MDE Escort User manual

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ESCORT Prism™ & Prism SE

Patient Monitor

Reference Manual

Prism Model

20401 20403

Prism SE Model

20411 20412 20413 20414

ESCORT Prism™ & Prism SE

Patient Monitor

Reference Manual

Prism Model

20401 20403

Federal law restricts this device to sale by or on the order of a physician.

E9030-33R Rev F

Prism SE Model

20411 20412 20413 20414

Medical Data Electronics • 12723 Wentworth Street • Arleta, California 91331-4330

(818) 768-6411 • FAX (818) 768-0759

Medical Data Electronics • Rembrandtlaan 1B, 3723 BG • Bilthoven, The Netherlands

Tel: +31 (0) 30 2289711 Fax: +31 (0) 30 2286244

Preface

The ESCORT Prism and Prism SE Series monitors are intended only as an adjunct to patient assessment. They cannot replace skilled nursing care and proper surveillance. Carefully read this reference manual, all directions for use of monitor accessories, and all precautionary information before attempting clinical use of any Prism or Prism SE. Always keep high-risk patients under close surveillance. This monitor is a portable patient monitor intended for monitoring vital signs of critically ill adult, pediatric and neonatal patients in the hospital environment.

Carefully read the Defibrillator/Pacer section of this manual, all directions for use of the defibrillator/pacer, and all precautionary information before attempting clinical use of the defibrillator/pacer.

The information in this document is subject to change without notice.

Warranty

The Prism, Prism SE and the Defibrillator/Pacer are warranted against defects in materials and workmanship for a period of twelve (12) months from the date of shipment to the original purchaser. Batteries, cables, cuffs, and sensors are warranted ninety (90) days from date of shipment. Warranty is valid only to the original buyer. Defective equipment should be returned freight prepaid to Medical Data Electronics. Equipment returned with defective parts and assemblies will be either repaired or replaced. This warranty is not applicable if repair has been attempted, if the instrument has been damaged due to operation outside the environmental and power specifications for the product, or due to improper handling or use.

The foregoing warranty is in lieu of all other warranties expressed o r imp lied , including but not limited to any implied warranty or merchantability, fitness or adequacy for any particular purpose or use. Medical Data Electronics shall not be liable for any incidental or consequential damages.

Technical Service

If you experience any problems with this product, please call:

Technical Service Tel: (818) 768-6411 Technical Service FAX: (818) 768-2899 Email technicalsupport@emailmde.com

Trademarks and Acknowledgments

ESCORT® and the MDE logo are registered trademarks of MDE. ESCORT Guardian MASIMO C-Lock SureTemp

is a registered trademark of Masimo Corp.

and NELLCOR® are registered trademarks of Nellcor, Inc.

is a registered trademark of Welch AllynTM Inc. Medico2 is a trademark of Oridion Systems Ltd. Mircrostream

, and ESCORT PrismTM are trademarks of MDE.

and FilterLine® are registered trademarks of Oridion Systems Ltd.

Safety Considerations (Prism & Prism SE)

Read the following sections before using the Prism or Prism SE monitors. These cautions and warnings are presented to both increase patient safety and prevent damage to the monitor.

WARNING: Shock hazard. Do not remove cover. There are NO user serviceable parts. Contact qualified service personnel for all service and repair.

Do not under any circumstances remove grounding conductor from power plug. If there is any doubt about the integrity of the protective earth conductor arrangement, operate monitor on internal battery power until AC power supply protective conductor is fully functional.

To maintain patient electrical isolation, connect only to other equipment with electronically isolated circuits.

WARNING: As with all electrical equipment, carefully route patient cabling to reduce possibility of patient entanglement or strangulation.

WARNING: There is a potential fire hazard when used with oxygenemitting equipment, and danger of explosion when used near flammable anesthetics.

WARNING: Do not use monitor during magnetic resonance imaging (MRI). Induced current could potentially cause burns. The monitor may affect MRI image and the MRI unit may affect the accuracy of the monitor.

WARNING: To avoid shock hazard with RS-232 System Interconnection, first consult IEC60601-1 for system interconnection guidance. Specific requirements for system interconnection are dependent upon device connected to the monitor and relative locations of each device from patient, and relative location of connected device to room containing the monitor. In all circumstances, the monitor must be connected to a grounded AC power supply. The monitor is referred to as an IEC 601/F device in the Summary of Situations contained in IEC60601-1.

WARNING: When a remote display monitor is connected to the unit via the VGA connector on side of unit, it is essential the remote monitor is powered from a properly rated and approved isolation transformer. This is required to meet earth leakage limits of 0.5 mA, as per IEC60601-1, Cl. 19.3 for monitor.

WARNING: When connecting monitor to any other instrument, verify proper operation before clinical use. Refer to the other instrument’s operation manual for complete instructions.

WARNING: All input/output interfaces to the patient monitors must be CSA601.1/UL2601-1, EN 60601-1 approved devices.

WARNING: Do not under any circumstance use replacement parts and connect devices that are not approved by Medical Data Electronics.

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CAUTION: Always locate the Prism or Prism SE and its power cord away from any electrosurgery and diathermy equipment and its power cord and cables.

CAUTION: When operating either the Prism or Prism SE monitor from an AC power source, the wall receptacle must be a three-wire, grounded, hospital grade outlet. Use only the monitor’s original hospital grade AC power plug and cord, or an equivalent hospital grade plug and cord. If in doubt about integrity of grounding of the main supply connection, the unit must be operated by battery power.

CAUTION: DO NOT plug the unit into a multiple outlet power strip to avoid summation of leakage currents.

CAUTION: Do not use in ambient temperatures above 40° C or below 5° C.

CAUTION: When using an external DC power source, the equipotential connector must be used as a protective ground terminal.

Symbols (Prism & Prism SE)

The following symbols appear on the Prism and Prism SE monitors, and may appear on accessory items. Familiarize yourself with these symbols and their meaning before using the monitor.

Type CF Defibrillation Protected Equipment: Isolated patient connections comply with allowable leakage current limits for direct cardiac application and are protected against effects of defibrillation.

Type CF Applied Part: Isolated Patient connections comply with the allowable leakage current limits for direct cardiac application.

Attention: Consult accompanying documents.

Replace Fuses as Marked: For protection against fire, replace only with

fuses of same type and rating.

Caution: Dangerous voltage.

Alternating Current: 100-240V @ 50/60 Hz.

Equipotential Connection: When external DC power is used, the

equipotential connection must be used as a protective ground terminal.

Fuse: Voltage and current ratings appear adjacent to symbol.

The CE symbol indicates device conforms to the Medical Device Directive.

Single patient use only.

Table of Contents

Chapter 1 – Physical Description........................................................................................................... 1-1

Prism & Prism SE Front Panel..................................................................................................... 1-1

Fixed Function Keys (USA and International)............................................................................. 1-2

ON/STBY ..............................................................................................................................1-2

ALARM SUSPEND .............................................................................................................. 1-2

ALARM SETUP.................................................................................................................... 1-3

FREEZE................................................................................................................................. 1-3

NIBP START/STOP.............................................................................................................. 1-3

PATIENT TYPE....................................................................................................................1-3

SYSTEM SETUP .................................................................................................................. 1-3

PAGE HOME ........................................................................................................................ 1-3

RECORD ............................................................................................................................... 1-4

Parameter Softkeys....................................................................................................................... 1-4

WAVEFORM SOFTKEYS................................................................................................... 1-4

SYSTEM SOFTKEYS........................................................................................................... 1-4

Indicators...................................................................................................................................... 1-5

AC ON INDICATOR ............................................................................................................ 1-5

BATTERY CHARGING INDICATOR................................................................................ 1-5

ALARM INDICATORS........................................................................................................ 1-5

Prism & Prism SE Display Screen ...............................................................................................1-6

ECG Lead in Use................................................................................................................... 1-7

Softkey Labels for Parameters Displayed in the Waveform Display Zone (WDZ)............... 1-7

Alarm Status for Parameters in the Waveform Display Zone................................................ 1-7

Alarm Status for Parameters in the NODZ............................................................................ 1-7

Numeric-Only Display Zone (NODZ)................................................................................... 1-7

Message Area for Parameters in the NODZ ..........................................................................1-7

System Message Area............................................................................................................ 1-8

Message Area for Parameters in the WDZ ............................................................................1-8

Waveform Display Zone with Associated Numerics............................................................. 1-8

Current Monitoring Mode (Patient Type selected)................................................................ 1-8

Prism SE Rear Panel..................................................................................................................... 1-9

External DC Input (12 - 28V) Connector ............................................................................ 1-10

Fuse Holder and Fuse Replacement..................................................................................... 1-10

AC Power Cord Input Connector and Optional Power Cord Mounting Bracket................. 1-10

Battery Compartment ........................................................................................................... 1-11

Model & Serial Number Label............................................................................................. 1-11

Add-On Module Interface.................................................................................................... 1-11

Auxiliary Output Connector ................................................................................................1-11

VGA Output Connector....................................................................................................... 1-11

Serial Interface (ISP Port).................................................................................................... 1-11

Equipotential Connector (Grounding Terminal).................................................................. 1-11

Prism Rear Panel ........................................................................................................................ 1-12

External DC Input (12 - 28V) Connector ............................................................................ 1-13

Equipotential Connector (Grounding Terminal).................................................................. 1-13

Batteries ............................................................................................................................... 1-13

Defibrillator/Pacer Interface ................................................................................................1-13

Fuse Holder/Voltage Selector and Fuse Replacement......................................................... 1-13

AC Power Cord Input Connector and Optional Power Cord Mounting Bracket................. 1-13

Auxiliary Output Connector ................................................................................................1-14

Add-On Module Interface.................................................................................................... 1-14

Recorder Release Lever....................................................................................................... 1-14

Model & Serial Number Label............................................................................................. 1-14

Prism SE Side Panel................................................................................................................... 1-15

Connector Panel................................................................................................................... 1-15

Dual Channel Recorder........................................................................................................ 1-15

SureTemp Unit..................................................................................................................... 1-15

Prism Side Panel......................................................................................................................... 1-16

Multiparameter Module....................................................................................................... 1-16

Dual Channel Recorder Module ..........................................................................................1-16

Serial Interface (ISP Port).................................................................................................... 1-16

VGA Output Connector....................................................................................................... 1-17

Prism’s Modular Components.................................................................................................... 1-18

Prism SE’s Modular Components.............................................................................................. 1-19

Chapter 2 – General Instructions for Using the Patient Monitor....................................................... 2-1

Determine the Power Source..................................................................................................... ... 2-1

Prism’s Modular Batteries............................................................................................................ 2-1

Prism SE’s Battery .......................................................................................................................2-1

Prism’s Multiparameter Module...................................................................................................2-1

Prism SE’s Connector Panel......................................................................................................... 2-2

Turning Monitor ON and OFF..................................................................................................... 2-2

Vital Sign Setup Menus................................................................................................................ 2-2

Temporary Suspension of Monitoring.......................................................................................... 2-3

Basic Configuration Functions..................................................................................................... 2-3

Monitor Default Settings..............................................................................................................2-5

Setting Up Parameter Display Options......................................................................................... 2-5

Parameter Availability and ON/OFF Status........................................................................... 2-5

Parameter ON/OFF................................................................................................................2-5

Parameter Labels ON/BLANK.............................................................................................. 2-5

Parameter Colors and Tones.................................................................................................. 2-5

“MORE PRAMS AVAIL” .................................................................................................... 2-6

Chapter 3 – Vital Sign Parameter Usage............................................................................................... 3-1

ECG.............................................................................................................................................. 3-1

Patient Preparation................................................................................................................. 3-2

Selecting a Telemetry Patient to Monitor.............................................................................. 3-4

Correcting CHK Leads (Check Leads) Errors....................................................................... 3-4

Respiration.................................................................................................................................... 3-5

Cardiovascular Artifact Detection (CVA) .............................................................................3-5

Using CO2 as the Resp Source.............................................................................................. 3-5

Pulse Oximetry (SPO2)................................................................................................................ 3-6

SPO2 Sensor Accessories—Nellcor ......................................................................................3-8

SPO2 Sensor Accessories—Masimo..................................................................................... 3-9

SPO2 Alarm Delay ................................................................................................................3-9

SPO2 Averaging Time........................................................................................................... 3-9

Temperature Monitoring ............................................................................................................3-10

Measuring a Patient’s Temperature with Continuous Probes.............................................. 3-10

Measuring a Patient’s Temperature with SureTemp®.......................................................... 3-10

Noninvasive Blood Pressure Measurements (NIBP).................................................................. 3-11

Selecting an appropriate NIBP Cuff .................................................................................... 3-13

Displaying the NIBP Table.................................................................................................. 3-13

Invasive Blood Pressure............................................................................................................. 3-14

Pulmonary Artery Monitoring ............................................................................................. 3-15

Storage of Invasive Pressure Values to VSC....................................................................... 3-16

5th Trace Option ...................................................................................................................3-16

Cardiac Output and Hemodynamic Calculations ....................................................................... 3-17

Selecting a Thermodilution Catheter ................................................................................... 3-18

End Tidal Carbon Dioxide (ETCO2) (Prism Only).................................................................... 3-19

ETCO2 (CO2) Sensor and Airway Adapter Maintenance (Prism Only)............................. 3-21

End Tidal Carbon Dioxide (ETCO2) (Prism SE Only).............................................................. 3-22

Graphical Trends........................................................................................................................ 3-24

Vital Sign Chart (VSC) ..............................................................................................................3-24

Storing VS Charts in Monitor Memory............................................................................... 3-26

“Episodic” VS Entries.......................................................................................................... 3-26

Clearing Patient Data from VSC (Vital Sign Chart)............................................................ 3-26

Oxycardiorespirogram (OxyCRG/CRG).................................................................................... 3-27

Alarms........................................................................................................................................ 3-28

Alarm Bells.......................................................................................................................... 3-30

Alarm Tones......................................................................................................................... 3-30

Latch Alarms........................................................................................................................ 3-31

Recorder ..................................................................................................................................... 3-31

Chapter 4 – Additional User Infromation............................................................................................. 4-1

Wireless Communication to a Central Station .............................................................................4-1

Guidelines for Cleaning................................................................................................................ 4-1

Maintenance and Calibration........................................................................................................ 4-2

Telemetry Monitoring ..................................................................................................................4-2

CIS Functions............................................................................................................................... 4-2

Storage and Transport .................................................................................................................. 4-2

Chapter 5 – Main Setup Menus .............................................................................................................5-1

System Setup Menus.................................................................................................................... 5-1

ECG Setup Menus........................................................................................................................ 5-2

Respiration Setup Menus.............................................................................................................. 5-2

Pulse Oximetry (SPO2) Setup Menus.......................................................................................... 5-3

Invasive Blood Pressure (IBP) Setup Menus ...............................................................................5-3

Noninvasive Blood Pressure (NIBP) Setup Menus...................................................................... 5-4

Continuous Temperature Setup Menus........................................................................................ 5-5

SureTemp Menu...........................................................................................................................5-5

End Tidal Carbon Dioxide (ETCO2) Setup Menus ..................................................................... 5-6

Cardiac Outpt Setup Menus.......................................................................................................... 5-6

Vital Sign Chart (VSC) Setup Menus .......................................................................................... 5-7

Chapter 6 – Factory Defaults .................................................................................................................6-1

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System Setup Factory Defaults .................................................................................................... 6-1

Recorder Factory Defaults............................................................................................................ 6-2

Vital Signs Chart Factory Defaults............................................................................................... 6-2

ECG Setup Factory Defaults........................................................................................................ 6-3

Respiration Setup Factory Defaults..............................................................................................6-3

SPO2 Setup Factory Defaults....................................................................................................... 6-4

BP1 Setup Factory Defaults ......................................................................................................... 6-5

BP2 Setup Factory Defaults ......................................................................................................... 6-6

BP3 Setup Factory Defaults ......................................................................................................... 6-7

NIBP Setup Factory Defaults....................................................................................................... 6-8

CO2 Setup Factory Defaults......................................................................................................... 6-9

CO Setup Factory Defaults........................................................................................................... 6-9

Temp1 Setup Factory Defaults................................................................................................... 6-10

Temp2 Setup Factory Defaults................................................................................................... 6-10

Chapter 7 – System & Parameter Messages .........................................................................................7-1

System Messages.......................................................................................................................... 7-1

System Messages................................................................................................................... 7-1

Battery Messages................................................................................................................... 7-2

Parameter Messages .....................................................................................................................7-2

ECG/Respiration Messages ................................................................................................... 7-2

SPO2 Messages...................................................................................................................... 7-3

Invasive Blood Pressure (BP1/BP2/BP3) Messages.............................................................. 7-3

Noninvasive Blood Pressure (NIBP) Messages..................................................................... 7-4

ETCO2 Messages................................................................................................................... 7-4

SureTemp Messages ..............................................................................................................7-5

Cardiac Output (CO) Messages ............................................................................................. 7-6

Chapter 8 – Defibrillator/Pacer.............................................................................................................. 8-1

Introduction.................................................................................................................................. 8-1

Safety Considerations (Defib/Pacer)............................................................................................ 8-1

Symbols (Defib/Pacer) ................................................................................................................. 8-2

Cleaning, Maintenance, & Calibration......................................................................................... 8-2

Defibrillator/Pacer Front Overview..............................................................................................8-3

Defibrillator/Pacer Rear Overview...............................................................................................8-4

Defibrillator/Pacer Front Panel..................................................................................................... 8-5

Using Defibrillator and Pacer Paddles and Electrodes................................................................. 8-6

External Paddles .................................................................................................................... 8-6

Pediatric Paddles.................................................................................................................... 8-6

Disposable Adhesive Electrodes............................................................................................ 8-6

To Apply Disposable Adhesive Electrodes to the Patient: .................................................... 8-7

Internal Paddles...................................................................................................................... 8-7

Operating the Defibrillator........................................................................................................... 8-8

Disarming the Defibrillator.................................................................................................... 8-9

“Hands-Off” Defibrillation........................................................................................................... 8-9

To Defibrillate Using “Hands-Off” Procedure: ..................................................................... 8-9

Synchronized Cardioversion ......................................................................................................8-11

To Initiate Synchronized Cardioversion Procedure:............................................................ 8-11

Operating the Pacer .................................................................................................................... 8-11

To Pace with Dedicated Electrodes: ....................................................................................8-12

Pacing and Defibrillating with the Same Electrodes............................................................ 8-14

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Chapter 9 – Clinical Information System.............................................................................................. 9-1

Introduction............................................................................................................................ 9-1

Operation ...............................................................................................................................9-1

Accessing the CIS Menu........................................................................................................ 9-2

Interacting with the CIS Menu............................................................................................... 9-3

CIS Status Message Zone ......................................................................................................9-4

Setting up a Patient for Data Collection ................................................................................ 9-4

Initializing a New Patient Record: ..................................................................................9-5

Initiating a Patient Query: ...............................................................................................9-5

Confirming the Patient:................................................................................................... 9-7

Filing Vital Signs / Results....................................................................................................9-7

Selecting the Appropriate Filing Mode:.......................................................................... 9-7

Using the VSC Function to Set Up CIS Charting Intervals ............................................9-8

Manually Entering Vital Signs Data Using the CIS Menu............................................ 9-13

CIS Module Storage Capacity....................................................................................... 9-14

Deleting Vital Signs Entries................................................................................................. 9-14

Viewing the Current Patient Information............................................................................. 9-15

Special Circumstances......................................................................................................... 9-15

Sending Patient Data Stored in the CIS Module After the Fact.................................... 9-15

Using the Temporary Name Feature .............................................................................9-17

Retrieving Vital Signs from Previous Patients.............................................................. 9-18

RS-232 Communication....................................................................................................... 9-19

Parameter Packet........................................................................................................... 9-19

Waveform Packet.......................................................................................................... 9-20

Additional Waveforms.................................................................................................. 9-23

Wiring Diagrams........................................................................................................... 9-24

Chapter 10 – Troubleshooting.............................................................................................................. 10-1

Chapter 11 – Supplies, Accessories, & Options.................................................................................. 11-1

Chapter 12 – Specifications ..................................................................................................................12-1

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Chapter 1 – Physical Description

This section describes the controls, indicators, and features located on the front, back, and side panels of the Prism and Prism SE Patient Monitors.

Prism & Prism SE Front Panel

1. Monitor On/Standby Keys

2. Battery Charging Indicator

3. AC Power Indicator

4. Alarm Indicator Lights

When flashing, one or more parameters are alarming

When lit, one or more alarms are suspended, OR all alarms are turned off

5. Alarm Suspend Key (180 seconds)

6. Alarm Setup Key

7. Softkeys for Parameters in Waveform Display Zone

8. Freeze/Unfreeze All Waveform Traces

9. NIBP Start/Stop Key

1-1

10. Patient Type Selection Key (Adult, Ped, Neo)

11. Start/Stop Manual Recordings

12. Display System Setup Menu

13. Return to Home Page

14. Seven Parameter/System Softkeys

Fixed Function Keys (USA and International)

The Prism & Prism SE monitor includes the following nine (9) fixed functions keys: ON/STBY, ALARM SUSPEND, ALARM SETUP, FREEZE, NIBP START/STOP, PATIENT TYPE, SYSTEM SETUP, PAGE HOME, and RECORD. Each of these keys, as the name implies (or

symbol for International), is fixed and performs its intended function regardless of the monitoring scenario. A brief description of each is provided below.

ON/STBY

Turns the display on and initializes the monitor when ON is pressed. When the monitor is turned on, you will hear two beeps. The monitor is returned to standby status by pressing STBY. When in STBY, the batteries continue to be charged if the monitor is connected to AC power, but no monitoring or storing of data occurs. The Prism SE batteries will also charge when using eternal DC power.

ALARM SUSPEND

Temporarily suspends alarm tones. The factory defaults for alarm suspend intervals are 180 seconds in adult mode, 90 seconds in pediatric mode, and 60 seconds in neonatal mode. If an alarm limit is violated, pressing ALARM SUSPEND will silence the alarm tone. Pressing the key again before the suspend time period has elapsed will reactivate the audible alarm tones if the alarm condition still exists. While alarms are suspended, the following message will appear on the monitor screen:

ALARMS SUSPENDED XXX

The XXX will be replaced with the number of seconds remaining until the alarm suspend condition is removed.

1-2

ALARM SETUP

Displays the alarm status for all vital sign parameters. Alarm ON/OFF status, alarm priority level, high and low limits, and recording type for each active parameter are displayed.

A bell… … next to the listed parameter indicates that one or more alarms for that parameter is ON. An X is displayed when all alarms for the associated parameter are OFF.

FREEZE

Freezes all displayed waveforms for evaluation purposes. Pressing FREEZE again releases waveforms.

NOTE: Waveforms cannot be frozen during recording. Initiating a recording will also release the frozen waveforms.

NIBP START/STOP

Pressing the NIBP START/STOP key immediately initiates an inflation and measurement. You can also press the NIBP softkey to access the setup keys for setting automatic measurement intervals.

PATIENT TYPE

The PATIENT TYPE key is used to select or display the current patient type. The selections are ADULT, PED, and NEO.

SYSTEM SETUP

SYSTEM SETUP is used to change the monitoring conditions that your monitor is currently set

up for.

PAGE HOME

Returns the monitor display to the HOME PAGE screen (i.e., the screen normally displayed during patient monitoring).

1-3

RECORD

Initiates a 16-second recording of any one or two parameter waveforms. To stop a recording in process, press RECORD prior to completion of a manual or alarm recording. To specify the parameters to be recorded, press the softkey(s) of the desired parameter(s) within two seconds after pressing the RECORD key. If no parameters are selected after pressing record, a 16-second strip of ECG waveform will be recorded.

NOTE: Active waveforms (i.e., parameters currently being monitored) do not need to be displayed in order to acquire a recorded waveform.

Parameter Softkeys

The monitor is equipped with eleven (11) softkeys. Softkey operation changes depending upon the monitoring mode, parameter, or configuration options being accessed. Four parameter softkeys are located to the right of the display screen. Seven parameter/system softkeys are located below the display screen.

WAVEFORM SOFTKEYS

These four softkeys, located on the right side of the front panel, provide access to the function keys of the parameters displayed in the waveform display zone. ECG is always assigned to the top waveform trace, and as many as three additional parameters, when available (i.e., installed), can be assigned to trace 2, 3, 4, or 5 depending upon options.

SYSTEM SOFTKEYS

The function of these seven softkeys, located directly below the display screen, depends on the label or function key displayed directly above the softkey. In the HOME PAGE state, parameter labels and associated numeric values may be displayed directly above one or more of the softkeys. To access the function keys for any of these parameters, press the softkey under the parameter label and a page of function keys that relates specifically to that parameter will be displayed.

1-4

Indicators

The monitor includes up to four indicators, which illuminate to notify the operator of a specific activity or situation. These indicators notify the operator of AC power, battery charging, and alarm status.

AC ON INDICATOR

The green AC ON LED (Light Emitting Diode) illuminates when the monitor is connected to AC power.

BATTERY CHARGING INDICATOR

The yellow CHARGING LED illuminates when the monitor’s batteries are charging. The CHARGING LED will not be illuminated when the batteries are fully charged, or when the monitor is not connected to AC power.

ALARM INDICATORS

When flashing, one or more parameters are alarming.

When lit, one or more alarms are suspended, OR all alarms are turned off.

1-5

Prism & Prism SE Display Screen

1. ECG Lead in Use

2. Softkey Labels for Parameters Displayed in the Waveform Display Zone (WDZ)

3. Alarm Status for Parameters in the Waveform Display Zone

4. Alarm Status for Parameters in the Numeric Only Display Zone

5. Numeric-Only Display Zone (NODZ)

6. Message Area for Parameters in the Numeric Only Display Zone

7. System Message Area

8. Message Area for Parameters in the Waveform Display Zone

9. Waveform Display Zone with Associated Numerics

10. Current Monitoring Mode (Patient Type selected)

1-6

1. ECG Lead in Use

Indicates the ECG lead displayed in the top trace of the WDZ. Choices include lead I, II, III, or V LD (and depending on hardware and software, choices may include aVF, aVL, or aVR) (for “chest lead” in a 5-lead configuration). If heart rate is being derived from SpO2 or Invasive Blood Pressure, PULSE is displayed.

2. Softkey Labels for Parameters Displayed in the Waveform Display Zone (WDZ)

The labels displayed adjacent to the parameter softkeys specify the parameters displayed in the WDZ.

3. Alarm Status for Parameters in the Waveform Display Zone

Each bell displayed in the WDZ indicates the alarm ON/OFF status for the parameter adjacent to it.

If a solid bell is displayed, one or more alarm for the associated parameter is ON.

If the bell is displayed with an X through it, the alarms for the associated parameter are OFF.

4. Alarm Status for Parameters in the Numeric-Only Display Zone (NODZ)

Each bell displayed in the Numeric-Only Display Zone indicates the alarm ON/OFF status for the parameter listed below it.

If a solid bell is displayed, one or more alarm for the associated parameter is ON.

If the bell is displayed with an X through it, the alarms for the associated parameter are OFF.

5. Numeric-Only Display Zone (NODZ)

The parameter labels displayed above the softkeys at the bottom of the front panel specify the parameters associated with each softkey. The numeric data associated with the parameters are displayed above the parameter labels in the Numeric-Only Display Zone.

NOTE: In the HOME PAGE state, the parameter labels and numeric data are displayed directly above the softkeys. When a parameter or system setup page is displayed above the softkeys, the Numeric-Only parameter labels and associated data are displayed slightly above the setup page.

6. Message Area for Parameters in the NODZ

Messages concerning parameters in the NODZ will be displayed in a reverse-video box on the left side of the screen, just above the NODZ. Message display is temporarily obscured when a parameter or system setup page is displayed. In the HOME PAGE state, the message continues to be displayed as long as the message condition exists.

1-7

7. System Message Area

A message that is not specific to a single parameter, such as “ALARMS SUSPENDED 180”, is displayed in a reverse-video box, just below the WDZ. Message display is temporarily obscured when a parameter or system setup page is displayed. In the HOME PAGE state, the message continues to be displayed as long as the message condition exists.

8. Message Area for Parameters in the WDZ

Messages concerning parameters displayed in the WDZ will be displayed in a video box below the numeric data for the corresponding waveform parameters. The message is displayed as long as the message condition exists.

9. Waveform Display Zone with Associated Numerics

The Waveform Display Zone displays waveform traces and associated numeric data for as many as four different parameters. The top waveform trace is reserved for the ECG waveform; however, you can assign different parameters to the other three waveform traces.

10. Current Monitoring Mode (Patient Type selected)

The current monitoring mode is displayed at the top of the screen — ADULT, PED, or NEO. The monitoring mode can be changed through the system function key ADULT/PED/NEO.

1-8

Prism SE Rear Panel

1. External DC` Input Connector (optional)

2. Fuse Holder

3. AC Power Cord Input Connector

4. Battery Compartment

5. Model & Serial Number Label

6. Add-On Module Interface (MDE Modules)

7. Auxiliary Output Connector (optional)

8. VGA Output Connector (optional)

9. Serial Interface (ISP Port)

10. Equipotential Connector (grounding terminal) (optional)

1-9

1. External DC Input (12 - 28V) Connector

Allows an external DC power source to be connected for extended use during transport where AC power is not available. Batteries are also charged with external DC power.

2. Fuse Holder and Fuse Replacement

The fuse holder contains the fuses for the monitor. Open the door of this holder to replace fuses. It is recommended that qualified technical service personnel replace fuses when necessary.

WARNING: For protection against fire, replace the fuses only with those of the same type and rating.

The Prism SE requires two identical slow blow T2.5A / 250V fuses for operation. Ensure that the AC power cord has been disconnected before replacing fuses. Carefully open the door of the fuse holder with a short 1/8" flat screwdriver. Replace the blown or defective fuse with one of the same type and rating. Noting orientation, gently slide the fuse holder back until it locks snugly into its original place. After the fuse replacement, connect the AC power cord to the Prism SE. The unit is now ready for operation.

3. AC Power Cord Input Connector and Optional Power Cord Mounting Bracket

Allows connection of the AC power cord to the monitor. In addition, the AC power cord must be plugged into an AC source before the monitor can operate on AC power and before the batteries can be charged.

For permanent connection, the MDE power cord bracket should be installed. See the following figure for instructions on installing the power cord mounting bracket.

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4. Battery Compartment

This compartment houses one battery (or up to two batteries on earlier units) which provide power in transport situations or when AC power is not available.

5. Model & Serial Number Label

This label contains the model number and serial number of the monitor.

6. Add-On Module Interface

If a transceiver module is connected here, wireless communications between the monitor and an MDE Central Station can be established.

If a telemetry receiver module is connected, communication between the monitor and an ambulatory transmitter can be established.

If a CIS module is connected, communication to a hospital information system computer can be established, or RS232 communications can be established.

7. Auxiliary Output Connector

Provides analog waveform or alarm relay closure interface signals from the Prism SE to other clinical instruments.

WARNING: When connecting the Prism SE to any other instrument, verify proper operation before clinical use. Refer to the other instrument’s operation manual for complete instructions.

8. VGA Output Connector

Allows for an external VGA monitor to be connected. The same information that is displayed on the Prism SE monitor will display on the external VGA monitor. Output resolution is 640 x 480 pixels.

9. Serial Interface (ISP Port)

This port is used to upload and download software data from external sources.

10. Equipotential Connector (Grounding Terminal)

Provides grounding for the monitor when the monitor is used with other medical equipment. It must be used as a protective ground terminal when the monitor is operated with external DC power.

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Prism Rear Panel

1. External DC Input Connector (optional)

2. Equipotential Connector (grounding terminal) (optional)

3. Batteries

4. Defibrillator/ Pacer Interface

5. Fuse Holder/Voltage Selector

6. AC Power Cord Input Connector

7. Auxiliary Output Connector

8. Add-On Module Interface (J1 Connector)

9. Recorder Release Lever

10. Model & Serial Number Label

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1. External DC Input (12 - 28V) Connector

Allows an external DC power source to be connected for extended use during transport where AC power is not available. Batteries are not charged with external DC power.

2. Equipotential Connector (Grounding Terminal)

Provides grounding for the monitor when the monitor is used with other medical equipment. It must be used as a protective ground terminal when the monitor is operated with external DC power.

3. Batteries

These two slots contain modular batteries which provide power in transport situations or when AC power is not available.

4. Defibrillator/Pacer Interface

Provides connection and communication between the Prism monitor and the ESCORT Defibrillator/Pacer.

5. Fuse Holder/Voltage Selector and Fuse Replacement

The fuse holder contains the fuses and the voltage selector for the monitor. Open the door of this holder to replace fuses or to configure the voltage selection block — 115 VAC or 230 VAC. The present voltage setting can be read through the small rectangular window on the door of the holder. It is recommended that qualified technical service personnel replace fuses or change the voltage selection when necessary.

WARNING: For protection against fire, replace the fuses only with those of the same type and rating.

The Prism requires two identical slow blow 0.5A fuses for 115 VAC operation, or two slow blow

0.25A fuses for 220 VAC operation. Ensure that the AC power cord has been disconnected before replacing fuses. Carefully open the door of the fuse holder with a short 1/8" flat screwdriver. Replace the blown or defective fuse with one of the same type and rating. Noting orientation, gently slide the fuse holder back until it locks snugly into its original place. After the fuse replacement, connect the AC power cord to the Prism. The unit is now ready for operation.

6. AC Power Cord Input Connector and Optional Power Cord Mounting Bracket

For permanent connection, the MDE power cord bracket should be installed. See the following figure for instructions on installing the power cord mounting bracket.

1-13

7. Auxiliary Output Connector

Provides analog waveform or alarm relay closure interface signals from the monitor to other clinical instruments.

WARNING: When connecting the Prism to any other instrument, verify proper operation before clinical use. Refer to the other instrument’s operation manual for complete instructions.

8. Add-On Module Interface

If a transceiver module is connected here, wireless communications between the monitor and an MDE Central Station can be established.

If a telemetry receiver module is connected, communication between the monitor and an ambulatory transmitter can be established.

If a CIS module is connected, communication to a hospital information system computer can be established, or RS232 communications can be established.

9. Recorder Release Lever

Push this lever towards the recorder to release.

10. Model & Serial Number Label

This label contains the model number and serial number of the monitor.

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Prism SE Side Panel

1-15

Connector Panel

The Prism SE can monitor several parameters. They include ECG, SPO2, IBP (Invasive Blood Pressure), NIBP (Noninvasive Blood Pressure), Respiration, ETCO

, Cardiac Output and

Temperature.

Dual Channel Recorder

The Recorder unit provides manual and alarm recordings of any one or two waveforms simultaneously.

SureTemp Unit

Allows you to take a patient’s temperature with different types of SureTemp probes and measurements sites.

Prism Side Panel

1-16

1-17

Multiparameter Module

The Multiparameter Module is configured for several parameters; however your Multiparameter Module may be configured for fewer parameters. The parameters include ECG, SPO

(Invasive Blood Pressure), NIBP (Noninvasive Blood Pressure), Respiration, ETCO

, IBP

Cardiac Output, Temperature and SureTemp. This module may be interchanged with any

Prism monitor.

Dual Channel Recorder Module

The Recorder module provides manual and alarm recordings of any one or two waveforms simultaneously.

Serial Interface (ISP Port)

This port is located inside the MPM well and is used to upload and download software data from external sources. Only Prism LCD models 20403 with CPU Board assembly 403950 has ISP capability.

VGA Output Connector

The VGA OUTPUT port allows for an external VGA monitor to be connected. The same information that is displayed on the Prism monitor will display on the external VGA monitor. See the following.

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Prism’s Modular Components

There are several modular (user-movable) components that can be shared by all Prism monitors.

• Multiparameter Module (MPM) – allows you to share various configurations of parameters

between monitors.

• Dual Channel Recorder Module – provides manual and alarm recordings of any one or two

waveforms simultaneously.

• Modular Batteries – supplies battery power to the Prism monitor for operation in transport

situations, or when AC power is not available.

• Transceiver Module – provides two-way wireless communication to the ESCORT-Link or

ESCORT Vision Central Station, and serves as a repeater for the wireless network.

• Telemetry Module – allows for bedside monitoring of telemetry patients.

• CIS Communication Module – provides serial and Ethernet TCP/IP interface to HIS/CIS

systems for automated charting.

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Prism SE’s Modular Components

There are several modular (user-movable) components that can be shared by all Prism & Prism SE monitors.

• Transceiver Module – provides two-way wireless communication to the ESCORT-Link or

ESCORT Vision Central Station, and serves as a repeater for the wireless network.

• Telemetry Module – allows for bedside monitoring of telemetry patients.

• CIS Communication Module – provides serial and Ethernet TCP/IP interface to HIS/CIS

systems for automated charting.

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Chapter 2 – General Instructions for Using the Patient Monitor

Determine the Power Source

The Prism and Prism SE can be powered in one of three ways: AC, battery, and external DC power.

An optional auxiliary DC connector (center pin positive) labeled EXT DC 12-28V, 30VA is located on rear panel of monitor to allow external DC power source when AC is not available.

NOTE: Monitor should be plugged into AC power at every opportunity to allow batteries (optional) to charge.

Prism batteries remain at their current power level during external DC operation, but will not charge until plugged into AC power. Prism SE batteries charge during DC operation.

To avoid corrosion, remove batteries if the monitor is disconnected from AC power for an extended period of time.

Prism’s Modular Batteries

The Prism utilizes up to two (2) rechargeable sealed lead-acid batteries.

NOTE: Never discharge batteries completely. To insure long battery life, always recharge batteries immediately after use. An optional battery charger (MDE Part Number E2700-12) is recommended. Batteries should be replaced every two (2) years regardless of test results. Used batteries should be recycled or disposed of properly.

 To install or remove a modular battery:

1. Turn the battery latch on rear of Prism monitor to allow installation or removal of battery.

2. Gently slide battery in/out from battery slot (if installing, latch battery after installing).

Prism SE’s Battery

The Prism SE utilizes one (1) rechargeable sealed lead-acid battery (up to two batteries for earlier units). Battery or batteries can only be changed or removed by qualified technical service personnel.

Prism’s Multiparameter Module

Vital sign parameters for your Prism monitor are factory configured in a Multiparameter Module (MPM). The MPM is removable, allowing you to move it from one monitor to another.

NOTE: Not all parameters and options are available for CE marked monitors. Consult your sales representative for more information.

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 To install the Multiparameter Module:

1. Align the Multiparameter Module’s front panel with the parameter labels facing you and

right-side up. Insure the edges of module are square with the edges of monitor housing.

2. Push the Multiparameter Module into monitor until it clicks into place.

 To remove the Multiparameter Module:

1. Turn power OFF by pressing the STBY key or unplugging the power cord.

2. Release the Multiparameter Module by squeezing the side handles toward center of module.

3. While squeezing handles, pull module straight out.

Prism SE’s Connector Panel

Vital sign parameters for your Prism SE monitor, are factory configured in the Connector Panel. The Connector Panel is not removable.

Turning Monitor ON and OFF

• Press the ON key to turn monitor on.

• Press the STBY key to turn monitor off.

Vital Sign Setup Menus

All vital signs have setup menus to adjust/alter the settings/limits. The following are some of the typical vital sign setup menu items.

 To open vital sign setup menu:

1. Touch softkey next to vital sign label on screen. Pressing the MORE softkey from SETUP

MENU accesses second page of menu. Some common functions are:

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ALARM ON/OFF—Allows alarm to be turned ON/OFF. ALARM LIMITS—Allows adjustment of limits through use of ↑↓ arrow keys. SIZE/SCALE—Allows adjustment of waveform in size or sensitivity. In an invasive waveform,

allows adjustment of scale for waveform being displayed.

TONE—Allows audible tone for ECG, SpO2, and Respiration. WF ON/OFF—Allows waveform for vital sign to be turned ON or OFF. VITAL SIGN ON/OFF—Alarms for vital sign must be turned off to allow vital sign to be turned

off. Turn off SpO2 and Respiration at completion of their use to eliminate data from these parameters being stored in Vital Signs Chart.

↑↓→

—Allows movement of highlighted cursor.

ADJ ↑↓ —Allows numeric adjustment to highlighted cursor value.

Temporary Suspension of Monitoring

The Prism and Prism SE allow you to temporarily halt all monitoring/vital sign gathering to allow the patient to be removed from the monitor for procedures, maneuvers, etc. All alarm settings, automated NIBP measurements, trace settings are “held” by the monitor until monitoring is resumed.

 To halt monitoring:

1. Press the SYSTEM SETUP key to open the System Setup menu.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

2. Press the PT SETUP softkey to open the following menu.

SUSP

ALL

MONTR

ENTER HT/WT

ENTER

NAME

ENTER

CLEAR NAME/

3. Press the SUSP ALL MONTR softkey.

ENTER

DATA

AUTO

ECG

EXIT

TRACE

SEL

 To resume monitoring:

1. Press any key on faceplate of monitor. All alarm settings, NIBP intervals, and trace settings

will resume.

Basic Configuration Functions

The Prism and Prism SE monitors allow viewing a variety of formats. Waveform and vital sign displays can be altered via a Trace selection feature. The monitor can be utilized for adult, pediatric, and neonatal patients. You can also configure the date and time settings.

 To assign parameters to waveform areas (Trace 2, Trace 3, Trace 4):

1. Press the SYSTEM SETUP key to open the System Setup menu.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

2-3

2. Press the TRACE SEL softkey to open the following menu.

DISP VSC

DISP

OCRG

TRACE

AUTO

TRACE

AUTO

TRACE

AUTO

3. Press the softkey under desired TRACE until the parameter to be displayed is highlighted.

Note that the only available parameters are those that are turned ON.

4. Press the PAGE HOME key. The change will occur on the screen. Note that by

selecting AUTO, the monitor will automatically assign parameters to traces according to the factory-defined hierarchy. In addition, when AUTO is selected, parameters that already occupy traces are selection choices.

 To select patient monitoring mode (Adult/Pediatric/Neonatal):

1. Press the PATIENT TYPE key to open the following menu.

ADULT PED NEO

2. Press the softkey under desired patient type.

3. Press the PAGE HOME key.

4. Note monitor screen displays current patient type in upper left of screen.

5. The monitor holds present monitoring mode until it is changed again.

 To set date and time:

1. Press the SYSTEM SETUP key to open the System Setup menu.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

2. Press the MORE softkey to open the following menu.

ADULT

PED

NEO

VOL

DISP

OCRG

REC

SETUP

TIMER CLOCK MORE

3. Press the CLOCK softkey to open the following menu.

SET

SEC

MIN

SEC

↑ ↑

SEC

↓ ↓

FORM D/M/Y

M/D/Y

CLOCK

TIME

OFF

4. Press the FORM softkey to select the display format.

5. Press the SET softkey to select desired unit to be changed

(SEC, MIN, HOUR, DAY, MONTH, YEAR).

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6. Use the UP ARROW ↑ ↑ and DOWN ARROW ↓ ↓ softkeys to adjust the date and time

settings.

7. Press the PAGE HOME key.

Monitor Default Settings

If you need to change power-up defaults so that your monitor powers up every time in a specialized mode or with settings different than the factory defaults, please refer this process to service personnel.

Setting Up Parameter Display Options

Parameter Availability and ON/OFF Status

The Parameter Availability ON/OFF feature is a default configuration function that allows you to cease monitoring selected vital sign parameters altogether. When a parameter is turned OFF in the factory defaults, it will not be available to be monitored until it is turned back ON again. This feature's default is "ON", permitting all installed vital signs to be monitored. Please consult service personnel to change the default value.

Parameter ON/OFF

Each parameter has a setting in its setup menu and in the default configuration menu that allows you to turn it ON or OFF. When turning a parameter OFF, the parameter will cease being monitored, and the alarm status/alarm bell will not display. Furthermore, if your monitor is configured with parameter labels "BLANK", and the sensor has been disconnected, no parameter label will appear. To turn a parameter back ON, you can change the value in default configuration, or simply plug in the associated connector. Once a parameter is displayed, you can change the ON/OFF value in its setup menu. This feature's factory default is "OFF". Please consult service personnel to change the default value.

Parameter Labels ON/BLANK

The Parameter Label ON/BLANK feature is a default configuration function that allows you to either display all parameter labels for all parameters installed, or display labels for only those vital signs that are actively being monitored. When parameter labels are set to "BLANK", the monitor will detect whether or not a connector is plugged in for each installed parameter, and will only display labels for those parameters that it detects (note that NIBP will always display, and if CO is available it will also display). This feature's factory default is "BLANK". Please consult service personnel to change the default value.

Parameter Colors and Tones

On a color Prism or Prism SE, you can change the colors of the parameter numerics and their associated waveforms in the power-up defaults. You can choose to assign any of 15 different colors to each parameter. It is recommended that service personnel perform this function.

Many parameters also have a tone associated with them. You can turn the tones ON or OFF in each respective parameter’s setup menu, and can adjust the tone volume for all parameters by accessing the VOL key on the second System Setup page.

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 To adjust tone volumes for all parameters:

1. Press the SYSTEM SETUP key to open the System Setup menu.

2-6

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

2. Press the MORE softkey to open the following menu.

TRACE

SEL

ADULT

PED

NEO

VOL

DISP

OCRG

REC

SETUP

TIMER CLOCK MORE

3. Press the VOL softkey to cycle through the 8 volume selections. The menu that displays after

pressing VOL also allows you to set up tone volumes for all parameter alarms.

NOTE: Minimum alarm volume can be defined in the power-up defaults.

“MORE PRAMS AVAIL”

If you have more than eleven different vital sign parameters being monitored at the same time, or have traces turned off that could accommodate some of the eleven parameters, you will see a message that says “MORE PRAMS AVAIL” in the system message area. You can access a second row of parameters by pressing SYSTEM SETUP, which will move the top row of vital signs up one level to allow the second row below them. To move back to the first row of vital signs, press the PAGE HOME key.

Please note that if the “MORE PRAMS AVAIL” message is displayed, you need to press the SYSTEM SETUP key to get past the second row of parameters before any System Setup menus can be accessed with the SYSTEM SETUP key.

2-7

2-8

Chapter 3 – Vital Sign Parameter Usage

NOTE: The Prism SE monitor can be used during defibrillation, but certain parameter readings may be inaccurate for a short time.

ECG

Prism and Prism SE monitors provide clinical viewing of the conduction of electrical impulses through various parts of the heart (ECG). Limb lead (I, II, and III) measurements are available when using a 3-lead ECG cable. Precordial leads (V1, V2, V3, V4, V5, and V6) can be viewed by using a 5-lead cable and selecting VLD (V-lead) on ECG setup page.

In many clinical situations it is necessary to view two ECG leads simultaneously to accurately assess a patient’s condition. This “dual-lead” capability is an optional feature in MDE monitors.

WARNING: For pacemaker patients, HR may continue to count pacemaker artifact during cardiac arrest or other arrhythmia. Keep pacemaker patients under close surveillance.

WARNING: Prism and Prism SE monitors are intended only to be used with “safety-protected” ECG cables and lead wires. These cables and lead wires prevent inappropriate connection of ECG lead wires to a power source, which could potentially result in burns or electrocution. ECG electrode wires should only be connected to patient ECG cable.

WARNING: After applying a defibrillator discharge to a patient being monitored by Prism SE, wait 5 seconds for a valid ECG indication on the monitor.

NOTE: For pacemaker rhythms, confirm PACE ON/OFF softkey is ON to enable pacer rejection and flagging. When PACE softkey is ON, monitor will indicate correct heart rate for all pacer pulse amplitudes and widths, with and without overshoot/undershoot (per AAMI/ANSI Standard EC-13, 1992, paragraphs 3.1.4.1 and 3.1.4.2). If PACE softkey is OFF, cardiotach may erroneously detect pacer artifact. Pacemaker output pulse detection and rejection vary from patient to patient and with type of pacemaker and pacing catheter.

3-1

Patient Preparation

When doing any patient monitoring, proper skin prep and electrode placement are critical to ensuring patient safety as well as accurate ECG, heart rate, and respiration readings. Follow the steps and diagrams below carefully:

1. Shave areas where electrodes are to be applied if hair is present.

2. For adult patients, rub electrode location briskly with dry gauze until skin is pink. If alcohol

is used to prepare the electrode site, wait until it has completely evaporated before applying electrodes.

3. Attach lead wires to electrodes before applying the electrodes to patient’s skin.

4. Apply electrodes to the patient’s skin, pressing firmly around entire edge of the adhesive

surface.

5. To help maintain stable ECG baseline, tape each electrode lead wire to skin.

6. When possible, locate positive and negative ECG electrodes at equal distances from

electrosurgical sites.

7. Check that electrodes are placed in proper locations. See the following diagrams:

Adult Electrode Placement

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Neonatal Electrode Placement

This placement is also good for RESP monitoring

Alternate Method: Position RA and LA electrodes at the 2nd intercostal space, midclavicular line

 To monitor a patient’s ECG:

1. Open the ECG SETUP menu by pressing the softkey next to the ECG label.

ALM

OFF

ALM

LIM

SIZE

LEAD

SEL

PACE

OFF

2. Press the ALM LIM softkey to adjust the values for current heart rate alarms.

3. Press the SIZE softkey to allow increase or decrease of QRS display. QRS needs to be at

least 1/2 millivolt.

4. Press the LEAD SEL softkey to select desired cable and lead. This page allows choice of

3-lead or 5-lead cable.

5. Insure cable matches selected lead cable. An error message “CHK LEADS” may indicate

device is looking for a 5-lead cable when a 3-lead cable is in use.

6. Press the PACE ON softkey to activate reject/flag pacer function (if applicable).

7. Press the MORE softkey.

8. Press the FILT softkey to turn filter OFF when ST segment monitoring is to be activated

(if applicable).

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Selecting a Telemetry Patient to Monitor

“Telemetry-monitored” patients must be prepared properly for telemetry functions to work. A 3-lead or 5-lead ECG cable (depending on the type of transmitter used) must be correctly connected to both the patient and the telemetry transmitter. The transmitter must then be secured to the patient with an appropriate transmitter pouch.

1. Open the ECG SETUP menu by pressing the softkey next to the ECG label.

ALM

OFF

ALM

LIM

SIZE

LEAD

SEL

PACE

OFF

2. Press the MORE softkey twice to access the third ECG Setup Page.

TLM

 

TLM

 

MODE

CABLE

TLM

3. Press the MODE softkey to select TLM (telemetry) if it is not already selected.

4. Press the TLM ID UP ARROW   or DOWN ARROW   softkeys until the transmitter

ID of the patient you wish to monitor appears in the ECG numeric display zone, directly under the heart rate numerics.

NOTE: If you cannot find the transmitter ID of the patient you wish to monitor, they may not be setup correctly. Contact service personnel to perform this procedure.

5. Press the PAGE HOME key to activate your selection and return to the main

monitoring screen. Telemetry ECG monitoring will begin automatically.

Correcting CHK Leads (Check Leads) Errors

If a CHK LEADS message is displayed on the screen after connecting the patient cable to the monitor or anytime during monitoring, check the following:

 The ECG cable, lead wires, and electrodes are properly and firmly connected  Electrodes are not excessively dry  The lead selected can be monitored with the ECG cable and lead wires currently connected

(for example, you are trying to monitor a V-lead with a 3-lead cable)

3-4

Respiration

Respiratory monitoring may be done either by impedance pneumography via ECG leads of RA (right arm) and LA (left arm) or through ETCO2. Location of ECG electrodes may need to be altered to allow correct count of RESPS. Review lead placement charts for respiratory monitoring. The monitor can be set to look via an AUTO mode for source of RESPS.

 To monitor a patient’s Respiration:

1. Open the RESP SETUP menu by pressing the softkey next to the RESP label.

ALM

OFF

ALM

LIM

SIZE

MM/S

12.5

AUTO

LEADS

APNEA DELAY

20S

2. Press the ALM ON softkey if respiratory alarms are to be activated.

3. Press the ALM LIM softkey to adjust values for current respiratory high/low alarms. Apnea

delay alarms can be set as needed.

4. Press the SIZE softkey to allow increase or decrease of RESP waveform. Adjusting

“sensitivity” may improve count accuracy.

5. If this parameter is no longer desired or patient is not a good candidate for respiratory count

via impedance pneumography, press the MORE softkey, then press the RESP OFF softkey.

TONE

OFF

CVA

OFF

RESP

OFF

Cardiovascular Artifact Detection (CVA)

MDE’s cardiovascular artifact detection gives you the ability to determine whether or not a patient’s (typically a neonate’s) heart beat is being interpreted as an inspiration. When ECG leads are used as a RESP source, artifact can occur because of the relative size of a neonate’s heart, and the close proximity of the leads to the movement created by the heart. To alert personnel to this possible occurrence, CVA detection looks for any period when 8 out of 10 RESP’s appear to occur simultaneous with a heartbeat. If this happens, the monitor will alarm when CVA is ON.

Using CO2 as the RESP Source

When you monitor ETCO2 (CO2) in addition to ECG and your RESP source (RR) is set to AUTO, the monitor will choose CO2 as the primary RESP source. This can be overridden if desired in the RESP setup menu.

3-5

Pulse Oximetry (SPO2)

A noninvasive method for continuously measuring oxygen saturation and pulse rate. Hospital policies, along with the sensor's directions for use, should be followed in care and rotation of monitored sites. Insure correct sensor is being used for the type of oximetry in your monitor.

 To monitor a patient’s SPO2:

1. Apply sensor to appropriate sensor site on patient. SPO2 monitoring commences

automatically.

2. Open the SPO2 menu by pressing softkey next to SPO2 label.

ALM

OFF

ALM

LIM

ALM

DELAY

MODE

NORM

FAST

LOCK

OFF

3. Press the ALM ON softkey if alarms are to be activated.

4. Press the ALM LIM softkey to adjust high and low values for saturation.

5. Press the ALM DELAY softkey to toggle between 5 or 10 seconds.

6. Press the LOCK ON softkey to activate C-LOCK (with Nellcor only).

7. Press the MODE softkey to choose averaging time of data (refer to the following tables,

MODE for Masimo, MODE for Nellcor MP204, or MODE for Nellcor MP405).

8. Press PAGE HOME. NOTE: To turn SPO2 OFF, press the SPO2 OFF softkey. Turning parameter off eliminates

SEARCH message and halts further SPO2 storage into VSC preventing 00% data storage.

MODE for Masimo Averaging Time Application

NORM (standard) 8 seconds Use when patient is relatively

inactive.

FAST 6 seconds Use for fast response

situations such as sleep studies.

SLOW

Note: Pulse rate will be displayed in all three SpO monitoring modes.

12 seconds Use during periods of

excessive patient motion.

MODE for Nellcor MP204 Averaging Time Application

NORM (standard, NELLCOR

Mode 1)

FAST (NELLCOR Mode 2) 2 to 3 seconds Use for fast response

SLOW (NELLCOR Mode 3) 10 to 15 seconds Use during periods of

5 to 7 seconds Use when patient is relatively

inactive.

situations such as sleep studies.

excessive patient motion.

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MODE for Nellcor MP405 Averaging Time Application

*NORM (NOT USED) (NOT USED) (NOT USED) FAST (NELLCOR Mode 2) Typically 7-8 seconds for

average pulse. Varies + – with pulse quality

and other functions.

*SLOW (NOT USED) (NOT USED) (NOT USED)

All monitoring situations.

*Nellcor OxiSmartXL Technology has eliminated the need for operation in NORM and

SLOW modes. Refer to the following NOTE.

NOTE: Since Nellcor OxiSmartXL technology has eliminated the need for operation in the SLOW mode, and depending on the version of main software, the following may occur if the SLOW mode is accidentally selected:

 Pulse waveform will be replaced by dotted lines  Dashed lines will replace pulse rate  Dashed lines will replace saturation values  A“02 WRT ER” message will be posted on the display

Upon returning to NORM or FAST mode, all SPO2 values and waveform will return, and the “02 WRT ER” message will disappear from the display.

WARNING: Incorrect sensor application or use may cause tissue damage or improper operation of the monitor. Follow directions for use provided with sensor.

NOTE: Regarding use of NELLCOR sensors:

 Before use, carefully read NELLCOR sensor directions for use.  Use only NELLCOR oxygen transducers. Use of oxygen transducers

produced by other manufacturers may result in improper performance.

 Do not use damaged NELLCOR sensors or patient cables. Do not

use a NELLCOR sensor with exposed optical components. Do not immerse sensor or patient cable in water, solvents, or cleaning solutions (sensors, cable, and connectors are not waterproof). Do not sterilize by irradiation, steam, or ethylene oxide. See cleaning instructions in Directions for Use for reusable NELLCOR sensors and patient cables.

3-7

SPO2 Sensor Accessories—Nellcor

Nellcor Sensors – Contact Nellcor

Sensor Model Patient size

Oxisensor® II oxygen transducers

(Sterile, Single-use only)

Oxiband oxygen transducer (reusable with nonsterile adhesive)

Durasensor oxygen transducer (Reusable, Nonsterile)

OxiCliq oxygen transducers (sterile, single use only)

Nellcor MP405 SPO2 Ext Cable – 10 Foot, must be used with the above sensors

WARNING: A pulse oximeter is an early warning device. Use a lab co-oximeter to completely understand the patient’s condition.

N-25/N-25LF I-20 D-20 D-25/D25-L R15

OXI-A/N OXI-P/I

DS-100A >40Kg

P N I A

E2800-64

<3 or > 40Kg 3 to 20 Kg 10 to 50Kg >30Kg >50Kg

<3 or > 40 Kg <3 to 40Kg

10 to 50 Kg <3 or > 40Kg 3 to 20 Kg >30Kg

NOTE: Inaccurate measurements or loss of pulse signal may be caused by:

 Incorrect sensor application or use  Significant levels of dysfunctional hemoglobins (HbCO or MetHb)  Intravascular dyes such as indocyanine green or methylene blue  Darkly pigmented skin  Exposure to excessive illumination, such as surgical lamps

(especially ones with a xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps, or direct sunlight (exposure to excessive illumination can be corrected by covering sensor with a dark or opaque material)

 Excessive patient movement  Venous pulsations  Placement of a sensor on an extremity with a blood pressure cuff,

arterial catheter, or intravascular line

NOTE: Loss of pulse signal can occur in any of the following situations:

 Sensor is too tight  Patient has hypotension, severe vasoconstriction, severe anemia,

or hypothermia

3-8

 There is arterial occlusion proximal to sensor



 Patient is in cardiac arrest or is in shock

SPO2 Sensor Accessories—Masimo

Name/Type Model Number Application

LNOP- ADT LNOP - ADT LNOP- PDT LNOP - PDT LNOP- NEO LNOP - NEO LNOP- NEO PT LNOP - NEO PT

Adult, digit

Adult/Pediatric

Neonatal < 10 kg

Neonatal < 1 kg

LNOP- DC I LNOP - DC I PC04 Patient Cable: 4 Ft. PC04 Adult/Pediatric/Neonatal PC08 Patient Cable: 8 Ft. PC08 Adult/Pediatric/Neonatal PC12 Patient Cable: 12 Ft. PC12 Adult/Pediatric/Neonatal

Adult/Pediatric

WARNING: Incorrect sensor application or use may cause tissue damage or improper operation of the monitor. Follow directions for use provided with sensor.

NOTE: Regarding use of LNOP sensors:

 Before use, carefully read LNOP sensor directions for use.  Use only Masimo oximetry sensors for SPO2 measurements. Other

oxygen transducers (sensors) may cause improper performance.

 Do not use damaged LNOP sensors or patient cables. Do not use

an LNOP

sensor with exposed optical components. Do not immerse sensor or patient cable in water, solvents, or cleaning solutions (sensors, cable, and connectors are not waterproof). Do not sterilize by irradiation, steam, or ethylene oxide. See cleaning instructions in Directions for Use for reusable Masimo LNOP sensors and patient cables.

SPO2 Alarm Delay

The SPO2 alarm incorporates a delay to minimize nuisance alarms related to brief erroneous SPO2 measurements that can be caused by patient artifact or external noise. The factory default time for this delay is 5 seconds and, if desired, a 10-second delay is also available by accessing the ALM DELAY softkey under the SPO2 setup menu. The monitor will generate an alarm if the averaged SPO2 numeric value exceeds the alarm limit for more than 5 or 10 seconds, depending on the delay selected.

SPO2 Averaging Time

SPO2 measurements are taken every 2 seconds and are averaged over a period of time (the designated averaging MODE) to display the most accurate oxygenation percentage and pulse rate. The MODE key in the SPO2 setup page lets you select a mode of measurement averaging to best fit your clinical needs.

3-9

Temperature Monitoring

The Prism and Prism SE can accommodate a variety of continuous temperature probes, as well as MDE SureTemp oral/axillary and rectal fast temperature probes. The unit automatically senses and configures the monitor for the probe type that it detects.

MDE SureTemp temperature measurements can be accomplished in either “normal” or “monitor” modes. In normal mode, the thermometer “predicts” body temperature in about 4 seconds for oral readings and 15 seconds for rectal. When in monitor mode, the thermometer measures body temperature in about 3 minutes, and will continue for as long as the probe remains in place (this is the only available mode for axillary temperatures).

Measuring a Patient’s Temperature with Continuous Probes

1. Connect the temperature probe to monitor.

2. Press the softkey below the TMP1 or TMP2 label to access setup functions, if necessary.

Note that if your monitor is equipped with both continuous and SureTemp capability, SureTemp is configured for TMP1.

ALM

OFF

ALM

LIM

UNIT

C

F

3. Press the PAGE HOME key to activate any new setup functions.

4. Place the probe in the appropriate measurement site to begin continuous monitoring.

Measuring a Patient’s Temperature with SureTemp

A temperature methodology that allows predictive or monitored temperatures. Blue top probe is used for oral or axillary modes with red top probe for rectal temperatures. Only Welch Allyn™ manufactured probe covers are to be used for this device. Probe covers by other manufacturers cause inaccurate results.

1. Open the SURETEMP menu by pressing the softkey next to the TMP 1 label. Note current

MODE and SITE. Pressing the softkeys allows changes to these settings.

MODE

NORM

MONTR

SITE

ORAL

AXIL

UNIT

C

F

NOTE: If TMP1 label is not present on monitor screen, remove probe from probe well and reinsert probe into probe well to display TMP1 label.

2. Once the TMP1 label appears, and MODE and SITE are established as described in Step 1,

remove probe from well and place probe cover onto probe. The message on screen is

3-10

T1 WAIT. DO NOT place probe into position until message reads T1 READY and an audible tone is heard.

3. When ready, place probe in position. ORAL and RECTAL methods require caregiver to

hold probe in position.

4. An audible tone for NORM mode signals completion of the measurement. A message on

screen displays T1 FINAL. The MONIT mode is continuous monitoring of temperature so no audible tone will occur to signal a final temperature. The message on screen notes T1 MONITOR.

5. Probe covers are discarded after use by “ejecting” probe cover off probe via blue/red ejects

button.

6. Replacement of probe into probe well is required to “reset” device.

WARNING: Incorrect insertion of rectal probe can cause bowel perforation. Read all instructions thoroughly before proceeding with probe placement.

NOTE: Regarding the use of SureTemp:  Do not initiate a temperature while unit is displaying T1 INIT on

screen (when monitor is first activated)

 Correct positioning of probe tip is critical with oral method  NORM mode allows predictive temps of 4 seconds for oral site and

15 seconds for rectal site

 Axillary site should be assessed in MONITOR mode  Probe should be reseated in probe well between temperatures to

allow recalibration of parameter

 If ambient temperature of monitor is above 90o F, or if the body

temperature is below 94

F, then NORMAL mode cannot be used

and the monitor will automatically switch to MONITOR mode

Noninvasive Blood Pressure Measurements (NIBP)

Prism and Prism SE noninvasive blood pressure (NIBP) monitoring can be started at any time by pressing the NIBP START/STOP key on the monitor’s front panel, or is user-configurable to take measurements at preset intervals. NIBP measures oscillometric waveforms as the air pressure in a standard cuff gradually reduces.

Additionally, initial and subsequent cuff inflations are adaptable for different patient types and blood pressure ranges. Depending on which patient mode is selected (ADULT, PED, or NEO), initial inflations can be setup anywhere from 60 to 220 mmHg, and subsequent readings will automatically inflate to only 25 mmHg above the previous systolic reading to increase measurement speed and patient comfort.

3-11

Each NIBP reading, recording, and trend printout will display an ET (elapsed time) number. This number indicates the number of minutes that have passed since the start of the last NIBP measurement.

 To manually measure NIBP:

1. Select proper cuff size and patient-monitoring mode for patient.

2. Place cuff snugly on patient with artery indicator over artery to be assessed.

3. Press the NIBP/PNI START/STOP key.

 To set automatic intervals:

1. Press the softkey next to the NIBP label to open the NIBP SETUP menu.

ALM

OFF

START STOP

4MIN

5MIN

10MIN

5MIN

AUTO

PROG MORE

2. Press the softkey under timing interval to highlight desired interval (for example, 5MIN).

3. Press softkey to turn AUTO ON.

4. Press the NIBP/PNI START/STOP key.

5. Note display of A:ET indicates auto mode is functioning and time since last reading.

 To set programming cycles:

1. Press the softkey next to the NIBP label to open the NIBP SETUP menu.

ALM

OFF

START STOP

4MIN

5MIN

10MIN

5MIN

AUTO

PROG MORE

2. Press softkey under PROG to open the following menu.

PROG

OFF

 

 

ADJ

 

ADJ

 

START MORE

3. Press the PROG ON OFF softkey to turn PROG ON.

4. Utilize NEXT    softkey to move highlighted cursor after value has been adjusted to

desired setting via the ADJ  softkeys.

5. Press the NIBP/PNI START/STOP key.

6. Note display of P:ET indicates programmed mode is functioning.

7. At conclusion of programmed cycle, PROGRAM ENDED is displayed.

3-12

Selecting an Appropriate NIBP Cuff

For patient safety and accurate NIBP readings, it is essential to select an appropriate cuff for patient type and size being monitored. The following table shows MDE part numbers for a variety of cuff sizes and types:

MDE Part Number Application

E2910-06 Neonatal - size 1 Box of 10 E2910-07 Neonatal - size 2 Box of 10 E2910-08 Neonatal - size 3 Box of 10 E2910-09 Neonatal - size 4 Box of 10 E2910-12 NIBP Cuff Infant – Screw Fittings E2910-13 NIBP Cuff Child – Screw Fittings E2910-14 NIBP Cuff Small Adult – Screw Fittings E2910-15 NIBP Cuff Adult – Screw Fittings E2910-16 NIBP Cuff Large Adult – Screw Fittings E2910-17 NIBP Cuff Thigh – Screw Fittings

WARNING: Excessive tightness of cuff may cause venous congestion. It may also cause pinching of skin, or bruising of arm, particularly if patient’s skin folds under cuff, causing uneven distribution of pressure on arm.

WARNING: Do not place cuff on an extremity being used for IV infusion, pulse oximetry, or direct (invasive) pressure monitoring.

WARNING: Operators should exercise caution and position distal edge of inflatable cuffs higher on patient’s arm, away from elbow, to avoid differential pressure damage to radial nerve.

WARNING: Closely observe patients undergoing thrombolytic or anticoagulant therapy for bruising or petechiae under or distal to cuff. Position the arm to minimize any artifact that could prolong inflation period.

CAUTION: Calibration tubing should be kept dry and free of particulate matter. Moisture or foreign substances in pneumatic system can cause damage to unit.

NOTE: Avoid compression or restriction of pressure tubes during NIBP reading.

3-13

Displaying the NIBP Table

The Prism and Prism SE monitors stores up to 100 NIBP readings, as well as any other parameters being monitored, with their corresponding time of measurement. When you turn the NIBP table ON, the most recent readings will be displayed in tabular format in the NIBP trace (NIBP must be set up in one of the three lower traces in the waveform display zone). Additionally, tabular information for all other parameters being monitored will also display in their corresponding times. You can press the RECORD key followed by the NIBP softkey to print all readings stored in memory.

Invasive Blood Pressure

INVASIVE PRESSURE monitoring allows user to simultaneously derive pressures from up to 3 different transduced lines. The system works with standard pressure transducers having 5 µV/V/mmHg sensitivity. Following placement of invasive lines, evaluate alarms and alarm limits to insure settings appropriate for patient. Default settings are set to label most commonly used pressures.

1. For optimum waveform size on screen, connect higher pressures to BP1 and lower pressures

such as pulmonary artery, CVP, or ICP to BP2 and BP3.

2. Connect transducer cable to monitor. Invasive BP automatically activates on screen.

 To display IBP in Trace slot:

1. Press the SYSTEM SETUP key to open the System Setup menu.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

2. Press the TRACE SEL softkey to open the following menu.

DISP

VSC

DISP

OCRG

TRACE

AUTO

TRACE

AUTO

TRACE

AUTO

3. Scroll through TRACE 2, 3, or 4 to highlight desired IBP.

4. Press the PAGE HOME key to initiate change.

5. Insure pressure line is level with transduced vessel or its reference point.

6. Open the BP setup menu by pressing the softkey next to the BP label:

ALM

OFF

ALM LIM

SIZE/

SCALE

SITE

OFF

ART

ZERO

ALL

ZERO

BP1

7. Press the ALM ON softkey to activate alarms.

8. Press the ALM LIM softkey to set alarms for displayed values.

9. Press the SIZE/SCALE softkey to change displayed scale or to turn scale on/off. A new

scale for the pressure line can be set at any time. Changing scales may be necessary to insure an appropriate waveform display.

3-14

10. Press the SITE softkey to cycle through site labels for invasive pressure line. Highlight

desired site.

11. Press the MORE softkey to access second page of menu.

SMD

S/D

MEAN

CAL

BP1

OFF

12. Displayed values for SYSTOLIC/MEAN/DIASTOLIC are chosen by pressing the

SMD-S/D-MEAN softkey.

13. Press the CAL softkey to initiate a calibration wave (waveform must be displayed in trace).

14. Press the BP ON/OFF softkey to turn vital sign on/off. Alarm must be OFF to turn parameter

off. Turn parameter off to eliminate technical messages and halt data into VSC.

 To zero invasive blood pressure:

1. Press the ALARM SUSPEND key.

2. Turn the stopcock off to patient and open to atmospheric air. WAIT for waveform to flatten.

3. Press the softkey under ZERO. User can zero all invasives simultaneously through ZERO

ALL.

ALM

OFF

ALM LIM

SIZE/

SCALE

SITE

OFF

ART

ZERO

ALL

ZERO

BP1

4. Observe for the 00 (± 1) on screen. Turn the stopcock off to atmospheric air and open to

patient.

5. Press the PAGE HOME key.

Pulmonary Artery Monitoring

PULMONARY ARTERY monitoring on the Prism or Prism SE allows additional menu keys

that specifically address functions of pulmonary artery catheter. These menu keys are displayed when invasive pressure is labeled for PA. Additional key(s) available are PAWP and SAVE:PAM:CVP.

 Measurement of pulmonary artery pressure (PAWP):

1. Press the softkey next to the PA label.

2. Press the PAWP softkey. Note display initiates a background scale and slows speed of PA

display to allow easier visualization of end expiratory phase of respiration.

3. Inflate balloon per manufacturer guidelines and observe for flattening of PA waveform,

indicating balloon is wedged. Allow full-screen display of wedged waveform. The FREEZE key allows display to be held on screen as user allows passive balloon deflation.

3-15

4. Press the CURSOR  softkeys to align cursor bar with end expiration. Note value displayed

on cursor bar and at bottom of screen changes as cursor bar is moved.

5. Press the SAVE PAWP softkey to store PAWP value for hemodynamic calculations. Press

the FREEZE key to release (if FREEZE key was used to hold display).

6. For a PA catheter that is not to be wedged, the monitor can store pulmonary artery diastolic

value in place of PAWP. Press the PAWP=CURSOR/PAD softkey to select PAD.

7. If a separate CVP line is not present, CVP can be temporarily measured by “bridging PA

line” to determine CVP value. Press the PA softkey, press MORE, then press SAVE PAM;CVP softkey.

NOTE: Storage of PAWP and CVP values requires initiation of Cardiac Output injections within 30 minutes for these values to be used for hemodynamic calculations.

Storgae of Invasive Pressure Values to VSC

STORAGE OF INVASIVE PRESSURE VALUES TO VSC: Invasive pressure values are

dynamic values that store into VSC any time a static value such as NIBP or SureTemp is stored. A single set can be stored into VSC through STORE VS function. These dynamic values can be stored at a timed interval as follows:

1. Press the softkey next to the VSC label to open the VSC SETUP menu.

VSC

SETUP

STOREVSTABLE

 

TABLE

 

TABLE

 

TEXT

SIZE

2. Press the VSC SETUP softkey to display the following menu.

AUTO

1MIN

OFF

STORE

ALM

SETUP

STORE

NIBP

STORE

TMP1

STORE

COONMORE

3. Press the AUTO softkey to highlight the desired storage interval.

4. Press the PAGE HOME key. Timed storage continues until monitor is turned off or

until user returns to this menu and makes another selection.

5th Trace Option

If the Prism or Prism SE is configured with the 5th Trace Option, TRACE 4 (Waveform Zone 4) can be split to display 2 Invasive Blood Pressures. The selections for displaying a 5

waveform in TRACE 4 are BP1 & 2, BP1 & BP3, and BP2 & BP3. The waveform label for TRACE 4 will display as IBP.

1. To access the individual BP menu, press the IBP softkey, a submenu will appear. Press the

desired BP to access the associated BP menu.

2. To record, press the appropriate BP softkey during the tab recording to designate that

parameter for recording.

3-16

If a BP in TRACE 4 or 5 is turned OFF, that BP will be removed from the waveform zone. The remaining BP will be expanded into the full Trace 4 area. The 5 then be terminated. Turning BP ON again will not restore it as the 5

TRACE Mode will

TRACE.

Cardiac Output and Hemodynamic Calculations

The monitor allows cardiac output injections and hemodynamic calculations. Use only a Swan-



Ganz

(or equivalent catheter).

Follow hospital policy/procedure for assembling cardiac output setup. Connect system after attaching bifurcated CO cable to port on monitor. To allow appropriate data acquisition for hemodynamics, insure invasive pressure lines are labeled correctly. The recommended procedure prior to completing cardiac outputs/hemodynamic profile is:

 To monitor a patient’s cardiac output:

1. Insure a MAP (mean arterial pressure) value is available via an arterial pressure or from

NIBP.

2. Zero all lines.

3. Obtain the PAWP/PAD and CVP values.

4. Open the menu for Cardiac Output by pressing softkey next to the CO label. CO display is

temporarily displayed on screen.

COMP

CONST

.470

START AVG

VIEW

RUN

DEL

RUN

ENTER

HTWTMORE

5. On initial use of CO, press the ENTER HT/WT softkey to enter values utilizing softkeys.

6. Once these values are complete, press the SAVE HT/WT softkey. Height and weight are

required for indexed values.

7. Verify displayed COEFFICIENT is correct. If value needs to be changed, press softkey under

COEF and use softkeys to change values.

8. Press the MORE softkey to return to prior menu.

9. Prepare to inject by obtaining needed injection volume.

10. Press the START softkey to initiate cardiac output measurement. Injection must be started

within 10 seconds of pressing START. Cardiac output injections should be a smooth, swift injection completed within 4 seconds of starting injection.

3-17

Injections are labeled as RUN 1, 2, etc. Subsequent injections are completed once START is redisplayed. A total of 6 RUNS can be displayed. Further RUNS require deletion of one of the 6.

11. Press the VIEW RUN 1 (2-6) softkey to view injection. To delete the run, press DEL RUN 1

(2-6) softkey and press the YES softkey.

12. Press the AVG CO softkey after all runs to be computed in the average are present. The

preliminary hemodynamic table is displayed.

NOTE: Injectate temperature (Ti), and blood temperature (Tb) are displayed in the CO trace. There must be at least a 12° C difference between Ti and Tb. When using iced solution or a CO-SET

—due to remaining fluid in the line— the Ti measured by the in-line probe will be more than 12° C cooler than Tb at the time of the injection regardless of the value of Ti displayed prior to the injection.

13. Vital sign parameter data that may require editing is displayed in right hand column. Review

these values.

To edit these values:

 Press the EDIT VS softkey  Press the ADJ  softkeys to adjust highlighted value  Press the NEXT   softkeys to move cursor to next vital sign for editing

14. Press the RUN CALCS softkey to display altered preliminary hemodynamic table.

15. Press the STORE CALCS softkey to display completed hemodynamic table.

16. Press the INDEX ON/OFF softkey to toggle between indexed and nonindexed values.

17. Hemodynamic table can be recorded with a bedside recorder. While hemodynamic table is

displayed on monitor screen, press the RECORD key and within 2 seconds press the softkey next to CO label.

CO allows 22 sets of hemodynamic data to be stored.

18. To view hemodynamic table at a later time, press the CO softkey, press the MORE softkey,

and press HEMOCALCS. Use softkey arrows to scroll table information.

Selecting a Thermodilution Catheter

The following Baxter-Edwards models of thermodilution catheters or their equivalent are recommended. “H” in part number refers to Heparin coating, and can be ordered without Heparin by excluding the “H” from part number.

Part Number Application

131HF7 Standard, non-REF capable

831HF75 Standard, non-REF capable with venous infusion port 93A-931H-7.5F Non-REF capable, infusion and pacing 93A-439H-7.5F REF capable, volumetric

3-18

End Tidal Carbon Dioxide (ETCO2) (Prism Only)

End tidal carbon dioxide (ETCO2) monitoring can show early indications of circulatory and pulmonary problems. In order to have a “normal” ETCO2 (CO2) reading a patient must have active cellular metabolism that produces CO2, a functional cardiovascular system to transport CO2 to the lungs and a normal intrinsic pulmonary function or proper ventilator-assist function.

The Prism monitor uses infrared absorption spectroscopy to measure CO2. MDE’s selfcalibrating sensor directs a single infrared beam through both a sampling chamber containing patient exhaled CO2, and a reference chamber containing a known concentration of CO2. Based on a comparison of these two values, the monitor calculates the patient’s CO2 concentration for each exhaled breath.

Both the mainstream and sidestream sensor continuously measures the level of CO2 during inspiration and expiration, and detects changes of CO2 levels during the respiratory cycle. These changes are shown on the CO2 capnogram waveform, with numeric values reflecting the highest level of CO respiration rate (if CO2 is selected as the respiration source), measures inspired CO2 (ICO2) to compare to an adjustable ICO2 alarm limit, and provides the ability to compensate for oxygen (O2) and nitrous oxide (N2O) greater than 50%.

 ETCO2 setup:

1. Press the softkey next to ETCO2 label to open the ETCO2 Setup menu.

detected at the end of expiration. Additionally, the monitor senses and displays

ALM

OFF

ALM

LIM

SCALE

MM/S

12.5

6.25

CO2

OFF

2. Press the ALM ON/OFF softkey to set patient alarms.

3. Press the ALM LIM softkey to adjust alarm values.

4. Press the SCALE softkey to chose appropriate scale.

5. Press the CO2 OFF to turn off ETCO2 function. Turn ETCO2 off after conclusion of

monitoring to prevent technical messages on screen.

6. Press the MORE softkey to view and select the UNIT softkey (% or mmHg), O2 ON/OFF

compensation softkey, or N2O ON/OFF compensation softkey.

UNIT

mmHg

OFF

N2O

OFF

ETCO2 allows numeric information and waveform to be displayed. ETCO2 waveform can be placed in a trace slot. Refer to configuration instructions.

3-19

WARNING: Do not allow CO2 sensor to come in contact with patient’s skin for prolonged period of time. CO2 sensor heats to prevent fogging of airway adapter windows.

WARNING: Do not use damaged sensor or one with exposed electrical contacts. Refer any servicing to qualified personnel.

CAUTION: Do not apply tension to sensor cable.

CAUTION: CO2 sensor is for use with approved airway adapters

only. CAUTION: CO2 airway adapter is non-sterile and intended for single

patient use only. CAUTION: Do not re-circulate exhaust gas back into closed loop

breathing system.

 Mainstream:

MDE’s mainstream CO2 sensor attaches to a disposable airway adapter, which is installed in the ventilator circuit tubing.

3-20

1. Inspect circular window on airway adapter for cracks or blemishes. Replace if necessary.

2. Attach airway adapter and sensor in line proximally to patient between endotracheal,

nasotracheal or tracheal tube and ventilator circuit, T-tube setup or bag/valve setup.

3. Carefully press sensor down onto airway adapter being careful not to damage glass window.

4. Connect ETCO2 cable to port on monitor. Function automatically activates.

5. Allow device to warm up for 45-60 seconds. The message WARM-UP is present on screen.

6. Support under sensor housing may be necessary to prevent excess traction on airway tube. Do

not allow sensor housing to set on patient’s skin.

 Sidestream:

The sidestream CO2 sensor attaches to a nasal cannula or in-line airway sampling system (for intubated patients). It can even attach to a divided oxygen delivery CO2 sampling nasal cannula if you need to deliver O2 while monitoring sidestream CO2.

1. Connect ETCO2 cable to monitor connector.

2. Insert fresh watertrap into sidestream motor port with a gentle twisting motion.

3. Place respiratory device (nasal cannula, facemask, airway tubing) to patient and attach

sampling port line from respiratory device to watertrap.

4. Allow device to warm up for 45-60 seconds. The message WARM-UP is present on screen.

3-21

ETCO2 (CO2) Sensor and Airway Adapter Maintenance (Prism Only)

CO2 sensor is a precision instrument, which requires proper maintenance to verify accuracy and durability. Great care must be exercised in handling the CO2

sensor. There are no user serviceable

parts inside sensor. The following precautions will help protect sensor and patients:

 Do not autoclave airway adapter or sensor  Do not immerse sensor or cable in liquid  Avoid damaging mainstream adapter glass window  Connect mainstream adapter to sensor away from patient  Mainstream airway adapter is non-sterile and intended for single patient use only  Always use mainstream neonatal adapter (MDE part #E2900-21) for neonatal patients.  After use, clean sensor with cloth moistened with green soap/green soap tincture

(V34 or equivalent)

 Always replace sensor and cable in its protective foam-lined case when not in use

End Tidal Carbon Dioxide (ETCO2) (Prism SE Only)

Prism SE uses molecular comparison spectroscopy to measure CO2. Prism SE’s sensor directs a single laser beam specific to CO2 through a sampling chamber containing patient exhaled CO2. The monitor calculates patient’s CO2 concentration for each exhaled breath.

Both intubated and nonintubated techniques continuously measure level of CO2 during inspiration and expiration, and detect changes of CO2 levels during respiratory cycle. These changes are shown on CO2 capnogram waveform, with numeric values reflecting highest level of CO2 detected at end of expiration. Additionally, Prism SE senses and displays respiration rate (if CO2 is selected as respiration source), and measures inspired CO2 (ICO2) to compare to an adjustable ICO2 alarm limit.

 ETCO2 setup:

1. Press the softkey next to ETCO2 label to open the ETCO2 Setup menu.

ALM

OFF

ALM

LIM

SCALE

MM/S

12.5

6.25

CO2

OFF

2. Press the ALM ON/OFF softkey to set patient alarms.

3. Press the ALM LIM softkey to adjust alarm values.

4. Press the SCALE softkey to chose appropriate scale.

5. Press the CO2 OFF to turn off ETCO2 function. Turn ETCO2 off after conclusion of

monitoring to prevent technical messages on screen.

6. Press the MORE softkey to view and select the UNIT softkey (% or mmHg), O2 ON/OFF

compensation softkey, or N2O ON/OFF compensation softkey.

3-22

UNIT

mmHg

OFF

N2O

OFF

ETCO2 allows numeric information and waveform to be displayed. ETCO2 waveform can be placed in a trace slot. Refer to configuration instructions.

CAUTION: Do not over tighten FilterLine tubing in connector.

CAUTION: The Microstream CO2 FilterLine tubing is for use with

approved airway adapters only. CAUTION: CO2 airway adapter and FilterLine are non-sterile and

intended for single patient use only. CAUTION: Do not re-circulate exhaust gas back into closed loop

breathing system. WARNING: Do not attempt to clear or “blow out” the FilterLine.

Replace FilterLine when occluded.

 To measure a patient’s ETCO2 (intubated):

1. Attach airway adapter proximally to patient between endotracheal, nasotracheal or tracheal

tube and ventilator circuit, T-tube setup or bag/valve setup. CO2 airway adapter is non-sterile and intended for single patient use only.

2. Connect appropriate end of ETCO2 FilterLine tubing to Prism SE’s connector panel. CO2

airway adapter and FilterLine are non-sterile and intended for single patient use only.

3. Observe WARM UP message on screen (WARM UP appears 5 seconds after a NO

SENSOR message). ETCO2 monitoring will commence approximately 10 seconds following setup and connection.

 To measure a patient’s ETCO2 (nonintubated):

3-23

1. Position nasal cannula on patient.

2. Connect ETCO2 tubing to Prism SE’s connector panel.

3. Observe WARM UP message on screen. ETCO2 monitoring will commence approximately

10 seconds following connection. If an error message appears, check tubing for blockage. If this does not correct problem, see the Troubleshooting section.

Graphical Trends

Graphical trend allows view of compilation of data collected for given parameter over defined time period. Time period choices are 1, 8, and 24 hours for each monitored parameter.

1. Press the SYSTEM SETUP key to open the System Setup menu.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

2. Press the MORE softkey twice to access the TREND softkey.

CONF TREND TEST

3. Press TREND softkey to display Trend Setup Page. Trend is displayed in TRACE 3.

4. Press the softkeys to alter display for parameter, trend time base, and scales. Use arrows to

move time visible on graph.

RESP SPO2

1 HR

8HR

24HR

SCALE

250

200

CURS

 

CURS

 

5. TREND can be recorded with use of bedside recorder. Press the RECORD key and within

two seconds press the softkey next to TRACE 3 (TREND GRAPH).

6. Press PAGE HOME to remove trend display and return to main monitoring

display.

3-24

Vital Sign Chart (VSC)

VSC is a feature that allows storage, display, documentation and editing of vital signs. The monitor stores 100 sets of tabular vital signs with most recent visible when VSC is viewed. To continuously display VSC in a trace slot, refer to configuration page.

1. VSC can be temporarily viewed in trace slot. Press SYSTEM SETUP key, then softkey

under DISP VSC.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

2. To open VSC menu, press the softkey next to the VSC label.

VSC

SETUP

STOREVSTABLE

 

TABLE

 

TABLE

 

TEXT

SIZE

3. Press the TABLE  (or ) softkey to scroll and view vital signs.

4. Press the TEXT SIZE softkey to alter text size of vital signs.

5. Press the STORE VS softkey to manually store all vital signs currently displayed on-screen.

6. Press the VSC SETUP softkey to access the AUTO store key for timed storing of dynamic

vital signs.

AUTO

1MIN

OFF

STORE

ALM

SETUP

STORE

NIBP

STORE

TMP1

STORE

COONMORE

7. Press the MORE softkey to access DEL VSC ENTRY (allows deletion of lines of vital sign

entries). CLEAR VSC TABLE allows deletion of entire VSC.

CLEAR

VSC

TABLE

DEL VSC

ENTRY

8. Recording Vital Signs: VSC can be recorded with use of bedside recorder. Press the

RECORD key and within two seconds press softkey next to VSC label.

9. Letter/symbol to left of vital sign entry indicates what prompted data to be stored.

As entries are added to the table, the oldest entries cycle down and off the screen but remain in memory. However, if a parameter trace below the VS chart is off, the table will automatically continue to fill downward until it fills the second trace as well.

There are a variety of options that can be selected to determine when vital signs are stored, as listed below. Each VSC storage option includes a small letter or symbol, which displays to the left of the time displayed for that entry. Each entry option can be turned ON or OFF depending on your charting requirements.

(blank) Entry made according to preselected automatic time interval.

3-25

(bell) Entry made when an alarm is violated (alarming vital sign is shown in inverse video). n Entry made when a user-initiated NIBP reading is completed. a Entry made when an automatic (timed interval) NIBP reading is completed. t Entry made when a predictive SureTemp reading is completed. v Entry made when the user presses the STORE VS key (indicates “validated” entry). m Entry made when the vital signs are manually entered via the CIS module or

Guardian telemetry transmitter.

p Indicates that the monitor was powered down prior to clearing VSC data. All

entries listed below the “p” entry were stored before the monitor was powered

down. s Indicates that ALL monitoring was SUSPENDED at this time entry. r Indicates that monitoring was RESTORED at this time entry.

Storing VS Charts in Monitor Memory

Up to 100 VSC entries remain stored in the monitor’s memory for the entire time the monitor is turned on. Additionally, you can set power-up defaults for your monitor so that these entries stay in memory for 5, 15, or 30 mins., or 1, 4, 8, or 24 hours after you shut off the monitor (this feature can also be turned OFF). This “power down memory” is factory set to 15 minutes. If you need to change this factory default, please consult service personnel.

“Episodic” VS Entries

Episodic entries are defined as vital sign measurements that are not continuously monitored, including NIBP and predictive SureTemp. Prism and Prism SE monitors include a VALID TIME setting in power-up defaults that defines how long episodic measurement numerics display onscreen. The factory default for this valid time is 15 minutes. This setting should only be changed by service personnel.

Episodic entries can initiate VSC entries if these functions are turned on in the VSC setup menu. Additionally, episodic measurements that are on-screen (i.e. within the valid time) will post once to the VS chart when entries are initiated by automatic VSC entry options.

NOTE: Episodic measurements will not post to a VS chart more than once for all automatic entries, even if they are displayed and within the Valid Time. There is one exception to this rule: the STORE VS key will capture ALL measurements displayed on the monitor at a given time, regardless of their continuous or episodic nature.

Clearing Patient Data from VSC (Vital Sign Chart)

Prism and Prism SE monitors allow power down memory for retention of vital signs/trends and can be cleared by user. This timeframe is configured as a default setting.

1. Press the SYSTEM SETUP key.

3-26

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

2. Press the CLEAR PT DATA softkey and press YES softkey.

3. Press the PAGE HOME key.

Oxycardiorespirogram (OxyCRG/CRG)

OxyCRG is an optional trend that allows display of compressed respiration waveform (1mm/sec) correlated with trend data derived from heart rate and SpO2 over most recent two minutes of monitoring. ECG, Respiration, and SpO2 must be actively monitored for proper monitoring of OxyCRG. OxyCRG can be temporarily or continually displayed (Trace 2 only).

 To temporarily display OxyCRG:

1. Monitor ECG, Respiration, and SpO2.

2. Press the SYSTEM SETUP key.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

3. Press the MORE softkey to display the following menu.

ADULT

PED

NEO

VOL

DISP

OCRG

REC

SETUP

TIMER CLOCK MORE

4. Press the DISP OCRG to display OxyCRG.

3-27

ECG

TRACE

SEL

5. To remove temporary display, press the PAGE HOME key.

 To display OxyCRG in Trace 2:

1. Monitor ECG, Respiration, and SpO2.

2. Press the SYSTEM SETUP key.

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

3. Press the TRACE SEL softkey to display the following menu.

DISP

VSC

DISP

OCRG

TRACE

CRG

TRACE

AUTO

TRACE

AUTO

4. Press TRACE 2 until CRG is highlighted.

5. Press the PAGE HOME key. OxyCRG information will display in TRACE 2.

 To access CRG setup page and available functions:

1. Press softkey next to the CRG label. Available functions are:

 SCALE ON softkey to activate parameter scales. Data display is 1.75 minutes if scales

are ON.

 CLEAR DATA softkey to clear all stored events from memory.  EVNT SCROL softkey to scroll through stored low alarm events. EVENT 01 is the most

recent.

 To record displayed event:

1. Press the RECORD key and within two seconds press softkey next to CRG label. Displayed

EVENT will be recorded to bedside recorder.

3-28

Alarms

Alarm ON/OFF status and limits can be set from individual parameter menus or from ALARM SETUP page. Do not temporarily silence or disable audible alarm if patient safety would be compromised. During alarm, bell next to parameter will flash.

 To temporarily suspend patient alarms:

1. ALARMS IN CURRENT VIOLATION – Press the ALARM SUSPEND key to temporarily

silence any alarm in violation. Note screen message says ALARM SILENCED. Alarms are silenced until silence interval on screen has elapsed OR until the alarm in violation falls within alarm settings.

2. NO CURRENT ALARM VIOLATION – Press the ALARM SUSPEND key to temporarily

suspend all alarms. Note screen message says ALARM SUSPEND and suspend interval on screen.

3. Alarms can be enabled again by pressing the ALARM SUSPEND key, or by waiting until

the alarm suspend interval has elapsed.

 To change alarm ON/OFF status using parameter menu:

1. Press the softkey next to the parameter label.

2. Press the ALM ON/OFF softkey to highlight desired status.

3. Press the PAGE HOME key.

 To change alarm limits using parameter menu:

1. Press the softkey next to the parameter label.

2. Press the ALM LIM softkey to access alarm limits menu and adjust accordingly.

 To change alarm ON/OFF status and limits using alarm setup page:

1. Press the ALARM SETUP key.

 

 

 

ADJ

 

ADJ

 

2. Press the NEXT   softkey to select alarm status or limit to be changed.

3. Press the ADJ  softkey to alter alarm status or limits.

4. Press the PAGE HOME key. Alarm settings and limits are user configurable. Alarm criteria can be set for different

environments and patient types. Turn alarms on or off by parameter and specify limits such as High and Low Heart Rate on Alarm Setup page or from individual parameter menus. Fully

3-29

understand the ramifications of turning alarms off, silencing alarms, suspending alarms, and resetting alarm criteria from factory defaults. Please read this section carefully.

WARNING: Do not temporarily silence or disable an audible alarm if patient safety would be compromised. In the event of an adverse patient condition, the audio alarm will not sound if it has been temporarily silenced or disabled.

NOTE: During an alarm, bell next to SETUP page will flash, but all alarm tones are suspended while ALARM SETUP screen is displayed. Alarm tones are immediately enabled when you exit ALARM SETUP screen.

Alarm Bells

NOTE: Check alarm limits each time a parameter is used to insure they are appropriate for patient being monitored.

NOTE: Alarms for some parameters are factory set to default to OFF setting. This may not be consistent with policies of your institution or types of patients being monitored by Prism and Prism SE monitors.

If a steady solid bell is displayed, an alarm for associated parameter is turned ON. Bell will also remain steady during a technical alarm, and an error message will flash in associated parameter’s waveform display zone. On color monitor, bell will turn from white to yellow during a technical alarm.

If a bell is displayed with an X through it, alarms for associated parameter are turned OFF.

3-30

(FLASHING)

A solid bell will flash if one or more alarm criteria are violated for associated parameter, and an alarm message will display in parameter’s message area. When monitored vital sign has returned within set up alarm limits, or when alarm is suspended, bell will stop flashing. On color monitor, bell will turn from white to red when in alarm.

(BLANK)

Alarm Tones

Alarm tone priorities can be assigned to each parameter. Factory defaults are Priority Level 2 for all parameters. Priority Level Alarms differ in the frequency rate as follows:

Priority Level Alarm Frequenc

Level 1 0.4 seconds Level 2 1.0 seconds Level 3 2.4 seconds Technical 3 seconds

Alarm priority levels can be changed on the Alarm Setup page and/or in the deep configuration of the monitor. It is recommended that you have service personnel perform any factory default/deep configuration functions, or consult the service manual.

Latch Alarms

The latch alarms function can be enabled in the deep configuration of the monitor. Factory default is OFF. It is recommended that you have service personnel perform any factory default/deep configuration functions, or consult the service manual. The alarm will remain latched after the limit is no longer violated and until manually cleared by the operator by pressing any key on the monitor.

If there is no bell displayed, associated parameter is not enabled.

The tone, alarm LED, softkey page, output(s), and status to the transponder will continue as if the limit is still in violation. The alarm page will no longer automatically return to the home page. The current alarm page is latched on the display. The recorder will stop recording the event (as it currently does) when the alarm condition disappears. Other alarms will not be recorded while the last alarm is latched. Other alarms will cause that parameters alarm bell to flash. It will continue to flash until the latch is cleared.

Recorder

The recorder is an option for the Prism and Prism SE monitors.

 Manual recordings:

1. For ECG, press the RECORD key to initiate a 16 second strip.

2. For other parameters, press the RECORD key, and within two seconds press softkey next to

vital sign label.

 Dual parameter recordings:

1. Press the RECORD key followed by softkeys next to each of selected parameters within two

seconds.

3-31

 Continuous recordings:

1. For ECG, press and hold the RECORD key for approximately three seconds.

2. For all other parameters, press the RECORD key followed by pressing softkey next to

selected parameter for approximately three seconds.

 To stop a recording in progress:

1. Press the RECORD key to stop current recording.

 To install or remove the dual channel recorder module: (Prism only)

1. Align recorder module so recorder door is facing you, door release is at top, and edges of

module line up with edges of monitor’s housing.

2. Push recorder module straight into monitor until securely in place and it cannot be removed

unless release tab is pressed again.

3. To remove, press recorder release tab inward while pulling recorder module out. See the

“Prism Rear Panel” section for location of recorder release tab.

NOTE: Prism SE recorder is not removable by user.

 Manually marking events on recordings:

1. Press the SYSTEM SETUP key.

3-32

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

2. Press the MORE softkey to display the following menu.

SEL

ADULT

PED

NEO

VOL

DISP

OCRG

REC

SETUP

TIMER CLOCK MORE

3. Press the REC SETUP softkey to access the Recorder Setup page.

REC

OFF

DELAY

OFF

TRACE

SNGL

DUAL

MARK

EVENT

4. Press MARK EVENT to access the event marker softkeys.

MARK

EVENT

MARK

EVENT

MARK

EVENT

MARK

EVENT

MARK

EVENTE5MORE

5. Begin your recording, then press any of the event marker softkeys (E1-E5) during the

recording at the point where you want the marker to be printed.

 Load new roll of paper:

3-33

1. Press the door release to open recorder.

2. Remove the empty spool.

3. Install new roll with paper unrolling from bottom side.

4. Pull out five (5) inches (12.7 cm) of paper.

5. Close the recorder door.

6. Tear excess paper using downward motion.

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3-35

Chapter 4 – Additional User Information

Wireless Communication to a Central Station

The Prism and Prism SE monitors have the capability to send vital sign data and waveforms wirelessly to ESCORT-Link and ESCORT Vision central stations via modular transponders (900 MHz - MDE part #20011 or 20011V, and 2.4 GHz - MDE part #20019 or 20019V) that attach to the back of monitor. It is recommended service personnel install this if not already installed.

NOTE: Transponders (both 900 MHz and 2.4 GHz) should be located in an open area at least 6.30 inches (16 cm) from any metal objects which could block or distort transmission or reception of signals.

NOTE: Do not route patient monitoring cables near transponder’s antenna.

WARNING: Make sure main power to monitor is disconnected from its AC source before attempting to attach or remove transceiver, telemetry, or CIS module. Refer all servicing to qualified technical personnel.

Guidelines for Cleaning

WARNING: To avoid electric shock, unplug AC power cord before cleaning.

CAUTION: Do not immerse instrument, switches, cables, connectors or accessories in liquids. Do not use isopropyl alcohol, caustic or abrasive cleaners, or other solvents that will damage housing. If disinfectants or alcohol must be used, apply sparingly to nonabrasive cloth first and gently wipe surfaces taking care not to let pool on plastic surfaces.

Use following guidelines and considerations when cleaning the Prism or Prism SE monitor:

• Clean monitor, cuffs, and hoses as required per hospital procedures. Only use lint free,

nonabrasive cloth that has been slightly dampened with mild detergent.

• Do not spray or pour liquids directly onto monitor or accessories.

• Do not allow any liquid to come into contact with power connector, fuse holder, or switches.

4-1

Maintenance and Calibration

There are no user-serviceable parts in Prism or Prism SE monitors. MDE recommends a yearly performance check to verify all functions on the Prism and Prism SE monitors. All maintenance and calibration should be performed by qualified personnel only. Refer to Chapter 9 in the ESCORT Prism or ESCORT Prism SE Patient Monitor Service Manual for periodic maintenance and calibration instructions. If returned to MDE, the Prism/Prism SE must be shipped in packaging specified by MDE.

Telemetry Monitoring

The Prism and Prism SE monitors have the ability to receive ECG plus other data from wireless telemetry transmitters. Because the monitor can receive signals from approximately 200 different remote transmitters, it is necessary to first set up all of the transmitter types and ID’s of any patients you may wish to monitor. This procedure was most likely done upon installation of the monitors, but if it was not, or transmitters need to be added or removed, it is recommended that service personnel perform this function because it requires power-up configuration of each monitor.

CIS functions

Prism and Prism SE monitors equipped with MDE’s CIS Module can share patient data with a CIS (Clinical Information System). In order to accomplish this, the monitor must be set up with the patient’s name and ID to match patient data with the correct patient record in the CIS. If your monitor is not equipped with a CIS Module, you can use this function to display the patient’s name/ID at the center/top of the screen. The information entered will also print in the tabular area of a recording strip. Refer to the Clinical Information System section later in this manual.

Storage and Transport

Storage and transport specifications are:

 Temperature = -10° C to 40° C  Humidity = 0% to 90%  Pressure = 500 to 1060hpa

4-2

4-3

Chapter 5 – Main Setup Menus

This section describes the main system setup and vital sign menus on the Prism and Prism SE monitors. The menus are the same for both monitor types.

System Setup Menus

Pressing the System Setup key accesses the following menus:

CLEAR

DATA

STOREVSDISP

VSCPTSETUP

AUTO

ECG

TRACE

SEL

CLEAR PT DATA—Clears all stored readings (NIBP, Temp) and trended data. STORE VS—Manually stores a Vital Sign Chart (VSC). DISP VSC—"Pops up" display of current vital sign chart (VSC). PT SETUP—Access to patient name and ID, and to Suspend Monitoring key. HR AUTO ECG—Specifies default parameter for heart rate derivation. TRACE SEL—Selects parameters displayed in Waveform Display Zone. MORE—Displays the next menu.

ADULT

PED

NEO

VOL

DISP

OCRG

REC

SETUP

TIMER CLOCK MORE

ADULT PED NEO—Selects the patient type with new alarm limits, etc. VOL—Adjusts the volume of alarm and parameter tones. DISP OCRG—Pops-up an Oxycardiorespirogram in Trace 2 (if installed). REC SETUP—Changes settings for general recording functions. TIMER—Sets up/displays elapsed time or current time of day. CLOCK—Sets the system date and time. MORE—Displays the next menu.

CONF TREND TEST

CONF—Accesses monitor configurations and power-up defaults. TREND—Sets up/displays graph of trended vital sign data. TEST—Displays system test screens for service personnel.

5-1

ECG Setup Menus

ECG function menus are accessed by pressing the softkey adjacent to the ECG label. The menus are as follows:

ALM

OFF

ALM

LIM

SIZE

LEAD

SEL

PACE

OFF

ALM ON OFF—Toggles ECG alarms ON or OFF. ALM LIM—Accesses alarm limits menu. SIZE—Accesses menu to increase/decrease ECG size. LEAD SEL—Accesses menu to select ECG cable (3/5) and ECG lead (I, II, III, V). PACE ON OFF—Turn on to reject and flag pacer artifact. MORE—Displays next menu.

TONE

OFF

FILT

OFF

MM/S

12.5

OFF

TONE ON OFF—Toggles QRS tone ON or OFF. FILT ON OF—Toggles ECG filtering between norm. (ON) and diag.(OFF) modes. MM/S 25/12.5—Selects ECG sweep speed. WF ON OFF—Turns ECG Waveform display ON or OFF. MORE—Displays next menu (the following menu is only available if the Telemetry option is

installed).

TLM

↑ ↑

TLM

↓ ↓

MODE

CABLE

TLM

TLM ID ↑ ↑—Selects the next higher telemetry transmitter for monitoring. TLM ID ↓ ↓—Selects the next lower telemetry transmitter for monitoring. MODE CABLE TLM—Selects ECG source from the monitor or telemetry receiver.

Respiration Setup Menus

Respiration function menus are accessed by pressing the softkey adjacent to the RESP label. The menus are as follows:

ALM

OFF

ALM

LIM

SIZE

ALM ON OFF—Toggles RESP alarms ON or OFF. ALM LIM—Accesses alarm limits menu. SIZE—Accesses menu to increase/decrease RESP waveform size. MM/S 12.5/25—Selects RESP sweep speed.

MM/S

12.5

AUTO

LEADS

APNEA DELAY

20S

5-2

RR AUTO LEADS—Selects RESP source, ECG leads, CO2, or AUTO detect. APNEA DELAY 20S—Selects allowable apnea period before alarming. MORE—Displays the next menu.

TONE

OFF

CVA

OFF

RESP

OFF

TONE ON OFF—Toggles RESP tone ON or OFF. CVA ON OFF—Toggles cardiovascular artifact detection ON or OFF. RESP ON OFF—Turns RESP monitoring ON or OFF.

Pulse Oximetry (SPO2) Setup Menus

SPO2 function menus are accessed by pressing the softkey adjacent to the SPO2 label. The menus are as follows:

ALM

OFF

ALM

LIM

ALM ON OFF—Toggles SPO2 alarms ON or OFF. ALM LIM—Accesses alarm limits menu. ALM DELAY—Selects SPO2 delay time. MODE—Selects SPO2 averaging time (not used for Nellcor MP405). LOCK ON OFF—Toggles ECG Sychronization (C-LOCK) ON or OFF (Nellcor only).

ALM

DELAY

MODE

NORM

FAST

LOCK

OFF

MORE—Displays the next menu.

OFF

TONE

OFF

SPO2

OFF

WF ON OFF—Turns waveform ON or OFF in Waveform Display Zone. TONE ON OFF—Toggles saturation tone ON or OFF. SPO2 ON OFF—Turns SPO2 monitoring ON or OFF.

Invasive Blood Pressure (IBP) Setup Menus

Invasive Blood Pressure function menus are accessed by pressing the softkey adjacent to the BP1, BP2, BP3, or IBP label. The menus are as follows:

ALM

OFF

ALM

LIM

SIZE/

SCALE

ALM ON OFF—Toggles alarms ON or OFF. ALM LIM—Accesses alarm limits menu. SIZE/SCALE—Accesses menu to increase/decrease waveform size.

SITE

OFF

ART

ZERO

ALL

ZERO

BP1

5-3

SITE OFF ART—Adds label next to numeric to identify IBP sites. ZERO ALL—Zeroes all connected transducers. ZERO BP1—Zeroes the transducer offset. MORE—Displays the next menu.

SMD

S/D

MEAN

CAL

BP1

OFF

SMD S/D MEAN—Selects numeric display format. CAL—Simulates a 100/50 mmHg square wave (hold for 5-10 sec.). BP1 ON OFF—Turns BP monitoring ON or OFF.

Noninvasive Blood Pressure (NIBP) Setup Menus

Noninvasive Blood Pressure function menus are accessed by pressing the softkey adjacent to the NIBP label. The menus are as follows:

ALM

OFF

START STOP

ALM ON OFF—Toggles NIBP alarms ON or OFF. START—Initiates an NIBP measurement. STOP—Stops an NIBP measurement in progress. 4MIN/5MIN/10MIN—Selects automatic reading interval. 5MIN AUTO ON—Turns AUTO mode ON/OFF and displays current selected interval.

4MIN

5MIN

10MIN

5MIN

AUTO

PROG MORE

PROG—To program an NIBP sequence. MORE—Displays the next menu.

ALM

OFF

ALM LIM

1ST

INFL

170

SMD

S/D

MEAN

SITE

OFF

LIST

NIBP

TABLE

ALM ON OFF—Toggles NIBP alarms ON or OFF. ALM LIM—Accesses alarm limits menu. 1ST INFL 170—Sets default first inflation pressure (mmHg). SMD S/D MEAN—Sets NIBP numeric display format. SITE OFF LIST—Adds label next to numeric to identify NIBP site. NIBP TABLE—Displays NIBP table. MORE—Displays the next menu.

NIBP

OFF

5-4

NIBP ON OFF—Press the NIBP softkey to turn ON or OFF.

Continuous Temperature Setup Menus

Continuous Temperature menus may be accessed by pressing the softkey adjacent to either of the Temp labels (TMP1, TMP2). Note that these menus are different for SureTemp (shown later):

ALM

OFF

ALM

LIM

UNIT

°C

°F

ALM ON OFF—Toggles Temp alarms ON or OFF. ALM LIM—Accesses alarm limits menu. UNIT °C / °F—Switches between °C and °F for temperature measurement. MORE—Displays the next menu.

TMP

OFF

TMP ON OFF—Turns Temp monitoring ON or OFF.

SureTemp Menu

If SureTemp is installed, SureTemp menu may be accessed by pressing the softkey adjacent to the TMP1 label. The menu is as follows:

MODE

NORM

MONTR

SITE

ORAL

AXIL

UNIT

°C

°F

MODE NORM MONTR—Toggles between predictive and monitored measurements. SITE ORAL AXIL—Selects oral or axillary measurement site (or rectal for rectal probe). UNIT °C / °F—Switches between °C and °F for temperature measurement. MORE—Displays the next menu.

TMP1

OFF

TMP1 ON OFF—Turns Temp monitoring ON or OFF.

End Tidal Carbon Dioxide (ETCO2) Setup Menus

ETCO2 menus may be accessed by pressing the softkey adjacent to the CO2 label. The menus are as follows:

5-5

ALM

OFF

ALM

LIM

SCALE

MM/S

12.5

6.25

CO2

OFF

ALM ON OFF—Toggles CO2 alarms ON or OFF. ALM LIM—Accesses alarm limits menu. SCALE 50/75—Selects CO2 waveform scale (50, 75, 100 mmHg). MM/S 12.5/6.25—Selects CO2 sweep speed. CO2 ON OFF—Turns CO2 monitoring OFF (alarms must be disabled). MORE—Displays the next menu.

UNIT

mmHg

OFF

N2O

OFF

UNIT % / mmHg—Toggles measurement units (% or mmHg). O2 ON OFF—Toggles O2 compensation ON or OFF (Prism only). NO2 ON OFF—Toggles N2O compensation ON or OFF (Prism only).

Cardiac Output Setup Menus

CO menus may be accessed by pressing the softkey adjacent to the CO label. The menus are as follows:

COMP

CONST

.470

START AVG

COMP CONST .470—Adjusts computational constant for catheter and injectate volume. START—Starts cardiac output measurement run. AVE—Calculates average of CO, REF, and derived parameter. VIEW RUN—Allows you to cycle through runs prior to averaging. DEL RUN—Allows deletion of unwanted runs prior to averaging.

VIEW

RUN

DEL

RUN

ENTER

HT WT

ENTER HT WT—Allows entry of patient height/weight. MORE—Displays the next menu.

CONST

↑

.470

CONST

.470

↑

CONST

.470

↑

5-6

CONST .470 (ARROW ON 4)—Use to change the tenths column of the constant. CONST .470 (ARROW ON 7)—Use to change the hundredths column of the constant. CONST .470 (ARROW ON 0)—Use to change the thousandths column of the constant. MORE—Displays the previous menu

Vital Sign Chart (VSC) Setup Menus

VSC menus are accessed by pressing the softkey adjacent to the VSC label. The menus are as follows:

VSC

SETUP

STOREVSTABLE

→ →

TABLE

↑ ↑

TABLE

↓ ↓

TEXT

SIZE

VSC SETUP—Accesses setup options for events that trigger entries. STORE VS—Manually stores a VSC entry including all VS data on-screen. TABLE → →—Scrolls to the right to show additional data, if available. TABLE ↑ ↑—Scrolls up to show additional data, if available. TABLE ↓ ↓—Scrolls down to show additional data, if available. TEXT SIZE—Decreases/enlarges the VSC table approx. 50%. MORE—Displays the next menu.

CLEAR

VSC

TABLE

DEL VSC

ENTRY

CLEAR VSC TABLE—Clears all VSC data currently stored in memory. DEL VSC ENTRY—Allows selective deletion of individual VSC entries. MORE—Returns to the first VSC Setup menu.

5-7

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5-8

Chapter 6 – Factory Defaults

When the Prism & Prism SE monitor is powered on for the first time, it will be in the Neonatal mode, and all parameters will be set to their factory defaults.

Each parameter has defaults for adult, pediatric, and neonatal modes (ADULT, PED, NEO). All parameter and system defaults can be user-configured.

It is important to recognize that changes made to these functions determine the status of those functions upon every subsequent power-up. As a result, default settings should not be changed unless the setting will be desired on a regular basis.

It is recommended that you have service personnel perform any factory default/deep configuration functions.

System Setup Factory Defaults

SYSTEM SETUP ADULT PED NEO DESCRIPTION

FACTORY DEFAULTS NO NO NO To restore all settings to factory defaults PWR DN MEMORY 15MIN 15MIN 15MIN Selected time for saving VSC settings ALRM VOLUME 7 7 7 Alarm tone volume setting (1-8)

ALM VOL MIN 1 1 1 TONE VOLUME 4 4 4 Key tone setting

TRACE 2 AUTO AUTO AUTO Waveform or feature for second trace TRACE 3 AUTO AUTO AUTO Waveform or feature for third trace TRACE 4 AUTO AUTO AUTO Waveform or feature for fourth trace HR SOURCE AUTO AUTO AUTO Heart rate source, ECG, SPO2, BP’s ALM SUSPND 180 90 60 Alarm suspend time PRAM LABELS BLANK BLANK BLANK To blank parameters when off CLOCK DISPLY OFF OFF OFF Time displayed on screen CABLE / TELM CABLE CABLE CABLE ECG mode - telemetry or cable REMOTE RECD OFF OFF OFF Telemetry recording ALARM FLASH ON ON ON Flashing alarm LED

LANGUAGE ENGL ENGL ENGL LINE FREQ 60HZ 60HZ 60HZ 50Hz or 60Hz input line frequency

PATIENT TYPE ALL ALL ALL ADULT, PED, NEO, or ALL ALARM CNTRL ON ON ON

Sets minimum allowable alarm tone volume setting (1-8)

Sets language (English, French, German, Spanish, Swedish, or Italian)

When default is set to ON, allows enabled alarms to be turned OFF

6-1

Recorder Factory Defaults

RECORDER SETUP ADULT PED NEO DESCRIPTION

RECD DELAY ON ON ON Four second delay ALRM RECDNG ON ON ON Alarm recording enable/disable DUAL RECDNG ON ON ON Dual trace recording REMOTE RECD OFF OFF OFF Telemetry recording

Vital Signs Chart Factory Defaults

VITAL SIGNS

CHART

STORE AUTO OFF OFF OFF Auto stores at selected intervals STORE NIBP ON ON ON Storing NIBP values STORE TMP ON ON ON Storing Temperature values STORE CO ON ON ON Storing Cardiac Output values

VALID TIME 30 30 30 STORE ALARM OFF OFF OFF Storing alarm violations

STR ECG ALM ON ON ON Storing ECG alarm violations STR SPO2 ALM ON ON ON Storing SPO2 alarm violations STR RESP ALM ON ON ON Storing Respiration alarm violations STR CO2 ALM ON ON ON Storing CO2 alarm violations STR BP ALM ON ON ON Storing IBP alarm violations STR NIBP ALM ON ON ON Storing NIBP alarm violations STR TMP ALM ON ON ON Storing temperature alarm violations

ADULT PED NEO DESCRIPTION

Displayed time for NIBP, Suretemp, and CO

6-2

ECG Setup Factory Defaults

ECG SETUP ADULT PED NEO DESCRIPTION

ALARMS ON ON ON Enables ECG alarms ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the ECG alarms until reset HIGH LIMIT 140 180 200 High alarm limit setting LOW LIMIT 50 80 100 Low alarm limit setting RCD ON ALARM WF WF WF Record when ECG alarm enabled FILTER ON ON ON ECG filter enable SIZE VCTR 1 1.00 0.80 0.80 3 lead select size SIZE VCTR 2 1.00 0.80 0.80 5 lead select size SWEEP SPEED 25 25 25 Waveform speed PACE DETECT OFF OFF OFF Pacer detection enable LEAD SELECT II II II Lead select I, II, III, or V 5 LEAD OFF OFF OFF 5 lead mode enable QRS TONE OFF OFF OFF QRS detect tone WAVEFORM ON ON ON ON ECG waveform enable PRAM COLOR GREEN GREEN GREEN Sets on-screen color of parameter

Respiration Setup Factory Defaults

RESPIRATION

SETUP

ALARMS OFF ON ON Enables respiration alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3)

LATCH ALARMS OFF OFF OFF HIGH LIMIT OFF OFF OFF High alarm limit setting

LOW LIMIT 5 5 5 Low alarm limit setting PRAM AVAIL ON ON ON Respiration enable or disable PRAM ON/OFF OFF OFF OFF Respiration standby RCD ON ALARM WF WF WF Record when Resp alarm enabled RESP SIZE 1.00 0.77 0.57 Respiration waveform size SWEEP SPEED 12.5 12.5 12.5 Respiration waveform speed APNEA DELAY 20 20 20 Time delay for apnea alarm APNEA ALM LVL 2 2 2 Sets alarm priority level (1, 2, or 3) CVA ON ON ON Artifact detection TONE OFF OFF OFF Respiration Rate tone CRG SCALES ON ON ON OXYCRG scales enable PRAM COLOR CYAN CYAN CYAN Sets on-screen color of parameter

ADULT PED NEO DESCRIPTION

Latches the Respiration alarms until reset

6-3

SPO2 Setup Factory Defaults

SPO2 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF ON ON Enables SPO2 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) ALARM DELAY 5 5 5 Delay time for alarm LATCH ALARMS OFF OFF OFF Latches the SPO2 alarm until reset ALARM TONE STD STD STD Tone during alarm HIGH LIMIT 100 100 95 High alarm limit setting LOW LIMIT 85 85 80 Low alarm limit setting PRAM AVAIL ON ON ON SPO2 enable or disable PRAM ON / OFF OFF OFF OFF SPO2 standby RCD ON ALARM VS VS VS Record when SPO2 alarm enabled TONE OFF OFF OFF Tone enable for SPO2 TONE RANGE WIDE WIDE WIDE SPO2 tone frequency range MODE NORM NORM NORM SPO2 averaging time C-LOCK OFF OFF OFF ECG synchronization WAVEFORM ON ON ON ON SPO2 waveform enable PRAM COLOR PURPL PURPL PURPL Sets on-screen color of parameter

6-4

BP1 Setup Factory Defaults

BP1 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enables BP1 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the BP1 alarm until reset SYS HI LIMIT 170 130 100 Systolic high alarm limit setting SYS LO LIMIT 90 65 50 Systolic low alarm limit setting DIA HI LIMIT 100 90 70 Diastolic high alarm limit setting DIA LO LIMIT 50 40 30 Diastolic low alarm limit setting MN HI LIMIT 120 100 80 Mean high alarm limit setting MN LO LIMIT 60 50 35 Mean low alarm limit setting PRAM AVAIL ON ON ON BP1 enable or disable PRAM ON / OFF OFF OFF OFF BP1 standby RCD ON ALARM WF WF WF Record when BP1 alarm enabled SIZE 120 120 120 BP1 waveform size SCALE OFF OFF OFF BP1 scale enable DISPD VALUES S/D S/D S/D BP1 numeric display format SITE OFF OFF OFF BP1 catheter site PRAM COLOR RED RED RED Sets on-screen color of parameter

6-5

BP2 Setup Factory Defaults

BP2 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enables BP2 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the BP2 alarm until reset SYS HI LIMIT 50 40 20 Systolic high alarm limit setting SYS LO LIMIT 20 5 5 Systolic low alarm limit setting DIA HI LIMIT 25 15 10 Diastolic high alarm limit setting DIA LO LIMIT 5 00 00 Diastolic low alarm limit setting MN HI LIMIT 30 25 15 Mean high alarm limit setting MN LO LIMIT 10 5 5 Mean low alarm limit setting PRAM AVAIL ON ON ON BP2 enable or disable PRAM ON / OFF OFF OFF OFF BP2 standby RCD ON ALARM WF WF WF Record when BP2 alarm enabled SIZE 30 30 30 BP2 waveform size SCALE OFF OFF OFF BP2 scale enable DISPD VALUES S/D S/D MEAN BP2 numeric display format SITE OFF OFF OFF BP2 catheter site PRAM COLOR YELLW YELLW YELLW Sets on-screen color of parameter

6-6

BP3 Setup Factory Defaults

BP3 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enables BP3 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the BP3 alarm until reset SYS HI LIMIT 25 25 25 Systolic high alarm limit setting SYS LO LIMIT 5 5 5 Systolic low alarm limit setting DIA HI LIMIT 5 5 5 Diastolic high alarm limit setting DIA LO LIMIT 00 00 00 Diastolic low alarm limit setting MN HI LIMIT 5 5 5 Mean high alarm limit setting MN LO LIMIT 00 00 00 Mean low alarm limit setting PRAM AVAIL ON ON ON BP3 enable or disable PRAM ON / OFF OFF OFF OFF BP3 standby RCD ON ALARM WF WF WF Record when BP3 alarm enabled SIZE 30 30 30 BP3 waveform size SCALE OFF OFF OFF BP3 scale enable DISPD VALUES MEAN MEAN MEAN BP3 numeric display format SITE OFF OFF OFF BP3 catheter site PRAM COLOR LTBLU LTBLU LTBLU Sets on-screen color of parameter

6-7

NIBP Setup Factory Defaults

NIBP SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enables NIBP alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the NIBP alarm until reset SYS HI LIMIT 170 130 100 Systolic high alarm limit setting SYS LO LIMIT 90 65 50 Systolic low alarm limit setting DIA HI LIMIT 100 90 70 Diastolic high alarm limit setting DIA LO LIMIT 50 40 30 Diastolic low alarm limit setting MN HI LIMIT 120 100 80 Mean high alarm limit setting MN LO LIMIT 60 50 35 Mean low alarm limit setting PRAM AVAIL ON ON ON NIBP enable or disable PRAM ON/OFF ON ON ON NIBP standby RCD ON ALARM VS VS VS Record when NIBP alarm enabled AUTO OFF OFF OFF Automatic mode enable INTERVAL 5MIN 5MIN 5MIN Automatic reading interval 1ST INFLATE 170 140 90 First inflation pressure TABLE DSPLY OFF OFF OFF Enables NIBP table display DISPD VALUES S/D S/D S/D NIBP numeric disply format TONE ON ON ON Enables end value tone SITE OFF OFF OFF NIBP cuff site PRAM COLOR ORNGE ORNGE ORNGE Sets on-screen color of parameter

6-8

CO2 Setup Factory Defaults

CO2 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enables CO2 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the CO2 alarm until reset HIGH LIMIT 50 50 50 High alarm limit setting LOW LIMIT 25 25 25 Low alarm limit setting ICO2 LIMIT 8 8 8 Inspired CO2 alarm limit setting PRAM AVAIL ON ON ON CO2 enable or disable PRAM ON/OFF OFF OFF OFF CO2 standby RCD ON ALARM WF WF WF Record when CO2 alarm enabled SCALE 50 50 50 CO2 waveform scale size UNITS mmHg mmHg mmHg Measurement units % or mmHg O2 COMPNSAT OFF OFF OFF O2 compensation enable N2O COMPNSAT OFF OFF OFF N2O compensation enable PRAM COLOR CYAN CYAN CYAN Sets on-screen color of parameter

CO Setup Factory Defaults

CO SETUP ADULT PED NEO DESCRIPTION

PRAM AVAIL ON ON ON Cardiac output enable or disable CONSTANT .470 .470 .470 PRAM ON/OFF OFF OFF OFF Cardiac output standby REF ON/OFF ON ON ON DISP TIMEOUT 5 5 5 Displayed time for CO measurement

UNITS IN/LB IN/LB IN/LB Inches/pounds or centimeters/kilograms PRAM COLOR PINK PINK PINK Sets on-screen color of parameter

Adjusts computational constant for catheter and injectate volume

Right ejection fraction measurement enable

6-9

Temp1 Setup Factory Defaults

TEMP1 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enables Temp1 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the Temp1 alarm until reset UNITS

Celsius or Fahrenheit HIGH LIMIT 38.0 38.0 37.5 High alarm limit setting LOW LIMIT 36.0 36.0 36.0 Low alarm limit setting PRAM AVAIL ON ON ON Temp1 enable or disable PRAM ON/OFF OFF OFF OFF Temp1 standby TONE ON ON ON Measurement update tone enable PRAM COLOR WHITE WHITE WHITE Sets on-screen color of parameter

Temp2 Setup Factory Defaults

TEMP2 SETUP ADULT PED NEO DESCRIPTION

ALARMS OFF OFF OFF Enable Temp2 alarm ALARM LEVEL 2 2 2 Sets alarm priority level (1, 2, or 3) LATCH ALARMS OFF OFF OFF Latches the Temp2 alarm until reset HIGH LIMIT 38.0 38.0 37.5 High alarm limit setting LOW LIMIT 36.0 36.0 36.0 Low alarm limit setting PRAM AVAIL ON ON ON Temp2 enable or disable PRAM ON/OFF OFF OFF OFF Temp2 standby PRAM COLOR GRAY GRAY GRAY Sets on-screen color of parameter

6-10

Chapter 7 – System & Parameter Messages

System and parameter messages remind, prompt, or warn you about the current condition of the monitor or its parameters. These messages are displayed in reverse video and may flash on and off to get your attention.

System Messages

The system messages, explained in the following tables, are displayed in a reverse-video box, just below the WDZ. They apply to conditions of the monitor that are not specific to any one parameter. See the “System Message Area” section for more information.

System Messages

SYSTEM MESSAGE MEANING

RECORDER PAPER The recorder is out of paper, or the paper is not installed

correctly.

REC DISABLE FREEZE You are trying to freeze waveforms while recording is in

progress. You can only freeze waveforms when they are not being recorded.

REC IN CONT RUN MODE Indicates that you have pressed and held the RECORD key so

that the recorder will run continuously. Press RECORD again to end continuous recording.

FREZ RELEASE FREZ Waveforms are currently frozen. To release the frozen

waveforms, you must press either the FREEZE or the RECORD key.

LINK RECORD SENT A record has been sent to the Central Station because the recorder

at PRISM monitor is either not present or out of paper.

ALARM SUSPEND XXX You have pressed the ALARM SUSPEND key, disabling all

alarm tones for the number of seconds (XXX) displayed. To enable alarm tones before the suspend time has expired, press the ALARM SUSPEND key again. The ALARM SUSPEND function is also enabled at power-up.

7-1

Battery Messages

MONITOR BAT HI > 60% Charge

MONITOR BAT MID 20-60% Charge

MONITOR BAT LOW < 20% Charge

MESSAGE BATTERY LEVEL

BATTERY VERY LOW

(Intermittent Alarm Tone Sounds)

Approximately 10 minutes of battery life remains

Parameter Messages

The following tables explain messages that are parameter specific. Messages concerning parameters displayed in the WDZ will be displayed in a video box below the numeric data for the corresponding waveform parameters. The message is displayed as long as the message condition exists. All messages that apply to parameters in the numeric-only zone are displayed in the numeric display area.

ECG/Respiration Messages

ECG/RESP MESSAGE MEANING

CVA Cardiovascular artifact (CVA) coincidence has been detected on

respiration. Respiration will reject coincident respiration while the message is displayed. At least 8 out of 10 coincident respirations are required to initiate and maintain the CVA

message. APNEA The apnea alarm limits have been exceeded. APN ALM OFF Respiration alarms are ON, but apnea alarm is OFF. CHK LEADS One or more electrodes or lead wires may be dry or loose. In

addition to the message, the ECG waveform and respiration

waveform, if it is displayed, become dotted lines.

7-2

SPO2 Messages

SPO2 MESSAGE MEANING

SPO2 SRCH (Nellcor only)

NO C-LOCK (Nellcor only)

NO SENSOR The SPO2 parameter is ON, but the sensor and/or sensor cable

SPO2 CAL The monitor is performing automatic self-calibration. The

Invasive Blood Pressure (BP1/BP2/BP3) Messages

BP1/BP2/BP3 MESSAGE MEANING

NO XDUCER The pressure transducer is not connected to the monitor. ZERO BP1

ZERO BP2 ZERO BP3

The monitor cannot locate the patient’s pulse. The patient’s

perfusion may be too poor to detect an acceptable pulse. Confirm

proper application of the sensor; make sure the ECG parameter is

available for C-LOCK synchronization; try another sensor site; or

try the OXISENSOR II R-15 sensor.

Indicates loss of synchronization between the ECG and SPO2

pulse waveform. Take steps to eliminate ECG artifact, or if the R-

wave amplitude is less than 4 mm, increase the ECG waveform

size by using the ECG SIZE softkey.

is/are not connected to the monitor.

calibration range is 50 to 100%.

Message flashes until the pressure channel is zeroed as a

reminder that pressures must be zeroed prior to use.

NO ZERO: PULSE DETECT Displayed over the BP SETUP page to indicate that either a pulse

or electrical noise was detected, which precluded zeroing the

transducer. Confirm that the transducer is vented to air before

pressing the ZERO key. ZERO OUT OF RANGE Displayed over the BP SETUP page to indicate that a

transducer’s offset exceeds the zero range (±100 mmHg) of the

monitor. Confirm that the transducer is vented to the air and

attempt to zero again.

7-3

MDE Escort User manual

Specifications and Main Features

Frequently Asked Questions

User Manual