Medtronic Capnostream20P_OPSManual_en_PT00092347A00 Centricity Cardiology INW Service Manual Software Version 6.9.6 R3 2097992-010D EN
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Capnostream™20p
Portable Bedside Monitor
Capnograph/Pulse Oximeter
Operator’s Manual
PN: PT00092347A
0482
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Notice: Purchase of this product confers no express or implied license under any Oridion Medical 1987 Ltd. patent
to use the instrument with any accessory that is not manufactured or licensed by Oridion Medical 1987 Ltd.
Possession or purchase of this device does not convey an express or implied license to use the device with
unauthorized sensors or cables which would, alone, or in combination with this device, fall within the scope of
one or more of the patents relating to this device.
Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. TM* Trademark of its
respective owner. All other brands are trademarks of a Medtronic company.
Oridion Medical 1987 Ltd., Covidien, and Nellcor Puritan Bennett LLC are Medtronic companies.
The capnography component of this product is covered by: US Patents: www.covidien.com/patents.
The pulse oximetry component of this product is covered by: US Patents: www.covidien.com/patents.
Exemptions
Oridion Medical 1987 Ltd.'s liability under this warranty does not include any transportation damage or other
charges or liability for direct, indirect or consequential damages or delay resulting from improper use or
application of the product or the substitution upon it of parts or accessories not approved by Oridion Medical 1987
Ltd.
All information in this manual is believed to be correct. Oridion Medical 1987 Ltd. shall not be liable for errors
contained herein with the performance or use of this manual.
Copyright © 2018 Oridion Medical 1987 Ltd. All rights reserved.
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Table of Contents
Table of Contents 1
List of Figures 8
List of Tables 10
Oridion Medical 1987 Ltd. ("Oridion Medical") - Warranty for
Oridion Monitors 11
13
Safety Information 13
Warnings ....................................................................................................................... 13
General ......................................................................................................................................13
MRI Scanning ............................................................................................................................14
Monitor Use with Defibrillators ..................................................................................................14
Alarms .......................................................................................................................................14
Fire Hazard................................................................................................................................14
Electrical ....................................................................................................................................15
Electro-magnetic Interference ...................................................................................................15
Definitions ..................................................................................................................... 16
Chapter 1 17
About this Manual 17
Overview ....................................................................................................................... 17
Intended Use ................................................................................................................. 17
Specific Indications for Use ........................................................................................... 18
Who Should Read This Manual ..................................................................................... 18
Contacting Technical Support ....................................................................................... 18
Symbols ........................................................................................................................ 18
Chapter 2 21
Technology Overview 21
Introduction ................................................................................................................... 21
Features ........................................................................................................................ 21
Technology Overview .................................................................................................... 21
What is Capnography? .............................................................................................................21
What is Pulse Oximetry? ...........................................................................................................22
Chapter 3 23
The Capnostream™20p Monitor 23
Unpacking and Inspection ............................................................................................. 23
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Portable Bedside Capnograph/Pulse Oximeter
Installing the Battery Pack ............................................................................................. 24
Testing the Battery and AC Connections ................................................................................. 25
Handling the Battery Pack ....................................................................................................... 26
Storing the Battery ................................................................................................................... 26
Disposing of the Battery ........................................................................................................... 26
Battery and Power Usage ........................................................................................................ 26
Mounting the Monitor..................................................................................................... 26
Setting up Periodic Maintenance ................................................................................... 27
Accessories ................................................................................................................... 27
Available Accessories .............................................................................................................. 27
Monitor Mounting Plate ............................................................................................................ 28
Printer Paper ............................................................................................................................ 28
Buttons, Indicators and Connections ............................................................................. 29
Monitor Front View ................................................................................................................... 29
Front Panel Control Buttons .......................................................................................... 30
Monitor Rear Panel .................................................................................................................. 31
Monitor Left and Right Views ................................................................................................... 32
Turning on the Monitor .................................................................................................. 32
Standard Sections of the Display Screen ...................................................................... 33
Home Screen Standard Display ............................................................................................... 34
Home Screen Numeric Display ................................................................................................ 38
Terminating Operation of the Monitor ............................................................................ 39
Screen Navigation ......................................................................................................... 40
Configuration Changes ............................................................................................................ 40
Setting Date, Time, Language, and Other Options ....................................................... 40
Screen Timeouts ........................................................................................................... 41
Screen Timeouts ...................................................................................................................... 41
Capnostream™20p: Operational Check Sheet ............................................................... 42
Chapter 4 45
Using the Capnostream™20p Monitor 45
Preparing the Monitor for a Patient ............................................................................... 45
Setting the Patient Type ........................................................................................................... 45
Using Patient Cases and Patient ID Numbers ............................................................... 46
Entering Patient Events ................................................................................................. 47
Changing the Alarm and Pulse Volumes ....................................................................... 48
Alarm Volume ........................................................................................................................... 48
Pulse Tone Volume .................................................................................................................. 48
Alarm Volume Default Options ................................................................................................. 49
Alarm Delay ................................................................................................................... 49
Use of Scavenging System ........................................................................................... 49
Turning the Pump Off for Suction or Lavage ................................................................. 50
Demo Mode ................................................................................................................... 51
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Monitor Screen Menu Reference Chart ......................................................................... 51
Chapter 5 55
Capnography with the Capnostream™20p Monitor 55
Microstream™ EtCO2 Consumables .............................................................................. 55
Basic Principles .........................................................................................................................56
Microstream™ EtCO2 Consumables .........................................................................................56
Connecting a FilterLine™ .............................................................................................. 56
CO2 Data Displayed by the Capnostream™20p Monitor ............................................... 57
Adjustable CO2 Parameters .......................................................................................... 58
Monitoring CO2 during MRI Scanning ........................................................................... 59
Chapter 6 61
Pulse Oximetry with the Capnostream™20p Monitor 61
Nellcor™ SpO2 Sensors ................................................................................................ 61
Data Update Period, Data Averaging, and Signal Processing .................................................62
Selecting Nellcor™ SpO2 Sensors............................................................................................62
Performance Considerations ....................................................................................................63
Connecting an SpO2 Sensor to the Monitor................................................................... 64
SpO2 Data Displayed by the Capnostream™20p Monitor ............................................. 64
Adjustable SpO2 Parameters......................................................................................... 66
SpO2 Alarm Limit Message ........................................................................................... 66
Chapter 7 67
Integrated Pulmonary Index™ 67
Introduction ................................................................................................................... 67
Warnings ....................................................................................................................... 68
IPI Display ..................................................................................................................... 68
IPI Options .................................................................................................................... 68
Chapter 8 69
Apneas per Hour and the Oxygen Desaturation Index 69
Introduction ................................................................................................................... 69
Apneas per Hour ........................................................................................................... 69
The Capnostream™20p Apneas per Hour ...............................................................................69
A/hr Visual Alert ........................................................................................................................70
Oxygen Desaturation Index (ODI) ................................................................................. 70
Apnea and O2 Desaturation Report .............................................................................. 70
Monitoring with A/hr and ODI ........................................................................................ 70
Smart A/hr and ODI Home Screen Display ................................................................... 71
A/hr and ODI Option ...................................................................................................... 71
A/hr and ODI Demo Mode ............................................................................................. 71
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Chapter 9 73
Alarms and Messages 73
Introduction ................................................................................................................... 73
Alarm Display ................................................................................................................ 74
Message Priorities ......................................................................................................... 76
Alarm Delay ................................................................................................................... 76
Types of Alarms ............................................................................................................ 76
High Priority Alarms ................................................................................................................. 77
Medium Priority Alarms ............................................................................................................ 78
Advisories ................................................................................................................................. 79
Silent Advisories ....................................................................................................................... 79
Parameter Standby Mode ............................................................................................. 80
Alarm Silence ................................................................................................................ 83
Changing Alarm Limits .................................................................................................. 83
Testing Alarm Settings .................................................................................................. 85
SpO2 Alarms and SatSeconds ...................................................................................... 85
SatSeconds Alarm Display ...................................................................................................... 86
Alarm Limits - Factory Defaults ..................................................................................... 86
Chapter 10 87
Using Trends 87
Introduction ................................................................................................................... 87
The Trend Display Screens ........................................................................................... 88
Graphical Trend Display Screen ................................................................................... 88
Graphical Trend Display........................................................................................................... 89
Using SCROLL and ZOOM ...................................................................................................... 89
Tabular Trend Display Screen ....................................................................................... 91
Choosing Trend Parameters ......................................................................................... 93
Important Notes Regarding Trend Reports ................................................................... 93
Specific Events as seen in Trend Data.......................................................................... 93
Using the Graphical Trend Screen for Monitoring Patients ........................................... 93
Printing the Trend Data ................................................................................................. 94
Clearing Trend Memory ................................................................................................. 94
Configuring Trends ........................................................................................................ 95
Event Marking Mode ................................................................................................................ 95
Trend Graphical Display........................................................................................................... 95
Trend Increment Display .......................................................................................................... 95
Chapter 11 97
Reports 97
Apnea and O2 Desaturation Report ............................................................................... 97
Printed Report Options ................................................................................................ 101
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Printed Reports ........................................................................................................... 101
Sample Reports........................................................................................................... 105
Sample Case Reports ............................................................................................................ 105
Sample Trend Reports ........................................................................................................... 106
Chapter 12 107
Downloading Patient Data 107
Introduction ................................................................................................................. 107
Data Transfer via the USB Data Port .......................................................................... 107
USB File Naming Convention ................................................................................................ 110
Examples ................................................................................................................................ 111
USB Error Messages ............................................................................................................. 111
Reading Patient Data from Saved Capnostream™20p Files ................................................ 111
Data Transfer via the RS-232 Port .............................................................................. 111
Analog Data Output with Capnostream™20p ............................................................. 112
Connecting Capnostream™20p and an Analog Device using the D/A Cable ...................... 113
Changing Default Digital/Analog Channel Values on Capnostream™20p ........................... 114
Calibrating the Analog Device for Capnostream™20p .......................................................... 115
Working with the Digital/Analog System ................................................................................ 117
Nurse Call Operation ................................................................................................... 117
Types of Nurse Call Systems ...................................................................................... 118
The Nurse Call Cable ............................................................................................................. 118
Activating Nurse Call .............................................................................................................. 119
Testing Nurse Call .................................................................................................................. 119
Operation with Hospital Patient Data Systems ............................................................ 120
Operation with Nuvon VEGA™* Systems ................................................................... 121
Chapter 13 123
Maintenance and Troubleshooting 123
Introduction ................................................................................................................. 123
Determining Monitor Service Hours ............................................................................. 123
CO2 Calibration ........................................................................................................... 124
CO2 Calibration Check ................................................................................................ 125
Calibration Check Procedure ................................................................................................. 125
Maintenance ................................................................................................................ 126
Replacing the Fuses .................................................................................................... 126
Replacing the Printer Paper Roll ................................................................................. 127
Cleaning ...................................................................................................................... 127
Troubleshooting........................................................................................................... 128
Electrical ................................................................................................................................. 128
CO2 Problems ........................................................................................................................ 128
SpO2 Sensor .......................................................................................................................... 129
Printer ..................................................................................................................................... 130
Nurse Call ............................................................................................................................... 130
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CO2 Calibration ...................................................................................................................... 130
Returning the Monitor .................................................................................................. 130
Technical Assistance................................................................................................... 130
Appendix 1 131
Institutional Settings 131
Institutional Defaults .................................................................................................... 131
Changing Institutional Defaults .................................................................................... 131
Resetting to Factory Defaults ...................................................................................... 132
Uploading or Downloading Institutional Defaults ......................................................... 132
Changing Monitor Settings .......................................................................................... 133
Alarm Limits ............................................................................................................................ 133
Alarm Delay ............................................................................................................................ 135
Trend Settings ........................................................................................................................ 135
Changing Parameters Order on the Trend Display ............................................................... 135
Events .................................................................................................................................... 136
How to Change Event Defaults .............................................................................................. 136
Monitor Settings ..................................................................................................................... 136
CO2 Parameters ..................................................................................................................... 138
SpO2 Parameters ................................................................................................................... 138
Appendix 2 139
Specifications 139
Power Supply .............................................................................................................. 139
Battery ......................................................................................................................... 139
Controls ....................................................................................................................... 139
Display ........................................................................................................................ 140
Microstream™ Capnography ........................................................................................ 140
Nellcor™ Oximax™ Pulse Oximetry ............................................................................. 141
Alarms ......................................................................................................................... 141
Outputs ........................................................................................................................ 142
Analog Output ........................................................................................................................ 142
Nurse Call ............................................................................................................................... 142
RS-232 ................................................................................................................................... 143
USB ........................................................................................................................................ 143
Internal Thermal Printer (optional) ............................................................................... 143
General Characteristics ............................................................................................... 144
Equipment Classification ............................................................................................. 144
Compliance ................................................................................................................. 144
Electromagnetic Immunity ...................................................................................................... 144
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Appendix 3 149
Microstream™ EtCO2 Consumables 149
Microstream™ EtCO2 Consumables ........................................................................... 149
Appendix 4 151
Capnostream™ Service Password 151
Capnostream™ Service Password.............................................................................. 151
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Portable Bedside Capnograph/Pulse Oximeter
List of Figures
Figure 1 - Installing the Battery Pack ............................................................................................... 24
Figure 2 - Battery Pack Close-up ..................................................................................................... 24
Figure 3 - Menu Bar with Battery Charge Level ............................................................................... 25
Figure 4 - Monitor Bottom View ........................................................................................................ 27
Figure 5 – Capnostream™20p Front View ....................................................................................... 29
Figure 6 - Front Panel Control Buttons ............................................................................................ 30
Figure 7 – Capnostream™20p Rear View ....................................................................................... 31
Figure 8 – Capnostream™20p Left View ......................................................................................... 32
Figure 9 - Salutation Screen ............................................................................................................. 33
Figure 10 - Typical Home Screen ..................................................................................................... 34
Figure 11 - Typical Home Screen when A/hr and ODI are not Available ........................................ 35
Figure 12 - Standard Home Screen without IPI Option ................................................................... 36
Figure 13 - Header Area ................................................................................................................... 36
Figure 14 - Typical Numeric Home Screen ...................................................................................... 38
Figure 15 - System Setup Screen .................................................................................................... 41
Figure 16 - Menu Bar ........................................................................................................................ 48
Figure 17 - Alarm Volume Selection................................................................................................. 48
Figure 18 - Pulse Tone Volume Selection ........................................................................................ 49
Figure 19 - Scavenger System Connection Point ............................................................................ 50
Figure 20 - Screen Menu Reference Chart when A/hr and ODI are available ................................ 52
Figure 21 - Screen Menu Reference Chart when A/hr and ODI are not available .......................... 53
Figure 22 - CO2 Data on the Capnostream™20p Monitor ............................................................... 57
Figure 23 - CO2 Section of Numeric Home Screen ......................................................................... 58
Figure 24 - SpO2 Data on the Capnostream™20p Monitor - Standard Screen............................... 65
Figure 25 - SpO2 Data on the Capnostream™20p Monitor – Standard Screen with IPI Disabled.. 65
Figure 26 - SpO2 Section of Numeric Home Screen ........................................................................ 66
Figure 27 - IPI Trend Graph ............................................................................................................. 67
Figure 28 – Capnostream™20p Alarm Review Screen ................................................................... 75
Figure 29 - Example Showing Alarms .............................................................................................. 77
Figure 30 - Alarm Limits Screen ....................................................................................................... 84
Figure 31 - Graphical Trend Display ................................................................................................ 88
Figure 32 - Scroll mode in the Graphical Trend ............................................................................... 90
Figure 33 - Tabular Trend Display .................................................................................................... 91
Figure 34 - Trend Memory Message ................................................................................................ 94
Figure 35 - Apnea and Desat Report Screen ................................................................................... 99
Figure 36 - Apnea and Desat Printed Report ................................................................................. 100
Figure 37 - Print Screen ................................................................................................................. 102
Figure 38 - Sample Case Reports Printout .................................................................................... 105
Figure 39 - Printed Trend Reports .................................................................................................. 106
Figure 40 - Typical Flash Memory Device ...................................................................................... 108
Figure 41 - USB Icon ...................................................................................................................... 109
Figure 42 - The Capnostream™20p D/A Cable (PN PM20ACB) .................................................. 113
Figure 43 - The Analog Port on Capnostream™20p ..................................................................... 113
Figure 44 – Capnostream™20p Digital / Analog Setup Screen .................................................... 115
Figure 45 - Stereo Phono Plug for Nurse Call................................................................................ 118
Figure 46 - Connection Point for Nurse Call .................................................................................. 119
Figure 47 - Service Screen ............................................................................................................. 124
Figure 48 - Insert Paper Roll into printer ........................................................................................ 127
Figure 49 - Institutional Defaults Screen ........................................................................................ 132
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Figure 50 - Software Support Screen ............................................................................................. 133
Figure 51 - Institutional Defaults Alarm Limits Screen ................................................................... 134
Figure 52 - Institutional Defaults: Monitor ...................................................................................... 137
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List of Tables
Table 1 - Symbols that Appear on the Monitor ................................................................................ 18
Table 2 – Capnostream™20p Accessories ...................................................................................... 27
Table 3 - Printer Paper Specifications .............................................................................................. 28
Table 4 – Capnostream™20p Front View ........................................................................................ 30
Table 5 – Capnostream™20p Rear View ........................................................................................ 31
Table 6 – Capnostream™20p Left View .......................................................................................... 32
Table 7 - Header Section.................................................................................................................. 36
Table 8 - Event Markings.................................................................................................................. 48
Table 9 - Audio Alarm Volume ......................................................................................................... 49
Table 10 - Adjustable CO2 Parameters ............................................................................................ 58
Table 11 – Nellcor™ SpO2 Sensors ................................................................................................. 62
Table 12 - Adjustable SpO2 Parameters .......................................................................................... 66
Table 13 - Adjustable IPI Options..................................................................................................... 68
Table 14 - Alarm Indications ............................................................................................................. 73
Table 15 - High Priority Alarms ........................................................................................................ 77
Table 16 - Medium Priority Alarms ................................................................................................... 78
Table 17 - Advisories ........................................................................................................................ 79
Table 18 - Silent Advisories .............................................................................................................. 79
Table 19 - Message and Alarm Status during Different Parameter Standby Situations ................. 82
Table 20 - Tabular Display Example ................................................................................................ 92
Table 21 - Detailed Tabular Display Example .................................................................................. 92
Table 22 - Monitor Parameters ......................................................................................................... 95
Table 23 - Printed Reports – Parameters ...................................................................................... 102
Table 24 - Data Transfer Types ..................................................................................................... 107
Table 25 - Select Data Output Type ............................................................................................... 109
Table 26 - File Naming Conventions .............................................................................................. 110
Table 27 - D/A Cable color codes .................................................................................................. 114
Table 28 - D/A Calibration Values .................................................................................................. 116
Table 29 - Troubleshooting ............................................................................................................ 117
Table 30 - Nurse Call Specs .......................................................................................................... 118
Table 31 - Nurse Call Indicators ..................................................................................................... 120
Table 32 - Factory Default Alarm/Indicator Limits .......................................................................... 134
Table 33 - Factory Default and Optional Alarm Delay Settings ..................................................... 135
Table 34 - Factory Default and Optional Trend Settings ............................................................... 135
Table 35 - Guidance and Manufacturer's Declaration - Electromagnetic Emissions .................... 145
Table 36 - Guidance and Manufacturer’s Declaration – Electromagnetic Immunity ..................... 145
Table 37 - Recommended Separation Distances between Portable and Mobile RF
Communications Equipment and the Monitor ...................................................................... 147
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Oridion Medical 1987 Ltd. ("Oridion Medical") -
Warranty for Oridion Monitors
THIS LIMITED WARRANTY applies to any patient monitor manufactured by Oridion Medical 1987 Ltd.
(“Oridion”), (“Products”). Subject to the limitations herein, Oridion warrants that Products, when delivered by
Oridion or its authorized distributor, for two (2) years following the delivery date, but no more than 27 months
following the date of production, will be free from defects in material and workmanship and will substantially
conform to published Oridion specifications for the respective Products and in effect at the time of manufacture.
This limited warranty excludes (i) Products purchased through unauthorized third parties; (ii) Products that have
been subject to misuse, mishandling, accident, alteration, neglect, unauthorized repair or installation; and (iii)
Products that have been used with accessory consumable products other than Oridion’s FilterLine™ products.
Furthermore, this limited warranty shall not apply to the use of Products in an application or environment that is not
within Oridion specifications or in the event of any act, error, neglect or default of Customer. Oridion at its sole
discretion will replace or repair the damaged Products. Customer may not return Products without first obtaining a
customer return material authorization (RMA) number from Oridion or one of the Authorized Service centers and a
copy of the Product purchase invoice.
Disclaimer
USER MAY USE THE PARAMETERS (INCLUDING ANY AND ALL REFERENCES TO CO2, SPO2,
CURRENT INTEGRATED PULMONARY INDEX™ AND FUTURE AND RELATED INDICES AND
CONFIGURATIONS AND SIGNAL ALARM NOTIFICATIONS) WHICH APPEAR ON ORIDION'S PATIENT
MONITORING DEVICES AND/OR ORIDION’S COMMUNICATION PROTOCOL AND/OR ANY OUTPUT IN
REPORTS DOWNLOADED FROM ORIDION'S PATIENT MONITORING DEVICES TO PRINTERS OR USB
MEMORY STICKS OR APPROVED SYSTEMS ("DATA") SOLELY AND EXCLUSIVELY FOR THE
PURPOSE OF PATIENT CARE. USER ACKNOWLEDGES THAT DATA TRANSMITTED FROM ORIDION'S
PATIENT MONITORING DEVICES MAY NOT BE TRANSFERRED, INTERFACED, EXCHANGED OR
OTHERWISE TRANSMITTED AND THAT ORIDION ACCEPTS NO RESPONSIBILITY WHATSOEVER FOR
THE ACCURACY OR COMPLETENESS OF DATA THAT HAS BEEN TRANSFERRED, INTERFACED,
EXCHANGED OR OTHERWISE TRANSMITTED. USER FURTHER ACKNOWLEDGES THAT IT MAY NOT
SELL, LICENSE OR OTHERWISE COMMERCIALIZE THE DATA, IN WHOLE OR IN PART. ANY OTHER
USE OF THE DATA OR INTERFACE WITH OTHER SYSTEMS, WHETHER BY USER OR ANY PARTY ON
ITS BEHALF, SHALL BE SUBJECT TO A SEPARATE LICENSING ARRANGEMENT WITH ORIDION
INCORPORATING, BUT NOT LIMITED TO, COMMERCIAL TERMS TO BE NEGOTIATED IN GOOD
FAITH.
USER ACKNOWLEDGES AND UNDERSTANDS THAT THE DATA IS PROVIDED “AS-IS” AND THAT
ORIDION DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING WARRANTIES OF
MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. ORIDION WILL NOT BE LIABLE
FOR ANY INJURIES OR DAMAGES TO ANY PERSONS OR TANGIBLE OR INTANGIBLE PROPERTY
RESULTING FROM ANY CAUSE WHATSOEVER. ORIDION DISCLAIMS ANY AND ALL LIABILITY FOR
DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR OTHER SIMILAR DAMAGES
REGARDLESS OF THE FORM OF ACTION WHETHER IN CONTRACT, TORT (INCLUDING
NEGLIGENCE), STRICT PRODUCT LIABILITY OR ANY OTHER LEGAL OR EQUITABLE THEORY, EVEN
IF ORIDION HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES OR DAMAGES.
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Do not touch this field - it is invisible and does not appear in the
Safety Information
final document
Warnings
Definitions
To use the Capnostream™20P monitor correctly and safely, carefully read this operator’s manual and the
Directions for Use that accompany Microstream
of the monitor
information in boldface type, and the specifications.
requires full understanding and strict observance of these instructions, the precautionary
™
etCO2 consumables (FilterLine™) and the SpO2 sensors. Use
Warnings
General
WARNING: If uncertain about the accuracy of any measurement, first check the patient’s vital signs by
alternate means, and then make sure the monitor is functioning correctly.
WARNING: The device should not be used as an apnea monitor.
WARNING: The device should be considered an early warning device. As a trend towards patient
deoxygenation is indicated, blood samples should be analyzed by a laboratory co-oximeter
to completely understand the patient's condition.
WARNING: To ensure patient safety, do not place the monitor in any position that might cause it to fall
on the patient.
WARNING: Carefully route patient cabling (SpO2 sensor and FilterLine™) to reduce the possibility of
patient entanglement or strangulation.
WARNING: Do not lift the monitor by the SpO2 sensor cable or FilterLine™, as they could disconnect
from the monitor, causing the monitor to fall on the patient.
WARNING: The monitor should not be used adjacent to or stacked with other equipment; if adjacent or
stacked use is necessary, the monitor shall be observed to verify normal operation in the
configuration in which it will be used.
WARNING: To ensure accurate performance and prevent device failure, do not expose the monitor to
extreme moisture, such as rain.
WARNING: The use of accessories, transducers, sensors and cables other than those specified may result
in increased emission and/or decreased immunity of the equipment and/or system.
WARNING: Re-use of single-use accessories could pose a cross-contamination risk to the patient or
damage the functioning of the monitor.
WARNING: CO2 readings, respiratory rate, pulse oximetry readings, and pulse signals can be affected by
sensor application errors, certain ambient environmental conditions, and certain patient
conditions.
WARNING: The monitor is a prescription device and is to be operated by qualified healthcare personnel
only.
WARNING: No modification of this equipment is allowed.
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WARNING: If calibration does not take place as instructed in the relevant service manual, the monitor
may be out of calibration. A monitor that is out of calibration may provide inaccurate
results.
WARNING: If the exhaust connector port appears damaged, do not use the device with anesthetic gases.
Note: Devices connected to the monitor must be medical grade only.
Note: The accurate display of the following parameters is required in order to fill the essential
performance of the device: Carbon dioxide levels in expired breath (CO2) and respiration rate
when monitoring with capnography, and arterial oxygen saturation of blood (SpO2) and Pulse
rate when monitoring with pulse oximetry. If the patient is being monitored with both functions,
all of these parameters will be displayed.
MRI Scanning
WARNING: Do not use oximetry sensors during magnetic resonance imaging (MRI) scanning.
Conducted current could cause burns. The sensors may affect the MRI image, and the MRI
unit may affect the accuracy of oximetry measurements.
WARNING: Do not use the FilterLine™ H Set Infant/Neonatal during magnetic resonance imaging
(MRI) scanning. Using the FilterLine™ H Set Infant/Neonatal during MRI scanning could
harm the patient.
CAUTION: During MRI scanning, the monitor must be placed outside the MRI suite. When the monitor
is used outside the MRI suite, etCO2 monitoring can be implemented using the FilterLine™
XL. (Refer to Monitoring CO2 during MRI Scanning on page 59.
CAUTION: Use of a CO2 sampling line with H in its name (indicating that it is for use in humidified
environments) during MRI scanning may cause interference. The use of non-H sampling
lines is advised. For a list of H sampling lines, see Microstream™ EtCO2 Consumables on
page 149.
Monitor Use with Defibrillators
WARNING: All cables and tubing, including SpO2 sensors and CO2 sampling lines, should be kept clear
of the defibrillator and its electrodes, and should not run between, adjacent to, or
overlapping the electrodes and the electrode wires, in order to reduce potential interference
between the monitor and defibrillation equipment.
WARNING: All SpO2 sensors must be completely intact and undamaged, in order to enable use of a
defibrillator with the monitor.
Alarms
WARNING: Do not silence the audible alarm if patient safety may be compromised.
WARNING: Always respond immediately to a system alarm since the patient may not be monitored
during certain alarm conditions.
WARNING: Before each use, verify that the alarm limits are appropriate for the patient being monitored.
WARNING: Check the audible alarm silence duration before temporarily silencing the audible alarms.
WARNING: Auditory alarm signal sound pressure levels which are less than ambient sound levels can
impede operator recognition of alarm conditions.
CAUTION: Setting alarm limits to extreme values may impair the alarm system’s effectiveness.
Fire Hazard
WARNING: When using the monitor with anesthetics, nitrous oxide or high concentrations of oxygen,
connect the gas outlets to a scavenger system.
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Portable Bedside Capnograph/Pulse Oximeter
15
WARNING: The monitor is not suitable for use in the presence of flammable anesthetic mixture with air,
oxygen or nitrous oxide.
WARNING: The FilterLine™ may ignite in the presence of O2 when directly exposed to laser, ESU
devices, or high heat. When performing head and neck procedures involving laser,
electrosurgical devices or high heat, use with caution to prevent flammability of the
FilterLine™ or surrounding surgical drapes.
Electrical
WARNING: To protect against electric shock hazard, the monitor’s cover is to be removed only by
qualified service personnel. There are no user-serviceable parts inside.
WARNING: To ensure patient electrical isolation, connect only to other equipment with circuits that are
electrically isolated.
WARNING: Connect the device only to a three-wire, grounded, hospital grade receptacle. The three-
conductor plug must be inserted into a properly wired three-wire receptacle; if a three-wire
receptacle is not available, a qualified electrician must install one in accordance with the
governing electrical code. Do not under any circumstances remove the grounding connector
from the power plug. Do not use extension cords or adapters of any type. The power cord
and plug must be intact and undamaged. To avoid the risk of electric shock, this equipment
must only be connected to a supply mains with protective earth.
WARNING: Ensure that the monitor is positioned so that its mains plug is accessible for immediate
disconnection from supply mains, when needed.
WARNING: If there is any doubt about the integrity of the protective earth conductor arrangement,
operate the device on internal battery power until the AC power supply protective
conductor is fully functional.
WARNING: Do not connect to an electrical outlet controlled by a wall switch or a dimmer.
WARNING: Measure the device's leakage current whenever an external device is connected to the serial
port. Leakage current must not exceed 100 microamperes.
WARNING: To avoid risk of electric shock, this equipment must only be connected to a supply mains
with protective grounding.
WARNING: Whenever the equipotential ground at the back of the device (reference Figure 7 –
Capnostream™20p Rear View on page 31) is to be used, the user must connect to the pin in
a way which will ensure that accidental disconnection is avoided.
WARNING: In a facility which provides detachable potential equalization conductors, the Equipotential
ground at the back of the device (reference Figure 7 – Capnostream™20p Rear View on
page 31) may be used for optional connection between Capnostream™20P and the potential
equalization busbar of the electrical installation. The Equipotential ground at the back of the
device should not be used for a protective earth connection.
WARNING: Always connect power cord to the device first, and then plug the power cord into the wall
outlet.
CAUTION: Electrical installation of the room or the building in which the monitor is to be used must
comply with regulations specified by the country in which the equipment is to be used.
CAUTION: Keep power cord, plug and socket clear in case an urgent power supply disconnection is
required.
Electro-magnetic Interference
This device has been tested and found to comply with the requirements for medical devices according to the
standard EN60601-1-2. This standard is designed to provide reasonable protection against harmful interference
in a typical medical installation.
Page 18
Definitions
16
Portable Bedside Capnograph/Pulse Oximeter
However, because of the proliferation of radio-frequency transmitting equipment and other sources of electrical
noise in healthcare environments (for example: cellular phones, mobile two–way radios, electrical appliances),
it is possible that high levels of such interference due to close proximity or strength of a source may result in
disruption of performance of this device.
WARNING: Operating high frequency electrosurgical equipment in the vicinity of the monitor can
produce interference in the monitor and cause incorrect measurements.
WARNING: Do not use the monitor with nuclear spin tomography (MRT, NMR, NMT) as the function
of the monitor may be disturbed.
WARNING: Portable RF communications equipment (including peripherals such as antenna cables and
external antennas) should be used no closer than 30 cm (12 inches) to any part of the
Capnostream™20p monitor, including its cables. Otherwise, degradation of the
performance of this equipment could result.
Note: The emissions characteristics of the Capnostream™20p monitor make it suitable for use in
industrial areas and hospitals (EN 55011 class A). If it is used in a residential environment (for
which EN 55011 class B is normally required) this equipment might not offer adequate
protection to radio-frequency communication services. The user might need to take mitigation
measures, such as relocating or re-orienting the equipment.
Definitions
Note: A Note is inserted to point out procedures or conditions which may otherwise be misinterpreted or
overlooked and to clarify apparently contradictory or confusing situations.
Caution: A Caution is inserted to call attention to a procedure which, if not followed exactly, can lead to
damage or destruction of the equipment.
Warning: A Warning is inserted to call attention to dangerous or hazardous conditions inherent to the
operation, cleaning, and maintenance of the equipment which may result in personal injury or death of the
operator or patient.
Page 19
Portable Bedside Capnograph/Pulse Oximeter
17
Chapter 1
About this Manual
Do not touch this field - it is invisible and does not appear in the
final document
Overview
Intended Use
Specific Indications for Use
Who Should Read This Manual
Contacting Technical Support
Symbols
Overview
This manual provides directions for setting up and operating the Capnostream™20p monitor.
Capnostream™20p is a portable bedside monitor that continuously monitors a patient’s:
• End tidal carbon dioxide (etCO
) - level of carbon dioxide in exhaled breath.
2
• Respiratory rate (RR).
• Fractional inspired carbon dioxide (FiCO
• Oxygen saturation (SpO
).
2
) - level of carbon dioxide present during inhalation.
2
• Pulse rate (PR).
The device also provides an Integrated Pulmonary Index™ (henceforth referred to as IPI) value, which is a
numerical value that integrates four major parameters measured by Capnostream™20p in order to provide a
simple indication of the patient’s ventilatory status. The integrated parameters are etCO
, RR, SpO2, and PR.
2
Only these four parameters are used to calculate IPI; other parameters are not taken into account.
In addition, the device provides the Apneas per Hour (A/hr) and an Oxygen Desaturation Index (ODI), used to
help in the identification and quantification of apnea and oxygen desaturation events for patients over age 22, as
follows:
• A/hr: a count of the number of pauses in breathing (of at least 10 seconds) which the patient
experienced, either over the past hour (on the Home screen) or average pauses per hour over a
period of time (on the Apnea and O
• ODI: the number of times that the SpO
to baseline in 240 seconds or less, either in the last hour (on the Home screen) or average
pauses per hour over a period of time (on the Apnea and O
The A/hr and ODI indices are not available in all locations. In order to equip your device with the A/hr and ODI
feature, contact Capnographyinfo@covidien.com
Desaturation screen).
2
value dropped 4% or more from baseline and returned
2
Desaturation screen).
2
.
Intended Use
The Capnostream™20p combined capnograph/pulse oximeter monitor and its accessories are intended to provide
professionally trained health care providers with continuous, non-invasive measurement and monitoring of
carbon dioxide concentration of the expired and inspired breath and respiration rate, and with continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO
for use with neonatal, pediatric, and adult patients in hospitals, hospital-type facilities, and intra-hospital
transport environments.
™
Capnostream
20p is to be operated by qualified healthcare personnel only.
) and pulse rate. It is intended
2
Page 20
Specific Indications for Use
18
Portable Bedside Capnograph/Pulse Oximeter
The Capnostream™20p monitor provides the clinician with an integrated pulmonary index (IPI). The IPI is based
on four parameters provided by the monitor: end tidal carbon dioxide, respiration rate, oxygen saturation and
pulse rate. The IPI is a single index of an adult or pediatric patient's ventilatory status displayed on a scale of
1 - 10, where 10 indicates optimal pulmonary status. IPI monitoring displays a single value that represents the
patient's pulmonary parameters and alerts clinicians to changes in the patient's pulmonary status.
The IPI is an adjunct to, and is not intended to replace, vital sign monitoring.
Specific Indications for Use
An additional indication of the monitor is to provide information to help in the identification of apnea and
oxygen desaturation events in adult patients (age 22 and up) in hospital ICU and general floor environments,
through the reporting of these events and calculation of the associated apnea per hour (A/hr) and oxygen
desaturation index (ODI).
Who Should Read This Manual
This manual should be read by:
• Health Care Professionals who will be using Capnostream™20p.
• Equipment managers responsible for ensuring that equipment conforms to institutional policies.
• Researchers or laboratory personnel who will be downloading patient data.
• Technical experts who will be connecting Capnostream™20p to a computer via the RS-232
interface.
WARNING: In the United States, federal law restricts this device to sale by or on the order of a
physician.
Contacting Technical Support
For any technical issue involving the Capnostream™20p monitor, please contact Medtronic Technical Support,
as follows:
North America: Tel: 1-888-ORIDION (674-3466), Fax: (781) 453-2722; Outside North America:
Tel: + (972) 2-589-9104, Fax: + (972) 2-582-8868; E-mail: Capnographytechnicalsupport@medtronic.com
Symbols
The following symbols appear on the body of the monitor.
Table 1 - Symbols that Appear on the Monitor
Symbol Description
Monitor ON/OFF button
AC power ON indicator
UNIT ON indicator
.
Event selection
Patient Admit/Discharge
Page 21
Symbols
Portable Bedside Capnograph/Pulse Oximeter
19
Symbol Description
Pump Off
Temporarily silence alarms
Type BF Defibrillator Proof Protection
Gas inlet
Gas outlet
Equipotential ground
USB flash memory connection port
CE Mark
For prescription use only
Directive on waste electrical and electronic
equipment
Follow instructions for use
Page 22
Page 23
Portable Bedside Capnograph/Pulse Oximeter
21
Chapter 2
Technology Overview
Introduction
Features
Technology Overview
Introduction
The Capnostream™20p bedside monitor provides accurate, continuous capnography and pulse oximetry
monitoring for intubated and non-intubated patients from neonate to adult. Using Microstream
patented FilterLine
simultaneous "hassle free" etCO
™
etCO2 consumables, and pulse oximetry technology, Capnostream™20p allows for
and SpO2 monitoring.
2
™
technology,
Features
• Dual parameter monitor that supports the current standard of care providing CO
measurements
and SpO2
2
• Integrated Pulmonary Index™ (IPI), which provides a simple, clear, and comprehensive
indication of a patient’s ventilatory status and trends
• Apneas per Hour and Oxygen Desaturation Index, indices used to help in the identification and
quantification of apnea and oxygen desaturation events (if available)
• Simple user interface with color screen
• Routine functions are accessed with 2 clicks
• 72-hour trends to review patient history
• One-click alarm review
• SARA™ (Smart Alarm for Respiratory Analysis), an embedded Smart Capnography alarm
management technology, which reduces clinically insignificant alarms
• Event marking to compare events and medication administration to changes in patient status
• Case recording to help organize patient files
• Nurse call
• Optional internal printer
• USB output to transfer patient data to USB flash memory devices
• Analog output for use in sleep labs and other laboratory environments
• RS-232 port for data transfer
Technology Overview
This section provides a basic overview of Capnography and Pulse Oximetry.
What is Capnography?
Capnography is a non-invasive method for monitoring the level of carbon dioxide in exhaled breath (etCO
assess a patient’s ventilatory status.
) to
2
Page 24
Technology Overview
22
Portable Bedside Capnograph/Pulse Oximeter
Capnostream™20p uses Microstream™ non–dispersive infrared (NDIR) spectroscopy to continuously measure
the amount of CO
present during inhalation (FiCO2), and the Respiratory Rate.
of CO
2
during every breath, the amount of CO2 present at the end of exhalation (etCO2), the amount
2
Infrared spectroscopy is used to measure the concentration of molecules that absorb infrared light. Because the
absorption is proportional to the concentration of the absorbing molecule, the concentration can be determined
by comparing its absorption to that of a known standard.
™
The Microstream
consumable or directly from the patient (via an oral/nasal cannula) into the monitor for CO
Moisture and patient secretions are extracted from the sample, while maintaining the shape of the CO
etCO2 consumables deliver a sample of the inhaled and exhaled gases from the ventilator
measurement.
2
2
waveform.
The 50 ml/min. sampling flow rate reduces liquid and secretion accumulation, decreasing the risk of obstruction
in the sample pathway in humid ICU environments.
™
Once inside the Microstream
This extremely small volume is quickly flushed, allowing for fast rise time and accurate CO
CO2 sensor, the gas sample goes through a micro-sample cell (15 microliters).
readings, even at
2
high respiration rates.
The Micro Beam IR source illuminates the micro-sample cell and the reference cell. This proprietary IR light
source generates only the specific wavelengths characteristic of the CO
compensations are required when different concentrations of N
O, O2, anesthetic agents and water vapor are
2
absorption spectrum. Therefore, no
2
present in the inhaled and exhaled breath. The IR that passes through the micro-sample cell and the IR that
passes through the reference cell are measured by the IR detectors.
The microprocessor in the monitor calculates the CO
concentration by comparing the signals from both
2
detectors.
What is Pulse Oximetry?
Pulse oximetry is based on the following:
• The difference in the absorption of red and infrared light (spectrophotometry) by
oxyhemoglobin and deoxyhemoglobin
• Changes in the volume of arterial blood in tissue during the pulse cycle (plethysmography), and
hence, light absorption by that blood.
A pulse oximeter determines Spot Oxygen Saturation (SpO
bed and measures changes in light absorption during the pulsatile cycle. Red and infrared low power light
emitting diodes (LEDs) in the oximetry sensor serve as light sources; a photodiode serves as the photo detector.
Because oxyhemoglobin and deoxyhemoglobin differ in light absorption, the amount of red and infrared light
absorbed by blood is related to hemoglobin oxygen saturation. To identify the oxygen saturation of arterial
hemoglobin, the monitor uses the pulsatile nature of arterial flow. During systole, a new pulse of arterial blood
enters the vascular bed and blood volume and light absorption increase. During diastole, blood volume and light
absorption reach their lowest point. The monitor bases its SpO
maximum and minimum absorption (measurements at systole and diastole). The focus of light absorption by
pulsatile arterial blood eliminates the effects of nonpulsatile absorbers such as tissue, bone, and venous blood.
) by passing red and infrared light into an arteriolar
2
measurements on the difference between
2
Page 25
Portable Bedside Capnograph/Pulse Oximeter
23
Do not touch this field - it is invisible and does not appear in the
Chapter 3
The Capnostream™20p Monitor
final document
Unpacking and Inspection
Installing the Battery Pack
Mounting the Monitor
Setting up Periodic Maintenance
Accessories
Buttons, Indicators and Connections
Front Panel Control Buttons
Turning on the Monitor
Standard Sections of the Display Screen
Home Screen Numeric Display
Terminating Operation of the Monitor
Screen Navigation
Setting Date, Time, Language, and Other Options
Screen Timeouts
Capnostream
™20p
: Operational Check Sheet
This chapter describes the physical components of the monitor and how to set up the monitor so it is ready for
use.
™
The Capnostream
installation, setup, and getting started processes. Photocopy the Check Sheet from the manual and check off the
steps on the Check Sheet as you set up the monitor.
20p Operational Check Sheet is provided at the end of this chapter to simplify the
Unpacking and Inspection
Unpack the monitor and check all the components before performing any further procedures.
T
O UNPACK AND INSPECT THE MONITOR:
1. Carefully remove the Capnostream™20p monitor and the accessories from the box.
2. Check that the items on the enclosed packing list are included:
• Capnostream™20p Monitor
• Operating Manual
• Two 3.15 Amp fast blow and low breaking capacity type fuses
• FilterLine™ Starter Kit
• Mains Electrical Power Cord
• SpO
• SpO
Sensor Pack
2
Extension Cable
2
• Printer Paper Roll (one installed and one extra roll)
• Battery Pack
• CD with additional documentation (RS-232 Capnostream Data Transfer Protocols, the Patient
Data Transfer Application Note, and this manual in additional languages)
3. Inspect each component.
If any component is damaged or missing, contact your local representative.
Page 26
Installing the Battery Pack
24
Portable Bedside Capnograph/Pulse Oximeter
Battery
Compartment
Door
Restraining lever
Battery
Connection
Socket
Restraining lever
Battery
Connection
Socket
Note: When unpacking the monitor, packaging waste shall be disposed of as according to local
regulations for the disposal of packaging waste.
Installing the Battery Pack
WARNING: The unit should always be operated with the battery installed in order to provide back-up
power in the event of a momentary or temporary power outage.
WARNING: Battery door should always remain closed during operation or when attached to AC power.
The monitor operates on AC power or on a battery. It is equipped with a rechargeable Lithium–Ion battery pack.
To install the battery pack, open the battery cover on the side of the monitor as shown below.
Figure 1 - Installing the Battery Pack
TO INSTALL THE BATTERY PACK:
1. Slide the two release latches on the battery compartment door inward and open the battery compartment
door.
2. While holding the battery pack with the wires on the right, rotate the restraining lever up to the horizontal
position and place the battery pack in the monitor.
3. Push the battery pack all the way in.
4. Hold the battery pressed in and lock it in position by returning the restraining lever to the vertical position.
5. Attach the battery connector into the battery connection socket, ensuring that the side with the protruding
grooves is on the right, so that the connector fits into the socket. Push the wires back into the monitor.
Figure 2 - Battery Pack Close-up
Page 27
Installing the Battery Pack
Portable Bedside Capnograph/Pulse Oximeter
25
Battery Charge
Level Indicator
6. Align the flaps on the battery compartment door with the slots in the monitor casing, close the door, and
slide the two release latches outward.
7. Charge the battery pack before first use, by placing the battery pack in the monitor and plugging in the
monitor, without turning on the monitor. The battery pack will then charge, within approximately 12 hours.
Once the battery pack is charged, you may turn on and start using the monitor. If the monitor is not plugged
in, it cannot run on the battery pack provided with the monitor without prior charging.
Ensure that the battery pack is fully charged before using the monitor without AC power. A fully charged
battery pack provides 2.5 hours of operation (without printer usage). When the monitor is connected to the AC
mains, the battery pack charges automatically. It takes approximately 12 hours to fully charge an empty battery
pack.
When you start using the monitor, verify that the battery icon at the bottom left of the monitor screen indicates
that the battery is full. Refer to Testing the Battery and AC Connections below for details.
If no battery pack is installed, the No Battery icon will appear on the screen and the advisory message NO
BATTERY INSTALLED will appear. It is best practice to turn off the monitor before installing or switching the
battery.
WARNING: There should always be a removable battery installed in the device. If the battery is not
installed, the unit will operate properly on AC power, but if AC power is lost for any reason
the monitor will not work.
WARNING: To replace the battery, first turn off the monitor and then unplug the unit from AC power.
Do not attempt to disconnect or connect a battery while the unit is turned on or connected to
AC power.
Note: If the battery is not fully charged, the battery icon will indicate the charge level of the battery.
Testing the Battery and AC Connections
The battery pack charge level and AC power connections should be confirmed before each use.
T
O TEST THE BATTERY:
1. Press the ON/OFF button to turn on the monitor.
2. Observe the battery icon level in the bottom left hand corner of the screen.
Figure 3 - Menu Bar with Battery Charge Level
3. If you have previously fully charged the battery, the battery icon should indicate that the battery is full.
Note: As part of the monitor power-up, the battery charge level indicator will show full for about
15 seconds after the monitor is turned on. The monitor will then update the battery charge
level indicator to show the true battery level.
Recharge the battery pack when the advisory message BATTERY LOW appears on the display screen. To
recharge the battery, make sure that the monitor is plugged into the AC mains. The orange AC power indicator
on the front panel of the monitor will light up.
For normal operation, always check that the orange AC power indicator light is on during monitor use. This will
ensure the battery is charged during use and the monitor is prepared in case of a power outage or a patient
transfer. If a patient has to be transferred to another location, the unit can be unplugged and transferred with the
patient. Care should be taken to reconnect the monitor to the AC mains following the transfer.
Page 28
Mounting the Monitor
26
Portable Bedside Capnograph/Pulse Oximeter
Handling the Battery Pack
CAUTION: Do not immerse the battery pack in water; it may malfunction.
CAUTION: Recharge the battery pack only in the monitor to avoid possible heating, burning or rupture
of the battery pack.
Storing the Battery
The battery pack must be stored in a cold, dry area, not inside the monitor. Its charge decreases over time. To
restore the battery pack to full power, recharge the battery before use. The battery should be fully recharged
every 3 months at minimum. Store at -20 to 25°C.
CAUTION: Storage or transport of the monitor under environmental conditions beyond those mentioned
in the specification will affect monitor performance and damage the battery and/or the
monitor.
Disposing of the Battery
CAUTION: Do not dispose of the battery pack in fire; it may explode.
Follow local governing ordinances and recycling instructions regarding disposal or recycling of batteries.
Battery and Power Usage
If power is lost when the monitor is operating from AC power, it automatically switches to the internal battery
pack for power. The duration of this backup power usage, based on battery capacity, is up to 2.5 hours. The
monitor maintains its settings, including alarm settings, while on battery operation. If settings have been set in
Institutional Defaults, these settings will remain in the monitor memory even if the monitor is not receiving
power at all, and will be available once the monitor is turned on again. Likewise, trend data in the device will
remain in the monitor memory even if the monitor is not receiving power at all, and will be available once the
monitor is turned on again.
The orange AC power indicator light is on when the monitor operates from an external power source, with no
relation to the status of the battery pack.
The green power-on indicator is on when the monitor is switched on.
If the orange AC power indicator light is off and the green power-on indicator is on, the monitor is operating
from the battery pack.
The battery icon will show the battery pack’s approximate charge level. An advisory message, BATTERY
LOW, appears when approximately 15 minutes of battery charge (equivalent to 14.0 V) remains.
Mounting the Monitor
The bottom of the Capnostream™20p device is designed to fit a 100mm VESA™* standard mounting plate.
(An example is the GCX model FLP-002-17C mounting plate which fits onto the GCX model RS-0006-64D
Page 29
Setting up Periodic Maintenance
Portable Bedside Capnograph/Pulse Oximeter
27
Roll Stand Assembly). The VESA™* mounting plate can be ordered from Medtronic; part number is 010713.
Please refer to the appropriate Directions for Use for these products.
Rubber
feet (4)
Mounting
Holes (4)
Figure 4 - Monitor Bottom View
CAUTION: Do not remove the rubber feet from the bottom of the monitor. These rubber feet are
required for operation of the monitor on a table, to prevent unwanted movement of the
monitor while in use. Even if the rubber feet are not currently in use, it is suggested that you
keep them in place for future need.
Setting up Periodic Maintenance
If your institution has a periodic maintenance database, log the monitor in this database for its periodic
calibration procedure. Calibration is required after the first 1,200 hours of use (or 12 months, whichever comes
first) and thereafter every 4,000 hours of use (or 12 months, whichever comes first). The number of operating
hours will appear just after the monitor turns on and on the monitor’s Service Screen. For more details about
calibration and other maintenance procedures, see Maintenance and Troubleshooting on page 123.
Accessories
Available Accessories
See the list of available accessories for Capnostream™20p below.
Table 2 – Capnostream™20p Accessories
Accessory
Paper (6 rolls) 010516 Paper fits Capnostream™20p integrated
Mounting Adaptor Plate
(VESA™*)
Medtronic Part
Number
printer. Monitor is shipped with one paper roll
and one spare paper roll. Refer to Replacing
the Printer Paper Roll on page 127 for paper
installation.
010713 Used for mounting Capnostream™20p to
GCX roll stands and other mounting
assemblies. Refer to Mounting the Monitor on
page 26 for mounting instructions.
Use
Page 30
Accessories
28
Portable Bedside Capnograph/Pulse Oximeter
Accessory
Quick Release Pole Clamp 011782
Roll Stand with Basket Not stocked by Medtronic GCX model RS-0006-64D
Mounting Adapter for Bernoulli
Transmitter
Battery Pack BP01000 Refer to Installing the Battery Pack on page
Nurse Call Cable 011149 Cable length 3.5 meters: Cable is supplied un-
Digital/Analog (D/A) Cable PM20ACB Used for transfer of data from
US Power Cord 014256
European Power Cord 014255
Medtronic Part
Number
011892
Use
Clamp fits pole mount (pole diameter 0.75in
[19mm] to 1.5in [38mm]) or rail mount (rail
size 10mm [0.39in] x 25mm [0.98in]).
With quick release mechanism.
Mounting adapter plate is included.
Roll Stand Kit 38" post with 5" Slide-in type
mounting plate – including: 21" base, 4"
casters, 10lb Counterweight, handle, and 6"
basket.
Mounting plate is required to use Roll Stand.
Used with a Bernoulli/Oxinet hospital system.
Refer to Operation with Hospital Patient Data
Systems on page 120.
24 for battery installation.
terminated so it can be built to fit system.
Refer to Nurse Call Operation on page 117 for
set up instructions.
Capnostream™20p to an analog device such
as a polysomnograph. Refer to Analog Data
Output with Capnostream on page 112 for set
up instructions.
Monitor Mounting Plate
The mounting kit contains a VESA™* Mounting Adapter, 100 x 100mm to 75 x 75mm, which can be affixed to
the bottom of the monitor as described above. This allows the monitor to be mounted on a wide range of GCX
stands and mounts including the GCX model RS-0006-64D Roll Stand Assembly. Please contact GCX
(www.gcx.com) for more information on their available solutions for mounting the monitor.
Please note that when mounting the monitor on a roll stand or other pole mount, it is important to use a stand
that has a minimum 21-inch (53.5 cm) wheel base diameter, to ensure stability.
Printer Paper
The monitor uses thermal printer paper with the following specifications:
Table 3 - Printer Paper Specifications
Item Value
Paper Width 58mm (2 ¼ in)
Paper Roll Diameter (maximum) 40mm (1 1/2 in)
Paper Length (maximum) 15.2 meters (50 ft)
Note: Some manufacturers use a different thickness of paper, so that a 15.2-meter roll from a
different manufacturer may exceed the maximum diameter limit and will not fit in the monitor.
Replacement paper rolls that meet the specifications can be obtained from Medtronic (part number 010516 for a
package of 6 rolls), or in North America from www.thermalpaperdirect.com (Model number 22550).
Page 31
Buttons, Indicators and Connections
Portable Bedside Capnograph/Pulse Oximeter
29
10
11
12 8 5
9
3
2
4
6
1
Buttons, Indicators and Connections
Following are the front, rear, and side views of the monitor showing the display, controls, and external
connection points.
Monitor Front View
The front panel of the monitor contains the display screen, action buttons and the control knob.
Figure 5 – Capnostream™20p Front View
Table 4 – Capnostream™20p Front View lists the numbered labels.
Page 32
Front Panel Control Buttons
30
Portable Bedside Capnograph/Pulse Oximeter
Table 4 – Capnostream™20p Front View
Label
1 Monitor power
2
3 Monitor power
4 Event button
5 Patient
6 Pump Off button Shuts off the
Name Description Label Name Description
Button switch 7 Temporary
ON/OFF
AC power
indicator
on indicator
Admit/Discharge
button
Orange light 8
Green light 9 Yellow alarm
Starts the process of
placing either a Quick or
Detailed Event marker in
the trend data.
Allows Starting and
Stopping a case and
entering patient ID.
Capnography pump for
a preset time in order to
protect the monitor
during suctioning
procedures.
Temporarily disables the
alarm silence
button
Red alarm
indicator
indicator
10 Control knob
11 Display screen Screen displaying the
12 Carrying
handle
Audio Alarm for two
minutes.
Indicator that flashes
during High Priority
alarms (see High Priority
Alarms on page 77).
Indicator that lights or
flashes according to the
alarm status (see Alarm
Display on page 74).
Rotary knob used to
navigate the screen and
select a function when
pressed.
patient data, menu bar,
patient mode, date-time,
and any information or
error messages.
Allows the monitor to be
carried.
Front Panel Control Buttons
The figure below is a close-up of the controls shown in Figure 5 – Capnostream™20p Front View on page 29
and described in Table 4 – Capnostream™20p Front View above.
Figure 6 - Front Panel Control Buttons
Page 33
Front Panel Control Buttons
Portable Bedside Capnograph/Pulse Oximeter
31
5 7 6
8
Monitor Rear Panel
The rear panel of the monitor contains power and communications connections.
9
4
3
2
1
Figure 7 – Capnostream™20p Rear View
Table 5 – Capnostream™20p Rear View describes the functions of the rear-monitor connections.
Table 5 – Capnostream™20p Rear View
Label Function Description Label Function Description
1 Mains fuse holder Two 3.15A fast blow and
low breaking capacity
type fuses.
2 Mains plug
3 USB port For flash memory stick. 8 Manufacturer labels
4 RS-232
5 Nurse Call Port used for attaching
Connection for AC
power.
9 pin female D type
connector for RS-232
communication.
to Nurse Call system.
6 Analog output 15 pin female D type
connector for 7
channel analog
output.
7
9 Carrying handle
10 Power Cord Strain
Potential
equalization
terminal
Relief
For connecting
potential equalization
conductor.
10
Page 34
Turning on the Monitor
32
Portable Bedside Capnograph/Pulse Oximeter
4
Monitor Left and Right Views
The left side of the monitor contains the battery housing and the connection points to the patient interface.
1
2
5
Figure 8 – Capnostream™20p Left View
Table 6 describes the functions of the features on the left side of the monitor.
Table 6 – Capnostream™20p Left View
Label Function Description
1 FilterLine™ Input connector To connect the FilterLine™ to the monitor.
Provided with an automatic door close.
2 Gas outlet To connect to a scavenger system when the
monitor is used in the presence of anesthetic
gases. The gas output is a barbed style connector
intended for 3/32-inch ID tubing.
3 SpO2 To connect SpO2 sensor to the monitor with an
extension cable.
4 Battery housing Where the battery pack is installed.
5 Barcode label Barcode of the Serial Number and Model Number
of monitor.
3
The right side of the monitor includes only the paper roll used for printing patient reports and buttons used to
control that printer. This printer roll holder is seen in Figure 48 - Insert Paper Roll into printer on page 127, and
instructions for replacing the printer roll appear in Replacing the Printer Paper Roll on page 127.
Turning on the Monitor
This section explains how to turn on the monitor.
CAUTION: The monitor is intended only as an adjunct in patient assessment. It must be used in
CAUTION: Use only Microstream™ etCO2 consumables and Nellcor™ sensors, to ensure that the
conjunction with clinical signs and symptoms.
monitor functions properly.
Page 35
Standard Sections of the Display Screen
Portable Bedside Capnograph/Pulse Oximeter
33
TO TURN ON THE MONITOR:
1. Plug the electrical cord into the mains plug in the rear of the monitor (see Figure 7 – Capnostream™20p
Rear View on page 31). Clip the power cord strain relief around the cable and tighten to ensure that the
power cord does not accidentally disconnect from the monitor.
2. Plug the electrical cord into the mains AC supply.
3. The orange power indicator on the front panel will light up.
CAUTION: If the orange light is not on, the monitor is running on battery power only and will stop
operating when the battery is discharged.
4. Press the Power ON/OFF button on the front panel to turn on the monitor. The following happens:
• The green power-on indicator lights up, showing that the monitor is turned on.
• An hourglass figure appears on the screen for a few seconds followed by the blue monitor
salutation screen for about 5 seconds as the monitor performs a self-test.
• The red alarm and yellow alarm lights will briefly light up and the speaker will beep.
CAUTION: If the red and yellow alarm lights do not light up or there is no sound from the speaker, the
monitor should not be used and should be sent for servicing.
• You will hear the pump briefly turn on for a few seconds, and then turn itself off. However, if a
FilterLine™ is connected to the monitor, the pump will remain on.
Standard Sections of the Display Screen
After the blue Salutation screen, a screen requesting that you clear the trend memory will appear. For an
explanation of that screen, see Using Patient Cases and Patient ID on page 46. Following that screen, the Home
screen will appear.
Figure 9 - Salutation Screen
Page 36
Standard Sections of the Display Screen
34
Portable Bedside Capnograph/Pulse Oximeter
The Home screen displays the CO2 and SpO2 information along with the IPI value and other information that is
standard on most other screens. This section explains the main parts of the screen.
The Home screen can display in one of two basic formats: graphical and numeric. The default display is the
standard display, described below. The numeric format provides a larger and easier-to-read numeric display
without the distraction of the graphical waveform display. To learn about the numeric display, read Home
Screen Numeric Display on page 38.
Home Screen Standard Display
The typical standard home screen shown in the two figures below shows data and waveforms for a patient being
monitored with a FilterLine™ and SpO
Header Area
CO2
Waveform
Real Time IPI
and A/hr and
ODI Numerics
sensor.
2
Real Time
CO
Numeric
2
Data
Real Time
SpO
2
Numeric
Data
Menu Bar
Figure 10 - Typical Home Screen
IPI Trend Data
Page 37
Standard Sections of the Display Screen
Portable Bedside Capnograph/Pulse Oximeter
35
Figure 11 - Typical Home Screen when A/hr and ODI are not Available
The Home Screens contains the following sections:
• Header Area described on page 36
• Menu Bar described on page 37
• Real Time IPI Data with Trend Graphical Display described on page 39
• A/hr and ODI Data described on page 37 (if available)
• Real Time CO2 Data and CO
waveform, described on page 37
2
• Real Time SpO2 Data described on page 37
Most of the other screens contain the Header Area, the Menu Bar, the Real Time CO
Data.
SpO
2
In most cases, as you move from screen to screen, the monitor will always display the Header, Menu Bar, real
time CO
and SpO
Numeric Data and real time SpO2 Numeric Data sections. The continuous display of the real time CO2
2
Numeric Data on the right allows continuous patient monitoring even when changing system settings
2
or observing patient history on the trend screens.
The IPI option on the screen may be disabled as part of the institutional defaults. (If the Patient Type is
Infant/Neonatal, the IPI is automatically disabled, and the only available option for the standard Home screen
display shows the SpO
waveform instead of the IPI trend waveform.) See Chapter 7 Integrated Pulmonary
2
Index™ on page 67 for more information. If the IPI option is disabled, a home screen without the IPI option
will be seen. An example of this Home screen is seen in Figure 12 - Standard Home Screen without IPI Option
on page 36.
Data, and the Real Time
2
Page 38
Standard Sections of the Display Screen
36
Portable Bedside Capnograph/Pulse Oximeter
2
3
4 6 5
7
A/hr and ODI
Header Area
CO2 Waveform
Data
SpO2 Waveform
Menu Bar
Figure 12 - Standard Home Screen without IPI Option
Real Time
CO
Numeric
2
Data
Real Time
SpO
2
Numeric
Data
Header Area
The Header section is always displayed along the top of the screen and contains the information listed in the
table below.
1
Figure 13 - Header Area
Table 7 describes the elements of the header area.
Table 7 - Header Section
Item Function Description
1 Time/Date Displays the Time and Date in selected formats.
2 Patient Type Indicates patient mode. Options are ADULT, PEDIATRIC 1-3 YRS, PEDIATRIC 3-6
YRS, PEDIATRIC 6-12 YRS, and INFANT/NEONATAL (for infants under 1 year)
3 Screen name Displays the current screen name.
4 Message area Messages explaining alarms and equipment status appear in this area.
5 Patient ID If a patient ID has been entered for the current case, the patient ID will appear.
6 Alarm status
indicator
7 USB Indicator
Indicates whether the audio alarms are enabled, temporarily disabled or permanently
disabled.
Indicates whether a USB Flash Memory device is currently attached to the monitor
Page 39
Standard Sections of the Display Screen
Portable Bedside Capnograph/Pulse Oximeter
37
Menu Bar
The menu bar of available options and functions is located along the bottom of the monitor display screen. At
the left-hand side is the battery charge level indicator. At the right-hand side is the speaker volume control.
The menu bar will change depending on which options and functions are available for a specific screen. In some
screens there are additional selectable options in the screen-specific area.
Real Time CO
This area of the screen displays the real time etCO
Data
2
and FiCO2 values along with selected units, and the
2
respiration rate (RR) in breaths per minute. Numeric display appears at right and a waveform display at left. For
more details regarding the displayed information, see CO2 Data Displayed by the Capnostream™20p Monitor
on page 57.
When the CO
alarm limit threshold is crossed, the device will alarm: the affected numeric will flash, the
2
numeric will appear with a red or yellow background (depending on whether it is a high priority patient [urgent]
alarm or a caution alarm), and a message will appear in the header area of the screen.
This area of the screen can be selected as if it were a menu option. Selecting this area gives access to the setup
screen for changing the CO
Real Time SpO
Data
2
parameter values.
2
This area of the screen displays real time numeric SpO2 data: SpO2, PR, and the pleth waveform or pulse beat
bar - is always shown. (If IPI is enabled and thus no SpO
waveform is displayed, the SpO2 pulse beat is
2
represented by the green bar at the left of this box.)
For more details about the displayed SpO
data, see Chapter 6 Pulse Oximetry with the Capnostream™20p
2
Monitor on page 61.
When the SpO
alarm limit threshold is crossed, the device will alarm: the affected numeric will flash, the
2
numeric will appear with a red or yellow background (depending on whether it is a high priority patient [urgent]
alarm or a caution alarm), and a message will appear in the header area of the screen.
This area of the screen can be selected as if it were a menu option. Selecting this area gives access to the setup
screen for changing the SpO
parameter values, including the option to turn the pulse beat tone on or off.
2
Real Time IPI Data with Trend Graphical Display
This area of the screen displays the real-time value of the IPI, a numerical value which summarizes four
parameters (etCO2, RR, SpO2, PR) in order to provide a quick indication of the patient’s respiratory status. The
IPI trend graph indicates the trend of this value over the chosen period of time (the default period is one hour).
On the IPI trend graph, the red and yellow horizontal lines indicate the currently set high priority patient
(urgent) alarm and caution alarm limits respectively.
For more information about this parameter, see Chapter 7 Integrated Pulmonary Index™ on page 67.
When the IPI alarm limit is exceeded, the device will alarm: the affected numeric will flash, the numeric will
appear with a red or yellow background (depending on whether it is a high priority patient [urgent] alarm or a
caution alarm), and a message will appear in the header area of the screen.
IPI data is not available for some patients; for more information, see Chapter 7 Integrated Pulmonary Index™
on page 67.
A/hr and ODI Data
This area of the screen displays the A/hr and ODI values (if available).
For more information about A/hr and ODI, see Apneas per Hour and the Oxygen Desaturation Index on
page 69.
When the apnea count in any one-hour period during the last 12 hours exceeds a set number, a Visual Alert, in
the form of an asterisk which appears next to the A/hr value, will appear on the screen, indicating to the user
Page 40
Standard Sections of the Display Screen
38
Portable Bedside Capnograph/Pulse Oximeter
Real Time IPI
Numeric and
IPI Trend Data
and A/hr and
that the A/hr and O2 Desat screen should be viewed. The A/hr and O2 Desat screen is reached with the
REPORTS menu button. For more information about the A/hr Visual Alert, see A/hr Visual Alert on page 70.
Home Screen Numeric Display
Header Area
Real Time
CO
Numeric
2
Data
ODI Data
Menu Bar
Figure 14 - Typical Numeric Home Screen
The numeric screen contains the following sections:
• Header Area on page 38
• Menu Bar on page 37
• Real Time IPI Data with Trend Graphical Display on page 39
• Real Time CO2 Data on page 37
• Real Time SpO2 Data on page 37
• A/hr and ODI Data on page 37 (if available)
Real Time
SpO
2
Numeric
Data
Header Area
The Header section is identical to the Header area seen with the standard Home screen.
Menu Bar
The menu bar is identical to the menu bar seen with the standard Home screen.
Real Time CO
This area of the screen displays the real time etCO
respiration rate (RR) in breaths per minute. Numeric display only is provided, sized so that it can easily be read
even at a distance. For more details regarding the displayed information, see CO2 Data Displayed by the
Capnostream™20p Monitor on page 57.
Data
2
and FiCO2 values along with selected units, and the
2
Page 41
Terminating Operation of the Monitor
Portable Bedside Capnograph/Pulse Oximeter
39
When the etCO2, FiCO2, or RR alarm limit threshold is crossed, the device will alarm: the affected numeric will
flash, the numeric will appear with a red or yellow background (depending on whether it is a high priority
patient urgent alarm or a caution alarm), and a message will appear in the header area of the screen.
This area of the screen can be selected as if it were a menu option. Selecting this area gives access to the setup
screen for changing the CO
parameter values.
2
Real Time SpO
Data
2
This area of the screen displays real time SpO2 data. Numeric display is provided, sized so that it can easily be
read even at a distance. As in the standard screen, only the parameters which are measured by the probe which
is currently connected to the device will appear on the screen. For more details about the displayed SpO
data,
2
see Chapter 6 Pulse Oximetry with the Capnostream™20p Monitor on page 61.
When the SpO
alarm limit threshold is crossed, the device will alarm: the affected numeric will flash, the
2
numeric will appear with a red or yellow background (depending on whether it is an urgent alarm or a caution
alarm), and a message will appear in the header area of the screen.
A/hr and ODI Data
This area of the screen displays the A/hr and ODI values (if available).
For more information about A/hr and ODI, see Apneas per Hour and the Oxygen Desaturation Index on page
69.
When the apnea count in any one-hour period during the last 12 hours exceeds a set number, a Visual Alert, in
the form of an asterisk which appears next to the A/hr value, will appear on the screen, indicating to the user
that the A/hr and O
Desat screen should be viewed. The A/hr and O2 Desat screen is reached with the
2
REPORTS menu button. For more information about the A/hr Visual Alert, see A/hr Visual Alert on page 70.
Real Time IPI Data with Trend Graphical Display
This area of the screen displays the real-time value of the IPI, a numerical value which summarizes four
parameters (etCO
, RR, SpO2, PR) in order to provide a quick indication of the patient’s respiratory status. The
2
IPI trend graph below the numeric value indicates the trend of this value over the chosen period of time.
On the IPI trend graph, the red and yellow horizontal lines indicate the currently set urgent alarm and caution
alarm limits respectively.
For more information about this parameter, see Chapter 7 Integrated Pulmonary Index™ on page 67.
When the IPI alarm limit is exceeded, the device will alarm: the affected numeric will flash, the numeric will
appear with a red or yellow background (depending on whether it is a high priority patient [urgent] alarm or a
caution alarm), and a message will appear in the header area of the screen.
Terminating Operation of the Monitor
Following patient monitoring, operation of the monitor shall be terminated as follows:
1. Remove the FilterLine™ and SpO
2. Switch the monitor to OFF by pressing the ON/OFF switch at the front of the monitor.
3. If the monitor is connected to AC power using the AC adapter, it may now be disconnected from AC power.
To continue charging the monitor when not in use for measurement, the monitor shall remain connected to
AC power. The monitor will continue charging its internal battery even when it is switched off.
Caution: Always use the on/off switch to turn off the monitor. Do not remove the battery and unplug
the monitor to turn it off. If the monitor is turned off by removing the battery and
unplugging the monitor, settings data may be lost.
sensor from the patient.
2
Page 42
Screen Navigation
40
Portable Bedside Capnograph/Pulse Oximeter
Screen Navigation
Select options and set values using the control knob. The control knob works in a manner similar to that of a
regular computer mouse. It is also used as a keyboard for entering letters and numbers.
O MOVE AROUND THE SCREEN:
T
1. Turn the control knob to the right or left to move to the next area on the screen, which is highlighted by the
frame changing to blue.
2. To make a selection, push the control knob in until it clicks.
T
O ENTER LETTERS AND NUMBERS:
1. When required to enter alphanumeric data, turn the control knob for navigation and then click on the input
data block on the screen.
The content of the data block is cleared and a small block with a yellow background will appear in place of
the first character. In the block will be a black letter A.
2. As you turn the control knob to the right or left, you will see the complete alphabet and numbers 0-9, the ←
backspace symbol, a blank space and the Enter symbol.
3. When the desired character is displayed, press on the control knob until it clicks. The inputted character will
return to its regular color (white) and the yellow block will move to the next character space.
4. Turn the control knob again to begin a new character selection.
5. To end alphanumeric entry, press the control knob twice after entering the final letter or symbol.
T
O CHANGE SETTINGS:
1. When you are on a screen with settings that can be changed, turn the control knob until the desired setting is
highlighted by the frame changing to blue.
2. To select the setting, push the control knob in until it clicks.
3. Turn the control knob until the new setting is reached.
4. To set the setting, push the control knob in until it clicks.
5. Continue to select settings, or turn the control knob to select BACK or HOME.
Configuration Changes
On most selection screens, when you make a change to one or more system parameters the new settings will
only become effective when you exit the screen by selecting HOME or BACK. If the selection screen is exited
by pressing one of the front panel control buttons located below the screen, or if you wait more than one minute
and the screen times out and resets, the changed settings will not be saved.
Setting Date, Time, Language, and Other Options
After you first turn on the monitor, check the top left-hand corner of the header to ensure that the date and time
are correct.
T
O CHANGE DATE, TIME, LANGUAGE, OR OTHER OPTIONS:
1. From the Home screen, use the control knob to select SYSTEM in the Menu Bar.
2. To adjust the date and time, use the control knob to select and change each setting.
3. To change the language of the display, use the control knob to change the language.
4. The newly set options (including language) will remain in effect until the monitor is turned off. To
permanently change the display language and other settings, see the information in Changing Institutional
Defaults on page 131.
5. To change any of the other listed parameters, choose the required option, and then select the HOME menu
button to return to the Home screen.
6. If A/hr and ODI are not available, the display option will not appear on this screen.
Page 43
Screen Timeouts
Portable Bedside Capnograph/Pulse Oximeter
41
Figure 15 - System Setup Screen
Screen Timeouts
Screen Timeouts
All setup and system screens will timeout after 60 seconds of no activity with the control knob, and revert back
to the home screen.
Page 44
Capnostream™20p: Operational Check Sheet
42
Portable Bedside Capnograph/Pulse Oximeter
Capnostream™20p: Operational Check Sheet
To get the Capnostream™20p monitor up and running quickly and smoothly, follow the list of instructions
below:
1. Unpack the monitor
• Remove the Capnostream™20p monitor and the accessories from the box.
• Check that the items on the enclosed packing list are included.
• Check that paper is in printer.
2. Install the battery pack
• Refer to Installing the Battery Pack on page 24 for installation instructions.
3. Turn on the monitor
• Plug the power cord into the mains plug in the rear of the monitor. Clip the power cord
strain relief around the cable and tighten to ensure that the power cord does not
accidentally disconnect from the monitor.
• Plug the power cord into the mains AC supply.
• The power indicator orange light at the front of the monitor will turn on.
• Press the Power ON/OFF button on the front panel to turn on the monitor. The power-
on indicator green light will light up, showing that the monitor is turned on.
• Note that both the power indicator orange light and the power-on indicator green light
should both be on during operation of the monitor.
4. Change the date, time or language
• Check that the date and time that appear are correct.
• Use the control knob to select SYSTEM in the Menu Bar
• Change each setting, including date and time, on that screen, if desired.
5. Set the Patient Type and Mode
• Use the control knob to select the PATIENT TYPE function on the menu bar of the
Home screen
• Select ADULT, PEDIATRIC (by age), or INFANT/NEONATAL as appropriate.
6. Connect a FilterLine™
• Slide open the FilterLine™ input connector shutter and connect the appropriate
FilterLine™.
• Connect the FilterLine™ to the patient as described in the Directions for Use supplied
with the FilterLine™. The sampling line connecter should be screwed clockwise into the
monitor CO
the monitor. This will assure that there is no leak of gases during measurement at the
connection point and that measurement accuracy is not compromised.
7. Connect a SpO2 Sensor
• Connect the SpO
the appropriate SpO
• Connect the SpO
8. Once either or both sensors are connected to the monitor, it is ready for operation.
9. Check Alarm Limits
port until it can no longer be turned, to ensure that it is connected securely to
2
extension cord firmly to the monitor SpO2 sensor port, and then connect
2
sensor to the extension cord.
2
sensor to the patient as described in its Directions for Use.
2
• Check the alarm limits default and make any permanent changes in the institutional
defaults.
Page 45
Capnostream™20p: Operational Check Sheet
Portable Bedside Capnograph/Pulse Oximeter
43
• Refer to Alarms and Messages on page 73 for more details about alarms.
10. Open a Patient Case
• To record patient data so that it is easy to track and retrieve, opening a patient case is
recommended. Opening a patient case is required when recording a Tabular Case Report.
• Refer to Using Patient Cases and Patient ID Numbers on page 46 for instructions.
11. Print Patient Data
• Choose the desired type of patient report and press the PRINT button on the screen.
• Refer to Chapter 11 Reports on page 97 for detailed information.
12. Set Up Nurse Call Operation (if applicable; Nurse Call connectivity accessories must be
purchased separately)
• Plug the Nurse Call cable into the Nurse Call socket on the back of the monitor and
connect the other end of the cable to the institution's system as determined by the
institution's requirements. Check that all cables are connected and tightened.
• Enable Nurse Call on the monitor as described in Nurse Call Operation on page 117.
• Verify communication between the monitor and the Nurse Call system.
13. Set Up Analog Data Output Operation (if applicable; analog system connectivity accessories must
be purchased separately)
• Connect the Oridion D/A (Digital/Analog) Data Cable (Part Number PM20ACB) to the
back of the monitor and connect the other end of the cable to an analog system such as a
polysomnograph as required. Check that all cables are connected and tightened.
• Set up analog data output on the monitor as described in Analog Data Output with
Capnostream on page 112.
• Verify that data transfer between the monitor and the system is taking place.
14. Set Up Bernoulli System Interface (if applicable; central monitoring system and accessories must
be purchased separately)
• Connect the Client Bridge to the RS-232 port at the back of the monitor. Make sure that
all connections are in place and sufficiently tightened.
• Verify that the Client Bridge is mounted safely.
• Verify communication between the Capnostream™20p monitor, the client bridge and the
Bernoulli central station.
• See Operation with Hospital Patient Data Systems on page 120 for more details.
15. Set Up Data Transfer via USB (USB flash drive must be purchased separately)
• Connect the USB Flash drive to the back of the monitor.
• Choose the desired type of patient report and press the Start USB button on the screen.
• Refer to Data Transfer via the USB Data Port on page 107 for detailed information.
Page 46
Page 47
Portable Bedside Capnograph/Pulse Oximeter
45
Do not touch this field - it is invisible and does not appear in the
Chapter 4
Using the Capnostream™20p Monitor
final document
Preparing the Monitor for a Patient
Using Patient Cases and Patient ID Numbers
Entering Patient Events
Changing the Alarm and Pulse Volumes
Alarm Delay
Use of Scavenging System
Turning the Pump Off for Suction or Lavage
Demo Mode
Monitor Screen Menu Reference Chart
Preparing the Monitor for a Patient
CAUTION: If any monitor response does not seem appropriate, do not use the monitor. Instead, contact
your local representative.
The following steps describe the procedure for preparing the monitor for a patient.
O PREPARE THE MONITOR FOR A PATIENT:
T
1. Turn on the monitor by pushing the on/off switch on the front panel.
2. The complete power on sequence is described in Turning on the Monitor on page 32.
3. Confirm that the green power-on indicator and the orange AC power indicator light are both on.
CAUTION: If the orange light is not on, the monitor is running on battery power only and will stop
operating when the battery is discharged. See Turning on the Monitor on page 32.
4. The red alarm and yellow alarm lights will briefly light up and the speaker will beep.
CAUTION: If the red and yellow alarm lights do not light up or there is no sound from the speaker, the
monitor should not be used and should be sent for servicing.
5. Check date and time to ensure that it matches the current date and time. If it does not, adjust the time using
the system screen as described in Setting Date, Time, Language, and Other Options on page 40.
6. Connect one or both sensors to the monitor, following the instructions in this manual. To connect the
sensors, please see Connecting a FilterLine on page 56 and Connecting an SpO2 Sensor to the Monitor on
page 64.
Once either or both sensors are connected to the monitor, it is ready for operation.
If a FilterLine™ is not connected, there is no CO
waveform and the message FILTERLINE
2
DISCONNECTED will appear.
If an SpO
sensor is not connected, there is no SpO2 waveform and the message SpO2 SENSOR
2
DISCONNECTED will appear.
It is possible to use either the Capnography function (etCO2) or the Pulse Oximetry function (SpO2) without
using the other function. If you only want to operate one function, connect ONLY the sensor for that function,
and the monitor will operate normally.
Note: The Capnostream™20p monitor is for use with one patient at a time only.
Setting the Patient Type
There are five different patient types recognized by the monitor, listed below.
Page 48
Using Patient Cases and Patient ID Numbers
46
Portable Bedside Capnograph/Pulse Oximeter
Infant/Neonatal: for patients from birth to the age of one year
Pediatric 1-3 yrs: for patients aged one to three years
Pediatric 3-6 yrs: for patients aged three to six years
Pediatric 6-12 yrs: for patients aged six to twelve years.
Adult: for patients aged 12 years and up
The patient type is displayed at the top left-hand corner of the screen. Setting the patient type is compulsory.
The original default patient type on the monitor is ADULT; once the patient type has been changed, the default
will be the current patient type.
CAUTION: The characteristics of a breath are calculated differently for the different patient types.
Setting the correct patient type is therefore very important. Incorrect setting will result in
inaccurate monitoring of the patient's respiration and affect the patient’s IPI value.
TO CHANGE THE PATIENT TYPE:
1. If the patient type that appears on the screen is correct for the current patient, there is no need to make any
change to the patient type. If you want to make a change, use the control knob to select the PATIENT TYPE
function on the menu bar of the Home screen.
2. Rotate the control knob to change the patient type, and press the control knob to register the change. This
change will remain in effect until the patient type is changed.
The monitor has independent alarm limit settings for Adult/Pediatric and Infant/Neonatal Patients which can be
configured according to the physiology observed in the particular age groups. See the relevant information in
Changing Alarm Limits on page 74.
Using Patient Cases and Patient ID Numbers
It is strongly recommended that you associate all data stored in the monitor with a patient ID that will identify
its origin with a particular patient. This allows stored trend data to be associated with a patient ID, and avoids
the possibility of confusing data from several patients in one trend printout or download.
O BEGIN A NEW CASE:
T
1. Once the patient is already connected to the monitor, press the Patient Admit/Discharge button on the
front panel of the monitor. The PATIENT ID field appears on the screen, and an automatically generated
14-digit ID number will appear in the ID field:
PATIENT ID
2. This automatically generated ID indicates the start date and time of the case session (format
YYYYMMDDhhmmss, indicating year, month, day, hour, minute and second of the session start). To use
the automatically generated ID number, use the control knob to select START CASE and click the START
CASE button to begin the case.
3. To change the ID number, if desired, turn the control knob to highlight PATIENT ID in blue on the screen
and click the control knob. Use the control knob to enter a new alphanumeric Patient ID by rotating and
pressing the control knob to select letters and numbers. If you wish to enter a space, turn the knob until you
see an empty square instead of a letter or numeral, and click to enter a space. You will note that the space
you are currently filling is highlighted in yellow. The maximum permitted length for the Patient ID is
20 characters. Select the Enter symbol to finish. See the section Screen Navigation on page 40 for
instructions on how to enter letters and numbers.
4. If you want to change the patient type for this patient, you may do so from this screen, using the control
knob to select and change the patient type.
5. Use the control knob to select START CASE.
Note: Once the START CASE button is pressed, the case has begun, and that button now becomes
STOP CASE.
20101209072645
Page 49
Entering Patient Events
Portable Bedside Capnograph/Pulse Oximeter
47
Note: A new case cannot begin until the previous case has been stopped with the STOP CASE
button.
Note: If you are not sure whether the monitor is currently monitoring a case, click the Patient
Admit/Discharge key to display the screen in which the START CASE button appears.
The status of the START CASE button can provide an indication of current status: when there
is no case started, it will show START CASE, and, in the middle of a case, it will show STOP
CASE.
6. To end a case when monitoring the patient is finished, press the Patient Admit/Discharge key, and then
select STOP CASE. This marks the end of the data for that patient. Stopping a case will erase the Trend
Memory, and a warning that indicates STOPPING THE CASE WILL ERASE TREND MEMORY;
PRESS "STOP CASE" AGAIN TO CONFIRM will appear on the screen when STOP CASE is pressed.
If you want to transfer or print case or trend data, this must be done before the case is stopped. If you do not
want to stop the case, simply turn the knob to remove the question from the screen and continue the case. If
you do want to stop the case, click the control knob again.
7. If STOP CASE is not pressed when the user finishes monitoring and powers off the monitor, the case will
continue when the monitor is turned off and then on again. However, when the monitor is powered up again
in such a case, a warning will suggest that the user clear trend data and close the case (to clear patient ID)
before beginning a new monitoring session. This screen is seen in Figure 34 - Trend Memory Message on
page 94. Medtronic strongly suggests that you do so in order to avoid mis-identification of patient data.
However, if you intend to continue monitoring the same patient as previously, you may want to retain the
trend and case data.
Clicking YES and CONFIRM? in the screen seen in Figure 34 - Trend Memory Message on page 94, will clear
the trend memory and close the current case, thus erasing all data in the monitor regarding that case.
WARNING: The monitor can store only one case at a time. The trend memory includes only data for the
current case, and, when the case is stopped, the trend memory is erased.
The monitor automatically stores patient data and records the date and time for all events, whether or not the
patient case option is used. As long as the trend memory is not erased, this data remains stored in the monitor,
until the trend memory is full and the beginning of the trend data is overwritten by new data. (See Chapter 10
Using Trends on page 87 for more information on trend capacity.) However, case printouts will only include
data recorded after the current case was started (even if the trend memory also includes data previous to the
current case). On the other hand, displayed trend data and trend printouts will include all data stored in the trend
memory.
Entering Patient Events
When scanning patient history in the monitor, it is often useful to have a record of patient events that could have
influenced the recorded readings. The monitor has the ability to record a wide variety of patient events. There
are two options: Quick Events and Detailed Events.
If the monitor is set to record Quick events, pressing the event button ( ) places a mark in the trend memory
showing that an event took place at the date and time the button was pushed. See Table 20 - Tabular Display
Example for an example of a quick event mark.
Detailed events allow the clinician to record more detail. There are three categories of events: administering
medication, physical activity by the patient, and interventions. These events can be marked in the monitor's
memory to assist in tracking patient care and appear in the trend displays and data output.
O USE DETAILED EVENTS:
T
1. Press the event button on the front display panel of the monitor.
2. The table below will appear on the display. Use the control knob to click on an event.
3. Click the control knob again to store the event and return to the HOME screen.
The table below shows the factory default settings. The event names can be changed using the institutional
Page 50
Changing the Alarm and Pulse Volumes
48
Portable Bedside Capnograph/Pulse Oximeter
defaults as described in Changing Institutional Defaults on page 131.
Table 8 - Event Markings
MEDICATION PATIENT INTERVENED
Fentanyl EATING OXYGEN
Versed DRINKING SUCTION
MIDAZOLAM COUGHING ADJ AIRWAY
Morphine AMBULATING NARCAN
Demerol CHEST PT ROMAZICON
Propofol TURNED NEB TX
SURFACTANT SNORING STIMULATED
Other OTHER CO2 insuffl*
ABG
OTHER
* CO2 Insufflation
If the monitor is set to record detailed events, but you do not wish to designate a specific event name, pressing
the event button twice will record an unlabeled event similar to a quick event mark. This is useful when
there is no time to designate details.
Changing the Alarm and Pulse Volumes
The alarm volume can be made louder or softer for patient alarms and pulse tone. The pulse tone can also be
turned off using the SpO
Alarm Volume
T
O MAKE THE ALARM VOLUME LOUDER OR SOFTER:
1. Use the control knob to select the speaker icon at the right-hand side of the menu.
2. Click the control knob once to select the alarm volume control.
3. Turn the control knob to raise or lower the volume. The selected alarm volume level will be audible as you
turn the knob. Click the knob twice to set the new volume level.
Note: The alarm volume cannot be set to zero using the alarm volume control. The audible alarm
can only be disabled in the Institutional Default settings.
menu. By default, the pulse tone is turned off.
2
Figure 16 - Menu Bar
Figure 17 - Alarm Volume Selection
Speaker
Volume
icon
Pulse Tone Volume
The monitor can be set to sound an audible beep for each pulse beat. The monitor is shipped from the factory
with the pulse tone turned off.
The pulse tone can also be turned off using the SpO
menu. By default, the pulse tone is turned off.
2
Page 51
Alarm Delay
Portable Bedside Capnograph/Pulse Oximeter
49
Setting the Pulse Tone Volume
To make the pulse tone louder or softer, use the control knob to select the speaker icon and click twice to select
the Pulse Tone volume setting.
Figure 18 - Pulse Tone Volume Selection
The pulse tone volume can be set to zero.
Turning the Pulse Tone On/Off
T
O TURN THE PULSE TONE VOLUME ON:
1. Use the control knob to select the SpO
display area. Click the control knob to go to the SpO2 Setup screen.
2
2. Turn the control knob to highlight the PULSE TONE setting, click the knob to select the option, turn the
knob once to change the setting to ON, and push the knob again to set the option.
3. A beep now sounds once for each pulse beat. To turn the pulse tone off, repeat the procedure and select
PULSE TONE off.
Alarm Volume Default Options
The institutional default alarm volume can be set to one of the three choices described below, in the
Institutional Defaults>Monitor screen. These choices determine the audio alarm volume when the device is
turned on. See Institutional Defaults on page 131 to learn more about Institutional Defaults.
Table 9 - Audio Alarm Volume
Audio Alarm Volume Option Description
Maximum The audio alarm volume will revert to the maximum volume when
the device is turned on, regardless of previous settings.
Last Setting The audio alarm volume will remain at the level last set on the
device, even after it is turned off and then turned on again.
Audio Off The audio alarm volume is off.
CAUTION: The Audio off option (which will create permanent alarm silence) should be set in the
Institutional Defaults only in a situation in which the caregiver is also monitoring the
patient by other means, to avoid the chance of missed alarms.
Alarm Delay
An option for Alarm Delay (for a number of alarms) is available. For more information, see Alarm Delay on
page 76.
Use of Scavenging System
When the patient is being sedated with a gaseous anesthetic, a scavenging system can be attached to the
monitor. The gas output connection is a barbed style connector intended for 3/32 inch ID tubing. Using any
appropriate tubing, connect the scavenging system to the gas outlet, located between the FilterLine™ and SpO
connections, as shown below in Figure 19, below.
Disposal of sampled gases should be carried out according to according to standard operating procedures or
local regulations for the disposal of gases.
2
Page 52
Turning the Pump Off for Suction or Lavage
50
Portable Bedside Capnograph/Pulse Oximeter
Scavenger system Connection Point
Figure 19 - Scavenger System Connection Point
Turning the Pump Off for Suction or Lavage
Use the Pump Off mode whenever performing suction or lavage. During Pump Off mode, pump activity is
suspended to protect the monitor from drawing in liquids which could cause a malfunction.
In the Pump Off mode, the CO2 module pump is switched OFF for a preset time to prevent liquids from
entering the monitor.
WARNING: If at any time the device displays the FILTERLINE BLOCKAGE message, replace the
FilterLine™.
TO CHANGE THE PUMP MODE:
1. Before performing lavage or suction, press the Pump Off button located on the front of the monitor.
The CO2 module pump turns off, the countdown timer begins and the Pump Off screen is displayed. The
countdown timer is shown in the CO2 waveform area.
Note: While the pump is off, CO2 is not monitored and no breath waveform, etCO2, FiCO2, or
respiration rate number values are displayed. SpO2 and pulse rate monitoring continues.
2. Pump Off mode can be ended by pressing the Pump Off button again.
3. Pump Off mode can be extended by using the control knob to select the EXTEND TIMER menu option.
When the monitor is in Pump Off mode, a timer appears in the message area at the top of the screen and shows
the total hours and minutes that the CO
When the timer finishes or you manually exit Pump Off by pressing the Pump Off button again, the pump will
turn on and CO2 monitoring will resume. The monitor automatically returns to the Home screen.
Note: The Pump Off button does not function while scrolling in Graphical and Tabular Trend
screens.
monitoring has been turned off.
2
Page 53
Demo Mode
Portable Bedside Capnograph/Pulse Oximeter
51
Demo Mode
The Capnostream™20p monitor provides the possibility of viewing pre-recorded standard data to display an
example of the monitor's appearance under standard measurement conditions. The Demo Mode permits
clinicians and technicians to understand what the screen will show when monitoring patients, and is useful to
them as a guide before attaching the monitor to real patients.
TO USE THE DEMO MODE:
1. To enter the Demo Mode, click SYSTEM and then SERVICE on the menu bar at the bottom of the screen.
Enter the Service password (see Changing Institutional Defaults on page 131) to enter the Service screen.
2. On the Service screen, click the DEMO MODE button on the menu bar. The monitor will now enter Demo
Mode and will display pre-recorded CO
and SpO2 data. As an indicator of operation under Demo mode, the
2
header will indicate DEMO MODE on a flashing orange background. An advisory message DEMO MODE
- PRERECORDED DATA will also appear. Service options and the Calibration Check feature are not
available to the user while the device is in Demo mode.
3. To exit the Demo Mode, you must turn off the monitor using the ON/OFF button at the front of the monitor.
When the monitor is turned on again, it will have returned to its standard operating status.
Monitor Screen Menu Reference Chart
The chart below shows the menu flow paths for navigating through the different screens of Capnostream™20p.
Page 54
Monitor Screen Menu Reference Chart
52
Portable Bedside Capnograph/Pulse Oximeter
Figure 20 - Screen Menu Reference Chart when A/hr and ODI are available
Page 55
Monitor Screen Menu Reference Chart
Portable Bedside Capnograph/Pulse Oximeter
53
Figure 21 - Screen Menu Reference Chart when A/hr and ODI are not available
Page 56
Page 57
Portable Bedside Capnograph/Pulse Oximeter
55
Do not touch this field - it is invisible and does not appear in the
Chapter 5
Capnography with the Capnostream™20p Monitor
final document
Microstream™ EtCO2 Consumables
Connecting a FilterLine
CO2 Data Displayed by the Capnostream™20p Monitor
Adjustable CO2 Parameters
Monitoring CO2 during MRI Scanning
Microstream™ EtCO2 Consumables
WARNING: Loose or damaged connections may compromise ventilation or cause an inaccurate
measurement of respiratory gases. Securely connect all components and check connections
for leaks according to standard clinical procedures.
WARNING: If too much moisture enters the FilterLine™ (i.e., from ambient humidity or breathing of
unusually humid air), the message Clearing FilterLine will appear in the
Capnostream™20p message area. If the FilterLine™ cannot be cleared, the message
FilterLine Blockage will appear in the CO2 waveform display section on the Home screen
and in the Capnostream™20p message area. (If there is no waveform display, the message
will appear only in the message area.) Replace the FilterLine™ once the FilterLine
Blockage message appears.
WARNING: The FilterLine™ may ignite in the presence of O2 when directly exposed to laser, ESU
devices, or high heat. When performing head and neck procedures involving laser,
electrosurgical devices or high heat, use with caution to prevent combustion of the
FilterLine™ or surrounding surgical drapes.
CAUTION: Before use, carefully read the Microstream™ etCO2 consumables Directions for Use.
CAUTION: Only use Microstream™ etCO2 consumables to ensure the monitor functions properly.
CAUTION: Microstream™ etCO2 consumables are designed for single patient use, and are not to be
reprocessed. Do not attempt to clean, disinfect or blow out the FilterLine™ as the monitor
can be damaged.
CAUTION: Dispose of Microstream™ etCO2 consumables according to standard operating procedures
or local regulations for the disposal of contaminated medical waste.
CAUTION: When monitoring with capnography during sedation, please note that sedation may cause
hypoventilation and CO2 waveform distortion or disappearance. Waveform attenuation or
disappearance is an indicator that the status of the patient’s airway should be assessed.
CAUTION: When monitoring patients during upper endoscopy, partial blockage of the oral airway due
to endoscope positioning may cause periods of low readings and rounded waveforms. The
occurrence will be more pronounced with high oxygen delivery levels.
CAUTION: If CO2 insufflation is performed during CO2 monitoring, the etCO2 values will accordingly
rise very significantly and this may result in device alarms and abnormally high waveforms
until the CO2 is evacuated from the patient.
Note: When connecting a sampling line to the monitor, screw the sampling line connecter clockwise
into the monitor CO2 port until it can no longer be turned, to ensure that it is connected
securely to the monitor. This will assure that there is no leak of gases during measurement at
the connection point and that measurement accuracy is not compromised.
Page 58
Connecting a FilterLine™
56
Portable Bedside Capnograph/Pulse Oximeter
Note: Following connection of the CO2 sampling line, check that CO2 values appear on the monitor
display.
Note: CO2 sampling lines used with the monitor are marked as to the upper limit of oxygen that may
be provided with the sampling line. At levels of oxygen provision higher than those marked on
the sampling line packaging, dilution of CO2 readings may occur, leading to lower CO2
values.
Basic Principles
™
When choosing Microstream
etCO2 consumables, the following should be considered:
• Whether the patient is intubated or non-intubated
• Whether the patient is on mechanical ventilation
• Duration of use
• Patient’s size and weight
• Whether the patient is breathing through his nose, his mouth, or alternating between oral and
nasal breathing
For further information, please contact your local representative.
Select the appropriate FilterLine™ and connect it to the monitor before attaching it to the patient’s airway. Be
sure to follow Microstream
™
etCO2 Consumables’ Directions for Use for proper connection.
Microstream
A list of Microstream
Note: Smart products provide oral and nasal sampling.
Note: The generic term FilterLine™, used in this manual, is interchangeable with any of the
Note: The listed products are also available in versions designed for other patient sizes.
™
EtCO2 Consumables
™
etCO2 consumables appear in Microstream™ EtCO2 Consumables on page 149.
H products are for long term use.
Microstream™ etCO2 consumables.
This listing describes the main products available. For more information about any Microstream™ FilterLine™
or additional sizing and packaging options for these products, see
http://www.covidien.com/rms/brands/microstream.
Connecting a FilterLine™
Before monitoring a patient with capnography, the appropriate FilterLine™ must be connected to the monitor
and to the patient.
T
O MAKE THE CONNECTIONS:
1. Slide open the FilterLine™ input connector shutter and connect the appropriate FilterLine™.
Screw the FilterLine™ connector into the monitor clockwise until it can no longer be turned.
2. Connect the FilterLine™ to the patient as described in the Directions for Use supplied with the
FilterLine™.
When the FilterLine™ is connected, the monitor will immediately begin to search for breaths, but it will not
indicate a No Breath condition before any valid breaths have occurred.
Note: The Capnostream™20p monitor’s CO2 function will enter standby mode automatically in
cases when the Capnostream™20p monitor is left on for 30 minutes or longer without a
FilterLine™ attached. In this case, CO2 monitoring on the monitor will go into automatic
standby mode and then will re-initialize once a FilterLine™ is attached. This initialization
process takes typically 30 seconds; it may take up to 180 seconds.
Page 59
CO2 Data Displayed by the Capnostream™20p Monitor
Portable Bedside Capnograph/Pulse Oximeter
57
CO2 Data Displayed by the Capnostream™20p Monitor
The Capnostream™20p monitor Home screen displays real time CO2 data. The displayed data includes:
• Real time etCO
Capnostream™20p Monitor on page 57 for details regarding the available units)
• Real-time FiCO
details regarding the available units)
• Respiration rate (RR) in breaths per minute
• CO
CO2 Waveform EtCO2, FiCO2
Waveform
2
Additionally, the monitor can display CO2 data in trend form, showing time, date, etCO2, RR, alarms, events,
and a CASE START marker. For more information about trend display, see Chapter 11 Using Trends on
page 87.
When the EtCO
health care professional to the specific parameter that is affected.
A delay may be set on a number of alarms, if desired, so that these alarms will sound only if the parameter
exceeded alarm limits for the set number of seconds. This option can be set using Institutional Defaults. See
Institutional Defaults on page 131 for more information on how to set Institutional Defaults.
If the numeric home screen is chosen, the CO
large font, to enable easy viewing, even at a distance. The CO
Figure 23 - CO2 Section of Numeric Home Screen, below.
Note: For both neonatal and adult patients, the EtCO2 numeric displayed on the screen is the
maximum value of CO2 over the last 20 seconds, updated once a second. An etCO2 alarm
will occur based on the EtCO2 value displayed on the screen.
Note: In high-altitude environments, EtCO2 values may be lower than values observed at sea level,
as described by Dalton's law of partial pressures. When using the monitor in high-altitude
environments, it is advisable to consider adjusting EtCO2 alarm settings accordingly.
Note: Measuring mode corrects the CO2 value for BTPS setting (Body Temperature, Pressure,
Saturation) which assumes that alveolar gases are saturated with water vapor. BTPS should
remain on for patient measurement. For other purposes, it may be turned off in the CO2 Setup
screen.
and FiCO2 values along with selected unit (see CO2 Data Displayed by the
2
values along with selected unit (see Adjustable CO2 Parameters on page 58 for
2
and Respiration
Rate values
Figure 22 - CO2 Data on the Capnostream™20p Monitor
High or Low alarm limits are exceeded, the affected numeric will flash to alert the attending
2
waveform will not appear. Instead, CO2 data will appear in a
2
section of the numeric home screen is seen in
2
Page 60
Adjustable CO2 Parameters
58
Portable Bedside Capnograph/Pulse Oximeter
Figure 23 - CO2 Section of Numeric Home Screen
Adjustable CO2 Parameters
The Capnostream™20p monitor provides the option of adjusting some parameter settings used for CO2
measurement to suit your patients, your institution's requirements, or other needs. To change these settings on a
temporary basis, until the device is turned off, follow the procedure below. To set changes as institutional
defaults so that the settings will remain in effect even after the monitor is turned off, see CO2 Parameters on
page 137.
TO CHANGE CO
1. On the Home screen, move the control knob to the CO
Click the control knob.
2. The CO2 Setup screen will appear. Move the control knob to the parameter that you wish to change and click
to select that parameter. Move the control knob to select the desired setting and click to select the setting. A
list of the settings that can be changed appears in Table 10 - Adjustable CO2 Parameters, below.
3. Move the control knob to the HOME button and click to select. The screen will also revert to the Home
screen after a few seconds if no additional actions are taken on that screen, but if the screen timed out and
reverted back to the HOME screen in this manner, changes will not be saved.
4. The changes in the parameters will remain in effect until the device is turned off.
PARAMETER SETTINGS:
2
section of the screen, so that it is outlined in blue.
2
BTPS* On/Off On
FiCO2 Display On/Off On
Pump-Off Timeout (minutes) 5, 10, 15 or 30 15
CO2 Waveform Scale (mmHg) 50, 100, 150, Auto Auto
EtCO2 Scale for Trend Display 50, 100, 150 50
RR Scale for Trend Display 50, 100, 150 50
Sweep Speed** (mm/sec) [for current patient
type]
A/hr Visual Alert Level (Apnea/Hr) (if available) 1-99 10
Table 10 - Adjustable CO2 Parameters
Parameter Choices Factory Default
1, 2, 3, 6.3, 12.5, 25 6.3
* BTPS denotes the standard correction used during measurement for body temperature, pressure, and saturation.
BTPS should be set to ON during all measurement procedures. The device automatically turns off the BTPS
correction during calibration procedures and turns it on again following these procedures. There is no need for the
user to make any changes to the BTPS setting.
Page 61
Monitoring CO2 during MRI Scanning
Portable Bedside Capnograph/Pulse Oximeter
59
** Sweep speed is the speed at which the waveform completes one cycle of the graph to cover the entire display screen
once.
Note: Please note that if the waveform scale is changed in the CO2 Setup screen or in Institutional
Defaults, a CO2 waveform with upper values that exceed the upper level of the scale will
appear incompletely, with the higher values cut off. Therefore, the default waveform scale is
Auto.
Monitoring CO2 during MRI Scanning
WARNING: Do not use the FilterLine™ H Set Infant/Neonatal during magnetic resonance imaging
(MRI) scanning. Using the FilterLine™ H Set Infant/Neonatal during MRI scanning could
harm the patient.
CAUTION: During MRI scanning, the monitor must be placed outside the MRI suite. When the monitor
is used outside the MRI suite, EtCO2 monitoring can be implemented by attaching the
FilterLine™ XL, to provide extended length.
CAUTION: Use of a CO2 sampling line with H in its name (indicating that it is for use in humidified
environments) during MRI scanning may cause interference. The use of non-H sampling
lines is advised. For a list of H sampling lines, see Microstream™ EtCO2 Consumables on
page 149.
Non-invasive etCO
monitor, a FilterLine™ XL, and an appropriate CO
O USE THE MONITOR DURING MRI SCANNING:
T
monitoring during magnetic resonance imaging (MRI) can be accomplished with the
2
sampling line.
2
1. Place the monitor outside the MRI suite. There must be a hole in the wall of the suite (approximately 10 cm.
diameter).
2. Connect the FilterLine™ XL to the monitor and guide the FilterLine™ XL through the hole in the wall of
the MRI suite.
3. Attach the FilterLine™ XL to the patient.
Note: Due to the extended length of the FilterLine™ XL, there may be an increased delay time and
thus a slower response time.
To purchase the FilterLine™ XL, contact your local representative.
Page 62
Page 63
Portable Bedside Capnograph/Pulse Oximeter
61
Do not touch this field - it is invisible and does not appear in the
Chapter 6
Pulse Oximetry with the Capnostream™20p Monitor
final document
Nellcor™ SpO2 Sensors
Connecting an SpO2 Sensor to the Monitor
SpO2 Data Displayed by the Capnostream™20p Monitor
Adjustable SpO2 Parameters
SpO2 Alarm Limit Message
Nellcor™ SpO2 Sensors
WARNING: Before use, carefully read the sensor Directions for Use, including all warnings, cautions,
and instructions.
WARNING: Do not immerse the sensor in water, solvents, or cleaning solutions (the sensor and
connectors are not waterproof). Do not sterilize by irradiation, steam, or ethylene oxide. See
the cleaning instructions in the directions for use for reusable pulse oximetry sensors.
WARNING: Before each use of SpO2 sensors, assure that the sensor is intact. Damaged sensors (torn,
worn out [abraded], or exposed optical components, wires or metal) are prohibited for use.
Use of damaged sensors may compromise patient safety and may result in patient injury.
Protection of the monitor against the effects of the discharge of a cardiac defibrillator is
dependent upon the use of appropriate SpO2 cables and sensors listed in Table 11 on
page 62.
WARNING: Use only Nellcor™ sensors for SpO2 measurements. Other sensors may cause improper
monitor performance.
WARNING: Do not use oximetry sensors during magnetic resonance imaging (MRI) scanning.
Conducted current could cause burns. The sensors may affect the MRI image and the MRI
unit may affect the accuracy of oximetry measurements.
WARNING: Tissue damage can be caused by incorrect application or use of a pulse oximetry sensor.
Inspect the sensor site as directed in the Instructions for Use. Do not apply the sensor too
tightly or by using excessive pressure. Do not wrap the sensor, apply supplemental tape, or
leave the sensor too long in one place. If the skin under the sensor becomes irritated, change
the location of the sensor.
CAUTION: Single-patient use sensors and adhesive sensors are intended for single-patient use only. Do
not transfer a single-use sensor or an adhesive sensor from one patient to a second patient.
Note: The oxygen transducers (sensors) used in this device can be categorized as surface devices
contacting skin for a limited duration of time. The sensors have passed the recommended
biocompatibility testing and are therefore in compliance with ISO 10993–1.
Note: Because light absorption by hemoglobin is wavelength dependent and because the mean
wavelength of LEDs varies, a monitoring system must know the mean wavelength of the
sensor's red LED to accurately measure SpO2. During monitoring, the monitoring system’s
software selects coefficients that are appropriate for the wavelength of that individual sensor's
red LED; these coefficients are then used to determine SpO2. Additionally, to compensate for
differences in tissue thickness, the light intensity of the sensor's LEDs is adjusted
automatically. Together these features provide automatic calibration of the SpO2 feature.
Page 64
Nellcor™ SpO2 Sensors
62
Portable Bedside Capnograph/Pulse Oximeter
Data Update Period, Data Averaging, and Signal Processing
The advanced signal processing of the OxiMax™ algorithm automatically extends the amount of data required
for measuring SpO
and pulse rate depending on the measurement conditions. The OxiMax™ algorithm
2
automatically extends the dynamic averaging time required beyond seven (7) seconds during degraded or
difficult measurement conditions caused by low perfusion, signal artifact, ambient light, electrocautery, other
interference, or a combination of these factors, which results in an increase in the dynamic averaging. If the
resulting dynamic averaging time exceeds 20 seconds for SpO
continuing to update SpO
and pulse rate values every second.
2
, the algorithm sets the pulse search bit while
2
As such measurement conditions extend, the amount of data required may continue to increase. If the dynamic
averaging time reaches 40 seconds, and/or 50 seconds for pulse rate, a technical alarm state results: the
algorithm sets the Pulse Timeout bit and the monitoring system reports a zero saturation indicating a loss-ofpulse condition, which should result in an audible alarm.
Functional Testers and Patient Simulators
Some models of commercially available bench top functional testers and patient simulators can be used to verify
the proper functionality of Covidien Nellcor™ monitoring systems, sensors, and cables. Reference the
individual testing device's operator's manual for the procedures specific to the model of tester used. While such
devices may be useful for verifying that the sensor, cabling, and monitoring system are functional, they are
incapable of providing the data required to properly evaluate the accuracy of a system's SpO
Fully evaluating the accuracy of the SpO
measurements requires, at a minimum, accommodating the
2
measurements.
2
wavelength characteristics of the sensor and reproducing the complex optical interaction of the sensor and the
patient’s tissue. These capabilities are beyond the scope of known bench top testers. SpO
measurement
2
accuracy can only be evaluated in vivo by comparing monitoring system readings with values traceable to SaO
measurements obtained from simultaneously sampled arterial blood using a laboratory CO-oximeter.
Many functional testers and patient simulators have been designed to inter-face with the monitoring system's
expected calibration curves and may be suitable for use with monitoring systems and/or sensors. Not all such
devices, however, are adapted for use with the OxiMax™ digital calibration system. While this will not affect
use of the simulator for verifying system functionality, displayed SpO
measurement values may differ from the
2
setting of the test device. For a properly functioning monitoring system, this difference will be reproducible
over time and from monitoring system to monitoring system within the performance specifications of the test
device.
2
Selecting Nellcor™ SpO
When selecting a sensor, consider the patient's weight and activity, the adequacy of perfusion, the available
sensor sites, and the anticipated duration of monitoring. The sensor models are summarized in Table 11 –
Nellcor™ SpO2 Sensors, below. For further information, please contact your local representative.
Nellcor™ pulse oximetry sensors contain light emitting diodes (LEDs) that emit red light at a wavelength of
approximately 660 nm, and infrared light at a wavelength of approximately 900 nm. The total optical output
power of the sensor LEDs is less than 15 mW. This information may be useful to clinicians, such as those
performing photodynamic therapy.
Sensors
2
Table 11 – Nellcor™ SpO2 Sensors
Oxygen Sensor Model Patient Weight
OXIMAX™ oxygen transducer
(single patient use)
MAX-N <3 kg or >40 kg
MAX-I 3 to 20 kg
MAX-P 10 to 50 kg
MAX-A >30 kg
MAX-AL >30 kg
MAX-R >50 kg
Page 65
Nellcor™ SpO2 Sensors
Portable Bedside Capnograph/Pulse Oximeter
63
Oxygen Sensor Model Patient Weight
MAX-FAST >40 kg
OXIMAX™ OxiCliq™ oxygen transducer
(single-use only)
OXIMAX™ Dura-Y™ multisite oxygen
transducer (Nonsterile, reusable)
For use with Dura-Y sensor:
Ear clip (Reusable, nonsterile)
Pedi-Check™ pediatric spot-check clip
(Reusable, nonsterile)
P 10 to 50 kg
A >30 kg
D-YS >1 kg
D-YSE 30 kg
D-YSPD 3 to 4 kg
OXIMAX™ Oxiband™ oxygen transducer
(Reusable with disposable nonsterile
adhesive)
OXIMAX™ Durasensor™ oxygen transducer
(Nonsterile, reusable)
Nellcor™ Preemie SpO2 Sensor, nonadhesive (Single-patient use)
Nellcor™ Neonatal SpO2 Sensor, nonadhesive (Single-patient use)
Nellcor™ Adult SpO2 Sensor, non-adhesive
(Single-patient use)
Nellcor™ Adult Respiratory Sensor, SpO2,
RR
Nellcor™ Flexible SpO2 Sensor
(non-sterile, reusable)
Sensor cable DOC-10 DOC-10 NA
Sensor cable OC-3 OC-3 NA
OXI-A/N <3 kg or>40 kg
OXI-P/I 3 to 40 kg
DS-100A >40 kg
SC-PR <1.5 kg
SC-NEO 1.5 to 5 kg
SC-A >40 kg
10068119 >30 kg
FLEXMAX
FLEXMAX-P
≥ 20kg
≥ 20kg
Performance Considerations
WARNING: Pulse oximetry readings and pulse signal can be affected by certain ambient environmental
conditions, sensor application errors, and patient conditions.
WARNING: Tissue damage can be caused by incorrect application or inappropriate duration of use of an
SpO2 sensor. Inspect the sensor site as directed in the sensor Directions for Use.
WARNING: Use only Nellcor™ approved sensors and pulse oximetry cables. Other sensors or oximetry
cables may cause improper monitor performance and may also result in increased
electromagnetic emission or decreased immunity to electromagnetic interference.
Inaccurate measurements can be caused by:
• incorrect application of the sensor
• placement of the sensor on an extremity with a blood pressure cuff, arterial catheter, or
intravascular line
• ambient light
• prolonged and/or excessive patient movement
• intravascular dyes or externally applied coloring, such as nail polish or pigmented cream
• failure to cover the sensor site with opaque material in high ambient light conditions
Loss-of-pulse signal can occur for the following reasons:
Page 66
Connecting an SpO2 Sensor to the Monitor
64
Portable Bedside Capnograph/Pulse Oximeter
• the sensor is applied too tightly
• a blood pressure cuff is inflated on the same extremity as the one with the sensor attached
• there is arterial occlusion proximal to the sensor
• poor peripheral perfusion
Clean and remove any substances such as nail polish from the application site. Periodically check to ensure that
the sensor remains properly positioned on the patient.
Select an appropriate sensor, apply it as directed, and observe all warnings and cautions presented in the
directions for use accompanying the sensor.
High ambient light sources such as surgical lights (especially those with a xenon light source), bilirubin lamps,
fluorescent lights, infrared heating lamps, and direct sunlight can interfere with the performance of an SpO
sensor. To prevent interference from ambient light, ensure that the sensor is properly applied, and cover the
sensor site with opaque material.
CAUTION: Failure to cover the sensor site with opaque material in high ambient light conditions may
result in inaccurate measurements.
If patient movement presents a problem, try one or more of the following remedies:
• Verify that the sensor is properly and securely applied.
• Move the sensor to a less active site.
• Use an adhesive sensor that tolerates some patient motion.
• Use a new sensor with fresh adhesive backing.
If poor perfusion affects performance, consider using the MAX-R sensor; it obtains measurements from the
nasal septal anterior ethmoid artery, an artery supplied by the internal carotid. This sensor may obtain
measurements when peripheral perfusion is relatively poor.
Reading accuracy in the presence of low perfusion (detected IR pulse modulation amplitude between 0.03% and
1.5%) was validated using signals supplied by a patient simulator. SpO
across the monitoring range over a range of weak signal conditions and compared to the known true saturation
and pulse rate of the input signals.
and pulse rate values were varied
2
2
Connecting an SpO2 Sensor to the Monitor
Before monitoring a patient with pulse oximetry, the appropriate SpO2 sensor must be connected to the monitor
and to the patient.
T
O CONNECT THE SPO2 SENSOR:
1. Connect the SpO
Nellcor™ SpO
extension cord firmly to the monitor SpO2 sensor port, and then connect the appropriate
2
sensor to the extension cord.
2
2. Connect the Nellcor™ SpO2 sensor to the patient as described in its Directions for Use, using a Nellcor SpO2
sensor extension cable.
3. When the SpO2 sensor is plugged into the extension cable and connected to the monitor, the monitor will
immediately begin to search for a pulse. It will indicate NO PULSE FOUND and SpO
SENSOR NOT
2
ON PATIENT until the time that the sensor is placed on the patient. This is classified as a Medium Priority
Alarm, and will generate a triple beep every thirty seconds. To avoid the alarm message and beeping, you
can connect the extension cable to the monitor, but wait to connect the SpO
sensor to the extension cable
2
until it is time to connect the patient to the monitor.
SpO2 Data Displayed by the Capnostream™20p Monitor
The Capnostream™20p monitor Home screen displays real time SpO2 data. The displayed data includes:
• SpO
Numeric
2
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SpO2 Data Displayed by the Capnostream™20p Monitor
Portable Bedside Capnograph/Pulse Oximeter
65
• Pulse Rate
• Sat Seconds figure (see SpO2 Alarms and SatSeconds on page 85 for an explanation of this issue)
• Plethysmograph (SpO2 waveform)
• Interference Indicator
SpO2 Waveform Bar
(plethysmograph)
Interference
Indicator
Sat Seconds
SpO2
Pulse Rate
Figure 24 - SpO2 Data on the Capnostream™20p Monitor - Standard Screen
On the standard home screen with IPI enabled (default standard home screen), the plethysmograph (the SpO2
waveform) is seen as a green vertical bar on the SpO
section of the screen (just to the left of the Sat Seconds
2
value). The bar indicates pulse beat by rising and falling with the patient's pulse beat. An interference indicator
(the yellow jagged line seen in the figure above) is shown when the incoming signal is inadequate or degraded.
If the signal is adequate, the indicator will not appear.
When the IPI display on the home screen is disabled (see IPI Options on page 68 and Institutional Defaults on
page 131), the SpO
section of the home screen will appear as seen in Figure 25 - SpO2 Data on the
2
Capnostream™20p Monitor – Standard Screen with IPI Disabled, below. The plethsysmographic waveform is
non-normalized, using real-time sensor signal to reflect relative pulsatile strength.
SpO2
Waveform
(plethysmo-
graph)
SpO2, Sat
Seconds and
Pulse Rate
values
Figure 25 - SpO2 Data on the Capnostream™20p Monitor – Standard Screen with IPI Disabled
Additionally, the monitor can display SpO2 data in trend form, showing time, date, SpO2, pulse rate (PR),
alarms, events and case markers to differentiate between patients. For more information about trend display, see
Chapter 11 Using Trends on page 87.
When the SpO
high or low alarm limits are exceeded, the affected reading will flash to alert the attending
2
health care professional to the specific reading that is affected.
If the numeric home screen is chosen, the SpO
large font, to enable easy viewing, even at a distance. The SpO
Home Screen Numeric Display on page 38.
waveform will not appear. Instead, SpO2 data will appear in a
2
section of the numeric home screen is seen in
2
Page 68
Adjustable SpO2 Parameters
66
Portable Bedside Capnograph/Pulse Oximeter
PR Scale for Trend Display
150, 300
150
SpO2, Sat
Seconds and
Pulse Rate
values
Figure 26 - SpO2 Section of Numeric Home Screen
Adjustable SpO2 Parameters
The Capnostream™20p monitor provides the option of adjusting some parameter settings used for SpO2
measurement to suit your patients, your institution's requirements, or other needs. To change these settings on a
temporary basis, until the device is turned off, follow the procedure below. To set changes as institutional
defaults so that the settings will remain in effect even after the monitor is turned off, see Institutional Defaults
on page 131.
TO CHANGE SPO
1. On the Home screen, move the control knob to the SpO
Click the control knob.
2. The SpO
click to select that parameter. Move the control knob to select the desired setting and click to select the
setting. A list of the settings that can be changed appears in Table 12 - Adjustable SpO2 Parameters, below.
3. Move the control knob to the HOME button and click to select. The screen will also revert to the Home
screen after a few seconds if no additional actions are taken on that screen.
4. The changes in the parameters will remain in effect until the device is turned off.
PARAMETER SETTINGS:
2
section of the screen, so that it is outlined in blue.
2
Setup screen will appear. Move the control knob to the parameter that you wish to change and
2
Pulse Tone On/Off On
Sat Sec (Sat Seconds) On/Off On
SpO2 Scale for Trend Display 0-100, 50-100 50-100
Sweep Speed** (mm/sec)
[for current patient type]
** Sweep speed is the speed at which the waveform completes one cycle of the graph to cover the entire display
SpO2 Alarm Limit Message
When the SpO2 alarm limit is set below 85%, a message reading SpO2 LOW ALARM LIMIT: xx will appear in
the header area, indicating the level of the SPO
Parameter Choices Factory Default
screen once.
Table 12 - Adjustable SpO2 Parameters
3, 6.3, 12.5, 25 25
LOW alarm limit.
2
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Portable Bedside Capnograph/Pulse Oximeter
67
Do not touch this field - it is invisible and does not appear in the
Chapter 7
Integrated Pulmonary Index™
final document
Introduction
Warnings
IPI Display
IPI Options
Introduction
The Integrated Pulmonary Index™ (henceforth referred to as IPI) is a numerical value which integrates four
major parameters measured by Capnostream™20p in order to provide a simple indication of the patient’s
overall ventilatory status. The integrated parameters are EtCO
are used to calculate IPI; other parameters are not taken into account.
IPI is calculated using the current values of these four parameters and their interactions, based on known clinical
data. IPI can thus provide an early indication of a change in ventilatory status which may not be shown by the
current value of any of these four parameters individually. The IPI is designed to provide additional information
regarding patient status, possibly before EtCO
, RR, SpO2, or PR values reach levels of clinical concern.
2
The IPI trend graph (seen on the Capnostream™20p home screen) is particularly valuable, as it displays the
patient ventilatory status trend in one easy-to-use graph, and thus can alert caregivers to changes in patient
status. The importance of the IPI, thus, lies not only in its absolute numeric number, but also in its relationship
to previous values, so that a graph can display an upward or downward trend in patient status and indicate to the
caregiver that attention or intervention may be required.
, RR, SpO2, and PR. Only these four parameters
2
Figure 27 - IPI Trend Graph
A technical note containing details regarding the IPI algorithm is available from Medtronic.
Since the index uses data from the monitoring of both CO2 and SpO2, it will only be available when both
parameters are available.
The range of the index is 1-10; index values should be understood as seen in the table below.
Index Range Patient Status
10 Normal
8-9 Within normal range
7 Close to normal range; requires attention
5-6
3-4 Requires intervention
1-2 Requires immediate intervention
Requires attention
and may require intervention
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Warnings
68
Portable Bedside Capnograph/Pulse Oximeter
Note: The interpretation of the patient's IPI score may change in different clinical environments. For
example, patients with specific respiratory difficulties (in contrast to normally healthy patients
who are being monitored during sedation or pain management) may require a lower IPI Low
Alert threshold to reflect their impaired respiratory capacity.
The IPI is available for all three groups of pediatric patients (1-3 years, 3-6 years, and 6-12 years), and for adult
patients. It is not available for Neonatal/Infant patients (patients up to the age of one year), and thus will not
appear on screens for Neonatal/Infant patients.
Warnings
WARNING: Ensure that the patient type is correctly selected before beginning monitoring of a patient.
Choosing an incorrect patient type could produce incorrect patient IPI data.
WARNING: When an IPI Low Alert is triggered for a patient, medical staff should review the patient's
status to determine if a change in medical care is required.
IPI Display
IPI appears on the Home screen and is available in all Capnostream™20p functions as a default option, along
with other patient parameters such as etCO
provided for IPI.
The IPI option may be disabled from the Institutional Defaults screen; see below for more information. In the
Neonatal measurement mode, the IPI option is automatically disabled.
or SpO2. On the Home screen, both numerics and a trend graph are
2
IPI Options
TO CHANGE IPI OPTION SETTINGS:
1. On the Home screen, click the SYSTEM button in the menu bar at the bottom of the screen.
2. The System Setup screen will appear. Move the control knob to the parameter that you wish to change and
click to select that parameter. Move the control knob to select the desired setting and click to select the
setting. A list of the IPI settings that can be changed appears in Table 13 - Adjustable IPI Options, below.
3. Move the control knob to the HOME button and click to select. The screen will also revert to the Home
screen after a few seconds if no additional actions are taken on that screen.
4. If the IPI Alert is disabled, it will not appear in the Home screen or in any other screen. It will be listed but
grayed out in the Alarm Limits screen.
5. The changes in the parameters will remain in effect until the device is turned off.
Table 13 - Adjustable IPI Options
Parameter Choices Factory Default
Home IPI Display 1 hour, 2 hour, 4 hour 1 hour
IPI Alert Enabled/Disabled Disabled
To change IPI Display and Alert options on a more permanent basis, use the Institutional Defaults option,
described in Institutional Defaults on page 131. The Home IPI Display settings can be changed in the
Institutional Defaults: Trend screen and the IPI Low Alert (enabled or disabled) can be changed in the
Institutional Defaults: Monitor screen. IPI Low Alert Alarm Limits can be changed in the Institutional
Defaults:Alarm Limits:Set Adult/Pediatric screen.
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Portable Bedside Capnograph/Pulse Oximeter
69
Do not touch this field - it is invisible and does not appear in the
Chapter 8
Apneas per Hour and the Oxygen Desaturation Index
final document
Introduction
Apneas per Hour
Oxygen Desaturation Index (ODI)
Apnea and O2 Desaturation Report
Monitoring with A/hr and ODI
Smart A/hr and ODI Home Screen Display
A/hr and ODI Option
A/hr and ODI Demo Mode
Introduction
The Apneas per Hour (A/hr) and Oxygen Desaturation Index (ODI) algorithm is part of the Smart Capnography
family of innovative algorithms developed by Medtronic. Smart Capnography simplifies the use of CO
™
monitoring on Microstream
enabled products, to improve patient safety and clinical workflow.
A/hr and ODI are not available in all locations. In order to equip your device with these algorithms, contact
Capnographyinfo@covidien.com.
A/hr and ODI provide an easy way to help with the identification and quantification of apnea and oxygen
desaturation events during a patient’s hospital stay.
A/hr and ODI report apnea and oxygen desaturation events and calculates the associated Apnea per Hour (A/hr)
and Oxygen Desaturation Index (ODI). By using A/hr and ODI, clinicians are able to recognize ventilation and
oxygenation abnormalities while patients are being monitored during their hospital stay with
Capnostream™20p. A/hr and ODI are for adult patients only (age 22 and older).
A/hr and ODI are displayed in real time on the home screen and on an easy-to-read Apnea and O
screen, which is available for printed reports and in file format exported to a USB flash drive.
2
Desat Report
2
Apneas per Hour
An apnea is a period of time during which breathing stops or is greatly reduced. The Apnea per Hour (A/hr)
calculated by the Capnostream™20p monitor as seen on the Home screen provides a count of the number of
pauses of at least 10 seconds in breathing the patient experienced over the past hour.
On the Apnea and O
2, 4, 8 and 12 hours. On that screen, the number of apnea events of ≥10 seconds; 10-19 seconds; 20-30 seconds;
and >30 seconds over the selected time period are also shown.
This A/hr value is used to help indicate to the caregiver the regularity of the patient’s breathing.
The Capnostream™20p Apneas per Hour
In the Capnostream™20p device, apnea per hour is a count of the number of times in an hour that breathing
ceased for ten seconds or more. Since this is a per-hour count, dashed lines will appear on the screen until one
hour has commenced since the beginning of monitoring.
A/hr is currently available for adult patients only and is intended for patients age 22 and older. It is not available
for infants (age 0-1) or for patients under age 22.
Desat Report screen, A/hr is the average Apneas per Hour over the selected time period of
2
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Oxygen Desaturation Index (ODI)
70
Portable Bedside Capnograph/Pulse Oximeter
A/hr Visual Alert
The A/hr Visual Alert, which appears as an asterisk next to the A/hr value, is used to indicate to the caregiver
that the apnea count in any one hour period during the last 12 hours exceeded a set number. (The default value
which will trigger an A/hr Visual Alert is 10.) The asterisk will appear only when an A/hr Visual Alert is
triggered, and it is updated once every 10 minutes. The Visual Alert on the screen indicates to the caregiver that
the Apnea and O2 Desat screen should be viewed to learn more about the patient’s breathing patterns. To change
the value which will trigger an A/hr Visual Alert, see Adjustable CO2 Parameters on page 58.
Oxygen Desaturation Index (ODI)
The Oxygen Desaturation Index (ODI) indicates the “dips” in SpO2 – that is, the number of times that the SpO2
value dropped 4% or more from baseline and returned to baseline in 240 seconds or less. (This refers to percent
of oxygen saturation, not percent of the patient’s current SpO
and stable (in the range of ± 1 SpO
point (%)) SpO2 value is detected over a 20-second period. This baseline,
2
updated once a second, will be the rounded maximum SpO
established based upon the definition above, then the previous baseline is kept.
On the Home screen, the ODI for the previous hour is shown. A lower ODI (that is, fewer such instances)
indicates more stability of the patient’s oxygen saturation. Since this index is a per-hour count, dashed lines will
appear on the screen until one hour has commenced since the beginning of monitoring.
On the Apnea and O
Desat Report screen, ODI is average per hour “dips” in SpO2 over the selected time period
2
of 2, 4, 8 and 12 hours.
ODI is currently available for adult patients only and is intended for patients age 22 and older. It is not available
for infants (age 0-1) or for patients under age 22.
rate). The baseline is created when a consistent
2
over these 20 seconds. If a valid baseline cannot be
2
Apnea and O2 Desaturation Report
The on-screen and printed Apnea and Desat reports show a comprehensive picture of the number of A/hr and
ODI events over a set time period of 2, 4, 8, or 12 hours. These reports provide both details regarding the A/hr
and ODI status of the patient and a general picture which can help the caregiver spot patient trends in these
areas. For more information on this report, see Apnea and O2 Desaturation Report on page 97.
Monitoring with A/hr and ODI
When monitoring patients with A/hr and ODI, please take the following issues into consideration:
CAUTION: Please note that A/hr and ODI do not report hypopnea events.
CAUTION: Apnea per Hour (A/hr) and Oxygen Desaturation Index (ODI) do not represent and should
not be interpreted as an apnea hypopnea index (AHI) as reported by formal
polysomnography studies.
CAUTION: Apnea per Hour (A/hr) and Oxygen Desaturation Index (ODI) do not represent and should
not be used to diagnose sleep disordered breathing.
CAUTION: Alarms and a noisy environment may affect A/hr and ODI values. See the Note regarding
recommendations on changing device settings for a sleeping patient below.
CAUTION: A/hr and ODI are reported by the monitor throughout the monitoring period; however, the
monitor cannot discern if the patient is actually sleeping. Also, if a patient removes a
sensor, the monitor may indicate apneas when no such apneas took place.
CAUTION: The administration of opioid analgesia and sedatives may cause respiratory depression,
which will result in transient apnea and O2 desaturation events that will be reflected in A/hr
and ODI values.
CAUTION: Please read all user information to ensure complete understanding of A/hr.
CAUTION: ODI values may be affected by the algorithms employed by the pulse oximetry module.
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Smart A/hr and ODI Home Screen Display
Portable Bedside Capnograph/Pulse Oximeter
71
Note: Please note that the patient type is used to calculate the A/hr and ODI. For this reason, it is
important to choose the patient type correctly. For the same reason, changing the patient type
(from adult to pediatric, for example) will clear the A/hr and ODI data stored for the current
patient. A/hr and ODI headings will not appear for infant/neonatal or pediatric patients.
Note: No A/hr or ODI data will appear on the Home screen for the first hour of monitoring, since A/hr
and ODI indicate the number of events over the last hour. Once one hour of monitoring has
passed, they will appear on the Home screen.
Note: When using the Capnostream™20p A/hr and ODI with a sleeping patient, it is recommended
that the Capnostream™20p device be attached to a central monitoring station where alarms
will be heard. Once this is done, the alarm sound on the Capnostream™20p at the patient’s
bedside can be disabled, so as not to disturb the patient’s sleep. The audible alarms are
silenced through SYSTEM>SERVICE>Service password (see Capnostream™ Service
Password on page 151>INST DEFAULTS>MONITOR. In the list of options on this screen,
change the AUDIO ALARM VOLUME to AUDIO OFF. This should only be done if the
Capnostream™20p is under constant surveillance via connection to a central station (or
another means of surveillance), so that patient alarms are noted by caregivers while the alarm
sound is turned off on the bedside Capnostream™20p device.
Smart A/hr and ODI Home Screen Display
A/hr and ODI appear on the Home screen and are available in all Capnostream™20p functions as a default
option, along with other patient parameters such as EtCO
The A/hr and ODI option may be disabled from the SYSTEM screen or from the Institutional Defaults screen;
see below for more information. For Infant/Neonatal and Pediatric patients, the Smart A/hr and ODI option is
automatically disabled.
or SpO2.
2
A/hr and ODI Option
TO CHANGE A/HR AND ODI OPTION SETTINGS:
1. On the Home screen, click the SYSTEM button in the menu bar at the bottom of the screen.
2. The System Setup screen will appear. Change A/hr, ODI DISPLAY to ENABLED or DISABLED as
desired.
3. Move the control knob to the HOME button and click to select. The screen will also revert to the Home
screen after a few seconds if no additional actions are taken on that screen.
4. The changes in the A/hr and ODI display will remain in effect until the device is turned off.
To change the A/hr and ODI option on a more permanent basis, use the Institutional Defaults option, described
in Institutional Defaults on page 131.
A/hr and ODI Demo Mode
To view the A/hr and ODI display without connecting a patient, you may set the monitor to Demo Mode by
clicking System>Service>Enter Service Password>Demo Mode. (For the Service Password, see
Capnostream™ Service Password on page 151.)
Page 74
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Portable Bedside Capnograph/Pulse Oximeter
73
Alarms and Messages
Do not touch this field - it is invisible and does not appear in the
final document
Introduction
Alarm Display
Message Priorities
Alarm Delay
Types of Alarms
Parameter Standby Mode
Alarm Silence
Changing Alarm Limits
Testing Alarm Settings
SpO
Alarms and SatSeconds
2
Alarm Limits - Factory Defaults
Chapter 9
Introduction
Capnostream™20p triggers alarms related to patient condition as well as equipment errors. Alarms alert the
health care provider that the patient’s condition is beyond predefined limits, or indicate a malfunction or
operating condition of the monitor hardware.
The monitor contains four levels of alarms and advisories, each defined by a set of audible and/or visual
indications:
• High Priority Alarms
• Medium Priority Alarms
• Advisories
• Silent Advisories
High Priority Alarms are provided with the option of setting red urgent alarms for each alarm issue, as well as
the possibility of setting yellow caution alarms for each alarm issue, if desired, in order to permit the clinician to
follow developing alarm situations.
The following table describes how the alarms are indicated.
Table 14 - Alarm Indications
Alarm Type
High Priority
(Patient) Alarms
(red high priority
patient urgent
alarms
High Priority
(Patient) NO
BREATH Alarm
Yellow caution
alarms
Audible Numerics Messages Indicator Light
Repeated Beep
Pattern
Repeated Beep
Pattern
None Flashing Yellow Message area Flashing Yellow
Flashing Red
(except NO
BREATH)
Numeric reverts to
zero (0)
Indicators
Message area Flashing Red
Message area (with
indication of time
elapsed since NO
BREATH) and in
waveform area
Flashing Red
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Alarm Display
74
Portable Bedside Capnograph/Pulse Oximeter
Alarm Type
Medium Priority Repeated triple
Advisories Single Beep N/A Message area N/A
Silent Advisories None N/A Message area N/A
Audible Numerics Messages Indicator Light
N/A Message area
beep
Indicators
Lit Yellow
(some messages
also in waveform
area – see below)
Some messages are displayed in the waveform area as well as in the message area; these messages are:
CO
Waveform Area Messages:
2
• FILTERLINE BLOCKAGE
• PERFORMING AUTO ZERO
• CLEARING FILTER LINE
• CO
ERROR
2
• CO2 STANDBY
• FILTERLINE DISCONNECTED
Waveform Area Messages (when there is an SpO2 waveform area instead of IPI information):
SpO
2
• SpO
SENSOR NOT ON PATIENT
2
• SpO2 STANDBY
• SpO2 SENSOR DISCONNECTED
• SPO2 ERROR
• SpO2 SENSOR ERROR
• PULSE NOT FOUND
Alarm Display
In order to view the visual alarm indicators, the intended position of the operator is in front of the monitor
display screen. The intended position of the operator in order to hear audible signals is any position near the
monitor (in a 360° range).
Alarm occurrences are prominently displayed in the real-time numeric section of all screens by the flashing of
the numeric and a change of color of the numeric background: the background of the numeric will flash red if
the value crosses the high priority patient (urgent) alarm limit threshold and flash yellow if the value crosses the
caution alarm limit threshold. (The latter is relevant only if caution alarm limits, which are optional, have been
enabled.)
Alarm occurrences are also displayed on all screens in the header area, in order to provide immediate input on
alarms to the health care provider. The preference of alarm display in the header area is described in Message
Priorities on page 76.
In addition, the message "NO BREATH" and "FILTERLINE BLOCKED" appear in the CO
well as in the header if this alarm condition exists. If the numeric home screen option is displayed (so that there
is no waveform area), this message will appear only in the header area.
Likewise, the message "SpO
SENSOR NOT ON PATIENT" appears in the SpO2 waveform area as well as in
2
the header if this alarm condition exists. If the IPI option is enabled or the numeric home screen is displayed, (so
that there is no waveform area), this message will appear only in the header area.
The alarm occurrences for a specific patient over a specific period of time can be reviewed in the trend screen
(see Chapter 10 Using Trends on page 87 for more details). Capnostream™20p also provides an Alarm Review
screen which displays the absolute number of each type of alarm generated over the last hour for the patient
waveform area as
2
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Alarm Display
Portable Bedside Capnograph/Pulse Oximeter
75
currently being monitored. The Alarm Review screen is seen in Figure 28 – Capnostream™20p Alarm Review
Screen, below.
This screen enables the health care provider to see at a glance how many alarms have been generated over the
last hour by the patient, in order to assess patient status. It is reached by clicking the ALARMS soft button on
the menu bar, from the Home screen or the Trend screens.
Figure 28 – Capnostream™20p Alarm Review Screen
The Alarm Review screen covers the following alarms:
• No Breath Alarm
• EtCO2 High and Low Alarms
• Respiration Rate High and Low Alarms
• SpO2 High and Low Alarms
• Pulse Rate High and Low Alarms
• IPI Low Alert
The order in which the parameters appear in this screen can be changed from the Institutional Defaults screen
(once a change is made, it will affect both this screen and the trend screens). See Changing Parameters Order on
the Trend Display on page 135 for more information.
The Alarm Review screen displays the absolute number of alarms that occurred in the last hour. Each type of
alarm is indicated by a horizontal bar of a different color, sized to represent the quantity of alarms. The number
of alarms appears to the right of the bar. The thin red vertical lines seen on the bar indicates the point at which a
change in alarm limits occurred.
All alarms displayed are based on the high priority patient (urgent) alarm limit set on the device. For example, if
the etCO
High alarm limit is set at 60, a level of 60 will be shown on the Alarm Review screen for etCO2 High,
2
to the left of the upper white bar. If the alarm limit has been changed, the current limit will appear, but the
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Message Priorities
76
Portable Bedside Capnograph/Pulse Oximeter
number of alarms will reflect the limit in place when that alarm occurred, thereby accurately representing the
number of alarms that occurred under each different alarm limit.
The Alarm Review screen will be cleared if the monitor is turned off or if the trend memory is cleared.
The Alarm Review screen will display alarms for the past hour, if the monitor has been running for an hour or
more. If the monitor has been running for less than an hour, the screen will display data from the time the
monitor was turned on. If the trend memory was cleared, data from the time the trend memory was cleared will
be shown.
Message Priorities
Alarms and advisory messages are displayed in the header area of the monitor in order of priority. When there is
an alarm, only the alarm messages will appear in the message area, and advisory messages will not appear until
the alarm condition is cleared. For example, if there is a RR HIGH ALARM, this alarm message will appear in
the message area, and the advisory message SPO
though the condition exists to generate this message.
If more than one alarm condition exists, the monitor will display each alarm message for about 4 seconds and
continue to repeat the messages in turn until the alarm conditions are cleared. For example, the RR HIGH
ALARM and SpO
LOW ALARM messages will alternate in the message area.
2
If no alarm condition exists but more than one advisory message condition exists, the advisory messages will
each appear for four seconds as described above. The advisory messages will continue to appear until the
condition clears or an alarm condition occurs and the alarm message is displayed instead of the advisory
message.
WEAK. REPOSITION SENSOR. will not appear even
2
Alarm Delay
Capnostream™20p provides the option to delay alarms (both the audible alarm and the alarm indicator on the
screen) by a number of seconds. If this option is used, the alarm signal (audio or visual) will only appear if the
alarm condition continues to be present past the delay time which has been set.
EtCO
, RR and PR High Alarms and SpO2 and PR Low Alarms can be delayed by 10, 15, 20, or 30 seconds, or
2
not at all (Alarm Delay disabled). The default option is Alarm Delay disabled. This option is available for all
patient types.
The Alarm Delay can be set from the Institutional Defaults screen, which can be reached by
SYSTEM>SERVICE>Input Service Password>INST DEFAULTS>ALARM LIMITS>SET ALARM
DELAY.
Types of Alarms
High priority patient alarms (urgent) indicate that the particular parameter has exceeded the set limit. A default
alarm limit is provided for each alarm situation. Alarm limits can be changed to fit the particular institution, if
desired.
In addition, Capnostream™20p provides the possibility to set a caution alarm for patient alarms at a lower value
level than that set for the standard high priority patient (urgent) alarm, to provide information for caregivers and
allow the caregiver to address a developing situation before it is critical. By default these caution alarms are
disabled. If they are enabled, a limit which is between the high priority alarm limit and the normal (healthy)
level is provided for each alarm situation and may be set to provide a caution alarm. To enable these caution
alarms, see Changing Alarm Limits on page 83.
The associated numeric on the display will blink yellow if the numeric has reached the caution alarm limit or
red if it has reached the high priority patient (urgent) alarm limit. Also, the red alarm LED and yellow caution
alarm LED will light appropriately. If a user does not wish to use this caution alarm on any particular alarm, he
can set both the high priority patient (urgent) alarm and caution alarm for that alarm to the same limits (see
Page 79
Types of Alarms
Portable Bedside Capnograph/Pulse Oximeter
77
Changing Alarm Limits on page 83). Then only the high priority patient (urgent) alarm will occur. You can also
revert to a single level system for all alarms by pressing the button for Caution Disable.
All recording and digital reporting of patient alarms involves both the high priority patient (urgent) alarms and
the caution alarms.
In addition, medium priority alarms, which alert the clinician to device issues (as opposed to patient issues,
which are covered by high priority alarms and caution alarms), are also provided.
The following is an example for illustration purposes only, showing how the red high priority patient (urgent)
alarm and the yellow caution alarm appear on the monitor.
Figure 29 - Example Showing Alarms
In the above example, RR has exceeded the RR HIGH alarm limit. The RR reading will flash red, the red arrow
pointing up indicates that the upper limit has been exceeded, and the message RR HIGH ALARM appears in the
message area at the top of the screen. In addition, the IPI value is below the IPI Low Alert alarm limit, indicated
by the IPI value flashing red, and the red arrow pointing down. The message IPI LOW ALARM will also appear
on the screen header (alternately with RR HIGH ALARM).
The yellow background on the SpO
value together with the yellow arrow pointing down indicates that the SpO2
2
LOW caution alarm level has been exceeded.
High Priority Alarms
Table 15 - High Priority Alarms
Message Description Corrective Action
NO BREATH XXX SECONDS No valid breath has been
detected for xxx seconds
ETCO2 HIGH ALARM The etCO2 is above the upper
alarm limit
ETCO2 LOW ALARM The etCO2 is below the lower
alarm limit
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
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Types of Alarms
78
Portable Bedside Capnograph/Pulse Oximeter
alarm limit
medical attention.
Message Description Corrective Action
RR HIGH ALARM The RR is above the upper
alarm limit
RR LOW ALARM The RR is below the lower alarm
limit
SPO2 HIGH ALARM The SpO2 is above the upper
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
Patient requires immediate
SPO2 LOW ALARM The SpO2 is below the lower
alarm limit
PULSE RATE HIGH ALARM The pulse rate is above the
upper alarm limit
PULSE RATE LOW ALARM The pulse rate is below the
lower alarm limit
FiCO2 HIGH ALARM
The FiCO
is above the upper
2
alarm limit
IPI LOW ALARM*
The IPI is below the lower alarm
limit.
SYSTEM RESET, CHECK
SETTINGS
The system has reset and will
revert to institutional default
settings.
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
Patient requires immediate
medical attention.
Reset your alarm limits and
other settings to match the
requirements of the patient
being monitored.
* The IPI LOW ALARM is an alert which is intended to indicate a change in patient status to the physician.
When this alert appears, levels of other patient parameters should be evaluated.
Medium Priority Alarms
Table 16 - Medium Priority Alarms
Message Description Corrective Action
CO2 ERROR Failure has occurred which
prohibits the operation of the CO
function.
SPO2 ERROR Failure has occurred which
prohibits the operation of the
function.
SpO
2
SpO2 SENSOR ERROR The SpO2 sensor connected to
the device is not functioning.
PULSE NOT FOUND No detectable pulse. Patient requires immediate medical
FILTERLINE
DISCONNECTED
SPO2 SENSOR
DISCONNECTED
SPO2 SENSOR NOT ON
No FilterLine™ is connected to
the device.
No SpO2 sensor is connected to
the device.
Sensor is off patient. Place sensor properly on patient.
PATIENT
REPLACE SpO2 CABLE The SpO2 cable is defective. Replace the SpO2 cable.
FILTERLINE BLOCKAGE FilterLine™ is kinked or clogged. Disconnect and reconnect the
Contact Medtronic authorized
personnel.
2
Contact Medtronic authorized
personnel.
Contact Medtronic authorized
personnel.
attention. Reposition sensor on
patient.
Will occur only when Parameter
Standby is enabled.
Insert FilterLine™ into CO2 port on
device.
Will occur only when Parameter
Standby is enabled.
Insert SpO2 sensor into SpO2 port on
device.
FilterLine™. Check the airway
adapter and if necessary, replace
the FilterLine™.
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Types of Alarms
Portable Bedside Capnograph/Pulse Oximeter
79
Advisories
Message Description Corrective Action
BATTERY LOW Battery charge level is low and
monitor will shut down soon.
REMOTE SYSTEM
DISCONNECTED
Capnostream™20p is no longer
connected to a remote system.
This message will only be present
if enabled by the host computer,
and may have different wording if
so programmed by the host
computer.
Table 17 - Advisories
Connect monitor to AC power.
Check connection with remote
system
Message Description
CLEARING FILTERLINE FilterLine™ kinked or clogged with water. Appears
during clearing time until FilterLine™ is unclogged,
or a blockage state is determined.
NO USB DEVICE FOUND A valid flash memory device is not connected to
the USB port.
USB FLASH FULL No room on the USB flash memory device.
USB TIME OUT USB communication stopped due to lack of
response from the USB device.
SPO2 WEAK. REPOSITION SENSOR.
SPO2 WEAK. TOO MUCH LIGHT.
SPO
WEAK. TRY EAR SENSOR.
2
SPO
WEAK. TRY NASAL SENSOR.
2
SPO
WEAK. TRY ADHESIVE SENSOR
2
SPO
WEAK. TRY USING HEADBAND
2
SPO
WEAK. SENSOR TOO COLD.
2
SPO
WEAK. CHECK BANDAGE.
2
SPO
WEAK. NAIL POLISH?
2
SPO
WEAK. SENSOR TOO TIGHT?
2
SPO
WEAK DUE TO INTERFERENCE.
2
SPO2 WEAK. CLEAN SENSOR SITE.
SpO2 module detects a weak pulse and suggests
possible causes.
Silent Advisories
Message Description
CO2 WARM UP CO2 module is preparing for operation.
CO2 READY Before the first measurement of CO2, after the FilterLine™ is
CALIBRATION REQUIRED CO2 calibration is overdue.
MAINTENANCE REQUIRED CO2 maintenance is overdue.
PERFORMING AUTOZERO The monitor automatically performs a zeropoint calibration.
USB DATA TRANSFER IN
PROGRESS
RS-232 DATA TRANSFER IN
PROGRESS*
USB DATA TRANSFER ABORTED USB data communication has been stopped.
Table 18 - Silent Advisories
connected and before patient breath is detected, CO
replaces the CO
WARM-UP message.
2
USB data communication in progress.
RS-232 data communication in progress.
READY
2
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Parameter Standby Mode
80
Portable Bedside Capnograph/Pulse Oximeter
Message Description
RS-232 DATA TRANSFER
ABORTED
USB DEVICE FAILED A USB device connected to the monitor has failed.
REPORT TRANSFER COMPLETE Data communication is complete.
CO2 MONITORING HAS BEEN
OFF FOR HH:MM
DEMO MODE - PRERECORDED
DATA
SPO2 LOW ALARM LIMIT: XX Displayed if the SpO2 Low alarm limit is set below 85%.
REMOTE SYSTEM CONNECTED* Capnostream™20p is connected to a remote system. This
REMOTE SYSTEM
DISCONNECTED*
INCOMPATIBLE SOFTWARE
VERSION
NO FILE FOUND Displayed during transfer of institutional defaults
A/hr REQUIRES 1 HOUR OF
DATA (if available)
ODI REQUIRES 1 HOUR OF DATA
(if available)
CO2 STANDBY CO2 standby has been activated.
SPO2 STANDBY SpO2 standby has been activated.
NO BATTERY INSTALLED No battery is installed in the device
RS-232 data communication has been stopped.
Displays the hours and minutes the pump has been turned off
during PUMP OFF mode.
Displayed during demo mode when no other message is
displayed.
message will only be present if enabled by the host computer,
and may have different wording if so programmed by the host
computer.
Capnostream™20p is no longer connected to a remote system.
This message will only be present if enabled by the host
computer, and may have different wording if so programmed by
the host computer.
Displayed during transfer of institutional defaults
A/hr does not appear, since one hour of data is required to
compute this value, and one full hour of data is not yet available
ODI does not appear, since one hour of data is required to
compute this value, and one full hour of data is not yet available
* When used with a remote system, this message may be displayed with a different wording if so programmed by
the host computer. The host computer may also initiate a message which would appear upon the stopping of
communications.
Parameter Standby Mode
There is an option of placing the monitor in a separate parameter standby mode for capnography and for pulse
oximetry. Once in this mode, the user can activate Parameter Standby as required. The purpose of this option is
to enable a situation in which the device will alarm when a sampling line/sensor is disconnected from the
device, but permit the user to turn off this option at will.
The options are as follows:
Page 83
Parameter Standby Mode
Portable Bedside Capnograph/Pulse Oximeter
81
Default
:
Standard
Monitoring
Activate Parameter
Standby for pulse
oximetry; During
SpO2 sensor
disconnect from
device or patient,
on-screen message
only
Do not activate
Parameter Standby
for pulse oximetry:
During SpO2 sensor
disconnect from
device or patient,
audible alarm and
on-screen message
ACTION 1
In Institutional Defaults
ACTION 2
Activate by 2-sec press
of Alarm Silence Key at
monitor front
Enable Parameter
Standby
Activate Parameter
Standby for
capnography
;
During CO2
sampling line
disconnect, on-
screen message
only
Do not activate
Parameter Standby
for capnography
:
During CO2
sampling line
disconnect, audible
alarm and on-
screen message
Continue standard monitoring:
During
CO2 sampling line or SpO2 sensor
disconnect, on-screen message only
and during SpO2 sensor disconnect
from patient, audible medium priority
alarm and on-screen message
In Standard Mode (when Parameter Standby Mode is not enabled), removing a FilterLine™ or SpO
sensor/extension cable from the device will cause a message to appear on the screen (FILTERLINE
DISCONNECTED or SpO
the SpO2 sensor from patient will set off an audible alarm and an on-screen message. By default, Parameter
Standby mode is disabled.
When Parameter Standby Mode is enabled, after a FilterLine™ has been connected and then removed from the
device, a medium priority alarm FILTERLINE DISCONNECTED will sound. Likewise, after a pulse oximetry
sensor/extension cable has been connected and then disconnected from the device, a medium priority alarm
SPO
SENSOR DISCONNECTED will sound. The purpose of this alarm is to prevent unauthorized
2
disconnection of a FilterLine™/SpO
When Parameter Standby Mode is enabled, removing the SpO2 sensor from patient will set off an audible alarm
and an on-screen message, as it does in Standard Mode.
Parameter Standby mode can be enabled by entering SYSTEM>SERVICE>Enter Service password>INST
DEFAULTS>MONITOR>Turn PARAMETER STANDBY MODE to ENABLED. Return to the Home screen
by clicking BACK>BACK>HOME.
However, there may be situations in which the clinician wants to use the Parameter Standby Mode but does not
want these alarms to sound, for either a disconnected FilterLine™ or an SpO
authorized the disconnection. For these situations, the monitor provides an option to put one or both parameters
on standby while these activities take place.
Once Parameter Standby mode is enabled under institutional defaults, it can be made active as follows:
1. Remove the FilterLine™ and/or SpO
Note: The capnography parameter standby mode can be made active only if the FilterLine™
Disconnected alarm is currently alarming, or if a FilterLine™ has not yet been connected to
the device, since the time that it was turned on. Likewise, the pulse oximeter parameter
standby mode can be accessed only if the SpO2 Sensor Disconnected alarm or the SpO2
Sensor Not on Patient alarm is currently alarming, or if an SpO2 sensor has not yet been
connected to the device or sensed a pulse, since the time it was turned on.
Note: The capnography parameter standby mode cannot be activated if the monitor is currently
2. To activate Parameter Standby Mode, press the alarm silence button at the bottom of the front panel ( )
monitoring a patient with capnography. Likewise, the pulse oximeter parameter standby mode
cannot be activated if the monitor is currently monitoring a patient with pulse oximetry.
for 2 seconds or longer. A new message CO
appear in the waveform area (if the waveform area is available) and in the message area. (This is in addition
2
SENSOR DISCONNECTED, as relevant) but no alarms will sound. Removing
2
sensor from the device, perhaps by patients or patients’ visitors.
2
sensor, because they have
2
sensor from the device or remove the SpO2 sensor from the patient.
2
STANDBY and/or SPO2 STANDBY (as required) will now
2
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Parameter Standby Mode
82
Portable Bedside Capnograph/Pulse Oximeter
to the FILTERLINE DISCONNECTED or SPO2 SENSOR DISCONNECTED or SpO2 SENSOR NOT
ON PATIENT alarms, as relevant, which will continue to appear in the waveform and message areas.)
Note: A short press on the Alarm Silence button will still turn off the audible alarms temporarily (for 2
minutes), as previously.
3. Once parameter standby is activated, the following will take place: In this mode, CO2 and/or SpO2 alarms do
not exist, so neither audible alarms, the flashing yellow LED on the Capnostream™20p front panel, storage
of these alarms in any data storage method, nor transfer of these alarms to central stations, nurse call
indications, etc., will take place.
4. To access both parameter standby modes at the same time, enter them one at a time, or press the Alarm
Silence button ( ) while the FilterLine™ is disconnected and the SpO2 sensor is not connected to a
patient or device, to enter both at the same time.
To exit the capnography parameter standby mode, reattach a FilterLine™. To exit the pulse oximetry parameter
standby mode, reattach the SpO
is in the Parameter Standby mode, simply reattaching a FilterLine™ to the monitor or SpO
sensor to the patient and device. (Thus, if the user is unaware that the monitor
2
sensor to the patient
2
will cause the monitor to exit the Parameter Standby mode and monitoring to resume.)
Table 19 - Message and Alarm Status during Different Parameter Standby Situations
Feature
FilterLine™ disconnected
(from device) on-screen
message / SpO
disconnected (from device)
on-screen message
FilterLine™ disconnected
(from device) alarm / SpO
sensor disconnected (from
device) alarm
SpO2 Sensor not on Patient
Medium Priority audible alarm
SpO2 Sensor not on Patient
on-screen message
CO2 Standby message / SpO2
Standby message
High Priority (patient) alarms Yes Yes No (for the parameter in standby)
Flashing red and yellow LEDs
on the Capnostream™20p
front panel during high Priority
(patient) alarms
Storage or transfer to remote
stations of high priority
(patient) alarms
sensor
2
2
Status when
Parameter Standby
mode disabled
Yes Yes Yes
No Yes No
Yes Yes No
Yes Yes Yes
No No Yes
Yes Yes No, for the parameter in standby
Yes Yes No, for the parameter in standby
Status when
Parameter Standby
mode enabled but not
activated
Status when Parameter
Standby mode enabled and
Parameter Standby activated
(since high priority [patient]
alarms related to the parameter
in standby do not exist in this
case)
(since high priority [patient]
alarms related to the parameter
in standby do not exist in this
case)
Page 85
Alarm Silence
Portable Bedside Capnograph/Pulse Oximeter
83
Alarm Silence
To temporarily silence/disable an alarm, press the alarm silence button: .
When the alarm silence button is pressed, all audible alarms are silenced for 2 minutes. This includes both
alarms that were already sounding and also alarms that may occur during the 2-minute period. The 2-minute
alarm silence can be cancelled by a second press of the alarm silence button.
Visual alarms are still present. While the alarm silence period is active, a bell with crossed dashed lines through
it ( ) is displayed on the screen. A crossed bell with solid lines symbol ( ) is shown if audio alarms are
permanently disabled in the institutional settings.
If permanent alarm silence has been set in the Institutional Defaults (by clicking SYSTEM>SERVICE>Input
Service password>INST DEFAULTS>AUDIO ALARM VOLUME >AUDIO OFF, see Changing
Institutional Defaults on page 131), this alarm silence button ( ) does not set temporary alarm silence.
Instead, while permanent alarm silence has been set in the Institutional Defaults, this button does not affect
alarm silence; it will emit a wrong-key beep when pressed. When permanent alarm silence is set, the bell icon (
) will flash periodically.
WARNING: Do not silence the audible alarms until you verify that the patient is being monitored by
other means.
Changing Alarm Limits
Alarm limits differ for Adult/Pediatric (for adults and all pediatric patients) and Infant/Neonatal patients. Each
set of alarms is set separately.
Alarm limits can be changed for high priority patient alarms (urgent alarms) and caution alarms on the Alarm
Limits screen. The Alarm Limits screen is accessed from the Alarm Review screen. On the Alarm Limits
screen, the caution alarms can be enabled or disabled. (If caution alarms are disabled, the values in the Caution
Alarm column will be grayed out.) The limits can also be reset to Institutional Default settings, using the
DEFAULT RESET button on the screen.
Note: In high-altitude environments, EtCO2 values may be lower than values observed at sea level,
as described by Dalton's law of partial pressures. When using the monitor in high-altitude
environments, it is advisable to consider adjusting EtCO2 alarm settings accordingly.
Page 86
Changing Alarm Limits
84
Portable Bedside Capnograph/Pulse Oximeter
Figure 30 - Alarm Limits Screen
TO CHANGE ALARM LIMITS:
1. Open the Alarm Limits screen by selecting the ALARM LIMITS button on the Menu bar at the bottom of the
Alarm Review screen.
2. To modify a setting, scroll to the individual limit setting using the control knob. Click the control knob to
select that setting, and then turn the control knob to select a new value. Click the control knob again to set
the new value.
3. To enable caution alarms, click the CAUTION ENABLE button on the screen, using the control knob. The
caution alarm limit values will now become active, and can be changed on this screen in the same manner as
high priority patient (urgent) alarm limits can be changed. The CAUTION ENABLE button will show
CAUTION DISABLE when the caution alarms are enabled, and clicking the CAUTION DISABLE button
will disable the caution alarms.
4. Use the control knob to select HOME and click the control knob again to return to the Home screen.
Changing the high alarm limit towards the low alarm limit will force the low alarm limit down if necessary, in
order to maintain a difference of at least 5 units between high and low alarm limits. This type of adjustment
causes the low alarm limit to also change in color to make it obvious that it is active. Similarly, if you change
the low alarm limit towards the high alarm limit, the high alarm limit is forced up if necessary, in order to
maintain a difference of at least 5 units between high and low alarm limits. This type of adjustment causes the
high alarm limit to also change in color to make it obvious that it is active.
The alarm will go off if it exceeds the High Limit value or goes below the Low Limit, not if it only reaches the
value.
Alarm limits will reset to their factory default when the power is turned off. To make the changes permanent,
use the Service Mode to change the Institutional Settings for the alarm limits (see Institutional Defaults on
page 131).
Note: A potential hazard may exist if different alarm pre-sets are used for the same or different
equipment in any single area.
Note: When the SpO2 alarm limit is set below 85%, a message reading SpO2 LOW ALARM LIMIT:
xx will appear in the header area, indicating the level of the SPO2 LOW alarm limit.
Page 87
Testing Alarm Settings
Portable Bedside Capnograph/Pulse Oximeter
85
Testing Alarm Settings
In order to test the NO BREATH alarm, establish a display of normal breathing on the device. Once normal
breathing is displayed, remove the sampling line from the patient's mouth to create a no breath situation. The
device should then display a NO BREATH alarm.
In order to test the pulse oximetry SENSOR NOT ON PATIENT alarm, establish a display of SpO
the Monitor. Once SpO
values are displayed, remove the sensor from the test subject to create a SENSOR
2
values on
2
NOT ON PATIENT situation. The monitor should then display a SENSOR NOT ON PATIENT alarm.
SpO2 Alarms and SatSeconds
Capnostream™20p uses the Nellcor™ SatSeconds technology to help reduce the number and frequency of false
alarms. The technology works with the SpO2 red urgent alarm limits and not with the yellow caution
SpO
2
limits.
When monitoring upper and lower alarm limits of oxygen saturation, an audible alarm is triggered when one of
these limits is violated by as little as one percentage point. In traditional alarm management, whenever the
%SpO
If such frequent alarms are not desired, they can be prevented by using the SatSeconds technique developed by
Nellcor™. Using this technique, upper and lower alarm limits are set in the same way they are set in traditional
alarm management. A SatSeconds limit can also be set, in order to sound an alarm while taking into account not
only the crossing of the %SpO
below the limit.
The method of calculation is as follows:
SatSeconds is calculated by multiplying the number of percentage points that the %SpO
limit by the number of seconds that the %SpO
equation:
Where:
Points = %SpO
The alarm response time, assuming a SatSeconds limit set at 50 and the SpO
described and illustrated below.
In this example, the %SpO2 level drops to 88 (2 points) and remains there for a period of 2 seconds
(2 points x 2 seconds = 4 SatSeconds).
The %SpO
The resulting SatSeconds are:
%SpO2 Seconds SatSeconds
2 x 2 = 4
4 x 3 = 12
6 x 6 = 36
Total SatSeconds = 52
level crosses the alarm limit, the alarm sounds every time the limit is exceeded.
2
alarm limit, but also the time for which the patient's %SpO2 reading is above or
2
level remains outside that limit. This can be stated as an
2
Points x Seconds = SatSeconds
percentage points outside of the limit
2
Seconds = number of seconds the %SpO
remains at that point outside of the limit.
2
LOW alarm limit set at 90, is
2
then drops to 86 for 3 seconds and then to 84 for 6 seconds.
2
falls outside of alarm
2
Page 88
Alarm Limits - Factory Defaults
86
Portable Bedside Capnograph/Pulse Oximeter
After approximately 10.9 seconds the SpO2 alarm would sound, because 50 SatSeconds had been exceeded
(note the arrow in the figure below).
Saturation levels may fluctuate rather than remain steady for a period of several seconds. Often, the %SpO
levels may fluctuate above and below the alarm limit, re-entering the non-alarm range several times.
During such fluctuations, the Capnostream™20p integrates the number of %SpO2 points, both positive and
negative, until either the SatSeconds limit (SatSeconds time setting) is reached, or the %SpO
level returns to
2
within a normal range and remains there.
2
SatSeconds Alarm Display
SatSeconds are displayed in the SpO2 display area on the monitor screen. When SatSeconds is enabled and the
reading is below the minimum, the SatSeconds counter will begin. If the SatSeconds limit is been reached,
SpO
2
an audible alarm sounds and the displayed %SpO
the audible alarm may be silenced by pressing the ALARM SILENCE button ( ).
numeric rate flashes. As with standard alarm management,
2
Alarm Limits - Factory Defaults
The factory defaults for the Adult and Neonatal alarm limits are given in Table 32 - Factory Default
Alarm/Indicator Limits on page 134.
Caution Alarms are disabled by default.
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Portable Bedside Capnograph/Pulse Oximeter
87
Using Trends
Do not touch this field - it is invisible and does not appear in the
final document
Introduction
The Trend Display Screens
Graphical Trend Display Screen
Tabular Trend Display Screen
Choosing Trend Parameters
Important Notes Regarding Trend Reports
Specific Events as seen in Trend Data
Using the Graphical Trend Screen for Monitoring Patients
Printing the Trend Data
Clearing Trend Memory
Configuring Trends
Chapter 10
Introduction
Capnostream™20p stores patient data that provides detailed information on the history of the patient during
monitoring.
The trend displays allow you to look at the patient history as part of the medical analysis to aid in patient
assessment.
The institution can define the trend storage to be: 12 hours of data at 5 seconds resolution, 24 hours of data at
10 seconds resolution, or 72 hours of data at a resolution of 30 seconds. Once trend contents reach maximum
capacity, new data will overwrite the data recorded at the beginning of the stored trend data.
The trend data stores the following parameters:
• Time, Date, EtCO
, RR, SpO2, PR, IPI (where relevant)
2
• High priority red urgent alarms and yellow caution alarms
• Equipment-caused events such as CLEARING FILTERLINE or other monitor-related
messages.
• Event markers input by the user, along with any event label.
• CASE START marker to indicate start of case
• Count of alarm occurrences (for all High Priority red urgent and yellow caution alarms)
Please note that A/hr and ODI (even if available) do not appear on the Trend screens or printouts. A/hr and ODI
are recorded, and can be viewed, on the Apnea and O2 Desaturation Report screen and printout. For more
details, see Apnea and O2 Desaturation Report on page 97.
Note: Download of trend information to a USB device before shutdown or before ending a patient
case is strongly recommended to ensure backup of the trend data.
Changing the resolution of how often data is stored can be done in the Institutional Defaults screen only (See
Institutional Defaults on page 131).
Note: Changing the resolution setting will clear the trend data previously stored in memory.
The trend data can be viewed on the monitor, printed, and downloaded via an RS-232 connection or a USB
flash memory device for transfer to a computer for further analysis. If you want to reference this data at a later
date, it is recommended to download the trend data before shutdown of the monitor, to ensure backup.
Page 90
The Trend Display Screens
88
Portable Bedside Capnograph/Pulse Oximeter
Time and date
of cursor
Patient data at
Event
If the patient will be monitored for a longer period than can be stored in the monitor memory, it is
recommended to regularly download patient data using the USB interface as described in Chapter 12
Downloading Patient Data on page 107.
The Trend Display Screens
Trend data is displayed in two different formats; graphical and tabular. The Graphical Trend screen allows you
to view the patient data over a longer time scale (2, 4 or 12 hours at a time) and scroll through the data looking
for patterns, specific events or alarms.
Once you have located the data of interest, you can zoom in to the specific event, or examine the messages and
data using the Tabular Trend screen. Tabular Trend presents the data in an easy to read table format.
In order to change the order of the displayed parameters on the Trend screens, see Changing Parameters Order
on the Trend Display on page 135.
Graphical Trend Display Screen
TO VIEW THE GRAPHICAL TREND DISPLAY SCREEN:
1. From the Home screen, use the control knob to select TREND from the soft buttons in the menu bar at the
bottom of the screen. The Graphical Trend screen, seen in Figure 31 - Graphical Trend Display, below, is
shown.
location
Zoom level
cursor location
indicator
2. Please note that the Trend screens display both Trend information (described below) and real time patient
numerics, which are displayed on the right-hand side of the screen. The Trend data displayed is historic data
from the trend memory. When the screen is first opened, it shows the cursor line in the middle of the
graphical display, which is the middle point of the displayed data. Data regarding the patient at the point in
time indicated by the cursor is displayed at left. Details regarding the graphical trend display appear in the
next section.
Yellow cursor
line
Real time
patient
data
Figure 31 - Graphical Trend Display
Page 91
Graphical Trend Display Screen
Portable Bedside Capnograph/Pulse Oximeter
89
Graphical Trend Display
In the center of the screen are the graphic trend displays. The upper two graphs show historic trend capnography
data: etCO
historic trend pulse oximetry data: SpO
values in an orange-colored graph.
On the left-hand side of the screen is the historic patient data at the date and time where the cursor is located.
The exact recorded date and time of the cursor location are displayed.
in white and respiration rate values in blue. Similarly, the two middle graphs show the patient's
2
data in pink and pulse rate values in green. The bottom graph shows IPI
2
• Zoom level: Can be set to 2, 4 or 12 hours using the ZOOM key
• Yellow cursor line: The vertical yellow line extends through all four graphs and is movable with
the control knob when the SCROLL option is selected. The cursor line shows the current location
in the trend data, with the exact date and time listed under the CURSOR LOCATION heading
near the top left of the screen as shown in Figure 31 - Graphical Trend Display on page 88.
• Alarm indicator: wide vertical red lines (for red urgent alarms) and yellow lines (for yellow
caution alarms) that may appear in the four graphs showing where in time an alarm occurred.
For EtCO
waveform for that parameter. In the case of NO BREATH alarms, the red line extends though
both the etCO
display screen, described in Tabular Trend Display Screen seen on page 91.
, SpO2, RR, and PR alarms, the red line is drawn through the respective graph of the
2
and RR graphs. The actual alarm details can be viewed in the Tabular Trend
2
• Event indicator: the small vertical pink line along the bottom of the graph shows when an event
was registered. The actual event can be viewed in the Tabular trend display screen, described in
Tabular Trend Display Screen on page 91.
The following controls for viewing graphical trend are selected from the Menu Bar.
• TABULAR – switches the display from Graphical to Tabular display (in the Tabular trend
display, this control changes the display to Graphical). See Tabular Trend Display Screen on
page 91 for an explanation of the tabular trend display.
• SCROLL – allows you to scroll through the patient data. The date and time of the cursor
location are indicated under CURSOR LOCATION.
• ZOOM – allows you to increase or decrease the time segment being looked at.
• PRINT TREND – provides a printout of the trend display currently seen on the screen.
• ALARM LIMITS – displays the Alarm Limits screen allowing you to see what the settings are,
and modify them if necessary.
Using SCROLL and ZOOM
There are many ways in which the Trend screens can be used to examine patient data. The following is a brief
overview of a general method of searching for and displaying specific events in the graphical Trend screen.
O VIEW TREND DATA IN SCROLL MODE:
T
1. In the graphical trend mode, use the control knob to select SCROLL from the Menu Bar. The box around
the word SCROLL in the Menu Bar and the time/date heading both turn yellow, indicating that you are in
scrolling mode.
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Graphical Trend Display Screen
90
Portable Bedside Capnograph/Pulse Oximeter
Figure 32 - Scroll mode in the Graphical Trend
2. When you scroll to the end of the screen and continue to scroll, the screen will change to add the next or
previous 1/2 time period to the display (for example, if you are viewing a 2-hour display, from 4 PM to
6 PM, and you scroll backward to reach 4 PM, the yellow line will return to the middle of the screen and you
will see 3 PM to 5 PM instead on the screen). Scrolling all the way to the right and getting a beep means you
are at the current time. Scrolling all the way to the left and getting a beep means that you are at the beginning
of the recorded data.
3. To see a longer or shorter time period on the display, select ZOOM on the Menu Bar and turn the control
knob to change the resolution to 2, 4 or 12 hours. The box on the Menu Bar around ZOOM turns yellow to
indicate that you are changing the zoom level. Click the control knob again to exit the Zoom function. You
can then return to Scroll mode to continue inspecting the patient's recorded data.
To see the greatest amounts of patient data, change the resolution to 12 hours. To do this, use the control
knob to select and click on ZOOM on the Menu Bar. The box around ZOOM will turn from blue to yellow
and the title area showing the display resolution will also turn yellow. Turn the control knob to select 12 HR
DISPLAY, and then click the control knob.
Now use the control knob to select and click on SCROLL on the Menu Bar. The box around SCROLL will
turn from blue to yellow, and the time and date heading under CURSOR LOCATION will also turn yellow.
Turn the control knob to move the cursor to the left or right. As you turn the control knob, the time changes,
and the patient data on the left-hand side of the screen also changes to show the readings at that point in
time.
To find an event or alarm occurrence, scroll the graphic display to look for event and alarm markers as
shown above in Figure 31 - Graphical Trend Display on page 88. Place the yellow cursor line on the red
alarm marker, then exit the scroll mode by clicking the control knob. When you zoom to a different time
display, the cursor will appear in the middle of the graphical screen at the appropriate time that it marked on
the previous screen.
Use the ZOOM button to select a Zoom option (i.e., to go to lower zoom level, 4, 2, or 1 hours) and scroll
again until you have found your specific area of interest.
To exit from Zoom change mode, click the control knob.
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Tabular Trend Display Screen
Portable Bedside Capnograph/Pulse Oximeter
91
4. To exit from Scroll mode, click the control knob.
To view more information about the displayed patient, use the control knob to select the TABULAR trend
display on the Menu Bar, and see the instructions below in the section Tabular Trend Display Screen on
page 91.
Tabular Trend Display Screen
TO VIEW THE TABULAR TREND DISPLAY SCREEN:
1. In the graphical trend mode, use the control knob to select TABULAR from the Menu Bar. The Tabular
Trend display screen will appear. To enter the Tabular Trend mode from the Home screen, click TREND on
the Menu bar and then TABULAR on the Menu bar.
2. Note that the real time patient data is displayed on the right-hand side of the screen, while the left side of the
screen displays the Tabular Trend with detailed historic patient data.
3. Click ZOOM on the Menu bar to change the time resolution from the current display to 60, 15, 3 or 1.5
minutes or the MINIMUM setting. The MINIMUM setting is defined as the trend recording resolution and
can be 5, 10 or 30 seconds (see Institutional Defaults on page 131 for instructions on how to change the
recording resolution).
The controls for viewing tabular data are:
• GRAPHICAL – switches the display from to Graphical from Tabular display (in the Graphical
trend display, this changes to Tabular)
• SCROLL – allows you to scroll through the table of patient data.
• ZOOM – allows you to increase or decrease how much time is averaged into each data point
shown in the table. At the lowest setting, the zoom allows you to examine detailed alarms and
events.
• PRINT TREND – provides a printout of the trend display currently seen on the screen.
Figure 33 - Tabular Trend Display
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Tabular Trend Display Screen
92
Portable Bedside Capnograph/Pulse Oximeter
40
48
16
98
71 7 5*
15
29
20
100
71
8
• ALARM LIMITS – displays the Alarm Limits screen to allow you to see what the settings are,
and change them if necessary.
The table below gives a sample of the tabular display at a resolution of 1.5 minutes.
Table 20 - Tabular Display Example
TIME EtCO
12:23 AM May 23 10
10 41 17 98 71 9 2*
12:24 AM May 23 10
12:26 AM May 23 10
10 49 16 98 70 7 1 21*
12:27 AM May 23 10
40 35 17 98 71 7 22*
12:29 AM May 23 10
10 29 16 98 71 8 1 22*
12:30 AM May 23 10
Events are indicated by a triangle (similar to the event button located on the front panel of the monitor) and
alarms are indicated by an asterisk. The number beside each indicates how many alarms or events occurred
during that time period.
4. To see the specific events and alarms, change the ZOOM setting to the MINIMUM value, which changes the
zoom level to the lowest time interval. Specific events and high priority red urgent and yellow caution
alarms will now appear in the table and you can use the Scroll option to scroll up and down the table. The
table below gives a sample of the tabular display at the MINIMUM resolution (in this case the minimum
resolution is set at 5 seconds).
mmHg
2
RR
bpm
SpO2
%
PR
bpm
IPI EVENTS
Table 21 - Detailed Tabular Display Example
TIME
sec
3:23 AM May 23 10
05 29 22 99 74 8 PROPOFOL
10 29 20 99 73 8
20 27 16 92 66 4
25 26 14 88 64 4
30 26 14 88 65 4
35 26 14 88 65 4
40 26 14 88 65 4
45 26 14 88 65 4
50 26 14 88 65 4
EtCO
mmHg
2
RR
bpm
SpO2
%
PR
bpm
IPI EVENTS
In the above example, oxygen was given to the patient during the period between 3:23:05 and 3:23:10 AM
followed by a rise in respiration rate to a level that triggered the high value alarm. This is indicated by the
red up arrow. Similarly, a low respiration rate alarm would have a red down arrow.
If the Event Marking Mode is set to QUICK, no text information is available at the lowest zoom level, but
a triangle will still appear to indicate that an event was marked.
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Choosing Trend Parameters
Portable Bedside Capnograph/Pulse Oximeter
93
5. The monitor will hold up to 72 hours of patient data. If there is more data than you can see on the screen,
then scrolling up will change to display earlier data (if you scroll up) or later data (if you scroll down).
Choosing Trend Parameters
The device displays the following trend parameters: EtCO2, RR, SpO2, PR, and IPI. The desired order of the
parameters can be set by the user using the Trend: Display Configuration screen (see Changing Parameters
Order on the Trend Display on page 135 for details). If you do not want to view these parameters in Trend
Reports, choose the BLANK option for some slots in the Trend: Display Configuration screen.
Important Notes Regarding Trend Reports
Please note the following issues regarding trend reports, including on-screen tabular trend reports, printed trend
reports, and downloaded trend reports:
• Each number displayed in the trend memory is an average of the results for each second over
the sampling period. For example, for a 30-second sampling period, the displayed result each
30 seconds is an average of the data points for each of the 30 seconds within the sampling
period.
• If an alarm took place anywhere in the sampling period (i.e., at some point during the
30 seconds of a 30-second time period, when data is being recorded every 30 seconds) it will be
noted, even if the averaged number recorded does not indicate a cause for an alarm.
• • “EtCO2 not available” is generated every time the device performs self-maintenance and takes
approximately 10 seconds. This occurs after 1 hour of use and thereafter approximately every
12 hours or after an ambient pressure or temperature change. When this occurs, EtCO2 and
other physiological values are held at their values prior to the self-maintenance.
This process allows the module to adjust itself to changes in ambient temperature and pressure.
Specific Events as seen in Trend Data
TO SEARCH FOR SPECIFIC EVENTS IN TREND DATA:
1. Use the cursor in the graphical trend screen to locate an area of interest.
2. Use ZOOM to get as close as possible to the specific area.
3. Switch to the Tabular trend display.
4. Use SCROLL to find the area of interest.
5. Zoom to minimum resolution to see detailed alarm and event information.
Using the Graphical Trend Screen for Monitoring Patients
It is possible to use the Graphical Trend screen as the main monitoring screen, rather than the Home screen.
Instead of seeing the real time waveforms, the Graphical Trend gives you the ability to easily track changes in
the patient's condition. The real time numeric data is shown on the right-hand side of the screen for both the
Trend and Home screens.
When using the Graphical Trend screen as the main monitoring screen, it is important to ensure that the graphs
are updated with the latest data. This will happen automatically as long as the Scroll function has not been used
since you entered the Graphical Trend screen. While in automatic update mode, the screen will automatically
update new data to the right of the yellow cursor line. When the area to the right of the cursor is filled, the
graphs will shift, allowing more data points to be plotted.
If you use the Scroll feature and then want to return to using the Graphical Trend to monitor the patient, simply
go to the Home screen and then select TREND again.
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Printing the Trend Data
94
Portable Bedside Capnograph/Pulse Oximeter
Printing the Trend Data
If the optional printer is installed, you can obtain a printout of the trend data that is displayed on the screen by
selecting PRINT TREND in the Menu Bar.
Clearing Trend Memory
It is recommended to erase trend memory when the monitor is switched to a new patient, in order to avoid
mistaking the earlier data for the present patient's data. If you are working with cases, and the current case is
ended, the trend memory is automatically cleared.
Note: Download of trend information to a USB device before shutdown or before ending a patient
case is strongly recommended to ensure backup of the trend data.
TO ERASE TREND MEMORY:
1. To erase the trend data from the monitor memory, use the control knob to go to the Home screen and select
SYSTEM on the menu.
2. On the System screen, select CLEAR TREND. The word CONFIRM? will appear just above the Menu Bar.
3. If you are certain that you want to erase the trend memory, click the control knob. If you do not want to
erase the trend memory, turn the knob to the left or right to cancel.
4. When the machine is turned on, a message appears, suggesting that you erase the trend memory in order to
start a new patient without information from previous patients in the trend memory. This screen appears in
Figure 34 - Trend Memory Message, below. Click YES to erase the trend memory. If you intend to continue
measurement of the same patient as previously, you may want to retain the trend memory. In that case, click
NO. If you record patient data as part of a case, trend memory will always be erased when you close the
case.
Figure 34 - Trend Memory Message
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Configuring Trends
Portable Bedside Capnograph/Pulse Oximeter
95
Configuring Trends
To change the parameters for trend displays, go to the Home screen and select SYSTEM to see the System
Setup screen. The table below shows the options as they appear on the System Setup screen.
Table 22 - Monitor Parameters
DATE MAY 25, 2011
TIME 11:27:32 AM
LANGUAGE ENGLISH
EVENT MARKING MODE DETAILED
TREND GRAPHICAL DISPLAY [hour] 4 hour
TREND INCREMENT DISPLAY [min] 1.5 min
NURSE CALL DISABLED
HOME SCREEN STANDARD
HOME IPI DISPLAY (hour) 1 hour
IPI ALARM DISABLED
The Trend Data parameters are Event Marking Mode, Trend Graphical Display and Trend Increment Display.
The Trend Display settings refer to how the screen will be initially be displayed when you enter the Trend
mode. Once you are on the Trend screen, these views can be easily changed using the Zoom feature. These
settings will remain until the monitor is powered off.
Changing the resolution of how often data is stored can be done in the Institutional Defaults screen only (See
Institutional Defaults on page 131).
Event Marking Mode
• Detailed Event Marking: When the Event button is pushed, you can enter a specific description
of the event from a table of 30 user definable values (see the section Entering Patient Events on
page 47).
• Quick Event Marking: Marks that an event occurred when the Event button is pushed, but does
not give any details.
If the monitor is set to Detailed event marking mode, but you don't have time to enter the detailed event, a
quick event mark can be entered by pushing the Event button twice.
Trend Graphical Display
Trend Graphical Display options are 2, 4 and 12 hours. The factory default is 4 hours.
Trend Increment Display
Trend Increment Display options for the Tabular Trend Display are MINIMUM, 1.5, 3, 15 or 60 minutes. The
factory default is 1.5 minutes. The MINIMUM setting is defined as the trend recording resolution and can be 5,
10 or 30 seconds (see Changing Institutional Defaults on page 131 for instructions on how to change the
recording resolution).
Changing the resolution of how often data is stored can be done in the Institutional Defaults screen only (See
Institutional Defaults on page 131).
Page 98
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Portable Bedside Capnograph/Pulse Oximeter
97
Chapter 11
Reports
Do not touch this field - it is invisible and does not appear in the
final document
Apnea and O2 Desaturation Report
Printed Report Options
Printed Reports
Sample Reports
When the user clicks on the REPORTS button on the Home screen, the Apnea and O2 Desat (Desaturation)
Report will appear on the screen. See Apnea and O2 Desaturation Report, below for more information. To print
other patient reports, click on the PRINT REPORT button on the Apnea and O
Desat Report screen. For more
2
information, see Printed Reports on page 101.
If A/hr and ODI display is not available or disabled (either in Institutional Defaults or in the System Setup
screen), or if the Patient Type is set to Infant/Neonatal or one of the Pediatric patient types, the REPORTS
button will not appear. Instead, clicking the PRINT button on the Home screen will open the Print screen. For
more information, see Printed Reports on page 101.
Apnea and O2 Desaturation Report
The on-screen and printed Apnea and Desat reports show a comprehensive picture of the number of apnea and
O
desaturation events over a set time period of 2, 4, 8, or 12 hours. They show the average A/hr and ODI score
2
for the whole period as well as listing the number of events during each part of the set time period, with the
apnea events listed by the number of seconds each event lasted. The sum of events in each row over the entire
time period (2, 4, 8, or 12 hours, as chosen by the user) is also shown. These reports provide both details
regarding the A/hr and ODI status of the patient and a general picture which can help the caregiver spot patient
trends in these areas.
This report is available only for adult patients, since A/hr and ODI are available only for adult patients.
In situations in which part of the information for the set period is missing (for example, SpO
during a particular half hour during the 12 hours seen on the screen, so ODI could not be measured for that half
hour) the relevant time section will be shaded in grey, to indicate the presence of missing data. If the first hour
of monitoring has not yet been completed, the relevant time section on this screen will also be shaded in grey
(since A/hr and ODI are per-hour indicators, they cannot be calculated and thus cannot be displayed if less than
one hour of data is available).
Note: This report is updated every 60 seconds. Since the A/hr and ODI numerics on the Home
screen are updated once a second, there may be a slight temporary discrepancy between the
numerics on the two screens from time to time.
Note: The recommended use for this screen is that it be viewed when the caregiver wants to know
more about the patient’s apnea and O2 desaturation events, or when an indicator on the
Home screen indicates that the report should be viewed. While the report is being displayed
on the monitor screen, the display is not updated, so it is best not to continually view this
report on the monitor, but to continuously view the Home screen while monitoring a patient.
The EtCO2, FiCO2, RR, SpO2, and PR numerics are all updated continuously on all screens,
including the A/hr and O2 Desat Report screen.
The Apnea and O2 Desat Report screen is reached with the REPORTS button on the menu on the Home screen.
The Print Report seen on the Print Report screen may be printed from the Apnea and O
with the built-in Capnostream™20p printer (using the START PRINTER button), or saved to a USB flash
memory drive (using the START USB button).
was not measured
2
Desat Report screen
2
Page 100
Apnea and O2 Desaturation Report
98
Portable Bedside Capnograph/Pulse Oximeter
Soft buttons on the Apnea and O2 Desat Report screen are as follows:
• TREND – to graphical trend screen
• PRINT – brings user to the standard print screen
• ZOOM – changes the time period viewed on the screen to another option. Options are 2, 4, and 12
hours.
• SCROLL – moves the cursor across the screen so that different time intervals can be viewed
• PRINT REPORT – brings user to the Apnea and O
The information provided in the Apnea and O
Desat Report saved to a USB flash memory drive is as follows:
2
Desat Report: Print Report screen.
2
Report Name Description Fields Included
Apnea and O2 Desat
Report
Tab delimited file with the suffix
.txt. Reports A/hr and ODI data
and all trend data for the previous
2, 4, 8, or 12 hours (depending on
selected ZOOM level).
DATE, TIME, CASE ID, Patient type, ZOOM selected
Apnea Count and Desat Count for each of the time periods
on the report, summation of Apnea count and Desat Count
for the entire period, and average A/hr and ODI scores
Patient Readings: EtCO2, RR, SpO2, PR, IPI
Patient Urgent Alarm Occurrences: EtCO2 HIGH, EtCO2
LOW, RR HIGH, RR LOW, NO BREATH, SpO
LOW, PR HIGH, PR LOW, IPI LOW
SpO
2
Equipment Advisory Message Occurrences:
Events: EVENT 1, EVENT 2, EVENT 3
The printed Apnea and O2 Desat Report includes the following information:
HIGH,
2
Report Name Description Fields Included
Apnea and O2 Desat
Report
A/hr and ODI data along with
patient readings (as seen in trend
report) and graphical trend data.
Report with show data for the
previous 2, 4, 8, or 12 hours
(depending on selected ZOOM
level).
DATE, TIME, CASE ID, Patient type, ZOOM selected,
summation of Apnea count and Desat Count for the entire
period, average A/hr and ODI scores for the period, and
Apnea Count and Desat Count for each of the time periods
on the report.
Patient Readings: EtCO2, RR, SpO2, PR, IPI
Patient Graphical Trend graphs: EtCO2, RR, SpO2, PR, IPI
An example of the printed Apnea and O2 Desat Report appears in Figure 36 - Apnea and Desat Printed Report
on page 100.
An example of the Apnea and O
Desat Report screen is seen in Figure 35 - Apnea and Desat Report Screen on
2
page 99.
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