Mindray Trio Operating Instructions Manual

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Operating Instructions

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0070-01-0628-02_revD_Trio ops color.indd 1 3/10/10 5:37:08 PM

Operating Instructions

Trio™ is a U.S. trademark of Mindray DS USA, Inc.

Navigator

™

Masimo SET

Nellcor

and OxiMax® are U.S. registered trademarks of Nellcor Puritan Bennett Inc.

SatSeconds

is a U.S. trademark of Mindray DS USA, Inc.

is a U.S. registered trademark of Masimo Corp.

™

is a U.S. trademark of Nellcor Puritan Bennett Inc.

0070-10-0666-01 Trio™ Operations Manual

Table of Contents

Foreword....................................................................................................................................................... v

Warnings, Precautions And Notes ....................................................................................................................v

Warnings ......................................................................................................................................................vi

Precautions ....................................................................................................................................................vii

Notes............................................................................................................................................................xi

Indication For Use........................................................................................................................................... xi

Unpacking ..................................................................................................................................................... xi

Symbols.........................................................................................................................................................xii

General Product Description.............................................................................................. 1 - 1

Front Panel..................................................................................................................................................... 1 - 3

Front Panel Keypad ................................................................................................................................. 1 - 4

Display................................................................................................................................................... 1 - 6

Left Side Panel................................................................................................................................................ 1 - 10

Right Side Panel ............................................................................................................................................. 1 - 11

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

Operations ....................................................................................................................... 2 - 1

Getting Started ............................................................................................................................................... 2 - 1

Setting-up Patients.................................................................................................................................... 2 - 1

Setting the Clock (Date and Time).............................................................................................................. 2 - 2

Menus ........................................................................................................................................................... 2 - 2

System Menu.................................................................................................................................................. 2 - 3

Patient Setup........................................................................................................................................... 2 - 3

List Trend................................................................................................................................................ 2 - 5

Graphic Trend ........................................................................................................................................ 2 - 5

Mark Event ............................................................................................................................................. 2 - 6

Monitor Setup ......................................................................................................................................... 2 - 6

Maintenance........................................................................................................................................... 2 - 13

Normal Screen........................................................................................................................................ 2 - 13

Parameter Menus............................................................................................................................................ 2 - 14

Electrocardiogram (ECG) Monitoring ......................................................................................................... 2 - 14

Respiration Monitoring............................................................................................................................. 2 - 29

Monitoring .................................................................................................................................... 2 - 32

SpO

NIBP Monitoring...................................................................................................................................... 2 - 44

Temperature Monitoring ........................................................................................................................... 2 - 53

IBP Monitoring (Optional)......................................................................................................................... 2 - 56

Alarms........................................................................................................................................................... 2 - 63

Alarm Categories .................................................................................................................................... 2 - 63

Alarm Priorities........................................................................................................................................ 2 - 64

Alarm Setup Menus ................................................................................................................................. 2 - 64

Alarm Troubleshooting ............................................................................................................................. 2 - 75

Trends ........................................................................................................................................................... 2 - 76

Graphic Trend ........................................................................................................................................ 2 - 76

List Trend................................................................................................................................................ 2 - 79

Recorder (Optional) ........................................................................................................................................ 2 - 82

Print Functions......................................................................................................................................... 2 - 82

Recorder Troubleshooting ......................................................................................................................... 2 - 86

Defaults............................................................................................................................ 3 - 1

Default Configurations..................................................................................................................................... 3 - 1

Factory Default Configuration.................................................................................................................... 3 - 1

User Default Configuration........................................................................................................................ 3 - 6

Current Configuration .............................................................................................................................. 3 - 6

Non-Volatile Configuration ....................................................................................................................... 3 - 7

Trio™ Operating Instructions 0070-10-0666-01 i

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Table of Contents

User Maintenance............................................................................................................. 4 - 1

Introduction.................................................................................................................................................... 4 - 1

Decontamination of the Monitor........................................................................................................................ 4 - 2

Care and Cleaning of the Monitor .................................................................................................................... 4 - 2

Care and Cleaning of Accessories.................................................................................................................... 4 - 3

SpO

Sensors ......................................................................................................................................... 4 - 3

Blood Pressure Cuffs ................................................................................................................................ 4 - 4

Temperature Sensor Cleaning and Disinfection (Reusable).................................................................................... 4 - 6

Battery Replacement and Maintenance .............................................................................................................. 4 - 6

Recorder Maintenance .................................................................................................................................... 4 - 7

Recorder Paper Replacement .................................................................................................................... 4 - 8

Care and Storage of Thermal Paper.................................................................................................................. 4 - 9

Care and Cleaning of ECG Cables and Leadwires ............................................................................................. 4 - 9

Accessories ....................................................................................................................... 5 - 1

Optional Accessories ...................................................................................................................................... 5 - 1

NIBP Accessories..................................................................................................................................... 5 - 1

Oximetry Sensors and Accessories............................................................................................................. 5 - 3

Reusable Temperature Probes.................................................................................................................... 5 - 4

Disposable Temperature Probes................................................................................................................. 5 - 4

ECG Accessories..................................................................................................................................... 5 - 4

IBP Accessories ....................................................................................................................................... 5 - 5

Miscellaneous Accessories........................................................................................................................ 5 - 5

Mounting Kits and Accessories.................................................................................................................. 5 - 6

Replacement Parts, Trio Rolling Stand......................................................................................................... 5 - 6

Appendix ......................................................................................................................... 6 - 1

Specifications................................................................................................................................................. 6 - 1

Safety Standards ..................................................................................................................................... 6 - 1

Safety Designations ................................................................................................................................. 6 - 2

Performance / Accuracy .......................................................................................................................... 6 - 3

Environmental / EMC .............................................................................................................................. 6 - 4

United States Food and Drug Administration Documents............................................................................... 6 - 4

Patient Parameter Specifications ....................................................................................................................... 6 - 5

ECG ...................................................................................................................................................... 6 - 5

ECG Performance Requirements ................................................................................................................ 6 - 5

ANSI/AAMI EC13-2002 Compliance........................................................................................................ 6 - 7

ECG Systole Detector and Heart Rate Meter ............................................................................................... 6 - 8

ECG Respiration Performance Requirements................................................................................................ 6 - 9

NIBP Sub-System Performance Characteristics ............................................................................................. 6 - 9

IBP Parameter Sub-System Performance Characteristics................................................................................. 6 - 12

IBP Safety Requirements............................................................................................................................ 6 - 12

Temperature Parameter Performance Characteristics .................................................................................... 6 - 13

Performance Requirements............................................................................................................... 6 - 13

SpO

Physical Specifications..................................................................................................................................... 6 - 17

Information Display and Control................................................................................................................ 6 - 17

LED Indicators ......................................................................................................................................... 6 - 17

Real Time Clock ...................................................................................................................................... 6 - 18

Input/Output Communications................................................................................................................... 6 - 18

Power Supply.......................................................................................................................................... 6 - 19

AC Mains Power Source .......................................................................................................................... 6 - 19

Battery Power.......................................................................................................................................... 6 - 19

Data Storage .......................................................................................................................................... 6 - 20

Printers................................................................................................................................................... 6 - 21

Physical Characteristics ............................................................................................................................ 6 - 21

ii 0070-10-0666-01 Trio™ Operating Instructions

Table of Contents

Environmental and Safety Characteristics.................................................................................................... 6 - 22

Warranty Statements....................................................................................................................................... 6 - 28

Phone Numbers and How To Get Assistance...................................................................................................... 6 - 29

Manufacturer’s Responsibility ........................................................................................................................... 6 - 29

Trio™ Operating Instructions 0070-10-0666-01 iii

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iv 0070-10-0666-01 Trio™ Operating Instructions

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Foreword Introduction

Foreword

The Trio Operating Instructions are intended to provide information for proper operation.

General knowledge of monitoring and an understanding of the features and the functions of the Trio Monitor are prerequisites for proper use.

Do not operate this monitor before reading these instructions.

Information for servicing this instrument is contained in the Trio Monitor Service Manual, (Part Number 0070-00-0627-03). For additional information or assistance, please contact a service representative in your area.

CAUTION: U.S. Federal Law restricts this device to sale by or on the

order of a physician or other practitioner licensed by U.S. state law to use or order the use of this device.

Patents: This device is covered under one (1) of more of the following U.S. patents and any foreign equivalents 4,621,643; 4,700,708; 4,770,179; 4,869,254; 4,653,498; 4,928,692; 4,934,372; 4,960,126; 5,078,136; 5,482,036; 5,490,505; 5,632,272; 5,685,299; 5,743,263; 5,758,644; 5,769,785; 6,157,850; 6,206,830; 4,802,486; 5,351,685; 5,421,329; 5,485,847; 5,533,507; 5,577,500; 5,803,910; 5,853,364; 5,865,736; 6,035,223; 6,263,222; 6,298,252; 6,463,310; 6,591,123; 6,675,031; 6,708,049; 6,801,797; 6,083,172 Re. 35,122. Possession or purchase of this device does not convey any express or implied license to use this device with replacement parts which would, alone, or in combination with this device, fall within the scope or one (1) or more of the patents related to this device.

Warnings, Precautions And Notes

Please read and adhere to all warnings, precautions and notes listed here and in the appropriate areas throughout this manual.

A WARNING is provided to alert the user to potential serious outcomes (death, injury, or serious adverse events) to the patient or the user.

A CAUTION is provided to alert the user to use special care necessary for the safe and effective use of the device. They may include actions to be taken to avoid effects on patients or users that may not be potentially life threatening or result in serious injury, but about which the user should be aware. Cautions are also provided to alert the user to adverse effects on this device of use or misuse and the care necessary to avoid such effects.

A NOTE is provided when additional general information is applicable.

Trio™ Operating Instructions 0070-10-0666-01 v

Introduction Warni ngs

Warnings

WARNING: Equipment not suitable for use in the presence of a

flammable anesthetic mixture with air or with oxygen or with nitrous oxide.

WARNING: The AC line cord and interface cables (i.e. non-patient

WARNING: Observe extreme caution when a defibrillator is used on a

WARNING: Route cables neatly. Ensure cables, hoses, and wires are

WARNING: This monitor is not intended for use in an MR environment.

WARNING: When using electrosurgery equipment, leads should be

WARNING: The Trio monitor is intended for hospital use under the direct

WARNING: Ensure that the conductive parts of ECG electrodes do not

WARNING: Pacemaker patients’ rate meters may continue to count the

cables) may utilize the same ground. Therefore, removal of the AC line cord does not necessarily isolate the Trio, if nonpatient interface cables are attached.

patient. Do not touch any part of patient, table or monitor when a defibrillator is in use.

away from patient’s neck to avoid strangulation. Keep floors and walkways free of cables to reduce risk to hospital personnel, patients and visitors.

placed equidistant from electrosurgery electrotome and the grounding plate to avoid cautery. Ensure that wires from electrosurgery equipment and ECG cables do not become tangled.

supervision of a licensed health care practitioner.

contact other conductive parts, including earth ground.

pacemaker rate during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms. Keep pacemaker patients under close surveillance. See Appendix section of this manual for disclosure of the pacemaker pulse rejection capability of this instrument.

WARNING: Do not clean the monitor or sensors while it is on and/or

connected to AC power.

WARNING: Ensure that the ECG lead wires are neatly secured in a

manner that will prevent them from encircling the patient’s neck, creating a strangulation hazard.

WARNING: Perform the decontamination process with the unit powered

down and power cord removed.

vi 0070-10-0666-01 Trio™ Operating Instructions

Precautions Introduction

Precautions

CAUTION: The use of portable and mobile RF communications

equipment, in the proximity of the Trio, can affect the performance of this monitor.

CAUTION: The use of unapproved accessories may diminish monitor

CAUTION: The Trio should not be used adjacent to or stacked with

CAUTION: Operation of the Trio below the minimum amplitude or

CAUTION: When using electrosurgery equipment, never place an

CAUTION: The patient size selection should be matched to the actual

CAUTION: To avoid possible damage to the Trio, use only approved

CAUTION: Line isolation transients may resemble actual cardiac

CAUTION: Use of accessories, transducers and cables other than those

performance.

other equipment. If adjacent or stacked use is necessary, the Trio should be observed to verify normal operation in the configuration in which it will be used.

value of PATIENT physiological signal may cause inaccurate results (see section 6.0, Appendix).

electrode near the grounding plate of the electrosurgery device. This may create interference with the ECG signal.

patient before monitoring begins.

ECG cables and approved accessories.

waveforms, thus inhibiting heart rate alarms. Check lead wires for damage and ensure good skin contact prior to and during use. Always use fresh electrodes and follow proper skin preparation techniques.

specified in the manual may result in increased Electromagnetic Emissions or decreased Electromagnetic Immunity of the Trio. It can also cause delayed recovery after the discharge of a cardiac defibrillator.

CAUTION: Thoracic respiration measurement may interfere with some

CAUTION: If a 3 Lead cable is used when a unit is set to 5 lead mode,

CAUTION: Do not place the SpO

CAUTION: Tissue damage or inaccurate measurement may be caused

CAUTION: Excessive ambient light may cause inaccurate

Trio™ Operating Instructions 0070-10-0666-01 vii

pacemakers. Refer to the pacemaker's manufacturer supplied manual.

no ECG signal will be obtained. If a 5 lead cable is used when the unit is set to 3 lead mode only Lead I, II and III are operable.

invasive catheter or blood pressure cuff in place.

by incorrect sensor application or use, such as wrapping too tightly, applying supplemental tape, failing to inspect the sensor site periodically or failing to position appropriately. Carefully read the sensor directions and all precautionary information before use.

measurements. In such cases, cover the sensor site with opaque material.

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sensor on an extremity with an

Introduction Precautions

CAUTION: Inaccurate SpO

measurements may be caused by:

• incorrect sensor application or use

• significant levels of dysfunctional hemoglobins, (e.g., carboxyhemoglobin or methemoglobin)

• intra-vascular dyes such as indocyanine green or methylene blue

• exposure to excessive illumination such as surgical lamps (especially ones with a xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps, or excessive ambient light. In such cases, cover the sensor site with opaque material.

• excessive patient movement

• venous pulsations

• electro-surgical interference

• placement of a sensor on an extremity that has a blood pressure cuff, arterial catheter or intra-vascular line.

• nail polish or fungus

CAUTION: In certain situations in which perfusion and signal strength

are low, such as in patients with thick or pigmented skin, inaccurately low SpO oxygenation should be made, especially in preterm infants

readings will result. Verification of

and patients with chronic lung disease, before instituting any therapy or intervention.

CAUTION: Many patients suffer from poor peripheral perfusion due to

hypothermia, hypovolemia, severe vasoconstriction, reduced cardiac output, etc. These symptoms may cause a loss in vital sign readings.

CAUTION: If the sensor or patient cable are damaged in any way,

discontinue use immediately. To prevent damage, do not soak or immerse the sensor in any liquid solution. Do not attempt to sterilize.

CAUTION: When equipped with Masimo SpO

oxygen sensors and cables. Use of other oxygen sensors

, use only Masimo

may cause improper oximeter performance.

CAUTION: When equipped with Nellcor SpO

sensors and cables. Use of other oxygen sensors may cause

, use only Nellcor oxygen

improper oximeter performance.

CAUTION: When using the Trio equipped with SpO

, use only

approved supplied oxygen transducers and Patient Cables. Use of other oxygen transducers may cause improper oximeter performance.

CAUTION: Use only approved blood pressure cuffs and hoses with the

Trio.

CAUTION: Please consult a physician for interpretation of blood

pressure measurements.

CAUTION: A blood pressure measurement can be affected by the

position of the patient, and his/her physiological condition as well as other factors, such as patient movement.

viii 0070-10-0666-01 Trio™ Operating Instructions

Precautions Introduction

CAUTION: A patient's skin is sometimes fragile (i.e. on pediatric and

CAUTION: Observe caution on all patients (Pediatrics and Adults) when

CAUTION: Any condition which may affect the regularity and strength

CAUTION: When cleaning sensors, do not use an excessive amount of

CAUTION: Do not subject the sensor to autoclaving.

geriatric patients or due to physiological conditions). In these cases, a longer time duration between measurements should be considered to decrease the number of cuff inflations over a period of time. In extreme cases, a thin layer of soft roll or cotton padding may be applied to the limb in order to cushion the skin when the cuff is inflated. This measure may affect NIBP performance and should be used with caution.

NIBP is set to the Continuous mode and the 1 minute Interval. When the NIBP “Continuous” interval is chosen, the Trio will continually take back to back blood pressure readings. As a safety precaution, a limit is placed on the Continuous mode to revert to an interval of every 5 minutes after 5 minutes of continuous readings.

of arterial pressures (such as patient movement, cardiac arrhythmias, restriction of hose, etc.), will affect the accuracy and ability to measure the NIBP.

liquid. Wipe the sensor surface with a soft cloth, dampened with a cleaning solution.

CAUTION: Do not use sensors or cables that are damaged or have

deteriorated.

CAUTION: Replace the battery with one of the following part numbers:

0146-00-0043 (for a sealed lead acid battery), 0146-00-0069 (for a Lithium Ion battery).

CAUTION: Remove the battery if the Trio is not likely to be used for an

extended period of time.

CAUTION: Remove the battery prior to shipping the Trio.

CAUTION: To avoid permanent damage, do not expose metal

components (pins, sockets, snaps) to disinfectants, soaps or chemicals.

CAUTION: The cuff must be properly applied to the patient's limb

before inflating. If it is inflated without being securely wrapped, damage to the cuff can result.

CAUTION: Only connect NIBP Luer fittings to Blood Pressure Cuff or

CAUTION: During the decontamination process, do not get the LpH SE

CAUTION: To ensure continued use of the Factory Defaults when the

Monitor.

Germicidal detergent into any vent openings.

unit is powered off and on, save the Factory Defaults as the User Default Configuration (see section 3.1.2).

Trio™ Operating Instructions 0070-10-0666-01 ix

Introduction Precautions

CAUTION: Prolonged and continuous monitoring may increase the risk

of skin erosion and pressure necrosis at the site of the sensor. Check the SpO proper positioning, alignment and skin integrity at least every eight (8) hours; with the Adult and Pediatric re-usable finger sensor, check every four (4) hours; for patients of poor perfusion or with skin sensitive to light, check every 2 - 3 hours; more frequent examinations may be required for different patients. Change the sensor site if signs of circulatory compromise occur.

sensor site frequently to ensure

x 0070-10-0666-01 Trio™ Operating Instructions

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Notes Introduction

Notes

NOTE: Potential hazards due to errors in software or hardware

have been minimized by actions taken in accordance with IEC 60601-1.

NOTE: Messages are provided to assist in the identification and

NOTE: Should the device become accidently saturated with any

NOTE: The comparison testing conducted via the auscultatory

NOTE: Only operate this device within the specified operating

correction of problems that may occur with the monitor.

liquid, immediately discontinue use and contact Customer Service.

method used both Phase 4 and Phase 5 Korotkoff sounds. Reports of study findings for both the auscultatory method as well as the intra-arterial methods are available by contacting Technical Support (201) 995-8116.

signal range.

Indication For Use

The Trio™ monitor is intended for use in healthcare settings under the direct supervision of a licensed healthcare practitioner. The intended use of the monitor is to monitor physiologic parameter data on adult and pediatric patients. Physiologic data includes: electrocardiogram, invasive blood pressure, non-invasive blood pressure (NIBP), pulse oximetry, heart rate (derived from ECG, SpO summarized in the operating instructions manual. The information can be displayed, stored, trended and printed.

The monitor is not intended for home use. The monitor is not intended to be an apnea monitor. It was not designed or validated for use as an apnea monitor.

, or NIBP), respiration and temperature as

Unpacking

Remove the instrument and accessories from the shipping cartons and examine them for signs of shipping damage. Save all packing materials, invoice and bill of lading. These may be required to process a claim with the carrier. Check all materials against the packing list. Contact your Sales Representative or Distributor for assistance in resolving shipping problems.

Trio™ Operating Instructions 0070-10-0666-01 xi

Introduction Symbols

Symbols

SYMBOL DESCRIPTION SYMBOL DESCRIPTION

Attention, Consult Accompanying Documents / Refer to Manual

Type BF Equipment

Dangerous Voltage

Equipotentiality

Alternating Current (AC) Alarm Off

ON/OFF (only for a part of the equipment)

Battery Charging Full Battery Indicator

Data Output Low Battery Indicator

Data Input/Output No Battery in Unit

Defibrillator Proof Type BF Equipment

Defibrillator Proof Type CF Equipment

Alarm Mute

NIBP Connection

A symbol designating compliance of the Trio monitor with the Medical Device Directive (MDD) 93/42/EEC, Class II b device.

xii 0070-10-0666-01 Trio™ Operating Instructions

Non-ionizing electromagnetic radiation

1.0

General Product Description

The Trio is a vital signs monitor intended for intra-hospital use on human patients. It is adaptable for use with adult and pediatric patients. The Trio is a three (3) to four (4) trace monitor. The unit has many features and functions, yet is easy to use through an integrated keypad, Navigator Panel Keypad for details.

™

Knob (see FIGURE 1-2) and an intuitive menu system. Refer to Front

The patient parameters that can be monitored with the Trio are: ECG (3-lead or 5-lead selectable), SpO

The Trio is equipped with an 8.4" Color High Resolution (800 x 600) TFT LCD. Digital displays are provided for Heart Rate, Pulse Rate, Pulse Oximetry (SpO2), Non-Invasive Blood Pressure (NIBP), Respiration Rate and Temperature (T1). Waveform displays are provided for ECG, Pleth and Respiration. An optional digital and waveform display for Invasive Blood Pressure (IBP) is available. The optional built-in thermal recorder provides hard copies of all digital data and waveforms, as well as Tabular and Graphic Trend information.

The Trio monitor can be mounted on a rolling stand, a wall mount bracket, a bed rail or operated as a tabletop device.

The Trio is powered by an AC connection or an optional internal battery.

NOTE: The Trio is suitable for use in the presence of the discharge

NOTE: The Trio is suitable for use in the presence of electrosurgery.

NOTE: The Trio may not meet performance specifications if stored

, Non-Invasive Blood Pressure, Respiration and Temperature.

of a defibrillator.

or used outside of the specified environmental conditions (see section 6.0).

Trio™ Operating Instructions 0070-10-0666-01 1 - 1

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General Product Description

Key Features

The Trio offers several new features that enhance the capabilities of the monitor. The main improvements of this release are as follows:

• Support for the full line of adult and pediatric NIBP Cuffs, see Section 5.

• Determination of heart rate from an NIBP measurement, see Section 2.

• An enhancement to SpO

monitoring that enables audible distinction of oxygen

saturation changes, see Section 2.

• A serial port that offers connectivity to various medical devices, see Section 1.

FEATURES STANDARD OPTIONAL

Display 8.4 inch color TFT LCD

4-trace erase bar refresh

ECG 3 or 5 Lead (I, II, III, aVR, aVL, aVF, V)

ECG Cascade

ESIS Capability (3 or 5 Lead) Blood Pressure Non-Invasive Blood Pressure SpO

Respiration Impedance Temperature One YSI 400 channel Trend Tabular and Graphic Trends up to 24 hours* Power Internal isolated power module Sealed lead acid battery or

Printing Two-trace recorder Communication Ethernet,

Other Handle with bedrail hook Wall mount and rolling stand

* When the monitor is powered OFF, the tabular and graphic trend data is maintained for 2 hours. If the

monitor remains OFF for more than 2 hours, the tabular and graphic trend data is deleted.

** Model number 0998-00-0600-4XXXX only

Masimo SET® SpO

Serial Communication Port (DIAP),**

Analog Output

Navigator

Dedicated keys

™

Knob

Nellcor® OxiMax® SpO

Lithium Ion battery

kits

1 - 2 0070-10-0666-01 Trio™ Operating Instructions

General Product Description Front Panel

1.1 Front Panel

FIGURE 1-1 Front View of Monitor

1. Alarm Light

Illuminates when an alarm is triggered.

2. Display

8.4” color TFT LCD (800 x 600 resolution).

3. Front Panel Keypad

™

Navigator

Knob and dedicated quick-action keys.

Trio™ Operating Instructions 0070-10-0666-01 1 - 3

Front Panel General Product Description

1.1.1 Front Panel Keypad

The front panel keypad is used to access many main functions quickly and easily (see FIGURE 1-2).

FIGURE 1-2 Keypad

1. POWER Press this key to power the Trio ON or OFF.

NOTE: The power supply and battery

charger are active any time AC power is supplied, regardless of whether the monitor is ON or OFF.

2. BATTERY CHARGING INDICATOR

A green LED that is illuminated when AC power is present and the battery is installed and charging. When the monitor is running on battery power, this LED does not illuminate. When a “low battery” condition exists, this LED flashes at a constant rate.

3. AC POWER

A green LED that is illuminated when AC power is present.

INDICATOR

4. NIBP Press this key to begin a NIBP measurement. During a

measurement, press this key to cancel the measurement and deflate the cuff.

5. PRINT Press this key to initiate a real-time printout of numeric data

and selected waveforms. Results are output via the optional internal printer. During a printing, press this key to cancel the print job. Various print settings (such as speed and duration of printout) are adjustable and may be set by accessing the PRINTER SETUP menu in the MONITOR SETUP menu. (Refer to section 2.3.5.3 for details).

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General Product Description Front Panel

6. ALARM MUTE Press this key to suspend audio alarms on all currently

alarming parameters. The alarms remain suspended for a user selected amount of time as set in the ALARM SETUP menu or until the alarm condition is no longer present. Any new alarms that occur while the alarm tone is silenced will disable the silence and sound the alarm tone. While the alarms are suspended, an ALARM MUTE icon is displayed in the message bar. When in ALARM MUTE mode, press this key again to re-enable the audio alarm.

7. NORMAL SCREEN

Press the key to close all open menus and return the normal real-time display.

8. NAVIGATOR™ KNOB

Rotate this knob to highlight the various menus on the display. When highlighted, the menu target will display as black text on a white background. Available menu targets on the main display include the MENU icon, ECG lead, ECG size, ECG filter, IBP label, ECG, NIBP, SpO2, IBP, RESP and TEMP. Press the knob to display the highlighted menu. Once a menu is displayed, rotate the knob to highlight one of the items listed. Press the knob to select the highlighted item.

• When it is not highlighted, the MENU icon will display as white text on the footer background with a white outline. When all other menu targets are not highlighted, they will be displayed in the colors that are defined in the PARAMETER COLORS menu.

• When navigating within a menu, the menu target will display as black text on a white background. When the menu target is selected by pressing the knob, it will display as follows:

• If the menu target is a Drop-Down Box, it will open with

the current selection displayed in black text on a white background. Rotate and press the knob as necessary to make a selection.

• If the menu target is a Text Edit Box, a cursor will be

inserted in the menu target and the letter “A” in the onscreen keypad will display in black text on a white background. Rotate and press the knob as necessary to input the desired text. Select “OK” in the onscreen keypad to accept the text and return the cursor to the Text Edit Box.

• If the menu target is a Spin Edit Box, it will display as

white text on a black background. Rotate and press the knob as necessary to make a selection.

Trio™ Operating Instructions 0070-10-0666-01 1 - 5

Front Panel General Product Description

1.1.2 Display

The Trio display provides menus, waveforms, parameter information, patient information, and messages. The Trio includes various features that enable the user to customize the display. Additionally, the user default feature enables the user to save the customized settings. The display is divided into the following areas (see FIGURE 1-3):

1. Demographics

2. Technical Alarms

3. Waveform Data/Menus

4. Parameter Tiles

5. Status Bar

FIGURE 1-3 Main Display

1. Demographics

The demographics area displays the following information:

Bed # Bed number (6 characters maximum)

First Name First name of the patient (10 characters maximum)

Last Name Last name of the patient (10 characters maximum)

Patient Size Size of the patient: ADU (Adult), PED (Pediatric)

1 - 6 0070-10-0666-01 Trio™ Operating Instructions

General Product Description Front Panel

Gender Gender of the patient: M (Male), F (Female)

Current Date XX-XX-XXXX (month-day-year)

Current Time

XX:XX:XX (hours:minutes:seconds)

(24-hour format)

Indicates that all alarm tones have been manually disabled. It is displayed when the ALARM MUTE button is pressed.

2. Technical Alarms

Technical Alarms are failures or errors that require resolution or attention to continue patient monitoring (also called System Error Messages).

3. Waveform Data/Menus

The waveform data/menus area is used to display parameter waveforms and system menus.

Waveform Data

Up to four (4) waveforms may be displayed. When all waveforms are selected in the TRACE SETUP menu, the waveforms will be displayed, from top to bottom, as follows: ECG, SpO

(Pleth), IBP (optional), Respiration (RESP). (Refer to Trace Setup for details.)

Up to four (4) waveforms may be displayed on this monitor.

• If the parameter waveforms only include ECG, SpO2 (PLETH), and Respiration (RESP), and the ECG cascade is set to OFF, then only three (3) waveforms will be displayed. If the ECG cascade is set to ON, then four (4) waveforms will be displayed. The first two (2) will be ECG.

• For those monitors in which IBP is ordered as an option, and the cascade is set to OFF, the display will show four (4) waveforms: ECG, SpO

(PLETH), IBP, and Respiration

(RESP). If the ECG cascade is set to ON, then the cascaded ECG will replace the

(PLETH) waveform.

SpO

ECG Lead, Gain and Filter are displayed in the upper left corner of the main display. The IBP waveform label is displayed in the upper left corner of the IBP waveform window.

The waveforms are refreshed according to the rate designated by the user. (Refer to specific parameter sections for details of sweep speed.)

Menus

When performing menu functions, a menu will be displayed, potentially obstructing the view of select waveforms. Select NORMAL SCREEN in the menu (or on the Front Panel Keypad) to exit all menus and return to the normal screen. If the user does not perform any screen operation for 30 seconds, the menu will be removed automatically and the screen will return to the normal display mode. Trend displays do not time out.

Trio™ Operating Instructions 0070-10-0666-01 1 - 7

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Front Panel General Product Description

4. Parameter Tiles

The numeric data in each parameter tile refreshes continuously, except for the NIBP value, which refreshes each time a measurement is completed (see section 6). Using the MODULE SETUP menu, parameters can be turned ON or OFF, and the screen display will adjust accordingly. The numeric data is displayed at fixed positions within each parameter tile. (see FIGURE 1-4).

FIGURE 1-4 Parameter Tiles

A. ECG

• PACER Display (ON or OFF)

• Heart Rate (HR)/Pulse Rate (PR) (Unit: bpm)

B. NIBP

• Systolic, Diastolic, Mean (Units: mmHg or kPa)

• Interval Display (CONT, 1min, 2min, 3min, 4min, 5min, 10min, 15min, 30min, 1HR, 2HRS, 4HRS, OFF)

• Elapsed Time Display (ET)

C. SpO2

• Pulse Rate (PR) (Unit: bpm)

•SpO

(Unit: %)

• Pulse Amplitude Indicator

D. IBP

• Systolic, Diastolic, Mean (Units: mmHg or kPa)

E. RESP

• Respiration Rate (Units: rpm)

F. TEMP

• Temperature (Units: °C or °F)

1 - 8 0070-10-0666-01 Trio™ Operating Instructions

General Product Description Front Panel

5. Status Bar

The status bar is located at the bottom of the screen. It displays the DEMO MODE status, the battery icons and the MENU icon.

• The DEMO MODE status message indicates that the monitor is in demo mode and is displaying simulated patient data.

• The battery icons indicate the relative charge status of the optional battery.

• Battery (Full)

The battery full icon appears in the lower right portion of the display when the unit is operated by battery power. When the batteries are fully charged, the color will be filled in as shown.

• Battery (Low)

The battery low icon appears in the lower right portion of the display when the unit is operating on battery power. When the batteries are running low, color appears only on the right portion of the indicator.

• No Battery in Unit

The no battery icon appears in the lower right portion of the display when a battery is not installed in the monitor.

•The MENU icon is used to access the SYSTEM MENU. It is a rectangular icon positioned below the parameter tiles and is the same width as that area.

Trio™ Operating Instructions 0070-10-0666-01 1 - 9

Left Side Panel General Product Description

1.2 Left Side Panel

The optional, two-trace thermal strip chart recorder and the battery compartment are located on the left side panel (see FIGURE 1-5).

FIGURE 1-5 Left Side Panel

1. Handle/bedrail hook

Handle with integrated bedrail hook

2. Recorder (Optional)

Two-trace thermal strip chart recorder

3. Recorder Power LED

A green LED that indicates that the recorder is receiving power

4. Battery compartment

The housing for the optional, user-replaceable, rechargeable battery (sealed lead acid or Lithium Ion)

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General Product Description Right Side Panel

SpO

IBP 1

ECG

1.3 Right Side Panel

The connectors for patient cables and sensors are located on the right side panel (see FIGURE 1-6).

FIGURE 1-6 Right Side Panel

1. SpO

This receptacle is used to attach the SpO

Receptacle

sensor to the monitor.

2. Optional IBP

A six-pin male receptacle used for an IBP connection.

3. ECG Receptacle

A six position female receptacle used to attach a 3 or 5 Lead ECG cable.

4. T1 Receptacle

A standard 1/4” phone jack is used to mate with the YSI series 400 temperature probe.

5. NIBP Quick-Connect Rectus* Pneumatic Fitting

This pneumatic fitting is used to attach the NIBP hose to the unit.

* Quick Connect Pneumatic Fittings available from Rectus-TEMA Corporation.

Trio™ Operating Instructions 0070-10-0666-01 1 - 11

Rear Panel General Product Description

1.4 Rear Panel

The following connectors are located on the rear panel (see FIGURE 1-7).

CS1

AO1

SP1

XXXX- XX - XXXX - XXXXX

FIGURE 1-7 Rear Panel

1. Ethernet Port (CS1)

The ethernet port is an RJ45 jack that is used for software upgrades.

NOTE: This port should not be used while monitoring a patient.

2. Analog Output (AO1)

The analog signal output connector may be used with a oscillometer, pen recorder or other external devices (see section 4). The connector is a BNC jack.

NOTE: After connecting any external device to the Analog Output,

verify that leakage currents do not exceed accepted limits.

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General Product Description Rear Panel

3. Serial Port (SP1) or VGA Output (RD1)

Trio monitors bearing a model number of 0998-00-0600-4XXXX are equipped with a 9-position D-shell serial port connector. Trio monitors bearing a model number of 0998-000600-0XXXX or 0998-00-0600-2XXXX are equipped with a 15-position D-Shell VGA output connector.

The proprietary serial port is a 9-position D-shell plug connector with interface based on TIA/ EIA-232-F signal compliance. Information is transferred via DIAP protocol. (For additional information see P/N 0070-00-0307).

The VGA output connector provides connectivity to a medical grade remote display. The connector is a 15-position D-Shell connector. Connection to this port should be made with the monitor power OFF. Power ON the monitor after powering ON the remote display.

NOTE: After connecting any external device to the Serial Port or the

VGA Output, verify that leakage currents do not exceed accepted limits.

4. Equipotential Lug

The equipotential lug provides equipotential grounding for hospital equipment.

NOTE: Ensure that when connecting external devices to the unit all

equipotential terminals are connected.

5. AC Receptacle

Insert the AC power cord into this receptacle.

Trio™ Operating Instructions 0070-10-0666-01 1 - 13

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Rear Panel General Product Description

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1 - 14 0070-10-0666-01 Trio™ Operating Instructions

2.0

Operations

2.1 Getting Started

The Trio features default factory settings that enable monitoring to begin without setting waveforms, parameters, alarms, or functions. Each of these settings can be changed based on specific patient or departmental needs. Certain operating characteristics (e.g. NIBP start pressure) are based on the selected patient size.

CAUTION: The patient size selection should be matched to the actual

patient before monitoring begins.

Before using the monitor, complete the following steps:

1. Examine the device, all external cables, inserted modules and accessories for damage

2. Check all monitor functions for proper operation.

NOTE: If the monitor is damaged, contact the biomedical engineer

of the hospital or Customer Service immediately.

2.1.1 Setting-up Patients

1. Turn the monitor ON using the POWER key on the front panel.

2. Remove all of the previous patient data (except BED # and SIZE) as follows:

a. Use the Navigator™ Knob to select the MENU icon located in the bottom right

corner of the screen. The SYSTEM MENU (FIGURE 2-1) is displayed.

b. From the SYSTEM MENU, select PATIENT SETUP. The PATIENT SETUP menu

(FIGURE 2-2) is displayed.

c. Select PATIENT DISCHARGE. A confirmation dialog is displayed with the prompt,

Discharge patient from monitor?.

d. Select YES to remove the previous patient data from the monitor.

3. Connect the patient to the monitor, apply appropriate accessories such as ECG

electrodes, NIBP cuff, SpO

probe, etc.

Trio™ Operating Instructions 0070-10-0666-01 2 - 1

Menus Operations

4. Enter the desired patient information into the Trio via the PATIENT SETUP menu.

Select appropriate patient SIZE.

5. If desired, press the NIBP key to initiate a non-invasive blood pressure measurement.

6. When monitoring has concluded, clear the patient's data by selecting PATIENT

DISCHARGE from the PATIENT SETUP menu.

2.1.2 Setting the Clock (Date and Time)

From the MONITOR SETUP menu the date and time can be set.

1. Using the Navigator Knob, select the MENU icon located in the bottom right corner of

the display.

2. From the SYSTEM MENU select MONITOR SETUP.

3. Select TIME SETUP.

4. Select YEAR, MONTH, DAY, HOUR, MINUTE or SECOND and adjust accordingly.

5. Select PREVIOUS MENU to return to the previous menu or select NORMAL SCREEN

(from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

2.2 Menus

The Trio menu system is accessed using the Navigator™ Knob. The flexibility of the menu system enables the configuration of various features including the monitored parameters, waveform sweep speed, audio volume, and parameter colors.

The MENU icon located in the bottom right corner of the display provides access to the SYSTEM MENU. The parameter menu label in each parameter tile provides access to its user-definable settings. Parameter menus include: ECG, NIBP, SpO2, IBP (optional), RESP and TEMP.

The menu system restricts the overlap of settings that adjust upper and lower alarm limits. The menu targets for these limits will be Spin Edit Boxes. See the following example for further explanation.

Example: if a lower limit is set to 82, the menu system will restrict the upper limit choices from being 82 or less.

NOTE: All menus time-out after 30 seconds of inactivity with the

exception of the List Trend and Graphic Trend menus, which display indefinitely until closed manually.

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Operations System Menu

2.3 System Menu

The SYSTEM MENU provides the following submenu choices: PATIENT SETUP, LIST TREND, GRAPHIC TREND, MARK EVENT, MONITOR SETUP, MAINTENANCE, and NORMAL SCREEN. For the default settings of all menu selections, refer to section 3.0,

“Defaults”.

Use the Navigator Knob to select the MENU icon in the lower right corner of the screen. The

SYSTEM MENU (FIGURE 2-1) is displayed. From the SYSTEM MENU, select a submenu.

FIGURE 2-1 System Menu

2.3.1 Patient Setup

Select PATIENT SETUP from the SYSTEM MENU. The PATIENT SETUP menu (FIGURE 2-

2) is displayed.

FIGURE 2-2 Patient Setup Menu

Trio™ Operating Instructions 0070-10-0666-01 2 - 3

System Menu Operations

The PATIENT SETUP menu provides the following choices for entering patient demographic information and for patient discharge.

NOTE: The ID #, BED#, FIRST NAME and LAST NAME use the on-

screen keypad to enter demographic information. The remaining demographic information is chosen from DropDown or Spin Edit Boxes.

ID # Select to enter the patient ID number (only appears on recorder printouts)

BED# Select to enter the patient bed number

FIRST NAME Select to enter the patient's first name

LAST NAME Select to enter the patient's last name

GENDER Select to enter the patient gender (choices are: F for Female, M for Male)

SIZE Select to enter the patient size (choices are: ADU for Adult and PED

for Pediatric)

BIRTH Select to enter the patient date of birth (format: year/month/day)

HT. (cm) Select to enter the patient height

WT. (kg) Select to enter the patient weight

PATIEN T DISCHARGE

Select to discharge the current patient and admit a new patient. Selecting

PATIENT DISCHARGE

The user is prompted to answer

opens the confirmation dialog box (FIGURE 2-3).

YES

or NO to the question:

Discharge

patient from monitor?

Select YES to discharge the current patient from the monitor, erase the stored record of the current patient (except BED # and SIZE) and exit the menu. Select NO to continue monitoring the current patient, maintain the stored record of the current patient and exit the menu.

NOTE: Selecting YES will delete all information

related to the currently monitored patient.

FIGURE 2-3 Confirmation Dialog Box

2 - 4 0070-10-0666-01 Trio™ Operating Instructions

Operations System Menu

Entering the ID #, BED#, FIRST NAME and LAST NAME

Use the onscreen keypad to enter the ID #, BED#, FIRST NAME and LAST NAME information, proceed as follows:

1. Select the PATIENT SETUP menu and use the Navigator™ Knob to scroll to the item

that will be entered or changed.

2. Press the Navigator Knob and the cursor will automatically move to the on-screen

keypad.

3. Move the cursor to the appropriate character and press the knob so that the character

appears in the box above. Continue this technique until the information for that item is complete.

NOTE: Select DEL to delete incorrect characters.

4. When finished entering the data for a particular item, select OK. The patient

information will be displayed in the box for that menu item and the cursor will return to the starting position.

5. Select PREVIOUS MENU to return to the previous menu. Select NORMAL

SCREEN (from the menu or the Front Panel Keypad) to exit the menu and return to the

normal screen.

Entering the GENDER, SIZE, BIRTH DATE, HEIGHT and WEIGHT.

Use the Drop-Down and Spin Edit Boxes to enter the GENDER, SIZE, BIRTH, HT. and WT. information, proceed as follows:

NOTE: Setting the SIZE will automatically select all user defined

1. Select the PATIENT SETUP menu and use the Navigator™ Knob to scroll to the item

2. Press the Navigator Knob to access the Drop-Down or Spin Edit box for that selection.

3. Scroll to the desired setting and press the knob to accept the selection.

4. Select PREVIOUS MENU to return to the previous menu. Select NORMAL

defaults for that patient size.

that will be entered or changed.

SCREEN (from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

2.3.2 List Trend

To access the LIST TREND menu/display, select LIST TREND from the SYSTEM MENU. Refer to "Trends" on page 2-76 for details on List Trend functions.

2.3.3 Graphic Trend

To access the GRAPHIC TREND menu/display, select GRAPHIC TREND from the SYSTEM MENU. Refer to "Trends" on page 2-76 for details on Graphic Trend functions.

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System Menu Operations

2.3.4 Mark Event

The Mark Event function places a time stamp event marker (A, B, C or D) in the trend memory. This function may be used to identify medication delivery, change in patient status, etc. There may be a time delay between the time at which the event is marked and the point in time at which it displays on the trend screen.

Select MARK EVENT from the SYSTEM MENU (see FIGURE 2-4).

FIGURE 2-4 Mark Event Menu

To mark an event, use the Navigator™ Knob to select EVENT A, B, C or D. Once an event is marked, the @ symbol appears in the event box. To cancel the selection, move the cursor to the event and press the knob again. Select PREVIOUS MENU to save the marked event, exit the MARK EVENT menu and return to the previous menu. Select NORMAL SCREEN (from the menu or the Front Panel Keypad) to save the marked event, to exit the menu and return to the normal screen.

NOTE: Marked Events will not be saved if the menu times out.

2.3.5 Monitor Setup

1. Select MONITOR SETUP from the SYSTEM MENU. The MONITOR SETUP menu,

containing various submenus (FIGURE 2-5), is displayed.

FIGURE 2-5 Monitor Setup Menu

2 - 6 0070-10-0666-01 Trio™ Operating Instructions

Operations System Menu

2.3.5.1 Alarm Setup

Select ALARM SETUP from the MONITOR SETUP menu (see FIGURE 2-5).

The ALARM SETUP menu allows the user to adjust various alarm functions. Refer to section

2.5, “Alarms” for details on Alarm functions.

2.3.5.2 Time Setup

From the MONITOR SETUP menu, select the TIME SETUP menu to modify the time and date settings displayed on the monitor (see FIGURE 2-6). The TIME SETUP menu allows the user to set the YEAR, MONTH, DAY, HOUR, MINUTE and SECOND. Use the Navigator™ Knob to adjust settings accordingly. Select PREVIOUS MENU to exit the TIME SETUP menu and return to the previous menu. Select NORMAL SCREEN (from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

FIGURE 2-6 Time Setup Menu

Trio™ Operating Instructions 0070-10-0666-01 2 - 7

System Menu Operations

2.3.5.3 Printer Setup

Select PRINTER SETUP from the MONITOR SETUP (see FIGURE 2-7).

FIGURE 2-7 Printer Setup Menu

Printer Setup Menu Selections

WAVEFORM 1 or WAVEFORM 2

The PRINTER SETUP menu allows the user to designate which two (2) parameter waveforms are displayed on the printout as WAVEFORM 1 and WAVEFORM 2. Only waveforms that are displayed on screen are available for selection.

Available parameter waveform selections include:

ECG: ECG waveform

: SpO2 Plethysmogram

SpO

IBP: IBP waveform (optional) RESP: Respiration waveform OFF: No display for this waveform

NOTE: Two (2) waveforms can not be set to

the same parameter. Attempting to set a duplicate parameter will cause the previous selection to default to the next available parameter waveform.

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Operations System Menu

TIME TIME represents the length of recording time. There are two (2)

selections available: CONTINUAL and 8s. CONTINUAL means once the user presses the PRINT key on the front panel, the recorder will continuously print out the selected waveform(s) until the button is pressed again. 8s indicates a waveform recording time length of 8 seconds.

INTERVAL INTERVAL represents the time interval between the start of recorder

activations. The following 10 selections are available: OFF,

10min, 20min, 30min, 40min, 50min, 1HR, 2HRS, 3HRS

and 4HRS. The system will initiate the print operation according to the selected time interval. All interval waveform printouts are 8 seconds in length.

NOTE: A real-time printout (based on TIME

as described in the previous menu) takes priority over a printout based on INTERVAL.

SPEED SPEED is used to select the speed at which the paper advances in

the printer. There are two (2) options: 25.0 and 50.0 mm/s.

GRID GRID is used to select output format: OFF produces a printout

without a background grid, and ON produces a printout with a background grid.

CLEAR PRINT TASK

CLEAR PRINT TASK is used to clear all print tasks from the

recorder. This can be used, for example, when multiple alarm print tasks are triggered simultaneously.

NOTE: The recorder is optional.

Select PREVIOUS MENU to return to the previous menu. Select NORMAL SCREEN (from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

Trio™ Operating Instructions 0070-10-0666-01 2 - 9

System Menu Operations

2.3.5.4 Analog Setup

The monitor can output an analog waveform from the analog output connector (AO1) on the rear panel.

Select ANALOG SETUP from the MONITOR SETUP menu (see FIGURE 2-8). Select ANALOG OUT, to set analog out to ON or OFF. Select ANALOG WAVE to select the parameter waveform output. Choices are ECG and IBP (optional).

Select PREVIOUS MENU to return to the previous menu. Select NORMAL SCREEN (from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

FIGURE 2-8 Analog Setup Menu

2.3.5.5 Module Setup

MODULE SETUP allows the user to customize the display by selecting the parameters to be monitored. Select MODULE SETUP from the MONITOR SETUP menu (see FIGURE 2-9).

FIGURE 2-9 Module Setup Menu

Select the parameters to monitor by using the Navigator™ Knob to select the item to be displayed. A check mark will be displayed in the box next to each parameter selected. To deselect a parameter, press the knob again (the check mark will be removed). Select PREVIOUS MENU to return to the previous menu. Select NORMAL SCREEN (from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

NOTE: If the optional IBP is not installed, it will not be displayed in

2 - 10 0070-10-0666-01 Trio™ Operating Instructions

the MODULE SETUP menu.

Operations System Menu

2.3.5.6 Trace Setup

TRACE SETUP allows the user to choose the traces that will be displayed in the waveform area and to choose the viewing mode. The viewing modes improve the viewability of the display depending on how the Trio is positioned for use. There are two viewing modes that can be selected from the WAVE DISPLAY pull-down menu.

• MODE 1 – provides an enhanced view angle and a less smooth wave. This mode should be used when the Trio is being viewed from an angle. In most instances, this mode will provide optimal viewing of waveform data. (MODE 1 is the factory default setting.)

• MODE 2 – provides a basic view angle and a smooth wave. This mode should be used when the Trio is wall-mounted and being viewed from below.

1. Select TRACE SETUP from the MONITOR SETUP menu. The TRACE SETUP menu

(FIGURE 2-10) is displayed.

FIGURE 2-10 Trace Setup Menu

2. Use the Navigator™ Knob to select each parameter waveform (a check mark in the box

next to a parameter indicates that it has been selected). To deselect a parameter waveform, press the knob again.

3. Choose the desired viewing mode from the WAVE DISPLAY pull-down menu.

4. Select PREVIOUS MENU to return to the previous menu. Select NORMAL SCREEN

(from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

NOTE: If the optional IBP is not installed, it will not be provided as

a choice in the TRACE SETUP menu.

Trio™ Operating Instructions 0070-10-0666-01 2 - 11

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System Menu Operations

2.3.5.7 Parameter Colors

1. Select PARAMETER COLORS from the MONITOR SETUP menu. The PARAMETER

COLORS menu (FIGURE 2-11) is displayed. From this menu, the colors for displayed

parameters can be selected. The numeric and waveform data for each parameter displays in the same color, as selected by the user. The color choices are: GREEN, RED,

YELLOW, BLUE, and WHITE.

FIGURE 2-11 Parameter Colors Menu

2. Select PREVIOUS MENU to return to the previous menu. Select NORMAL SCREEN

(from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

2.3.5.8 Restore Defaults

1. Select RESTORE DEFAULTS from the MONITOR SETUP menu. The RESTORE

DEFAULTS menu (FIGURE 2-12) is displayed.

FIGURE 2-12 Restore Defaults Menu

The RESTORE DEFAULTS menu allows the user to perform the following two (2) functions:

•The RESTORE USER DEFAULTS function allows the user to revert back to a previously saved group of monitor settings for the selected patient size.

•The RESTORE FACTORY DEFAULTS function allows the user to revert back to the group of monitor settings initially set by the manufacturer. Factory alarm defaults for each parameter are indicated in the parameter sections to follow. (See section 3.0 “Defaults” for a complete list of Factory Default Settings.)

2. Select PREVIOUS MENU to return to the previous menu. Select NORMAL SCREEN

(from the menu or the Front Panel Keypad) to exit the menu and return to the normal screen.

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Operations System Menu

2.3.5.9 Save Current

SAVE CURRENT allows the user to save the current customized settings as the default settings (or the “User Default Configuration”), replacing the existing user-defined configuration for the current patient size.

1. Select SAVE CURRENT from the MONITOR SETUP menu. The confirmation dialog

box in FIGURE 2-13 is displayed.

2. Select YES to replace the existing user-defined configuration with the current customized

settings. Select NO to cancel the task.

FIGURE 2-13 Confirmation Dialog Box

2.3.6 Maintenance

Refer to the Trio Service Manual (Part Number 0070-00-0627-03) for details on maintenance functions.

2.3.7 Normal Screen

Select NORMAL SCREEN to exit the SYSTEM MENU and return to the normal screen.

Trio™ Operating Instructions 0070-10-0666-01 2 - 13

Parameter Menus Operations

2.4 Parameter Menus

2.4.1 Electrocardiogram (ECG) Monitoring

ECG is a continuous waveform of a patient's cardiac electrical activity. The ECG waveform will display in the first waveform area of the Trio.

The quality of an ECG signal is directly affected by electrode site skin preparation, electrode patch quality and ECG lead placement. If artifact is present on the ECG waveform, then the arrhythmia processing, alarm processing, and quality of the monitoring function may be affected. The presence of artifact can prevent the monitor from establishing an accurate ECG reference waveform, increasing the difficulty experienced in assessing the ECG rhythm.

Optimizing the ECG signal is imperative for accurate monitoring. Use high quality electrodes, designed to acquire the ECG with excellent base line stability, recovery from defibrillation and minimum artifact from patient movement.

With the Trio, ECG can be obtained by using either a 3 Lead or 5 Lead ECG cable in conjunction with a lead set and skin electrodes. For best performance and safety, inspect the ECG cables and electrodes daily.

WARNING: Ensure that the conductive parts of ECG electrodes do not

contact other conductive parts, including earth ground.

CAUTION: To avoid possible damage to the Trio, use only approved

ECG cables and approved accessories.

CAUTION: Line isolation transients may resemble actual cardiac

CAUTION: Use of accessories, transducers and cables other than those

NOTE: This device is not intended for direct cardiac application.

2.4.1.1 Skin Preparation

Proper skin preparation is essential in obtaining an accurate ECG reading. Electrode sites should be clean and dry and should provide a smooth flat surface. Incidental electrical activity and inaccurate readings may arise from incorrect skin preparation.

The following procedure is recommended for secure electrode patch application:

1. Shave the hair from the electrode sites in a circular area with a diameter of 2 – 4 inches.

2. Use a dry gauze pad to remove excess skin oils, skin cells and residue from the

electrode sites. Never rub the skin until it is raw or bleeding.

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Operations Parameter Menus

NOTE: Prepare the electrode site with alcohol only if the skin is

extremely greasy. If alcohol is used as a drying agent, always allow the skin to dry before placing the electrode patch on the skin.

2.4.1.2 Electrode Patch Location

NOTE: Store electrode patches at room temperature and open just

prior to use.

NOTE: Avoid more than one type of electrode on a patient because

of variations in electrical resistance.

NOTE: Avoid placing electrode patches directly over bone

prominences or over any high activity movement areas such as shoulders or arms because muscle motion produces electrical activity. If an electrode patch is placed over a large muscle such as the pectorals, the monitor may detect this additional muscle activity and could lead to false arrhythmia calls.

1. To prevent evaporation of the contact gel medium, peel the backing off of the electrode

patch only when it is ready for use. Visually inspect the contact gel medium for moistness. If the gel medium is not moist, do not use the electrode patch. Dry electrode patches are not conductive.

NOTE: If using the snap type electrode wires, attach the electrode

patch to the lead wire before placing patch on the patient.

2. Attach the electrode patch to the skin at the prepared site. Smooth the electrode patch

down in a circular motion to ensure proper skin contact. If using soft gel electrodes, never push down directly over the contact gel medium as this may displace the gel and cause monitoring artifact. If using hard gel electrodes, it is recommended that during application, the center of the electrode should be slightly pressed onto the skin to ensure direct contact. Consult the electrode patch manufacturer’s instructions for specific use.

3. Secure the lead wires to the patient according to hospital practice. For additional

information see section 2.4.1.3, “Lead Placement”.

WARNING: Ensure that the ECG lead wires are neatly secured in a

manner that will prevent them from encircling the patient’s neck, creating a strangulation hazard.

NOTE: It is recommended that electrode patches be changed at

least every 24 – 36 hours to maintain proper contact with the skin. Some patients may require electrodes to be changed more often. Electrode patches are disposable and should be applied only once. Try to avoid reusing the exact same electrode site during reapplication. If an electrode becomes wet with fluid, change the electrode patch.

Trio™ Operating Instructions 0070-10-0666-01 2 - 15

Parameter Menus Operations

White

Black

Red

Yel l ow

Green

2.4.1.3 Lead Placement

The computerized arrhythmia algorithm works best when the patient’s R wave is significantly larger than the P wave or the T wave. If the R wave is not significantly larger than other lower voltage waves on the ECG tracing, the computer may have some difficulty in identifying the appropriate waves. On some patients, electrode patch placement and/or the viewed ECG lead may need to be adjusted in order to obtain a significant R wave.

This section outlines lead placement according to the guidelines of the American Heart Association (AHA) and the International Electro-Technical Commission (IEC).

Standard 3-wire Lead Sets

Standard 3-wire lead sets include 3 ECG leads (I, II and III). Only 1 lead is monitored.

FIGURE 2-14 3-wire Lead Placement

(AHA)

• Place the RA (white) electrode under the patient’s right clavicle, at the midclavicular line within the rib cage frame.

• Place the LA (black) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the LL (red) electrode on the patient’s lower left abdomen within the rib cage frame.

FIGURE 2-15 3-wire Lead Placement

(IEC)

• Place the R (red) electrode under the patient’s right clavicle, at the midclavicular line within the rib cage frame.

• Place the L (yellow) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the F (green) electrode on the patient’s lower left abdomen within the rib cage frame.

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Operations Parameter Menus

Black

White

Brown V Lead (any V position)

Green

Red

Yellow

Red

White C Lead (any position)C

Black

Green

Standard 5-wire Lead Sets

Standard 5-wire lead sets monitor 7 ECG leads: I, II, III, aVR, aVL, aVF and V.

FIGURE 2-16 5-wire Lead Placement

(AHA)

• Place the RA (white) electrode under the patient’s right clavicle, at the midclavicular line within the rib cage frame.

• Place the LA (black) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the LL (red) electrode on the patient’s lower left abdomen within the rib cage frame.

• Place the RL (green) electrode on the patient’s lower right abdomen within the rib cage frame.

• Place the V (brown) electrode in one of the V-lead positions (V1 – V6) depicted in the following section.

FIGURE 2-17 5-wire Lead Placement

(IEC)

• Place the R (red) electrode under the patient’s right clavicle, at the midclavicular line within the rib cage frame.

• Place the L (yellow) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the F (green) electrode on the patient’s lower left abdomen within the rib cage frame.

• Place the N (black) electrode on the patient’s lower right abdomen within the rib cage frame.

• Place the C (white) electrode in one of the C-lead (C1 – C6) positions depicted in the following section.

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Trio™ Operating Instructions 0070-10-0666-01 2 - 17

Parameter Menus Operations

V-Lead and C-Lead Electrode Positions

FIGURE 2-18 V-Lead Electrode Placement

(AHA)

• V1 - Place the electrode at the fourth intercostal space, on the right sternal border

• V2 - Place the electrode at the fourth intercostal space, on the left sternal border

• V3 - Place the electrode midway between V2 and V4 on a line joining these 2 locations

• V4 - Place the electrode at the fifth intercostal space on the midclavicular line

• V5 - Place the electrode at the fifth intercostal space on the anterior axillary line

• V6 - Place the electrode at the fifth intercostal space on the mid-axillary line

FIGURE 2-19 C-Lead Electrode Placement

(IEC)

• C1 - Place the electrode at the fourth intercostal space, on the right sternal border

• C2 - Place the electrode at the fourth intercostal space, on the left sternal border

• C3 - Place the electrode midway between C2 and C4 on a line joining these 2 locations

• C4 - Place the electrode at the fifth intercostal space on the midclavicular line

• C5 - Place the electrode at the fifth intercostal space on the anterior axillary line

• C6 - Place the electrode at the fifth intercostal space on the mid-axillary line

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Operations Parameter Menus

White

Black

Red

Yellow

Green

Lead II Monitoring

FIGURE 2-20 Lead II Monitoring (AHA) FIGURE 2-21 Lead II Monitoring (IEC)

• Place the RA (white) electrode under the patient’s right clavicle, at the midclavicular line within the rib cage frame.

• Place the LA (black) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the LL (red) electrode on the patient’s lower left abdomen within the rib cage frame.

• Place the R (red) electrode under the patient’s right clavicle, at the midclavicular line within the rib cage frame.

• Place the L (yellow) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the F (green) electrode on the patient’s lower left abdomen within the rib cage frame.

Select ECG Lead II on the monitor. Lead II is the direct electrical line between the RA (white) electrode and the LL (red) electrode.

Select ECG Lead II on the monitor. Lead II is the direct electrical line between the R (red) electrode and the F (green) electrode.

Trio™ Operating Instructions 0070-10-0666-01 2 - 19

Parameter Menus Operations

White

Red

Black

Red

Green

Yellow

Modified Chest Lead (MCL) Monitoring

FIGURE 2-22 MCL Monitoring with a

3-wire Lead Set (AHA)

• Place the RA (white) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the LA (black) electrode on the right sternal border, at the fourth intercostal space within the rib cage frame.

• Place the LL (red) electrode on the patient’s lower left abdomen within the rib cage frame.

Select ECG Lead I for MCL

monitoring.

Lead I is the direct electrical line between the RA (white) electrode and the LA (black) electrode.

Select ECG Lead II for MCL

monitoring.

Lead II is the direct electrical line between the RA (white) electrode and the LL (red) electrode.

FIGURE 2-23 MCL Monitoring with a

3-wire Lead Set (IEC)

• Place the R (red) electrode under the patient’s left clavicle, at the midclavicular line within the rib cage frame.

• Place the L (yellow) electrode on the right sternal border, at the fourth intercostal space within the rib cage frame.

• Place the F (green) electrode on the patient’s lower left abdomen within the rib cage frame.

Select ECG Lead I for MCL

monitoring.

Lead I is the direct electrical line between the R (red) electrode and the L (yellow) electrode.

Select ECG Lead II for MCL

monitoring.

Lead II is the direct electrical line between the L (red) electrode and the F (green) electrode.

2 - 20 0070-10-0666-01 Trio™ Operating Instructions

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Operations Parameter Menus

Black

White

Red

Pacer

White

Red

V Brown

Green

Black

Monitoring a Pacemaker Patient

FIGURE 2-24 3-wire Lead Placement for

a Pacemaker Patient (AHA)

FIGURE 2-25 5-wire Lead Placement for

a Pacemaker Patient (AHA)

A Pacemaker patient usually requires a different electrode patch placement configuration than a non-pacemaker patient.

Do not place an ECG electrode directly over the pacemaker generator. Place the electrode patches 3 – 5 inches away from the pacemaker generator area. For example, if the pacemaker generator is located in the right subclavian area, relocate the Right Arm (white) electrode closer in towards the center of the chest.

WARNING: Pacemaker patients’ rate meters may continue to count the

CAUTION: Thoracic respiration measurement may interfere with some

pacemakers. Refer to the pacemaker's manufacturer supplied manual.

Using a Transcutaneous Electrical Nerve Stimulator (TENS)

Since a TENS unit transmits electrical impulses, avoid placing ECG electrode patches near the TENS electrodes. ECG electrode patches may need to be repositioned and the ECG lead viewed may need to be adjusted until the optimum ECG tracing is obtained.

Trio™ Operating Instructions 0070-10-0666-01 2 - 21

Parameter Menus Operations

2.4.1.4 ECG Monitoring

NOTE: If an electro-surgical device is to be used on the patient, use

the ESIS cable. Respiration from ECG is not available if the ESIS cable is used.

• Plug the patient cable firmly into the ECG connector on the Trio. An ECG waveform will begin to display in the ECG waveform tile and the heart rate will be displayed in the ECG parameter tile to the right (see FIGURE 2-26).

• Select the desired ECG lead by turning the Navigator™ Knob to highlight the lead label, located in the upper left corner of the ECG waveform tile. Press the knob to enable scrolling through available leads. Lead II is the default setting.

• Select the desired ECG size by turning the Navigator™ Knob to highlight the current waveform size, located in the upper left corner of the ECG waveform tile. Press the knob to enable scrolling through available sizes. The default setting is 2 cm/mV.

NOTE: Check ECG electrode sites every day for skin irritation.

Replace electrodes as necessary.

2 - 22 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

2.4.1.5 ECG Lead, Size and Filter Settings

FIGURE 2-26 ECG settings on the Main Display

Use the Navigator™ Knob to select the following ECG settings (located in the upper left corner of the ECG waveform tile): ECG Lead, ECG Size, and ECG Filter.

1. ECG Lead

• The selectable leads when in 3 Lead mode are I, II and III

• The selectable leads when in 5 Lead mode are I, II, III, aVR, aVL, aVF and V

CAUTION: If a 3 Lead cable is used when a unit is set to 5 lead mode,

no ECG signal will be obtained. If a 5 lead cable is used when the unit is set to 3 lead mode only Lead I, II and III are operable.

2. ECG Size

The selectable waveform sizes are: 0.25, 0.5, 1 and 2.

• A waveform scale bar displays on the right side of each ECG channel. The height of

the waveform bar is directly proportional to the waveform amplitude

3. ECG Filter

The available filter modes are: MONITOR, EXTENDED and SURGERY. These modes offer different frequency ranges over which the ECG signal is measured and displayed along with varying amounts of noise suppression.

• MONITOR Mode MONITOR mode should be used for typical monitoring conditions. Its frequency range

of 0.50 Hz to 40 Hz filters out most low frequency noise that can be generated by patient motion, muscle artifact, etc.

Trio™ Operating Instructions 0070-10-0666-01 2 - 23

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Parameter Menus Operations

• EXTENDED Mode EXTENDED mode should be used for diagnostic purposes. It has the widest frequency

range and least noise suppression of the 3 modes. Its extended frequency range of

0.05 Hz to 100 Hz can provide a more accurate view of the waveform, but as a result can also be more susceptible to low frequency noise generated by patient motion, muscle artifact, etc.

• SURGERY Mode SURGERY mode is recommended for use in OR situations or where the ability to

measure a heart rate is more important than the fidelity of the waveform. It has the narrowest frequency range (1 Hz to 20 Hz) and hence the most noise suppression. It filters out more low frequency noise as well as the extreme amount of high frequency noise generated by an Electro-Surgical Device. However, the resultant waveform lacks detail. SURGERY mode is not recommended for Paced patients. The Pacer pulse can become sufficiently distorted so that it could be mistaken for a QRS complex, whereby a heart rate would continue to be counted even though the patient could be in cardiac arrest.

NOTE: During surgery or procedures which may introduce

NOTE: There will be a delay in the heart rate and systole beep,

2.4.1.6 ECG Setup

electrosurgical interference, the SURGERY mode should be used.

reappearing after a change of lead or scale.

FIGURE 2-27 ECG Setup Menu

Accessing the ECG Setup Menu

To access the ECG SETUP menu, select ECG from the ECG parameter tile using the Navigator™ Knob. Once in the ECG SETUP menu, use the Navigator Knob to adjust settings. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

2 - 24 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

ECG Setup Menu Selections

ALM

NOTE: In the French configuration, the HR

(Heart Rate) alarm is always ON. It cannot be disabled by turning it OFF.

Allows the user to turn the HR (Heart Rate) alarm ON or OFF. Choose ON to enable the alarm; choose OFF to disable the alarm. If the

alarm is set to OFF, the alarm OFF symbol will display to the right of ECG on the screen. The HR alarm is activated when the heart rate is equal to or exceeds set high or low HR values.

ALM PRIORITY Allows the user to select the priority of the ECG alarm. Choices are 1,

2 and 3. Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during a HR alarm condition.

Choose ON to enable printing upon HR alarm. Choose OFF to disable printing upon HR alarm.

HR ALM HI Allows the user to set the upper limit of the HR alarm. (See “Heart

Rate Alarm Limits” on page 2-27.)

HR ALM LO Allows the user to set the lower limit of the HR alarm. (See “Heart

Rate Alarm Limits” on page 2-27.)

SOURCE Determines the source of heart rate. An audible tone is generated

when a heart beat is detected from the selected source. The selections are ECG, SpO2 and AUTO.

NOTE: When heart rate is being measured, a

heart rate source label (“SOURCE:XXXX”) is displayed in the ECG parameter tile. This label indicates from where the heart rate parameter is derived and is displayed in the same color as the ECG waveform.

ECG: When ECG is selected as the heart rate source, the label HR

(heart rate) is displayed in the ECG parameter tile. This label and its associated numeric value are displayed in the same color as the ECG waveform. The audible tone sounds with each R wave. SpO2: When SpO

is selected as the heart rate source, the label PR

(pulse rate) is displayed in the ECG and SpO2 parameter tiles. This label and its associated numeric value are displayed in the same color as the SpO

numeric value. The audible tone sounds at the peak of

each pulse wave.

Trio™ Operating Instructions 0070-10-0666-01 2 - 25

Parameter Menus Operations

AUTO: When AUTO is selected as the heart rate source, the label and associated numeric value in the ECG parameter tile will be displayed based on the following hierarchy:

1. ECG will be the heart rate source as previously described if ECG is currently being monitored.

2. SpO2 will be the heart rate source as previously described if SpO2 is currently being monitored and ECG is not currently being monitored.

3. NIBP will be the heart rate source if NIBP is currently being monitored, ECG and SpO

are not currently being monitored,

and the ECG ALM (alarm) is set to OFF. The label HR (heart rate) will be displayed in the ECG parameter tile. This label and its associated numeric value are displayed in the same color as the NIBP numeric/waveform data.

NOTE: Heart rate that is sourced through

NIBP will time-out according to the NIBP “DISPLAY TIMEOUT” rules described on page 2-49.

PACER To be used when a patient has a pacemaker. This should be used

whether the pacemaker is active or is in standby mode. The ON selection will mark each detected pacemaker signal on the

ECG waveform.

CASCADE ECG cascade extends the ECG waveform into the second waveform

tile. The selections are ON or OFF.

LEAD TYPE Set the lead type on the monitor to match the type of ECG cable used.

The selections are 3 Lead or 5 Lead ECG cables.

SWEEP Adjusts the speed of the ECG waveform on the display. The selections

are 12.5, 25.0 and 50.0 mm/sec.

BEEP VOL Beep volume is the volume of the audible tone for the Heart Rate. The

selections are OFF, LOW, MED and HIGH.

RESTORE

Allows the user to restore the ECG user default configuration.

DEFAULTS

FIGURE 2-28 Confirmation Dialog Box

2 - 26 0070-10-0666-01 Trio™ Operating Instructions

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Operations Parameter Menus

Heart Rate Alarm Limits

PATIENT SIZE HIGH ALARM (bpm) LOW ALARM (bpm)

Adult (ADU) 60 – 250 [150] 30 – 120 [45] Pediatric (PED) 100 – 300 [175] 30 – 150 [70]

* Factory default values shown in brackets.

Alarms occurring during the process of ECG measurement include two (2) types: physiological alarms and technical alarms. Physiological alarms occur when the patient’s heart rate value is equal to or exceeds set alarm limits. Technical alarms are any ECG-related alarms, which are not physiological, such as functional failures.

2.4.1.7 ECG Troubleshooting

MESSAGE/ PROBLEM REASON SOLUTION

ECG LEAD OFF, or ECG XX LEAD OFF

ECG INIT ERR ECG module failure Notify hospital technician or

ECG COMM STOP Intermittent communication failure Notify hospital technician or

ECG COMM ERR Intermittent communication failure Notify hospital technician or

HR ALM LMT ERR Functional failure Notify hospital technician or

ECG NOISE ECG signal interference Apply fresh, moist electrodes.

Noisy ECG trace Loose or dry electrodes Apply fresh, moist electrodes.

Excessive Electrosurgical Interference

Intermittent Signal Connections not tight and/or properly

ECG electrodes are detached from the skin, ECG cables are disconnected from the monitor or ECG lead wires are disconnected from ECG cable

Defective cable or lead wires Replace cable or lead wires as

Patient cable or leads are routed too close to other electrical devices.

Inadequate skin preparation prior to application of electrode

secured

Electrodes dry or loose Repeat skin preparation and apply

Cable or leadwires damaged Check with a continuity tester.

Check all patient connections. Prep chest, change electrodes, check and replace leads.

Customer Support

Replace cable or lead wires as necessary.

Eliminate 60 Hz interference. Use ECG cable with internal filter block.

necessary Eliminate 60 Hz interference. Use

ECG cable with internal filter block. Repeat skin preparation and

electrode placement procedures. Apply fresh, moist electrodes. Ensure proper connection. (cable to

monitor, cable to lead, lead to electrode).

fresh, moist electrodes.

Trio™ Operating Instructions 0070-10-0666-01 2 - 27

Parameter Menus Operations

MESSAGE/ PROBLEM REASON SOLUTION

Excessive alarms: Heart rate, lead fault

Low Amplitude ECG Signal

No ECG waveform Size not set properly Readjust the ECG wave gain as

Base Line Wander Patient moving excessively. Secure lead wires and cable to

Electrodes dry Repeat skin preparation and apply

fresh, moist electrodes.

Alarm limits set too close to patient's normal heart rate

R-wave wrong size Readjust the waveform size or

Excessive patient movement or muscle tremor

Gain set too low Readjust the ECG wave gain as

Electrodes dry/old Apply fresh, moist electrodes. Skin improperly prepped Abrade the skin and repeat skin

This could be the patient's normal QRS complex.

Electrode positioned over a bone or muscle mass

Lead wires and/or patient cable not fully inserted into proper receptacle

Cables or lead wires damaged Check with a continuity tester.

Patient respiration variance. Reposition electrodes Electrodes dry or loose Repeat skin preparation and apply

Readjust alarm limits.

move ECG electrodes to optimize R-wave.

Reposition electrodes and secure with tape if necessary.

required. Refer to "ECG Lead, Size and Filter Settings" on page 2-23 for instructions on adjusting the wave gain setting.

preparation. Verify with a 12-lead electro-

cardiogram. Reposition electrodes.

required. Refer to "ECG Lead, Size and Filter Settings" on page 2-23 for instructions on adjusting the wave gain setting.

Check cables for proper connection

patient.

fresh, moist electrodes.

2 - 28 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

2.4.2 Respiration Monitoring

The Trio utilizes thoracic impedance to measure respiration. This is accomplished by passing a small electrical signal across the RA and LL (R and F) ECG limb leads. This signal changes as the patient's chest wall rises and falls during the breath cycle. The change of impedance between the two (2) electrodes, (due to the thoracic movement), produces a respiratory waveform on the screen.

2.4.2.1 Setting Up Respiration Measurement

For Respiration monitoring, it is not necessary to use additional electrodes. However, the proper placement of electrodes is important. Depending upon the medical condition of the patient it may be necessary to reposition the ECG electrodes to optimize respiratory signal.

Prep the patient’s skin for electrode placement as described in the ECG section of this manual (See section 2.4.1).

2.4.2.2 Respiration Setup Menu

Accessing the Respiration Menu

To access the RESP SETUP menu, select RESP from the RESP parameter tile using the Navigator™ Knob. The RESP SETUP menu (FIGURE 2-29) is displayed. Use the Navigator Knob to adjust settings. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

FIGURE 2-29 Respiration Setup Menu

Respiration Setup Menu Selections

ALM Allows the user to turn the RESP (Respiration) alarm ON or OFF.

Choose ON to enable the alarm; choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display to the right of RESP on the screen. The RESP alarm is activated when the respiration rate exceeds set high or low RESP values.

Trio™ Operating Instructions 0070-10-0666-01 2 - 29

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Parameter Menus Operations

ALM PRIORITY Allows the user to select the priority of the RESP alarm. Choices are

1, 2 and 3. Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during a RESP alarm

condition. Choose ON to enable printing upon RESP alarm. Choose OFF to disable printing upon RESP alarm.

ALM HI Allows the user to set the upper limit of the RESP alarm. (See

“Respiration Rate Alarm Limits” on page 2-30.)

ALM LO Allows the user to set the lower limit of the RESP alarm. (See

“Respiration Rate Alarm Limits” on page 2-30.)

SWEEP Adjusts the speed of the RESP waveform on the display. The

selections are 6.25, 12.5 and 25.0 mm/sec.

SCALE Changes the size of the RESP waveform. The selections are 0.25,

0.5, 1, 2, 3, 4 and 5.

RESTORE DEFAULTS

Allows the user to restore the RESP user default configuration.

FIGURE 2-30 Confirmation Dialog Box

Respiration Rate Alarm Limits

PATIENT SIZE HIGH ALARM (rpm) LOW ALARM (rpm)

Adult (ADU) 10 – 100 [30] 6 – 30 [6] Pediatric (PED) 15 – 150 [30] 6 – 40 [6]

* Factory default values shown in brackets.

Alarms occurring during the process of Respiration measurement include two (2) types: physiological alarms and technical alarms. Physiological alarms occur when the patient’s respiration rate is equal to or exceeds set alarm limits. Technical alarms are any Respiratoryrelated alarms, which are not physiological, such as functional failures.

2 - 30 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

2.4.2.3 Respiration Troubleshooting

MESSAGE/ PROBLEM REASON SOLUTION

RESP ALM LMT ERR Functional failure Notify hospital technician or

Customer Support

RR EXCEED Respiration value exceeds the

measurement range

Respiration Waveform too Large

Respiration Waveform too Small

ARTIFACT Respiration value equals the heart rate Check patient, notify physician

No Respiration Wav efo rm

No Respiration rate displayed

Scales set inappropriately Change lead selection

Patient breathing shallow or turned on side

Scale set inappropriately Change Respiration scale

Shallow breathing Change Respiration scale, Adjust

Cessation of breathing Check patient, notify physician Cable not connected Check cable connections ESIS cable in use Use non-ESIS cable only for

Cable not connected Check cable ESIS cable in use Use non-ESIS cable only for

Cardiovascular Artifact Detected Check patient, notify physician

Check patient, notify physician

Change Respiration scale

Change lead selection

leads

Respiration detection

respiration detection

Change Respiration scale Adjust leads

Trio™ Operating Instructions 0070-10-0666-01 2 - 31

Parameter Menus Operations

SpO2

bpm

Pulse Rate

SpO

Pulse Amplitude Indicator

Alarm OFF Symbol

(SpO2 alarm high only)

SatSeconds Indicator

(Nellcor® only)

SatSeconds Setting

(Nellcor® only)

2.4.3 SpO2 Monitoring

Each of the following terms are associated with blood oxygenation: oxygen saturation, pulse oximetry, SpO2 and plethysmography.

Oxygen saturation in capillary blood is measured by a method called pulse oximetry. Pulse oximetry is a continuous and non-invasive measurement of oxyhemoglobin saturation (the amount of oxygen attached to the hemoglobin in red blood cells). SpO arterial oxygen saturation. This term is used interchangeably with SaO2. This value is displayed in the SpO Amplitude Indicator. The indicator provides a graphic depiction of the relative pulse volume.

When the Trio is equipped with Nellcor® OxiMax® SpO2, the SpO2 parameter tile displays a SatSeconds™ Indicator when the SatSeconds function is enabled as described in section 2.4.3.2.

parameter tile (FIGURE 2-31) along with the Pulse Rate and the Pulse

is the estimation of

FIGURE 2-31 SpO2 Parameter Tile

The corresponding plethysmogram is a waveform representation of the arterial oxygenation and pulse detection. The pleth waveform is automatically scaled and no adjustment can be made to its size. The SpO

Traditional pulse oximetry determines SpO bed and measuring changes in light absorption during the pulsatile cycle. Red and infrared

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light-emitting diodes (LEDs) in oximetry sensors serve as the light sources, a photodiode serves as the photo detector.

Traditional pulse oximetry assumes that all pulsations in the light absorbance signal are caused by oscillations in the arterial blood volume. This also assumes that the blood flow in the region of the sensor passes entirely through the capillary bed rather than through any arterio-venous shunts.

results are updated once every second.

by passing red and infrared light into a capillary

Operations Parameter Menus

Performance Considerations

To ensure optimal SpO2 measurement, use an appropriate sensor, apply it as directed, and observe all warnings and cautions. Sensors are designed for specific sites on patients with designated weight ranges. To select the appropriate sensor, consider the patient’s weight, level of activity, adequacy of perfusion, available sensor sites and the sterility requirement.

If excessive ambient light is present, cover the sensor site with opaque material. Failure to do so may cause inaccurate measurements. Light sources that can affect performance include surgical lights (especially those with a xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps, and direct sunlight.

If a reading is unobtainable or inaccurate, consider the following:

• If the patient is poorly perfused, apply the sensor to a different finger or toe.

• Ensure that the sensor is properly aligned and securely applied.

• Use a new sensor.

• Move the sensor to a less active site.

• Use a type of sensor that tolerates some patient motion.

• Ensure that the sensor and site are clean/non-greasy. Remove nail polish and fungus.

Calibration

The oximetry sub-system incorporates automatic calibration mechanisms. No other calibration is required.

Auto Scaling

The pleth waveform is automatically scaled and is not proportional to the patient’s pulse volume. There is no adjustment that can be made to the pleth waveform.

CAUTION: Prolonged and continuous monitoring may increase the risk

of skin erosion and pressure necrosis at the site of the sensor. Check the SpO2 sensor site frequently to ensure proper positioning, alignment and skin integrity at least every eight (8) hours; with the Adult and Pediatric re-usable finger sensor, check every four (4) hours; for patients of poor perfusion or with skin sensitive to light, check every 2

- 3 hours; more frequent examinations may be required for different patients. Change the sensor site if signs of circulatory compromise occur.

Trio™ Operating Instructions 0070-10-0666-01 2 - 33

Parameter Menus Operations

CAUTION: Do not place the SpO2 sensor on an extremity with an

CAUTION: Tissue damage or inaccurate measurement may be caused

CAUTION: Inaccurate SpO2 measurements may be caused by:

invasive catheter or blood pressure cuff in place.

• incorrect sensor application or use

• significant levels of dysfunctional hemoglobins, (e.g., carboxyhemoglobin or methemoglobin)

• intra-vascular dyes such as indocyanine green or methylene blue

• excessive patient movement

• venous pulsations

• electro-surgical interference

• placement of a sensor on an extremity that has a blood pressure cuff, arterial catheter or intra-vascular line.

• nail polish or fungus

CAUTION: In certain situations in which perfusion and signal strength

are low, such as in patients with thick or pigmented skin, inaccurately low SpO2 readings will result. Verification of oxygenation should be made, especially in preterm infants and patients with chronic lung disease, before instituting any therapy or intervention.

CAUTION: Many patients suffer from poor peripheral perfusion due to

CAUTION: If the sensor or patient cable are damaged in any way,

CAUTION: Excessive ambient light may cause inaccurate

hypothermia, hypovolemia, severe vasoconstriction, reduced cardiac output, etc. These symptoms may cause a loss in vital sign readings.

discontinue use immediately. To prevent damage, do not soak or immerse the sensor in any liquid solution. Do not attempt to sterilize.

measurements. In such cases, cover the sensor site with opaque material.

2 - 34 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

2.4.3.1 Masimo SET® SpO

The Masimo pulse oximeter determines SpO2 in the traditional manner of passing red and infrared light into a capillary bed and measuring changes in light absorption during the pulsatile cycle. It assumes that arterio-venous shunting is highly variable and that fluctuating absorbance by venous blood is the major component of noise during the pulse. The Masimo pulse oximeter calculates the ratio of the arterial signals without the noise.

Masimo SET provides a family of sensors suitable for a wide variety of clinical settings and patient sizes. All sensors are:

• Indicated for continuous non-invasive monitoring of arterial oxygen saturation (SpO and Pulse Rate

• Non-sterile

• Usable during patient movement

The LNOP®•DCI Adult Reusable Finger Sensor can be used for “spot check” applications if needed. Adhesive-type sensors are also available. Refer to "Accessories" on page 5-1 for approved sensors. All sensors are intended for “single-patient use only” unless indicated as “reusable”.

CAUTION: When equipped with Masimo SpO2, use only Masimo

oxygen sensors and cables. Use of other oxygen sensors may cause improper oximeter performance.

)

NOTE: Refer to instructions included with each SpO

cable for proper placement and use.

sensor and

1. Select an SpO2 sensor that is appropriate for the size of the patient.

2. Attach the connector of the SpO2 sensor to the SpO2 extension cable.

3. Attach the SpO

sensor to the patient’s finger (or other appropriate site).

4. Orient the connector on the end of the SpO2 extension cable so that the Masimo SET

logo is facing upward. Plug the connector into the SpO panel of the Trio. The SpO

measurement will display when the Trio detects that the

receptacle on the right side

sensor is connected to the patient. A plethysmogram will be displayed to the left of the

parameter tile (if SpO2 is selected in the TRACE SETUP menu).

SpO

NOTE: To disconnect the cable from the Trio, squeeze the tabs on

the sides of the connector and then pull it straight out.

CAUTION: Prolonged and continuous monitoring may increase the risk

- 3 hours; more frequent examinations may be required for different patients. Change the sensor site if signs of circulatory compromise occur.

Trio™ Operating Instructions 0070-10-0666-01 2 - 35

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Parameter Menus Operations

2.4.3.1.1 Masimo SET® SpO2 Setup Menu

FIGURE 2-32 Masimo SET SpO2 Setup Menu

Accessing the Masimo SET SpO2 Setup Menu

To access the MASIMO SPO2 SETUP menu, select SpO2 from the SpO2 parameter tile using the Navigator™ Knob. Once in the MASIMO SPO2 SETUP menu, use the Navigator Knob to adjust settings. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

Masimo SET SpO2 Setup Menu Selections

ALM PRIORITY Enables the user to select the priority of the SpO2 alarm. Choices are:

1, 2 and 3. Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during an SpO

condition. Choose ON to enable printing upon SpO OFF to disable printing upon SpO2 alarm.

SPO2 ALM HI Allows the user to set the upper limit of the SpO

“Masimo SET SpO2 Alarm Limits” on page 2-38.)

SPO2 ALM LO Allows the user to set the lower limit of the SpO

SET SpO2 Alarm Limits” on page 2-38.)

PR ALM HI Allows the user to set the upper limit of the Pulse Rate alarm. (See

“Masimo SET SpO2 Alarm Limits” on page 2-38.)

alarm

alarm. Choose

alarm. (See

alarm. (See “Masimo

PR ALM LO Allows the user to set the lower limit of the Pulse Rate alarm. (See

“Masimo SET SpO2 Alarm Limits” on page 2-38.)

SWEEP Adjusts the speed of the SpO

selections are 12.5 and 25.0 mm/sec.

2 - 36 0070-10-0666-01 Trio™ Operating Instructions

waveform on the display. The

Operations Parameter Menus

BEEP VOL Beep volume is the volume of the audible pulse rate tone when SpO2

is selected as the HR Source. The selections are OFF, LOW, MED and HIGH.

AVG T IM E Averaging time is the length of time during which the SpO

calculated. The selections are 2-4, 4-6, 8, 10, 12, 14, and 16 seconds. When 2-4 or 4-6 are selected, the FastSAT mode is enabled. In this mode, shorter averaging times are achieved under low noise conditions. Under high noise conditions, a longer averaging time is utilized.

SENSITIVITY MODE

Sensitivity mode should be selected based on signal quality and patient motion. In most cases where there is some level of patient motion present, the normal sensitivity setting is appropriate. If patient motion is limited, the high sensitivity setting can be used. High sensitivity should be used when it is difficult to get a reading on a patient with low perfusion. This mode will compromise the probe off detection. Selections are Normal and High.

SENSOR OFF AUDIO

Controls the onset of the audio beep alarm for the “SpO2 Sensor OFF” condition. The selections are ON and OFF.

If ON is selected, then the audio beep alarm will sound when an “SpO2 Sensor OFF” condition occurs. If OFF is selected, then the audio beep alarm will not sound when an “SpO2 Sensor OFF” condition occurs.

value is

RESTORE

Allows the user to restore the SpO

user default configuration.

DEFAULTS

FIGURE 2-33 Confirmation Dialog Box

Trio™ Operating Instructions 0070-10-0666-01 2 - 37

Parameter Menus Operations

Masimo SET SpO2 Alarm Limits

HIGH

SpO

PATIENT SIZE

Adult (ADU) 80 – 100 [OFF] 50 – 99 [85] 60 – 240 [150] 25 – 120 [45] Pediatric (PED) 80 – 100 [OFF] 50 – 99 [85] 100 – 240 [175] 25 – 150 [70]

* Factory default values shown in brackets.

NOTE: If the SpO2 alarm high is set to OFF, the alarm OFF

symbol will display in the SpO

ALARM (%)

SpO2 LOW ALARM (%)

Alarms occurring during the process of SpO2 measurement include two (2) types: physiological alarms and technical alarms. Physiological alarms occur when the patient’s pulse rate or oxygen saturation level is equal to or exceeds set alarm limits. Technical alarms are any SpO

-related alarms, which are not physiological, such as functional failures.

2.4.3.1.2 Masimo SET® SpO2 Troubleshooting

MESSAGE REASON ACTION

SpO

: Sensor Off SpO2 sensor may be

: No Sensor SpO2 sensor may be

SpO

: Interference Noise detected on the pulse

SpO

: Pulse Search Hardware settings are being

SpO

: Low Perfusion Patient perfusion is low Check patient connection and patient

SpO

: Too Much Light There is too much ambient room

: Unrecognized

SpO

Sensor

SpO

Communication Error

: Board Fault Masimo SET board failed to

SpO

: Sensor Fault Defective Sensor Replace sensor

SpO

disconnected from the patient

disconnected from the monitor or the extension cable

signal prevents pulse discrimination

adjusted in order to discriminate a pulse waveform

light for the sensor to function properly

The sensor is not recognized by the monitor

The monitor and the SpO2 modules are not communicating properly

operate properly

PR HIGH ALARM (bpm)

parameter tile.

Place the sensor on the patient.

Plug the sensor into the monitor or the extension cable.

Decrease patient motion. Check sensor.

Wait several seconds for saturation value to be displayed. If it does not display, do one of the following:

• Change to site where pulse is stronger if patient is vasoconstricted.

• Change or readjust sensor if loose.

status Minimize the room light around the

patient. Check sensor.

Replace the sensor with a recommended authorized sensor

Power the unit OFF/ON. If problem persists, notify hospital technician or Customer Support.

Notify hospital technician or Customer Support

PR LOW ALARM (bpm)

2 - 38 0070-10-0666-01 Trio™ Operating Instructions

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Operations Parameter Menus

2.4.3.2 Nellcor® SpO

Nellcor provides a family of sensors suitable for a wide variety of clinical settings and patients. Specific sensors have been developed for a variety of patient sizes.

Nellcor’s SatSeconds™ Alarm Management feature in their OxiMax® SpO2 sensor offers an effective means of managing nuisance alarms without sacrificing patient safety. Nuisance alarms are often triggered by minor and brief desaturation events that are clinically insignificant and are often managed by widening alarm limits, turning OFF the alarm or monitor, or simply ignoring the alarm. The SatSeconds feature distinguishes clinically insignificant events from events of consequence.

When an SpO clockwise. The difference between the measurement and the limit multiplied by the time the measurement remains outside the limit determines if or when the SatSeconds alarm occurs. For example:

The low SpO

• If the measurement is 85% for 4 seconds (i.e., 5% below the limit for 4 seconds), then 5% X 4 seconds = 20 SatSeconds. This is less than the 25 SatSeconds setting, therefore no alarm will occur.

• If the measurement is 85% for 7 seconds (i.e., 5% below the limit for 7 seconds), then 5% X 7 seconds = 35 SatSeconds. This is greater than the 25 SatSeconds setting, therefore an alarm occurs at 5 seconds because 5% X 5 seconds = 25 SatSeconds. The alarm continues for another 2 seconds.

When the SpO clears (empties) counter-clockwise in the same amount of time that it took for the SatSeconds alarm condition to be acquired. The “clear” time is equivalent to the acquire time.

measurement exceeds the alarm limit, the SatSeconds indicator begins to fill

alarm is set at 90% and the SatSeconds “clock” is set to 25.

measurement returns to within the alarm limits, the SatSeconds indicator

Nellcor’s SatSeconds™ Alarm Management technology also features a safety precaution. When three (3) SpO

alarm violations occur within 60 seconds, a priority 2 alarm will

trigger even if the SatSeconds limit has not been reached.

CAUTION: When equipped with Nellcor SpO2, use only Nellcor oxygen

sensors and cables. Use of other oxygen sensors may cause improper oximeter performance.

NOTE: Refer to instructions included with each SpO

cable for proper placement and use. If the sensor LED does not illuminate within 3 seconds after being connected, then the sensor is probably defective and should be replaced.

sensor and

1. Select an SpO2 sensor that is appropriate for the size of the patient.

2. Attach the connector of the SpO

sensor to the SpO2 extension cable.

3. Attach the SpO2 sensor to the patient’s finger (or other appropriate site).

4. Plug the connector on the end of the SpO

the right side panel of the Trio. The SpO

extension cable into the SpO2 receptacle on

measurement will display when the Trio

detects that the sensor is connected to the patient. A plethysmogram will be displayed to the left of the SpO

NOTE: To disconnect the cable from the Trio, squeeze the tabs on

the sides of the connector and then pull it straight out.

Trio™ Operating Instructions 0070-10-0666-01 2 - 39

parameter tile (if SpO2 is selected in the TRACE SETUP menu).

Parameter Menus Operations

CAUTION: Prolonged and continuous monitoring may increase the risk

- 3 hours; more frequent examinations may be required for different patients. Change the sensor site if signs of circulatory compromise occur.

2.4.3.2.1 Nellcor® SpO2 Setup Menu

FIGURE 2-34 Nellcor SpO2 Setup Menu

Accessing the Nellcor SpO2 Setup Menu

To access the NELLCOR SPO2 SETUP menu, select SpO2 from the SpO2 parameter tile using the Navigator™ Knob. Once in the NELLCOR SPO2 SETUP menu, use the Navigator Knob to adjust settings. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

Nellcor SpO2 Setup Menu Selections

ALM PRIORITY Enables the user to select the priority of the SpO2 alarm. Choices are:

1, 2 and 3. Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during an SpO

condition. Choose ON to enable printing upon SpO OFF to disable printing upon SpO

alarm.

SPO2 ALM HI Allows the user to set the upper limit of the SpO

(See “Nellcor SpO2 Alarm Limits” on page 2-42.)

SPO2 ALM LO Allows the user to set the lower limit of the SpO

(See “Nellcor SpO2 Alarm Limits” on page 2-42.)

alarm

alarm. Choose

alarm.

2 - 40 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

PR ALM HI Allows the user to set the upper limit of the Pulse Rate alarm.

(See “Nellcor SpO2 Alarm Limits” on page 2-42.)

PR ALM LO Allows the user to set the lower limit of the Pulse Rate alarm.

(See “Nellcor SpO2 Alarm Limits” on page 2-42.)

SWEEP Adjusts the speed of the SpO

waveform on the display. The

selections are 12.5 and 25.0 mm/sec.

BEEP VOL Beep volume is the volume of the audible pulse rate tone when SpO

is selected as the HR Source. The selections are OFF, LOW, MED and HIGH.

SENSOR OFF AUDIO

Controls the onset of the audio beep alarm for the “SpO2 Sensor OFF” condition. The selections are ON and OFF.

SAT SECONDS Controls pulse oximetry nuisance alarms (see section 2.4.3.2 for

details on SatSeconds™ features). The selections are OFF, 10, 25, 50 or 100.

When SatSeconds is enabled, the SpO

Low and High Alarm

functions are automatically disabled. As a safety precaution, if three (3) SpO

alarm violations occur within 60 seconds, a priority 2 alarm

will trigger even if the SatSeconds limit has not been reached.

RESTORE

Allows the user to restore the SpO

user default configuration.

DEFAULTS

FIGURE 2-35 Confirmation Dialog Box

Trio™ Operating Instructions 0070-10-0666-01 2 - 41

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Parameter Menus Operations

Nellcor SpO2 Alarm Limits

SpO

HIGH

PATIENT SIZE

Adult (ADU) 80 – 100 [OFF] 50 – 99 [85] 60 – 250 [150] 20 – 120 [45] Pediatric (PED) 80 – 100 [OFF] 50 – 99 [85] 100 – 250 [175] 20 – 150 [70]

* Factory default values shown in brackets.

ALARM (%)

SpO2 LOW ALARM (%)

PR HIGH ALARM (bpm)

PR LOW ALARM (bpm)

NOTE: If the SpO2 alarm high is set to OFF, the alarm OFF

symbol will display in the SpO

-related alarms, which are not physiological, such as functional failures.

2.4.3.2.2 Nellcor SpO2 Troubleshooting

MESSAGE REASON ACTION

SPO2 SENSOR OFF SpO

SPO2 NO SENSOR SpO

SPO2 PULSE SEARCH Hardware settings are being

SPO2 CHECK SENSOR

SPO2 COMMUNICATION ERROR

SPO2 BOARD FAULT SpO

SPO2 MOTION Motion is detected. Decrease patient motion. SPO2 INIT ERR SpO2 module failure. Notify hospital technician or Customer

SPO2 COMM STOP SpO2 module failure or

SPO2 ALM LMT ERR Functional failure. Notify hospital technician or Customer

PR ALM LMT ERR Functional failure. Notify hospital technician or Customer

sensor may be

disconnected from the patient

sensor may be

disconnected from the monitor or the extension cable

adjusted in order to discriminate a pulse waveform

sensor may be defective,

SpO

incompatible, or improperly connected.

The monitor and the SpO modules are not communicating properly

board is not producing

measurement values.

communication error.

parameter tile.

Place the sensor on the patient.

Plug the sensor into the monitor or the extension cable.

Wait several seconds for saturation value to be displayed. If it does not display, do one of the following:

• Change to site where pulse is

• Change or readjust sensor if loose. Reconnect the same sensor or replace

the sensor.

Power the unit OFF/ON. If problem persists, notify hospital technician or Customer Support.

Support Notify hospital technician or Customer

Support

stronger if patient is vasoconstricted.

2 - 42 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

MESSAGE REASON ACTION

SPO2 EXCEED SpO2 value exceeds the

measurement range.

PR EXCEED PR value exceeds the

measurement range.

Check patient, notify physician

Trio™ Operating Instructions 0070-10-0666-01 2 - 43

Parameter Menus Operations

2.4.4 NIBP Monitoring

The Trio utilizes the oscillometric method of measuring Non-Invasive Blood Pressure (NIBP). The measurement includes Systolic (SYS), Diastolic (DIA) and Mean Arterial Pressures (MAP).

Two (2) frequency modes of obtaining measurements are available: MANUAL and INTERVAL. Each mode will display the Systolic (SYS), Diastolic (DIA) and Mean Arterial Pressure (MAP) values in the NIBP tile.

MANUAL MODE Each time a measurement is desired, press the NIBP key on the Trio

keypad to initiate a measurement. Press the NIBP key a second time to stop a measurement already in progress.

INTERVAL MODE Measurements are taken automatically at selected time intervals. The

selections are: CONT (continuous), 1min, 2min, 3min, 4min,

5min, 10min, 15min, 30min, 1HR, 2HRS, 4HRS or OFF. The NIBP key on the Trio keypad must be pressed to initiate the first

measurement of the interval measurement cycle. If the patient is discharged from the monitor while in interval mode, the interval setting will revert to the User Default and the next measurement will be delayed until the NIBP key is pressed. During the delay period, the interval setting will remain displayed in the NIBP numeric tile and the Elapsed Time (ET) will display as “0min”.

CAUTION: Use only approved blood pressure cuffs and hoses with the

CAUTION: A patient's skin is sometimes fragile (i.e. on pediatric and

CAUTION: Please consult a physician for interpretation of blood

CAUTION: A blood pressure measurement can be affected by the

CAUTION: Any condition which may affect the regularity and strength

CAUTION: Observe caution on all patients (Pediatrics and Adults) when

Trio.

pressure measurements.

position of the patient, and his/her physiological condition as well as other factors, such as patient movement.

of arterial pressures (such as patient movement, cardiac arrhythmias, restriction of hose, etc.), will affect the accuracy and ability to measure the NIBP.

2 - 44 0070-10-0666-01 Trio™ Operating Instructions

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Operations Parameter Menus

The initial default cuff inflation pressure is dependent on the patient size setting as follows:

PATIENT SIZE SETTING DEFAULT CUFF INFLATION PRESSURE

Adult 178 ± 5 mmHg Pediatric 133 ± 5 mmHg

After the first successful measurement, the subsequent inflation pressure for the same patient will be 50 ±10 mmHg above the previous systolic pressure measurement.

Upon power ON of the Trio, the NIBP unit of measure defaults to the most recent setting made in the NIBP SETUP menu.

2.4.4.1 Cuff Application

1. Select a blood pressure cuff that is appropriate for the size of the patient. Measure the circumference of the patient's limb for the best results.

NOTE: Using a correctly sized cuff, among other considerations,

has a direct bearing on the accuracy of the obtained NIBP measurements. A cuff that is too narrow for the limb will result in erroneously high readings. Selection of the cuff size should be based on the circumference of the patient’s limb. The design dimensions of the cuffs and their intended use are based on recommendations made by the American Heart Association.

NOTE: Use only the authorized blood pressure cuffs and hoses

listed in section 5.0, “Accessories” with the Trio.

2. Attach the NIBP cuff to the NIBP extension hose.

3. Attach the NIBP extension hose to the NIBP pneumatic fitting on the Trio.

4. Apply the cuff to the patient as shown in FIGURE 2-36. To reduce errors, ensure that the

cuff is deflated and lies directly against the patient's skin. The cuff should fit snugly. There should be no clothing between the patient’s skin and the cuff

CAUTION: The cuff must be properly applied to the patient's limb

before inflating. If it is inflated without being securely wrapped, damage to the cuff can result.

FIGURE 2-36 Application of the Blood Pressure Cuff

Trio™ Operating Instructions 0070-10-0666-01 2 - 45

Parameter Menus Operations

2.4.4.2 Measurement

1. Ensure that the appropriate PATIENT SIZE (Adult or Pediatric) has been selected from the PATIENT SETUP menu accessible from the SYSTEM MENU.

2. Depending on the desired measurement frequency mode, proceed as follows:

Manual Mode Press the NIBP key, located on the front panel keypad, to begin the NIBP measurement.

Interval Mode

a. Open the NIBP SETUP menu by selecting NIBP from the main display using the

Navigator™ Knob. Once in the NIBP SETUP menu, select the INTERVAL Drop- Down menu and choose the desired setting.

b. Press the NIBP key, located on the front panel keypad, to initiate the first

measurement of the interval measurement cycle.

• To initiate a STAT blood pressure at any time between intervals, press the NIBP key on the front panel keypad.

• To exit the Interval Mode, choose OFF from the INTERVAL Drop-Down menu.

NOTE: If CONT (Continuous) is chosen as the interval, the

monitor will take continuous blood pressure readings for five (5) minutes. After 5 minutes, the Trio will automatically revert to an Interval Mode of 5 minutes. The NIBP key on the front panel keypad must be pressed to initiate the new interval.

The cuff begins to inflate. After reaching the default pressure for the selected patient size, the cuff gradually deflates and the Trio collects oscillometric pulsations. During this inflation and deflation portion of the measurement, the current pressure in the cuff is displayed in the lower right corner of the NIBP parameter tile as “CUFF:XXX”.

If a measurement cannot be obtained, the Trio automatically reinflates the cuff to 30 – 60 mmHg higher than the initial inflation pressure, but will not exceed the maximum cuff pressure listed in the “NIBP Sub-System Functional Requirements”, section 6.2.6.5.

The patient should remain still to avoid the introduction of unnecessary motion artifact. After the cuff pressure drops below the diastolic pressure, the measurements are displayed in the NIBP parameter tile. These results will remain displayed in the NIBP parameter tile until the user-definable DISPLAY TIMEOUT interval has been reached or until a new NIBP measurement is obtained. The default DISPLAY TIMEOUT interval is 15 minutes.

NOTE: Pressing the NIBP key while the NIBP measurement is in

progress will stop the measurement and deflate the cuff.

2 - 46 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

ET:5min

CUFF: 100

NIBP

mmHg

108

(84)

Cont measuring...

Interval:OFF

Systolic Value

Mean Value

Status Message

Elapsed Time

(since the last

measurement)

Diastolic Value

Unit of Measure

Current Cuff Pressure

Alarm OFF Symbol

Interval

2.4.4.3 NIBP Display Tile

If ECG and NIBP are selected in the MODULE SETUP menu, NIBP will be displayed in the second parameter tile, beneath the ECG parameter tile. If ECG is not selected in the MODULE SETUP menu, NIBP will be displayed in the first parameter tile. The following data is displayed:

FIGURE 2-37 NIBP Parameter Tile

The following status messages may be displayed during the measurement of NIBP:

MESSAGE CAUSE

Cont measuring… Displayed during Continuous measuring Auto measuring… Displayed during Automatic / Interval measuring Please start Displayed after selecting an INTERVAL in the NIBP SETUP Measurement over Displayed after an NIBP measurement has been manually stopped by

pressing the NIBP key during the measurement.

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Trio™ Operating Instructions 0070-10-0666-01 2 - 47

Parameter Menus Operations

2.4.4.4 NIBP Setup Menu

FIGURE 2-38 NIBP Setup Menu

Accessing the NIBP Setup Menu

To access the NIBP SETUP menu, select NIBP from the NIBP parameter tile using the Navigator™ Knob. Once in the NIBP SETUP menu, use the Navigator Knob to adjust settings. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

NIBP Setup Menu Selections

ALM Allows the user to turn the NIBP alarm ON or OFF. Choose ON to

enable the alarm; choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display to the right of NIBP on the screen. The NIBP alarm is activated when the blood pressure value exceeds set high or low NIBP values.

ALM PRIORITY Allows the user to select the priority of the NIBP alarm. Choices are 1,

2 and 3. Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during a NIBP alarm condition.

Choose ON to enable printing upon NIBP alarm. Choose OFF to disable printing upon NIBP alarm.

SYS ALM HI Allows the user to set the upper limit of the Systolic NIBP alarm. (See

“NIBP Alarm Limits” on page 2-50.)

SYS ALM LO Allows the user to set the lower limit of the Systolic NIBP alarm. (See

“NIBP Alarm Limits” on page 2-50.)

2 - 48 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

MEAN ALM HI Allows the user to set the upper limit of the Mean NIBP alarm. (See

“NIBP Alarm Limits” on page 2-50.)

MEAN ALM LO Allows the user to set the lower limit of the Mean NIBP alarm. (See

“NIBP Alarm Limits” on page 2-50.)

DIA ALM HI Allows the user to set the upper limit of the Diastolic NIBP alarm. (See

“NIBP Alarm Limits” on page 2-50.)

DIA ALM LO Allows the user to set the lower limit of the Diastolic NIBP alarm. (See

“NIBP Alarm Limits” on page 2-50.)

UNITS Allows the user to select the unit of measurement for NIBP. The

selections are mmHg or kPa.

INTERVAL Allows the user to select the interval at which NIBP measurement will

automatically initiate. It also allows the user to turn the automatic measurement OFF. The selections are: CONT (continuous), 1min,

2min, 3min, 4min, 5min, 10min, 15min, 30min, 1HR, 2HRS, 4HRS and OFF.

DISPLAY TIMEOUT

RESTORE DEFAULTS

Allows the user to select the interval at which the NIBP measurement will time-out from the display. The selections are: 15min, 30min, 45min, and 1HR.

NIBP measurement will time-out from the display when the elapsed time exceeds the chosen interval, except during an NIBP alarm condition. The time-out will be suspended until the alarm condition is resolved and will then resume. When the time-out interval has been exceeded, the NIBP measurement is replaced by dashes.

Allows the user to restore the NIBP user default configuration.

FIGURE 2-39 Confirmation Dialog Box

Trio™ Operating Instructions 0070-10-0666-01 2 - 49

Parameter Menus Operations

NIBP Alarm Limits

SYS

PATIENT SIZE

Adult (ADU) 70 – 240

Pediatric (PED) 40 – 180

* Factory default values shown in brackets.

HIGH (mmHg)

[180]

[150]

SYS LOW (mmHg)

50 – 150 [80]

15 – 130 [70]

MEAN HIGH (mmHg)

60 – 200 [100]

50 – 180 [80]

MEAN LOW (mmHg)

40 – 140 [40]

10 – 100 [30]

DIA HIGH (mmHg)

40 – 130 [100]

50 – 100 [80]

DIA LOW (mmHg)

30 – 120 [50]

10 – 50 [40]

Alarms occurring during the process of NIBP measurement include two (2) types: physiological alarms and technical alarms. Physiological alarms occur when the patient’s pressure values are equal to or exceed set alarm limits. Technical alarms are any NIBPrelated alarms, which are not physiological, such as functional failures.

Indirect BP Measurements and Associated Errors

Place the patient in a supine position to obtain true physiological pressure. If the cuff is not at the patient's heart level, the pressure values obtained will not reflect the true physiological pressure. Instead, the readings will be decreased by 0.75 mmHg (0.10 kPa) for every inch above heart level, and increased by 0.75 mmHg (0.10 kPa) for every inch below heart level. This is due to changes in hydrostatic pressure.

Precautions While Making Automatically Cycled Blood Pressure Measurements

Reports have been made of nerve injury occurring from automatically cycled blood pressure measurements. The following practices are recommended when making automatically cycled blood pressure measurements:

• Position and support the limb in such a way as to minimize stretching of affected nerves, as well as, weight exertion on affected nerves

• Avoid cuff placement that applies pressure on the ulnar nerve. Cuff tubing should not exit the cuff over the course of the ulnar nerve at the elbow

• Select a measurement interval that provides adequate venous drainage during cuff deflation

• Periodically inspect the limb bearing the cuff in order to detect venostasis

• If necessary, move cuff to another limb to relieve single-limb stress

Cuff Size

When applying the NIBP cuffs use the range markings as a guide to ensure proper fit and cuff size. Use of a narrow cuff may give erroneous pressure readings. If a standard cuff is applied to an obese patient or a patient with large biceps, the excess tissue will dissipate the applied pressure, requiring additional attempts to collapse the artery. This may result in high pressure readings. Over-wrapping a slender arm may also give erroneous pressure readings due to excessive force exerted on the arm.

2 - 50 0070-10-0666-01 Trio™ Operating Instructions

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Operations Parameter Menus

Other Factors

An accurate determination of blood pressure can be difficult to obtain if a patient's cardiac rhythm is irregular. Irregular cardiac rhythm changes the stroke volume from beat to beat. This changing stroke volume may increase the time it takes to complete a measurement cycle.

Newborn NIBP Technique

Newborn patients present unique obstacles to NIBP measurement. Their vital signs can change frequently and their physiological signals are prone to noise interference. The following suggestions will help to obtain the best possible NIBP measurement.

1. Try to measure infants when they are calm. A kicking/crying baby may disturb or

dislodge the cuff causing noise within the system and as a result, yielding unstable blood pressure readings. If necessary, hold the cuffed limb steady, but do not impede circulation; do not hold onto the cuff and do not pat the cuffed limb to comfort the child.

2. Try placement on the baby's calf. Irritable newborns will react to cuff pressure on the

arm, but may better tolerate placement on the calf. Place the cuff just above the ankle.

3. Use the correct size Newborn and Infant size cuffs. When applying, verify the cuff’s

Index line falls between the Range lines.

4. Use disposable cuffs. Disposable cuffs are more pliant than the reusable ones. They

generally fit smaller infants better.

5. Gently place the cuff on the patient. If the cuff is too snug, it won't work properly. On

infants, the cuff should easily move over the limb.

Trio™ Operating Instructions 0070-10-0666-01 2 - 51

Parameter Menus Operations

2.4.4.5 NIBP Troubleshooting

MESSAGE/ PROBLEM REASON SOLUTION

NS ALM LMT ERR Functional failure Notify hospital technician or

Customer Support

NM ALM LMT ERR Functional failure Notify hospital technician or

Customer Support

ND ALM LMT ERR Functional failure Notify hospital technician or

Customer Support

NIBP SELF TEST ERR NIBP module hardware failure Notify hospital technician or

Customer Support

NIBP COMM ERR Communication with NIBP module has

failed

LOOSE CUFF Cuff is not properly wrapped or no

cuff exists

AIR LEAK Cuff, hose or connector is damaged Check cuff and hose connections,

Internal Leak

AIR PRESSURE ERROR

WEAK SIGNAL Cuff is too loose or patient pulse is too

RANGE EXCEEDED NIBP value exceeds the upper

EXCESSIVE MOTION and/or SIGNAL SATURATED

OVER PRESSURE Pressure has exceeded the specified

PNEUMATIC LEAK During pneumatic test, leak is

NIBP SYSTEM FAI LURE

NIBP TIME OUT Measuring time has exceeded 120

MEASURE FAIL The system cannot perform

Unable to obtain a BP reading

Stable pressure value is not available. e.g. hoses are pinched or occluded

weak

measurement limit Monitor is detecting too much motion

and/or noise to obtain a reading

upper safety limit

detected Operation of blood pressure pump

system failed

seconds

measurement, analysis or calculation Patient movement Wait until patient is calm or gently

Cuff or hose not attached or leaking Check all connections HR irregular / arrhythmia present Check patient, notify physician Blood pressure is out of range Check patient, verify BP with

Incorrect cuff size / brand Measure patient’s limb, verify cuff

Notify hospital technician or Customer Support

Check cuff, reapply if necessary

replace as necessary. If problem persists, notify hospital technician or Customer Support.

Check hoses. If failure persists, notify hospital technician or Customer Support.

Check patient, reapply hose. Notify physician.

Check patient, notify physician

Instruct patient to remain still during the NIBP cuff reading. If patient is agitated, consider trying to take the pressure at a later time when patient is calm.

Try again. If failure persists, notify hospital technician or Customer Support.

Notify hospital technician or Customer Support

Check patient, restart NIBP measurement

hold patient’s limb

manual method, notify physician

size. Use only approved accessories.

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Operations Parameter Menus

2.4.5 Temperature Monitoring

The temperature (TEMP) measurement function of the Trio is designed to take continuous temperature readings from the YSI 400 series probes. One (1) temperature channel is standard on the Trio.

1. If using a disposable temperature probe:

Connect the preferred disposable temperature probe into the reusable temperature cable. Plug the cable into the monitor.

2. If using a reusable temperature probe:

Plug the reusable probe directly into the monitor

3. Follow probe manufacturer's suggested temperature monitoring sites and suggested

procedures for site checks, reapplication and moving of the probes.

4. Check the probe site frequently for position, ensuring good contact with the site chosen.

For example, check the skin probe frequently to ensure good skin contact.

NOTE: A self-test of the temperature measurement is performed

automatically once per hour during the monitoring period. The test procedure lasts approximately 2 seconds and does not affect the normal measurement of the temperature monitoring.

2.4.5.1 Temperature Setup

FIGURE 2-40 Temperature Setup Menu

Accessing the Temperature Setup Menu

To access the TEMP SETUP menu, select TEMP from the TEMP parameter tile using the Navigator™ Knob. Once in the TEMP SETUP menu, use the Navigator Knob to adjust settings. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

Trio™ Operating Instructions 0070-10-0666-01 2 - 53

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Parameter Menus Operations

Temperature Setup Menu Selections

ALM Allows the user to turn the TEMP alarm ON or OFF. Choose ON to

enable the alarm; choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display to the right of TEMP on the screen. The TEMP alarm is activated when the temperature value exceeds set high or low TEMP values.

ALM PRIORITY Enables priority selection for the TEMP alarm. Choices are 1, 2 and

3. Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during a TEMP alarm

condition. Choose ON to enable printing upon TEMP alarm. Choose OFF to disable printing upon TEMP alarm.

TEMP ALM HI Allows the user to set the upper limit of Temperature 1 alarm. (See

“Temperature Alarm Limits” on page 2-54.)

TEMP ALM LO Allows the user to set the lower limit of Temperature 1 alarm. (See

“Temperature Alarm Limits” on page 2-54.)

TEMP UNIT Allows the user to select the unit of measure for temperature. The

selections are degrees Celsius (°C) or degrees Fahrenheit (°F).

RESTORE DEFAULTS

Allows the user to restore the TEMP user default configuration.

FIGURE 2-41 Confirmation Dialog Box

Temperature Alarm Limits

HIGH ALARM (ºC)

Temperature (T1) 35 – 43 [40] 26 – 38 [30] 95 – 109.4 [104] 78.8 – 100.4 [86]

* Factory default values shown in brackets.

LOW ALARM (ºC)

HIGH ALARM (ºF)

LOW ALARM (ºF)

Alarms occurring during the process of temperature measurement include two (2) types: physiological alarms and technical alarms. Physiological alarms occur when the patient’s temperature values are equal to or exceed set alarm limits. Technical alarms are any temperature-related alarms, which are not physiological, such as functional failures.

2 - 54 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

2.4.5.2 Temperature Troubleshooting

MESSAGE/ PROBLEM REASON SOLUTION

T1 SENSOR OFF Temperature cable of channel 1 may

be disconnected from the monitor

TEMP SENSOR OFF

T1 ALM LMT ERR Functional failure Notify hospital technician or

TEMP ALM LMT ERR Functional failure Notify hospital technician or

T1 EXCEED Temperature value of channel exceeds

TEMP EXCEED Temperature value of channel exceeds

Temperature Probes not working

Temperature not displayed

Temperature cable of channel 1 may be disconnected from the monitor

measurement range

measurement range Poor contact from probes to body Check the body surface contact at

Cable not plugged in Check cable and probe

Make sure that the temperature cable is properly connected, check connection between probe and cable

Customer Support

Customer Support Check patient, notify physician

Check patient, notify physician

the probe tip Reposition or apply

thermoconductive gel

Trio™ Operating Instructions 0070-10-0666-01 2 - 55

Parameter Menus Operations

2.4.6 IBP Monitoring (Optional)

Invasive Blood Pressure (IBP) is a direct measurement of the patient's arterial or venous blood pressure. IBP utilizes a catheter that is inserted directly into a vein or artery and is connected to a transducer for interpretation of Systolic (Sys), Diastolic (Dia) and/or Mean Arterial Pressures (MAP).

The user may label the IBP channel according to the insertion site of the catheter or according to the vessel being monitored. To do this select the IBP label, located in the upper left corner of the IBP waveform tile, using the Navigator™ Knob. The labels are: ART, PA, CVP, RAP,

LAP and ICP. The selection of IBP labels will alter the IBP waveform default scale.

LABEL DEFINITION DEFAULT SCALE (mmHg) ART Arterial Blood Pressure 0 – 150 PA Pulmonary Artery Pressure 0 – 100 CVP Central Venous Pressure 0 – 40 RAP Right Atrial Pressure 0 – 40 LAP Left Atrial Pressure 0 – 40 ICP Intracranial Pressure 0 – 40

N O T E : Fo r C V P, RA P, L AP an d I C P on ly the Mean Arterial Pressure is

measured.

NOTE: An arterial pressure catheter should not be used on a limb

that is being utilized for any other medical procedure. For example, an IV catheter, NIBP measurement or SpO readings.

NOTE: Please refer to pressure transducer manufacturer's

instructions for suggested procedures and maintenance. Follow hospital policy regarding catheter insertion, insertion site checks and cleaning.

NOTE: Pressure transducers are protected against the effects of

defibrillation and electrocautery.

NOTE: Please refer to the local hospital policy for requirements for

routine zeroing and calibration of invasive pressure lines.

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Operations Parameter Menus

2.4.6.1 IBP Select Menu

The IBP Select menu allows the user to access two sub-menus: IBP ZERO or IBP SETUP (see FIGURE 2-42).

FIGURE 2-42 IBP Select Menu

Accessing the IBP Select Menu

To access the IBP SELECT menu, select IBP from the IBP parameter tile using the Navigator™ Knob. Once in the IBP SELECT menu, use the Navigator Knob to open the IBP

ZERO menu (to zero the invasive pressure) or IBP SETUP menu. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

Invasive Blood Pressure Monitoring

1. Plug the pressure transducer cable into the IBP connector on the side panel.

2. Connect the catheter line with flushing device to a pressure transducer, making sure the

tubing is free of air bubbles.

3. Zero the pressure transducer:

• Adjust the transducer to the mid-axillary line of the patient's chest (heart level)

• Turn the transducer stopcock to open the transducer vent to atmosphere

•Open the IBP SELECT menu by using the Navigator™ Knob to select IBP on the

display

•Select IBP ZERO from the IBP SELECT menu

• Once in the IBP ZERO menu, select IBP ZERO to zero the invasive line

• A successful message will be displayed in the IBP ZERO menu when the invasive line

has been zeroed successfully

• A failure message will be displayed if the transducer fails to zero

Trio™ Operating Instructions 0070-10-0666-01 2 - 57

Parameter Menus Operations

FIGURE 2-43 IBP Zero Menu

4. Label the Invasive Pressure line

• Use the Navigator™ Knob to select the IBP label located in the upper left corner of the

IBP waveform tile

• Turn the Navigator Knob to scroll through the various labels. Choices are: ART, PA,

CVP, RAP, LAP, and ICP

• Press the Navigator Knob to select the desired label

2.4.6.2 IBP Setup Menu

FIGURE 2-44 IBP Setup Menu

Accessing the IBP Setup Menu

To access the IBP SELECT menu, select IBP from the IBP parameter tile using the Navigator™ Knob. Once in the IBP SELECT menu, use the Navigator Knob to open the IBP SETUP menu. To close the menu, select NORMAL SCREEN (from the menu or the Front Panel Keypad).

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Operations Parameter Menus

IBP Setup Menu Selections

ALM Allows the user to turn the IBP alarm ON or OFF. Choose ON to

enable the alarm; choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display to the right of IBP on the screen. The IBP alarm is activated when the blood pressure value exceeds set high or low IBP values.

ALM PRIORITY Enables priority selection for the IBP alarm. Choices are 1, 2 and 3.

Priority 1 alarms are considered the most serious.

ALM PRINT Enables or disables automatic printing during an IBP alarm condition.

Choose ON to enable report printing upon IBP alarm. Choose OFF to disable printing upon IBP alarm.

SYS ALM HI Allows the user to set the upper limit of the Systolic IBP alarm.

(See “IBP Alarm Limits” on page 2-61.)

SYS ALM LO Allows the user to set the lower limit of the Systolic IBP alarm.

(See “IBP Alarm Limits” on page 2-61.)

MEAN ALM HI Allows the user to set the upper limit of the Mean Arterial Pressure IBP

alarm. (See “IBP Alarm Limits” on page 2-61.)

MEAN ALM LO Allows the user to set the lower limit of the Mean Arterial Pressure IBP

alarm. (See “IBP Alarm Limits” on page 2-61.)

DIA ALM HI Allows the user to set the upper limit of the Diastolic IBP alarm.

(See “IBP Alarm Limits” on page 2-61.)

DIA ALM LO Allows the user to set the lower limit of the Diastolic IBP alarm.

(See “IBP Alarm Limits” on page 2-61.)

SWEEP Adjusts the speed of the IBP waveform on the display. The selections

are 12.5 and 25.0 mm/sec.

UNITS Allows the user to select the units of measurement for IBP. The

selections are mmHg or kPa.

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Parameter Menus Operations

SCALE ADJUST Opens the IBP SCALE ADJUST menu and is used to change the

scale at which the invasive pressure is displayed. Scale should be adjusted to make the waveform as large as possible on the display without clipping or cutting off any part.

To adjust the scale, use the Navigator™ Knob to scroll to the desired area of the scale and select the desired limit. Three (3) scale choices are available: HI, LO and MID. MID allows the user to establish a reference line between the HI and LO set limits of the scale.

RESTORE DEFAULTS

FIGURE 2-45 IBP Scale Adjust Menu

Allows the user to restore the IBP user default configuration.

FIGURE 2-46 Confirmation Dialog Box

2 - 60 0070-10-0666-01 Trio™ Operating Instructions

Operations Parameter Menus

IBP Alarm Limits

IBP LABEL

Adult

ART

Ped

Adult

Ped

Adult

CVP

Ped

Adult

RAP

Ped

Adult

LAP

Ped

Adult

ICP

Ped

* Factory default values shown in brackets.

SYS HIGH (mmHg)

5 – 300 [180]

5 – 240 [150]

5 – 300 [180]

5 – 240 [150]

n/a n/a 5 – 150

n/a n/a 5 – 100

n/a n/a 5 – 150

n/a n/a 5 – 100

n/a n/a 5 – 150

/a n/a 5 – 100

n/a n/a 5 – 150

n/a n/a 5 – 100

SYS LOW (mmHg)

0 – 150 [80]

0 – 130 [70]

0 – 150 [80]

0 – 130 [70]

MEAN HIGH (mmHg)

5 – 150 [100]

5 – 100 [80]

5 – 150 [100]

5 – 100 [80]

[10]

MEAN LOW (mmHg)

- 5 – 100 [40]

- 5 – 50 [30]

- 5 – 100 [40]

- 5 – 50 [30]

- 5 – 100 [0]

- 5 – 50 [0]

- 5 – 100 [0]

- 5 – 50 [0]

- 5 – 100 [0]

- 5 – 50 [0]

- 5 – 100 [0]

- 5 – 50 [0]

DIA HIGH (mmHg)

5 – 140 [100]

5 – 100 [80]

5 – 140 [100]

5 – 100 [80]

n/a n/a

DIA LOW (mmHg)

0 – 120 [50]

0 – 95 [40]

0 – 120 [50]

0 – 98 [40]

Alarms occurring during the process of IBP measurement include two (2) types: physiological alarms and technical alarms. Physiological alarms occur when the patient’s pressure values are equal to or exceed set alarm limits. Technical alarms are any IBP-related alarms, which are not physiological, such as functional failures.

Trio™ Operating Instructions 0070-10-0666-01 2 - 61

Parameter Menus Operations

2.4.6.3 IBP Troubleshooting

MESSAGE/ PROBLEM REASON SOLUTION

SENSOR OFF, FAIL Transducer may be disconnected

during attempt to zero

IN DEMO FAIL Monitor is in DEMO mode during

PRESSURE OVER RANGE, FAIL

PULSATILE PRESSURE, FAIL

IBP SENSOR OFF IBP cable may be disconnected from

IBP INIT ERR1 Module failure Notify hospital technician or

IBP COMM STOP Module failure or communication

IBP COMM ERR Communication error Notify hospital technician or

IBP ALM LMT ERR Functional failure Notify hospital technician or

IBP SYS EXCEED Systolic pressure value exceeds

IBP DIA EXCEED Diastolic pressure value exceeds

IBP MAP EXCEED Mean arterial pressure value exceeds

IBP NEED ZEROCAL

Dampened Invasive Wav efo rm

IBP not Displayed / No Waveform

Abnormally high or low readings

attempt to zero Stopcock not open to atmosphere Turn stopcock to atmosphere prior

Stopcock is not open to atmosphere and a pulsatile pressure has been detected

monitor

failure

measurement range

measurement range Zero calibration must be performed

before measuring IBP

Air bubbles in tubing Eliminate air from tubing Kinked invasive catheter Change position of catheter, check

Catheter against wall of blood vessel Check for leaks at connector, flush

Blood in tubing Pump pressure bag up to

Catheter partially occluded Consult physician Cable not plugged in Check cable connections Transducer not connected Check transducer connections Stopcock turned improperly Check transducer for proper

Transducer not zeroed Check and zero the transducer Transducer too HIGH or too LOW in

relation to patient's heart

Check transducer and cables for connection. If problem persists, notify hospital technician or Customer Support

Turn monitor OFF. Turn ON to return to normal monitoring mode

to zero attempt. If problem persists, notify hospital technician or Customer Support

Turn stopcock to atmosphere prior to zero attempt. If problem persists, notify hospital technician or Customer Support

Make sure that cable is properly connected

Customer Support Notify hospital technician or

Customer Support

Customer Support Check patient, notify physician

Check patient, notify physician

Zero calibration must be performed. Notify hospital technician or Customer Support.

patient

catheter

300 mmHg

alignment

Check patient, adjust transducer, re-zero

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Operations Alarms

2.5 Alarms

The Trio provides audio and visual alarms to indicate:

• The functional status of the monitor

• That the measured parameter values are equal to or exceed the alarm limits

These alarms are divided into three categories: Physiological, Technical and General. Alarms in each category are classified in one of three levels based on their degree of severity. These levels are Priority 1, 2 or 3.

When the Trio is turned ON, an audible tone and the alarm light will indicate that the audio and visual alarm functions of the monitor are working properly. If the tone is not heard and/ or the alarm light does not flash when the unit is turned ON, contact the hospital biomedical technician or a Customer Service representative.

Technical and General alarm messages will display in the message area located in the upper right portion of the Trio display, with the exception of the NIBP technical alarms. NIBP technical alarms will display at the bottom of the NIBP parameter tile.

2.5.1 Alarm Categories

Physiological Alarms

Physiological alarms are alarms prompted by changes in the patient's medical condition. These alarms occur when the patient’s vital signs are equal to or exceed set alarm limits.

Alarm limits are available for Heart Rate (HR), Systolic (SYS) blood pressure, Diastolic (DIA) blood pressure, Mean Arterial Pressure (MEAN), Respiration (RESP), SpO (TEMP). All of these alarm limits have an OFF selection with the exception of SpO low. Each of these parameters has default alarm limits. However, parameter alarm limits can be customized based on the individual patient's needs.

NOTE: In the French configuration, the HR (Heart Rate) alarm is

always ON. It cannot be disabled by turning it OFF.

A physiological alarm will occur when the parameter alarm is set to ON and the measured value is equal to or exceeds the set alarm limit. Alarms will not activate if the alarm is set to

If ALARM PRINT is set to ON for a given parameter, a printed record will automatically be generated when the parameter value is equal to or exceeds the set alarm limits.

Technical Alarms

Technical alarms refer to a communication error or functional failure, which require resolution or attention to continue patient monitoring. Technical alarms are also called System Errors.

and Temperature

alarm

OFF

Upon detecting a system error, the monitor alarms immediately. If more than one (1) technical alarm occurs, each alarm will cycle until the associated error is resolved.

Trio™ Operating Instructions 0070-10-0666-01 2 - 63

Alarms Operations

General Alarms

General alarms are alerts that cannot be classified as physiological or technical, but that require attention. General alarms are not related to patient medical condition.

2.5.2 Alarm Priorities

Alarms in each category (Physiological, Technical or General) are classified based on their degree of severity. The priority determines the frequency of audio and visual alerts. There are two (2) visual alerts: the alarm light and the alarm-related message on the display. For an

ECG Lead Off alarm, the alarm will sound according to the ECG priority setting.

1. Priority One (1) Alarm: This alarm requires an urgent and immediate response from

the clinician. The numeric value of the alarming parameter will flash at a constant rate in black text on a red background. The alarm light will flash red with high frequency. The audio alert cycles once every ten (10) seconds.

2. Priority Two (2) Alarm: This alarm requires a serious response and consideration by

the clinician. The numeric value of the alarming parameter will flash at a constant rate in black text on a yellow background. The alarm light flashes amber with a slow frequency. The audio alert cycles once every 25 seconds.

3. Priority Three (3) Alarm: This alert should be attended to as soon as possible by the

clinician. The numeric value of the alarming parameter displays in black text on a yellow background and does not flash. The alarm light will be amber and does not flash. The audio alert cycles once every 25 seconds.

All physiological alarms can be changed by the clinician. Technical alarm priorities are preset in the system and can not be changed. The alert message for technical alarms displays on a yellow background. To change the parameter alarm priorities, open the individual PARAMETER SETUP menus and select the priority desired. Parameter alarm priorities may also be adjusted in the ALARM SETUP menu.

NOTE: When alarms of different priorities occur simultaneously, the

monitor will display the alarm with the highest priority.

2.5.3 Alarm Setup Menus

The Alarm Setup Menus enable the customization of the COMMON ALARM SETUP as well as the ALARM SETUPs for the following individual parameters: HR, SPO2, NIBP, IBP, RESP, and TEMP.

2.5.3.1 Accessing the Alarm Setup Menus

1. Using the Navigator™ Knob, select ALARM SETUP from the MONITOR SETUP

menu. The default ALARM SETUP menu is the COMMON ALARM SETUP as shown in FIGURE 2-47.

2. Use the ALM SEL Drop-Down menu to access the ALARM SETUP menu for a specific

parameter. The choices are: HR ALARM SETUP, SPO2 ALARM SETUP, NIBP

ALARM SETUP, IBP ALARM SETUP, RESP ALARM SETUP, and TEMP ALARM SETUP. The selected ALARM SETUP menu will determine the other available menu

selections.

NOTE: For more information on parameter alarms and instructions

for setting these alarms, refer to the parameter-specific section of this Operator's Manual.

2 - 64 0070-10-0666-01 Trio™ Operating Instructions

Operations Alarms

COMMON ALARM SETUP Menu Selections

FIGURE 2-47 Common Alarm Setup Menu

ALM SEL

(Alarm Selection)

Choose COMMON ALARM SETUP.

ALARM VOL Volume of the audio alert. Selections are: LOW, MED, and HIGH.

ALM PRINT TIME Length of the printed waveform. Selections are: 8s, 16s, or 32s.

ALM MUTE TIME Length of time for the alarm to be silenced. Selections are:1min,

2min, 5min, 10min, and PERMANENT.

When ALM MUTE TIME is set to PERMANENT and Alarm Mute is active, the message “Alarms Permanently Muted” displays at a constant rate in the technical alarms area.

• If another technical alarm occurs at the same time, both messages will display alternately.

•If the ALM MUTE TIME is changed to something other than PERMANENT, the following conditions will exist:

• The elapsed time is defined as the time from which ALM

MUTE TIME had been set to PERMANENT to the time at which it was changed to something other than PERMANENT.

• If the elapsed time exceeds the newly selected ALM MUTE

TIME, then the Alarm Mute will immediately deactivate. Example: Elapsed time = 5min, New ALM MUTE TIME = 2min, Alarm Mute immediately deactivates.

• If the elapsed time is less than the newly selected ALM

MUTE TIME, then the Alarm Mute will continue to be active for the remainder of the newly selected time period. Example: Elapsed time = 2min, New ALM MUTE TIME = 10min, Alarm Mute continues to be active for 8 minutes and then deactivates.

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Alarms Operations

HR ALARM SETUP Menu Selections

FIGURE 2-48 HR Alarm Setup Menu

ALM SEL

Choose HR ALARM SETUP.

(Alarm Selection)

ALM

NOTE: In the French configuration, the HR

(Heart Rate) alarm is always ON. It cannot be disabled by turning it OFF.

Allows the user to turn the HR (Heart Rate) alarm ON or OFF. Choose ON to enable the alarm; choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display to the right of ECG on the screen. The HR alarm is activated when the heart rate is equal to or exceeds set high or low HR values.

ALM PRIORITY Allows the user to select the priority of the alarm. Choices are 1,

2 and 3. Priority 1 alarms are considered the most serious.

ALM PRINT Allows the user to enable or disable automatic printing during a

physiological alarm condition. Choose ON to enable printing upon alarm. Choose OFF to disable printing upon alarm. See “Recorder (Optional)” on page 2-82 for details.

HR ALM HI Allows the user to set the upper limit of the HR alarm. (See “Heart

Rate Alarm Limits” on page 2-27.)

HR ALM LO Allows the user to set the lower limit of the HR alarm. (See “Heart

Rate Alarm Limits” on page 2-27.)

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Operations Alarms

SPO2 ALARM SETUP Menu Selections

FIGURE 2-49 SPO2 Alarm Setup Menu (Masimo® only)

FIGURE 2-50 SPO2 Alarm Setup Menu (Nellcor® only)

NOTE: See the appropriate subsection of the “SpO2 Monitoring”

ALM SEL

(Alarm Selection)

ALM PRIORITY Allows the user to select the priority of the alarm. Choices are 1,

Trio™ Operating Instructions 0070-10-0666-01 2 - 67

section for the alarm limits

Choose SPO2 ALARM SETUP.

2 and 3. Priority 1 alarms are considered the most serious.

Alarms Operations

ALM PRINT Allows the user to enable or disable automatic printing during a

physiological alarm condition. Choose ON to enable printing upon alarm. Choose OFF to disable printing upon alarm. See “Recorder (Optional)” on page 2-82 for details.

SPO2 ALM HI Allows the user to set the upper limit of the SPO2 alarm. Choices

are 80 – 100% and OFF. Choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display within the parameter tile. The alarm is activated when the measurement equals or exceeds the high limit.

SPO2 ALM LO Allows the user to set the lower limit of SPO2 alarm.

PR ALM HI Allows the user to set the upper limit of the Pulse Rate alarm.

PR ALM LO Allows the user to set the lower limit of the Pulse Rate alarm.

SENSOR OFF AUDIO

SAT SECONDS

(Nellcor® only)

Controls the onset of the audio beep alarm for the “SpO2 Sensor OFF” condition. The choices are ON and OFF.

Controls pulse oximetry nuisance alarms (see section 2.4.3.2 for details on SatSeconds™ features). The selections are OFF, 10, 25, 50 or 100.

When SatSeconds is enabled, the SPO2 Low and High Alarm functions are automatically disabled. As a safety precaution, if three (3) SPO2 alarm violations occur within 60 seconds, a priority 2 alarm will trigger even if the SatSeconds limit has not been reached.

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Operations Alarms

NIBP ALARM SETUP Menu Selections

FIGURE 2-51 NIBP Alarm Setup Menu

ALM SEL

(Alarm Selection)

ALM Allows the user to turn the alarm ON or OFF. Choose ON to

ALM PRIORITY Allows the user to select the priority of the alarm. Choices are 1,

ALM PRINT Allows the user to enable or disable automatic printing during a

SYS ALM HI Allows the user to set the upper limit of the Systolic NIBP alarm.

Choose NIBP ALARM SETUP.

enable the alarm; choose OFF to disable the alarm. If the alarm is set to OFF, the alarm OFF symbol will display within the parameter tile. The alarm is activated when the measurement exceeds the high or low limits.

2 and 3. Priority 1 alarms are considered the most serious.

physiological alarm condition. Choose ON to enable printing upon alarm. Choose OFF to disable printing upon alarm. See “Recorder (Optional)” on page 2-82 for details.

(See “NIBP Alarm Limits” on page 2-50.)

SYS ALM LO Allows the user to set the lower limit of the Systolic NIBP alarm.

(See “NIBP Alarm Limits” on page 2-50.)

MEAN ALM HI Allows the user to set the upper limit of the Mean NIBP alarm.

(See “NIBP Alarm Limits” on page 2-50.)

Trio™ Operating Instructions 0070-10-0666-01 2 - 69

Alarms Operations

MEAN ALM LO Allows the user to set the lower limit of the Mean NIBP alarm.

(See “NIBP Alarm Limits” on page 2-50.)

DIA ALM HI Allows the user to set the upper limit of the Diastolic NIBP alarm.

(See “NIBP Alarm Limits” on page 2-50.)

DIA ALM LO Allows the user to set the lower limit of the Diastolic NIBP alarm.

(See “NIBP Alarm Limits” on page 2-50.)

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Operations Alarms

IBP ALARM SETUP Menu Selections

FIGURE 2-52 IBP Alarm Setup Menu

ALM SEL

(Alarm Selection)

ALM Allows the user to turn the alarm ON or OFF. Choose ON to

ALM PRIORITY Allows the user to select the priority of the alarm. Choices are 1,

ALM PRINT Allows the user to enable or disable automatic printing during a

SYS ALM HI Allows the user to set the upper limit of the Systolic IBP alarm.

Choose IBP ALARM SETUP.

2 and 3. Priority 1 alarms are considered the most serious.

physiological alarm condition. Choose ON to enable printing upon alarm. Choose OFF to disable printing upon alarm. See “Recorder (Optional)” on page 2-82 for details.

(See “IBP Alarm Limits” on page 2-61.)

SYS ALM LO Allows the user to set the lower limit of the Systolic IBP alarm.

(See “IBP Alarm Limits” on page 2-61.)

MEAN ALM HI Allows the user to set the upper limit of the Mean IBP alarm.

(See “IBP Alarm Limits” on page 2-61.)

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Mindray Trio Operating Instructions Manual

Specifications and Main Features

Frequently Asked Questions

User Manual