate value will be
displayed.
BOTH: The monitor displays HR and PR simultaneously. The PR value is displayed
at the right side of SpO
hot key. Both HR alarm and PR alarm are available. As for the
2
sound of HR or PR in BOTH mode, HR is given the priority, i.e., if HR is available, the
system prompts the sound of heart rate, but if HR is not available, then it will prompt
the sound of pulse rate.
SWEEP
Available options for ECG SWEEP are 12.5 mm/s, 25.0 mm/s, and 50.0
mm/s.
LEAD TYPE: to select either 5 LEADS or 3 LEADS.
HR CHANNEL
"CH1" : to count the heart rate by channel-1 waveform
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65
"CH2": to count the heart rate by channel-2 waveform
"AUTO": the monitor selects a channel automatically for HR calculation
ECG ALM SETUP
Input the initial password "70808" for alarm setup to enter its interface,
the following items can be set:
HR ALM: pick "ON" to enable alarm prompt and data record during
the heart rate alarm; pick "OFF" to disable the alarm function, and there will be
a
in parameter area.
ALM LEV: selectable from "HI" and "MED". Level HIGH represents
the most serious alarm.
ALM HI: to set the upper limit of HR alarm.
ALM LO: to set the lower limit of HR alarm.
ST ALM SETUP: refer to the section ST Segment Monitoring in the
following for details.
ARR ALM SETUP: refer to the section ARR Monitoring in the
following for details.
NOTE:
ECG alarm is activated when the heart rate exceeds ALM HI value or falls
below ALM LO value.
Please set the alarm limits according to clinical condition of individual
patient.
The setup of HR alarm limits is very important in monitoring process. The
upper limit should not too high. Considering the factors of variability, the
upper limit of HR alarm should 20 beats/min higher than the patient's heart
rate at most.
DEF POINT: refer to the section ST Segment Monitoring in the following
for details.
ARR RECALL: refer to the section ARR Monitoring in the following for
details.
OTHER SETUP: Pick this item to access ECG SETUP menu.
BEAT VOL: 8 selections are available: OFF, 1~7. 7 indicates maximum
volume. OFF indicates no sound.
PAC E : "ON" means the detected signal will be marked by a "¹" above the
ECG waveform. "OFF" means no pacemaker analysis.
WARNING
For a patient using pacemaker, the heart rate meter may count the
pacemaker pulse when patient appears cardiac arrest or arrhythmia.
Therefore, do not entirely rely on the alarms of heart rate meter. Patient with
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66
pacemaker should be closely monitored.
If monitoring a patient with pacemaker, set "PACE" to On. If monitoring a
patient without pacemaker, set "PACE" to Off. If "PACE" is on, the system will
not perform some types of ARR analysis. For detailed information, please
refer to the section about arrhythmia analysis.
When the "PACCE" is on, the arrhythmia events related to ventricular
premature beat (including PVCs count) will not be detected, neither the ST
segment analysis.
NOTCH: ON/OFF.
EMG: ON/OFF.
PITCH TONE: ON/OFF
ECG CAL: pick this item to start calibrating ECG. The method to end
calibrating: re-select this button in the menu or change the lead name on the
screen.
ADJUST WAVE POS:
1. CHANNEL: CHANNEL I/CHANNEL II
2. UP-DOWN: to adjust the up and down of channel-1/channel-2 ECG
waveform
3. DEF POS: return to the original position
DEFAULT: pick this item to access the ECG DEFAULT CONFIG dialog box, in
which user may select either the FACTORY DEFAULT CONFIG or the USER
DEFAULT CONFIG. After selecting one item and exiting the dialog box, the
system will pop up a dialog box asking for user’s confirmation.
10.6 ECG Alarm and Prompt Message
10.6.1 Alarms
Alarms occurring in the process of ECG measurement contain two types:
physiological alarm and technical alarm. Prompt messages may also appear in the
mean time. For the audio and visual features during the appearance of these alarms
and prompt messages, please refer to the related description in Chapter 5 Alarm. In
the screen, physiological alarms and prompt messages (general alarms) are displayed
in the physiological alarm area of the monitor, while technical alarms, and prompt
messages that unable to trigger alarms are displayed in the technical alarm area. This
section does not describe the alarm part about arrhythmia and ST analysis.
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the
parameters and related measured waveforms when the alarms occur on the
condition that the alarm record switch in related menu is On.
Tables below describe respectively the possible alarms those may occur during the
measurement.
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67
ECG SIGNAL
WEAK
No ECG signal of the patient is detected.
HIGH
HR HI
Measured HR value is higher than the
upper alarm limit.
User-selectabl
e
alarm limit.
e
Alarm
level
OFF
LL LEAD OFF
If the fault persists, stop using
personnel of our company.
Make sure the patient is quiet,
Physiological alarms:
Message Cause Alarm level
HR LOW Measured HR value is lower than the lower
Technical alarms:
Message Cause
ECG LEAD OFF
or RESP LEAD
V LEAD OFF
ECG electrodes
fall off the skin
or ECG cables
fall off the
LA LEAD OFF
monitor.
RA LEAD OFF
MODULE
ERROR
Occasional
communication
failure
ECG measuring
NOISE
signal is greatly
interfered.
10.7 ST Segment Monitoring
The default setting for ST segment monitoring is "OFF", so the monitor
will not process ST analysis. You can switch it to ON when necessary.
The ST segment algorithm can measure the elevation or depression of the
ST segment on the user-specified lead. The relevant ST measurement results
are displayed numerically at the parameter areas ST1 and ST2. View the trend
data displayed graphically and in tables under "TREND GRAPH" and "TREND
TABLE" menu.
Unit: mV
Measurement range: -2.0~+2.0 mV
Meaning of the value: positive means elevating, negative means
depressing.
LOW
HIGH
LOW
User-selectabl
Solution
Make sure that all electrodes,
leads and patient cables are
properly connected.
the measurement function
provided by this ECG module,
and inform the biomedical
engineer or maintenance
the electrodes are properly
connected and AC power
system is well grounded.
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68
NOTE:
When setting ST ANALYSIS on, the monitor will select "DIAGNOSTIC" mode.
You can set it to "MONITOR" mode or "SURGERY" mode as required. However
at this time ST value has been severely distorted.
10.7.1 ST ON/OFF
To set the display of ST parameter on or off:
1. Select "ECG ALM SETUP" item in the "ECG SETUP" menu, refer to the "ECG
SETUP" for details;
2. Then select "ST ALM SETUP" to enter its interface, set the "ST ANALYSIS" to
on or off.
10.7.2 ST alarm setup
Select "ECG ALM SETUP" item in the "ECG SETUP" menu, input the initial password of
alarm setup "70808", click "ST ALM SETUP"to modify the following items:
ST ANAL: the switch for ST analysis. Set it to ON to activate the ST analysis
or OFF to disable the ST analysis.
ST ALM: pick "ON" to enable prompt message and data record during the
ST analysis alarm; pick "OFF" to disable the alarm function, and there will be a
beside parameter area ST1. ST alarm is activated when the result exceeds
the upper limit of ST value or falls below the lower limit of ST value.
ALM LEV: to set the ST alarm level. There are three selections: "HI",
"MED" and "LO".
ALM REC: "ON" means that the system will enable the recorder for alarm
recording.
ALM HI: to set the upper limit of ST alarm. The maximum setting is +2.0.
The minimum high limit should be 0.1 larger than the set low limit.
ALM LO: to set the lower limit of ST alarm. The minimum setting is –2.0.
The maximum low limit should be 0.1 lower than the set high limit.
10.7.3 DEF point setup
Identify the analysis point for ST segment.
Select the "DEF POINT" item in "ECG SETUP" menu, in which the value of ISO
and ST point can be set.
1. ISO (Base point): to set the baseline point.
2. ST (Starting point): to set the measurement point.
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69
}
Q
R Wav e
P
S
T
ST Valu e
ISO
-78 ms
ST
The ISO and ST are the two measurement points in ST segment, both of them can be
adjusted.
The reference point is the position where the peak of R-wave locates (as figure
below). The ST measurement value for each heartbeat complex wave is the
difference between the two measurement points.
+109 ms
The position of measurement points (ISO and ST) should be adjusted at the beginning
of monitoring, or the patient's HR or ECG waveform changes significantly. Abnormal
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70
alarm limit.
ble
ST measuring value of channel 1 is below the lower
alarm limit.
User-selecta
ble
ST measuring value of channel 2 is above the upper
alarm limit.
User-selecta
ble
ST measuring value of channel 2 is below the lower
alarm limit.
User-selecta
ble
QRS complex is not considered in ST segment analysis.
NOTE:
Abnormal QRS complex is not considered in ST segment analysis.
The measurement points should be adjusted if the patient's HR or ECG
waveform changes significantly, detailed instructions are described in the
following.
10.7.4 Adjust ISO/ST point
These two points can be adjusted by turning the knob.
For ST measurement points setting, enter the "DEF POINT" window. The QRS
complex template displays in the window (If the channel is switched off, the system
prompts "ST ANALYSIS KEY IS OFF!".). It is adjustable of the highlight lines in the
window. You may select ISO or ST, then switch the knob left or right to move the line,
then to decide the baseline point and the measurement point.
NOTE:
The alarm limits for two ST measurements are identical. The setting of alarm
limits can not be made only for one channel.
10.7.5 ST alarms and Prompt messages
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the
parameters and related measured waveforms when the alarms occur on the
condition that the alarm record switch in related menu is On.
Possible physiological alarms during ST measurement are listed as below.
Physiological alarms:
Message Cause Alarm Level
ST1 HI
ST measuring value of channel 1 is above the upper
User-selecta
STI LOW
ST2 HI
ST2 LOW
10.8 ARR Monitoring
Arrhythmia analysis
The arrhythmia analysis is used to monitor ECG of neonate and adult patient in
clinical, detect the changing of heart rate and ventricular rhythm, and also save
arrhythmia events and generate alarming information. Arrhythmia analysis can
monitor the patient with or without pacemaker. Qualified personnel can use
arrhythmia analysis to evaluate patient’s condition (such as heart rate, PVCs
frequency, rhythm and abnormal heartbeat) and decide the treatment accordingly.
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71
Besides detecting the changing of ECG, arrhythmia analysis can also monitor patients
and give proper alarm for arrhythmia.
The arrhythmia monitoring is shutoff by default. You can enable it when
necessary.
This function can call up the doctor's attention to the patient's heart rate
by measuring and classifying the arrhythmia and abnormal heart beat,
and triggering the alarm.
The monitor can conduct up to 13 different arrhythmia analysis.
The monitor can store the latest 60 alarm events (a single-channel ECG
waveform 4 seconds before and after the alarm) during the arrhythmia
analysis process. The operator can edit these arrhythmia events through this
menu.
10.8.1 ARR Analysis ON/OFF
To set the ARR analysis on or off:
1. Select "ECG ALM SETUP" item in the "ECG SETUP" menu, refer to the "ECG
SETUP" for details;
2. Then select "ARR ALARM" to enter its interface, set the "ARR ANAL" to on or
of f.
10.8.2 ARR alarm setup
Select "ECG ALM SETUP" item in the "ECG SETUP" menu, input the initial
password of alarm setup
"70808", click "ARR ALM SETUP"to modify the following items:
ARR ANAL: Pick "ON" during monitoring. Default set is "OFF".
PVCS ALM: pick "ON" to enable prompt message and data record when
alarm occurs; pick "OFF" to disable the alarm function, and there will be a
beside PVCs parameter area.
ALM LEV: selectable from HI, MED, LO. Level HIGH represents the most
serious PVCs alarm.
ALM REC: pick "ON" to enable the recording when PVCs alarm occurs.
ALM HI: PVCs alarm is activated when the PVCs exceeds the set ALM HI
value.
ARR RELEARN: press this button to start a learning procedure.
ARR ALM: to set the arrhythmia alarm. In this menu, "ALM" is the alarm
switch, "LEV" is alarm level, "REC" is the switch of alarm recording.
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72
Arrhythmia Alarm Setup
Select "Page Down" to enter the interface for following setup.
Arrhythmia Alarm Setup
You can pick ALL ALM ON to enable alarm function of all arrhythmia types and pick
ALL ALM OFF to disable this function. Likewise, you can pick ALL REC ON to enable
recording function for all arrhythmia types and pick ALL REC OFF to disable this
function. Changing the ALM LEV can reset alarm level of all arrhythmia types.
10.8.3 ARR Recall
1. Pick this item to review and edit the ARR analysis result.
2. Select "ARR RECALL" item in the "ECG SETUP" menu, the following interface
will pop up.
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73
The recent stored ARR events are listed in this interface:
UP/DOWN: Observe event lists of other pages.
CURSOR: Move the cursor to select an event in the list.
RENAME: Rename the selected Arr. event. Turn the knob until your
necessary name appears, then press the knob.
WAVE: Press this button to display the waveform of the selected
arrhythmia event, time of occurrence and the parameters at this time in
the window.
In the arrhythmia waveform recall interface:
UP/DOWN: To observe waveforms of other Arrhythmia events.
CURSOR: To observe the whole 8s waveform of Arrhythmia event.
RECORD: To print out displayed waveform of Arrhythmia event.
EXIT: To return to ARR RECALL menu listing Arrhythmia events.
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74
PVCs measuring value is above the upper
alarm limit.
User-selectable
Type
is detected for
consecutive 6 seconds.
e
Fibrillation wave for consecutive 4
he number of continuous
rger than the upper
5).
The RR interval is less than 600ms.
pacemaker
e
pacemaker
e
Without
pacemaker
User-selectabl
e
NOTE:
If there are more than 60 Arrhythmia events, the latest ones will be retained.
10.8.4 PVCs Alarms and Prompt messages
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the
parameters and related measured waveforms when the alarms occur on the
condition that the alarm record switch in related menu is On.
Possible physiological alarms and technical alarms during PVCs measurement are
listed as below.
Physiological alarm:
Message Cause Alarm Level
PVCS ALM
Arrhythmia alarm
The alarm is triggered when an Arrhythmia occurs. If the ALM is ON, the alarm
sounds and the alarm indicator flashes. If the REC is ON, the alarm record will be
printed out (the ECG waveform of the channel being analysed 4 seconds prior to and
after the alarm).
Alarms and prompt messages related to arrhythmia analysis are listed as below:
Physiological alarm:
Applicable
Message
Patient
Occurring Condition Alarm Level
ASYSTOLE All patients
VFIB /VTAC
VT>2
COUPLET
BIGEMINY
Without
pacemaker
Without
Without
Without
pacemaker
TRIGEMINY
No QRS complex
seconds, or t
ventricular beats is la
limit of cluster ventricular beats (≥
3 < the number of cluster PVCs < 5
2 consecutive PVCs
Vent Bigeminy
Vent Trigeminy
User-selectabl
User-selectabl
e
User-selectabl
User-selectabl
User-selectabl
e
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75
HR is less than 100, R-R interval is less
the average interval,
pause of
(the next R wave advances onto the
previous T wave).
pacemaker
f
above mentioned PVCs.
e
nterval
is less than 0.5s.
e
5 consecutive QRS complex, RR interval
is longer than 1.5s.
e
When HR is less than 100 beats/min, no
heart beat is tested during the period
When HR is larger than 100 beats/min,
no beat is tested with 1 second.
No QRS complex and pacing pulse are
ble during the period 1.75 times of
R interval (only
considering patients with pacemaker. )
When pacing pulse is available, no QRS
exists during the period 1.75
ge RR interval (only
considering patients with pacemaker.)
Alarm
Level
ARR
LEARNING
The QRS template building required for Arr. Analysis
is in process.
R ON T
Without
pacemaker
than 1/3 of
followed by a compensatory
1.25 times of the average R-R interval
User-selectabl
e
PVC
Without
TAC H Y All patients
BRADY All patients
MISSED
BEATS
PNP
PNC
Without
pacemaker
With
pacemaker
With
pacemaker
Single PVC not belonging to the type o
5 consecutive QRS complex , RR i
1.75 times of the average RR interval; or
availa
the average R-
complex
times of the avera
User-selectabl
User-selectabl
User-selectabl
User-selectabl
e
User-selectabl
e
User-selectabl
e
Applicable patient type: "All patients" refers to perform Arr.analysis on patients
either with pacemakers or without pacemakers.
"Without pacemaker": refers to perform Arr. Analysis only on the patients without
pacemakers.
"With pacemaker": refers to perform Arr. Analysis only on the patients with
pacemakers.
Prompt message:
Message Cause
NOTE:
Arrhythmia name displays in the alarm area.
No alarm
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Chapter 11 RESP Monitoring
11.1 Introduction
Measurement method: chest impedance. When the patient breathes, the thoracic
activity causes a change in the thoracic impedance between the two ECG electrodes.
The monitor produces a respiratory wave on the screen by measuring the impedance
change (due to the movement of the thorax), then it calculates the respiration rate
based on the waveform cycle.
11.2 Safety information
WARNING
Respiratory measurement does not recognize the reason of suffocation, it will
only give alarm if no next respiration is checked within the predetermined
time after the last breath, so it can not be used for diagnostic purposes.
11.3 Placement for RESP electrode
Since the same leads are used for ECG and respiration monitoring, the lead
placement is very important. Some patients, due to their clinical condition, expand
their chest laterally, causing a negative intrathoracic pressure. In these cases it is
better to place the two crocodile clips used for respiration monitoring laterally in the
right axillary and left lateral chest areas, at the maximum point of the breathing
movement, to optimize the respiratory waveform.
Electrodes Placement
NOTE:
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77
RESP measurement value is higher than upper
alarm limit.
User-selectabl
e
The RESP monitoring is not recommended to be used on patients who are
very active, as this can cause false alarms.
Placing the red and white electrodes diagonally to obtain the optimal
respiration waveform. Avoid the liver area and the ventricles of the heart in
the line between the RESP electrodes so as to avoid cardiac overlay or
artifacts from pulsating blood flow. This is particularly important for
neonates.
11.4 RESP SETUP
Press RESP hot key on the screen to "RESP SETUP" interface:
ALM REC: select "ON" to enable report printing upon RESP alarm.
SWEEP: 6.25 mm/s, 12.5 mm/s, 25.0 mm/s
WAVE AMP: RESP waveform can be amplified for displaying, amplification
factor: ×0.25, ×0.5, ×1, ×2, ×4.
RESP FROM: LL-RA or LA-RA
RESP alarm setup:
Enter the initial password "70808" to set the following contents:
ALM: when RESP alarm occurs, the system will prompt and store the
alarm information after selecting "ON", it will not alarm when selecting "OFF",
and "
" will appear in parameter area.
ALM LEV: HIGH, MED and LOW, high represents the most serious alarm.
ALM HI: set the upper alarm limit.
ALM LO: set the lower alarm limit.
APNEA ALM: set the time of judging an apnea case. Range: 10 ~ 40 s,
increase / decrease 5 s after every rotating.
DEFAULT: select it to "RESP DEFAULT CONFIG" menu, in which the user may
select "FACTORY DEFAULT CONFIG" or "USER DEFAULT CONFIG". After selecting
any of the items and exiting the dialog box, the system will pop up the dialog
box asking for confirmation
11.5 RESP Alarm message
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the
parameters and related measured waveforms when the alarms occur on the
condition that the alarm record switch in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during RESP measurement.
Physiological alarms:
Message Cause Alarm Level
RR HI
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78
RESP measuring value is lower than lower alarm
limit.
User-selectabl
e
interval.
Alarm
Level
Make sure all electrodes, leads
and cables are connected
normally.
RR LOW
RESP APNEA
RESP can not be measured within specific time
Technical alarms:
Message Cause
RESP LEAD
OFF
RA, RL or LL
falls off.
HIGH
Remedy
MED
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79
Chapter 12 SpO2 Monitoring
12.1 Introduction
SpO
Plethysmogram measurement is employed to determine the oxygen saturation
2
of hemoglobin in the arterial blood. If, for example, 97% hemoglobin molecules in
the red blood cells of the arterial blood combine with oxygen, then the blood has a
SpO
oxygen saturation of 97%. The SpO2 numeric on the monitor will read 97%. The
2
SpO
numeric shows the percentage of hemoglobin molecules which have combined
2
with oxygen molecules to form oxyhemoglobin. The SpO
/PLETH parameter can also
2
provide a pulse rate signal and a plethysmogram wave.
How the SpO
/ PLETH Parameter Works
2
Arterial oxygen saturation is measured by a method called pulse oximeter. It is
a continuous, non-invasive method based on the different absorption spectra
of reduced hemoglobin and oxyhemoglobin. It measures how much light, sent
from light sources on one side of the sensor, is transmitted through patient
tissue , to a receiver on the other side.The sensor measurement wavelengths
are nominally 660nm for the Red LED and 880nm for Infrared LED. Maximum
optical power output for the Red LED is 6.65 mW and the Infrared LED is 6.75
mW. Optical sensors as the light-emitting components, will bring influence to
other medical devices applied the wavelength range. This information may be
useful for clinicians who carry out optical therapy.
The amount of light transmitted depends on many factors, most of which are
constant. However, one of these factors, the blood flow in the arteries, varies
with time, because it is pulsating. By measuring the light absorption during a
pulsation, it is possible to get the oxygen saturation of the arterial blood.
Detecting the pulsation gives a PLETH waveform and pulse rate signal.
The SpO
value and the PLETH waveform can be displayed on the main screen.
2
12.2 Safety information
WARNING
Only the SpO
sensor specified in this manual can be used, please use it
2
following the Use Manual, and obey all warnings and precautions.
Check if the sensor cable is in normal condition before monitoring. After
unplugging the SpO
the error message “SpO
Do not use the SpO
sensor cable from the socket, the system shall display
2
SENSOR OFF” and give the audible alarm.
2
sensor once the package or the sensor is found damaged.
2
Instead, you shall return it to the vendor.
ES (Electrosurgery) equipment cable and SpO
cable must not be tangled up.
2
Prolonged and continuous monitoring may increase the risk of unexpected
change of skin condition such as abnormal sensitivity, rubescence, vesicle,
repressive putrescence, and so on. It is especially important to check the
sensor placement of patient of poor perfusion or immature dermogram by
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80
light collimation and proper attaching strictly according to changes of the skin.
Check the sensor placement periodically and move it when the skin
deteriorates. More frequent examinations may be required for different
patients.
The person who is allergic to silicone or ABS can not use this device.
The SpO
this monitor. The monitor can only use the SpO
probe accompanying with the monitor is only intended for use in
2
probe supplied in this
2
manual. It is the operator's responsibility to check the compatibility of the
monitor, probe and extension cord before use, to avoid the patient's injury.
NOTE:
SpO2 waveform is not proportional to the pulse volume.
Some models of functional tester or patient simulator can measure the
accuracy of the device that reproduces the calibration curve, but it can not be
used to evaluate the accuracy of this device.
SpO
function is calibrated to show functional oxygen saturation.
2
The PLETH waveforms are not normalized, so the accuracy of the measured
values may decrease when the waveform does not tend to be smooth and
stable. When the waveform tends to be smooth and stable, the measured
value is the best value, and the waveform is the most standard.
The update time of measurement data is less than 10 seconds, which depends
on the PR value. Data averaging and other signal processing have no effect on
SpO
displaying and data values transmitted.
2
The device does not need to be calibrated during maintenance.
12.3 SpO
Measurement
2
1. During measuring, make sure that the wearing parts meet the following
conditions:
Pulsating blood flow, and circulation perfusion is well.
The thickness does not change, the thickness change will cause the mismatch
for the sensor and wear
parts.
2. PR will be displayed only under the following situations:
Select "HR FROM" as "SpO
" or “BOTH” in the ECG SETUP menu.
2
Select "HR FROM" as “AUTO” in the ECG SETUP menu and there is no ECG
signal.
NOTE:
Make sure the fingernail covers the light.
The SpO
value is always displayed in a fixed place.
2
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81
The declaration for SpO2 accuracy is supported by a clinical study covering the
entire range.
12.4 Monitoring steps
1. Switch on the monitor.
2. Insert the sensor plug into the SpO
jack.
2
3. Ear Sensor Placement
You can easily place the ear sensor as shown below.
Ear Sensor Placement
4. Tongue Sensor Placement
You can easily place the tongue sensor as shown below.
Tongue Sensor Placement
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82
WARNING
Check the wearing parts once per 2 to 3 hours to ensure the good skin texture
and proper light alignment. If the skin texture changes, move the sensor to
another location. It is best to change the wearing parts once per 4 hours.
NOTE:
Do not use photoelectric oximeters and SpO
sensors during magnetic
2
resonance imaging (MRI) scanning, as the induced current may cause burns.
12.5 Measurement Limitations
During measuring, the measurement accuracy can be affected by:
High-frequency electrical interference, such as the interference created by the
host system, or interference from external sources, for example electrosurgical
apparatus connected to the system.
Diagnostic test.
Electrosurgery unit.
Intravascular dye injections
Electromagnetic field effects, such as nuclear magnetic resonance equipment.
Excessive patient movement(patient moves actively or passively).
Improper sensor installation or incorrect contact position of the patient
Place the sensor on an extremity that has a blood pressure cuff, arterial
catheter, or intravascular line.
Significant concentrations of non-functional hemoglobin, such as
carboxyhemoglobin(COHb) and methemoglobin(MetHb).
Bad circular perfusion of the part being measured
For some special patients, it should be a more prudent inspecting in the
measurement part. The sensor can not be clipped on the edema and tender
tissue.
When the device is carried from cold environment to warm or humid
environment, please do not use it immediately.
Make sure the optical path is free from any optical obstacles like rubberized
fabric, to avoid inaccurate measurement.
Excessive ambient light may affect the measurement result. It includes
fluorescent lamp, dual ruby light, infrared heater, direct sunlight, etc.
The SpO
sensor and photoelectric receiving tube should be arranged in a way
2
with the subject’s arteriole in a position there between.
12.6 SpO
Turn the knob to move the cursor onto the SpO
the knob to "SpO
ALM REC: pick "ON", the system will output alarm information when SpO
SETUP
2
2
SETUP" menu.
hot key in the Parameter area, push
2
2
alarm occurs.
SWEEP: 12.5mm/s, 25.0 mm/s
SpO
alarm setup
2
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Set the following contents after entering the initial password "70808":
SpO
information when SpO
ALM: pick "ON", the system will give alarm prompt and store alarm
2
alarm occurs; pick "OFF", the system will not give alarm
2
and instead display a beside “SpO2”.
ALM LEV: set the alarm level, selectable from HI, MED and LO. HIGH
represents the most serious case.
SpO
exceeds set SpO
ALM HI and SpO2 ALM LO: SpO2 alarm is activated when the result
2
ALM HI value or falls below SpO2 ALM LO value.
2
PR ALM: pick "ON", the system will give alarm prompt and store alarm
information when PR alarm occurs.
PR ALM HI: PR alarm is activated when the pulse rate exceeds set PR ALM
HI value.
PR ALM LO: PR alarm is activated when the PR falls below PR ALM LO
value.
To further detect alarms for individual measurement parameters, perform a
measurement check on yourself or by using the simulator, adjust the alarm limits
setting and check if the correct alarm response is triggered.
WARNING
Set the upper limit of SpO
alarm to completely equal to off-state upper limit
2
alarm. High-oxygen level will cause fibrous fibrosis for preterm infants.
Therefore, the upper limit of the SpO
alarm must be carefully chosen
2
according to accepted clinical practice.
NOTE:
When the SpO
will be displayed continuously in the SpO
DEFAULT: select it to "SpO
alarm set is lower than 85 %, upper and lower limit of alarm
2
parameter area.
2
DEFAULT CONFIG" menu, in which you can select
2
"FACTORY DEFAULT CONFIG" or "USER DEFAULT CONFIG". After selecting one
item and exiting the interface, the system will pop up the dialog box asking for
your confirmation.
12.7 SpO
Alarm message
2
NOTE:
There is no alarm delay for SpO2.
SpO
alarm information
2
When the alarm switches are set to "ON" in relevant menus, the physiological alarms
caused by the parameter exceeding the alarm limit may possibly trigger the recorder
to automatically output the alarm parameter value and corresponding waveforms.
Tables below describe the possible physiological alarms, technical alarms and prompt
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Message
Cause
Alarm Level
upper limit of alarm.
User-selectabl
lower limit of alarm.
User-selectabl
e
PR measurement value is higher than the upper
limit of alarm.
User-selectabl
PR measurement value is lower than the lower
User-selectabl
Alarm
Level
or the monitor.
monitor and the cables is well.
SpO2 module
error.
Stop using the measuring
service staff.
Message
Cause
Alarm Level
PR
SpO2 SEARCH
TIMEOUT
SpO2 module cannot detect SpO2
signal for a long time.
HIGH
messages occurring during SpO2 measurement.
Physiological alarm:
SpO2 HI
SpO2 LOW
SpO2 measurement value is higher than the
SpO2 measurement value is lower than the
PR HI
PR LOW
limit of alarm.
Technical alarms:
Message Cause
SpO2
SENSOR
OFF
SpO2
COMM ERR
SpO2 sensor may
be disconnected
from the patient
failure or
communication
Prompt message:
SpO2 SEARCHING
e
e
e
Remedy
Make sure the sensor is placed
LOW
HIGH
in patient's finger or other parts,
and the connection between the
function of SpO2 module, notify
biomedical engineer or our
SpO2 module is searching for pulse. No alarm
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Chapter 13 NIBP Monitoring
13.1 Introduction
Measurement method: Oscillometry. It is applicable for adult, pediatric and neonate.
In order to know how the Oscillometry works, we compare it with auscultatory
method:
Auscultatory method: the doctor listens the blood pressure by the stethoscope,
to obtain the systolic pressure and diastolic pressure. When the artery pressure
curve is normal, the mean pressure can be calculated by the systolic pressure
and diastolic pressure.
Oscillometry: the blood pressure can not be listened by the monitor, it
measures the vibration amplitude of cuff pressure. Cuff vibration appears when
the blood pressure changes, the cuff pressure corresponding to the maximum
amplitude is the mean pressure, the systolic and diastolic pressure can be
calculated by the mean pressure.
In a word, the auscultatory method measures the systolic and diastolic pressure, then
calculates the mean pressure. And the Oscillometry measures the mean pressure,
then calculates systolic and diastolic pressure.
The clinical meaning for NIBP measurement must be determined by the physician.
When measuring during in representative patients group, compare the blood
pressure values measured by the device and auscultatory method, its accuracy meets
the requirements specified in IEC 80601-2-30:2009.
13.2 Safety information
WARNING
Before measuring, make sure that the monitoring mode and cuff type you
selected are appropriate for your patient(cat, dog or other animals). As false
settings may imperil patient's safety, higher adult settings are not suitable for
pediatric and neonate.
The animal on which the NIBP measurement is done must be no lessthan 2kg.
You must not perform NIBP measurement on patients with sickle-cell disease
or under any condition which the skin is damaged or expected to be
damaged.
Do not apply the cuff to a limb that has an intravenous infusion or catheter.
This could cause tissue damage around the catheter when infusion is slowed
or blocked during cuff inflation.
NIBP measurement can be performed during electrosurgery and defibrillator
discharge, as the device has the function of protecting burn patients.
The device can be used in existence of electrosurgical equipment, but when
using them together, user(doctor or nurse) should guarantee the patient's
safety.
Make sure that the air conduit connecting the blood pressure cuff and the
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monitor is neither blocked nor tangled.
The width of the cuff should be either 40% of the limb circumference or 2/3
of the upper arm length. The inflatable part of the cuff should be long
enough to circle 50-80% of the limb. The wrong size cuff can cause erroneous
readings. If the cuff size is in question, use a larger cuff.
If liquid is inadvertently splashed on the device or its accessories, or may
enter the conduit or inside the monitor, please contact with the maintenance
department in hospital.
NOTE:
If you are in doubt about the accuracy of any reading(s), check the patient's
vital signs by an alternative method before checking the functioning of the
monitor.
When the alarm prompt information for low battery appears, it is not
recommended to start NIBP measurement. As in this circumstance, it may
cause device shutdown.
13.3 Measurement Limitations
NIBP measurement can not be done on the patients with extreme heart rate(lower
than 40 bpm or higher than 240 bpm) or connecting with heart-lung machine.
The measurement may be inaccurate or can not be done in the following conditions:
Patient Movement
Measurement will be unreliable or may be impossible if the patient is moving,
shivering or having convulsions. As these conditions may interfere the detection of
the arterial pressure pulsation, and the measurement time will be prolonged.
Cardiac Arrhythmia's
Measurement will be unreliable and may be impossible if the patient has irregular
heartbeat arisen from cardiac arrhythmia, and the measurement time will be
prolonged.
Heart-lung Machine
Measurements will not be possible if the patient is connected to a heart-lung
machine.
Pressure Change
Measurement will be unreliable and may be impossible if the patient's blood
pressure is changing rapidly over the period of time during which the arterial
pressure pulsation are being analyzed to obtain the measurement values.
Severe Shock
If the patient is in severe shock or hypothermia, measurements will be unreliable
since the decrease for the blood flowed to the peripheries will cause the reduction of
artery pulsation.
Fat patient
The thick fat layer under the limb will decrease the measurement accuracy, as the
vibration from artery can not arrive to the cuff which is arisen from the fat damping.
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13.4 Measurement steps
1. Confirm the patient type, if it is false, please change "Patient type" in "PATIENT
SETUP" of "SYSTEM MENU".
2. Connect the airway tube with the NIBP interface of the device, then switch on
thedevice.
3. Select the cuff, make sure the cuff is completely deflated, then apply the cuff to
the patient's arm or leg following the instructions below.
Confirm the limb perimeter of the patient.
Fo r a CAT
For conscious patients, measurements from the coccygeal artery can be taken by
wrapping the cuff around the base of the tail. For anesthetized
patients,measurements from the median artery on the foreleg can be used by
wrapping the cuff around the forelimb, between the elbow and carpus. For cats less
than five pounds when measurements are difficult to obtain, place the cuff around
the leg above the elbow to obtain measurements from the brachial artery. Hair need
not be clipped except when heavily matted.
Cat Cuff Placement
For a DOG
For measurements in dogs, it is preferable to use the right lateral, stemal or dorsal
recumbent position. If the dog is in a sitting position, place the front paw on the
operator’s knee and take measurements from the metacarpus. The metacarpus,
metatarsus and anterior tibial are recommended for the cuff placement. For
anesthetized patients, most surgeries are done on the posterior part of the body so
the metacarpal area of the forelimb is most convenient. In situations where this is
not possible, place the cuff around the metatarsus just proximal to the tarsal pad or
around the hind leg next to the hock. For conscious patients, measurements from the
coccygeal artery can be used over the tail site.
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Dog Cuff Placement
For larger animals
It is preferable for a large animal, such as a horse and a cow, to be in a stock, standing
still. Measurments from the coccygeal artery on the ventral surface may be used by
placing the cuff around the base of the tail.
4. Connect the cuff to the airway tube. Make sure that the airway tube is neither
blocked nor
tangled.
5. Select a measurement mode in "NIBP SETUP" interface. Refer to the following
paragraphs "Operation Hints" for Details
6. Press "STA RT" button on the front panel to start a measurement.
NOTE:
The limb chosen for taking the measurement should be placed at the same
level as the patient's heart
If the animal’s hair over the artery site is too thick or matted for good contact,
it should be clipped.
The width of the cuff should be either 40% of the limb circumference (50% for
neonates) or 2/3 of the upper arm length. The inflatable part of the cuff
should be long enough to encircle 50-80% of the limb. The wrong size of cuff
can cause erroneous readings. If the cuff size is in question, then use a larger
cuff.
13.5 Operation hints
1. Manual operation
Select "MANUAL" in "INTERVAL" item of "NIBP SETUP" interface, then press
"START" button on the front panel to start a manual measurement.
During the idle time of auto measuring process, press "STAR T" button on the
front panel to start a manual measurement. Press "STA RT" button again to stop
manual measurement and the system continues auto measuring.
2. Auto measuring
Select a interval value in "INTERVAL" item of "NIBP SETUP" interface to perform auto
measurement., then press "START" button on the front panel to start the first
measurement, after finishing, the system will automatically measure according to the
interval time.
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3 4 2 1 6 8 5
MANUAL
9
CUFF:100
7
3. Continuous measuring
Select "CONTINUAL" item in "NIBP SETUP" interface to start a continuous
measurement. The precess will continue 5 minutes.
4. Stop measuring
During measuring, press "START" button on the front panel to stop measuring.
WARNING
In auto or continuous mode, if the time is too long, then the limb rubbed with
the cuff may appear purpura, ischemia and nerve injury. So when monitoring
the patient, patient's limb color, warmth and sensitivity should be checked
frequently. Once any abnormality appears, please replace the cuff location or
stop the NIBP measurement.
13.6 Amend results
Keep the limb to be measured and the patient's heart on one horizontal position.
Otherwise amend the measurement results by the following methods:
If the cuff is higher than the horizontal position of the heart, then the value
should add 0.75 mmHg(0.10 kPa) after the displayed value.
If the cuff is lower than the horizontal position of the heart, then the value
should subtract 0.75 mmHg(0.10 kPa) after the displayed value.
13.7 NIBP display
There is no waveform for NIBP measurement, it only displays the NIBP measurement
results. The following figure is only used for reference, your device may display a
different interface.
NIBP OVER PRESSURE
1. Alarm is off
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(mmHg/kPa)
FACTORY DEFAULT ADU
CONFIG
80/100/120/140/150/160/180/200
/220/240
CONFIG
FACTO RY D E FAULT NE O
CONFIG
USER DEFAULT ADU
CONFIG
/220/240
USER DEFAULT PED
CONFIG
USER DEFAULT NEO
CONFIG
2. Measurement time
3. Mean pressure
4. Unit: mmHg or kPa
5. Diastolic pressure
6. Current cuff presure
7. Prompt information area: display the prompt information related to the
N I BP.
8. Measurement mode
9. Systolic pressure
13.8 NIBP SETUP
Move the cursor to the NIBP hot key, press it to enter the "NIBP SETUP" interface.
ALM REC: select "ON" to enable report printing upon NIBP alarm.
Unit: mmHg or kPa
INTERVAL
Interval time in AUTO mode: 1/2/3/4/5/10/15/30/60/90/120/240/480/960 minutes.
After selecting the interval time, the information "Please start" will appear in the
NIBP prompt area, then press "START" button to start the first auto measurement.
Select "MANUAL" in interval time to stop auto measuring and enter to manual
measurement.
INFLATION
Press this button to select the initial pressure value for the cuff next time, there are
different pre-inflation value ranges in different default configurations, as shown in
the following table.
Default configurations
Default inflation
value
Selectable inflation value in manual
mode in NIBP menu(mmHg/kPa)
FACTORY DEFAULT PED
Press "MENU" button to enter "SYSTEM MENU" menu, then select a factory or user
configuration in "DEFAULT" menu, after configuration, return to the main interface to
select NIBP hot key to enter "NIBP SETUP" menu. Here the initial value for "Inflation"
is the initial inflation pressure value corresponding to default configuration, as shown
150
100 80/100/120/140/150/160/180/200
70 60/70/80/100/120
150
80/100/120/140/150/160/180/200
100 80/100/120/140/150/160/180/200
70 60/70/80/100/120
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in the above table. Move the cursor to the "Inflation" item and press it, inflation
value range(as shown in the above table) in MANUAL mode can be seen.
NOTE:
"Inflation" is used to help user select the cuff inflation pressure next time, but
the subsequent inflation is the measurement value of last systolic pressure
based on the same patient. The system momorizes the value, which can
shorten the measurement time of the same patient and increase the
measurement accuracy.
If user only sets the "Patient type" in "PATIENT SETUP" interface, does not
perform any selection in "DEFAULT", the system will operate according to the
initial setting of relative module parameter in "Patient type". The change of
default type setting in "DEFAULT" will alter the "Patient type" in "PATIENT
SETUP" interface.
NIBP alarm setup
Enter the initial password "70808" to set the following contents:
AlM: when pressure alarm occurs, the system will prompt and store the
alarm information after selecting "ON", it will not alarm when selecting "OFF",
and "
" will appear in parameter area.
ALM LEV: HIGH, MED and LOW, "HIGH" represents the most serious
alarm.
Pressure alarm is set according to the HIGH and LOW limits, alarm is activated when
the pressure is higher than the HIGH limit or lower than the LOW limit. Alarm for
systolic pressure, mean pressure and diastolic pressure can be set separately.
RESET
Restore measurement status of the pressure pump. Press this button to restore the
initial settings of the pressure pump. When the pressure pump does not work
properly and the system fails to give prompt information for the problem, press this
button to activate self-test procedure, thus restore the system from abnormal
performance.
CONTINUAL
Start a continuous measurement, after selecting it, the menu will automatically
disappears and measure continuously.
CALIBRATE(NIBP pressure calibration )
NIBP pressure calibration should be performed once per two years at least or once
when you thought that the reading is inaccurate.
Prepared materials:
Standard manometer
Metal container(500 ml)
Spheroidal air pump
Airway tube
T-shape connector
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