Mindray BIO Medical electronics EPM User Manual

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User Manual

Patient Monitor

FCC ID: ZLZ-EPM

ePM 15M, ePM 12M, eP

Mindray

M 10M, ePM 15, ePM 12, ePM 10

Shenzhen Mindray BIO-Medical electronics Co.,LTD.

Intellectual Property Statement

WARNING

enzhen Mindray BIO-Medical electronics Co.,LTD.(hereinafter called Mindray) owns the intellectual

property rights to this Mindray product and this manual. This manual may refer to information protected by copyright or patents and does not convey any license under the patent rights or copyright of Mindray, or of others.

Mindray intends to maintain the contents of this manual as confidential information. Disclosure of the information in this manual in any manner whatsoever without the written permission of Mindray is strictly forbidden.

Release, amendment, reproduction, distribution, rental, adaptation, translation or any other derivative work of this manual in any manner whatsoever without the written permission of Mindray is strictly forbidden.

the trademark, registered or otherwise, of Mindray in China and other countries. All other

is trademarks that appear in this manual are used only for informational or editorial purposes. They are the property of their respective owners.

This posting serves as notice under 35 U.S.C.§287(a) for Mindray patents: http://www.mindrayna.com/patents.

Manufacturer’s Responsibility

Contents of this manual are subject to changes without prior notice.

Mindray is responsible for the effects on safety, reliability and performance of this product, only if:

■ all installation operations, expansions, changes, modifications and repairs of this product are conducted by

Mindray authorized personnel;

■ the electrical installation of the relevant room complies with the applicable national and local

requirements;

■ the product is used in accordance with the instructions for use.

• Only skilled/trained clinical professionals should operate this equipment.

• It is important for the hospital or organization that uses this equipment to perform a recommended

Service

Mindray maintains a network of service representatives and factory-trained distributors. Prior to requesting service, perform a complete operational check of the instrument to verify proper control settings. If operational problems continue to exist, contact Mindray service.

In North America contact the Service Department at (800) 288-2121, ext: 8116 for Technical Support or (201) 995-8000 for assistance in determining the nearest field service location.

Please include the instrument model number, the serial number, and a description of the problem with all requests for service.

Any questions regarding the warranty should be directed to the local sales or service representative.

service/maintenance plan. Neglect of this may result in machine breakdown or personal injury.

Preface

Manual Purpose

This manual contains the instructions necessary to operate the product safely and in accordance with its function and intended use. Observance of this manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety.

This manual is based on the maximum configuration and therefore some contents may not apply to the product. If you have any question, please contact Mindray.

This manual is an integral part of the product. It should always be kept close to the equipment so that it can be obtained conveniently when needed.

Intended Audience

This manual is geared for clinical professionals who are expected to have a working knowledge of medical procedures, practices and terminology as required for monitoring of patients.

Illustrations

All illustrations in this manual serve as examples only. They may not necessarily reflect the setup or data displayed on the patient monitor.

Conventions

■ Italic text is used in this manual to quote the referenced manuals, chapters, sections and formulas.

■ Bold text is used to indicate the screen texts and names of hard keys.

■ → is used to indicate operational procedures.

1 Safety

WARNING

CAUTION

NOTE

WARNING

1.1 Safety Information

• Indicates a potential hazard or unsafe practice that, if not avoided, could result in death or serious

injury.

• Indicates a potential hazard or unsafe practice that, if not avoided, could result in minor personal

injury or product/property damage.

• Provides application tips or other useful information that does not involve patient or user risk.

1.1.1 Warnings

• Patient with a pacemaker – on ventricular paced patients, episodes of Ventricular Tachycardia may

not always be detected. Do not rely entirely upon the system’s automated arrhythmia detection algorithm. Keep pacemaker patients under close surveillance.

• This equipment is used for a single patient at a time.

• To avoid explosion hazards, do not use the equipment in the presence of oxygen-rich atmospheres,

flammable anesthetics, or other flammable agents.

• Do not touch the equipment’s metal parts or connectors when in contact with the patient; otherwise

patient injury may result.

• Never mix patient electrode types or brands. Dissimilar metals or other incompatibilities may cause

considerable baseline drift and may increase trace recovery time after defibrillation.

• To reduce the hazard of burns during high-frequency surgical procedure, ensure that the monitor’s

cables and transducers never come into contact with the electro-surgery unit (ESU).

• The neutral electrode of the electro-surgery unit (ESU) shall properly contact the patient. Otherwise,

burns may result.

• MR unsafe: the N Series monitors are not intended to be used within the Magnetic Resonance (MR)

environment.

• Before connecting the equipment to the mains power, ensure that the voltage and frequency ratings

of the power line are the same as those indicated on the equipment’s label or in this manual.

• Before putting the system into operation, the operator must verify that the equipment, connecting

cables, and accessories are in correct working order and operating condition.

• To avoid risk of electric shock, the equipment must only be connected to mains power with

protective earth, or operated on battery power.

• Do not touch the patient and live parts simultaneously. Otherwise patient injury may result.

• Do not touch the patient or metal parts in contact with the patient during defibrillation. Otherwise

serious injury or death could result.

• Do not open the equipment housings. All servicing and future upgrades must be carried out by

trained and authorized personnel.

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• Do not rely exclusively on the audible alarm system for patient monitoring. Turning the alarm

CAUTION

volume to a low level or off may result in a hazard to the patient. Always keep the patient under close surveillance.

• Alarm settings should be customized according to patient situations.

• Do not place the equipment or accessories in any position that might cause it to fall on the patient.

• Do not start or operate the equipment unless the setup was verified to be correct.

• To avoid inadvertent disconnection, route all cables in a way to prevent a stumbling hazard. Wrap

and secure excess cabling to reduce risk of entanglement by patients or personnel. The physiological data and alarm messages displayed on the equipment are for reference only and cannot be directly used for diagnostic interpretation. The equipment should not be used as the sole basis for medical decisions. It must be used in conjunction with clinical signs and symptom. If any measurement seems questionable, first check the patient’s vital signs by alternate means and then check the equipment for proper functioning.

1.1.2 Cautions

• Use only parts and accessories specified in this manual.

• Disposable accessories are not designed to be reused. Reuse may cause a risk of contamination and

affect the measurement accuracy.

• Ensure that the equipment is supplied with continuous electric power during operation from the

mains power or batteries. Sudden power failure may cause data loss.

• When no battery is installed, ensure that the monitor is supplied with continuous electric power

during operation. Sudden power failure may lead to data loss.

• This equipment is intended for single patient use.

• Store and use the equipment in specified environmental condition. The monitor and accessories

may not meet the performance specification due to aging, stored or used outside the specified temperature and humidity range.

• Magnetic and electrical fields are capable of interfering with the proper performance of the

equipment. For this reason make sure that all external devices operated in the vicinity of the equipment comply with the relevant EMC requirements. Mobile phones, X-ray equipment, and MRI devices are possible sources of interference as they may emit higher levels of electromagnetic radiation.

• Always install or carry the equipment properly to avoid damage caused by drops, impacts, strong

vibrations or other mechanical forces.

• Dry the equipment immediately in case of rain or water spray.

• Some settings are password protected and can only be changed by authorized personnel. Contact

your department manager or biomedical engineering department for the passwords used at your facility.

• Do not loop the patient cabling into a tight coil or wrap around the device, as this can damage the

patient cabling.

• Dispose of the package material as per the applicable waste control regulations. Keep it out of

children’s reach.

• At the end of its service life, the equipment, as well as its accessories, must be disposed of in

compliance with the guidelines regulating the disposal of such products. If you have any questions concerning disposal of the equipment, please contact Mindray.

1 - 2

1.1.3 Notes

NOTE

• The equipment software copyright is solely owned by Mindray. No organization or individual shall

resort to modifying, copying, or exchanging it or to any other infringement on it in any form or by any means without due permission.

• Put the equipment in a location where it can be easily viewed and operated.

• The equipment uses a mains plug as isolation means to the mains power. Do not locate the

equipment in a place difficult to access the mains plug.

• During normal use, the operator is expected to face the front of the equipment.

• Remove the battery before shipping the monitor or if it will not be used for an extended period of

time.

• Remove the battery before transporting the equipment or if the equipment will not be used for a

long time.

• The software was developed in compliance with IEC62304, to minimize the possibility of hazards

arising from software errors.

• This manual describes all available features and options. The equipment configuration may not have

all of them.

• Observance of this manual is a prerequisite for proper product performance and correct operation

and ensures patient and operator safety.

• Keep this manual in the vicinity of the equipment so that it can be referenced when needed.

1.2 Equipment Symbols

Symbol Description Symbol Description

General warning sign Refer to instruction manual/booklet

Serial number Catalogue number

Date of manufacture Manufacturer

USB connector Protected against vertically falling water

Battery indicator Computer network

Equipotentiality Alternating current

drops per IEC 60529

Defibrillation-proof type CF applied part Defibrillation-proof type BF applied part

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Symbol Description Symbol Description

Stop USB IBP zero key

NIBP start/stop Calibration

Unlocking Menu

Power On/Off Graphical record

Gas outlet Gas inlet

Output Input/output

Pushing prohibited Non-ionizing electromagnetic radiation

Authorised representative in the European Community

Conforms to ANSI Std. ES60601-1, IEC Std. 60601-1-8, IEC Std. 60601-2-25, IEC Std. 60601-2-26, IEC Std. 606012-27, IEC Std. 80601-2-30, IEC Std. 60601-2-34, IEC Std. 60601-2-49, ISO Std. 0601-2-55, ISO Std. 80601-2-56, and ISO Std. 80601-2-61

Certified to CAN/CSA Std. C22.2 No. 60601-1, No. 60601-1-6, No. 60601-1-8, No. 60601-2-25, No. 60601-2-26, No. 60601-2-27, No. 80601-2-30, No. 60601-2-34, No. 60601-2-49, No. 80601-2-55, No. 80601-2-56, and No. 80601-2-61

Dispose of in accordance to local requirements

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2 Equipment Introduction

2.1 Indications for Use

The ePM 10M/ePM 12M/ePM 15M patient monitor, hereafter called the monitor, is intended to be used for monitoring, displaying, reviewing, storing, alarming and transferring of multiple physiological parameters including ECG (3-lead, 5-lead, 6-lead, and 12-lead selectable, arrhythmia detection, ST segment analysis, QT/QTc monitoring, and heart rate (HR)), respiration (Resp), temperature (Temp), pulse oxygen saturation (SpO rate (PR), non-invasive blood pressure (NIBP), invasive blood pressure (IBP), cardiac output (C.O.), carbon dioxide (CO2), oxygen (O2), anesthetic gas (AG) and bispectral index (BIS). The monitor also provides an interpretation of resting 12-lead ECG.

All the parameters can be monitored on single adult, pediatric, and neonatal patients except for the following:

■ C.O. monitoring is intended for adult patients only.

■ The arrhythmia detection and PAWP monitoring are intended for adult and pediatric patients only.

The monitor is to be used in healthcare facilities by clinical professionals or under their guidance. They should only be used by persons who have received adequate training in their use. The monitor is not intended for helicopter transport, hospital ambulance, or home use.

2.2 Applied Parts

), pulse

The applied parts of the monitor are:

■ ECG electrode and leadwire

■ SpO

■ Temp probe

■ NIBP cuff

■ IBP transducer

■ C.O. sensor

■ CO

■ AG sampling line, water trap, airway adapter, and mask

sensor

sampling line/nasal sampling cannula, water trap, and mask

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2.3 System Components

NOTE

(9) (8) (7)

(2)

(1)

(6) (5) (4) (3)

The monitor consists of the main unit, display, external modules, input devices and output devices.

• The monitor may not include all these components. Contact the local service personnel for available

components.

2.3.1 Main Unit

The main unit processes data from modules.

2.3.1.1 Front View

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(1) Alarm lamp

When a physiological alarm or technical alarm occurs, this lamp lights and flashes corresponding with the alarm priority:

◆ High priority alarms: the lamp quickly flashes red.

◆ Medium priority alarms: the lamp slowly flashes yellow.

◆ Low priority alarms: the lamp lights in cyan without flashing.

(2) Display

(3) NIBP Start/Stop hard key

Press to start an NIBP measurement or stops the current NIBP measurement.

(4) Record Start/Stop key

Press to start a recording or stop the current recording.

(5) Alarm Pause hard key

Press to pauses the current alarms

(6) Alarm Reset hard key

Press to acknowledge the on-going alarm.

(7) Power indicator

2.3.1.2 Left View

(2) (3) (4)

(1)

(8) (7) (6)

(5)

◆ On: when the AC power is connected.

◆ Off: when the AC power is not connected.

(8) Battery indicator

◆ Yellow: the battery is being charged.

◆ Green: the battery is fully charged.

◆ Flashing green: the monitor operates on battery power.

◆ Off: no batter y is installed, or the battery is malfunctioning, or the monitor is powered off and

no power is connected.

(9) Power switch

◆ Pressing this switch turns on the monitor.

◆ When the monitor is on, pressing and holding this switch turns off the monitor.

(1) Temperature probe connector (2) SpO

(3)IBP cable connector (4) ECG cable connector

(5) CO

watertrap seat (6) NIBP cuff connector

(7) Gas outlet (8) C.O. cable connector

probe connector

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2.3.1.3 Right View

(2)

(1)

(2) (3) (4) (5) (6) (7)

(1)

(1) Handle (2) Recorder

2.3.1.4 Rear View

(1) Alarm lamp

When a physiological alarm or technical alarm occurs, this lamp lights and flashes corresponding

with the alarm priority:

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◆ High priority alarms: the lamp quickly flashes red.

◆ Medium priority alarms: the lamp slowly flashes yellow.

◆ Low priority alarms: the lamp lights in cyan without flashing.

(2) AC Power input

(3) Equipotential Grounding Terminal

When using the monitor together with other devices, connect their equipotential grounding

terminals together to eliminate the potential difference between them.

(4) Network Connector

(3)

(4)

(1) (2)

It is a standard RJ45 connector which connects the monitor to the central monitoring system (CMS) or other network devices.

(5) USB connectors

It connects USB devices, for example the barcode reader.

(6) VGA Connector

It connects It connects a external display, which extends the display capability of your monitor. The contents displayed on the external display screen accords with those displayed on the monitor screen.

(7) Multifunctional Connector

It outputs defibrillator synchronization signals, nurse call signals and analogy output signals.

2.3.2 External Modules

The external modules are used to monitor the patient’s physiological parameters, record patient information and data, and connect external devices. The monitor provides the following modules:

■ Parameter modules: acquires and processes the patient’s data and sends the data to the main unit.

■ BeneLink module: connects external devices. The monitor outputs data from external devices through the

BeneLink module.

2.3.2.1 Available Modules

Refer to 29Accessories for available modules.

The monitor can simultaneously use maximum of two IBP modules. The other modules can only be used one at a time. Otherwise, the monitor will issue a module conflict prompt.

For example, if a CO2 module is already loaded and then another CO2 module is inserted, the monitor will then prompt module conflict. To solve the problem of module conflict, just remove a module.

2.3.2.2 Example Module

The parameter modules have similar structure:

■ The parameter label is marked at the upper left corner.

■ Hard keys are located on the upper part.

■ Patient cable connectors are located at the lower part.

Take the IBP module as an example:

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(1) Setup hard key: enters or exits the IBP Setup menu.

(2) Zero hard key: enters the Zero IBP menu.

(3) Module status indicator

◆ On: the module works properly.

◆ Flashing: the module is initializing.

◆ Off: the module is not connected or the module fails.

(4) Patient cable connectors

2.3.3 Input Devices

The monitor allows data entry through touchscreen, remote controller, hardkey and barcode reader.

You can only use Mindray specified input devices.

2.3.4 Printing Devices

You can use Mindray specified printer and/or recorder to output patient information and data.

The monitor is configured with a build-in recorder.

The printer can be connected to the monitor through the network to output patient reports.

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3 Getting Started

WARNING

CAUTION

NOTE

3.1 Equipment Preparation Safety Information

• Use only installation accessories specified by Mindray.

• Connect only approved devices to this equipment. Devices connected to the equipment must meet

the requirements of the applicable IEC standards (e.g. IEC 60950 safety standards for information technology equipment and IEC 60601-1 safety standards for medical electrical equipment). The system configuration must meet the requirements of the IEC 60601-1 medical electrical systems standard. Any personnel who connect devices to the equipment’s signal input/output port are responsible for providing evidence that the safety certification of the devices has been performed in accordance to the IEC 60601-1. If you have any questions, please contact Mindray.

• If it is not evident from the equipment specifications whether a particular combination with other

devices is hazardous, for example, due to summation of leakage currents, please consult the manufacturer or an expert in the field. A determination must be made that the proposed combination will not negatively affect the devices themselves or the patient's safety.

• The equipment should be installed by Mindray authorized personnel.

• When disposing of the packaging material, be sure to observe the applicable waste control

regulations and keep it out of children’s reach.

• Before use, verify whether the packages are intact, especially the packages of single use accessories.

In case of any damage, do not apply it to the patient.

• Make sure that the equipment operating environment meets the specific requirements. Otherwise

unexpected consequences, e.g. damage to the equipment, could result.

• Avoid rough handling during transport.

• Put the equipment in a location where it can be easily viewed and operated.

• Keep this manual in the vicinity of the equipment so that it can be referenced when needed.

• Save the packing case and packaging material as they can be used if the equipment must be

reshipped.

• Many settings in the patient monitor are password protected. It is recommended to change the

default passwords and keep the passwords safe. Passwords should only be changed by authorized personnel. Contact the department manager or biomedical engineering department for the passwords used at the facility.

3.2 Monitor Installation

The monitor can be installed in various ways as required.

■ Wall mount

■ Placed on desk

■ Trolley tray

■ Bedrail clamp

■ Bedrail hook

3 - 1

3.2.1 Unpacking and Checking

WARNING

CAUTION

NOTE

Before unpacking, examine the packaging carefully for signs of damage. If any damage is detected, contact the carrier, distributor, or Mindray.

If the packing case is intact, open the package and remove the equipment and accessories carefully. Check all materials against the packing list and check for any mechanical damage. Contact Mindray in case of any problems.

3.2.2 Environmental Requirements

The operating environment of the equipment must meet the requirements specified in this manual.

The environment where the equipment is used shall be reasonably free from noises, vibration, dust, corrosive, flammable and explosive substances. Moreover, to maintain good ventilation, the equipment shall be at least 2 inches (5cm) away from the walls of the cabinet.

When the equipment is moved from one place to another, condensation may occur as a result of temperature or humidity difference. In this case, never start the system before the condensation evaporates.

3.3 Setting Up the Equipment

Observance of this manual is a prerequisite for proper product performance and correct operation. It ensures patient and operator safety.

3.3.1 Connecting the AC Mains

The monitor is powered by an AC power supply. Before connecting the equipment to the AC mains, check that the voltage and frequency ratings of the power line are the same as those indicated besides the AC power input.

To use the AC power source, follow this procedure:

1. Connect the female end of the power cord with the AC power input.

2. Connect the male end of the power cord with a wall AC outlet.

3. Check that the AC indicator is on.

The AC indicator is off if the AC mains is not connected. When AC mains is connected, the AC indicator is illuminated in green.

• Operate the equipment on battery power if the integrity of the protective earth conductor or the

protective earthing system in the installation is in doubt.

• Always use the accompanying power cord delivered with the monitor.

• Before connecting the equipment to the AC mains, ensure that the voltage and frequency ratings of

the power line are the same as those indicated besides the AC power input.

• Use the cable retainer to secure the power cord to prevent it from falling off.

3 - 2

3.3.2 Connecting the Input Devices

Connect the barcode reader to the USB port if necessary.

3.3.3 Connecting the Parameter Module

To connect the parameter module, follow this procedure:

1. Push the module rack door open, and then push it until you hear a click.

2. With the module properly oriented, align the module insertion guide slot with the module rack insertion guide. Push the module into the module rack until you hear a click.

3. Push the lock at the bottom of the module inwards to lock the module.

3.3.4 Removing the Parameter Module

To remove the parameter module, follow this procedure:

1. Pull outwards the lock at the bottom of the module to release the module.

2. Lift the latches at the bottom of the module and slide the module out of the module rack. Hold on the module to make sure it does not drop when it comes out.

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CAUTION

• When removing the module, be careful not to drop it. Always support with one hand while pulling

CAUTION

out with the other.

3.4 Turning on the Monitor

Before beginning measurements, turn on the monitor. Perform the following inspections:

1. Check the monitor and modules for any mechanical damage. Make sure that all external cables, plug-ins and accessories are properly connected.

2. Connect the power cord to the AC power source.

Pressing the power switch turns on the monitor.

• Check that visual and auditory alarm signals are presented correctly when the equipment is

powered on.

• Do not use the monitor on a patient if you suspect it is not working properly, or if it is mechanically

damaged. Contact the service personnel or Mindray.

3.5 Operation and Navigation

Everything needed to operate the monitor is on its screen. Almost every element on the screen is interactive. Screen elements include parameter values, waveforms, quick keys, information fields, alarms fields, dialogs, and menus. Often you can access the same element in different ways. For example, you can access a parameter dialog by selecting the corresponding numeric area or waveform area, through the Menu hard key on the parameter module, or through the Parameter Setup quick key.

3.5.1 Using the Touchscreen

You can use the touchscreen to select a screen element by pressing directly on the monitor’s screen.

To avoid accidental use, you can temporarily disable the touchscreen by holding and pressing the Main Menu quick key and sliding as directed by the arrow. A padlock symbol displays at the top of the main menu quick key if the touchscreen is disabled.

The touchscreen lock period is configurable. To do so, follow this procedure:

1. Access Display in either of the following ways:

◆ Select the Screen Setup quick key → select the Display tab.

◆ Select the Main Menu quick key → from the Display column select Display.

2. Set Screen Lock Duration.

The touchscreen is enabled when the preset time is reached. To manually enable the touchsceen, hold and press the Main Menu quick key and slide as directed by the arrow.

• Check that the touchscreen is not damaged.broken, or loose. If there is any sign of damage, stop

using the monitor and contact the service personnel.

3.5.2 Using the On-Screen Keyboard

The on-screen keyboard enables information entry:

■ Enter the information by selecting one character after another.

■ Select the Backspace key to delete single characters or select to delete the entire entry.

■ Select the Caps Lock key to access uppercase letters.

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■ Select the Enter key to confirm the entry and close the on-screen keyboard.

NOTE

(1) (2) (3) (4) (5)

(7)

(9)

(6)

(8)

3.5.3 Using the Barcode Reader

The monitor supports both a linear (1D) barcode reader and two-dimensional (2D) barcode reader. The barcode reader is connected to the monitor’s USB connector.

If you are using the Mindray custom 2D barcode reader (Model HS-1R or HS-1M), before using the it for the first time, clear old data formats and configure the barcode reader.

• The Mindray custom barcode reader can scan both 2D and 1D barcodes. Other barcode readers can

only output the patient’s medical record number (MRN) and visit number.

3.5.3.1 Clearing Old Data Formats (for the Mindray Custom 2D Barcode Reader)

Before using the Mindray custom barcode reader for the first time, clear old data formats. To do so, follow this procedure:

1. Scan the following engineering barcode to clear the previous data format.

2. Scan the 2D engineering barcode which contains the hospital’s data format.

• Contact the scanner manufacturer or Mindray for obtaining the engineer barcodes for clearing data

formats and programming the hospital’s data format.

3.5.4 Using the Remote Controller

The remote controller can control the monitor by connecting the receiver of the remote controller to the monitor’s USB connector. For more information on how to use the remote controller, see the Instructions for Use delivered with the remote controller.

3.6 Screen Display

The following figure shows the normal screen:

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(1) Patient information area: displays patient information, including patient category, gender, department, room

number, bed number, and so on. The displayed patient information is configurable. Selecting this area enters the Patient Management menu. For more information, see 5.3Managing Patient Information.

(2) The current configuration

(3) Technical alarm information area: displays prompt messages on the above; displays technical alarm messages

at the bottom.

(4) Physiological alarm information area: displays high priority physiological alarms on the above; displays

medium and low priority physiological alarms at the bottom.

(5) System status information area: displays alarm symbol, battery status, network status, currently connected

CMS, storage device status, and system time. For more information, see 3.6.1On-screen Symbols.

(6) Parameter numerics area: displays parameter values, alarm limits, and alarm status. This area also displays

parameter list. Selecting a parameter numeric block enters corresponding parameter menu. Selecting the parameter list enters tabular trend review. For more information, see 3.9.3Displaying the Parameter List.

(7) Quick key area: displays selected quick keys.

(8) Parameter waveform/numerics area: displays parameter waveforms, parameter values, alarm limits, and alarm

status. This area also displays parameter list. Selecting a parameter numeric area or waveform area enters corresponding parameter menu. Selecting the parameter list enters tabular trend review. For more information, see 3.9.3Displaying the Parameter List.

(9) Parameter waveform area: displays parameter waveforms and parameter alarms. Select a waveform enters

corresponding parameter menu. For more information, see 3.9.3Displaying the Parameter List.

3.6.1 On-screen Symbols

The following table lists the on-screen symbols displayed on the system status information area:

Symbol Description Symbol Description

Adult, male Adult, female

Pediatric, male Pediatric, female

Neonate, male Neonate, female

Wireless network is connected. The solid part indicates network signal strength.

Wired network is connected. Wired network is not connected.

All the alarms are paused. Individual physiological alarms are turned off

Wireless network is not connected.

or the monitor is in the alarm off status.

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Audible alarm tones are paused. Audible alarm tones are turned off.

Symbol Description Symbol Description

(1)

(2)

(3)

(4)

(5)

(6)

3.6.2 Dialogs

All dialogs have similar style and structure, see the figure below:

Alarms are acknowledged and the alarm system is reset.

The battery has low power and needs to be charged.

The battery is being charged. No battery is installed.

The battery is working correctly. The green portion represents the remaining charge.

The battery has critically low charge and needs to be charged immediately. Otherwise, the monitor will soon automatically shut down soon.

3.6.3 Quick Keys

The monitor provides quick keys to allow quick access to some functions. The quick key area is located at the bottom of the screen. The Main Menu key is permanently located the right, and the More key is permanently located at the left. Selecting the More quick key shows more quick keys. The quick keys displayed on the screen are configurable.

(1) Dialog heading

(2) Tabs

(3) Operation buttons

(4) Exit button: closes the current dialog.

(5) Main body area: includes dialog items and options.

(6) Switch:

◆ Green: the switch is on.

◆ Gray: the switch is off.

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3.6.3.1 Available Quick Keys

The following table shows available quick keys.

Symbol Label Function Symbol Label Function

Main Menu Enters the main menu. More Shows more quick keys.

Alarm Setup Enters the Alarm dialog. Alarm Reset Acknowledges ongoing

Audio Pause Pauses alarm tone. Discharge

Review Enters the Review dialog. Standby Enters Standby mode.

Patient Management

NIBP Start/ Stop

NIBP STAT Starts a five-minute

Zero IBP Enters the Zero IBP dialog. C.O. Measure Opens the C.O.

Enters the Patient Management dialog.

Starts an NIBP measurement or stops the current NIBP measurement.

continuous NIBP measurement.

Patie nt

Screen Setup Enters the Screen Setup

Stop All Stops all NIBP

NIBP Measure Enters the NIBP Measure

alarms and reset the alarm system.

Enters the Discharge

Patient

dialog.

measurements.

dialog.

Measure

screen.

PAW P E nters the PAWP screen. Venipuncture Inflates the NIBP cuff to

help venous puncture.

Param eters Setup

Manual Event Manually triggers and

OxyCRG Opens the OxyCRG screen. ECG Full-

Privacy Mode Enters Privacy mode. Night Mode Enters Night mode.

Intubation Mode

Enters the Parameters Setup dialog.

saves an event.

Enters the intubation mode.

Remote View Opens the Remote View

screen.

Minitrends Enters the

screen.

Enters the ECG full screen.

Screen

Unit Enters the Unit dialog.

Minitrends

3 - 8

Symbol Label Funct ion Symbol Label Func tion

Volume Enters the Vol ume dialog. Freeze Freezes waveforms.

Calculations Enters the Calculations

dialog.

Print Starts printing a real-time

report.

ECG Lead/Gain Enters the ECG Lead/Gain

dialog.

GCS

Discharged Patients

CPB Mode Enters the CPB mode. Integrated

Enters the GCS dialog.

Enters the Discharged

Patients

dialog.

Load Config Enters the Load Config

Record Starts/Stops a recording.

Call Help Sends the Call Help signal

EWS

ECG 24h Sum Views the 24-hour ECG

Devices

dialog.

over the network.

Enters the EWS screen.

summary.

Enters the Integrated

Device screen

3.6.3.2 Configuring the Displayed Quick Keys

To select the quick keys for display, follow this procedure:

1. Access Quick Key in either of the following ways:

◆ Select the Screen Setup quick key → the Select Quick Keys tab.

◆ Select the Main Menu quick key → from the Display column select Quick Keys.

2. Select the Current tab to configure the quick keys for display on the screen: From the top of this page,

select a block location to show a certain quick key, and then select the quick key from the quick key list. For example, to show the Screen Setup quick key at the first block, select the first block, and then select Screen Setup from the list.

3. Select the More tab to configure the quick keys for display when the More quick key is selected.

3.7 Operating Modes

The monitor provides different operating modes. This section describes the different monitoring modes and standby modes.

3.7.1 Monitoring Mode

Monitoring mode is the most frequently used clinical mode for patient monitoring. When the monitor is turned on, it automatically enters Monitoring mode.

3.7.2 Privacy Mode

Privacy mode is a special clinical monitoring mode. In Privacy mode, the monitor does not display patient information and monitoring data. This provides controlled access to patient data and ensures confidentiality.

Privacy mode is only available when the patient admitted by the monitor is also monitored by the CMS. The monitor continues monitoring the patient, but patient data is only visible at the CMS.

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3.7.2.1 Entering Privacy Mode

WARNING

NOTE

CAUTION

To enter Privacy mode, choose either of the following ways:

■ Select the Privacy Mode quick key → select OK.

■ Select the Main Menu quick key → from the Display column select Privacy Mode → select OK.

The monitor has the following features after entering Privacy mode:

■ The screen turns blank.

■ Except for the low battery alarm, the monitor inactivates alarm tones and alarm lights for all other alarms.

■ The monitor suppresses all system sounds, including heart beat tone, pulse tone, and prompt tone.

• In Privacy mode, all audible alarms are suppressed and the alarm light is deactivated at the monitor.

Alarms are presented only at the CMS. Pay attention to potential risk.

• Privacy mode is not available if the Department is set to OR.

• You cannot enter Privacy mode if a low battery alarm is active.

3.7.2.2 Exiting Privacy Mode

The monitor automatically exit Privacy mode in any of the following situations:

■ The monitor disconnects from the CMS.

■ The low battery alarm occurs.

You can also operate the touchscreen, mouse, or keyboard to manually exit Privacy mode.

3.7.3 Night Mode

Night mode is a special clinical monitoring mode used to avoid disturbing the patient. Night mode reduces screen brightness, sound volumes, and pauses NIBP measurements.

3.7.3.1 Entering Night Mode

To enter Night mode, follow this procedure:

1. Select the Night Mode quick key, or select the Main Menu quick key → from the Display column select Night Mode.

2. Change Night mode settings if necessary.

3. Select Enter Night Mode.

Night mode settings are as follows by default:

■ Brightness: 1

■ Alarm Volume: 2

■ QRS Volume: 1

■ Key Volume: 0

■ NIBP End Tone: Off

■ Stop NIBP: Off

• Verify Night mode settings before entering Night mode. Pay attention to the potential risk if the

setting value is low.

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3.7.3.2 Exiting Night Mode

NOTE

WARNING

To cancel Night mode, follow this procedure:

1. Select the Night Mode quick key, or select the Main Menu quick key → from the Display column select Exit Night Mode.

2. Select OK.

• If the monitor is connected to the CMS, it automatically exits Night mode when being disconnected

from the CMS.

• The monitor resume the previous settings after exiting Night mode.

3.7.4 Standby Mode

Standby mode can Temporarily stop patient monitoring without switching off the monitor.

3.7.4.1 Entering Standby Mode

1. Select the Standby quick key, or select the Main Menu quick key → from the Patient Management column select Standby.

2. Set Location to define where the patient is when the monitor enters Standby mode.

3. Select OK.

The monitor behaves as follows after entering Standby mode:

■ Stops all parameter measurements.

■ Disables all the alarms and prompt messages, except for the battery low alarm.

■ Turns screen brightness to the dimmest after entering Standby mode for 30 seconds.

• Pay attention to the potential risk of placing the monitor to standby. In Standby mode, the monitor

stops all parameter measurements and disable all the alarm indications, except for the battery low alarm.

3.7.4.2 Changing the Patient Location at Standby

To change the patient’s location, select Location from the Standby screen.

3.7.4.3 Exiting Standby Mode

To exit Standby mode, choose any of the following ways:

■ Select Resume Monitor to exit Standby mode and resume monitoring the current patient.

■ Select Discharge Patient to discharge the current patient.

■ Select New Patient to exit Standby mode and admit a new patient.

If the monitor automatically enters Standby mode after a patient is discharged, choose any of the following ways to exit Standby mode:

■ Select New Patient to exit Standby mode and admit a new patient.

■ Select Pre-admit to enter the patient information for preparing to admit a new patient.

3.7.5 Discharge Mode

Discharge mode is a special Standby mode after a patient is discharged.

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3.8 Configuring the Monitor

CAUTION

NOTE

Configure the monitor before putting it in use.

3.8.1 Setting the Date and Time

To set the system time, follow this procedure:

1. Select the Main Menu quick key → from the System column select Time.

2. Set Date and Time.

3. Set Date Format.

4. Switch off 24 Hour Time to use the 12-hour mode.

5. Switch on Daylight Savings Time to use daylight savings time. You can manually switch on or off the

daylight saving time only when the auto daylight savings time function is disabled. For more information, see 3.8.2Adjusting the Screen Brightness for details.

If the monitor is connected to a central monitoring system (CMS) or hospital clinical system (HIS), the date and time are automatically taken from the CMS. In this case, you cannot change the date and time on the monitor.

• Changing the date and time affects the storage of trends and events and may result in loss of data.

3.8.2 Adjusting the Screen Brightness

The brightness of the primary screen and secondary screen can be adjusted separately. To adjust the screen brightness, follow this procedure:

1. Access Display in either of the following ways:

◆ Select the Screen Setup quick key → select the Display tab.

◆ Select the Main Menu quick key → from the Display column select Display.

2. Set Brightness for the corresponding display.

• Screen brightness automatically changes with ambient light level when Brightness is set to Auto.

3.8.3 Adjusting the Volume

■ Set Alarm Volume in either of the following ways:

◆ Select the Volu me quick key.

◆ Select the Main Menu quick key → from the Alarm column select Setup.

■ Set Reminder Volume by selecting the Main Menu quick key → from the Alarm column select Setup.

■ Set QRS Volume in any of the following ways:

◆ Select the Volu me quick key.

◆ From the ECG dialog select Setup.

◆ From the SpO

■ Select the Volu me quick key to set Key Volume.

dialog select PR Setup.

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3.9 General Operation

NOTE

This section describes the operations that are generally used when monitoring a patient.

3.9.1 Switching On or Off a Parameter

You can also manually switch on or off a parameter when its module is connected. If setting parameter switches is not password protected, follow this procedure to set parameter switches:

1. Access Parameters On/Off in either of the following ways:

◆ Select the Screen Setup quick key → select the Parameters On/Off tab.

◆ Select the Main Menu quick key → from the Parameters column select Parameters On/Off.

2. Enable or disable desired parameters.

When a parameter is switched off, the monitor stops data acquisition and alarming for this measurement.

• When a parameter is manually switched off and the corresponding parameter module is plugged in,

you cannot monitor this parameter.

3.9.2 Displaying Parameter Numerics and Waveforms

Configure the parameter numerics, waveforms, and their sequence displayed on the normal screen by following this procedure:

1. Access Tile Layout in either of the following ways:

◆ Select the Screen Setup quick key → select the Tile Layout tab.

◆ Select the Main Menu quick key → from the Display column select Tile Layout.

2. Select a parameter numeric area or waveform area, and then from the popup list select an element to display in this area. The parameters and waveforms not selected will not displayed.

If you are using the independent secondary display, you can select parameter and waveform locations on the secondary display.

• ECG parameters and waveform are always displayed on the first line of the parameter numeric area

and waveform area.

3.9.3 Displaying the Parameter List

You can display trends of HR, SpO2, RR, and NIBP/IBP in the parameter numerics area. To do so, follow this procedure:

1. Access Tile Layout in either of the following ways:

◆ Select the Screen Setup quick key → select the Tile Layout tab.

◆ Select the Main Menu quick key → from the Display column select Tile Layout.

Select the parameter numerics area where you want to display the parameter list, and then from the popup list select Parameter List.

3.9.4 Accessing Parameter Setup Dialogs

Each parameter has a setup dialog to allow adjusting the alarm and parameter settings. Enter a parameter setup dialog by using any of the following methods:

■ Select the parameter numeric area or waveform area.

■ Press the setup hard key on the module front.

■ Select the Parameter Setup quick key, and then select the desired parameter.

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■ Select the Main Menu quick key → from the Parameters column select Setup → select the desired

NOTE

parameter

• In this manual, the first method is normally used to enter the setup dialog. But you can use any

method you prefer.

3.9.5 Changing Measurement Colors

Set the color of measurement values and waveforms for each parameter by following this procedure:

1. Select Main Menu quick key → from the Parameters column select Parameter Color.

2. Select the Current tab and set the colors of the currently monitoring measurement values and waveforms.

3. Select the All tab and set the colors of measurement values and waveforms for all parameters.

3.10 Freezing Waveforms

During patient monitoring, the freeze feature allows you to freeze the currently displayed waveforms on the screen so that you can have a close examination of the patient’s status. Additionally, you can select any frozen waveform for recording.

3.10.1 Freezing Waveforms

To freeze waveforms, select the Freeze quick key. Except waveforms of the following screens, all displayed waveforms stop refreshing and scrolling after you select the Freeze quick key:

■ Minitrends screen

■ OxyCRG screen

■ Remote View screen

■ EWS screen

3.10.2 Viewing Frozen Waveforms

To view the frozen waveforms, follow this procedure:

■ Select the or button in the Freeze screen.

■ Slide the frozen waveform leftward or rightward.

At the lower right corner of the bottom-most waveform displays the freeze time. The initial frozen time is 0 s. With the waveforms scrolling, the freeze time changes at an interval of 1 second. For example, -2 s means two seconds before the frozen time. This change will be applied for all waveforms on the screen.

• You can view the frozen waveforms of up to 120 seconds.

3.10.3 Unfreezing Waveforms

To unfreeze the frozen waveforms, select the button at the upper right corner of the Freeze Big

Numerics.

3.10.4 Printing Frozen Waveforms

To print the frozen waveforms, select the button at the upper left corner of the Freeze Big Numerics.

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3.11 Checking Software Licenses

NOTE

To run the following functions in the monitor, software licenses are required:

■ Early Warning Score (EWS)

■ ECG 24H Summary

To check the licenses, select the Main Menu quick key → select License → Local.

To install the licenses, follow this procedure:

1. Connect the USB drive with the licenses in to the monitor’s USB connector.

2. Select the Main Menu quick key →select License → select External.

3. Select Install.

3.12 Capturing the Screen

The monitor provides the function of screen capture. To capture the current screen display, follow this procedure:

1. Connect the USB drive to the monitor’s USB connector.

2. Press and hold the More quick key. Wait until it turns from blue to grey.

The captured pictures are automatically saved in the USB drive.

3.13 Connecting the CMS

You can connect the monitor to the BeneVision CMS through wired LAN or wireless LAN. When connected to the CMS, the system provides the following function.

■ The monitor can transmit parameter values, waveforms, alarms, and events to the CMS. From the CMS, you

can check the patient’s monitoring data and alarms.

■ The monitor can transmit parameter values and alarms from the connected external devices to the CMS.

From the CMS you can check the patient’s monitoring data and alarms obtained from the connected external devices.

■ Patient information, alarm settings, and alarm status can be synchronized between the monitor and the

CMS.

■ You can start or stop NIBP measurements from the CMS.

■ In case of network disconnection, the monitor can transmit the offline data to the CMS when the network is

reconnected.

For more information on the CMS, see BeneVision Central Monitoring System Operator's Manual (PN: 046-010879-

00).

To select a CMS, select the system status information area at the top right corner of the main screen. Select the desired CMS from the popup CMS list.

• You can select CMS only when the Select CMS switch is on. For more information, see

25.12.7Enabling Selecting a CMS.

3.14 Connecting the eGateway

You can connect the monitor to the eGateway through wired LAN or wireless LAN to implement interaction between the monitor and external devices. When connected to the eGateway, the system provides the following functions:

■ The monitor can transmit parameter values, waveforms, alarm settings, and events to the eGateway.

■ The monitor can transmit parameter values and alarm settings received from the BeneLink-connected

external devices to the eGateway.

■ Clock can be synchronized between the monitor and the eGateway.

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3.15 Disconnecting the Wireless Network

CAUTION

NOTE

To disconnect the wireless network manually, follow this procedure:

1. Swipe the screen from top down with a single finger.

2. Select

To reconnect the wireless network after it is disconnected manually, follow this procedure:

1. Swipe the screen from top down with a single finger.

2. Select

3.16 Turning Off the Monitor

Before turning off the monitor, perform the following check:

1. Ensure that patient monitoring has been completed.

2. Disconnect the cables and sensors from the patient.

3. Save or clear the patient data as required.

To turn off the monitor, press and hold the power switch for 3 seconds.

Turning off the monitor does not disconnect the monitor from the AC mains. To completely disconnect the power supply, unplug the power cord.

• Press and hold the power switch for 10 to forcibly shut down the monitor if it could not be shut down

normally. This may cause loss of patient data.

• If a monitor is on during a power loss, then the monitor is automatically switched on when the power

is restored.

• In case of a temporary power failure, if the power is restored within 30 minutes, monitoring will

resume with all active settings unchanged. If the monitor is without power for more than 30 minutes, it behaves the same as if it were normally turned off.

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4 User Screens

NOTE

The monitor provides different user screens to facilitate patient monitoring in different departments and clinical applications.

4.1 Choosing a Screen

The monitor enters the normal screen after it is powered on. The normal screen is most frequently used for patient monitoring. To select other screens, follow this procedure:

1. Access the Choose screen tab in either of the following ways:

◆ Select the Screen Setup quick key.

◆ Select the Main Menu quick key → from the Display column select Choose screen.

2. Select the desired screen.

4.2 Normal Screen

The normal screen is most frequently used for patient monitoring. For general department, ICU, and CCU, normal screen is used by default.

4.2.1 Entering the Normal Screen

To enter the normal screen, choose any of the following ways:

■ Swipe left or right on the touchscreen with two fingers to switch to the normal screen.

■ Select the Screen Setup quick key → select the Choose Screen tab → select Normal Screen.

■ Select the Main Menu quick key → from the Display column select Choose Screen → select Normal

Screen.

4.2.2 Configuring the Normal Screen

You can configure the parameter numerics, waveforms, and their sequence displayed on the normal screen. To do so, follow this procedure:

1. Access Tile Layout in either of the following ways:

◆ Select the Screen Setup quick key.

◆ Select the Main Menu quick key → from the Display column select Tile Layout.

2. Select a parameter numeric area or waveform area, and then from the popup list select an element you want to display in this area. The parameters and waveforms you did not select will not displayed.

• ECG parameters and waveform are always displayed on the first line of the parameter numeric area

and waveform area.

4 - 1

4.3 The Big Numerics Screen

The Big Numerics screen displays parameter numerics in big font size. The Big Numerics screen displays measurement values and waveforms of up to six parameters. You can configure the parameters and their layout on the big numeric screen.

4.3.1 Entering the Big Numerics Screen

To enter the big numerics screen, choose any of the following ways:

■ Swipe left or right on the touchscreen with two fingers to switch to the big numerics screen.

■ Select the Screen Setup quick key → select the Choose Screen tab → select big numerics Screen.

■ Select the Main Menu quick key → from the Display column select Choose Screen → select big

numerics Screen.

4.3.2 Configuring the Big Numerics Screen

To configure the big numerics screen, follow this procedure:

1. Access Choose screen in either of the following ways:

◆ Select the Screen Setup quick key .

◆ Select the Main Menu quick key → from the Display column select Choose screen.

2. Select the Big Numerics tab

3. Select a parameter numeric area or waveform area, and then from the popup list select an element to display in this area.

4.4 Minitrends Screen

The Minitrends screen shows the recent graphic trends of parameters.

4.4.1 Entering the Minitrends Screen

Choose one of the following methods to enter the Minitrends screen:

■ Select the Minitrends quick key.

■ Select the Screen Setup quick key → Select the Choose Screen tab→ select Minitrends.

■ Select the Main Menu quick key → from the Display column select Choose Screen → select Minitrends.

4 - 2

4.4.2 The Display of Minitrends Screen

(2)

(6)

(4)

(3)

(5)

(1)

(7)

The following figure shows the minitrends screen. Your display may be configured to look slightly different.

(1) Scale

(2) Routine Vital/Baseline button. If the department is set to OR, then the Baseline

button is available. For other departments, the Routine Vital button is available.

(3) Routine Vital/Baseline

(4) Select this button to view the trends of longer time

(5) Time line

(6) Alarm statistic area

(7) Aldrete Score button. This button is available for the OR department.

4.4.3 Viewing Trends of Longer Time

To view the trends of longer time, follow this procedure:

1. Enter the Minitrends screen.

2. Select

button from the Minitrends screen, or swipe right on the screen with a finger.

4.4.4 Setting Minitrends Parameters

To set parameters, follow this procedure:

1. Enter the Minitrends screen.

2. Select the Setup button.

3. Set parameters. If you want to use the default parameters, select Default Parameter.

4 - 3

4.4.5 Setting the Minitrend Length

NOTE

To set the Minitrend length, follow this procedure:

1. Enter the Minitrends screen.

2. Select the Setup button.

3. Set the Minitrend Length.

4.4.6 Setting the Alarm Statistics Switch

The Minitrends screen can be configured to display the statistic number of physiological alarm in its lower half screen. To set the alarm statistics switch, follow this procedure:

1. Enter the Minitrends screen.

2. Select the Setup button.

3. Switch on or off the Alarm Statistics switch.

4.4.7 Setting the Alarm Statistics Length

The time length within which the alarms statistics are made is configurable. To set the alarm statistics length, follow this procedure:

1. Enter the Minitrends screen.

2. Select the Setup button.

3. Set Alarm Statistics Duration.

4.4.8 Routine Vital/Baseline

The Routine Vital/Baseline function is used for marking the parameter measurements of certain moment for later reference. If the department is set to OR, then the Baseline button is available. For other departments, the

Routine Vital button is available.

4.4.8.1 Manually Marking the Routine Vital/Baseline

To manually mark the Routine Vital/Baseline, follow this procedure:

1. Enter the Minitrends screen.

2. Select the Routine Vital button or Baseline button.

• If you do not see the Baseline button or Routine Vital button in the Minitrends screen, you can select

the Setup button and switch on the Baseline switch, or set the Routine Vital to Manual or Auto.

4.4.8.2 Configuring Automatic Routine Vital Settings

The monitor can automatically mark the routine vital sign values. To enable this function, follow this procedure:

1. Enter the Minitrends screen.

2. Select the Setup button.

3. Select Auto from the dropdown list of Routine Vital.

4. Select Time to set the time for marking the first routine vital sign values.

5. Select Interval to set the interval for marking the routine vital sign values.

4 - 4

4.4.9 Aldrete Score

WARNING

NOTE

Select Aldrete Score to show the latest score and scoring time. To understand the current patient status, select a

score for each item and then select OK to get a new score.

• The Aldrete score and recommendation is for reference only. Clinicians must make the decision of

discharging the patient from recovery according to the patient’s actual condition.

4.5 The OxyCRG Screen

The OxyCRG screen is the default user screen when the neonatology department is selected. It displays 6-minute HR/btbHR, SpO2 trends, CO2/Resp compressed waveform, ABD parameters, and the latest ABD events.

The OxyCRG function is intended for neonatal patents only.

4.5.1 Entering the OxyCRG Screen

To enter the OxyCRG screen, choose any of the following ways:

■ Swipe left or right on the touchscreen with two fingers to switch to the OxyCRG screen.

■ Select the OxyCRG quick key.

■ Select the Screen Setup quick key → select the Choose Screen tab → select OxyCRG.

■ Select the Main Menu quick key → from the Display column select Choose Screen → select OxyCRG.

4.5.2 OxyCRG Events

The following table lists the ABD events and their criteria:

Event type Description Remarks

A Apnea event: the apnea duration exceeds the threshold.

• A20: the apnea duration is greater or equal to 20 seconds.

• A15: the apnea duration is between 15 to 20 seconds (excluding 20 seconds).

• A10: the apnea duration is between 10 to 15 seconds (excluding 15 seconds).

B Bradycardia event: the duration of low heart rate, bradycardia, extreme bradycardia,

or asystole exceeds the threshold.

D Low SpO2 event: the duration of SpO

BD Bradycardia and low SpO

AB Apnea and bradycardia happens at the same time. Red event

AD Bradycardia and low SpO

ABD Apnea, bradycardia, and low SpO

• The monitor records all ABD events for OxyCRG review, but only red events displays in the ABD list of

the OxyCRG screen.

A20 is a red event

Desat exceeds the threshold. /

happen at the same time. /

happen at the same time. Red event

4.5.3 The Display of the ABD Event Area

The ABD event area displays parameter values of currently active OxyCRG events and lists the latest red ABD events.

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4.5.4 Setting OxyCRG Parameters

NOTE

Select parameter trends or compressed waveform to set parameters and the compressed waveform you want to display. The selected parameters will be used for ABD event calculation.

4.5.5 Setting the Threshold of ABD Events

Select any parameter trend or the compressed waveform to perform the following setup:

■ Set the threshold of ABD events.

■ Set Event Storage Format:

◆ 1 min+3 min: stores data one minute before and three minutes after the event.

◆ 3 min+1 min: stores data three minutes before and one minute after the event.

◆ 2 min+2 min: stores data two minutes before and two minutes after the event.

The stored data includes the trends of the OxyCRG parameters, compressed waveform, alarm thresholds, NIBP, and Temp measurements.

4.5.6 Editing ABD Events

To edit ABD events, follow this procedure:

1. Select the Mark button to enter the Mark dialog box.

2. Drag the event list upwards and downwards to select the desired event.

3. Select the patient’s status when the event happens.

4. Select Save.

4.6 The SpO2 Screen

For neonatal patients, if you are only concerned with the patient’s SpO2 and pulse rate, you can use the SpO2 screen.

The SpO

• The SpO

4.6.1 Entering the SpO2 Screen

To enter the SpO2 screen, choose any of the following ways:

■ Swipe left or right on the touchscreen with two fingers to switch to the SpO

■ Select the Screen Setup quick key → select the Choose Screen tab → select SpO2 Screen.

■ Select the Main Menu quick key → from the Display column select Choose Screen → select SpO

screen displays SpO2 related data. It also displays realtime Temp and NIBP measurements.

screen is intended for neonatal patient only.

Screen.

screen.

4 - 6

4.6.2 The Display of SpO2 Screen

NOTE

(5)

(6)

(1)

(2)

(3)

(4)

The following figure shows the SpO2 screen. Your display may be configured to look slightly different.

Tabular trend: displays trends of SpO2, PR, and PI.

(1)

(2) SpO

(3)

(4)

(5)

(6)

statistics area: displays the statistics data of each SpO2 section.

Temp area: displays Temp measurements and alarm limits.

NIBP area: displays NIBP measurements and alarm limits.

SpO2 area: displays measurements and alarm limits of PR, and PI. The dashboards show information of alarm limits. The

The Pleth waveform

△ pointers indicate the current measurement values.

4.6.3 Operating the SpO2 Screen

You can access parameter setup and trends review from the SpO2 screen. To do so, follow this procedure:

■ Select the trend of SpO

■ Select the SpO

statistics area to enter the SpO2 Statistics Setup dialog. Set the range of each SpO2

, PR, or PI to enter the Tabul ar Tre nds review page.

section and the target section.

■ Select the value of SpO

■ Select the Temp area to enter the Tem p dialog.

■ Select the NIBP area to enter the NIBP dialog.

, PR, or PI, the dashboard, or Pleth waveform to enter the SpO2 dialog.

4.7 Remote View

On the monitor, you can observe alarm conditions and view real time physiological data from patients on other compatible remote networked monitoring devices, such as a bedside monitor or a telemetry device.

A device from a remote site is called a remote device or bed. The monitor can simultaneously watch up to 12 remote devices. They all can show waveforms of one remote device.

You can watch the remote devices in the Remote View screen, or the alarm watch tiles on the main screen.

In the Remote View screen, you can view real time parameters and waveforms from one specific device, and watch the alarms of other monitored devices at the same time.

• A particular monitor (for example Monitor 1) can be viewed by at most 32 remote devices at the

same time, of which eight of those remote devices can watch Monitor 1’s waveforms.

4 - 7

4.7.1 Entering the Remote View Screen

(2)

(3)

(1)

To enter the Remote View screen, choose one of the following ways:

■ Select the Remote View quick key.

■ Select the bed at the alarm watch tile on the main screen. For more information, see 4.7.10.2Displaying the

Alarm Watch Tile on the Main Screen.

■ Select the Screen Setup quick key → select the Primary Display tab or Secondary Display tab (as

available)→ select the Choose Screen tab → select Remote View.

4.7.2 About the Remote View

The following figure shows the Remote View window.

(1)

Alarm watch area

◆ Display all the monitored remote beds.

◆ Each bed displays the room number, bed number, connection status and alarm status. The

background color indicates the alarm status on the corresponding bed.

Background Color Description

Green No alarm is occurring to the bed.

Red The remote device is disconnected or a high priority alarm is occurring. The high

Yellow The medium priority alarm is occurring. The medium priority alarm currently is the

Cyan The low priority alarm is occurring. The low priority alarm currently is the highest

Grey The bed is in the standby mode.

(2)

Main body

Display the patient’s information, alarm status and messages, waveforms, measurements, etc. of the selected bed. This bed is called main bed.

priority alarm currently is the highest alarm level on the bed. If the remote device is disconnected, the icon is displayed.

highest alarm level on the bed.

alarm level on the bed.

4 - 8

WARNING

• The data presented in the Remote View screen has a delay. Do not rely on this screen for real time

NOTE

data.

4.7.3 Adding a Bed

After adding the desired remote devices, then the alarms from these devices can be viewed on the monitor. To add a remote device, follow this procedure:

1. Enter the Select Bed dialog. To do so, choose either of the following ways:

◆ In the Remote View screen, select Select Bed. For more information, see 4.7.1Entering the Remote

View Screen.

◆ Select the icon at the alarm watch tile if the tile is configured to display on the main screen.

2. In the Select Bed dialog, select a desired department. All the beds under this department will be listed.

3. Select a desired tile at the A-W1or A-W2 area and then select a bed from the bed list. The selected bed will appear in the tile.

• The added bed is indicated by a check mark (√) at the right of the bed list.

4.7.4 Removing a Bed

To remove a remote device from remote monitoring, follow this procedure:

1. Enter the Select Bed dialog. Choose either of the following ways:

◆ In the Remote View screen, select Select Bed. For more information, see 4.7.1Entering the Remote

View Screen.

◆ Select the icon in the alarm watch tile if the tile is configured to display on the main screen.

2. In the Select Bed dialog, select a bed at the A-W1or A-W2 area, and then select Clear Bed. If you want remove all beds, select Clear All Beds.

4.7.5 Displaying the Main Bed

In the Remote View screen, you can select a bed in the alarm watch area, then the main body of the Remote View screen will display the real time monitoring screen of the device.

4.7.6 Saving a Manual Event

You can initiate a manual event on the remote monitor by selecting Manual Event in the Remote View screen.

4.7.7 Managing Alarms from Remote Devices

You can view and manage the alarms coming from remote devices.

If the monitor and remote devices have alarms at the same time, the monitor presents alarms according to the following rules:

■ If the alarm tone pattern for the monitor is same as that for the remote devices, the monitor prioritizes all

the alarms and sounds the highest alarm tone.

■ If the alarm tone pattern for the monitor is different from that for the remote devices, the monitor sounds

the alarms in their corresponding tone.

The monitor provides the same alarm tone pattern for the remote device alarms as those for the monitor alarms by default. You can change the alarm tone pattern of the remote monitor; see 25.3.5.5Setting the Tone Pattern for Alarms from Remote Devices.

4 - 9

4.7.8 Resetting Alarms for Remote Devices

(1)

(5)

(4)

(3)

(2)

You can reset the alarms on the remote devices by selecting Alarm Reset in the Remote View screen. This function needs to be enabled. For more information, see 25.3.5.1Resetting Alarms for Remote Devices.

4.7.9 Selecting Beds By Care Group

If configured, the monitor automatically selects beds in the same care group during the shift of care groups in the CMS. To enable this function, follow this procedure:

1. Enter the Select Bed window. Choose either of the following ways:

◆ In the Remote View window, select Select Bed. For more information, see 4.7.1Entering the Remote View Screen for entering the Remote View window.

◆ Select the icon in the alarm watch tile if the tile is configured to display on the main screen.

2. In lower left corner of the Select Bed window, select Select Beds By Care Group.

4.7.10 Alarm Watch

The alarm watch function provides the alarm notification by color and sound.

■ The monitor sounds the highest priority alarm tone from all the monitored remote devices.

■ The monitor displays the highest priority alarm in corresponding background color for each bed at the

following areas:

◆ At the top of the Remote View. For more information, see 4.7.2About the Remote View for details.

◆ On the main screen. For more information, see 4.7.10.1About Alarm Watch Tile for details.

4.7.10.1 About Alarm Watch Tile

The main screen can display up to three alarm watch tiles, namely A-W1, A-W2 and A-W3. Each tile can accommodate up to six beds.

The following figure shows the alarm watch tiles.

(1)

Alarm watch tile label

(2)

Disconnection icon: when the remote device is disconnected, this icon displays at the tile, and the tile background color is red.

(3)

Select bed icon: select it to enter the Select Bed window.

(4)

More than one bed tile: when more than one bed is assigned to a tile, the tile displays the alarm status, connection status, etc.

4 - 10

(5)

One bed tile: when only one bed is assigned to a tile, the tile displays the parameter value and alarm message from this bed, etc.

The alarm watch tile is similar to alarm watch area in the Remote View. For more information, see 4.7.2About the Remote View.

4.7.10.2 Displaying the Alarm Watch Tile on the Main Screen

To configure the alarm watch tile to be displayed on the monitor’s main screen, follow this procedure:

1. Select the Main Menu quick key → from the Display column select Choose Screen to enter the Screen Setup dialog.

2. Select the Tile Layout tab.

3. Select the numeric area where you want to display the alarm watch tile, and then in the drop-down list, select Alarm Watch → A-W1or A-W2.

4 - 11

5 Managing Patients

WARNING

5.1 Starting Monitoring a Patient

After turning on the monitor, follow this procedure to monitor a patient:

1. Admit the patient.

2. Check patient settings. Make sure that alarm limits, patient category and paced status, and so on, are appropriate for the patient. Change them if necessary.

3. Perform desired measurements. For more information, see corresponding measurement chapters.

5.2 Admitting a Patient

The monitor admits a new patient in the following situations:

■ After a patient is manually discharged, the monitor automatically admits a new patient.

■ After being switched off for the selected time period, the monitor automatically discharges the previous

patient and admits a new patient at startup.

■ If the monitor has not detected certain patient vital signs (ECG, SpO2, PR, RR, NIBP) for 30 minutes, it will

prompt whether to start monitoring a new patient if any of the above vital signs are detected again.

Always input patient information as soon as the patient is admitted. For more information, see5.2.2Editing Patient Information for details.

• The default Patient Category setting is Adult, and Paced setting is Unspecified. Set Paced and check

if the Patient Category setting is correct for the patient.

• For paced patients, set Paced to Yes. If it is incorrectly set to No, the monitor could mistake a pace

pulse for a QRS and fail to alarm when the ECG signal is too weak.

• For non-paced patients, set Paced to No.

5.2.1 Entering the Patient Management Dialog

Use any of the following methods to enter the Patient Management dialog:

■ Select the patient information area at the top left corner of the screen.

■ Select the Patient Management quick key.

■ Select the Main Menu quick key → from the Patient Management column select Patient Management.

5.2.2 Editing Patient Information

Edit patient information after a patient has been admitted, or when patient information is incomplete, or when it is necessary to change patient information:

To edit patient information, follow this procedure:

1. Enter the Patient Management dialog. For more information, see 5.2.1Entering the Patient Management Dialog.

2. Edit patient information as required.

If a barcode reader is connected to the monitor, scanning the patient’s barcode will enter the patient’s information.

5 - 1

NOTE

• The monitor will reload the configuration if you changed the patient category.

NOTE

5.2.3 Loading Patient Information from the CMS

If the monitor is connected to the central monitoring system (CMS). You can load patient information from the CMS to the monitor. To do so, follow this procedure:

1. Enter the Find Patient dialog in either of the following ways:

◆ Select the Main Menu quick key → from the Patient Management column select Find Patient.

◆ From the Patient Management dialog select Find Patient.

2. Input query criteria.

3. Select Search. Then a list pops up, including all the patients that meet the query criteria.

4. Select a patient from the patient list, and then select Admit. Corresponding patient information in the

monitor will be updated.

• If ADT Query is switched on, input query criteria from the Discharged Patient page.

5.2.4 Loading Patient Information from the ADT Server

If the monitor is connected with the Admit-Discharge-Transfer (ADT) server through the eGateway. You can load patient information from ADT server to the monitor.

To do so, follow this procedure:

1. Enter the Find Patient dialog in either of the following ways:

◆ Select the Main Menu quick key → from the Patient Management column select Find Patient.

◆ Select Find Patient from the Patient Management dialog.

2. Input query criteria.

3. Select Search. Then a list pops up, including all the patients that meet the query criteria.

4. Select a patient from the patient list, and then select Admit. Corresponding patient information in the

monitor will be updated.

• You can load patient information from the ADT server only when ADT Query is enabled. For more

information, see 25.12.12Using the ADT Gateway.

• The monitor can automatically upload the patient information from the ADT server when:

◆ The configured keywords of the monitor and the eGateway are the same.

◆ The IP address of the monitor is added to the eGateway configuration dialog.

• Loading patient information from the ADT server updates only patient information in the monitor.

The patient’s monitoring data is not changed and the patient is not discharged.

5.3 Exporting Patient Data

To export the data of the current patient and discharged patients, follow this procedure:

1. Connect the USB drive to the monitor’s USB connector.

2. Access the Discharged Patients dialog box by either of the following ways:

◆ Select the Discharged Patients quick key.

◆ Select the Main Menu quick key → from the Patient Management column select Discharged

Patients.

3. From the patient list select desired patients.

5 - 2

4. Select Export Data.

WARNING

5.4 Deleting Patient Data

To delete the data of discharged patients, follow this procedure:

1. Access the Discharged Patients dialog box by either of the following ways:

◆ Select the Discharged Patients quick key.

◆ Select the Main Menu quick key → from the Patient Management column select Discharged

Patients.

2. From the patient list select desired patients.

3. Select Delete.

5.5 Stopping a Parameter Measurement

To stop monitoring a parameter, follow this procedure:

1. Remove corresponding sensor from the patient.

2. Disconnect the sensor from the patient cable.

3. Disconnect the patient cable from the parameter module.

5.6 Discharging a Patient

Before monitoring a new patient, discharge the previous patient. The technical alarms are reset, and monitor settings returns to their defaults. For more information, see 24.3Setting Default Patient Category.

After a patient is discharged, the monitor automatically admits a new patient.

• Always discharge the previous patient before starting to monitor a new patient. Failure to do so can

lead to data being associated with the wrong patient.

To manually discharge a patient, use any of the following methods to access the Discharge Patient dialog:

■ Swipe down the touchscreen with two fingers.

■ Select the Discharge Patient quick key.

■ Select the patient information area at the top left corner of the screen→ Discharge Patient.

■ Select the Patient Management quick key → Discharge Patient.

■ Select the Main Menu quick key → from the Patient Management column select Discharge.

Select a button in the Discharge Patient dialog:

■ Print End Case Report: prints the end case report when the patient is discharged.

■ Discharge: clears the waveform data of the current patient. The monitor loads the default configuration

and goes to the standby mode. The current patient becomes a discharged patient.

■ Clear Patient Data: discharges the current patient and clears the waveform data. The monitor still uses the

current configuration and does not go to the standby mode. The current patient becomes a discharged patient.

5 - 3

6 Interfacing with External Devices

WARNING

NOTE

6.1 BeneLink Introduction

BeneLink module is intended for connecting external devices, such as ventilators and anesthesia machines, to the monitor. It allows information (patient data, alarms, etc.) from external devices to be displayed, saved, recorded, or printed through the monitor. If the monitor is connected with the CMS or eGateway, information from external devices can also be transmitted to the CMS or eGateway.

For more information on connecting external devices via the BeneLink module, see BeneLink Module Operator’s Manual (PN: 046-011948-00).

6.2 BeneLink Safety Information

• Devices of the same category cannot be connected to the BeneLink module simultaneously.

• The parameter labels used on the patient monitor may be different from those used on the external

device.

• The alarms from external devices may be delayed before transmission to the patient monitor.

• There can be differences between the alarm priorities displayed on the monitors and the priorities

displayed on external devices interfaced through BeneLink.

• The alarm messages from external devices are derived from the open protocol of the corresponding

external device. For more information about these alarms, please see the operator’s manual for the corresponding devices.

6 - 1

6.3 Differences in Displayed Values

NOTE

(5)

(6)

(4)

(3)

(2)

(1)

In certain cases, there may be differences between the numerics displayed on the monitor and those on external devices. The table below lists some situations and possible reasons.

Situation Possible Reasons

Some parameter values are displayed as invalid values on the monitor.

The monitor and external device display parameter values with different numbers of places of decimals.

Non-continuously measured values and continuously measured values have the same displaying mode in the patient monitor.

Parameter values displayed on the patient monitor and those displayed in the external device are slightly different.

• When the pressure units are converted among cmH

unchanged, for example, 1cmH2O=1hPa=1mbar, which may differ from some external devices.

6.4 Connecting an External Device

The patient monitor and the external device may have different parameter configuration or displaying range of values. If the patient monitor displays a parameter not configured in the external device, or a parameter value from the external device exceeds the displaying range of the monitor, then the corresponding parameter value is displayed on the monitor as an invalid value.

The monitor displays parameter values from the external device based on the monitor displaying rules. Same parameter value is displayed differently when the monitor and the external device display numbers with different precision.

For non-continuously measured values, the monitor displays the latest measured values until a new measurement is transmitted by the external device.

Some parameter values are converted to different units when transmitted to the monitor. Sometimes, values from the external device may be delayed before transmission to the patient monitor.

O, hPa and mbar, the parameter values remain

An external device is connected to the BeneLink module through an ID adapter. The ID adapter supports only its matching device.

(1) BeneLink Module (2) Label

6 - 2

(3) RJ45 connecting cable (4) ID Adapter

(5) External device (6) Serial port adapting cable (optional)

To connect an external device, follow this procedure:

CAUTION

1. Insert the BeneLink module into the module rack.

2. Connect the ID adapter that matches the external device to the BeneLink module with an RJ45 connecting cable.

3. Plug the ID adapter into the RS232 port on the external device. Some external devices may have ports incompatible with the ID adapter. In this case, a serial port adapting cable is required.

4. Stick a device name label to the RJ45 connecting cable at the end close to the BeneLink module. When the BeneLink module is connected to several external devices, you can tell devices easily with these labels. Switch on the external device.

After the external device is connected to the monitor, the indicators on both the ID adapter and the BeneLink module illuminate to show that the monitor successfully communicates with the external device.

• First installation and debugging should be executed by Mindray service personnel or an authorized

technician.

• Please check the compatibility of the external device and the ID adapter before connection.

Otherwise, unpredictable system failure may result.

• Ports on the BeneLink module are not conventional network connectors. They are intended for

connecting with the serial port of designated devices only. Do not connect them to network interfaces.

6.5 Accessing the Integrated Devices Screen

You can view the information of external devices in the Integrated Devices screen of the monitor. The Integrated Devices screen provides information of both individual device and multi devices. To access the Integrated Devices screen, follow this procedure:

■ Select the Integrated Device quick key.

■ Select the Screen Setup quick key → select Integrated Devices.

■ Select the Main Menu quick key → from the Display column select Choose Screen →select Integrated

Devices.

■ Select the numeric area or waveform area of any parameter from the external device →select Integrated

Devices button.

The Integrated Devices screen has the following features:

■ For the parameters measured by the external device, the measurements display directly after the

parameter labels.

■ For the parameters controlled by the external device, the settings are enclosed in parenthesis after

parameter labels.

6 - 3

■ For the parameters measured and controlled by the external device, measurements and settings are

NOTE

displayed after parameter labels, and settings are also enclosed in parenthesis. For example, PEEP 18 (20), in which PEEP is parameter label, 18 is the measurement, and (20) is the setting.

• Parameters in the Integrated Devices screen are displayed in the order as shown in the selection

dialog. If the screen cannot display all the selected parameters, only the beginning selected parameters are displayed.

6.6 Displaying Parameters from External Devices

This monitor can display parameters from external devices in the main screen:

■ Display waveforms from external devices in the waveform area.

■ Display labels and measurements of parameters from external devices in the numeric area.

■ Display respiratory loops of parameters from external deivices in the Loops screen.

• When displayed in the monitor main screen, parameter labels of external devices are prefixed with

the plug sign “+”. For example, if SpO and its waveform label is displayed as “+Pleth”.

is from an external device, its label is displayed as “+SpO2”,

• If a parameter can be obtained either from the monitor or an external device, the measured value,

waveform or loops coming from the monitor will be displayed preferentially.

6.6.1 Setting Waveform Properties for Parameters from External Devices

To set the waveform properties for parameters from external devices, follow this procedure:

1. Access the parameter setup dialog by selecting its waveform area or numeric area.

2. Set Speed or Scale.

6.6.2 Setting Alarms from External Devices

To enable or disable the storage, display, and sound of the external device alarms of a certain priority and category, follow this procedure:

1. From the Integrated Devices screen select Setup.

2. Set switches as desired.

If the storage, display, or audio settings of a specific alarm are different from its category or priority, set them individually by adding the Alarm ID to the alarm list. To do so, follow this procedure:

1. From the Integrated Devices screen select Setup.

2. Input the Alarm ID for this alarm, and select Add.

To delete the special case handling of a specific external device alarm, select the desired Alarm ID, and select Delete.

Refer to the BeneLink Module Operator’s Manual (PN: 046-011948-00) for the list of supported alarms and Alarm IDs.

6.6.3 Setting Parameters from External Devices for Display

To select parameters displayed in the Integrated Devices screen, follow this procedure:

1. From the Integrated Devices screen select Select Parameter.

2. Select desired parameters.

6 - 4

In the main screen, the numeric area of some parameters from an external device, for example the +Paw

NOTE

parameter, can display multiple parameters. To select parameters for display, follow this procedure:

1. Select the numeric area of the parameter from the external device.

2. Select the Select Parameter tab.

3. Select the parameters for display.

6.6.4 Setting Units for Parameters from External Devices

To set units for parameters from external devices, follow this procedure:

1. Select the numeric area or waveform area of any parameter from the external device.

2. Select the Unit tab.

3. Set the unit for O2, CO 2, Pressure or Tem p.

6.6.5 Accessing the Loops Screen

To access the Loops screen, follow this procedure:

1. Select the numeric area or waveform area of +Paw, +Flow, or +Vol to enter its corresponding setup dialog.

2. Select the Loops button.

• The monitor only displays real-time loops of the external device, and these loops cannot be

displayed or saved as reference loops.

6.7 Viewing Alarms from External Devices

If the patient monitor is configured to do so, the monitor displays alarms from external devices in the physiological and technical alarm information areas. A plus sign “+” is added before each alarm message from external devices.

6.8 Viewing Parameter Trends from External Devices

If the patient monitor is configured to do so, the monitor saves parameters trends and alarm events from external devices. You can review these data in the Tab ular Trend s, Graphic Trends, Events and Full Disclosure pages in the Review screen.The monitor adds a “+” before the parameter label of external devices.

For more information, see 18Review.

• Parameters from external devices are saved and displayed according to the time on the monitor.

6.9 Recording and Printing Parameter Trends from External Devices

You can record or print parameter trends from external devices. For more information, see 18Review, 21Recording, and 22Printing.

6 - 5

7 Alarms

WARNING

7.1 Alarm Introduction

This chapter describes alarm functions and alarm settings.

7.2 Alarm Safety Information

• A potential hazard can exist if different alarm presets and default configuration settings are used for

the same or similar equipment in the same care area, for example an intensive care unit or cardiac operating room.

• If the monitor is connected to the central monitoring system (CMS) or other monitors, alarms can be

presented and controlled remotely. Remote suspension, inhibition, or reset of monitor alarms via the CMS or other monitors may cause a potential hazard. For more information, see the operator’s manuals for the CMS and the other monitors.

• The monitors in the care area may each have different alarm settings to suit different patients.

Always check that the alarm settings are appropriate for the patient before starting the monitoring. Always make sure that necessary alarm limits are active and set according to the patient's clinical condition.

• Setting alarm limits to extreme values may cause the alarm system to become ineffective. For

example, setting the SpO

• When the alarm sound is switched off, the monitor gives no alarm tones even if a new alarm occurs.

Be careful when considering to switch off the alarm sound. When the alarms are off or while alarm audio is paused either temporarily or indefinitely, observe the patient frequently.

• When monitoring patients that are not continuously attended by a clinical operator, properly

configure the alarm system and adjust alarm settings as per the patient's condition.

• Do not rely exclusively on the audible alarm system for monitoring. Adjustment of alarm volume to a

low level may result in a hazard to the patient.

high alarm limit to 100%, is equivalent to switching the alarm off.

7.3 Understanding the Alarms

7.3.1 Alarm Categories

The monitor has two different types of alarms: physiological alarms and technical alarms.

■ Physiological alarms are triggered by patient measurement exceeding the parameter limits, or by an

abnormal patient conditions.

■ Technical alarms are triggered by an electrical, mechanical, connectivity, or other monitor abnormal

operation, or by failure of a sensor or component. Technical alarm conditions may also be caused when an algorithm cannot classify or interpret the available data.

Apart from the physiological and technical alarms, the monitor can also prompt with some messages describing the system status or patient status.

7.3.2 Alarm Priorities

By severity, the alarms are classified into the following priority levels:

■ High priority alarms: indicates a life threatening situation or a severe device malfunction. High priority

alarms require an immediate response.

■ Medium priority alarms: indicates abnormal vital signs or a device malfunction. Medium priority alarms

require a timely response.

7 - 1

■ Low priority alarms: indicate a discomfort condition, a device malfunction, or an improper operation. Low

NOTE

priority alarms require you to be aware of this condition.

■ Messages: provides additional information on the patient or the equipment.

7.3.3 Alarm Indicators

When an alarm occurs, the monitor indicates it through visual or audible alarm indications. For more information, see the following table.

Alarm Indicator High Priority

Alarm

Alarm lamp Red

Flashing frequency: 1.4 -

2.8 Hz Duty cycle: 20 -

60% on

Audible tone pattern

Alarm message White text

ISO Repeat pattern

of triple + double+ triple + double beeps

Mode 1 Repeat pattern

of high-pitched single beep

Mode 2 Repeat pattern

of high-pitched triple beeps

inside a red box

Medium Priority Alarm

Yel l ow Flashing

frequency: 0.4 -

0.8 Hz Duty cycle: 20 -

60% on

Repeat pattern of triple beeps

Repeat pattern of double beeps

Black text inside a yellow box

Low Priority Alarm

Cyan No flashing Duty cycle:

100% on

Single beep None None

Low-pitched single -beep

Low-pitched single beep

Black text inside a cyan box

Message Comments

None None

None

White text

Alarm messages are displayed in the alarm information area at the top of the screen. You can select the alarm messages to show the alarm list.

Alarm priority indicator

Parameter value White text

*** ** * None The indicator appears in

front of the corresponding alarm message.

None None inside a flashing red box

Black text inside a flashing yellow box

Black text inside a flashing cyan box

• When multiple alarms of different priority levels occur simultaneously, the monitor selects the

highest priority alarm to light the alarm lamp and issue the alarm tone.

• When multiple alarms of different priority levels occur simultaneously and should be displayed in

the same area, the monitor only displays the messages from the highest priority alarm.

• When multiple alarms of the same priority levels occur simultaneously and should be displayed in

the same area, all the alarm messages are displayed cyclically.

• Some physiological alarms, such as Asystole, are exclusive. They have identical alarm tones and

alarm lights with normal high level physiological alarms, but their alarm messages are displayed exclusively. That is, when an exclusive physiological alarm and a normal high level physiological alarm are triggered simultaneously, only exclusive physiological alarm message will be displayed.

7 - 2

7.3.4 Alarm Status Symbols

NOTE

Apart from the alarm indicators as described in 7.3.3Alarm Indicators, the monitor uses the following symbols to indicate the alarm status:

Alarm pause: indicates that all the alarms are paused.

Alarm off: indicates that individual measurement alarms are turned off or the system is in the

alarm off status.

Audio pause: indicates that audible alarm tones are paused.

Audio off: indicates that audible alarm tones are turned off.

Alarm reset: indicates that alarms are acknowledged and the alarm system is reset.

7.4 Accessing On-screen Help for Technical Alarms (AlarmSight)

In the technical alarm list, alarm messages followed by Detail include help messages or pictures to help you identify the problem. This function is called AlarmSight. To access AlarmSight, follow this procedure:

1. Select an alarm displaying in the technical alarm information area to enter the Alarms dialog.

2. From the alarm list select the desired alarm.

• If there are no displayed alarms, then selecting the technical alarm area will not open any dialogs.

7.5 Checking the Physiological Alarms List

If the patient monitor has more than one physiological alarm, you can see the physiological alarm list by selecting the physiological alarm information area to enter the Alarms dialog. If there is only one physiological alarm, selecting the physiological alarm information area enters the Review dialog for the event created by this alarm.

7 - 3

7.6 Changing Alarm Settings

NOTE

Alarms settings can be changed by selecting Main Menu and choosing from the list in the Alarm column.

7.6.1 Setting Parameter Alarm Properties

To set parameter alarm properties, follow this procedure:

1. Access the Limits page in either of the following WAYS:

◆ Select the Alarm Setup quick key.

◆ Select the Main Menu quick key → from the Alarm column select Limits.

2. Select a parameter tab and set alarm properties as desired.

You can also change the alarm properties of individual parameter from the corresponding parameter dialog.

• The monitor may be configured to require an password or login to change alarm settings. For more

information, refer to 25.13.3Selecting Password for User Authentication.

7.6.2 Setting Alarm Tone Properties

7.6.2.1 Changing the Alarm Volume

To change the alarm volume, follow this procedure:

1. Access the Setup page in either of the following ways:

◆ Select the Alarm Setup quick key → select the Setup tab.

◆ Select the Main Menu quick key → from the Alarm column select Setup.

2. Set Alarm Volume. The alarm volume can be set from X to 10, in which X is the minimum volume allowed

by your department, and 10 is the maximum volume.

3. Select High Alarm Volume to set the volume of the high priority alarm.

4. Select Reminder Volume to set the volume of the reminder tone.

• Alarm volume can only be set to 0 if the monitor is connected to a Central Monitoring System.

• When the alarm volume is set to 0, the alarm sound is turned off and the audio off symbol appears

on the screen.

7 - 4

• You cannot set the volume of high priority alarms if Alarm Volume is set to 0.

NOTE

• You can set the Alarm Volume to 0 only when your monitor is connected to the CMS. If your monitor

is not connected to the CMS, the lowest setting of Alarm Volume is 1.

• When your monitor is connected to the CMS and Alarm Volume is set to 0, Alarm Volume

automatically changes to 2 if the CMS is disconnected.

7.6.3 Setting the Auto Limits for New Patient Switch

If the Auto Limits for New Patient function is enabled, a dialog box can pop up to ask you whether to set alarm limits based on the latest parameter measurements for a newly admitted patient. To set the Auto Limits for New Patient switch, follow this procedure:

1. Enter the alarm setup page in any of the following ways:

◆ Select the Alarm Setup quick key → select the Setup tab.

◆ Select the Main Menu quick key → from the Alarm column select Setup.

2. Set the Auto Limits for New Patient switch.

When Auto Limits for New Patient is switched on, the confirmation dialog box pops up if all of the following requirements are met:

■ Within 10 minutes after the patient is admitted.

■ Continuous measurements are stable.

■ An NIBP measurement has been taken

■ HR alarm switch is on.

■ No fatal alarms are triggered.

■ The patient is not in poor perfusion condition.

■ Alarm limit of any parameter was not manually changed.

■ The monitor is not in intubation mode, rescue mode, private mode, or CPB mode.

• The Auto Limits for New Patient function is intended for newly admitted patients only.

• The automatically set alarm limits take effect only after being confirmed.

7.6.4 Initiating Auto Alarm Limits

The monitor provides the auto alarm limits function to automatically adjust alarm limits according to the patient’s vital signs. When auto limits are selected, the monitor calculates safe auto limits based on the latest measured values. To get accurate auto alarm limits, collect a set of measured vital signs as a baseline.

To initiate auto alarm limits, follow this procedure:

1. Access the Limits page in either of the following ways:

◆ Select the Alarm Setup quick key.

◆ Select the Main Menu quick key → from the Alarm column select Limits.

2. From the Limits page, select Auto Limits at the left bottom.

3. Select OK from the popup dialog box.

Then the monitor will automatically calculate alarm limits based on the latest measured values. Before applying these automatically created alarm limits, confirm if they are appropriate for the patient from the Limits dialog. If not, you can adjust them manually. These alarm limits will remain unchanged until you select auto limits again or adjust them manually.

The monitor calculates auto limits based on the following rules:

7 - 5

Module Parameter Lower Limit Upper Limit Auto Limit Range

Adult/ pediatric

ECG HR/PR

(bpm)

HR × 0.8 or 40 (whichever is greater)

Resp RR (rpm) RR × 0.5 or 6

(whichever is greater)

SpO

SpO2 (%) Same as the

default alarm limit

NIBP NIBP-S

(mmHg)

NIBP-D (mmHg)

NIBP-M (mmHg)

(SYS × 0.68 +

10)

(Dia × 0.68 +

(Mean × 0.68 + 8)

Neonate Adult/

pediatric

(HR - 30) or 90 (whichever is greater)

HR × 1.25 or 240 (whichever is smaller)

(RR - 10) or 30 (whichever is greater)

Same as the default alarm limit

(SYS - 15) or 45 (whichever

(RR × 1.5) or 30 (whichever is smaller)

Same as the default alarm limit

(SYS × 0.86 +

38)

is greater)

(Dia - 15) or 20 (whichever

(Dia × 0.86 +

32)

is greater)

(Mean - 15) or 35 (whichever

(Mean × 0.86 + 35)

is greater)

Neonate

(HR + 40) or 200 (whichever is smaller)

(RR + 25) or 85 (whichever is smaller)

Same as the default alarm limit

(SYS + 15) or 105 (whichever is smaller)

(Dia + 15) or 80 (whichever is smaller)

(Mean + 15 or

95) (whichever is smaller)

Adult/pediatric: 35 to 240 Neonate: 55 to 225

Adult/pediatric: 6 to 55 Neonate: 10 to 90

Same as the measurement range

Adult: 45 to 270 Pediatric: 45 to 185 Neonate: 35 to 115

Adult: 25 to 225 Pediatric: 25 to 150 Neonate: 20 to 90

Adult: 30 to 245 Pediatric: 30 to 180 Neonate: 25 to105

Tem p (xx refers

Txx (°C) (Txx - 0.5) (Txx - 0.5) (Txx + 0.5) ( Txx + 0.5) 1 to 49

T (°C) Same as the

temperat ure site)

IBP: ART/ Ao/UAP/

IBP-S

(mmHg) BAP/FAP/ LV/ P1- P4 (Arterial pressure)

IBP-D

(mmHg

IBP-M

(mmHg)

IBP: PA IBP-S

(mmHg)

IBP-D

(mmHg

IBP-M

(mmHg)

IBP: CPP CPP

(mmHg)

Same as the default alarm limit

default alarm

limit

SYS × 0.68 + 10(SYS - 15) or

45 (whichever

is greater)

(Dia × 0.68 + 6)(Dia - 15) or

20 (whichever

is greater)

Mean × 0.68 + 8 (Mean - 15) or

(whichever is

greater)

Same as the default alarm limit

SYS × 0.86 + 38

Same as the default alarm limit

(SYS + 15) or 105 (whichever is smaller)

(Dia × 0.86 +

32)

(Dia + 15) or 80 (whichever is smaller)

Mean × 0.86 + 35(Mean + 15)

or 95 (whichever is smaller)

Same as the measurement range

Adult: 45 to 270 Pediatric: 45 to 185 Neonate: 35 to 115

Adult: 25 to 225 Pediatric: 25 to 150 Neonate: 20 to 90

Adult: 30 to 245 Pediatric: 30 to180 Neonate: 25 to 105

SYS × 0.75 SYS × 0.75 SYS × 1.25 SYS × 1.25 3 to 120

Dia × 0.75 Dia × 0.75 Dia × 1.25 Dia × 1.25 3 to 120

Mean × 0.75 Mean × 0.75 Mean × 1.25 Mean × 1.25 3 to 120

CPP × 0.68 + 8 (CPP-15) or

35,

(whichever is

greater)

CPP × 0.86 + 35(CPP+15) or

95, (whichever is smaller)

Adult: 20 to 235 Pediatric: 25 to175 Neonate: 25 to 100

7 - 6

Module Parameter Lower Limit Upper Limit Auto Limit Range

IBP: CVP/ LAP/ RAP/ UVP/P1P4 (Venous pressure)

IBP-M (mmHg)

EtCO2 (mmHg)

FiCO

Adult/ pediatric

Neonate Adult/

pediatric

Neonate

Mean × 0.75 Mean × 0.75 Mean × 1.25 Mean × 1.25 3 to 40

0 to 32: remains the same

Same as the measurement range

33 to 35: 29 33 to 35: 29 33 to 35: 41 33 to 35: 41 Same as the

measurement range

36 to 45: (etCO

- 6)

36 to 45: (etCO2 - 6)

36 to 45: (etCO2 + 6)

Same as the measurement range

46 to 48: 39 46 to 48: 39 46 to 48: 51 46 to 48: 51 Same as the

measurement range

>48: remains the same

None None Same as the

>48: remains the same

default alarm limit

>48: remains the same

Same as the default alarm limit

Same as the measurement range

awRR (rpm)

awRR × 0.5 or 6 (whichever is greater)

AG EtCO

FiCO

awRR (rpm)

Same as the CO2 module

awRR × 0.5 or 6 (whichever is greater)

FiAA/EtAA Same as the

default alarm limit

FiO

/EtCO2Same as the

default alarm limit

FiN EtN

Same as the default alarm limit

C.O. TB (°C) Adult: (TB - 1)

Pediatric: N/A

C.I. N/A N/A N/A N/A N/A

TFC N/A N/A N/A N/A N/A

(awRR - 10) or 30 (whichever is greater)

Same as the default alarm limit

awRR × 1.5 or 30 (whichever is smaller)

Same as the default alarm limit

N/A Adult: (TB + 1)

Pediatric: N/A

(awRR+25) or 85 rpm (whichever is

Adult/pediatric: 6 to 55 Neonate: 10 to 90

smaller)

awRR+25 or 85 (whichever is smaller)

Same as the default alarm

Adult/pediatric: 6 to 55 Neonate: 10 to 90

Same as the measurement range

limit

Same as the default alarm

Same as the measurement range

limit

Same as the default alarm

Same as the measurement range

limit

N/A Same as the

measurement range

7.6.5 Setting the Apnea Delay Time

To set the zero respiration rate delay time, follow this procedure:

1. Access the Setup page in either of the following ways in either of the following ways:

◆ Select the Alarm Setup quick key → select the Setup tab.

◆ Select the Main Menu quick key → from the Alarm column select Setup.

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2. Select Apnea Delay to set the zero respiration rate delay time.

7.6.6 Switching on or off V-Tach Latching

When V-Tach Latching Lock is switched on, you can switch on or off V-Tach Latching. To do so, follow this procedure:

1. Access the Setup page in either of the following ways in either of the following ways:

◆ Select the Alarm Setup quick key → select the Setup tab.

◆ Select the Main Menu quick key → from the Alarm column select Setup.

2. Switching on or off V-Tach Latching.

7.6.7 Restoring the Default Alarm Settings

To reset all alarm settings to the defaults, follow this procedure:

1. Access the Alarm page in either of the following ways:

◆ Select the Alarm Setup quick key.

◆ Select the Main Menu quick key → from the Alarm column select Limits.

2. On the Limits page, select Defaults at the bottom.

7.6.8 Setting the Length of Printed Waveforms

You can define the length of printed waveforms when an alarm is triggered. To do so, follow this procedure:

1. Access the Setup page in either of the following ways:

◆ Select the Alarm Setup quick key → select the Setup tab.

◆ Select the Main Menu quick key → from the Alarm column select Setup.

2. Set Printing Duration On Alarm.

7.7 Pausing Alarms/Pausing Alarm Tones

You can either pause alarms or pause alarm tones. This depends on the pause setting. To set the pause function, refer to 25.3.3Defining the Pause Function.

7.7.1 Pausing Alarms

If the Pause function is configured to alarm pause, pressing the Alarm Pause quick key can temporarily disable alarm indicators. For the configuration of the pause function, see 25.3.3Defining the Pause Function. When alarms are paused, the following rules are followed:

■ No physiological alarm will be presented.

■ For technical alarms, alarm sounds are paused, but alarm lamps and alarm messages continue to be

presented.

■ The remaining alarm pause time is displayed in the physiological alarm information area.

■ The alarm pause symbol is displayed in the system information area.

When the alarm pause time expires, the alarm paused state is automatically deactivated. You can also cancel the alarm paused state by pressing the Alarm Pause quick key again.

7.7.1.1 Prolonging the Alarm Pause Time

If enabled, you can temporarily prolong the alarm pause time after the monitor enters the alarm paused state. This capability is disabled by default. To prolong the alarm pause time, follow this procedure:

1. In the physiological alarm information area, select the alarm pause countdown.

2. Select Pause 5 min, Pause 10 min, or Pause 15 min.

7 - 8

NOTE

• Prolonging alarm pause time does not affect the setting of alarm pause time.

WARNING

NOTE

WARNING

7.7.1.2 Switching Off All Alarms

If Pause Tim e is set to Permanent (see section 25.3.3.1Setting the Alarm Pause Time/Alarm Tone Pause Time), Pressing the Alarm Pause quick key permanently switches off all alarms. The alarm off state has the following features:

■ Physiological alarms are switched off. The alarm lamp does not flash and alarm sound is not issued.

■ Alarm sound of technical alarms is switched off, but alarm lamp flashes and alarm messages are presented.

■ The message Alarm Off with red background is displayed in the physiological alarm information area.

■ The alarm off symbol is displayed in the system status information area.

To exit the alarm off state, press the Alarm Pause quick key again.

• Pausing or switching off alarms may result in a hazard to the patient.

7.7.2 Pausing Alarm Sound

If the Pause function is configured to Audio Pause, pressing the Audio Pause quick key pauses alarm tone and sets the quick key to be highlighted. For the configuration of the pause function, see section 25.3.3Defining the Pause Function. When alarm tones are paused, the following rules are followed:

■ The sound of all physiological alarms and technical alarms are switched off.

■ The remaining audio pause time is displayed in the physiological alarm information area.

■ The audio pause symbol is displayed in the system information area.

When the audio pause time expires, the audio paused state is automatically deactivated. You can also cancel the audio paused state by pressing the highlighted Audio Pause quick key.

7.7.2.1 Prolonging the Alarm Tone Pause Time

If enabled on the machine, you can temporarily prolong the alarm tone pause time after the monitor enters the alarm tone paused state. This capability is disable by default. To prolong the audio pause time, follow this procedure:

1. In the physiological alarm information area, select the alarm pause countdown.

2. Select the alarm tone pause time. Options may include Pause 5 min, Pause 10 min, or Pause 15 min.

• Prolonging alarm pause time does not affect the setting of alarm tone pause time.

7.7.2.2 Switching Off Alarm Sound

If Pause Tim e is set to Permanent (see section 25.3.3.1Setting the Alarm Pause Time/Alarm Tone Pause Time), pressing the Audio Pause quick key permanently switches off all alarm sound. The audio off state has the following features:

■ Alarm sound of both physiological alarms and technical alarms is switched off.

■ The audio off symbol is displayed in the system information area.

To exit the audio off state, press the Audio Pause quick key again.

• Pausing or switching off alarm sound may result in a hazard to the patient.

7 - 9

7.8 Resetting Alarms

NOTE

Press the Alarm Reset quick key to acknowledge the ongoing alarms and reset the alarm system. When the alarm system is reset, the alarm reset symbol displays in the system status information area for alarm symbols.

• If a new alarm is triggered after the alarm system is reset, the alarm reset icon will disappear and the

alarm light and alarm tone will be reactivated.

7.8.1 Resetting Physiological Alarms

For physiological alarms, when the alarm system is reset, the following occur:

■ The alarm sound is silenced.

■ A √ appears before the alarm message, indicating that the alarm is acknowledged.

■ The color of the parameter numeric background corresponds with the alarm priority, but the parameter

numeric does not flash.

7.8.2 Resetting Technical Alarms

For technical alarms, when the alarm system is reset, the following occur:

■ Some technical alarms are cleared. The monitor gives no alarm indications.

■ Some technical alarms are changed to prompt messages.

■ For some technical alarms, the alarm is silenced and a √ appears before the alarm message, indicating that

the alarm is acknowledged.

For details about the indications of technical alarms when the alarm system is reset, see D.2Technical Alarm

Messages.

7.9 Latching Alarms

The latching setting for physiological alarms defines how alarm indicators behave if you do not reset the alarms.

■ If you do not “latch” physiological alarms, their alarm indications disappear when the alarm condition ends.

■ If you “latch” physiological alarms, all visual and audible alarm indications remains (if configured) until the

alarms are reset. For latched alarms the time when the alarm is last triggered is displayed behind the alarm message.

The monitor can be set to separately latch visual indications or simultaneously latch the visual and the audible indications.

■ When visual indications are latched, visual indications, including alarm lamp, alarm message and its

background remains when the alarm condition ends and the time when the alarm last triggered is displayed behind the alarm message.

■ When audible indications are latched, the monitor continues to issues alarm sounds when the alarm

condition ends.

To set how you want to latch the physiological alarms, see section 25.3.4Latching Physiological Alarms.

• Changing alarm priority may affect the latching status of the corresponding alarm. Determine if you

need to adjust the latching status for the specific alarm when you have changed its alarm priority.

• When the alarm system is reset, latched physiological alarms are cleared.

7 - 10

7.10 Nurse Call

WARNING

NOTE

The monitor provides a nurse call connector to output a nurse call signal when a user-defined alarm occurs. To obtain a nurse call signal, use the nurse call cable to connect the hospital nurse call system with the monitor’s nurse call connector.

Alarms are indicated on the nurse call device only when the following conditions are met:

■ The nurse call system is enabled.

■ A user-defined alarm occurs.

■ Alarms are not paused or reset.

• Do not rely exclusively on the nurse call system for alarm notification. Remember that the most

reliable alarm notification combines audible and visual alarm indications with the patient’s clinical condition.

7.11 Calling for Help

This monitor can be configured to call monitors in the same department, the central station, and the nurse call system so that nearby doctors and nurses can come for help.

7.11.1 Issuing the Call Help Signal

To call help, select the Call Help quick key and select OK from the popup dialog box. If OK is not selected within 5 seconds then the monitor will automatically send out the call help signal.

After the call help signal is sent out, the Call Help quick key flashes in red. Select the Call Help quick key again to stop the call help signal.

Monitors receiving the call help signal issue a sound and a dialog box pops up indicating which monitor is calling. Select OK to acknowledge the call and stop the sound at this monitor.

• The call help function works only when the monitor is connected to the network.

• The call help sound may disturb patients in the same department.

7.12 CPB Mode

The CPB (Cardiopulmonary Bypass) mode is activated only if you set the department to OR.

In the CPB mode, all the physiological alarms and technical alarms are switched off. So when performing CPB, you can put the monitor in the CPB mode to inactivate unnecessary alarms.

7.12.1 Entering the CPB Mode

To enter the CPB mode, choose either of the following ways:

■ Select the CPB Mode quick key.

■ Select the Main Menu quick key → from the Alarm column select CPB Mode.

In the CPB mode, CPB Mode is displayed in the physiological alarm area with a red background color.

• When the CPB mode is entered, the monitor stops all NIBP measurements. You can restart NIBP

measurements after entering the CPB mode.

7 - 11

7.12.2 Exiting the CPB Mode

To exit the CPB mode, choose either of the following ways:

■ Select the CPB Mode quick key.

■ Select the Main Menu quick key → from the Alarm column select Exit CPB Mode.

7.13 Intubation Mode

Intubation mode is available for Resp, CO2, and AG monitoring. When performing intubation during general anesthesia, you can put the monitor in the intubation mode in order to inactivate unnecessary alarms.

In the intubation mode, Resp, CO

7.13.1 Entering the Intubation Mode

To enter the intubation mode, choose either of the following ways:

■ Select the Intubation Mode quick key.

■ From the bottom of the Resp, CO2, or AG dialog, select Intubation Mode.

■ Select the Main Menu quick key → from the Alarm column select Intubation Mode.

7.13.2 Exiting the Intubation Mode

To exit the intubation mode, choose either of the following ways:

and AG related physiological alarms are switched off.

■ Select the Intubation Mode quick key.

■ From the bottom of the Resp, CO2, or AG dialog, select Exit Intubation Mode.

■ Select the Main Menu quick key from the Alarm column → select Exit Intubation Mode.

7.14 Testing Alarms

The monitor automatically performs a selftest at startup. Check that an alarm tone is heard, the alarm lamp illuminates, one after the other, in red, yellow, and cyan. This indicates that the visible and audible alarm indicators functions correctly.

7 - 12

8 Monitoring ECG, Arrhythmia, ST and QT

WARNING

CAUTION

(1) (2) (3) (4) (5) (6)

(7)

8.1 ECG Introduction

The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as waveforms and numerics. ECG monitoring provides 3-, 5-, 6-, and 12-lead ECG monitoring, ST-segment analysis, arrhythmia analysis, QT/QTc measurements, and optional 12-lead resting analysis via the Glasgow algorithm.

The associated monitor incorporating ST analysis has the ST label.

The associated monitor incorporating 12-lead has the 12-lead label.

8.2 ECG Safety Information

• This equipment is not intended for direct cardiac application.

• Ensure that the conductive parts of ECG electrodes and associated connectors, including the neutral

electrode, do not come into contact with any other conductive parts including earth.

• Always use defibrillation-proof ECG cables during defibrillation.

• Do not touch the patient, or metal devices connected to the patient, during defibrillation.

• To minimize the hazard of burns during high-frequency surgical procedures, ensure that the

monitor’s cables and transducers never come into contact with the electrosurgery unit (ESU).

• To minimize the hazard of burns during use of high-frequency surgical unit (ESU), the ECG

electrodes should not be located between the surgical site and the ESU return electrode.

• Only use parts and accessories specified in this manual. Follow the instructions for use and adhere to

all warnings and cautions.

• Periodically inspect the electrode application sites to ensure skin integrity. If the skin quality

changes, replace the electrodes or change the application site.

• Interference from an ungrounded instrument near the patient or electrosurgery usage can induce

noise and artifact into the waveforms.

8.3 ECG Display

The following figures show the ECG waveform and numeric areas. The display may be configured to look slightly different.

8 - 1

CAUTION

NOTE

(1) ECG lead label of the displayed waveform (2) ECG waveform gain

(1)

(2)

(3)

(4)

(3) ECG filter mode (4) Notch filter status

(5) Paced status: If Paced is set to Ye s , is displayed. If Paced is set to No, is displayed.

(6) HR/PR alarm message

(7) Pace pulse marker: If Paced is set to Ye s , pace pulse markers “|” are displayed corresponding to detected pacer for each beat.

(1) Parameter label (2) HR measurement unit

(3) HR alarm limits (4) HR value

8.4 Preparing for ECG Monitoring

8.4.1 Preparing the Patient Skin

Proper skin preparation is necessary to ensure good signal quality at the electrode sites, as the skin is a poor conductor of electricity. To properly prepare the skin, choose flat areas and then follow this procedure:

1. Shave hair from skin at chosen electrode sites.

2. Gently rub skin surface at sites to remove dead skin cells.

3. Thoroughly cleanse the site with a mild soap and water solution. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.

4. Dry the skin completely before applying electrodes.

8.4.2 Applying Electrodes and Connecting the Patient

To connect ECG cables, follow this procedure:

1. Check that electrode packages are intact and the electrodes are not past the expiry date. Ensure the electrode gel is moist. If you are using snap electrodes, attach the snaps to the electrodes before placing electrodes on the patient.

2. Place the electrodes on the prepared sites. Ensure that all electrodes have good skin contact.

3. Connect the leadwires to the patient cable if not already connected.

4. Plug the patient cable into the ECG connector.

• Never mix patient electrode types or brands. This may lead to impedance mismatches issues.

• When applying the electrodes, avoid bony area, obvious layers of fat, and major muscles. Muscle

movement can result in electrical interference. Applying electrodes on major muscles, for example

8 - 2

on muscles of the thorax, may lead to erroneous arrhythmia alarms due to excessive muscle

movement.

8.4.3 Lead Wire Color Code

The following table lists the color coding of leadwires for AHA standards:

Lead

Right arm RA White

Left arm LA Black

Right leg (neutral) RL Green

Left leg LL Red

Chest 1 V1 Brown/Red

Chest 2 V2 Brown/Yellow

Chest 3 V3 Brown/Green

Chest 4 V4 Brown/Blue

Chest 5 V5 Brown/Orange

Chest 6 V6 Brown/Violet

Label Color

8.4.4 ECG Electrode Placements

In this section, electrode placement is illustrated using the AHA naming convention.

8.4.4.1 3-leadwire Electrode Placement

The following is the electrode configuration when a 3-leadwire cable is used:

■ RA placement: directly below the clavicle and near the right

shoulder.

■ LA placement: directly below the clavicle and near the left

shoulder.

■ LL placement: on the left lower abdomen.

8.4.4.2 5-leadwire and 6-leadwire Electrode Placement

The following is the electrode configuration for a 5-leadwires cables:

■ RA placement: directly below the clavicle and near the right

shoulder.

■ LA placement: directly below the clavicle and near the left

shoulder.

■ RL placement: on the right lower abdomen.

■ LL placement: on the left lower abdomen.

■ V placement: on the chest in any of the V1 to V6 positions.

For 6-leadwire placement, you can use the position for the 5 leadwire placement but with two chest leads. The two chest leads (Va and Vb) can be positioned at any two of the V1 to V6 positions. For

8 - 3

more information, see 8.4.4.3Chest Electrode Placement. The Va and Vb lead positions are configurable. For more

NOTE

information, see 8.5.3.3Changing Va and Vb Labels.

8.4.4.3 Chest Electrode Placement

The chest electrode can be placed at the following positions:

■ V1 placement: on the fourth intercostal space to the right of

the sternum.

■ V2 placement: on the fourth intercostal space to the left of

the sternum.

■ V3 placement: midway between the V2 and V4 electrode

positions.

■ V4 placement: on the fifth intercostal space at the left

midclavicular line.

■ V5 placement: on the left anterior axillary line, horizontal with

the V4 electrode position.

■ V6 placement: on the left midaxillary line, horizontal with the V4 electrode position.

■ V3R-V6R placement: on the right side of the chest in positions corresponding to those on the left.

• For the 5-leadwire and 6-leadwire placement, place the precordial electrode according to the

physician's preference.

8.4.4.4 10-leadwire Electrode Placement

12-lead ECG uses 10 electrodes, which are placed on the patient’s four limbs and chest. The limb electrodes should be placed on the limb extremities and the chest electrodes placed according to the physician’s preference. The figure at right illustrates the conventional 10-leadwire electrode placement.

8.4.4.5 Lead Placement for Surgical Patients

8 - 4

The surgical site should be taken into consideration when placing electrodes on a surgical patient. For example, for open-chest surgery, the chest electrodes can be placed on the lateral chest or back. To reduce artifacts and interference from electrosurgical units, you can place the limb electrodes close to the shoulders and lower abdomen and the chest electrodes on the left side of the mid-chest. Do not place the electrodes on the upper arm. Otherwise, the ECG waveform will be very small.

WARNING

• To reduce the hazard of burns during use of electrosurgical units (ESU), the ECG electrodes should

WARNING

not be located between the surgical site and the ESU return electrode.

• Never entangle the ESU cable and the ECG cable together.

• When using ESU, never place ECG electrodes near the grounding plate of the ESU, as this can cause a

lot of interference on the ECG signal.

• When using electrosurgery units, ensure proper contact of the ESU return electrode to the patient to

avoid burns at monitor measurement sites. Also ensure that the ESU return electrode is near the operating area.

8.4.5 Choosing the ECG Lead Type

To choose ECG lead type, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Set Lead Set according to the lead type you are going to use. The default lead type is Auto. In this case, the

monitor automatically detects the lead type.

8.4.6 Checking Paced Status

It is important to correctly set the patient’s paced status before you start monitoring ECG. The paced symbol is displayed when Paced is set to Ye s . Pace pulse markers “|” are displayed on each ECG waveform whenever a pacer signal is detected. If Paced is set to No or unspecified, the symbol will be shown in the ECG waveform area.

To change the paced status, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Pacer tab.

3. Set Paced to Ye s or No.

You can also change the patient’s paced status from the Patient Management dialog. For more information, see

5.2.1Entering the Patient Management Dialog.

If you did not set the paced status, the monitor issues a prompt tone when pace pulse is detected. At the same time, the paced symbol flashes and the message Please check if the patient has a pacemaker? appears in the ECG waveform area. Check and set the patient’s paced status.

• For paced patients, you must set Paced to Yes. If it is incorrectly set to No, the monitor could mistake

a pace pulse for a QRS complex and fail to alarm when the ECG signal is too weak. On ventricular paced patients, episodes of ventricular tachycardia may not always be detected. Do not rely entirely upon the system’s automated arrhythmia detection algorithm.

• False low heart rate or false asystole alarms may result with certain pacemakers because of

pacemaker artifacts, such as electrical overshoot of the pacemaker overlapping the true QRS complexes.

• Do not rely entirely on rate meter alarms when monitoring patients with pacemakers. Always keep

these patients under close surveillance.

• The auto pacer recognition function is not applicable to pediatric patients, neonatal patients, and

patients with NMT monitoring.

8 - 5

8.4.7 Enabling Pacer Rejection

NOTE

The pace pulse rejection function is disabled by default. To enable this function, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Pacer tab.

3. Switch on Pacer Reject.

• When pace pulses are detected, the pace pulse markers “|” are shown on the ECG waveforms. Pacer

Rejection setting has no impact on the display of pace pulse markers “|”.

• You can switch on pacer rejection only when Paced is set to Yes. If Paced is set to no, the Pacer Reject

function is disabled.

8.5 Changing ECG Settings

8.5.1 Choosing an ECG Screen

When monitoring ECG, several display options are available.

■ For 3-lead ECG monitoring, only normal screen is available.

■ For 5-lead ECG monitoring, besides the normal screen, you can also choose Full-screen (7-lead) or Half

Screen (7-lead).

■ For 6-lead ECG monitoring, besides the normal screen, you can also choose Full-screen (8-lead) or Half

Screen (8-lead).

■ For 12-lead ECG monitoring, besides the normal screen, you can also choose Full-screen (7-lead), Half

Screen (7-lead), or 12-Lead (12-lead analysis).

To choose the desired screen configuration, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select Full-Screen, Half-Screen, or 12-Lead when visible.

To return to the normal screen, press the highlighted button to unselect that screen.

Alternately you can choose the desired screen configuration as follows:

1. Select the Screen Setup quick key → Choose Screen or select the Main Menu quick key → from the Display column select Choose Screen.

2. Select ECG Full-Screen, ECG Half-Screen, or ECG 12-Lead.

8.5.2 Setting ECG Alarm Properties

To select the desired ECG alarm options, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Alarm tab.

3. Select the desired alarm options.

8.5.3 Changing ECG Wave Settings

8.5.3.1 Selecting the Leads of Displayed ECG Waveforms

To select the desired ECG waveforms to be displayed, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Select ECG to set the lead of each displayed ECG waveform.

8 - 6

4. If more than three ECG waveforms are to be displayed, select the More Leads tab, and then select ECG to

CAUTION

set leads of other ECG waveforms.

For optimal ECG analysis, select leads with the following characteristics:

■ The QRS complex should be either completely above or below the baseline and it should not be biphasic.

■ The QRS complex should be tall and narrow.

■ The P waves and T waves should be less than 0.2mV.

• Ensure that you have selected the optimal leads with the best waveform amplitude and the highest

signal-to-noise ratio. Selecting the optimal leads is important for detecting beats, classifying beats, and detecting ventricular fibrillation.

8.5.3.2 Changing ECG Waveform Size

If the ECG waveform is too small or clipped, you can change its size by selecting the appropriate Gain setting. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Select ECG gain to set the size of each ECG waveform.

4. If more than three ECG waveforms are displayed, select the More Leads tab, and then select ECG Gain to change the sizes of other ECG waveforms. If you select Auto, the monitor automatically adjusts the size of the ECG waveforms for all the leads.

8.5.3.3 Changing Va and Vb Labels

When monitoring ECG with 6-leadwire. You can change the labels of Va and Vb leads. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Set Va and Vb according to the locations of the Va and Vb electrode sites. Default settings are Va and Vb.

8.5.3.4 Changing ECG Waveform Speed

To change ECG waveform speed, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Set the desired Speed.

8.5.3.5 Setting the ECG Filter

To set the appropriate ECG waveform filter mode, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Set Filter.

◆ Diagnostic: use when diagnostic quality ECG is required. The unfiltered ECG waveform is displayed so

that changes such as R-wave notching or discrete elevation or depression of the ST segment are visible.

◆ Monitor: use under normal monitoring conditions.

◆ Surgery: use when the signal is distorted by high frequency or low frequency interference. High

frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference usually leads to wandering or rough baseline. The surgery filter reduces

8 - 7

artifacts and interference from electrosurgical units. Under normal measurement conditions,

NOTE

CAUTION

selecting Surgery may suppress certain features or details of the QRS complexes.

◆ ST: recommended for ST monitoring.

8.5.3.6 Switching On or Off the Notch Filter

The notch filter removes the line frequency interference. To switch on or off the notch filter, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Switch on or off Notch Filter.

• The notch filter can only be switched on or off when ECG Filter is set to Diagnostic. In other filter

modes, the notch filter is always on.

8.5.4 Disabling the Smart Lead Off Function

The monitor provides the smart lead off function. When the lead corresponding to the first ECG wave gets detached but another lead is available, the monitor automatically switches to the available lead to recalculate heart rate, and to analyze and detect arrhythmias. When you reconnect the detached leads, the monitor automatically switches back to the original lead.

The smart lead off function is enabled by default. To disable this function, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Switch off Smart Lead.

8.5.5 Adjusting the QRS Volume

To adjust the QRS volume, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab.

3. Set QRS Volume.

When valid SpO value.

measurements are available, the monitor adjusts the pitch of QRS tone based on the SpO2

8.5.6 Adjusting the Minimum QRS Detection Threshold

To avoid false asystole alarm due to low R wave amplitude, and to avoid tall T waves and P waves being mistaken for QRS complexes, the monitor provides a means to manually adjust the minimum QRS detection threshold.

To adjust the minimum QRS detection threshold, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Setup tab and set Filter to Monitor.

3. Select the QRS Threshold tab.

4. Select up or down arrow buttons to adjust the minimum threshold for QRS detection. Selecting Default

resets the QRS threshold to the default value (0.16 mV).

• The setting of the QRS detection threshold can affect the sensitivity for arrhythmia, ST, QT/QTc

detection, and heart rate calculation.

8 - 8

• If the QRS amplitude is low, the monitor might not be able to detect the beats and false asystole calls

NOTE

WARNING

CAUTION

may occur.

• The minimum QRS detection threshold can only be adjusted when the ECG filter is set to Monitor.

8.6 Monitoring Arrhythmia

Arrhythmia monitoring is intended for adult and pediatric patients.

8.6.1 Arrhythmia Safety Information

• Heart rate reading may be affected by cardiac arrhythmias. Do not rely entirely on heart rate alarms

when monitoring patients with arrhythmias. Always keep these patients under close surveillance.

• The arrhythmia analysis program is intended to detect ventricular arrhythmias and atrial

fibrillation. It is not designed to detect all the atrial or supraventricular arrhythmias. It may incorrectly identify the presence or absence of an arrhythmia. Therefore, a physician must analyze the arrhythmia information with other clinical findings.

• Atrial fibrillation (Afib) detection function is not intended for pediatric and neonatal patients.

• Since the arrhythmia detection algorithm sensitivity and specificity are less than 100%, it is possible

for false arrhythmias to be detected and true arrhythmia events to not be detected. The possibility increases when the signal is noisy.

• The ECG size and minimum QRS detection threshold settings affect arrhythmia detection and heart

rate calculation sensitivity.

• If QRS amplitude is low, the monitor might be unable to calculate heart rate and thus create false

asystole calls. During the learning phase of the algorithm, arrhythmia detection may not be available. It is recommended to closely monitor patient condition during, and for several minutes after, the learning phase to allow the algorithm to reach optimal detection performance.

8.6.2 Arrhythmia Events

This section lists all arrhythmia events and their criteria.

8.6.2.1 Lethal Arrhythmia Events

Arrhythmia message Description

Asystole No QRS complex detected within the set time interval in the absence of ventricular

fibrillation or chaotic signal.

V-Fib/V-Tach A fibrillatory wave for 6 consecutive seconds.

A dominant rhythm of adjacent PVCs and the ventricular rate is greater than the V-tach rate limit.

V-Tach The number of consecutive PVCs is greater than or equal to the V-Tach PVCs limit, and the

ventricular rate is greater than or equal to the V-Tach rate limit.

8 - 9

8.6.2.2 Nonlethal Arrhythmia Events

Arrhythmia message Description

Vent Brady The number of consecutive PVCs is greater than or equal to V brady PVC limit and the

ventricular rate is less than the V-Brady Rate limit.

Extreme Tachy The heart rate is greater than the extreme tachycardia limit.

Extreme Brady The heart rate is less than the extreme bradycardia limit.

R on T R on T PVC is detected.

Run PVCs More than two consecutive PVCs, but lower than the V-Brady PVCs limit, and the ventricular

rate is lower than the V-Tach rate limit.

Couplet A Pair of PVCs detected in between normal beats.

Multiform PVC Multiform PVCs detected in Multif. PVC's Window (which is adjustable).

PVC One PVC detected in between normal beats.

Bigeminy A dominant rhythm of N, V, N, V, N, V

Trigeminy A dominant rhythm of N, N, V,N, N, V, N, N, V

Tachy The heart rate is greater than the tachycardia limit.

Brady The heart rate is lower than the bradycardia limit.

Pacer not Capture No QRS complex detected for 300 ms following a pace pulse (for paced patients only).

Pacer not Pacing No pace pulse detected for 1.75 x average R-to-R intervals following a QRS complex (for

Missed Beat At least 3 consecutive Ns

Nonsus V-Tach The number of consecutive PVCs is lower than the V-Tach PVCs limit but greater than 2, and

Vent Rhythm The number of consecutive PVCs is greater than or equal to the V-Brady PVCs limit, and

Pause No QRS complex is detected within the set pause time threshold.

Irr Rhythm Consistently irregular rhythm (N

A-Fib (for adult only) P wave is absent and normal beat RR intervals are irregular.

paced patients only).

*, and

The current RR interval is greater than 1.5 x previous RR interval, and The next RR interval is lower than 1.5 x average RR interval, and HR lower than 100 and the current RR interval is greater than 1.75 x average RR interval , or

HR is greater than or equal to 100 and the current RR interval is greater than 1000 ms.

the ventricular rate is greater than or equal to the V-Tach Rate limit.

ventricular rate is greater than or equal to the V-Brady Rate limit but lower than V-Tach Rate limit.

*, irregular RR interval change is greater than 12.5%)

PVCs/min PVCs/min exceeds high limit.

Pauses/min Pauses/min exceeds high limit.

Irr Rhythm End Irregular rhythm no longer detected for the irregular rhythm end delay time.

A-Fib End (for adult only) Atrial fibrillation no longer detected for the A-Fib end delay time.

*N: normal beat; V: ventricular beat

8.6.3 Displaying Arrhythmia Information

You can display the arrhythmia information in the numeric area. To do so, follow this procedure:

1. Access Tile Layout using either of the following ways:

◆ Select the Screen Setup quick key → select the Tile Layout tab.

◆ Select Main Menu quick key → from the Display column select Tile Layout.

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2. Click the numeric area where you want to display the arrhythmia information, and then select ECG →

NOTE

Arrhythmia.

8.6.4 Changing Arrhythmia Settings

8.6.4.1 Changing Arrhythmia Alarm Settings

To set the arrhythmia alarm properties, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Arrhythmia tab→ Alarm tab.

3. Set alarm properties as desired.

• You can switch off lethal arrhythmia alarms only when the monitor is set to enableLethal Arrh

Alarms Off. For more information, see 25.3.9.1Setting the Lethal Arrhythmia Alarms Switch.

• The priority of lethal arrhythmia alarms is always high. It cannot be altered.

8.6.4.2 Changing Arrhythmia Alarm Threshold Settings

You can change threshold settings for certain arrhythmia alarms. When an arrhythmia exceeds its threshold, an alarm will be triggered. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Arrhythmia tab → select the Threshold tab.

3. Enter the password if required. For more information, refer to 25.13.3Selecting Password for User Authentication.

4. Set the threshold for the desired arrhythmia alarms.

• The asystole delay time relates to ECG relearning. When heart rate is less than 30 bpm, it is

recommended to set Asystole Delay to 10 sec.

8.6.4.3 Arrhythmia Threshold Range

Arrhythmia Threshold Range

Asystole Delay 3 sec to 10 sec

Tachy (HR High) 60 bpm to 295 bpm

Brady (HR Low) 16 bpm to 120 bpm

Extreme Tachy 60 bpm to 300 bpm

Extreme Brady 15 bpm to 115 bpm

Multif PVCs Window 3 beats to 31 beats

V-Tach Rate 100 bpm to 200 bpm

V-Brady Rate 15 bpm to 60 bpm

V-Tach PVCs 3 beats to 99 beats

V-Brady PVCs 3 beats to 99 beats

PVCs/min High 1 to 100

Pauses/min 1 to 15

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Arrhythmia Threshold Range

Pause Threshold 1.5 sec, 2.0 sec, 2.5 sec, 3.0 sec

AF/Irr Rhy End Time 0 min, 1 min, 2 min, 3 min, 4 min, 5 min, 10 min, 15 min, 30

8.6.4.4 Setting Thresholds for PVC-Related Alarms

PVC-related alarms are detected on the basis of the current PVC rate and the number of consecutive PVCs.

To set the required thresholds for PVC-related alarms, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the Arrhythmia tab → select the More Threshold tab.

3. Enter the password if required. For more information, refer to 25.13.3Selecting Password for User Authentication.

Adjust V-Tach PVCs, V-Tach Rate, V-Brady PVCs, and V-Brady R ate as necessary to set the thresholds for the desired PVC-related alarms.

The following figure illustrates the conditions under which PVC alarms will be generated if V-Tach PVCs is set to 6, V-Tach Rate is set to 130, V-Brady PVCs is set to 5, and V-Brady Rate is set to 40.

min

If both V-Tach PVCs and V-Tach Rate are greater than or equal to the limits, a V-Tach alarm is generated.

■ If the number of consecutive PVCs is lower than the V-Tach PVCs limit (6) but greater than 2, and PVC rate is

greater or equal to the V-Tach Rate limit (130), a Nonsus V-Tach alarm is generated.

■ If the number of consecutive PVCs is greater than or equal to the V-Brady PVCs limit (5), and PVC rate is

lower than the V Brady limit (40), a Vent Brady alarm is generated.

■ If both the V-Brady PVCs and V-Brady Rate are lower than the limits, but V-Brady PVCs is greater than 2, a

Run PVCs alarm is generated.

■ If the V-Brady PVCs and V-Brady Rate are greater than or equal to limits, but the Vent rate is is lower than V-

Tach Rate (130), a Vent Rhythm alarm is generated.

8.6.5 Intelligent Arrhythmia Alarm

Normally, an arrhythmia alarm is presented when an alarm condition is detected. However, there are certain situations that can inhibit audible and visible alarm indications even though an alarm condition was detected. For more information, see 8.6.5.1Arrhythmia Alarm Chains and 8.6.5.2Arrhythmia Alarm Timeout Rules.

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8.6.5.1 Arrhythmia Alarm Chains

Asystole

VͲFib/VͲTach

VͲTach / Vent Brady

Extreme Tachy/

Extreme Brady

Pause

Nonsus VͲTach /

Vent Rhythm

Tachy/Brady

Run PVCs

Couplet

R on T

Bigeminy

Trigeminy

Multiform PVC

PVC

Pacer not Capture /

Pacer not Pacing /

Missed Beats

HR High /

HR Low

Pauses/min

AͲFib/

AͲFib End

Irr. Rhythm/

Irr.Rhythm End

PVCs/min

PVC Alarm Chain

Beat Detection

Alarm Chain

Rate Alarm Chain AͲFib Alarm Chain

High Priority Medium Priority

If multiple alarms overlap, announcing all of the detected alarm conditions would be confusing, and a more serious condition might be overlooked. So arrhythmia alarms are prioritized by alarm "chains".

8.6.5.2 Arrhythmia Alarm Timeout Rules

The following table explains how audible and visual alarms are indicated during arrhythmia alarm timeout.

Previous alarm Current alarm Alarm indication

Alarm in high priority chain

Alarm in medium priority chain

Alarm in high priority chain Alarm light and alarm tone

Alarm in medium priority chain During timeout period, alarm light and alarm tone

are disabled. When the timeout period is reached, alarm light and alarm tone are reactivated.

Alarm in high priority chain Alarm light and alarm tone

Alarm in the same medium priority chain, but with higher priority

The same alarm reoccurs During timeout period, alarm light and alarm tone

Alarm in the same medium priority chain, but with lower priority

Alarm light and alarm tone

are disabled. When the timeout period is reached, alarm light and alarm tone are reactivated.

During timeout period, alarm light and alarm tone are disabled. When the timeout period is reached, alarm light and alarm tone are reactivated.

Alarm in other medium priority chain Alarm light and alarm tone

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8.6.5.3 Arrhythmia Alarm Refractory Period

WARNING

For the following eight alarms in medium priority chain, there is a 30-second refractory period. That is to say, if the same alarm is not presented within 30 seconds after the previous alarm disappears.

■ Couplet

■ R on T

■ PVCs/min High

■ Multiform PVCs

■ PVC

■ Missed Beat

■ Pacer not Capture

■ Pacer not Pacing

8.7 ST Segment Monitoring

ST segment analysis is intended for adult, pediatric and neonatal patients.To use this feature, the MPM must be labeled to support ST analysis, see 8.1ECG Introduction.

8.7.1 ST Safety Information

• ST segment deviation values may be affected by such factors as certain drugs or metabolic and

conduction disturbances.

• ST deviation is often calculated at a fixed offset from the J point. Changes in heart rate may affect ST.

• The significance of ST segment changes needs to be determined by a physician.

• This monitor provides information regarding changes in ST deviation levels. The clinical significance

of the ST level change information should be determined by a physician.

8.7.2 Enabling ST Monitoring

The ST monitoring function is disabled by default. Before you start ST monitoring, enable the ST function. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab→ select the Setup tab.

3. Switch on ST Analysis.

Reliable ST monitoring cannot be ensured under the following situations:

■ You are unable to get a lead that is not noisy.

■ Arrhythmias, such as atrial fibrillation or atrial flutter, which may cause an irregular baseline.

■ The patient is continuously ventricularly paced.

■ The patient has left bundle branch block.

In these cases, you may consider switching off ST monitoring.

8.7.3 Displaying ST Deviation Numerics

To display ST numerics, follow this procedure:

1. Access Tile Layout by either of the following ways:

◆ Select the Screen Setup quick key → select the Tile Layout tab.

◆ Select Main Menu quick key → from the Display column select Tile Layout.

2. Click the numeric area where you want to display the ST numerics, and then select ECG → ST.

8 - 14

The ST parameter display area is configured differently according to the ECG cable used:

(4) (5)

(1) (2)

)

(1) (2)

(3)

(4) (5)

■ When you are using the 3-lead ECG leadwires, a separate ST numeric area does not appear on the display.

The ST deviation value displays in the ECG numeric area.

■ When you are using the 5-lead ECG leadwires, the ST numeric area displays 7 ST deviation values: ST-I, ST-II,

ST-III, ST-aVR, ST-aVL, ST-aVF, ST-V.

■ When you are using the 6-lead ECG leadwires, the ST numeric area displays 8 ST deviation values: ST-I, ST-II,

ST-III, ST-aVR, ST-aVL, ST-aVF, ST-Va, ST-Vb.

■ When you are using the 12-lead ECG leadwires, the ST numeric area displays12 ST deviation values: ST-I, ST-

II, ST-III, ST-aVR, ST-aVL, ST-aVF, ST-V1, ST-V2, ST-V3, ST-V4, ST-V5, ST-V6.

This example shows the ST numeric area when 5-lead ECG cable is used. The monitor screen may look slightly different:

(1) Parameter label (2) ST measurement unit

(3) ST alarm off symbol (4) Lead labels

(5) ST numerics: a positive value indicates ST segment elevation, and a negative value indicates ST segment depression.

8.7.4 Displaying ST Segments in the Waveform Area

You can display ST segments in the waveform area. To do so, follow this procedure:

1. Access Tile Layout by either of the following ways:

◆ Select the Screen Setup quick key → select the Tile Layout tab.

◆ Select Main Menu quick key → from the Display column select Tile Layout.

2. Select the waveform area where you want to display the ST segments, and then select ST→ ECG → ST Segment.

ST segment shows a QRS complex segment for each measured ST lead. The current ST segment is drawn in the same color as the ECG wave, usually green, superimposed over the stored reference segment, drawn in a different color. The information is updated once every ten seconds.

8 - 15

CAUTION

(1) ST lead (2) Current ST deviation value

(3) Baseline ST deviation value (4) 1 mV scale

(5) Current ST segment (green) and baseline ST segment (white)

8.7.5 Entering the ST View

In ST View mode a complete QRS segment for each ST lead is displayed. The color of the current ST segments and ST deviation values is consistent with the color of the ECG waveforms, normally green. The color of the baseline ST segments and ST deviation values is white.

To enter the ST View, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab.

3. From the bottom of the dialog, select ST View.

8.7.6 Saving the Current ST Deviation and Segment as Baseline

ST deviation is typically monitored as a relative change from a baseline value. Set an ST baseline when ST deviation values become stable. If you did not set the ST baseline, the monitor automatically saves the baseline when valid ST deviation values appear for 5 minutes. To set the ST baseline, follow this procedure:

1. From the ST View, select Set Baseline.

2. From the pop-up dialog box, select OK to set the current ST segments and values as the baseline.

From the ST View, you can also perform the following operations:

■ Display or hide ST baseline by selecting Display Baseline or Hide Baseline.

■ Display or hide the position of ISO point, J point and ST point by selecting Display Marker or Hide Marker.

• Updating ST baseline affects ST alarms.

8.7.7 Entering the ST Graphic

To display ST Graphic, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab.

3. Select ST Graphic.

The following figure shows the ST Graphic when ST Alarm Mode is set to Absolute. The height of the bar indicates the ST deviation value of corresponding ST lead. The color of the bar indicates ST alarm status: green indicates that corresponding ST deviation value is within alarm limits; cyan, yellow and red indicate that the ST deviation value exceeds the alarm limits. The color matches ST alarm priority.

8 - 16

The following figure shows the ST Graphic when ST Alarm Mode is set to Relative. The height of grey bar indicates the baseline ST deviation value and the green bar (cyan, yellow or red if an alarm occurs) indicates relative ST from that baseline.

8.7.8 Changing ST Settings

8.7.8.1 Setting ST Alarm Properties

To set ST alarm properties, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab→ Alarm tab.

3. Set ST Alarm Mode to Absolute or Relative.

◆ Absolute: you can separately set the alarm properties for each ST alarm for each lead.

◆ Relative: you can set the alarm properties for ST Single and ST Dual alarms.

4. Set ST alarm properties.

8.7.8.2 Changing Leads for ST Display

The monitor automatically selects the three most deviated leads for ST display. You can also manually select the leads. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab → select the Setup tab.

3. Set ST Segment. You can select up to 3 leads.

8 - 17

8.7.8.3 Showing ISO Point, J Point, and ST Point Markers

CAUTION

(1) (2) (3) (4)

In the waveform area, the ISO point, J point, and ST point marker do not display on the ST segments by default. To display these markers, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab→ select the Setup tab.

3. Switch on Show Markers.

8.7.9 Adjusting ST Measurement Points

8.7.9.1 About ST Point, ISO Point, and J Point

The ST deviation value for each beat is the potential difference between the isoelectric (ISO) point and the ST point. The ISO point provides the baseline. The ST point is located between the J point and the start of the Twave. The J point is the end of the QRS complex. As the ST point is at a fixed distance away from the J point (40, 60, 80 etc msec), manually adjusting the J point helps you correctly position the ST point.

( 1 ) I S O p o i n t ( 2 ) J p o i n t ( 3 ) S T p o i n t ( 4 ) S T d e v i a t i o n

8.7.9.2 Setting ST Point, ISO Point, and J Point

• If Auto Adjust is Off, or if the patient's heart rate or ECG morphology changes significantly, the ISO

and ST points need to be occasionally adjusted because this may affect the QT interval and thus the location of the ST point. False ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set.

• Always ensure that the locations of ST points are appropriate for the patient.

To set the ST point, ISO point, and J point, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the ECG dialog.

2. Select the ST tab→ select the Adjust tab.

3. Set ST Point.

The setting for Auto Adjust defines the method of adjusting the ISO and J point locations. Auto Adjust is enabled by default. In this case, the locations of the ISO point and J point are automatically determined by the algorithm. When Auto Adjust is disabled, you need to manually adjust the position of the ISO point and J point using the arrows at the right sides of ISO and J.

■ The ISO point (isoelectric) location shown is relative to the R-wave peak. Position the ISO point in the

middle of the flattest part of the waveform (between the P and Q waves).

■ The J point location is indicated relative to the R-wave peak. Position the J point at the end of the QRS

complex and the beginning of the ST segment.

8 - 18

■ The ST point is positioned a fixed distance from the J point. Position the ST point relative to the J point at

J+60/80ms, J+40ms, J+60ms or J+80ms. When J+60/80ms is selected, the ST point will be positioned 80

ms (heart rate 120 bpm or less) or 60 ms (heart rate more than 120 bpm) from the J point.

8.8 QT/QTc Interval Monitoring

The QT interval is the time between the beginning of the Q-wave and the end of the T-wave. It represents the total duration of the depolarization (QRS duration) and repolarization (ST-T ) phases of the ventricles. QT interval monitoring can assist in the detection of long QT syndrome.

The QT interval has an inverse relationship to heart rate. Faster heart rates shorten QT interval and slower heart rates prolong QT interval. Therefore, several formulas are commonly used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc.

QT/QTc interval monitoring is intended for adult, pediatric, and neonatal patients.

8.8.1 QT/QTc Monitoring Limitations

Some conditions may make it difficult to achieve reliable QT/QTc monitoring, for example:

■ R-wave amplitudes are too low

■ The presence of frequent ventricular ectopic beats

■ RR intervals are unstable

■ P-waves tending to encroach on the end of the previous T-wave at high heart rates

■ The T-wave is very flat or T-wave are not well defined

■ The end of the T-wave is difficult to delineate because of the presence of U-waves

■ QTc measurements are not stable

■ In the presence of noise, asystole, ventricular fibrillation, atrial fibrillation, or ECG lead off

For reliable QT/QTc monitoring, choose lead with good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave.

Some conditions such as left or right bundle branch block or ventricular hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.

Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm.

If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates), QT will not be measured. When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable QTc calculation it is important to avoid measurements when the heart rate is changing.

8.8.2 Enabling QT/QTc Monitoring

The QT monitoring function is disabled by default. Before you start QT monitoring, enable the QT function. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the

2. Select the

3. Switch on

QT tab→ select the Setup tab.

QT Analysis.

8.8.3 Displaying QT Numerics and Segments

To display QT numerics and Segments, follow this procedure:

1. Access

2. Click the parameter numeric area where you want to display the QT numerics, and then select

Tile Layout by either of the following ways:

◆ Select the Screen Setup quick key → select the Tile Layout tab.

◆ Select Main Menu quick key → from the Display column select Tile Layout.

QTc

ECG dialog.

ECG → QT/

8 - 19

NOTE

• QTc values are calculated based on the QT-HR, not the ECG HR. To view the QT-HR, open the QT View.

(4)

(2)

(1)

(5)

(3)

(6)

For more information, see 8.8.4Entering the QT View.

The following picture shows the QT numeric area. The monitor screen may look slightly different:

(1) QTc alarm limit (if QTc alarm is off, the alarm off symbol is displayed)

(2) Parameter label (3) QTc value

(4) QTc value (the difference between the current and baseline QTc values)

(5) QT value

8.8.4 Entering the QT View

QT View shows the current and baseline QT parameter values and waveforms. To enter QT View, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the

2. Select the

3. Select

The following picture shows a typical QT view.

■ The current waveform is shown in the upper half in green.

■ The baseline waveform is shown below in white.

■ The waveform of selected lead is highlighted, while the waveforms of other leads are in light green or light

gray.

■ The start of the QRS complex and the end of the T wave are marked with a vertical line.

■ In some conditions, no QT measurement can be made. Then the cause of failed QT measurement is shown

at the bottom of the QT numerics area and the message “Cannot Analyze QT” is shown in the technical alarm area.

QT tab.

QT View.

ECG dialog.

8 - 20

Select the left or right arrow to switch leads, and the corresponding waveform will be highlighted.

8.8.5 Saving the Current QTc as Baseline

CAUTION

In order to quantify changes in the QTc value, you can set a QTc baseline. If no baseline has been set for this patient within the first five minutes after getting valid QT values, the monitor will automatically set a baseline. To set the current values as baseline, follow this procedure:

1. From the

2. From the pop-up dialog box, select

If you set a new baseline the previous baseline is discarded.

From the

■ Select the left or right arrow to select a lead label to highlight corresponding waveform.

■ Select Display Baseline or Hide Baseline to display or hide the baseline waveform.

QT View, select Set Baseline.

QT View, you can also perform the following operations:

• Updating QTc baseline affects the ΔQTc value and alarm.

8.8.6 Changing QT Settings

8.8.6.1 Setting QT Alarm Properties

To set QT alarm properties, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the

2. Select the

3. Set QTc and QTc alarm properties.

QT tab→ select the Alarm tab.

OK. This baseline will then be used to calculate QTc.

ECG dialog.

8.8.6.2 Selecting Leads for QT Calculation

You can select one lead or all leads for QT calculation. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the

2. Select the

3. Set

QT tab→ select the Setup tab.

QT Leads. All is selected by default. This means all leads are used for QT calculation.

8.9 ECG Relearning

Changes in ECG beat morphology could result in incorrect arrhythmia alarms and/or inaccurate heart rate. ECG relearning allows the monitor to learn the new dominant beat morphology and thus reduce false arrhythmia alarms and inaccurate HR values. Once learning is complete, the dominant QRS complex is stored as a reference template. The reference template is used as the normal morphology of that patient and it is compared with incoming beats to identify possible arrhythmias.

8.9.1 Auto ECG Relearning

Auto arrhythmia relearning happens in the following situation:

■ The ECG lead type or lead label is changed.

■ ECG leads are off and are not reconnected within 60 seconds.

■ The patient‘s paced status is changed.

ECG dialog.

8 - 21

8.9.2 Initiating an ECG Relearning Manually

CAUTION

WARNING

NOTE

If you suspect that false arrhythmia alarms are presented, you may need to manually initiate an ECG relearn. To do so, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the

2. Select

Relearn.

ECG dialog.

• Initiate ECG relearning only during periods of predominantly normal rhythm and when the ECG

signal is relatively noise-free. If ECG learning takes place during arrhythmias, the ectopic beats may be incorrectly learned as normal QRS complexes. This may result in missed detection of subsequent arrhythmia events.

8.10 Defibrillation Synchronization Pulse Output

The 12-lead MPM module provides an analog out connector to output synchronization pulses for defibrillators. If a defibrillator is connected, it receives a synchronization pulse (100 ms, +5 V) through the analog out connector each time an R-wave is detected. The 3/5/6 lead MPM module does not offer this output.

• According to IEC 60601-2-4: 2010, the peak of the synchronized defibrillator discharge should be

delivered within 60 ms of the peak of the R wave. The signal at the ECG output (sync pulse) on the monitor is delayed by maximum of 30 ms. the biomedical engineer should verify that the ECG/ Defibrillator combination does not exceed recommended maximum delay of 60 ms.

• Before defibrillation, ensure that both defibrillator and monitor have passed the system test and

can be safely used together.

8.11 ECG Troubleshooting

This section lists some of the problems that might be encountered during ECG monitoring. If you encounter problems when using the monitor or accessories, check the table below before requesting for services. If the problem persists after you have taken corrective actions, contact the service personnel.

• For the physiological and technical alarm messages, see DAlarm Messages.

Problem Corrective Actions

Noisy ECG traces 1. Check that the electrodes are not detached or dry. Replace with fresh and

Excessive electrosurgical Interference Use ESU-proof ECG cables. For more information, see

Muscle Noise Inadequate skin preparation, tremors, tense subject, and/or poor electrode

moist electrodes if necessary.

2. Check that leadwires are not defective. Replace leadwires if necessary.

3. Check that the patient cable or leadwires are not routed too close to other electrical devices. Move the patient cable or leadwires away from electrical devices and their cables if necessary.

29.1ECG Accessories.

placement.

1. Perform skin preparation again and re-place the electrodes. For more information, see

and Connecting the Patient

2. Apply fresh, moist electrodes. Avoid muscular areas.

8.4.1Preparing the Patient Skin and 8.4.2Applying Electrodes

8 - 22

Problem Corrective Actions

Intermittent Signal 1. Check that cables are properly connected.

2. Check that electrodes are not detached or dry. Perform skin preparation again as described in moist electrodes.

3. Check that the patient cable or leadwires are not damaged. Change them if necessary.

Excessive alarms: heart rate, lead fault 1. Check that electrodes are not dry. Perform skin preparation again and

re-place the electrodes. For more information, see

Patient Skin

2. Check for excessive patient movement or muscle tremor. Reposition the electrodes. Replace with fresh and moist electrodes if necessary.

Low Amplitude ECG Signal 1. Check that the ECG gain is not set too low. Adjust the gain as required.

For more information, see

2. Perform skin preparation again and re-place the electrodes. For more information, see

Electrodes and Connecting the Patient

3. Check electrode application sites. Avoid bone or muscular area.

4. Check that electrodes are not dry or used for a prolonged time. Replace with fresh and moist electrodes if necessary.

8.4.1Preparing the Patient Skin and apply fresh and

8.4.1Preparing the

and 8.4.2Applying Electrodes and Connecting the Patient.

8.5.3.2Changing ECG Waveform Size.

8.4.1Preparing the Patient Skin and 8.4.2Applying

No ECG Waveform 1. Check that the ECG gain is not set too low. Adjust the gain as required.

Base Line Wander 1. Check for excessive patient movement or muscle tremor. Secure

For more information, see

2. Check that the leadwires and patient cables are properly connected.

3. Change cable and lead wires if necessary.

4. Check that the patient cable or leadwires are not damaged. Change them if necessary.

leadwires and cable.

2. Check that electrodes are not detached or dr y and replace with fresh and moist electrodes if necessary. For more information, see

the Patient Skin

3. Check for ECG filter setting. Set ECG Filter mode to baseline wander on the display.

and 8.4.2Applying Electrodes and Connecting the Patient.

8.5.3Changing ECG Wave Settings.

8.4.1Preparing

Monitor to reduce

8 - 23

9 Resting 12-Lead ECG Analysis

NOTE

9.1 Resting 12-Lead ECG Analysis Introduction

The monitor can be configured with the Glasgow 12-lead resting ECG analysis algorithm.The monitor incorporating the Glasgow algorithm is labelled with the logo of Glasgow as shown in

The Glasgow algorithm is intended for adult, pediatric, and neonatal patients.

9.2 Entering the 12-Lead Screen

To enter the 12-Lead screen, follow this procedure:

1. Select the ECG numeric area or waveform area to enter the

ECG dialog.

8.1ECG Introduction.

2. From the bottom of the

You can also enter the 12-Lead screen by following this procedure:

■ Select the Screen Setup quick key → select the Choose Screen tab → select ECG 12-Lead.

■ Select Main Menu quick key → from the Display column select Choose Screen → select ECG 12-Lead.

ECG dialog, select 12-Lead.

• The ECG 12-Lead screen is available only when the Glasgow algorithm is configured (associated

module has the Glasgow label) and Lead Set is set to Auto or 12-Lead.

9.3 Initiating Resting 12-Lead ECG Analysis

Before initiating 12-lead ECG analysis, check that all electrodes are correctly connected to the lead wires and the ECG trunk cable is properly connected. Check that patient information is correct. Keep the patient still.

To initiate 12-Lead ECG analysis, select

9.4 Changing 12-Lead ECG Analysis Settings

On the ECG 12-Lead screen, you can set the high frequency filter, baseline drift removal (BDR) filter, and the waveform layout.

9.4.1 Setting the High Frequency Filter

Analyze from the bottom left of the 12-Lead screen.

The high frequency filter attenuates muscle artifact by restricting the included frequencies. The setting of the high frequency filter is 35 Hz by default. To change the setting, follow this procedure:

1. On the ECG 12-Lead screen, select the ECG numeric area or waveform area to enter the

2. Select the

3. Set

The high frequency filter is a low-pass filter. That is to say, signal frequencies higher than the set frequency are filtered out. For example, if you set signal exceeding 35 Hz is attenuated.

Setup tab.

High-Freq Cut-off.

High-freq Cutoff to 35 Hz, then signal below 35 Hz is kept in the signal and

ECG dialog.

9 - 1

9.4.2 Setting the Baseline Drift Removal Filter

NOTE

The baseline drift removal (BDR) filter suppresses most baseline drift interference and also is able to preserve the fidelity of the ST-segment level. BDR is switched on by default. To set the BDR, follow this procedure:

1. On the ECG 12-Lead screen, select the ECG numeric area or waveform area to enter the

ECG dialog.

2. Select the

3. Switch on or off used.

Setup tab.

Baseline Drift Removal as desired. If BDR is switched off, the 0.05 Hz high pass filter is

• BDR introduces around 1-second delay. Using BDR is recommended except when the delay is

unacceptable.

9.4.3 Setting the 12-Lead Waveform Layout

To set the 12-lead waveform layout, follow this procedure:

1. On the ECG 12-Lead screen, select the ECG numeric area or waveform area to enter the

2. Select the

3. Set

◆ Standard: the waveform sequence is I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6.

◆ Cabrera: the waveform sequence is aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6.

For the Glasgow algorithm, the sequence of the chest leads depends on the setting of

placement

Setup tab.

Waveform Layout.

is set to V4R, the sequence of chest leads is V4R, V1, V2, V4, V5, V6.

ECG dialog.

V3 placement. If V3

9.4.4 Editing Patient Information

Some patient information may directly affect ECG analysis. Complete and correct patient information is helpful for accurate diagnosis and treatment of the patient. Enter patient information before starting a resting ECG analysis.

To enter patient information, follow this procedure:

1. On the ECG 12-Lead screen, select

2. On the

Patient Demographics page, input or edit patient information.

Setup to enter the 12-Lead Setup dialog.

• Saving information will also save the information as though it was entered in the Patient

Management dialog.

• Changes are not saved until you press Save. So changing to another tab without saving and then

pressing the exit button “X” will lose any changes.

• Check that patient information is correct before starting a resting 12-lead analysis.

• Using pediatric lead placement V4R, V1, V2, V4 - V6 is recommended if the patient is under 16 years

of age. Please record V4R using the V3 electrode. Also set V3 Electrode to V4R. This is a normal practice for a patient of this age.

9.4.5 Setting Tachycardia and Bradycardia Thresholds

To set tachycardia and bradycardia thresholds, follow this procedure:

1. On the ECG 12-Lead screen, select

Setup to enter the 12-Lead Setup dialog.

9 - 2

2. Select the

3. Set

Tac hy and Brady.

Setup tab.

NOTE

• The tachycardia threshold only applies to patients whose age exceeds 180 days.

• The bradycardia threshold only applies to patients whose age exceeds 2191 days (6 years).

9.4.6 Setting the 12-Lead Interpretation Report

To set the 12-lead interpretation report, follow this procedure:

1. On the ECG 12-Lead screen, select

Setup to enter the 12-Lead Setup dialog.

2. Select the

3. Set the format and items included in the 12-lead interpretation report.

Report tab.

9.5 Saving the 12-Lead Interpretation Report

At the completion of 12-lead ECG interpretation, select Save to save the report. You can review the saved 12lead interpretation reports. For more information, see

18.2.1112-Lead ECG Review Page.

9.6 Printing the 12-Lead Interpretation Report

At the completion of 12-lead ECG interpretation, select Print or Record to output the report via printer or recorder.

9.7 Exiting the ECG 12-Lead Screen

To exit the ECG 12-Lead screen, select Exit on the ECG 12-Lead screen.

9 - 3

10 Monitoring Impedance Respiration (Resp)

WARNING

CAUTION

(1)

(5)

(4)

(3)

(2)

10.1 Resp Introduction

Impedance respiration is measured across the thorax. When the patient is breathing or ventilated, the volume of air changes in the lungs, resulting in impedance changes between the electrodes. Impedance respiration rate (RR) is calculated from the signal representing these impedance changes, and a respiration waveform is displayed on the patient monitor screen.

Impedance respiration monitoring is intended for adult, pediatric and neonatal patients.

Respiration may also be measured using a CO

Impedance Respiration (Resp)

modules.

and 17Monitoring Anesthetic Gas (AG) for respiration information specific to those

10.2 Impedance Resp Safety Information

• When monitoring the patient’s impedance respiration, do not use ESU-proof ECG cables. The

monitor cannot measure impedance respiration with ESU-proof ECG cables.

• If you do not set the detection level for the respiration correctly in manual detection mode, it may

not be possible for the monitor to detect zero respiration rate. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in case of zero respiration rate.

• The respiration measurement does not recognize the cause of zero respiration rates. It only

indicates an alarm if a pre-adjusted time has elapsed without a breath being detected since the last detected breath. Therefore, it cannot be used for diagnostic purpose.

• If operating under conditions according to the EMC Standard IEC 60601-1-2 (Radiated Immunity 3V/

m), field strengths above 3V/m may cause erroneous measurements at various frequencies. Therefore, it is recommended to avoid the use of electrically radiating equipment in close proximity to the impedance respiration measurement unit.

• The current used to measure impedance respiration may cause rate changes in Minute Ventilation

Rate Responsive Pacemakers. If you suspect the patient monitor is affecting the pacemaker rate then replace the ECG cable with an ECG cable that contains ESU filters.

module or anesthetic gas (AG) module. Refer to 10Monitoring

• Only use parts and accessories specified in this manual.

• Impedance respiration monitoring is not for use on patients while they are active, as this can cause

false alarms.

10.3 Resp Display

10 - 1

NOTE

CAUTION

(1) Resp waveform gain (2) Resp lead label (3) Alarm limits

(1)

(2)

(4) Respiration rate (RR) (5) RR source

• If ESU-proof ECG cables are used, the Resp waveform area will display the message “Check Leads”.

Replace the ECG cable if necessary.

10.4 Preparing for Impedance Resp Monitoring

10.4.1 Preparing the Patient

Follow this procedure to prepare the patient:

1. Shave hair from skin at chosen sites.

2. Gently rub skin surface at sites to remove dead skin cells.

3. Thoroughly cleanse the site with a mild soap and water solution.

4. Dry the skin completely before applying the electrodes.

• Proper skin preparation is necessary for good signal quality at the electrode site, as the skin is a poor

conductor of electricity.

10.4.2 Placing the Electrodes

Impedance respiration is acquired using standard ECG electrodes and cables. Either lead I (RA-LA) or lead II (RALL) can be used.

For more information, see

8.4.4ECG Electrode Placements

10 - 2

(1) Lead I (2) Lead II

CAUTION

• Correct electrode placement can help to reduce interference from cardiac related impedance

NOTE

changes: avoid including the liver area and the ventricles of the heart between the respiratory electrodes. This is particularly important for neonates.

• Some patients with restricted movements breathe mainly abdominally. In these cases, you may

need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory waveform.

• Some patients (especially neonates) expand their chests laterally, causing a negative intrathoracic

pressure. In these cases, it is better to place the two respiration electrodes in the right midaxillary and the left lateral chest areas at the patient’s maximum point of the breathing movement to optimize the impedance respiration waveform.

• To optimize the impedance respiration waveform, place the RA and LA electrodes horizontally when

monitoring respiration with ECG Lead I; place the RA and LL electrodes diagonally when monitoring respiration with ECG Lead II.

• Periodically inspect electrode application sites to ensure skin integrity. If the skin quality changes,

replace the electrodes or change the application site.

• Store the electrodes at room temperature. Open the electrode package immediately prior to use.

• Check that the electrode packages are intact and that the electrodes are not past the expiration

date. Ensure the electrode gel is moist.

10.5 Changing Resp Settings

10.5.1 Setting the Resp Alarm Properties

To set the Resp alarm properties, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

3. Enter the password if required. For more information, refer to

tion

4. Set alarm properties as desired.

Alarm tab.

10.5.2 Setting the RR Source

To set RR source, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

3. Choose

When you select

ECG. When the manually selected RR source is not available, the monitor automatically switches the RR

then

Source to Auto.

Setup tab.

RR Source from the dropdown list.

Auto, the monitor automatically selects the RR source following order of priority: first CO2, and

10.5.3 Choosing the Respiration Lead

To set the respiration lead, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

Setup tab.

Resp dialog.

25.13.3Selecting Password for User Authentica-

Resp dialog.

3. Set

If you cannot get an acceptable impedance Resp waveform or you suspect the veracity of the Resp value after choosing the Resp lead, you may need to adjust the electrode placement.

Resp Lead.

10 - 3

10.5.4 Setting the Resp Waveform Size

To set the Resp waveform size, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

Setup tab.

Resp dialog.

3. Set

Gain.

10.5.5 Setting the Resp Waveform Speed

To set the Resp waveform speed, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

3. Set

Setup tab.

Speed.

10.5.6 Setting the Auto Detection Switch

To set the auto detection switch, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

3. Switch on or off

◆ If Auto Threshold Detection is switched on, the monitor automatically adjusts the Resp waveform

◆ If Auto Threshold Detection is switched off, you have to manually adjust the Resp waveform

In the auto threshold detection mode, if you are monitoring Resp and the ECG parameter is switched off, the monitor cannot compare the heart rate and Resp rates to detect cardiovascular artifact. The respiration detection level is automatically set higher to prevent the detection of cardiovascular artifact as respiration.

In the manual detection mode (where auto threshold detection is off), cardiovascular artifact can, in certain situations, trigger the respiration rate counter. This may lead to a false indication of a high respiration or an undetected zero respiration rate condition. If you suspect that cardiovascular artifact is being registered as respiratory activity, raise the detection level above the zone of cardiovascular artifact. If the Resp wave is so small that raising the detection level is not possible, you may need to optimize the electrode placement.

Setup tab.

Auto Threshold Detection.

detection level, or threshold.

threshold. For more information, see

Resp dialog.

10.5.7Adjusting the Resp Waveform Detection Threshold.

10.5.7 Adjusting the Resp Waveform Detection Threshold

Use the manual detection mode (where auto threshold detection is off) in the following situations:

■ The respiration rate and the heart rate are close.

■ Patients have intermittent mandatory ventilation.

■ Respiration is weak. Try repositioning the electrodes to improve the signal.

To set the Resp waveform threshold to the desired level, follow this procedure:

1. Select the Resp numeric area or waveform area to enter the

2. Select the

3. Select the up and down arrows below

Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.

Threshold tab.

Upper Line and Lower Line to define the Resp waveform threshold.

Resp dialog.

10 - 4

11 Monitoring Pulse Oxygen Saturation (SpO

NOTE

WARNING

11.1 SpO2 Introduction

Pulse Oxygen Saturation (SpO2) monitoring is a non-invasive technique used to measure the amount of oxygenated hemoglobin and pulse rate by measuring the absorption of selected wavelengths of light. The light generated in the emitter side of the probe is partly absorbed when it passes through the monitored tissue. The amount of transmitted light is detected in the detector side of the probe. When the pulsative part of the light signal is examined, the amount of light absorbed by the hemoglobin is measured and the pulse oxygen saturation can be calculated. This device is calibrated to display functional oxygen saturation.

SpO

monitoring is intended for adult, pediatric and neonatal patients.

The monitor can be configured with Masimo or Nellcor SpO

■ Masimo SpO

■ Nellcor SpO

■ Mindray SpO

: the connector is purple with a logo of Masimo SET.

: the connector is grey with a logo of Nellcor.

: the connector is blue without any logo.

module:

)

• The SpO

example, only connect the Masimo SpO2 extension cable can be connected to the Masimo SpO2 sensor connectors.

• A functional tester or SpO

extension cable used must be compatible with the SpO2 sensor connectors used. For

simulator can be used to determine the pulse rate accuracy.

simulator cannot be used to assess the SpO2 accuracy.

11.2 SpO2 Safety Information

• When a trend toward patient deoxygenation is indicated, analyze the blood samples with a

laboratory co-oximeter to completely understand the patient’s condition.

• Do not use SpO

potentially causes burns. The sensor may affect the MRI image, and the MRI unit may affect the accuracy of the oximetry measurements.

sensors during magnetic resonance imaging (MRI). Induced current could

• Prolonged continuous monitoring may increase the risk of undesirable changes in skin

characteristics, such as irritation, reddening, blistering or burns. Inspect the sensor site every two hours and move the sensor if the skin quality changes. Change the application site every four hours. For neonates, or patients with poor peripheral blood circulation or sensitive skin, inspect the sensor site more frequently.

• If the sensor is too tight because the application site is too large or becomes too large due to edema,

excessive pressure for prolonged periods may result in venous congestion distal from the application site, leading to interstitial edema and tissue ischemia.

• When patients are undergoing photodynamic therapy they may be sensitive to light sources. Pulse

oximetry may be used only under careful clinical supervision for short time periods to minimize interference with photodynamic therapy.

• Setting alarm limits to extreme values may cause the alarm system to become ineffective. For

example, high oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration, do not set the high alarm limit to 100%, which is equivalent to switching off the alarm.

• SpO

is empirically calibrated in healthy adult volunteers with normal levels of carboxyhemoglobin

(COHb) and methemoglobin (MetHb).

11 - 1

CAUTION

• Change the application site or replace the sensor and/or patient cable when a persistent SpO2 Low

NOTE

Signal Quality message is displayed on the equipment. These messages may indicate that patient monitoring time is exhausted on the patient cable or sensor.

• Replace the cable or sensor when a “SpO2 Sensor Off”, “SpO2 No Sensor”, or “SpO2 Low Signal

Quality” message is consistently displayed while monitoring consecutive patients after completing troubleshooting steps listed in this manual.

• Variation in measurements may be profound and may be affected by sampling technique as well as

the patient's physiological conditions. Any results exhibiting inconsistency with the patient’s clinical status should be repeated and/or supplemented with additional test data. Blood samples should be analyzed by laboratory instruments prior to clinical decision making to completely understand the patient’s condition.

• Use only SpO

adhere to all warnings and cautions.

sensors specified in this manual. Follow the SpO2 sensor’s instructions for use and

• Additional information specific to the Masimo sensors compatible with the equipment, including

information about parameter/measurement performance during motion and low perfusion, may be found in the sensor's directions for use (DFU).

• Masimo cables and sensors are provided with X-Cal™ technology to minimize the risk of inaccurate

readings and unanticipated loss of patient monitoring. Refer to the Cable or Sensor DFU for the specified duration of the patient monitoring time.

11.3 SpO2 Measurement Limitations

The following factors may influence the accuracy of SpO2 measurement:

■ Patient physiological characteristics:

◆ Cardiac arrest

◆ Hypotension

◆ Darkly pigmented skin

◆ Shock

◆ Severe vasoconstriction

◆ Hypothermia

◆ Severe anemia

◆ Ventricular septal defects (VSDs)

◆ Venous pulsations

◆ Poor perfusion

◆ Dysfunctional hemoglobin, such as carboxyhemoglobin (COHb) and methemoglobin (MetHb)

◆ Elevated levels of bilirubin

◆ Vasospastic disease, such as Raynaud’s, and peripheral vascular disease

◆ Hemoglobinopathies and synthesis disorders such as thalassemias, Hb s, Hb c, sickle cell, etc.

◆ Hypocapnic or hypercapnic conditions

◆ Birthmark(s), tattoos, skin discolorations, moisture on skin, deformed or abnormal fingers. etc.

■ Interfering substances:

◆ Intravascular dyes (such as indocyanine green, methylene blue, indigo carmine, etc.)

◆ Dyes in the measure site, such as nail polish

■ Environmental conditions:

◆ Excessive ambient light

◆ Electrosurgery equipment

11 - 2

◆ Defibrillation (may cause inaccurate reading for a short amount of time)

NOTE

CAUTION

( 5 )

(1) (2) (3)

( 4 )

◆ Excessive patient/sensor motion

◆ Electromagnetic field

◆ Arterial catheters and intra-aortic balloon

■ Others

◆ Inappropriate positioning of the SpO

◆ Cuff or arterial blood pressure measurement device on the same limb as the SpO

11.4 SpO2 Display

(1) Pleth waveform (Pleth/Plethb): visual indication of patient’s pulse. The waveform is not normalized.

sensor, or use of incorrect SpO2 sensor

sensor

(2) Oxygen saturation of arterial blood (SpO

oxyhemoglobin and deoxyhemoglobin.

(3) Perfusion indicator: the pulsatile portion of the measured signal caused by arterial pulsation.

(4) Pulse rate (derived from the pleth wave): detected pulsations per minute.

(5) Perfusion index (PI): gives the numerical value for the pulsatile portion of the measured signal caused by arterial

pulsation. PI is an indicator of the pulsatile strength. You can also use it to assess the SpO

◆ Above 1 is optimal.

◆ Between 0.3 and 1 is acceptable.

◆ Below 0.3 indicates low perfusion. Set Sensitivity to Maximum first. Reposition the SpO

better site. If low perfusion persists, choose another method to measure oxygen saturation if possible.

• PI is displayed for Masimo SpO

11.5 Preparing for SpO

To prepare to monitor SpO2, follow this procedure:

1. Select an appropriate sensor according to the module type, patient category and weight.

2. Clean the contact surface of the reusable sensor.

3. Remove colored nail polish from the application site.

4. Apply the sensor to the patient according to the instruction for use of the sensor.

5. Select an appropriate extension cable according to the connector type and plug the cable into the SpO connector.

6. Connect the sensor to the extension cable.

): percentage of oxygenated hemoglobin in relation to the sum of

and Mindray SpO2 modules.

Monitoring

signal strength.

sensor or find a

• Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct

circulation and lead to inaccurate measurements.

• At elevated ambient temperatures, be careful with measurement sites that are not well perfused,

because this can cause burns after prolonged application.

11 - 3

• Avoid placing the sensor on extremities with an arterial catheter, an NIBP cuff or an intravascular

NOTE

venous infusion line.

• For neonatal patients, make sure that all sensor connectors and adapter cable connectors are

outside the incubator. The humid atmosphere inside can cause inaccurate measurements.

11.6 Changing the SpO2 Settings

11.6.1 Changing the SpO2 Alarm Settings

To c hange t he SpO2 alarm settings, follow this procedure:

1. Select the SpO

2. Select the

3. Enter the password if required. For more information, refer to

Authentication.

4. Set the alarm properties as desired.

numeric area or waveform area to enter the SpO2 dialog.

Alarm tab.

• The desat alarm is a high level alarm notifying you of potentially life threatening drops in oxygen

saturation. When the SpO2 value is below the desat alarm limit and desat alarm switch is set on, the message “SpO2 Desat” is displayed.

• You can switch off the SpO

information, see section 25.3.7.6Setting the Switch of the SpO

Desat alarm only when the SpO2 Desat Alarm Off is enabled. For more

25.13.3Selecting Password for User

2 Desat Alarm Off

11.6.2 Nellcor SatSecondsTM Alarm Management

With traditional alarm management, high and low alarm limits are set for monitoring oxygen saturation. During monitoring, once an alarm limit is violated, an audible alarm immediately sounds. When the patient SpO fluctuates near an alarm limit, the alarm sounds each time the limit is violated. Such frequent alarms can be distracting. Nellcor’s SatSeconds alarm management technique is used to reduce these nuisance alarms.

The SatSeconds feature is available with the Nellcor SpO motion artifacts. With SatSeconds alarm management, high and low alarm limits are set in the same way as those with traditional alarm management. A SatSeconds limit is also set. The SatSeconds limit controls the amount of time that SpO

The method of calculation is as follows: the percentage points of the SpO limit is multiplied by the number of seconds remaining outside the limit. This can be stated as the equation:

SatSeconds = Points × Seconds

Only when the SatSeconds limit is reached, the monitor gives a SatSeconds alarm. For example, the figure below demonstrates the alarm response time with a SatSeconds limit set at 50 and a low SpO example, the patient SpO points) for 3 seconds, and then to 84% (6 points) for 6 seconds. The resulting SatSeconds are:

saturation may be outside the set limits before an alarm sounds.

drops to 88% (2 points) and remains there for 2 seconds. Then it drops to 86% (4

% SpO

2× 2= 4

4× 3= 12

6× 6= 36

Seconds SatSeconds

to decrease the likelihood of false alarms caused by

saturation falling outside the alarm

limit set at 90%. In this

Total SatSeconds= 52

11 - 4

After approximately 11 seconds, a Sat-Second alarm would sound, because the limit of 50 SatSeconds would

NOTE

%SpO2

S e c o n d s

have been exceeded.

Saturation levels may fluctuate rather than remaining steady for a period of several seconds. Often, the patient

may fluctuate above and below an alarm limit, re-entering the non-alarm range several times. During such

SpO

fluctuation, the monitor integrates the number of SpO SatSeconds limit is reached, or the patient SpO

points, both positive and negative, until either the

re-enters the non-alarm range and remains there.

• The SpO

limits 3 times within one minute even if the setting of SatSeconds is not reached.

To set the SatSeconds, follow this procedure:

1. Select the SpO

2. Select the

3. Set

Too Low or SpO2 Too High alarm is presented in the case that SpO2 value violates the alarm

numeric area or waveform area to enter the SpO2 dialog.

Alarm tab.

Sat-Seconds.

11.6.3 Setting SpO2 Sensitivity (for Masimo SpO2)

For Masimo SpO2, selects the Sensitivity as per signal quality and patient motion.

Normal sensitivity is the recommended for patients who are experiencing some compromise in blood flow or perfusion. It is advisable for care areas where patients are observed frequently, such as the intensive care unit (ICU).

Adaptive Probe Off Detection (APOD) sensitivity is the recommended sensitivity mode where there is a high probability of the sensor becoming detached. It is also the suggested mode for care areas where patients are not visually monitored continuously. This mode delivers enhanced protection against erroneous pulse rate and arterial oxygen saturation readings when a sensor becomes inadvertently detached from a patient due to excessive movement.

Maximum sensitivity is recommended for use on patients with weak signals (e.g. high ambient noise and/or patients with very low perfusion) and for use during procedures or when clinician and patient contact is continuous such as in higher acuity settings.The settings of sensitivity in the SpO are linked.

To s et SpO

1. Select the SpO

2. Select the

3. Set

sensitivity, follow this procedure:

numeric area or waveform area to enter the SpO2 dialog.

SpO2 Setup tab.

Sensitivity to Maximum, Normal, or APOD.

module and SpO2b module

11 - 5

CAUTION

• When using the Maximum Sensitivity setting, performance of "Sensor Off" detection may be

NOTE

compromised. If the equipment and the sensor becomes detached from the patient, the potential for false readings may occur due to environmental noise such as light, and vibration.

• The settings of sensitivity in the SpO

module and SpO2b module are linked.

11.6.4 Changing Averaging Time (for Masimo and Mindray SpO2)

The SpO2 value displayed on the monitor screen is the average of data collected within a specific time. The shorter the averaging time is, the quicker the monitor responds to changes in the patient’s oxygen saturation level. Contrarily, the longer the averaging time is, the slower the monitor responds to changes in the patient’s oxygen saturation level, but the SpO averaging time will help with understanding the patient’s state.

To set the averaging time, follow this procedure:

1. Select the SpO

2. Select the

3. Set

Averaging.

numeric area or waveform area to enter the SpO2 dialog.

SpO2 Setup tab.

measurement is more stable. For critically ill patients, selecting a shorter

11.6.5 Monitoring SpO2 and NIBP Simultaneously

When monitoring SpO2 and NIBP on the same limb simultaneously, you can switch on NIBP Simul to lock the SpO

alarm status until the NIBP measurement ends. If you switch off NIBP Simul, low perfusion caused by NIBP

measurement may lead to inaccurate SpO

To s et the

1. Select the SpO

2. Select the

3. Set

NIBP Simul, follow this procedure:

numeric area or waveform area to enter the SpO2 dialog.

Alarm tab.

NIBP Simul.

readings and therefore cause false physiological alarms.

11.6.6 Changing the Sweep Speed of the Pleth Wave

To set the sweep speed of Pleth waveforms, follow this procedure:

1. Select the SpO

2. Select the

3. Set

Speed.

numeric area or waveform area to enter the SpO2 dialog.

SpO2 Setup tab.

11.7 Changing the PR Settings

11.7.1 Changing the PR Alarm Settings

To change the PR alarm settings, follow this procedure:

1. Select the SpO

2. Select the

3. Enter the password if required. For more information refer to

Authentication

4. Set the alarm properties as desired.

numeric area or waveform area to enter the SpO2 dialog.

PR Alarm tab.

25.13.3Selecting Password for User

11 - 6

11.7.2 Changing the QRS Volume

NOTE

If the Alarm Source is set to PR, the QRS tone is derived from PR measurements. To set the QRS volume, follow this procedure:

1. Select the SpO

2. Select the

3. Set

QRS Volume.

numeric area or waveform area to enter the SpO2 dialog.

PR Setup tab.

If the SpO information, see

value is valid, the monitor also adjusts the QRS tone (pitch tone) according to the SpO2 value. For

25.14.3Setting the SpO

• Changing the QRS volume settings in the PR Setup page also changes the QRS volume settings in the

Setup page of the ECG dialog.

11.7.3 Setting the PR Source

Current pulse source is displayed in the PR numeric area if current PR source is not SpO2. The PR from current pulse source has the following characteristics:

■ PR is stored in the monitor’s database and can be reviewed in the graphic and tabular trends.In graphic

trends, as the PR curve has the same color as that of current PR source.

■ PR is sent via the network to the CMS, if available.

To set which parameter is used as a PR source, follow this procedure:

1. Select the SpO

2. Select the

3. Set

The dropdown list of the When you select source is unavailable, the system will automatically switch will automatically select the first pressure label as the PR source.

PR Source.

numeric area or waveform area to enter the SpO2 dialog.

PR Setup tab.

PR Source displays the currently available PR sources from top to bottom by priority.

Auto, the system will automatically select the first option as the PR source. If the current PR

2 Tone Mode

PR Source to Auto. When you select IBP, the system

11.7.4 Showing/Hiding PR

You can set whether to display the PR value in the SpO2 parameter area. To do so, follow this procedure:

1. Select the SpO

2. Select the

3. Select the

4. Switch on or off

numeric area or waveform area to enter the SpO2 menu.

PR tab.

Setup tab.

Display PR.

11.8 SpO2 Troubleshooting

This section lists the problems that might occur. If you encounter the problems when using the equipment or accessories, check the table below before requesting service. If the problem persists, contact your service personnel.

• For the physiological and technical alarm messages, see Appendix DAlarm Messages.

11 - 7

Problem Solution

Do not see SpO2 numeric area or waveform area on the main screen

Dashes “- -” display in place of numerics 1. Check that the cable connections of SpO

Low amplitude SpO

SpO

value is inaccurate 1. Check the patient’s vital signs.

signal 1. The SpO2 sensor and NIBP cuff are placed on the same limb.

1. Check that the SpO2 is set to display in the Screen Setup → →

Tile Layout page. For more information, see 3.9.2Displaying

Parameter Numerics and Waveforms

2. Check that the SpO SpO

measurement.For more information, see 3.9.1Switching On or

Off a Parameter

3. Check that the cable connections of the SpO extension cable are tight. Replace the SpO cable if needed.

extension cable are tight. Replace the SpO cable if needed.

2. Reconnect the SpO

3. Check the PI value. If the PI value is too low, adjust the SpO or apply the sensor to a site with better perfusion.

4. Move the sensor to a place with weaker ambient light, or cover the sensor to minimize the ambient light if the alarm SpO2 Too Much

Light

appears.

Change the monitoring site if necessary.

2. Check the PI value. If the PI value is too low. Adjust the SpO or apply the sensor to a site with better perfusion.

2. Check for conditions that may cause inaccurate SpO more information, see

3. Check the monitor, the SpO functioning.

parameter switch is enabled. If not, enable the

sensor if the alarm SpO2 Sensor Off appears.

11.3SpO

2 Measurement Limitations

module or the MPM for proper

sensor and the

sensor or the extension

sensor and the

sensor or the extension

sensor,

readings. For

11.9 Masimo Information

Masimo Patents

This posting serves as notice under 35 U.S.C.§287(a) for Masimo patents: http://www.masimo.com/patents.htm.

No Implied License

Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized sensors or cables which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.

11.10 Nellcor Information

Nellcor Patents

This posting serves as notice under 35 U.S.C.§287(a) for Covidien patents: http://www.covidien.com/patents.

No Implied License

11 - 8

Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized replacement parts which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.

12 Monitoring Temperature (Temp)

CAUTION

(2)

(1)

(4)

(1)

(3)

(2)

(3)

12.1 Temperature Introduction

The monitor can continuously monitor the patient’s skin temperature and core temperature. Thermally sensitive resistors (thermistors) are used, and are based on the principle that electrical resistance of the thermistor changes as temperature changes. The resistance change of the thermistors is used to calculate the temperature.

Up to two temperature sites can be monitored simultaneously and the difference between two measured sites is calculated.

Temperature monitoring is intended for adult, pediatric and neonatal patients.

12.2 Temperature Safety Information

• Verify that the probe detection program works correctly before monitoring. Remove the

temperature probe cable from the temperature probe connector, and check that the monitor can display the alarm messages and give alarm tones correctly.

12.3 Temperature Display

The following figure shows the Temp numeric area for temperature monitoring with the MPM module or Temp module. Your display may be configured to look different.

(1) Temperature site (2) Temperature alarm limits (3) Temperature value

(4) Temperature difference (

ΔT): Difference between two temperature sites. It displays only when ΔT is switched on.

12.4 Preparing for Temperature Monitoring

To prepare temperature monitoring, follow this procedure:

1. Select an appropriate probe for your patient according to patient category and measured site.

2. Plug the probe or temperature cable to the temperature connector. If using a disposable probe, connect the probe to the temperature cable.

3. Follow the probe manufacturer’s instructions to connect the probe to the patient.

12 - 1

12.5 Changing Temperature Settings

NOTE

12.5.1 Setting the Temperature Alarm Properties

To set the temperature alarm properties, follow this procedure:

1. Select the temperature numeric area to enter the

2. Select the

3. Enter the password if required. For more information, refer to

Authentication.

4. Set the alarm properties as desired.

Alarm tab.

12.5.2 Selecting the Temperature Label

Select the temperature label according to the measurement site. To do so, follow this procedure:

Te mp dialog.

25.13.3Selecting Password for User

1. Select the temperature numeric area to enter the

2. Select the

3. Set the temperature label.

Label Description Label Description

T1 Temperature of application site 1 T amb Ambient temperature

T2 Temperature of application site 2 T airw Airway temperature

T skin Skin temperature T vesic Vesical temperature

T core Core temperature T blood Blood temperature

T axil Axillary temperature T myo Myocardial temperature

T naso Nasopharyngeal temperature T tymp Tympanic temperature

T eso Esophageal temperature T cereb Cerebral temperature

T rect Rectal temperature

Setup tab.

12.5.3 Displaying the Temperature Difference

To display the temperature difference between two measurement sites monitored by the same temperature module, switch on

1. Select the temperature numeric area to enter the

2. Select the

3. Switch on

ΔT. To do so, follow this procedure:

Setup tab.

ΔT.

Te mp dialog.

12.6 Temperature Troubleshooting

• For the physiological and technical alarm messages, see Appendix DAlarm Messages.

12 - 2

Mindray BIO Medical electronics EPM User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual