Nihon Kohden BSM-6000 Reference Guide
Life Scope® BSM-6000 Series
Bedside Monitor and BSM-1700
Series Transport Monitor
Clinical Reference Guide
Version 08-12+
© 2019 All Rights Reserved
us.nihonkohden.com
Table of Contents
Introduction 1
Life Scope
BSM-1700 Series Transport Monitor 4
Basic Operating Concepts 6
Admission Procedure 7
Discharge Procedure 8
ECG Monitoring 9
ECG Signal Acquisition – Electrode Placement 9
ECG Signal Acquisition – Skin Preparation 11
ECG Parameter Operations 12
Arrhythmia Analysis 13
ECG Monitoring – Troubleshooting 15
Non-Invasive Blood Pressure (NIBP) Data Acquisition 16
NIBP Parameter Operations 17
NIBP Monitoring - Troubleshooting 18
®
BSM-6000 Series Bedside Monitor 2
Pulse Oximetry (SpO
SpO
SpO
Parameter Operations 21
2
Monitoring - Troubleshooting 24
2
) Data Acquisition 20
2
Respiration (RESP) Data Acquisition 25
RESP (RR) Parameter Operations 26
RESP Monitoring - Troubleshooting 27
End Tidal CO
End Tidal CO
cap-ONE
Data Acquisition Using the TG-920P CO2 Sensor 28
2
Data Acquisition Using the TG-980P/TG-970P
2
®
Sensor 31
CO Parameter Operations for TG-980-P/TG-970-P 32
CO Parameter Operations 33
CO Monitoring - Troubleshooting 34
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Temperature (TEMP) 35
Monitoring Screen Options 36
Vital Signs, Parameter and Arrhythmia Alarms 37
Interbed Alarms 39
Noise Detection 40
ST Alarms 41
Arrhythmia Alarms 41
Atrial Fibrillation Alarm 42
Arrhythmia Troubleshooting - Interventions 43
12-Lead Electrocardiogram/ST Analysis 44
12-Lead ECG Procedure 45
ST Analysis 46
ST Alarms 46
To Change the ST Measurement Points 47
To View Minute to Minute Stored ST Data 47
Invasive Blood Pressure (IBP) 48
IBP Parameter Operations 48
Set Up/Zero IBP (Invasive Blood Pressure) 48
Change IBP Label (On Screen and in Cable) 50
Calculation Method – STANDARD, PEAK 50
IBP Monitoring - Troubleshooting 52
PA Catheter Insertion 53
Perform Hemodynamic Readings 53
CO Monitoring - Troubleshooting 55
Patient Data Review 56
Trend Window 57
Trend Graphs 57
Tables 57
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NIBP Trend 58
HEMO Calculations 58
LUNG Trend 59
Arrhythmia Recall Window 60
Alarm History Window 61
Full Disclosure Window 62
Zoom In Window 62
ST Window 63
12-Lead Window 63
OCRG Window (Oxy-cardio-respiratory-gram) 64
Drug Calculations 65
Drug Calculations Operations 66
LUNG Calculations 67
LUNG FUNCTION Operations 68
Anesthesia Agent Monitoring 69
Recording 71
Transport Function 72
BSM-1700 Series Monitor 73
BSM-1700 Home Screen Display: Standard Mode/Transport Mode 74
Transport Mode 75
Transport Function using the BSM-1700 75
Connecting to the BSM-6000 Series Monitor 76
Menu Window 77
Using ZM-View Function 78
Starting and Ending ZM-View Function 79
System Settings 80
Cleaning and Disinfecting 81
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Introduction
4
Introduction
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class or
as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
The procedures in this guide reflect Life Scope TR Bedside Monitor (BSM)
6000 Series and the BSM- 1700 series monitor. Both are based on the use
of the monitor in an adult or pediatric environment. The BSM- 1700 series
monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise the
basic operation is nearly identical to each other and this guide will serve to
reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical technical and
other specific information, and for additional information as directed in this
guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class
or as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
1
The procedures in this guide reflect Life Scope
®
BSM-6000 series bedside
monitor and the BSM-1700 series transport monitor. Both are based on the
use of the monitor in an adult or pediatric environment. The BSM-1700
series monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise,
the basic operations are nearly identical to each other and this guide will
serve to reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical, technical, and
other specific information, and for additional information as directed in
this guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut is
described with the icon.
For additional assistance, please contact your hospital biomedical
services representative. For technical or clinical product assistance, a tollfree customer support service is provided at 1-800-325-0283.
us.nihonkohden.com
Life Scope® BSM-6000 Series Bedside Monitor
5
Life Scope TR 6000 Series
Bedside Monitor
2
us.nihonkohden.com
3
6
The monitor operates on AC power with optional batteries for backup.
When the monitor is operating on battery, the screen brightness can be
dimmed to conserve power.
The batteries are recharged when the monitor is connected to AC power,
and they should be changed every year. Refer to the Operator’s Manual
for additional information.
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BSM-1700 Series Transport Monitor
7
BSM-1700 Series Monitor
4
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5
8
The BSM-1700 series monitor can operate on either battery power or DC
power supplied by the optional cradle. Battery life is approximately 4-5
hours. When not in use, it is recommended to keep the BSM-1700 docked
in the cradle and plugged in to charge.
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Basic Operating Concepts
9
Basic Operating Concepts
Normally, the monitoring screen is displayed on the bedside monitor. Key
operations are performed on the touch screen display using a gentle touch
with the fingertip or touch pen, the infrared remote controller, or a computer
mouse that is connected to the USB port: 1) Touch (or click) the
PARAMETER VALUE to enter the parameter menus, 2) Touch (or click)
the PATIENT NAME area to enter the PATIENT INFO menu, 3) Touch a
FUNCTION KEY in the upper left corner to access frequently used
functions.
The BSM-6000 and 1700 Series bedside monitors have an optional
infrared remote controller:
Normally, the monitoring screen is displayed on the bedside monitor. Key
operations are performed on the touch screen display using a gentle
touch with the fingertip or touch pen, the infrared remote controller, or a
computer mouse that is connected to the USB port: 1) Touch (or click) the
PARAMETER VALUE to enter the parameter menus; 2) Touch (or click) the
PATIENT NAME area to enter the PATIENT INFO menu; 3) Touch a FUNCTION
KEY in the upper left corner to access frequently used functions.
The BSM-6000 and -1700 Series bedside monitors have an optional infrared
remote controller:
6
The MENU window can be displayed by pressing the MENU key on the
front panel or on the remote controller. When you access a function on
the monitor, the menu is displayed in a tabbed “file folder” format. Touch
or click on the tab to access the individual menu. The monitoring screen
can be displayed at any time by pressing the HOME key on the front
panel or on the remote controller.
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Admission Procedure
The Life Scope BSM 6000 Series bedside monitor is ready for data
collection once the power is turned ON.
1. Press the power switch and release — the monitoring screen
appears after monitor warms up.
2. Verify the alarm settings and input unit (see VITAL SIGNS,
PARAMETER, and ARRHYTHMIA ALARMS section in this guide).
3. Connect the patient.
4. Enter patient demographic information (optional).
a. Press the MENU key
b. Touch the ADMIT button in the PATIENT section on the menu
OR Touch the patient name field at the top of the screen
c. Select the patient type (Adult, Pediatric, or Neonate),
if necessary.
i. Selecting each patient type will set the vital sign alarm
limits, arrhythmia alarm settings, NIBP initial cuff inflation
pressure, invasive pressure scales, QRS detection type, and
trend graph scales, based on the patient type.
7
d. Touch the NAME data button and/or touch the PATIENT ID
e. Enter the patient name and/or number using the
on-screen keyboard.
f. DEL clears all characters to the right of the cursor.
g. BS erases to the left of the cursor, one character at a time.
h. Touch the ENTER button to enter the patient name or number.
i. If demographics are entered after patient monitoring has
commenced, do not press the ADMIT key. Data loss could
occur if this action is performed post demographic entry.
Press the HOME key to return to the monitoring screen. If the bedside
monitor is a part of a network with a central nursing station (CNS),
the information can be entered at the central station using the
ADMIT/DISCHARGE menu.
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Discharge Procedure
4
Introduction
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class or
as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
The procedures in this guide reflect Life Scope TR Bedside Monitor (BSM)
6000 Series and the BSM- 1700 series monitor. Both are based on the use
of the monitor in an adult or pediatric environment. The BSM- 1700 series
monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise the
basic operation is nearly identical to each other and this guide will serve to
reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical technical and
other specific information, and for additional information as directed in this
guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut
4
Introduction
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class or
as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
The procedures in this guide reflect Life Scope TR Bedside Monitor (BSM)
6000 Series and the BSM- 1700 series monitor. Both are based on the use
of the monitor in an adult or pediatric environment. The BSM- 1700 series
monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise the
basic operation is nearly identical to each other and this guide will serve to
reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical technical and
other specific information, and for additional information as directed in this
guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut
The discharge procedure is performed between patients to delete
information from the bedside monitor and the CNS and to reset default
alarm settings on both monitors. When this procedure is not performed,
the most current 24 hours of data is stored in memory. The amount of
time that data is stored after power is turned off on the bedside monitor
depends on the setup functions. Once the information is deleted, it
CANNOT be retrieved.
To discharge a patient:
1. Press the MENU key
2. Touch the ADMIT button in the PATIENT section in the menu
OR Touch the patient name field at the top of the screen
3. Touch the DISCHARGE tab
4. Touch YES to confirm. This procedure readies the monitor for the
next patient’s admittance.
5. Turn the monitor power off, if needed (press and hold the power
switch for 3 seconds until the display blanks).
8
A “COMMUNICATION LOSS” message displays on the central station when
the bedside monitor is turned off.
Suspend Monitoring
The SUSPEND MONITORING function is used to suspend data processing and
alarms during temporary interruptions in monitoring. No patient information
is deleted with this procedure, but the monitoring screen remains active and
alarms are suspended while the patient is disconnected.
1. Disconnect the patient from the monitor.
2. Press the MENU key.
3. Touch the SUSPEND MONITORING button in the ALARM section.
The menu closes and the “SUSPEND MONITORING ALL ALARMS OFF”
message appears. Monitoring resumes automatically once the patient is
reattached, depending on the configured time interval.
A SUSPEND MONITORING function button may be present on the
screen and/or the remote for a one-touch function.
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ECG Monitoring
12
12
ECG Signal Acquisition – Electrode Placement
The Life Scope G9 bedside monitor is equipped to use 3, 6, or 10
electrodes to monitor heart rate, rhythm, and ST segments, as well as
impedance respiration.
9
Chest electrodes may be placed in any chest lead position, depending on
the monitoring requirements. V1 and V3 are shown. V1 is useful for arrhythmia
monitoring. V3 is the most sensitive lead for anterior wall ischemia. Other Vleads are useful for ST segment and arrhythmia monitoring as well.
*Default V leads
3 Electrode Placement
Chest Lead Position
R/RA (white) Midclavicular line 2 fingers below R clavicle
L/LA (black) Midclavicular line 2 fingers below L clavicle
N/RL (green) R anterior-axillary line at edge or lower rib
F/LL (red) L anterior-axillary line at edge of lower rib
*V1 (blue) 4th inter-costal space(ICS), right sternal border
V2 4th ICS, left sternal border
*V3 (orange) Halfway between V2 and V4
V4 5th ICS, left mid-clavicular line
V5 Anterior axillary line at same level as V4
V6 Mid-axillary line at same level as V4
6 Electrode Placement
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The 10-electrode ECG cable is used to perform diagnostic-quality
13
12-lead electrocardiograms, as with an ECG cart. Electrode placement
for the procedure on the bedside monitor should be the same as the
cart procedure to provide consistency for serial comparison between
ECGs. Electrode placement is suggested here but should be decided by
individual hospital protocols. Tab or patch electrodes may be used.
10
10 Electrode Placements
Limb electrodes should be placed on the actual limbs if the hospital
protocols require this placement for diagnostic 12-lead ECG samples.
Continuous 12-lead monitoring is difficult with the limb leads on the
extremities because of the motion artifact, so use the torso limb
placement for continuous monitoring, when possible.
See the 12-lead ECG section in this guide for the 12-lead procedure.
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ECG Signal Acquisition – Skin Preparation
14
The ECG waveform is monitored for heart rate, arrhythmias, ST segment
measurements, and pacemaker activity. Electrical impulses are
conducted through the gel on the ECG electrodes, so moist gel is
required for proper detection. Inadequate detection can cause electrical
noise on the ECG tracing and inaccurate interpretation by the monitor.
We recommend that electrodes be changed at least daily to promote
adequate signal detection but follow the recommendations of your
electrode manufacturer and/or hospital policy.
Proper skin preparation is also important for respiration monitoring, as the
respiration parameter uses the same electrodes. It is most important to
remove hair and dead skin cells for accurate detection, and to remove
skin oils so the electrodes will adhere to the patient’s skin.
1. Select the electrode site according to the diagram above.
2. Trim excess hair according to hospital protocols.
3. Gently abrade skin areas with dry gauze to remove dead skin cells.
4. If skin is oily, clean the site with soap/water and friction and then wipe
off with dry gauze. You may use an alcohol prep according to your
policy, if needed.
11
5. Attach the lead wire to the electrode.
6. Attach the electrode to the patient, pressing the circumference of
electrode to secure it.
7. Position the ECG cable to prevent tangling.
Stress Loop: The lead wires can transmit electrical interference to the
monitor; to minimize this interference with patient movement, fasten the
individual lead wire to the skin with surgical tape.
us.nihonkohden.com
ECG Parameter Operations
4
Introduction
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class or
as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
The procedures in this guide reflect Life Scope TR Bedside Monitor (BSM)
6000 Series and the BSM- 1700 series monitor. Both are based on the use
of the monitor in an adult or pediatric environment. The BSM- 1700 series
monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise the
basic operation is nearly identical to each other and this guide will serve to
reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical technical and
other specific information, and for additional information as directed in this
guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut
The heart rate is calculated by using a moving average or by counting
each individual beat. The AVERAGE mode uses an average of 12 beats
and updates them with each new beat to display the new average every
3 seconds. The INSTANT mode updates the heart rate with each beat and
displays the new rate every 3 seconds.
The ECG menu allows adjustments while monitoring ECG. To access the
ECG parameter menu, touch the heart rate value.
MAIN Tab Options:
Sensitivity – Increases or decreases the size of the ECG tracings.
1. Touch x1/4, x1/2, Auto, x1, x2, or x4. Ensure correct electrode
a. Auto allows the monitor to set a sensitivity that is required for
detection based on the previous 16 beats.
Lead – The top lead is analyzed for arrhythmias when SINGLE arrhythmia
analysis is selected; the top two leads are analyzed with MULTIPLE. Ensure
correct electrode placement and then select the option to display the
lead with QRS complexes that are > 5 mm tall.
placement and then select the option to display the QRS at > 5 mm tall.
12
Touch the desired lead to display in the top position — unavailable leads
are grayed out.
Alarms – HEART RATE/VPC/ST
Increase, decrease, or turn OFF alarm limits
1. Touch limit and then
2. Touch limit and then
Change alarm limit by touching and dragging the slider.
LEARN
Initiates a “relearn” of the patient’s dominant QRS for arrhythmia processing
and the “LEARNING” message is displayed on screen. Use this function
whenever the patient’s rhythm has changed, incorrect detection occurs, or
to store a new dominant template in the MAIN or ARRHYTHMIA ANALYSIS tabs.
ST ALARMS tab: allows for setting alarms on all monitored leads.
Provides alarm settings for individual or ALL leads. Individual settings set
alarms relative to iso point; ALL sets relative to current ST measurements.
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s
to increase
t
to decrease OR
Arrhythmia Analysis
Arrhythmia alarms occur when ARRHYTHMIA ANALYSIS is turned on in the
ARRHYTH ANALYSIS tab, the individual arrhythmia alarm is turned to ON,
and the monitor detects an arrhythmia event. Single (top) or multiple (top
two) ECG leads are selected for analysis in the ARRHYTH ANALYSIS tab.
To view or change these settings:
1. Touch the heart rate value.
2. Touch the ARRHYTH tab.
3. Touch the ON button for the arrhythmia events you want to alarm.
OTHER Tab Options:
Filters – DIAG, MONITOR, MAXIMUM
Filters reduce AC interference on the ECG waveform. MONITOR should be
chosen for routine patient monitoring.
HUM Filter – ON/OFF
HUM filters reduce interference on the ECG waveform during battery
operation. ON should be chosen for routine patient monitoring with the
monitor plugged into AC power.
Number of Electrodes
Signals the monitor to the type and numbers of ECG lead wires. Choose
STANDARD for Nihon Kohden lead blocks. Use INDIV 6 or INDIV 10 when
using individual or disposable lead wires.
13
ECG Measurement – ON/OFF
This option is available if SpO
and pulse rate monitoring are needed and
2
can only be turned off if no ECG signal is detected. Turn OFF to view only
SpO
and SpO2 PR when patient is connected to SpO2 probe and monitor.
2
Sync Pitch – FIXED, SpO
Provides a variable change in the audible tone as the SpO
, PRESS
2
value
2
changes. FIXED does not change as the value changes.
Sync Source – ECG, SpO
, PRESS
2
Provides the sync sound from the selected pulse source. If the QRS SYNC
function is enabled, a green light on top of the monitor also flashes with
each pulse.
When SpO
or PRESS is selected, the associated pulse rate is displayed in
2
the corresponding color when the PR is ON. This is helpful in OR when the
cautery is in use. SYNC SOUND VOLUME is controlled in MENU > VOLUME.
us.nihonkohden.com
HR Display Mode – AVERAGE, INSTANT
Two modes that can be used to calculate heart rate:
AVERAGE – Monitor detects 12 consecutive beats (including VPCs),
averages the R-R intervals, and uses this average to calculate the current
HR. When a new beat is detected, the HR is recalculated using the latest
12 beats. The HR display is updated every 3 seconds.
INSTANT – HR is calculated based on the last 2 beats and is updated every
3 seconds.
Pacing
Detection – ON/OFF
Turn this to ON when the patient has a pacemaker. This tells the monitor
to detect the pacer spike and look for capture following that spike. False
arrhythmia alarms could occur if detection is left OFF with an internal
pacemaker present.
Mark – ON/OFF
Turn this ON to enhance the pacer spike ON SCREEN. The enhanced spike
is not printed.
14
Auto Lead Change – ON/OFF
This option is available with the 6 or 10 electrode cable. This allows for the
monitored lead to automatically change between lead I, II, and III if lead
wires or electrodes become disconnected for more than 5 seconds.
ECG 2/3 Waves Tab:
This allows you to select the numbers of ECG leads to display (1, 2, or 3), the
lead to display in each position, and to change the sensitivity on the second
and third leads. Choose the primary (top) ECG lead in the ECG MAIN tab.
V-Leads Tab:
This allows you to assign the V-leads for the Va and Vb chest leads when
using the 6 electrode cable. Once the leads are assigned, they become
available on the ECG 2/3 Waves tab.
ST Point Tab:
This allows you to adjust the measurement points from the default settings
and the markers show the iso, r-wave, j-point, and ST point. Use the < >
keys for changes.
us.nihonkohden.com
ECG Monitoring – Troubleshooting (see operator manual)
Problem Possible Cause Action
Inaccurate HR QRS is too small Change sensitivity so QRS is >
5 mm tall
Arrhythmia alarm
occurs frequently
when HR is normal
ECG waveform
does not appear
on screen when
electrodes are
properly attached
AC interference
on the waveform
Baseline
wandering
QRS is not detected
correctly
Dominant QRS is
not appropriate for
arrhythmia monitoring
Patient moved or EMG
noise is superimposed
NUMBER OF
ELECTRODES setting
in ECG MENU is not
correct
Electrode is dry Change electrode(s)
ECG FILTER is set to
DIAGNOSTIC
Baseline is not stable
due to respiration
or movement
The electrode is dry Change electrodes
Change to different lead with a
tall QRS and small T wave (View
all leads of available ECG in the
12-Lead Analysis tab)
Learn ECG or change the
ECG lead
Move electrodes to positions with
less muscle. Use stress loops.
Set correct number of electrodes
for attached ECG cable. Use
STANDARD unless individual lead
wires are used.
Set ECG FILTER to MONITOR or
MAXIMUM
Move electrodes to positions with
less muscle. Consider stress loops.
15
Inaccurate
pacemaker
detection or false
VPC calls for
paced beats
us.nihonkohden.com
Contact resistance
between skin and
electrode is high
The ECG filter is set to
DIAGNOSTIC
Pacemaker impulse
is not detected and/
or paced beats
are labeled as
ventricular
Abrade skin gently with dry gauze
before applying electrodes
Set the ECG filter to MONITOR or
MAXIMUM
Ensure PACING DETECTION is ON.
Display a different ECG lead, such
as V1. Try alternate electrode
placement: Move LL up and
RA down.
Non-Invasive Blood Pressure (NIBP)
19
Data Acquisition
The Nihon Kohden NIBP monitor uses the occlusive-oscillometric method
to measure systolic, diastolic, and mean arterial non- invasive blood
pressure. This method may yield dierent results from direct, invasive
arterial pressure.
The initial adult inflation volume is 180mmHg, pediatric is 140mmHg, and
then subsequent inflations are 30mmHg above the last systolic reading.
ADULT/CHILD is displayed in the NIBP numeric area when that hose/cuff is
connected.
The monitor automatically detects the neonatal hose when connected
and displays a “NEONATAL” message in the NIBP numeric area. The
initial neonatal inflation volume is 70-100mmHg (based on system
configuration), and then subsequent inflations are 30mmHg above the last
systolic reading.
The NIBP is measured from the change in amplitude pattern of pulsatile
oscillation in cuff pressure as the cuff pressure is reduced from above
systolic to below diastolic pressure. The systolic pressure is the pressure
at which the pulsatile oscillation suddenly increases, and the diastolic
pressure is the pressure at which the pulsatile oscillation suddenly
decreases. The mean arterial pressure is the point where maximum
pulsatile oscillation occurs.
16
INACCURATE READINGS MAY OCCUR DURING PATIENT MOVEMENT.
Cuff selection should be based on the size of the patient’s arm. The
American Heart Association recommends that the cuff width be 40% of
the circumference of the upper arm. Inappropriate cu size can result in
inaccurate NIBP results.
us.nihonkohden.com
NIBP Parameter Operations
4
Introduction
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class or
as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
The procedures in this guide reflect Life Scope TR Bedside Monitor (BSM)
6000 Series and the BSM- 1700 series monitor. Both are based on the use
of the monitor in an adult or pediatric environment. The BSM- 1700 series
monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise the
basic operation is nearly identical to each other and this guide will serve to
reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical technical and
other specific information, and for additional information as directed in this
guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut
4
Introduction
This Clinical Reference Guide is designed to assist you to learn the
monitors’ basic operations during the pre-implementation training class or
as a self-study tool as you use the system on your clinical unit. It is also
designed as a reference tool when you need a refresher for infrequently
performed procedures.
The procedures in this guide reflect Life Scope TR Bedside Monitor (BSM)
6000 Series and the BSM- 1700 series monitor. Both are based on the use
of the monitor in an adult or pediatric environment. The BSM- 1700 series
monitor operates similarly to the BSM-6000 series and any differences
between the two will be explained at the end of this guide. Otherwise the
basic operation is nearly identical to each other and this guide will serve to
reflect both BSM’s.
The Clinical Reference Guide is an adjunct to the Operator’s Manual and
does not replace it. Please refer to that manual for critical technical and
other specific information, and for additional information as directed in this
guide.
Whenever you see this icon in this guide, a one touch
“shortcut” is available for the particular function. That shortcut
1. Ensure the appropriate cuff size for the patient and position extremity
at heart level, as readings may vary with a cuff higher or lower than
this position. Monitor automatically identies hose connected
(ADULT/CHILD, NEONATE) and displays that on screen.
2. Press the NIBP INTERVAL key to display the automatic interval options
and select the desired interval.
3. Press the NIBP START/STOP key to initiate reading.
Single NIBP readings can be started at any time using the NIBP
START/STOP key
To access the NIBP parameter menu, touch the NIBP value.
MAIN Tab Options:
Initial Cu Pressure Type:
This allows you to choose ADULT or CHILD to adjust the initial inflation
pressure. Subsequent inflations are 30mmHg over the last systolic reading.
Measurement Interval – Manual to 8-hour
Touch the desired interval and then press the NIBP START/STOP key to
initiate the automatic readings. Inflation may start automatically if
configured to do so.
17
•
STAT mode takes continuous readings for 10 minutes as set in
the setup menu (view in NIBP Mode tab).
SIM mode is available in the OR mode and allows for staged
readings as set in the setup menu (view in NIBP Mode tab).
NIBP intervals may be set using the NIBP INTERVAL key.
Alarms – SYSTOLIC, DIASTOLIC, MAP
Increase, decrease, or turn OFF alarm limits
1. Touch limit then
2. Touch limit then
Set value to ABOVE MAXIMUM or BELOW MINIMUM to turn alarm OFF.
PWTT Tab: ON/OFF – choose to set the trigger time in minutes. Available
with NK SpO
when SpO
us.nihonkohden.com
•
s
to increase
t
to decrease
monitors and allows for automatic blood pressure readings
2
indicates a change in blood pressure.
2
OTHER Tab Options:
Target Cu Pressure – Adjusts inflation volume. Use this for patient
comfort before the cuff inflates.
Display Oscillation Graph – Graph shows the detected pulse amplitude
on a pressure scale and can be used to determine if the reading was
affected by patient movement or other interference. Can be turned ON/
OFF. (Graph only displayed on home screen if there is enough room.)
NIBP Monitoring – Troubleshooting (see operator manual)
Problem Possible Cause Action
Cuff inflation
pressure is <
10mmhg or NIBP
data disappears for
a few seconds
Cuff does not inflate
when NIBP START/
STOP key is pressed
Abnormal
measurement results
are displayed
Auto measurement
does not start even
when time interval
has passed
Cuff suddenly
inflates
Cuff hose is not
connected to monitor
socket properly
Hose is not connected
to socket
Cuff size is incorrect Select cuff size appropriate to
Cuff is not wrapped
correctly
Patient movement Take readings without patient
Measurement on
wrong site
Time interval is set
incorrectly or NIBP
START/STOP key was
not pressed to set
interval
Measurement mode is
set to AUTO
NIBP measurement is
triggered by PWTT
Connect hose to monitor
properly
Connect the hose to socket
firmly
patient’s size
Position cuff snuggly on
patient’s arm
movement
Position cuff over artery
Check interval and press NIBP
START/STOP key
Check time interval
PWTT TRIGGERED NIBP is set to a
threshold on the SYSTEM SETUP
screen
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Problem Possible Cause Action
“MEASURE TIME OUT”
message
“SYSTOLIC OVER”
message is displayed
Cannot measure
NIBP
Patient movement or
irregular pulse
Blood pressure is
higher than the
NEONATAL mode can
detect
Noise interfered with
calculation of NIBP
Pulse wave is unstable
due to arrhythmias
Cu or hose has leak Change cu or hose
Reposition, retry, or use another
method
Change to the ADULT/CHILD
hose and use the appropriately
sized cuff for the infant.
Remove cause
Check blood pressure using
alternative methods
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Blood congestion
occurs
Thrombus occurs
NIBP data on the
screen is dark
“CHECK CUFF AND
HOSE” message is
displayed
“PATIENT MOVEMENT
REMEASURING”
message is displayed
Measuring over long
periods of time at
intervals less than2.5
minutes
Sickle cell patients NIBP is contraindicated on sickle
10 minutes elapsed
from last reading
Cu or hose has leak
or is hose is bent or
obstructed
Patient moved during
measurement
Patient moved during
measurement or pulse
is too small to detect.
Cu is not appropriate
for patient or is
attached incorrectly
Increase measuring interval
Use alternate site for NIBP
measurements
cell anemia patients
NIBP data returns to normal
brightness with next reading
Check cu and hose for leaks or
straighten hoses
Wait for patient to stop moving
and measure again
Wait for patient to stop moving
and measure again
Check that cu is appropriate
and positioned correctly
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Pulse Oximetry (SpO2) Data Acquisition
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cable, which accepts
The Nihon Kohden SpO2 monitor uses a SpO2 cable, which accepts
reusable or disposable probes. The monitor comes in three options for
pulse oximetry: Nihon Kohden, Nellcor OxiMax, and Masimo. The menu
options vary slightly depending on the algorithm used.
Nihon Kohden probes are obtained from Nihon Kohden, but Nellcor and
Masimo probes are obtained from those companies directly. There are
many options for probes from each company, ranging from neonate to
adult, and it is important to use the appropriate probe for the size and
age of the patient. There are options for probes that are used on the
ear and forehead, in addition to the traditional foot or hand and finger
probes. See the operator manual for additional information.
The probe is positioned with the photo emitter (cable side) on top so light
is passed through the measurement site to the photo detector directly
opposite the emitter. Results are best if used on fingers without nail
polish or acrylic nails. Ambient light may affect readings, so placing the
extremity under cover may improve detection.
20
When measuring SpO
for long periods of time, it is recommended that
2
the site be alternated to relieve pressure on the measuring digit.
Change site every four hours for reusable and every four to eight hours for
disposable probes. Discontinue use of probe if skin irritation occurs or signs
of circulatory compromise.
The SpO
monitor is able to “read through”
2
motion and alerts you to this condition by
placing an “M” on the screen.
The Masimo version uses this symbol to indicate
a “low Signal IQ” that is discussed below.
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SpO2 Parameter Operations
To access the SpO2 parameter menu, touch the SpO2 value.
MAIN Tab Options:
Sensitivity – X1/8 to X8 – AUTO finds the appropriate size and adjusts the
size of the SpO
Touch the setting and observe the waveform in the SpO
waveform on the screen and on the recording paper.
2
window.
2
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Alarms – SpO
Alarm Limits
2
Increase, decrease, or turn OFF alarm limits.
1. Touch limit then
2. Touch limit then
s
to increase
t
to decrease
Set value to ABOVE MAXIMUM or BELOW MINIMUM to turn alarm OFF.
OTHER Tab Options:
Sync Source – ECG, SpO2, PRESS
Provides the sync sound from the selected pulse source. If the QRS
SYNC function is enabled, a green light on top of the monitor also
flashes with each pulse. WHEN SpO
ASSOCIATED PULSE RATE IS DISPLAYED IN THE CORRESPONDING COLOR
WHEN THE PR IS ON. This is helpful in OR when the cautery is in use.
SYNC SOUND VOLUME is controlled in MENU>VOLUME.
Sync Pitch – FIXED, SpO
, PRESS
2
Provides a variable change in the audible tone, as the SpO
changes and can be configured in one of two ways. FIXED does not
change as the value changes.
OR PRESS IS SELECTED,THE
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value
2
SPO2 VALUE Sync Pitch of Sync Sound
100 to 81% High to low pitch, in 1% steps
100 to 40% High to low pitch, in 1% steps
Less than 81%
or less than 40%
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Low Pitch
Nihon Kohden Monitors Only
Response - FAST, NORMAL, SLOW
There are three response modes in the Nihon Kohden version of the BSM.
Each uses a different time to ensure accurate measurements according
to patient conditions. When measurement conditions are unstable, the
response becomes slower in all modes.
FAST: Select this mode for special applications that require a fast
response time, such as with short apnea episodes.
NORMAL: Select this for normal monitoring.
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SLOW: Select this when you need to suppress a rapid change in SpO
.
2
Masimo Monitors Only
Perfusion Index
Indicates the percentage of pulsatile (arterial) to non-pulsatile (venous)
signals. The range of Perfusion Index is 0.02% (very weak pulse strength)
to 20% (very strong pulse strength). Placing the sensor at the site with the
highest Perfusion Index number improves the performance during motion.
Perfusion Index Display
To display the Perfusion Index, press the SpO
Press ON/OFF tab for PI DISPLAY. The PI will be displayed next to the
associated SpO
value.
2
Signal IQ
The signal quality indicator is used to identify the occurrence of the pulse
and the associated signal quality of the measurement. The Signal IQ,
shown as a vertical line, coincides with the peak of the arterial pulsation on
the waveform. The height of the line indicates the quality of the measured
signal. When the signal quality is very low, the height of the line becomes
low and a “M” is displayed along with the SpO
tab, then NUMERIC DISPLAY.
2
value on the monitor.
2
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