Nihon Kohden BSM-6301, BSM-6501, BSM-6701 User manual Part 2 [gb]

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User’s Guide

Part II

Bedside Monitor

BSM-6301/BSM-6501/BSM-6701

BSM-6000 series BSM-6301A BSM-6301K BSM-6501A BSM-6501K BSM-6701A BSM-6701K

0614-901229T

In order to use this product safely and fully understand all its functions, read this manual before using the product.

Keep this manual near the instrument or in the reach of the operator and refer to it whenever the operation is unclear.

This product stores personal patient information. Manage the information appropriately.

Patient names on the screen shots and recording examples in this manual are ctional and any resemblance to any

person living or dead is purely coincidental.

The contents of this manual are subject to change without notice.

If you have any comments or suggestions on this manual, please contact us at: www.nihonkohden.com

The entire contents of this manual are copyrighted by Nihon Kohden. All rights are reserved. No part of this document

may be reproduced, stored, or transmitted in any form or by any means (electronic, mechanical, photocopied, recorded,

or otherwise) without the prior written permission of Nihon Kohden.

Trademark

The mark printed on the SD card that is used in this instrument is a trademark. The company name and model name are

trademarks and registered trademarks of each company.

Contents

Conventions Used in this Manual and Instrument .............................................................. i

Warnings, Cautions and Notes ................................................................................. i

Text Conventions ....................................................................................................... i

Related Documentation ....................................................................................................... i

Safety Standards ................................................................................................................ ii

Safety Information ............................................................................................................... ii

Section 1 ECG Monitoring ..................................................................... 1.1

General ............................................................................................................................ 1.3

Using the Output Signal from the ECG/BP OUT Socket .......................................1.4

Preparing for ECG Monitoring ......................................................................................... 1.5

Preparation Flowchart ........................................................................................... 1.5

Number of Electrodes and Measuring Leads ........................................................ 1.5

Electrode Position .................................................................................................. 1.5

3 Electrode Leads ....................................................................................... 1.5

6 Electrode Leads ....................................................................................... 1.6

Mason-Likar Modiﬁcation ............................................................................ 1.7

Standard 12 Leads ...................................................................................... 1.8

Electrode Positions for Detecting the Pacemaker Pulse ........................................ 1.8

Changing the Electrode Lead ...................................................................... 1.8

Changing the Electrode Positions ...............................................................1.8

Selecting Electrodes and Lead .............................................................................. 1.9

Types of Electrodes and Lead ................................................................... 1.10

Connecting Cables and Attaching Disposable Electrodes ................................... 1.11

Connecting the Electrode Cable to the Input Unit .....................................1.11

Connecting the Electrode Cable to the BSM-1700 series Bedside

Monitor ...................................................................................................... 1.11

Attaching Disposable Electrodes to the Patient .........................................1.12

Monitoring ECG ............................................................................................................. 1.13

ECG Information on the Home Screen ................................................................ 1.14

ECG Data Display ................................................................................................1.14

Measuring ST Level ............................................................................................. 1.15

Detached Electrode Detection and Display .........................................................1.15

AC Interference and Display ................................................................................ 1.16

Monitoring Arrhythmia .................................................................................................... 1.17

General ................................................................................................................ 1.17

Arrhythmia Analysis Data Display.............................................................. 1.18

Changing Arrhythmia Monitoring Settings ........................................................... 1.19

Turning Arrhythmia Analysis On or Off ...................................................... 1.19

Selecting Arrhythmia Analysis Leads ........................................................1.20

Selecting the Patient Type for QRS Detection ........................................... 1.21

Learning the ECG Waveform for Arrhythmia Detection (VPC

Learning) ................................................................................................... 1.22

Checking the Dominant QRS ....................................................................1.23

4-1

4-2

4-3

User’s Guide Part II BSM-6000 C.1

CONTENTS

Changing ECG Settings ................................................................................................. 1.25

Turning ECG Measurement On or Off .................................................................1.26

Changing the Monitoring Lead ............................................................................ 1.27

Optimum Lead ........................................................................................... 1.28

Selecting the Number of ECG Traces on the Home Screen ...................... 1.28

Changing a Lead ....................................................................................... 1.29

Assigning Va and Vb (Ca and Cb) Leads when Monitoring with

6 Electrodes .............................................................................................. 1.30

Auto Lead Change On or Off ..................................................................... 1.31

Changing the ECG Sensitivity ............................................................................. 1.31

Changing the Heart Rate/Pulse Rate, VPC and ST Alarm Limits ....................... 1.33

Changing Arrhythmia Alarm Settings ..................................................................1.34

Changing the ST Alarm Limits ............................................................................. 1.37

Changing the ST Level Measurement Condition .................................................1.38

Changing Pacing Settings ...................................................................................1.41

Turning Pacing Spike Detection On or Off ................................................. 1.41

Displaying Pacing Mark ............................................................................. 1.43

Changing the Number of Electrodes ................................................................... 1.43

Selecting Mode for Updating the Heart Rate ....................................................... 1.44

Selecting the Filter Type ......................................................................................1.44

Turning the Hum Filter On or Off .........................................................................1.45

Changing the Sync Sound Source ...................................................................... 1.45

Selecting Sync Sound Pitch ................................................................................ 1.47

Use with an Electrosurgical Unit .................................................................................... 1.49

Section 2 Respiration Monitoring ......................................................... 2.1

General ............................................................................................................................ 2.2

Measurement Method ............................................................................................ 2.2

Impedance Method ...................................................................................... 2.2

Thermistor Method ...................................................................................... 2.2

Preparing for Respiration Monitoring in Impedance Method............................................2.3

Preparation Flowchart ........................................................................................... 2.3

Electrode Position and Waveform Examples .........................................................2.4

Electrode Position ........................................................................................ 2.5

Amplitude .................................................................................................... 2.5

Connecting Cables and Attaching Disposable Electrodes ..................................... 2.5

Preparing for Respiration Monitoring in Thermistor Method ............................................2.6

Preparation Flowchart ........................................................................................... 2.6

Respiration Pickups ............................................................................................... 2.6

Connecting the Cable to the Unit ........................................................................... 2.7

Attaching the Respiration Pickup ........................................................................... 2.7

When Using Respiration Pickup for Nose.................................................... 2.7

When Using Respiration Pickup for Airway .................................................2.7

Monitoring Respiration ..................................................................................................... 2.8

Respiration Information on the Home Screen........................................................2.9

Changing Respiration Settings ......................................................................................2.10

Changing the Monitoring Lead in Impedance Method ......................................... 2.10

Changing the Respiration Sensitivity ................................................................... 2.11

C.2 User’s Guide Part II BSM-6000

CONTENTS

Turning Respiration Measurement On or Off in Impedance Method ...................2.12

Changing the Respiration Rate and Apnea Alarm Limits .................................... 2.13

Changing the Respiration Waveform Sweep Speed ............................................ 2.14

Displaying Impedance Method Respiration Rate as the Second Respiration

Parameter ............................................................................................................2.15

Section 3 CO2 Monitoring ...................................................................... 3.1

General ............................................................................................................................ 3.2

Mainstream Method ............................................................................................... 3.2

Sidestream Method ............................................................................................... 3.3

Measurement Error with the TG-900P or TG-920P CO2 Sensor Kit ...................... 3.3

Use with Volatile Anesthetic Agents ....................................................................... 3.5

Preparing for CO2 Monitoring ........................................................................................... 3.6

Preparation Flowchart ........................................................................................... 3.6

Mainstream Method ..................................................................................... 3.6

Sidestream Method ..................................................................................... 3.6

Types of CO2 Sensor Kits for Mainstream Method ................................................3.7

TG-900P CO2 Sensor Kit ............................................................................. 3.8

TG-920P CO2 Sensor Kit ............................................................................. 3.9

TG-950P CO2 Sensor Kit ........................................................................... 3.10

TG-970P and TG-980P CO2 Sensor Kits .................................................. 3.11

Connecting the CO2 Sensor Kit to the Unit .......................................................... 3.12

Connecting the CO2 Sensor Kit to the Respiration Circuit ................................... 3.12

Performing Zero Calibration when Using a TG-950P, TG-970P or TG-980P

CO2 Sensor Kit .................................................................................................... 3.12

Calibrating by Air .......................................................................................3.13

Calibrating with N2 Gas..............................................................................3.14

Monitoring CO2 .............................................................................................................. 3.15

CO2 Information on the Home Screen ................................................................. 3.16

Changing CO2 Settings .................................................................................................. 3.18

Changing the Scale ............................................................................................. 3.18

Changing the CO2, Respiration Rate and Apnea Alarm Limits ............................ 3.19

Setting the Inspiration Composition ..................................................................... 3.20

Changing the CO2 Waveform Sweep Speed ....................................................... 3.21

Changing Duration for Holding ETCO2 Maximum Value ...................................... 3.22

Inspection of Measuring Accuracy ................................................................................. 3.24

Daily Inspection of Measuring Accuracy .............................................................. 3.24

Inspection of Measuring Accuracy (Precise Method) .......................................... 3.24

4-1

4-2

4-3

Section 4 SpO2 Monitoring .................................................................... 4.1

Section 4-1 SpO2 Monitoring with Nihon Kohden Probes ................................... 4.1.1

General ......................................................................................................................... 4.1.2

When Monitoring Dual SpO2 .............................................................................. 4.1.4

Preparing for SpO

Preparation Flowchart ........................................................................................ 4.1.6

Selecting a Probe ............................................................................................... 4.1.6

User’s Guide Part II BSM-6000 C.3

Monitoring ...................................................................................... 4.1.6

Nihon Kohden Reusable Probes ..............................................................4.1.6

CONTENTS

Nihon Kohden Disposable Probes ............................................................4.1.7

Connecting Cables and Attaching the Probes .................................................... 4.1.8

Connecting Cable to the Unit ....................................................................4.1.8

Connecting Cable to the BSM-1763/1773 Bedside Monitor ..................... 4.1.9

Attaching the Probe to the Patient ............................................................ 4.1.9

Monitoring SpO2 ......................................................................................................... 4.1.10

SpO2 Information on the Home Screen ............................................................4.1.11

SpO2 Information on the SpO2 Window ............................................................4.1.11

PI (Pulse-amplitude Index) .....................................................................4.1.11

SpO2 Information on the SpO2-2 Window ......................................................... 4.1.12

Changing SpO2 Settings ............................................................................................. 4.1.13

Changing the Sensitivity ................................................................................... 4.1.14

Changing the SpO2 and Pulse Rate Alarm Limits ............................................ 4.1.15

Changing the Sync Sound Source ................................................................... 4.1.17

Selecting Sync Sound Pitch ............................................................................. 4.1.18

Selecting the Response Mode .......................................................................... 4.1.19

Selecting SpO2 Sensitivity Mode ...................................................................... 4.1.20

Displaying Pulse Rate, DSpO2 and PI on the Home Screen ............................. 4.1.21

Displaying the SQI Bar Graph on the Home Screen ........................................4.1.22

Displaying PI Trendgraph on the Home Screen ................................................ 4.1.23

Section 4-2 SpO2 Monitoring with Nellcor Probes ............................................... 4.2.1

General ......................................................................................................................... 4.2.2

When Monitoring Dual SpO2 .............................................................................. 4.2.4

Preparing for SpO2 Monitoring ...................................................................................... 4.2.6

Preparation Flowchart ........................................................................................ 4.2.6

Selecting a Probe ............................................................................................... 4.2.6

Nellcor SpO2 Probes ................................................................................ 4.2.6

Connecting Cables and Attaching the Probes .................................................... 4.2.7

Connecting Cable to the Unit ....................................................................4.2.7

SpO2 Measurement at Two Sites .............................................................. 4.2.8

Attaching the Probe to the Patient ............................................................ 4.2.8

Monitoring SpO2 ........................................................................................................... 4.2.9

SpO2 Information on the Home Screen ............................................................4.2.10

Changing SpO2 Settings ............................................................................................. 4.2.11

Changing the Sensitivity ................................................................................... 4.2.12

Changing the SpO2 and Pulse Rate Alarm Limits ............................................ 4.2.13

Changing the Sync Sound Source ................................................................... 4.2.15

Selecting Sync Sound Pitch ............................................................................. 4.2.16

Displaying Pulse Rate and DSpO2 on the Home Screen .................................. 4.2.17

Section 4-3 SpO2 Monitoring with Masimo Probes .............................................. 4.3.1

General ......................................................................................................................... 4.3.2

When Monitoring Dual SpO

Preparing for SpO2 Monitoring ...................................................................................... 4.3.6

Preparation Flowchart ........................................................................................ 4.3.6

Selecting a Probe and Patient Cable ..................................................................4.3.6

Masimo SpO

Probes ............................................................................... 4.3.7

SpO2 Connection Cords ........................................................................... 4.3.8

C.4 User’s Guide Part II BSM-6000

.............................................................................. 4.3.4

CONTENTS

Connecting Cables and Attaching the Probes .................................................... 4.3.8

Connecting Cable to the Unit ....................................................................4.3.8

SpO2 Measurement at Two Sites .............................................................. 4.3.9

Attaching the Probe to the Patient ............................................................ 4.3.9

Monitoring SpO2 ......................................................................................................... 4.3.10

SpO2 Information on the Home Screen ............................................................4.3.11

SpO2 Information on the SpO2 Window ............................................................4.3.12

Signal IQ ................................................................................................. 4.3.12

PI (Perfusion Index) ................................................................................ 4.3.12

SpO2 Information on the SpO2-2 Window ......................................................... 4.3.13

Changing SpO2 Settings ............................................................................................. 4.3.14

Changing the Sensitivity ................................................................................... 4.3.15

Changing the SpO2 and Pulse Rate Alarm Limits ............................................ 4.3.16

Changing the Sync Sound Source ................................................................... 4.3.18

Selecting Sync Sound Pitch ............................................................................. 4.3.19

Selecting the Averaging Time ...........................................................................4.3.20

Selecting the Sensitivity Mode .......................................................................... 4.3.21

Turning FAST SAT Mode On or Off ...................................................................4.3.22

Displaying Pulse Rate, DSpO2 and Perfusion Index (PI) on the Home

Screen .............................................................................................................. 4.3.23

4-1

4-2

4-3

Section 5 NIBP Monitoring .................................................................... 5.1

General ............................................................................................................................ 5.2

Preparing for NIBP Measurement .................................................................................... 5.4

Preparation Flowchart ........................................................................................... 5.4

Selecting the Cuff .................................................................................................. 5.4

Types of Cuffs ........................................................................................................ 5.5

Reusable Cuffs ............................................................................................ 5.5

Disposable Cuffs .........................................................................................5.6

Connecting Cables and Attaching the Cuff to the Patient ......................................5.7

Connecting Air Hose and Cuff to the Unit ................................................... 5.7

Attaching the Cuff to the Patient .................................................................. 5.9

Measuring and Monitoring NIBP .................................................................................... 5.11

Measurement Mode and Interval ......................................................................... 5.11

Manual Measurement ................................................................................ 5.12

Auto Measurement ....................................................................................5.12

Auto Measurement with PWTT ..................................................................5.12

STAT Measurement ................................................................................... 5.14

SIM Mode Measurement ........................................................................... 5.14

NIBP Information on the Home Screen ...............................................................5.15

Dimming and Hiding the NIBP Data .......................................................... 5.15

Performing NIBP Measurement ........................................................................... 5.16

Manual Measurement ................................................................................ 5.16

Auto Measurement ....................................................................................5.17

Auto Measurement with PWTT ..................................................................5.19

STAT Measurement ................................................................................... 5.21

SIM Mode Measurement ........................................................................... 5.22

Changing NIBP Settings ................................................................................................ 5.25

User’s Guide Part II BSM-6000 C.5

CONTENTS

Selecting the Initial Cuff Inﬂation Pressure .......................................................... 5.25

Selecting the Initial Cuff Inﬂation Pressure Type ....................................... 5.25

Setting the Cuff Inﬂation Pressure ............................................................. 5.26

Displaying the Oscillation Graph .......................................................................... 5.27

Turning Inﬂate Mode On or Off ............................................................................5.28

Changing the NIBP Alarm Limits ......................................................................... 5.28

Turning PWTT Trigger NIBP Measurement On or Off .......................................... 5.30

Using Venous Puncture Mode........................................................................................ 5.31

Section 6 IBP Monitoring ...................................................................... 6.1

General ............................................................................................................................ 6.2

Preparing for Blood Pressure Monitoring ......................................................................... 6.4

Preparation Flowchart ........................................................................................... 6.4

Selecting the Blood Pressure Measuring Device ...................................................6.4

Blood Pressure Transducers........................................................................6.5

IBP Connection Cords ................................................................................. 6.6

JP-940P IBP Connection Box ......................................................................6.6

Installing the Blood Pressure Measuring Device ................................................... 6.7

Connecting Cables to the Unit ..................................................................... 6.7

Assembling the Transducer .........................................................................6.8

Adjusting Zero Balance ....................................................................................... 6.10

Zero Balance Mode ................................................................................... 6.10

Adjusting Zero Balance ............................................................................. 6.10

Memorizing the Zero Balance Values ........................................................ 6.13

The CHECK ZERO Page ..........................................................................6.13

Monitoring IBP ............................................................................................................... 6.14

IBP Information on the Home Screen .................................................................. 6.14

Changing IBP Settings ................................................................................................... 6.16

Changing the Label ............................................................................................. 6.16

Types of Labels ......................................................................................... 6.17

Changing the Labels ................................................................................. 6.17

Changing the Scale ............................................................................................. 6.18

Changing the IBP and Pulse Rate Alarm Limits .................................................. 6.19

Selecting the Mode for Calculating IBP ...............................................................6.21

Selecting the Data Display Mode on the Home Screen .......................................6.22

Displaying CPP On or Off .................................................................................... 6.22

Automatically Use ET Mode for Calculating Mean CVP ......................................6.23

Changing the Sync Sound Source ...................................................................... 6.24

Selecting Sync Sound Pitch ................................................................................ 6.25

Selecting the IBP Waveform Display Mode .........................................................6.26

Displaying PPV or SPV on the Home Screen ......................................................6.27

Selecting PPV or SPV Display on the Home Screen ................................6.27

Changing PPV or SPV Average Time .................................................................. 6.29

Section 7 Temperature Monitoring ....................................................... 7.1

General ............................................................................................................................ 7.2

Preparing for Temperature Monitoring ............................................................................. 7.3

C.6 User’s Guide Part II BSM-6000

CONTENTS

Preparation Flowchart ........................................................................................... 7.3

Selecting the Probe ............................................................................................... 7.3

Reusable Probes ......................................................................................... 7.3

Disposable Probes ......................................................................................7.4

Temperature Connection Cord .................................................................... 7.4

Connecting Cables and Attaching the Probe ......................................................... 7.5

Connecting Cable to the Unit .......................................................................7.5

Attaching the Probe to the Patient ............................................................... 7.6

Using the Insulation Pad .............................................................................. 7.6

Monitoring Temperature ................................................................................................... 7.7

Temperature Information on the Home Screen ...................................................... 7.7

Changing Temperature Settings.......................................................................................7.8

Changing the Label ............................................................................................... 7.8

Types of Labels ........................................................................................... 7.8

Types of Labels for Blood Temperature Measured Regions ........................ 7.9

Changing the Label ..................................................................................... 7.9

Setting the Site for Calculating Temperature Difference ...................................... 7.10

Changing the Temperature Alarm Limits .............................................................7.10

Section 8 BIS Monitoring ...................................................................... 8.1

General ............................................................................................................................ 8.2

List of Terms .......................................................................................................... 8.2

Preparing for BIS Monitoring ........................................................................................... 8.3

Preparation Flowchart for Using the BIS Processor .............................................. 8.3

Preparation Flowchart for Using the BIS Monitor ..................................................8.4

Monitoring BIS ................................................................................................................. 8.5

BIS Information on the Home Screen .................................................................... 8.8

BIS Information on the BIS Window ......................................................................8.9

Changing the BIS Settings ............................................................................................. 8.10

Checking the Impedance of the BIS Sensor ........................................................ 8.10

Automatically Checking Impedance ..........................................................8.11

Manually Checking Impedance .................................................................8.11

Changing the BIS Alarm Limits ............................................................................ 8.12

Changing the Sensitivity ...................................................................................... 8.13

Turning the Filter On or Off .................................................................................. 8.13

Selecting the BIS Average Time (Smoothing Rate) ............................................. 8.14

Changing the EEG Waveform Sweep Speed ...................................................... 8.14

Selecting the Second Current Trendgraph ........................................................... 8.15

4-1

4-2

4-3

Section 9 Cardiac Output Monitoring ...................................................9.1

General ............................................................................................................................ 9.2

Preparing for Cardiac Output Monitoring ......................................................................... 9.3

Preparation Flowchart ........................................................................................... 9.3

Selecting the Catheter ........................................................................................... 9.3

Types of Catheter ........................................................................................ 9.3

Preparing the Injectate .......................................................................................... 9.4

Usable Injectate ........................................................................................... 9.4

User’s Guide Part II BSM-6000 C.7

CONTENTS

Injectate Temperature and Volume .............................................................. 9.4

Measuring the Injectate Temperature .......................................................... 9.5

Assembling the Measuring System .......................................................................9.7

Connecting Cables to the Unit ..................................................................... 9.7

Measuring System Setup Examples ........................................................... 9.8

Changing Settings for CO Measurement ....................................................................... 9.10

Setting the Coefﬁcient Value ................................................................................ 9.10

Procedure .................................................................................................. 9.11

The Preset Coefﬁcient Value Settings ....................................................... 9.12

Changing the Height and Weight ......................................................................... 9.13

Changing the Blood Temperature Alarm Setting .................................................9.14

Measuring the Pulmonary Capillary Wedge Pressure ................................................... 9.16

Inserting and Retaining the Catheter in the Patient ............................................. 9.16

Inserting Position and Inserting Method .................................................... 9.16

Inserting the Catheter into the Patient and Monitoring Blood Pressure .... 9.16

Entering the Pulmonary Capillary Wedge Pressure and Other IBP Values ......... 9.18

Measuring CO ................................................................................................................ 9.20

Before Measurement ...........................................................................................9.20

Measuring CO ..................................................................................................... 9.21

When Measurements Cannot be Performed Correctly .............................. 9.22

Deleting the Data from the CO Table .................................................................. 9.23

Recording Hemodynamics Data .......................................................................... 9.23

Adding Acquired Data to the Hemodynamics Table on the TREND Window .......9.24

Explanation of Hemodynamics Data .............................................................................. 9.25

CO Value Calculation Equation/Coefﬁcient Value Calculation Value .............................9.26

Section 10 Gas Monitoring .................................................................... 10.1

General .......................................................................................................................... 10.2

Measuring Parameters ........................................................................................10.2

Preparing for Gas Monitoring ......................................................................................... 10.3

Monitoring Gas .............................................................................................................. 10.4

Gas Information on the Home Screen ................................................................. 10.5

Gas Information on the GAS Window ..................................................................10.6

Changing Gas Settings .................................................................................................. 10.7

Changing the Respiration Rate, Apnea and Gas Alarm Limits ............................ 10.8

Changing the Waveform Scale .......................................................................... 10.10

Changing the Sampling Rate ............................................................................. 10.10

Performing Zero Calibration ............................................................................... 10.12

Turning Gas Measurement On or Off ...............................................................10.13

Selecting the Parameters to be Displayed on the Home Screen ....................... 10.13

Performing Gas Calibration .......................................................................................... 10.15

Section 11 O2 Monitoring ...................................................................... 11.1

General .......................................................................................................................... 11.2

Preparing for O2 Monitoring ........................................................................................... 11.3

Preparation Flowchart ......................................................................................... 11.3

Oxygen Sensor and Connection Cord ................................................................. 11.3

C.8 User’s Guide Part II BSM-6000

CONTENTS

Connecting the Oxygen Sensor to the Unit ......................................................... 11.3

Calibrating the O2 Sensor .................................................................................... 11.4

Calibration with Air (Simple Method) ......................................................... 11.5

Calibration with 100% O2 (Precise Method) .............................................. 11.6

Connecting the Oxygen Sensor to the Inspiration Circuit and Starting

Measurement ....................................................................................................... 11.7

Monitoring O2 ................................................................................................................. 11.8

O2 Information on the Home Screen ....................................................................11.8

Changing O2 Settings .................................................................................................... 11.9

Changing the O2 Alarm Limits ............................................................................. 11.9

Principle and Structure of Oxygen Sensor ................................................................... 11.10

Structure of Oxygen Sensor .............................................................................. 11.10

Life Span of Oxygen Sensor .............................................................................. 11.10

Precautions when Using the Oxygen Sensor .................................................... 11.11

Section 12 Ventilator Monitoring .......................................................... 12.1

General .......................................................................................................................... 12.2

Monitoring Parameters and Settings ...................................................................12.2

Preparing for Ventilator Parameter Monitoring ............................................................... 12.7

Monitoring Ventilator Parameters ...................................................................................12.8

Ventilator Information on the Home Screen ......................................................... 12.8

Ventilator Information on the MEASURE Window ............................................... 12.9

Ventilator Information on the SETTINGS and WAVEFORM Windows

(IF-928P, IF-938P and IF-943P only) ................................................................. 12.10

Changing Ventilator Settings ........................................................................................ 12.11

Checking the Ventilator Settings ........................................................................ 12.11

Changing the FLOW, Paw or VOL Scale ...........................................................12.12

Selecting the Ventilator Parameters to be Displayed on the Home Screen .......12.12

Viewing the Loop Graph (IF-938P and IF-943P only) ........................................12.13

Changing the Loop Graph Scale ............................................................. 12.13

Changing the Settings for the Loop Graph .............................................. 12.14

4-1

4-2

4-3

Section 13 TOF Monitoring ...................................................................13.1

General .......................................................................................................................... 13.2

List of Terms ........................................................................................................ 13.2

Preparing for TOF Monitoring ........................................................................................13.3

Monitoring TOF ..............................................................................................................13.4

TOF Information on the Home Screen ................................................................. 13.4

Opening the TOF Window .................................................................................... 13.4

TOF Information on the TOF Window .................................................................. 13.5

Recording the TOF Data ...................................................................................... 13.5

Section 14 CCO Monitoring .................................................................. 14.1

CCO Monitoring by APCO/IBP Processor ..................................................................... 14.3

General ................................................................................................................ 14.3

List of Terms .............................................................................................. 14.3

User’s Guide Part II BSM-6000 C.9

CONTENTS

Preparation Flowchart for Using the APCO/IBP Processor ................................. 14.3

Monitoring CCO ................................................................................................... 14.4

CCO Information on the Home Screen .....................................................14.4

CCO Information on the CCO Window ......................................................14.5

Displaying the CCO Window .....................................................................14.5

Hemodynamics Table on the HEMO TREND Page of the TREND

Window ...................................................................................................... 14.6

Changing the CCO Settings ................................................................................ 14.6

Entering the Patient’s Date of Birth, Gender, Height and Weight ........................14.6

Displaying the PATIENT INFO Page .......................................................... 14.7

Entering the Date of Birth .......................................................................... 14.7

Entering the Height and Weight .................................................................14.8

Entering the Gender .................................................................................. 14.8

Closing the PATIENT INFO Page ..............................................................14.8

Adjusting Zero Balance ....................................................................................... 14.9

Adjusting Zero Balance ............................................................................. 14.9

Changing the CCO and CCI Alarm Limits ......................................................... 14.10

Changing the Scale ........................................................................................... 14.11

Selecting the CCO Parameters to be Displayed on the Home Screen .............. 14.12

Selecting the CCO/CCI Average Time ............................................................... 14.12

Selecting the Current Trendgraph ...................................................................... 14.13

Recording the CCO Data on the WAVEFORM Page of CCO Window .............. 14.13

CCO Monitoring by CCO Monitor ................................................................................14.15

General .............................................................................................................. 14.15

Monitoring Parameters and Settings .......................................................14.15

Preparing for CCO Monitoring ........................................................................... 14.16

Monitoring CCO ................................................................................................. 14.17

CCO Information on the Home Screen ...................................................14.17

CCO Information on the CCO Window ....................................................14.18

Opening the CCO Window ......................................................................14.18

Hemodynamics Table on the HEMO TREND Page of the TREND

Window .................................................................................................... 14.18

Changing the CCO Settings .............................................................................. 14.19

Selecting the CCO Parameters to be Displayed on the Home Screen .... 14.19

PCCO Monitoring by PiCCO Monitor ...........................................................................14.20

General .............................................................................................................. 14.20

List of Terms ............................................................................................ 14.21

Monitoring Parameters and Settings .......................................................14.22

Preparing for PiCCO Monitoring ........................................................................ 14.23

Monitoring PiCCO .............................................................................................. 14.23

PiCCO Information on the Home Screen ................................................14.23

PiCCO Information on the MEASURE page of CCO Window .................14.24

Recording the PiCCO Data on the WAVEFORM Page of CCO

Window .................................................................................................... 14.25

Hemodynamics Table on the HEMO TREND Page of the TREND

Window .................................................................................................... 14.26

Changing the PiCCO Setting ............................................................................. 14.26

Changing the Scale of the AP Waveform on the WAVEFORM Page of

the CCO Window ..................................................................................... 14.26

C.10 User’s Guide Part II BSM-6000

CONTENTS

Selecting the Absolute or Index Value to be Displayed ...........................14.27

CCO/SvO2 Monitoring by SO2/CCO Monitor ................................................................ 14.28

General .............................................................................................................. 14.28

List of Terms ............................................................................................ 14.28

Preparing for CCO/SvO2 Monitoring .................................................................. 14.29

Monitoring CCO/SvO2 ....................................................................................... 14.29

CCO Information on the Home Screen ...................................................14.29

CCO/SvO2 Information on the CCO Window ...........................................14.30

Opening the CCO Window ......................................................................14.30

Hemodynamics Table on the HEMO TREND Page of the TREND

Window .................................................................................................... 14.30

Changing the CCO/SvO2 Settings ..................................................................... 14.31

Selecting the CCO/SvO2 Parameters to be Displayed on the Home

Screen ..................................................................................................... 14.31

Explanation of Hemodynamics Data ............................................................................ 14.32

Section 15 FLOW/Paw Monitoring ........................................................15.1

General .......................................................................................................................... 15.2

List of Terms ........................................................................................................ 15.2

Preparing for FLOW/Paw Monitoring .............................................................................15.3

Preparation Flowchart ......................................................................................... 15.3

Monitoring FLOW/Paw ................................................................................................... 15.4

FLOW/Paw Information on the Home Screen ......................................................15.4

FLOW/Paw Information on the FLOW/Paw Window ............................................ 15.5

Changing FLOW/Paw Settings ......................................................................................15.6

Changing the MV, Ppeak, PEEP, Respiration Rate and Apnea Alarm Limits ...... 15.6

Changing the Scale ............................................................................................. 15.8

Setting the Inspired Gas Composition ................................................................. 15.8

Setting the Temperature and Humidity of the Inspired Gas ............................... 15.10

Selecting the FLOW/Paw Parameters to be Displayed on the Home Screen .... 15.10

Turning FLOW/Paw Measurement On or Off .....................................................15.11

Viewing the Loops........................................................................................................15.12

Displaying the Loop Window ..............................................................................15.12

Changing the Loop Graph Scale .......................................................................15.13

Registering Reference Loops ............................................................................ 15.14

Turning Reference Loop Display On or Off ........................................................ 15.17

Changing the Loop Graph Scale on the REFERENCE Tab............................... 15.18

Recording the Loops on the FLOW/Paw Window .............................................. 15.19

Changing the Loop Settings .............................................................................. 15.20

Selecting the Loop Types to Display on the Home Screen ...................... 15.20

Selecting the Number of Displayed Loops ..............................................15.21

4-1

4-2

4-3

Section 16 EEG Monitoring ................................................................... 16.1

General .......................................................................................................................... 16.2

List of Terms ........................................................................................................ 16.2

Preparing for EEG Monitoring ........................................................................................ 16.3

Monitoring EEG ............................................................................................................. 16.4

User’s Guide Part II BSM-6000 C.11

CONTENTS

EEG Information on the Home Screen ................................................................ 16.4

EEG Information on the EEG Window .................................................................16.5

Returning EEG Waveforms to the Baseline ............................................... 16.5

Displaying the Calibration Waveforms ....................................................... 16.5

Changing the EEG Settings ........................................................................................... 16.6

Setting Montage .................................................................................................. 16.6

Checking the Electrode Impedance ..................................................................... 16.8

Automatically Checking Impedance ..........................................................16.8

Manually Checking Impedance .................................................................16.9

Changing the SEF and TP Alarm Limits ............................................................ 16.10

Changing the EEG Sensitivity ........................................................................... 16.11

Selecting the Edge Frequency for SEF ..............................................................16.11

Changing the Filter Settings .............................................................................. 16.12

Limiting the EEG Amplitude ............................................................................... 16.12

Selecting Channels and Parameters to Display on the Home Screen ...............16.13

Recording the EEG Waveforms on the EEG Window ........................................ 16.13

Recording the EEG Waveforms on the EEG Window ..............................16.13

Recording All EEG Waveforms ................................................................ 16.14

Viewing the CSA and DSA...........................................................................................16.16

Displaying the CSA and DSA Page ................................................................... 16.16

Changing the CSA/DSA Settings ...................................................................... 16.17

Selecting the CSA/DSA Amplitude Type ................................................. 16.17

Selecting the CSA/DSA Updating Interval ............................................... 16.17

Selecting the DSA Color Gradation ......................................................... 16.18

Selecting the CSA/DSA Display Sensitivity ............................................. 16.19

Selecting the CSA/DSA Frequency ......................................................... 16.20

Printing CSA/DSA .............................................................................................. 16.21

Section 17 tcPO2 /tcPCO2 Monitoring ................................................... 17.1

General .......................................................................................................................... 17.2

List of Terms ........................................................................................................ 17.2

Preparing for tcPO2/tcPCO2 Monitoring ............................................................... 17.2

Monitoring tcPO2/tcPCO2 .............................................................................................. 17.3

tcPO2/tcPCO2 Information on the Home Screen ..................................................17.3

tcPO2/tcPCO2 Information on the tcPO2/tcPCO2 Window .................................... 17.4

Section 18 Analog Input Monitoring .................................................... 18.1

General .......................................................................................................................... 18.2

Preparing for Analog Input Monitoring ........................................................................... 18.2

Monitoring Analog Waveforms ....................................................................................... 18.3

Analog Input Information on the Home Screen ...................................................18.3

Analog Waveforms on the ANALOG INPUT Window ..........................................18.4

Opening the ANALOG INPUT Window .....................................................18.4

Changing Analog Input Monitoring Settings .................................................................. 18.5

Changing the Analog Waveform Sensitivity ......................................................... 18.5

Recording the Analog Waveforms .................................................................................. 18.6

C.12 User’s Guide Part II BSM-6000

CONTENTS

Section 19 Anesthetic Monitoring ........................................................ 19.1

General .......................................................................................................................... 19.2

Monitoring Parameters and Settings ...................................................................19.3

Preparation for Monitoring Anesthetic and Ventilation Parameters ................................19.6

Monitoring Anesthetic and Ventilation Parameters ........................................................ 19.6

Anesthetic and Ventilation Information on the Home Screen ............................... 19.7

Anesthetic and Ventilation Information on the GAS and VENT Windows ............ 19.7

GAS Window .............................................................................................19.7

VENT Window ...........................................................................................19.8

Changing Anesthetic and Ventilation Settings ............................................................... 19.9

Changing the Waveform Scale ............................................................................ 19.9

Selecting the Parameters to be Displayed on the Home Screen ....................... 19.10

Section 20 rSO2 Monitoring ................................................................... 20.1

General .......................................................................................................................... 20.2

List of Terms ........................................................................................................ 20.2

Preparing for rSO2 Monitoring ........................................................................................ 20.2

Monitoring rSO2 ............................................................................................................ 20.3

rSO2 Information on the Home Screen ................................................................ 20.3

Opening the rSO2 Window ............................................................................................. 20.4

Changing rSO2 Settings ................................................................................................. 20.5

4-1

4-2

4-3

User’s Guide Part II BSM-6000 C.13

Conventions Used in this Manual and Instrument

Warnings, Cautions and Notes

Warnings, cautions and notes are used in this manual to alert or signal the reader to specic information.

WARNING

A warning alerts the user to possible injury or death associated with the use or misuse of the instrument.

CAUTION

A caution alerts the user to possible injury or problems with the instrument associated with its use or

misuse such as instrument malfunction, instrument failure, damage to the instrument, or damage to other

property.

NOTE

A note provides speciﬁc information, in the form of recommendations, prerequirements, alternative methods or

supplemental information.

Text Conventions

• Names of hard keys on the bedside monitor are enclosed in square brackets: [Menu]

• Messages that are displayed on the screen are enclosed in quotation marks: “CHECK ELECTRODES”

• Names of items that are displayed on the screen are enclosed in angle brackets: <SENSITIVITY>

Safety Standards

The safety standard of this bedside monitor is classied as follows:

Type of protection against electrical shock: CLASS I EQUIPMENT (AC Powered)

Internally Powered EQUIPMENT (BATTERY Powered)

Degree of protection against electrical shock

Debrillator-proof type CF applied part:

AY-631P, AY-633P, AY-651P, AY-653P, AY-661P, AY-663P, AY-671P and AY-673P:

ECG, Respiration (impedance and thermistor method), IBP, Temperature,

SpO2, SpO2-2, CO2, O2, NIBP, BIS, CCO (APCO)

AY-660P: ECG, Respiration (impedance method), IBP, Temperature, SpO2, CO2, NIBP

AA-672P, AA-674P, JA-694P: Respiration (thermistor method), IBP, Temperature, SpO2-2, CO2, O2, BIS,

CCO (APCO)

BSM-1700 series: ECG, Respiration (impedance method), IBP, Temperature, SpO2, SpO2-2, CO2,

NIBP, BIS

CF applied part:

AY-631P, AY-633P, AY-651P, AY-653P, AY-661P, AY-663P, AY-671P, AY-673P, AA-672P, AA-674P, JA-694P

and BSM-1700 series: CO

Degree of protection against harmful ingress of water:

IPX0 (non-protected)

Degree of safety of application in the presence of FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH

OXYGEN OR NITROUS OXIDE: Equipment not suitable for use in the presence of FLAMMABLE

ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR

NITROUS OXIDE

Mode of operation: CONTINUOUS OPERATION

Safety Information

This User’s Guide only contains safety information related to monitoring parameters. Full information is in the

BSM-6000A/K series Bedside Monitor Operator’s Manual (code number: 0614-900685U).

WARNING

Do not diagnose a patient based on only part of the monitoring data on the bedside monitor or only on

the data acquired by the bedside monitor. Overall judgement must be performed by a physician who

understands the features, limitations and characteristics of the bedside monitor by reading this operator’s

manual thoroughly and by reading the biomedical signals acquired by other instruments.

ii User’s Guide Part II BSM-6000

Section 1 ECG Monitoring

General ................................................................................................................................................................ 1.3

Using the Output Signal from the ECG/BP OUT Socket ...........................................................................1.4

Preparing for ECG Monitoring ............................................................................................................................. 1.5

Preparation Flowchart ............................................................................................................................... 1.5

Number of Electrodes and Measuring Leads ............................................................................................ 1.5

Electrode Position......................................................................................................................................1.5

3 Electrode Leads ........................................................................................................................... 1.5

6 Electrode Leads ........................................................................................................................... 1.6

Mason-Likar Modiﬁcation ................................................................................................................ 1.7

Standard 12 Leads .......................................................................................................................... 1.8

Electrode Positions for Detecting the Pacemaker Pulse ........................................................................... 1.8

Changing the Electrode Lead .......................................................................................................... 1.8

Changing the Electrode Positions ...................................................................................................1.8

Selecting Electrodes and Lead .................................................................................................................. 1.9

Types of Electrodes and Lead ....................................................................................................... 1.10

Connecting Cables and Attaching Disposable Electrodes ......................................................................1.11

Connecting the Electrode Cable to the Input Unit ......................................................................... 1.11

Connecting the Electrode Cable to the BSM-1700 series Bedside Monitor .................................. 1.11

Attaching Disposable Electrodes to the Patient ............................................................................1.12

Monitoring ECG ................................................................................................................................................. 1.13

ECG Information on the Home Screen ....................................................................................................1.14

ECG Data Display ...................................................................................................................................1.14

Measuring ST Level ................................................................................................................................1.15

Detached Electrode Detection and Display ............................................................................................. 1.15

AC Interference and Display .................................................................................................................... 1.16

Monitoring Arrhythmia .......................................................................................................................................1.17

General ....................................................................................................................................................1.17

Arrhythmia Analysis Data Display .................................................................................................1.18

Changing Arrhythmia Monitoring Settings ............................................................................................... 1.19

Turning Arrhythmia Analysis On or Off .......................................................................................... 1.19

Selecting Arrhythmia Analysis Leads ............................................................................................ 1.20

Selecting the Patient Type for QRS Detection ............................................................................... 1.21

Learning the ECG Waveform for Arrhythmia Detection (VPC Learning) ....................................... 1.22

Checking the Dominant QRS ........................................................................................................ 1.23

Changing ECG Settings .................................................................................................................................... 1.25

Turning ECG Measurement On or Off ..................................................................................................... 1.26

Changing the Monitoring Lead ................................................................................................................ 1.27

Optimum Lead ...............................................................................................................................1.28

Selecting the Number of ECG Traces on the Home Screen ......................................................... 1.28

Changing a Lead ........................................................................................................................... 1.29

Assigning Va and Vb (Ca and Cb) Leads when Monitoring with

6 Electrodes .................................................................................................................................. 1.30

Auto Lead Change On or Off ........................................................................................................1.31

User’s Guide Part II BSM-6000 1.1

Changing the ECG Sensitivity ................................................................................................................. 1.31

Changing the Heart Rate/Pulse Rate, VPC and ST Alarm Limits ........................................................... 1.33

Changing Arrhythmia Alarm Settings ...................................................................................................... 1.34

Changing the ST Alarm Limits ................................................................................................................ 1.37

Changing the ST Level Measurement Condition .....................................................................................1.38

Changing Pacing Settings .......................................................................................................................1.41

Turning Pacing Spike Detection On or Off.....................................................................................1.41

Displaying Pacing Mark ................................................................................................................. 1.43

Changing the Number of Electrodes ....................................................................................................... 1.43

Selecting Mode for Updating the Heart Rate........................................................................................... 1.44

Selecting the Filter Type .......................................................................................................................... 1.44

Turning the Hum Filter On or Off .............................................................................................................1.45

Changing the Sync Sound Source .......................................................................................................... 1.45

Selecting Sync Sound Pitch .................................................................................................................... 1.47

Use with an Electrosurgical Unit ........................................................................................................................ 1.49

1.2 User’s Guide Part II BSM-6000

1. ECG MONITORING

General

To monitor ECG, attach disposable electrodes to the patient and connect

them to the ECG/RESP socket on the input unit or BSM-1700 series bedside

monitor. Up to 12 leads can be monitored with arrhythmia analysis and ST level

measurement.

WARNING

The bioelectric impedance measurement sensor of a minute

ventilation rate-adaptive implantable pacemaker may be affected by

cardiac monitoring and diagnostic equipment which is connected to

the same patient. If this occurs, the pacemaker may pace at its

maximum rate and give incorrect data to the monitor or diagnostic

equipment. In this case, set the <IMPEDANCE MEASUREMENT>

on the RESP/CO2 window to OFF on the bedside monitor. For a

patient that requires the respiration monitoring, measure the

respiration by thermistor method.

NOTE

• ECG monitoring using 10 electrodes is not available when an AY-660P

input unit is used.

• When a line isolation monitor is used, noise from the line isolation

monitor may resemble actual ECG waveforms on the bedside monitor

and cause false heart rate alarms or no alarm at all.

User’s Guide Part II BSM-6000 1.3

1. ECG MONITORING

Using the Output Signal from the ECG/BP OUT Socket

CAUTION

When using the output signal from the monitor as

the synchronization signal for other equipment

such as an IABP (intra-aortic balloon pump) or

deﬁbrillator:

• Set the timing of the IABP by checking the

waveform on the IABP screen.

• Check the condition of the bedside monitor

at all times. The output signal may become

unstable.

• Check that the delay time of the output signal is

within the range of the connected equipment.

• Analog ECG, analog BP and heart rate trigger output are not available

when an AY-660P input unit is used.

• The output signal from the ECG/BP OUT socket may become unstable

in the following conditions.

- Electrode is dry or detached.

- Electrode lead is damaged or disconnected from the electrode.

- Electrode lead is pulled.

- AC interference or EMG noise superimposed.

- Air bubbles or blood clog in the circuit for monitoring IBP.

- Cord or cable is disconnected or damaged.

• All instruments which are to be connected to the ECG/BP OUTPUT

socket must use a YJ-910P or YJ-920P ECG/BP output cable and

comply with the IEC 60601-1 safety standard for medical equipment.

CAUTION

Only a Nihon Kohden deﬁbrillator can use the

output signal from the monitor as a

synchronization signal. Check that the delay time

of the output signal (heart rate trigger 20 ms

maximum) is within the range of the connected

deﬁbrillator.

NOTE

The following shows the delay time of the output signal.

Output Signal Delay Time

ECG 20 ms

BP 40 ms

Heart rate trigger 20 ms

1.4 User’s Guide Part II BSM-6000

1. ECG MONITORING

Lead I

Lead II

Lead III

Preparing for ECG Monitoring

Preparation Flowchart

1. Select the electrode lead and electrodes.

2. Connect the electrode lead to the ECG connection cord and connect the ECG

connection cord to the ECG/RESP socket on the input unit or BSM-1700

series bedside monitor.

3. Attach the disposable electrodes to the patient and attach the electrode lead

to the electrodes.

4. Monitoring starts. Set necessary settings.

Number of Electrodes and Measuring Leads

The leads which can be monitored differ according to the type of electrode lead

and number of electrodes used. This monitor automatically identies the number

of electrodes attached to the patient.

No. of Electrodes Lead Features

Electrode Position

R/RA

L/LA

F/LL

3 I, II, III Can measure at the thoracic wall.

6 I, II, III, aVR, aVL, aVF, two leads from V1 to V6 Similar to the standard 12 lead.

10 I, II, III, aVR, aVL, aVF, V1 to V6 Standard 12 lead.

3 Electrode Leads

Electrode Position

Symbol Lead Color (Clip Color) Electrode Position

Red (Red-beige) White (White-beige)

Yellow (Yellow-beige) Black (Black-beige)

Green (Green-beige) Red (Red-beige)

Right infraclavicular fossa

Left infraclavicular fossa

Lowest rib on the left anterior axillary line

Lead Connection

R/RA

L/LA

F/LL

R/RA

F/LL

L/LA

R/RA

L/LA

F/LL

User’s Guide Part II BSM-6000 1.5

1. ECG MONITORING

Standard limb leads

Monopolar limb leads

Monopolar chest leads

V1 to V6 leads

R/RA

Cb/Vb

Ca/Va

N (RF/RL)

F/LL

L/LA

6 Electrode Leads

Electrode Position

The 5-electrode method with lead II and lead V5 is effective for monitoring

myocardial ischemia. You can improve monitoring accuracy considerably

by adding lead V4 to this combination. Ca and Cb (Va and Vb) can be at any

position of the standard 12 leads C1 to C6 (V1 to V6), but C4 and C5 (V4 and

V5) are most appropriate for myocardial ischemic monitoring.

For details on attaching the Ca or Cb electrode to C1, C2, C3 or C6, refer to the

“Standard 12 Leads” section.

Symbol Lead Color (Clip Color) Electrode Position

N* (RF) N* (RL)

Ca Va

Cb Vb

Red (Red-beige) White (White-beige)

Yellow (Yellow-beige) Black (Black-beige)

Green (Green-beige) Red (Red-beige)

Black (Black-beige) Green (Green-beige)

White (Brown-white) Brown (Blue-brown)

White (Black-white) Brown (Orange-brown)

Right infraclavicular fossa

Left infraclavicular fossa

Lowest rib on the left anterior axillary line

Right anterior axillary line at the same level as F

Fifth intercostal space on the left midclavicular line (C4 position of standard 12 leads)

Left anterior axillary line at the same level as Ca (C5 position of standard 12 leads)

* N is the electrical reference point.

Lead Position

Lead I

R/RA

N (RF/RL)

R lead aVL lead aVF lead

R/RA

N (RF/RL)

L/LA

F/LL

L/LA

F/LL

Lead II Lead III

R/RA

N (RF/RL)

R/RA

N (RF/RL)

L/LA

F/LL

N (RF/RL)

L/LA

F/LL

N (RF/RL)

R/RA

L/LA

F/LL

L/LA

F/LL

1.6 User’s Guide Part II BSM-6000

R/RA

N (RF/RL)

L/LA

F/LL

1. ECG MONITORING

R/RA

C1/V1

C2/V2

C3/V3

C4/V4

N (RF/RL)

L/LA

C5/V5

F/LL

C6/V6

Mason-Likar Modiﬁcation

WARNING

Do not use 12 lead ECG interpretation results and measured values

from the Mason-Likar modiﬁcation for diagnosis because the limb

electrode placement is not the same as the standard 12 lead ECG.

This may cause wrong diagnosis since 12 lead ECG interpretation of

this monitor is based on the standard 12 lead ECG.

The Mason-Likar modication places the four limb electrodes close to the

shoulders and lower abdomen. The six C (V) electrodes are placed on the chest

in the same position as the standard 12 lead ECG electrode placement. The

waveforms acquired from the Mason-Likar modication are different from those

of the standard 12 lead.

Electrode Position

Symbol Lead Color (Clip Color) Electrode Position

N* (RF) N* (RL)

C1 V1

C2 V2

C3 V3

C4 V4

C5 V5

C6 V6

Red (Red-beige) White (White-beige)

Yellow (Yellow-beige) Black (Black-beige)

Green (Green-beige) Red (Red-beige)

Black (Black-beige) Green (Green-beige)

White (Red-white) Brown (Red-brown)

White (Yellow-white) Brown (Yellow-brown)

White (Green-white) Brown (Green-brown)

White (Brown-white) Brown (Blue-brown)

White (Black-white) Brown (Orange-brown)

White (Purple-white) Brown (Purple-brown)

Right infraclavicular fossa

Left infraclavicular fossa

Lowest rib on the left anterior axillary line

Right anterior axillary line at the same level as F

Fourth intercostal space at the right border of the sternum

Fourth intercostal space at the left border of the sternum

Halfway between C2 and C4

Fifth intercostal space on the left midclavicular line

Left anterior axillary line at the same level as C4

Left midaxillary line at the same level as C4

* N is the electrical reference point.

Lead Connection

The lead connection is the same as the 6 electrode lead.

User’s Guide Part II BSM-6000 1.7

1. ECG MONITORING

R/RA

C2/V2

C1/V1

C3/V3

C4/V4

C5/V5

N (RF/RL) F/LL

C6/V6

L/LA

Standard 12 Leads

Electrode Position

Symbol Lead Color (Clip Color) Electrode Position

N* (RF) N* (RL)

C1 V1

C2 V2

C3 V3

C4 V4

C5 V5

C6 V6

Red (Red-beige) White (White-beige)

Yellow (Yellow-beige) Black (Black-beige)

Green (Green-beige) Red (Red-beige)

Black (Black-beige) Green (Green-beige)

White (Red-white) Brown (Red-brown)

White (Yellow-white) Brown (Yellow-brown)

White (Green-white) Brown (Green-brown)

White (Brown-white) Brown (Blue-brown)

White (Black-white) Brown (Orange-brown)

White (Purple-white) Brown (Purple-brown)

Inside of right arm between the wrist and the elbow

Inside of left arm between the wrist and the elbow

Inside of the left calf between the knee and the ankle

Inside of the right calf between the knee and the ankle

Fourth intercostal space at the right border of the sternum

Fourth intercostal space at the left border of the sternum

Halfway between C2 and C4

Fifth intercostal space on the left midclavicular line

Left anterior axillary line at the same level as C4

Left midaxillary line at the same level as C4

* N is the electrical reference point.

Lead Connection

The lead connection is the same as the 6 electrode lead.

Electrode Positions for Detecting the Pacemaker Pulse

If the pacemaker pulse cannot be detected, change the electrode lead or electrode

positions as follows.

Changing the Electrode Lead

If the pacemaker pulse cannot be detected with lead II, use lead I or lead III.

Changing the Electrode Positions

If the pacemaker pulse cannot be detected with lead I or lead III, change the

electrode position as follows.

1. With the lead II position, move the F/LL electrode up.

L/LA

R/RA

F/LL

Lead II

1.8 User’s Guide Part II BSM-6000

1. ECG MONITORING

R/RA

Lead II

L/LA

F/LL

L/LA

F/LL

2. If step 1 was not effective, move the R/RA electrode down.

3. If step 2 was not effective, move the R/RA and F/LL electrodes closer

together.

If the pacemaker pulse is still not detected, the pacing pulse on the body

surface may be too small. The sensitivity performance is limited.

Selecting Electrodes and Lead

Select the appropriate electrodes and lead according to the purpose.

WARNING

When using a deﬁbrillator together with the

monitor, use Ag/AgCl electrodes. Other types of

electrodes, stainless steel in particular, will

adversely affect the ECG waveform by slowing

the baseline recovery on the monitor and result in

no monitoring immediately following deﬁbrillation.

CAUTION

Only use Nihon Kohden speciﬁed electrodes and

electrode leads. When other type of electrodes or

electrode leads are used, the “CHECK

ELECTRODES” message may be displayed and

ECG monitoring may stop.

CAUTION

• When using the electrodes with DIN type lead,

use only Vitrode V or N electrodes. If other

electrodes are used, the electrode lead might

not be properly connected and ECG monitoring

may be unstable.

• Do not use electrodes of different metals. ECG

monitoring may be unstable if electrodes of

different metals are used.

NOTE

• Electrode leads other than Nihon Kohden’s might not be deﬁbrillator-

proof.

• Do not use different types of electrodes together. This might cause ECG

monitoring to become unstable.

User’s Guide Part II BSM-6000 1.9

1. ECG MONITORING

Types of Electrodes and Lead

No. of Electrodes Disposable Electrodes Electrode Lead ECG Connection Cord

Vitrode F-150M, F-150S, L-150, L-150X

(I, II, III)

Disposable Electrode with DIN type lead, Vitrode V-090M3, V-09IO3, V-120S3, N-03IS3

Vitrode F-150M, F-150S, L-150, L-150X

(I, II, III, aVR, aVL,

aVF, 2 from V1 to

V6)

BR-903P (IEC)/BR-903PA (AHA) (Clip type, 0.8 m) BR-963P (IEC) (Clip type: 0.8 m)

BR-906P (IEC)/BR-906PA (AHA) (Clip type, 0.8 m)

JC-906P (IEC)/JC-906PA (AHA), 3 m JC-916P (IEC), 1.5 m

(I, II, III, aVR, aVL,

aVF, V1, V2, V3, V4,

V5, V6)

Disposable Electrode with DIN type lead, Vitrode V-060M6, V-06IO6

Vitrode F-150M, F-150S, L-150, L-150X

Disposable Electrode with DIN type lead, Vitrode V-040M4, V-04IO4, V-060M6, V-06IO6

ECG Patient Cable BJ-900P (IEC)/BJ-900PA (AHA)

JC-900P (IEC)/ JC-900PA (AHA)

1.10 User’s Guide Part II BSM-6000

1. ECG MONITORING

Connecting Cables and Attaching Disposable Electrodes

Connecting the Electrode Cable to the Input Unit

1. Connect the electrode lead and ECG connection cord so that their white

panels face the same side.

White panels

When using the electrode with DIN type lead, connect the electrode lead

of the electrode directly to the ECG connection cord according to the panel

symbols.

2. Connect the ECG connection cord to the ECG/RESP socket.

When connecting the 3-electrode lead

When using more than 3 electrodes with DIN type lead with JC-906P or

JC-906PA ECG connection cord, the number of electrodes must be set on the

OTHER page of the ECG window. Refer to the “Changing the Number of

Electrodes” section.

Connecting the Electrode Cable to the BSM-1700 series Bedside

Monitor

Refer to the manuals of the BSM-1700 series bedside monitor for details.

User’s Guide Part II BSM-6000 1.11

1. ECG MONITORING

Attaching Disposable Electrodes to the Patient

Attach the electrodes to the patient by referring to the manual provided with the

electrodes.

WARNING

After attaching the electrode to the patient and connecting the cable

to the monitor, check that electrodes are attached to the patient and

check that the cable is connected to the monitor properly. When the

electrodes are removed from the patient, do not touch the metal part

of the electrode with bare hands or let the metal part of the electrode

contact the metal part of the bed or any other conductive parts.

Failure to follow this warning may cause electrical shock or injury to

the patient by discharged energy.

CAUTION

Do not reuse disposable electrodes.

NOTE

• To maintain good contact between the electrode and skin, check that

the paste of the disposable electrode is not dry.

• When contact of the disposable electrode becomes poor, replace the

electrode with a new one immediately. Otherwise, contact impedance

between the skin and electrode increases and the correct ECG cannot

be obtained.

To obtain a stable ECG:

• Shave excess hair.

• Rub the patient’s skin with a piece of cotton where the electrodes are to be

attached.

• If the skin is dirty, clean with soap and water. Dry completely.

1.12 User’s Guide Part II BSM-6000

1. ECG MONITORING

Monitoring ECG

When electrodes are attached to the patient and cables are connected properly,

ECG and heart rate appear on the screen. The monitor automatically learns the

patient’s dominant ECG.

One lead appears on the home screen. Up to three leads can be displayed on the

home screen when monitoring with six or ten leads. You can display eight leads

on the 12 LEAD window when monitoring with six electrodes and twelve leads

when monitoring with ten electrodes. To perform 12 lead ECG interpretation,

ECG must be monitored with ten electrodes. For details about the 12 lead ECG

interpretation, refer to the Operator’s Manual or Section 7 of the User’s Guide

Part I.

The number of traces to be displayed on the home screen can be set on the

DISPLAY window. Refer to Section 4 of the User’s Guide Part I.

CAUTION

When the “CHECK ELECTRODES” message is

displayed, ECG is not monitored properly and the

ECG alarm does not function. Check the

electrode, electrode leads and connection cord,

and if necessary, replace with new ones.

• After adjusting the sensitivity of the ECG on the screen and changing

necessary settings, check that the dominant QRS is appropriate.

• Before starting monitoring of a pacemaker patient, check that the

pacing mark is displayed on the ECG.

• The maximum heart rate range is 300 beats/min. “300” is displayed on

the screen even when the patient’s heart rate is above 300.

CAUTION

When the “NOISE” or “CANNOT ANALYZE”

message is displayed, ECG data and alarm are

not reliable. Remove the cause by checking the

electrodes, electrode leads, patient’s body

movement, EMG and peripheral instruments

grounding. Also make sure that an electric

blanket is not used.

NOTE

User’s Guide Part II BSM-6000 1.13

1. ECG MONITORING

ECG Information on the Home Screen

Heart rate trendgraph

Heart rateQRS sync mark

ST level of the third trace ST level of the

second trace ST level of the ﬁrst trace

The ST recall waveform, and reference ST recall waveform of selected monitoring ECG leads are displayed on the home screen depending on the settings on the ST window of the REVIEW window. Up to 3 waveforms can be displayed. Refer to Section 6 of the User’s Guide Part I.

ST level trendgraph

Scale of heart rate and ST level trendgraphs

ECG waveform

Sensitivity

Lead

Filter setting QRS detection type

VPC

ECG Data Display

The following ECG related data is acquired when ECG is monitored.

Displayed Data

Screen/Window

Home screen

TREND window (Refer to the Operator’s Manual or Section 6 of the User’s Guide Part I)

ARRHYTHMIA RECALL window (Refer to the Operator’s Manual or Section 6 of the User’s Guide Part I)

ST RECALL window (Refer to the Operator’s Manual or Section 6 of the User’s Guide Part I)

Arrhythmia analysis can be turned on or off on the ECG window → ARRHYTH ANALYSIS page.

Alarm on/off and threshold can be set individually for certain arrhythmias on the ARRHYTH page on the ECG

window or ARRHYTH ALARMS window. When alarm recording is turned on, the data and waveform are recorded at the arrhythmia alarm occurrence. *3 The arrhythmia waveforms to be saved as recall les are set on the RECALL window of the Review window.

<ARRHYTHMIA ANALYSIS> is

set to ON*

Heart rate ST level

Arrhythmia classication message

<ARRHYTHMIA ANALYSIS> is

Heart rate ST level

“ASYSTOLE” alarm occurrence Number of VPC per minute Arrhythmia alarm occurrence (when arrhythmia alarm is set to ON*2)

Heart rate trendgraph ST level trendgraph Number of VPC trendgraph Heart rate list

Heart rate trendgraph

ST level trendgraph

Heart rate list

ST level list ST level list Number of VPC list

Recall les of the arrhythmias set to

be saved*

“ASYSTOLE” recall les

ST recall les ST recall les

set to OFF*

1.14 User’s Guide Part II BSM-6000

1. ECG MONITORING

Baseline

ST wave

ST level

Measuring ST Level

The ST level is the amplitude between the baseline and ST wave. The ECG

waveform is averaged for 15 seconds to remove artifacts. The baseline and the

ST wave are detected from the averaged ECG, and the ST level is measured.

NOTE

• If there are too many arrhythmias, there is noise on the ECG, or the

heart rate is below 32, ST level might not be measured and ST level is

not displayed on the screen.

• Although the ST algorithm has been tested for accuracy of the ST

analysis result, the signiﬁcance of the ST level changes need to be

determined only by a physician.

• If there is baseline drift on the ECG, ST waves are distorted and the ST

measurement may be impossible.

ST levels of up to 12 leads can be displayed on the ST window of the Review

window. Refer to “ST Window” of the Operator’s Manual or Section 6 of the

User’s Guide Part I.

You can change the ISO point, J point and ST point for ST level measurement

on the ECG window → ST POINT page. Refer to the “Changing the ST Level

Measurement Condition” section.

Detached Electrode Detection and Display

When an electrode or electrode lead is detached during ECG monitoring, a

“CHECK ELECTRODES” alarm occurs.

When monitoring with 6 or 10 electrodes and <AUTO LEAD CHANGE> on

the ECG window is set to ON, and the “CHECK ELECTRODES” message is

displayed for more than 5 seconds, the lead for the rst trace on the home screen

is automatically changed to a stable lead.

Five seconds after the detached electrode or electrode lead is attached again, the

lead of the rst trace returns to the lead prior to auto lead change.

While the “CHECK ELECTRODES” message is displayed, the correct ECG

waveform is not displayed. To prevent incorrect reading of ECG during an

error condition, the ECG waveform is temporarily replaced with a square wave

and at line. Check the electrodes if this message appears. Refer to “Screen

Messages” section of the Operator’s Manual.

When the “CHECK ELECTRODES” message is displayed, ECG is

not monitored properly and the ECG alarm does not function. Check

the electrode, electrode leads and connection cord, and if necessary,

replace with new ones.

CAUTION

User’s Guide Part II BSM-6000 1.15

1. ECG MONITORING

AC Interference and Display

When the “CHECK ELECTRODES” message appears, the ECG waveforms

become square waves for 2 seconds, then change to at lines above the baseline.

To prevent incorrect reading of ECG during an error condition, when there is a

large AC interference (hum) on the waveform, the “CHECK ELECTRODES”

message appears and the waveform appears as shown below, depending on the

lter setting on the ECG window.

When the waveform looks like this, check that the bedside monitor is properly

grounded.

Hum noises may interfere if the electrodes are dry. Replace the electrodes with

new ones.

When <FILTERS> is set to DIAG

Noise superimposes on the waveform.

When <FILTERS> is set to MONITOR or MAXIMUM

When noise superimposes on the waveform and it is difcult to detect QRS

waves, the ECG waveforms become square waves for 2 seconds, then change to

at lines above the baseline.

1.16 User’s Guide Part II BSM-6000

1. ECG MONITORING

Monitoring Arrhythmia

General

The following functions are available for arrhythmia monitoring.

• Arrhythmia alarm indication (alarm sound, screen message and alarm indicator

lamp). Refer to the Operator’s Manual or Section 5 of the User’s Guide Part I.

• Arrhythmia waveform storage (Arrhythmia recall les). Refer to the

Operator’s Manual or Section 6 of the User’s Guide Part I.

• Arrhythmia waveform recording. Refer to the Operator’s Manual or Section 10

of the User’s Guide Part I.

• VPC display and trendgraph. Refer to the Operator’s Manual or Section 4 and

6 of the User’s Guide Part I.

WARNING

For arrhythmia monitoring, set <ARRHYTHMIA ANALYSIS> on the

ECG window to ON. Otherwise, there is no sound or indication for

arrhythmia alarms (except for ASYSTOLE).

When arrhythmia analysis is set to on, arrhythmia analysis starts as soon as

the ECG monitoring starts. The monitor automatically detects and classies

arrhythmia by comparing each beat of the real-time ECG waveform to a

reference ECG waveform (dominant QRS). If the following points of a QRS do

not match the dominant QRS, that QRS is recognized as an arrhythmia.

• RR interval

• QRS width

• QRS amplitude

• QRS polarity

It is important to check the dominant QRS on the ECG window at the start of

ECG monitoring for accurate arrhythmia monitoring.

CAUTION

At the start of ECG monitoring, check that the dominant QRS is

appropriate. Otherwise arrhythmia monitoring may be inaccurate.

When the QRS wave or RR interval changes too frequently, it becomes difcult

for the monitor to distinguish between the normal ECG and arrhythmia. To solve

this problem, the monitor uses pattern matching and multi template matching for

analyzing arrhythmia. However, when the patient’s QRS changes rapidly, check

that the appropriate dominant QRS is used for arrhythmia analysis.

User’s Guide Part II BSM-6000 1.17

1. ECG MONITORING

Arrhythmia Analysis Data Display

When the monitor detects an arrhythmia, the arrhythmia alarm and data are

indicated. The message display interval depends on the priority setting on the

ALARM SETTINGS window. For details on this setting, refer to Section 3-2 of

the Administrator’s Guide.

Highlighted heart rate

Arrhythmia alarm message

The following arrhythmias are analyzed.

Arrhythmia Name Description

ASYSTOLE Longer than 3 to 10 seconds (selectable) with no QRS complex.

VF Ventricular brillation longer than 4 seconds.

EXT TACHY*

EXT BRADY*

V BRADY*

VPC RUN

SV TACHY*

TACHYCARDIA Heart rate above the upper heart rate limit.

BRADYCARDIA Heart rate below the lower heart rate limit.

PAUSE*

V RHYTHM*

COUPLET VPC couplet (paired VPCs). 2 consecutive VPCs.

EARLY VPC

MULTIFORM*

BIGEMINY

TRIGEMINY*

FREQ VPC

VPC Ventricular premature contraction.

AF*

IRREGULAR RR*

PROLONGED RR*

NO PACER PULSE*

1*5

PACER NONCAPTURE*

These arrhythmias become available when “EXTENDED” is selected for <ARRHYTHMIA TYPE> on the SYSTEM SETUP screen.

1*5

Refer to Section 3 of the Administrator’s Guide.

This number is set in the VT alarm setting.

120 beats/min when <QRS DETECTION TYPE> is set to ADULT, 150 beats/min when <QRS DETECTION TYPE> is set to CHILD

or NEONATE.

Ventricular tachycardia. 3 to 9 (selectable*1) or more consecutive VPCs when heart rate exceeding the VT heart rate limit (16 to 300 beats/min selectable*

Extreme tachycardia exceeding the EXTREME TACHY limit.

Extreme bradycardia dropping below the EXTREME BRADY limit.

Ventricular bradycardia. 3 or more consecutive VPCs when heart rate drops below the V BRADY heart rate limit (15 to 299 beats/min selectable).

VPC short run. 3 to 8 (selectable) consecutive VPCs when heart rate exceeds the VPC RUN heart rate limit (16 to 300 beats/min selectable*

). or The selected number*

of consecutive VPCs when heart rate drops below the VT heart rate limit.

Supraventricular tachycardia. 3 to 9 (selectable) or more consecutive normal QRS of regular R-R interval

when heart rate exceeding the SV TACHY heart rate limit (16 to 300 beats/min selectable).

1 to 3 seconds (selectable) with no QRS.

Ventricular rhythm. 3 or more consecutive VPCs.

Early VPC including R-on-T type. VPC with a time interval from the preceding normal QRS complex of

less than approximately one-third of the normal R-R interval, at heart rate dropping below 120*

beats/

min.

Two different shaped VPCs within the last 3 minutes.

Ventricular bigeminy. 3 or more consecutive pairs of VPC and normal QRS. A dominant rhythm of N-V-

N-V-N-V (N = normal beat, V = ventricular beat)

Ventricular trigeminy. A dominant rhythm of N-N-V-N-N-V.

Frequent VPCs. VPC rate (VPCs/min) reaching or exceeding the preset limit of 1 to 99 VPCs/min (selectable).

Atrial brillation longer than 2 minutes.

Consistently irregular R-R intervals.

R-R interval 1.75 times longer than the dominant R-R interval.

No QRS and pacing pulse within the bradycardia limit. Oversensing.

No QRS from the preceding pacing pulse for the preset time interval (40 to 480 ms selectable). Non-

capture.

1.18 User’s Guide Part II BSM-6000

1. ECG MONITORING

*4 Not available for BSM-6000K series. Available only when <ARRHYTHMIA TYPE> on the ECG page of the SYSTEM SETUP

window is set to EXTENDED, and <AF DETECTION> on the ECG page of the SYSTEM SETUP window is set to On. For the SYSTEM SETUP window settings, refer to the Administrator’s Guide.

Available only when pacing detection is set to ON.

WARNING

It is not possible to obtain 100% accurate detection of every

arrhythmia.

WARNING

Do not use AF detection for children or neonates. The monitor might

not correctly detect AF in children or neonates.

WARNING

The monitor requires a minimum of 2 minutes of continuous analysis

before AF can be detected. Detection may take up to 2.5 minutes.

NOTE

If arrhythmia type is changed to “EXTENDED” and the bedside monitor

is connected via network to a central monitor that has old software, the

“Lost communication with instruments in the network” message appears

on the bedside monitor and the bedside monitor cannot be monitored on

the central monitor.

The QRS is annotated as follows.

QRS Annotation Description

N Normal QRS complex

V Ventricular premature contraction

P Paced QRS

? Impossible to classify or during learning

– Noise

Changing Arrhythmia Monitoring Settings

Check the following settings for arrhythmia monitoring.

Turning Arrhythmia Analysis On or Off

For arrhythmia monitoring, set <ARRHYTHMIA ANALYSIS> on the

ECG window to ON. Otherwise, there is no sound or indication for

arrhythmia alarms (except for ASYSTOLE).

WARNING

When arrhythmia monitoring is necessary, select “ON”.

User’s Guide Part II BSM-6000 1.19

1. ECG MONITORING

This arrhythmia analysis on/off setting returns to the master setting on the

ARRHYTH page of the MASTER window when:

• The monitor power is off for more than 30 minutes and <SHOW

ADMIT CONFIRMATION WINDOW> is turned off in the SYSTEM

CONFIGURATION screen.

• The patient is admitted or discharged.

To change the master setting, refer to Section 3 of the Administrator’s Guide.

1. Display the ARRHYTH ANALYSIS page of the ECG window.

Press the [Menu] key → ECG key → ARRHYTH ANALYSIS tab.

2. Select ON or OFF in the <ARRHYTHMIA ANALYSIS> box to turn

arrhythmia analysis on or off.

3. Press the [Home] key to return to the home screen.

Selecting Arrhythmia Analysis Leads

Select the leads for arrhythmia analysis.

1. Display the ARRHYTH ANALYSIS page of the ECG window.

Press the [Menu] key → ECG key → ARRHYTH ANALYSIS tab.

2. Select SINGLE or MULTIPLE in the <ARRHYTHMIA ANALYSIS

METHOD> box to select analyzing leads.

SINGLE: The lead selected for the rst trace is analyzed.

MULTIPLE: The leads selected for the rst and second traces are analyzed.

3. Press the [Home] key to return to the home screen.

1.20 User’s Guide Part II BSM-6000

1. ECG MONITORING

Selecting the Patient Type for QRS Detection

CAUTION

At the start of ECG monitoring, check that the correct patient type is

set for <QRS DETECTION TYPE> on the ARRHYTH ANALYSIS

page of the ECG window. If an inappropriate patient type is set,

heart rate cannot be counted accurately and noise or P waves may

be counted as QRS and cardiac arrest may be overlooked.

Select the monitoring patient type. The selected patient type is displayed on the

home screen.

This QRS detection type set on the ECG window returns to this master setting

when:

• The monitor power is off for more than 30 minutes and <SHOW

ADMIT CONFIRMATION WINDOW> is turned off in the SYSTEM

CONFIGURATION screen.

• The patient is admitted or discharged.

To change the master setting, refer to Section 3 of the Administrator’s Guide.

The QRS settings depend on the patient type.

Items

Detect narrow QRS Not available Not available Available

QRS detection sensitivity Automatic sensitivity

Default setting of ISO point R – 80 ms R – 56 ms

Default setting of J point R + 48 ms Cannot be set

Default setting of ST point J + 60 ms R + 60 ms

1. Display the ARRHYTH ANALYSIS page of the ECG window.

Press the [Menu] key → ECG key → ARRHYTH ANALYSIS tab.

2. Select the patient type in the <QRS DETECTION TYPE> box.

ADULT CHILD NEONATE

QRS DETECTION TYPE Setting

Same as the <SENSITIVITY> setting

Automatic sensitivity

3. Press the [Home] key to return to the home screen.

User’s Guide Part II BSM-6000 1.21

1. ECG MONITORING

Learning the ECG Waveform for Arrhythmia Detection (VPC

Learning)

The monitor automatically detects and classies arrhythmia waveforms when

arrhythmia analysis is set to on. To do this, the monitor compares each beat of

the real-time ECG waveform to a reference ECG waveform which is called

dominant QRS.

The monitor automatically samples this dominant QRS in the following

situations:

• When ECG monitoring begins

• When the monitoring lead is changed

• When the “CHECK ELECTRODES” alarm message is resolved

• When the waveform changes from ventricular rhythm to supraventricular

rhythm and satises the conditions specied by Nihon Kohden.

Sampling the reference waveform is called “Learning”.

Learning takes a few seconds. During learning, a “LEARNING” message is

displayed on the screen. After learning, the dominant QRS is replaced with the

new one and the monitor resumes analyzing the ECG waveforms.

NOTE

• To make the monitor learn, <ARRHYTHMIA ANALYSIS> on the

ARRHYTH ANALYSIS page of the ECG window must be set to ON.

• During learning, alarms other than “ASYSTOLE”, “VF”,

“BRADYCARDIA” and “TACHYCARDIA” do not function.

You can make the monitor “relearn” the reference ECG waveform at any time,

for example, when the automatic VPC classication is questionable.

CAUTION

If there is any doubt about the arrhythmia analysis, make the monitor

relearn the patient’s ECG and check that the dominant QRS is

appropriate. Otherwise, an important arrhythmia may be overlooked.

1. Display the MAIN or ARRHYTH ANALYSIS page of the ECG window.

Press the [Menu] key → ECG key → MAIN or ARRHYTH ANALYSIS tab.

1.22 User’s Guide Part II BSM-6000

1. ECG MONITORING

Dominant QRS

2. Touch the LEARN key. The monitor learns the reference ECG waveform

and the dominant QRS is refreshed.

Date and time the dominant QRS is acquired

3. Check that the dominant QRS is appropriate for arrhythmia analysis.

4. Press the [Home] key to return to the home screen.

Checking the Dominant QRS

The monitor detects QRS of the monitoring ECG and classies them into

templates. The monitor selects the most typical QRS, called dominant QRS, and

uses it for analyzing arrhythmia. Whenever ECG is learned or relearned, the

dominant QRS is refreshed.

The ECG on the ARRHYTH ANALYSIS window are annotated by the following

QRS classication.

QRS Annotation Description

N Normal QRS complex

V Ventricular premature contraction

P Paced QRS

? Impossible to classify or during learning

– Noise

If there is any doubt about the arrhythmia analysis, make the monitor relearn the

patient’s ECG and check the dominant QRS.

1. Display the ARRHYTH ANALYSIS page of the ECG window.

Press the [Menu] key → ECG key → ARRHYTH ANALYSIS tab.

User’s Guide Part II BSM-6000 1.23

1. ECG MONITORING

2. The dominant QRS and ECG of the rst trace is displayed on the

ARRHYTH ANALYSIS page.

QRS annotation

Dominant QRS

NOTE

The ECG waveform on the ECG window is delayed 5 seconds.

3. Check that the dominant QRS is appropriate.

To change the dominant QRS, touch the LEARN key to relearn the ECG.

The dominant QRS is refreshed.

4. Press the [Home] key to return to the home screen.

1.24 User’s Guide Part II BSM-6000

1. ECG MONITORING

Changing ECG Settings

Change settings on the ECG window. The following settings can be changed for

ECG monitoring.

• ECG measurement on or off

• Monitoring lead and lead name

• ECG sensitivity

• Number of ECG traces on the home screen

• Learn ECG. Refer to the “Monitoring Arrhythmia” section.

• Heart rate, arrhythmia and ST alarm limits and setting

• Arrhythmia analysis on or off. Refer to the “Monitoring Arrhythmia” section.

• Arrhythmia analysis lead. Refer to the “Monitoring Arrhythmia” section.

• Check dominant QRS. Refer to the “Monitoring Arrhythmia” section.

• ST level settings

• Pacing settings

• Number of electrodes

• Auto lead change on or off when electrode is detached

• Heart rate display mode

• Filter mode

• Hum lter on or off

• Sync source

• Sync sound pitch

• Pulse rate display on or off

• QRS detection type

The following items can be set on the SYSTEM SETUP window. Refer to

Section 3 of the Administrator’s Guide.

• ECG electrode lead type (IEC or AHA)

• Heart rate sync sound pitch

• ECG display color

• Arrhythmia type (standard or extended)

• Cascade ECG waveform

The ST level unit (mV or mm) can be set on the SYSTEM CONFIGURATION

screen. Refer to Section 2 of the Administrator’s Guide.

The scale of the heart rate and ST level trendgraphs on the home screen are the

same scale as the trendgraphs of the Review window. Refer to the Operator’s

Manual or Section 6 of the User’s Guide Part I.

ST waveform and reference ST recall waveform display on the home screen can

be set to ON or OFF. Refer to Section 6 of the User’s Guide Part I.

The ECG sweep speed is the speed set on the DISPLAY window. Refer to

Section 3 of the User’s Guide Part I.

If the ECG CHECK ELECTRODES or CANNOT ANALYZE alarm occurs and

no action is taken for a selected duration, the alarm level can be escalated. Refer

to Section 3 of the Administrator’s Guide.

User’s Guide Part II BSM-6000 1.25

1. ECG MONITORING

Turning ECG Measurement On or Off

When monitoring SpO2 only, detection of arrhythmia and asystole is

not available and arrhythmia alarms such as ASYSTOLE, VF or VT

are not available. If the patient requires ECG monitoring, monitor the

ECG.

When monitoring SpO2 only (without ECG monitoring), turn on both

the upper and lower limit alarms for PR and SpO2. If the patient’s

pulse is not detected during asystole or other condition, a “CANNOT

DETECT PULSE” or “CHECK PROBE” alarm occurs instead of an

SpO2 limit alarm. Furthermore, if the patient has no pulse, noise from

probe movement could be misjudged as a pulse and cause an

incorrect PR or SpO2 value to be displayed.

CAUTION

You can select ECG measurement on or off.

Home screen example when <ECG MEASUREMENT> is turned off

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

1.26 User’s Guide Part II BSM-6000

1. ECG MONITORING

2. Select ON or OFF in the <ECG MEASUREMENT> box.

ON: Measured value and waveform are displayed on the home screen.

ECG related alarms are enabled.

OFF: Measured value and waveform are not displayed. ECG related alarms

are disabled.

Changing the Monitoring Lead

3. Start ECG monitoring and check that the ECG waveform is displayed on the

home screen.

NOTE

• The <ECG MEASUREMENT> setting cannot be changed to OFF while

ECG is monitored.

• Even when the setting is set to OFF, the setting automatically changes

to ON when ECG measurement is started. If the measured value and

waveform are not displayed on the home screen within 10 seconds,

change the setting to ON manually.

• After setting <ECG MEASUREMENT> to ON, check that the ECG

waveform is displayed on the home screen.

One lead can be monitored with 3 electrodes and three leads can be monitored

with 6 or 10 electrodes on the home screen.

No. of Electrodes Lead

3 I, II, III

6 I, II, III, aVR, aVL, aVF, two leads from V1 to V6

10 I, II, III, aVR, aVL, aVF, V1 to V6

When monitoring with 6 or 10 electrodes, the lead of the rst trace can be

automatically changed to a stable lead when there is an electrode detachment or

the “CHECK ELECTRODES” message is displayed for more than 5 seconds.

Refer to the “Auto Lead Change On or Off” section.

User’s Guide Part II BSM-6000 1.27

1. ECG MONITORING

Optimum Lead

NOTE

Follow the physician’s instructions for lead position when available.

It is generally considered that Lead II and Lead V1 are suitable for arrhythmia

monitoring and that Lead V4 and Lead V5 are suitable for myocardial ischemia

monitoring.

Some types of ECGs are difcult for automatic analysis, and heart rate or

arrhythmia detection level is not accurate for some patients. In these cases, use

the following procedure to nd the appropriate lead for automatic analysis.

1. Measure the patient’s ECG with the standard 12 ECG leads using an ECG

instrument.

2. Select the optimum lead according to the following guidelines:

i) Select the lead with the highest QRS wave amplitude and least

difference in amplitude compared with a VPC or pacing pulse.

0.5 ≤ QRS1/QRS2 ≤ 2

ii) Select the lead with less than 0.2 mV amplitude of the P-wave.

P ≤ 0.2 mV

iii) Select the lead with a T-wave amplitude which is less than one-third of

the QRS wave.

T1 ≤ 1/3QRS1, T2 ≤ 1/3QRS2

QRS1

QRS2

Selecting the Number of ECG Traces on the Home Screen

Select the number of ECG traces on the home screen. This setting can also be

changed on the WAVES page of the DISPLAY window.

1. Display the ECG 2/3 WAVES page of the ECG window.

Press the [Menu] key → ECG key → ECG 2/3 WAVES tab.

1.28 User’s Guide Part II BSM-6000

1. ECG MONITORING

2. Select the number of ECG traces from the <NO. ECG WAVES> box.

3. Press the [Home] key to return to the home screen.

Changing a Lead

You can change the lead of traces on the home screen.

NOTE

• When the lead is changed on the MAIN window, the lead on the

ARRHYTH ANALYSIS window also changes.

• When the <NUMBER OF ELECTRODES> setting on the OTHER

window is changed, the lead setting automatically changes to II.

Change the number of electrodes setting before changing the lead.

1. Display the MAIN page of the ECG window.

Press the [Menu] key → ECG key → MAIN tab.

2. Select the lead from the <LEAD> box. The rst trace changes to the selected

lead.

To change the lead for the second and third traces on the home screen, touch

the ECG2/3 WAVES tab and select the lead for each trace.

User’s Guide Part II BSM-6000 1.29

1. ECG MONITORING

For the second trace

For the third trace

3. Press the [Home] key to return to the home screen.

Assigning Va and Vb (Ca and Cb) Leads when Monitoring with

6 Electrodes

You can assign the leads for Va and Vb when using 6 electrodes. After assigning

the Va and Vb leads, select the monitoring lead.

1. Display the V-LEADS page of the ECG window.

Press the [Menu] key → ECG key → V-LEADS tab.

2. Select the lead by touching the desired lead key. The selected lead becomes

available to be selected on the ECG2/3 WAVES window.

If necessary, you can change the sensitivity for the second and third traces.

Refer to the “Changing the ECG Sensitivity” section.

3. Press the [Home] key to return to the home screen.

1.30 User’s Guide Part II BSM-6000

1. ECG MONITORING

Auto Lead Change On or Off

When monitoring with 6 or 10 electrodes and <AUTO LEAD CHANGE> on the

OTHER window is set to ON, the lead for the rst trace on the home screen can

be automatically changed to a stable lead when there is an electrode detachment

or the “CHECK ELECTRODES” message is displayed for more than 5 seconds

on the screen. While the “AUTO LEAD CHANGE” message is displayed, the

“CHECK ELECTRODES” alarm message is not displayed.

Five seconds after the detached electrode or electrode lead is attached again, the

lead of the rst trace returns to the lead prior to auto lead change.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

2. Select ON or OFF in the <AUTO LEAD CHANGE> box.

Changing the ECG Sensitivity

3. Press the [Home] key to return to the home screen.

The sensitivity determines the size of the waveform on both the screen and

recording paper. For stable QRS detection, the QRS amplitude should be larger

than 1 cm on the screen.

NOTE

When <QRS DETECTION TYPE> on the ARRHYTH ANALYSIS page is

set to “ADULT” or “NEONATE”, the sensitivity is set automatically.

The sensitivity can be set manually or automatically. When you select auto

sensitivity, the sensitivity is automatically determined according to the average

QRS amplitude of the previous 16 beats. When sensitivity is set automatically,

“AG” (auto gain) appears beside the sensitivity on the screen.

QRS Wave Amplitude Auto Sensitivity

< 5 mm

< 10 mm

< 20 mm

< 30 mm

≥ 30 mm × 1/4

× 4

× 2

× 1

× 1/2

User’s Guide Part II BSM-6000 1.31

1. ECG MONITORING

NOTE

During learning or when there is noise, auto sensitivity is not possible.

1. Display the MAIN page of the ECG window.

Press the [Menu] key → ECG key → MAIN tab.

2. Select the sensitivity from the <SENSITIVITY> box.

For the ﬁrst trace

For the second trace

To change the sensitivity for the second and third traces, display the ECG2/3

WAVES page and select the sensitivity from the <ECG2 SENSITIVITY>

box for the second trace and the <ECG3 SENSITIVITY> box for the third

trace.

For the third trace

3. Press the [Home] key to return to the home screen.

1.32 User’s Guide Part II BSM-6000

1. ECG MONITORING

Changing the Heart Rate/Pulse Rate, VPC and ST Alarm Limits

CAUTION

When the alarm limit is set to OFF, there will be no alarm for that

limit. Be careful when you set the alarm limit to OFF.

You can set the upper and lower heart rate/pulse rate, VPC and ST level of the

rst trace alarm limits on the ECG window. You can set all alarms, including the

upper and lower heart rate alarm limits, on the ALARM LIMITS window (See

the Operator’s Manual or Section 5 of the User’s Guide Part I).

Setting Range

NOTE

• VPC alarm limit can only be set when <ARRHYTHMIA ANALYSIS> on

the ECG window is ON.

• If “EXT TACHY” or “EXT BRADY” are set to ON, the “ALARM CAP”

setting for the “HR/PR” cannot be set. To apply the “ALARM CAP”

setting for the “HR/PR”, set “EXT TACHY” and “EXT BRADY” to OFF.

HR/PR: Upper limit: When <SYNC SOURCE> is set to ECG:

16 to 300 beats/min in 1 beat/min steps, OFF*1*

When <SYNC SOURCE> is set to PRESS or SpO2:

31 to 300 beats/min in 1 beat/min steps, OFF*1*

When EXT TACHY alarm is set to ON:

16 to EXT TACHY alarm limit in 1 beat/min steps*1*

(default setting: ADULT-140, CHILD-170,

NEONATE-200)

Lower limit: When <SYNC SOURCE> is set to ECG:

OFF, 15 to 299 beats/min in 1 beat/min steps*1*

When <SYNC SOURCE> is set to PRESS or SpO2:

OFF, 30 to 299 beats/min in 1 beat/min steps*1*

When EXT BRADY alarm is set to ON:

EXT BRADY alarm limit to 299 in 1 beat/min steps*1*

(default setting: ADULT-50, CHILD-75,

NEONATE-100)

On BSM-6000A series, if <CRISIS VITAL ALARM MANAGEMENT> on the SYSTEM

CONFIGURATION screen is turned on and “ALARM PRIORITY” on the SYSTEM SETUP

window is set to CRISIS, the alarm setting is set to the alarm master setting.

On BSM-6000A series, if <ALARM CAP> on the SYSTEM CONFIGURATION screen is

turned on, the alarm setting is affected by the “ALARM CAP” setting on the SYSTEM SETUP

window.

VPC: Upper limit: 1 to 99 beats/min in 1 beats/min steps, OFF

(default setting: OFF)

ST: Upper limit: –1.99 to +2.00 mV in 0.01 mV steps (–19.9 to

+20.0 mm in 0.1 mm steps), OFF (default setting: OFF)

Lower limit: OFF, –2.00 to +1.99 mV in 0.01 mV steps (–20.0 to

+19.9 mm in 0.1 mm steps) (default setting: OFF)

User’s Guide Part II BSM-6000 1.33

1. ECG MONITORING

1. Display the MAIN page of the ECG window.

Press the [Menu] key → ECG key → MAIN tab.

2. Touch the HR/PR key to change the heart rate/pulse rate alarm limits.

Touch the VPC key to change the VPC alarm limit.

Touch the ST key to change the ST level of the rst trace alarm limits.

Selected parameter

Current measured value

Upper limit

Upper limit slider

Lower limit

Current measured value

3. Touch and drag the sliders to the desired level on the setting bar. Use the

If the upper limit is set to a value above the maximum, the upper limit alarm

is set to OFF. If the lower limit is set to a value below the minimum, the

lower limit alarm is set to OFF.

4. Press the [Home] key to return to the home screen.

Changing Arrhythmia Alarm Settings

For arrhythmia monitoring, set <ARRHYTHMIA ANALYSIS> on the

ECG window to ON. Otherwise, there is no sound or indication for

arrhythmia alarms (except for ASYSTOLE).

Lower limit slider

Setting bar

key to adjust the setting.

WARNING

CAUTION

When the alarm is turned OFF for an arrhythmia, there will be no

alarm for that arrhythmia type. There is no message or mark to

indicate that a certain arrhythmia alarm is turned off. Therefore, be

careful when you turn off an arrhythmia alarm.

NOTE

When an arrhythmia alarm is turned OFF, there will be no alarm recording

for that arrhythmia type even when alarm recording is set to ON on the

RECORD window.

1.34 User’s Guide Part II BSM-6000

1. ECG MONITORING

You can turn on or off the alarm for individual arrhythmias and set the threshold

for some arrhythmias. The following table shows the setting for each arrhythmia.

Parameter Detection Condition (Default Setting)

ASYSTOLE 3 to 10 seconds (ADULT, CHILD: 5 s NEONATE: 3 s) ON xed

VF ––– ON xed

VT ––– ON xed

EXT TACHY*

EXT BRADY*

V BRADY*

1*2

1*3

Upper heart rate alarm limit to 300 beats/min (ADULT: 160, CHILD 190, NEONATE: 220)

15 to lower heart rate alarm limit (ADULT: 40, CHILD 60, NEONATE: 80)

15 to 299 beats/min (ADULT, CHILD: 50 NEONATE: 60)

3 to 8 VPCs (3)

VPC RUN

16 to 300 beats/min (ADULT, CHILD: 100 NEONATE: 140)*

3 to 9 VPCs (6) ON/OFF (OFF)

SV TACHY*

16 to 300 beats/min (ADULT, CHILD: 170 NEONATE: 210)

PAUSE*

V RHYTHM*

1.0 to 3.0 s (ADULT, CHILD: 3.0 NEONATE: 1.5) ON/OFF (ON)

–––

COUPLET ––– ON/OFF (OFF)

EARLY VPC ––– ON/OFF (OFF)

MULTIFORM*

––– ON/OFF (OFF)

BIGEMINY ––– ON/OFF (OFF)

TRIGEMINY*

AF*

IRREGULAR RR*

PROLONGED RR*

NO PACER PULSE*1*

PACER NON-CAPTURE*1*

––– ON/OFF (OFF)

–––

40 to 480 ms (400) ON/OFF (OFF)

––– ON/OFF (OFF)

Alarm ON/OFF Setting

(Default Setting)

ON/OFF (OFF)

ON/OFF (ADULT OR: OFF, ICU/ NICU: ON CHILD, NEONATE: OFF)

ON/OFF (OFF)

ON/OFF (ADULT OR: OFF, ICU/ NICU: ON CHILD, NEONATE: OFF)

ON/OFF (ADULT: ON, CHILD, NEONATE: OFF)

*1 These arrhythmias become available when “EXTENDED” is selected for <ARRHYTHMIA TYPE> on the SYSTEM SETUP screen.

Refer to Section 3 of the Administrator’s Guide.

When EXT TACHY alarm setting is OFF, HR setting range is 16 to 300 beat/min or OFF.

When EXT BRADY alarm setting is OFF, HR setting range is 15 to 299 beat/min or OFF.

Not available for BSM-6000K series. Available only when <ARRHYTHMIA TYPE> on the ECG page of the SYSTEM SETUP

window is set to EXTENDED, and <AF DETECTION> on the ECG page of the SYSTEM SETUP window is set to On. For the

SYSTEM SETUP window settings, refer to the Administrator’s Guide.

Available only when pacing detection is set to ON.

You can also set arrhythmia alarm limits on the ARRHYTH ALARMS window

(See the Operator’s Manual or Section 5 of the User’s Guide Part I).

NOTE

If arrhythmia type is changed to “EXTENDED” and the bedside monitor

is connected via network to a central monitor that has old software, the

“Lost communication with instruments in the network” message appears

on the bedside monitor and the bedside monitor cannot be monitored on

the central monitor.

User’s Guide Part II BSM-6000 1.35

1. ECG MONITORING

1. Display the ARRHYTH page of the ECG window.

Press the [Menu] key → ECG key → ARRHYTH tab.

Threshold setting

ON/OFF key

2. To turn off an arrhythmia alarm, touch the ON key to turn it to OFF.

To turn on an arrhythmia alarm, touch the OFF key to turn it to ON.

To set the threshold, use the or key to adjust the setting.

NOTE

For BSM-6000A series bedside monitors:

• Items can be turned on or off but thresholds are ﬁxed and cannot

be changed. The thresholds are set by the administrator on the

MASTER window of the SYSTEM SETUP window.

• Arrhythmia alarm whose priority is set to CRISIS on the ALARM

window of the SYSTEM SETUP window cannot be set to OFF.

Refer to Section 3 of the Administrator’s Guide.

When EXTENDED is selected for the arrhythmia type in the SYSTEM

SETUP window, touch the threshold to display the ARRHYTH window and

adjust the setting.

3. Press the [Home] key to return to the home screen.

1.36 User’s Guide Part II BSM-6000

1. ECG MONITORING

Changing the ST Alarm Limits

Selected lead

CAUTION

When the alarm limit is set to OFF, there will be no alarm for that

limit. Be careful when you set the alarm limit to OFF.

You can set the upper and lower ST alarm limits for each lead individually or

altogether on the ECG window. You can set all alarms, including the upper and

lower ST of all leads alarm limits, on the ALARM LIMITS window (See the

Operator’s Manual or Section 5 of the User’s Guide Part I).

Setting Range

Upper limit: –1.99 to +2.00 mV in 0.01 mV steps (–19.9 to +20.0 mm in

0.1 mm steps), OFF (default setting: OFF)

Lower limit: OFF, –2.00 to +1.99 mV in 0.01 mV steps (–20.0 to +19.9 mm in

0.1 mm steps) (default setting: OFF)

1. Display the ST ALARMS page of the ECG window.

Press the [Menu] key → ECG key → ST ALARMS tab.

Current ST level of the selected lead

2. To set the upper and lower alarm for a lead

i) Select the lead.

ii) Touch and drag the sliders to the desired level on the setting bar. Use the

or key to adjust the setting.

If the upper limit is set to a value above the maximum, the upper

limit alarm is set to OFF. If the lower limit is set to a value below the

minimum, the lower limit alarm is set to OFF.

Current ST level of the selected lead

Upper limit slider

Upper limit

Setting bar

Lower limit

Lower limit slider

User’s Guide Part II BSM-6000 1.37

1. ECG MONITORING

ISO point

To set alarms altogether for all leads according to the current ST value

i) Touch the ST-ALL key.

ii) Touch and drag the sliders to the desired level on the setting bar. Use the

or key to adjust the setting.

iii) Touch the SET key to set the upper and lower limits according to the

current value of the ST value.

Upper limit

Upper limit slider

Lower limit slider

Lower limit

ST-ALL key

3. Press the [Home] key to return to the home screen.

Changing the ST Level Measurement Condition

In the ST level measurement, the ISO point determines the baseline and the ST

point and J point determine the ST level from the baseline. You can change the

ISO point, J point and ST point for ST level measurement.

ST point

J point

Although the ST algorithm has been tested for accuracy of the ST

analysis result, the signiﬁcance of the ST level changes need to be

determined only by a physician.

Setting Range

ISO point: (R –) 0 to 248 ms in 4 ms steps

J point: (R +) 0 to 340 ms in 4 ms steps

ST point: (R +) R +: 0 to * ms in 4 ms steps

* When J point is set to R +: 340 ms, ST point is J + 0 ms.

SET key

NOTE

Setting bar

Default Setting

When <QRS DETECTION TYPE> is set to ADULT:

ISO point: R – 80

J point: R + 48

ST point: R + 60

When <QRS DETECTION TYPE> is set to CHILD or NEONATE:

ISO point: R – 56

ST point: R + 60

1.38 User’s Guide Part II BSM-6000

1. ECG MONITORING

When QRS DETECTION TYPE is set to CHILD or NEONATE

1. Display the ST POINT page of the ECG window.

Press the [Menu] key → ECG key → ST POINT tab.

2. Select the lead(s) by touching the lead key to be displayed on the ST POINT

page. The QRS wave(s) of the selected lead(s) appears on the window.

Lead keys

If the QRS wave does not appear on the window, close the window then

open it again.

NOTE

R point vertical cursor is ﬁxed.

3. To change the ISO point and ST point

i) Touch the ISO point vertical cursor and ST point vertical cursor to move

the vertical cursor left to right.

ii) Touch the or key to move the vertical cursor left or right to adjust

the setting. The cursor moves in 4 ms steps.

ISO point vertical cursor

ST point vertical cursor

4. To register the ST level measurement condition settings, touch the SET key.

The ST level is measured with the new measurement condition settings.

To refresh the QRS waves on the ST POINT window, touch the REFRESH

key.

User’s Guide Part II BSM-6000 1.39

1. ECG MONITORING

5. Press the [Home] key to return to the home screen.

When QRS DETECTION TYPE is set to ADULT

1. Display the ST POINT page of the ECG window.

Press the [Menu] key → ECG key → ST POINT tab.

2. Select the lead(s) by touching the lead key to be displayed on the ST POINT

page. The QRS wave(s) of the selected lead(s) appears on the window.

Lead keys

If the QRS wave does not appear on the window, close the window then

open it again.

NOTE

• R point vertical cursor is ﬁxed.

• When moves the J point vertical cursor, ST point vertical cursor also

moves.

3. To change ISO and J points

i) Touch the ISO point vertical cursor and J point vertical cursor to move

the vertical cursor left to right.

ii) Touch the or key to move the vertical cursor left or right to adjust

the setting. The cursor moves in 4 ms steps.

ISO point vertical cursor J point vertical cursor

1.40 User’s Guide Part II BSM-6000

1. ECG MONITORING

To change the ST point

i) Touch the ST POINT key to open the ST POINT dialog box.

ii) Touch the ST point vertical cursor to move the vertical cursor.

iii) Touch the or key to move the vertical cursor left or right. The

cursor moves in 4 ms steps.

iv) Touch the key to close the dialog box.

4. To register the ST level measurement condition settings, touch the SET key.

The ST level is measured with the new measurement condition settings.

Changing Pacing Settings

To refresh the QRS waves on the ST POINT window, touch the REFRESH

key.

5. Press the [Home] key to return to the home screen.

Turning Pacing Spike Detection On or Off

When the patient has an implanted cardiac pacemaker, the pacing pulse may be

counted as QRS and the heart rate may be miscounted. The pacing pulse is a

very small wave which cannot be displayed on the monitor. When pacing spike

detection is set to ON, the pacemaker spikes are rejected which allows correct

heart rate counting. When pacing mark is set to ON, the pacing mark is displayed

on the ECG. Refer to the “Displaying Pacing Mark” section.

The pacing spike detection is automatically turned on when <PACE MAKER>

on the ADMIT page of the ADMIT DISCHARGE window is set to YES.

When pacing spike detection is set to OFF, the non-paced mark

upper right of the screen.

appears in the

User’s Guide Part II BSM-6000 1.41

1. ECG MONITORING

WARNING

Turn the pacing pulse detection to ON when

monitoring a pacemaker patient. Otherwise the

pacemaker pulse is not rejected. However, even

when the pacing pulse detection is set to ON, the

pacemaker pulse might not be rejected. When the

pacemaker pulse is not rejected, the pacemaker

pulse is detected as QRS and false heart rate

may be indicated or critical arrhythmia such as

asystole may be overlooked. Keep pacemaker

patients under close observation.

* For the pacemaker pulse rejection capability of BSM-6000

series bedside monitor, refer to the “Specications - ECG”

in the operator’s manual.

When you monitor a premature baby or infant and the monitor miscounts

the narrow width QRS, set this to OFF.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

WARNING

Even when the pacing pulse detection is set to

ON, the pacemaker pulse can be overlooked or

detected as QRS. You cannot conﬁrm the

pacemaker operation only from the detected

pacemaker pulse.

NOTE

2. Touch the ON or OFF key under <DETECT> in the <PACING> box to

select on or off.

1.42 User’s Guide Part II BSM-6000

1. ECG MONITORING

Displaying Pacing Mark

When the <PACING DETECT> is set to ON, the pacing mark can be displayed

on the ECG waveform.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

Touch the ON or OFF key under <MARK> in the <PACING> box to select on

or off. When set to ON, the pacing mark is displayed on the ECG waveform.

3. Press the [Home] key to return to the home screen.

Changing the Number of Electrodes

Select the type and number of electrodes.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

2. Select the type and number of electrodes in the <NUMBER OF

ELECTRODES> box.

STANDARD: Any electrodes other than DIN type. The number of

INDIV 6: Monitoring with 3 or 6 DIN type electrodes.

INDIV 10: Monitoring with 10 DIN type electrodes. The RF/RL

3. Press the [Home] key to return to the home screen.

electrodes (3, 6 or 10) is automatically recognized by the

monitor.

electrode must be attached.

User’s Guide Part II BSM-6000 1.43

1. ECG MONITORING

Selecting Mode for Updating the Heart Rate

There are two calculation modes, “AVERAGE” and “INSTANT”.

AVERAGE: The heart rate is calculated by a moving average. The monitor

detects 12 consecutive beats including VPC, averages the R-R

intervals of the latest 12 beats and uses this average to calculate

the current heart rate. When a new beat is detected, the heart rate

is recalculated using the latest 12 beats. The heart rate display is

updated every 3 seconds.

INSTANT: The heart rate is calculated every beat. The heart rate display is

updated every 3 seconds.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

2. Select AVERAGE or INSTANT in the <HR DISPLAY MODE> box.

Selecting the Filter Type

3. Press the [Home] key to return to the home screen.

There are following types for ECG lter.

DIAG: No lter. This mode is best for viewing the details of the

waveform. It is similar to the real ECG. (0.05 to 150 Hz)

MONITOR: Low-cut and high-cut lter. (0.3 to 40 Hz)

MAXIMUM: Baseline drift-free, hum (AC) and high-cut lter. Appropriate when

there is noise from AC or ESU. (1 to 18 Hz)

NOTE

When performing deﬁbrillation, set the <FILTERS> to MONITOR or

MAXIMUM. The waveform recovery may become slow due to electrode

polarization when DIAG is set.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

1.44 User’s Guide Part II BSM-6000

1. ECG MONITORING

2. Select lter type from the <FILTERS> box.

3. Press the [Home] key to return to the home screen.

Turning the Hum Filter On or Off

The hum lter type is set on the SYSTEM SETUP window. Refer to Section 3 of

the Administrator’s Guide.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

2. Touch the ON or OFF key under <HUM FILTER> in the <FILTERS> box to

3. Press the [Home] key to return to the home screen.

Changing the Sync Sound Source

You can select ECG, SpO2 pulse (SpO2) or arterial blood pressure pulse (PRESS)

as the sync sound source. When the arterial blood pressure pulse is selected, the

blood pressure of the highest priority label is used. The sync source can also be

changed on the SpO2 and PRESS windows.

select on or off.

When pulse wave and pressure waveform are irregular because of an IABP,

select ECG.

NOTE

• When heart rate is unstable because of an ESU, select SpO

PRESS.

User’s Guide Part II BSM-6000 1.45

1. ECG MONITORING

• When the SpO2 connection cord is disconnected or the SpO2 probe is

detached and an alarm occurs, the sync source changes to ECG (HR).

The sync source returns to SpO2 when the SpO2 is measured again.

• The SpO2-2 cannot be set to the sync sound source.

When the sync source is set to ECG and ECG is not measured, there is no sync

sound.

When SpO2 or PRESS is selected, the pulse rate is displayed to the left of the

heart rate on the screen and the sync mark synchronizes with the pulse.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

2. Select the sync source in the <SYNC SOURCE> box.

ECG: QRS

PRESS: Pulse wave of the highest priority arterial blood pressure

SpO2: SpO2 pulse

To display the pulse rate to the left of the heart rate on the home screen,

select ON for <PR DISPLAY>. This setting is only available when <SYNC

SOURCE> is set to ECG.

3. Press the [Home] key to return to the home screen.

1.46 User’s Guide Part II BSM-6000

1. ECG MONITORING

Selecting Sync Sound Pitch

* The AY-661P and AY-663P input

unit and BSM-1763 bedside

monitor are not available in the

US.

The sync sound can be variable pitch or xed pitch pips. The xed pitch is high

pitch as the default, but medium or low pitch can also be set on the SYSTEM

SETUP window (see Section 3 of the Administrator’s Guide). When you select

variable pitch, the pitch of the sync sound changes according to SpO2 value or

systolic BP value of the arterial blood pressure so that you can recognize the

change on the patient from the pitch of the sync sound without looking at the

monitor. The sync pitch can also be changed on the SpO2 and PRESS windows.

When using an AY-661P*, AY-663P*, AY-671P or AY-673P input unit or

BSM-1700 series bedside monitor*, the sync sound pitch can be set to change

according to the SpO2 value of the second SpO2 (SpO2-2) when monitoring dual

SpO2.

When the sync sound source is set to SpO2 and the SpO2 value is below

81%SpO2, the low pitch is automatically selected.

When the sync sound source is set to SpO2 and the “CHECK PROBE” or

“DETECTING PULSE” message is displayed on the screen, the sync sound

stops.

When the sync sound source is set to ECG or PRESS, the sync pitch is set

to SpO2 and the SpO2 cannot be displayed on the screen, the low pitch is

automatically selected.

When the sync sound source is set to ECG or SpO2, the sync pitch is set

to PRESS and the IBP cannot be displayed on the screen, the low pitch is

automatically selected.

When the sync sound source is set to ECG or SpO2 and the IBP connection cord

is disconnected, the low pitch is automatically selected. After connecting the IBP

connection cord, adjust zero balance.

1. Display the OTHER page of the ECG window.

Press the [Menu] key → ECG key → OTHER tab.

2. Select the sync sound pitch from the <SYNC PITCH> box.

FIXED: The pitch is xed to the pitch selected on the SYSTEM

SETUP window.

PRESS: The pitch is high when the BP value is above 120 mmHg.

The pitch is low when the BP value is below 20 mmHg.

The pitch changes from high to low in 20 steps for each

5 mmHg change between 120 and 20 mmHg BP value.

The BP value of the highest priority arterial blood

pressure is used.

User’s Guide Part II BSM-6000 1.47

1. ECG MONITORING

SpO2 and SpO2-2: The pitch changes in 20 steps from high to low for each

1%SpO2 change in SpO2 value between 100%SpO2 and

81%SpO2.

When the SpO2 is selected, the pitch changes according

to the SpO2 value acquired from the SpO2 socket. When

the SpO2-2 is selected, the pitch changes according to the

second SpO2 (SpO2-2) value acquired from the MULTI

socket. (SpO2-2 is only available when using an AY-661P,

AY-663P, AY-671P or AY-673P input unit or BSM-1700

series bedside monitor.)

3. Press the [Home] key to return to the home screen.

1.48 User’s Guide Part II BSM-6000

1. ECG MONITORING

grounding for monitor

Bedside monitor

Power supply and grounding for ESU

Use with an Electrosurgical Unit

For use with an electrosurgical unit (ESU), this monitor has a circuit to

protect the patient from skin burn and to reduce ESU interference on the ECG

waveform. However, the effectiveness of this circuit depends on electrode

position and monitor setup. With an ESU, pay attention to the following points.

When the monitor is used with an electrosurgical unit (ESU), ﬁrmly

attach the entire area of the ESU return plate. Otherwise, the current

from the ESU ﬂows into the electrodes of the monitor, causing

electrical burn where the electrodes are attached. For details, refer to

the ESU manual.

When using the monitor with an ESU, locate the monitor and ESU

appropriately and ground instruments properly. Otherwise noise from

the ESU may interfere with the ECG and the heart rate and

arrhythmia analysis may be incorrect.

WARNING

CAUTION

• Arrangement

Install the monitor as far from the ESU as possible. If possible, locate them on

opposite sides of the operating table.

• Power supply

Noise from the ESU may interfere with the ECG signal through the AC power

line. Supply power to the monitor and ESU from different outlets located as far

from each other as possible. Do the equipotential grounding properly.

3 electrodes

Power supply and

ESU

Operating table

User’s Guide Part II BSM-6000 1.49

• Measure with 3-electrode lead

Use the minimum number of electrodes. Use new electrodes.

1. ECG MONITORING

Make small

As far as possible from electrode and as near as possible to incision.

• Minimize noise

1. Select an ECG lead where the active ECG electrodes are located as far

from the incision as possible.

2. Position the + and – electrodes as close as possible.

3. Select the leads where the angle (θ) between the active electrodes and the

incision is as small as possible.

4. Set the electrosurgical return plate as close to the incision as possible.

Return plate

Incision

• Set the following items on the OTHER page of the ECG window.

FILTERS: MAXIMUM

SYNC SOURCE: SpO2 or PRESS

• Monitor respiration by thermistor method or monitor CO

Noise is superimposed on the waveform and the respiration rate cannot be

monitored accurately in the impedance method. When monitoring respiration,

turn respiration monitoring off or monitor the respiration by thermistor method

or monitor CO2.

1.50 User’s Guide Part II BSM-6000

Section 2 Respiration Monitoring

General ................................................................................................................................................................ 2.2

Measurement Method ............................................................................................................................... 2.2

Impedance Method ......................................................................................................................... 2.2

Thermistor Method .......................................................................................................................... 2.2

Preparing for Respiration Monitoring in Impedance Method ...............................................................................2.3

Preparation Flowchart ............................................................................................................................... 2.3

Electrode Position and Waveform Examples ............................................................................................. 2.4

Electrode Position ...........................................................................................................................2.5

Amplitude ........................................................................................................................................ 2.5

Connecting Cables and Attaching Disposable Electrodes ........................................................................2.5

Preparing for Respiration Monitoring in Thermistor Method ................................................................................ 2.6

Preparation Flowchart ............................................................................................................................... 2.6

Respiration Pickups ................................................................................................................................... 2.6

Connecting the Cable to the Unit ..............................................................................................................2.7

Attaching the Respiration Pickup ..............................................................................................................2.7

When Using Respiration Pickup for Nose .......................................................................................2.7

When Using Respiration Pickup for Airway ..................................................................................... 2.7

Monitoring Respiration ......................................................................................................................................... 2.8

Respiration Information on the Home Screen ...........................................................................................2.9

Changing Respiration Settings .......................................................................................................................... 2.10

Changing the Monitoring Lead in Impedance Method............................................................................. 2.10

Changing the Respiration Sensitivity .......................................................................................................2.11

Turning Respiration Measurement On or Off in Impedance Method ....................................................... 2.12

Changing the Respiration Rate and Apnea Alarm Limits ........................................................................ 2.13

Changing the Respiration Waveform Sweep Speed................................................................................2.14

Displaying Impedance Method Respiration Rate as the Second Respiration Parameter ........................2.15

User’s Guide Part II BSM-6000 2.1

2. RESPIRATION MONITORING

General

Measurement Method

On this monitor, respiration can be measured by two methods: impedance

method and thermistor method. When respiration is measured by both the

impedance method and thermistor method, the values measured by the thermistor

method is used.

Impedance Method

In the impedance method, respiration is measured and monitored by attaching

the ECG electrodes to the patient and connecting them to the ECG/RESP socket.

This method measures changes in impedance between the R and F (RA and LL)

or R and L (RA and LA) ECG electrodes.

WARNING

The bioelectric impedance measurement sensor of a minute

ventilation rate-adaptive implantable pacemaker may be affected by

cardiac monitoring and diagnostic equipment which is connected

to the same patient. If this occurs, the pacemaker may pace at its

maximum rate and give incorrect data to the monitor or diagnostic

equipment. In this case, set the <IMPEDANCE MEASUREMENT>

on the RESP/CO2 window to OFF on the bedside monitor. For

a patient that requires the respiration monitoring, measure the

respiration by thermistor method.

Thermistor Method

In the thermistor method, respiration is measured and monitored by attaching the

respiration pickup to the patient or connecting it to the respiration circuit, and

connecting the respiration pickup to the MULTI socket.

This method measures and compares temperature changes caused by respiration

and inspiration using the respiration pickup.

Use this method when using an ESU or if measurement by the impedance

method is unavailable.

NOTE

The MULTI socket on the AY-660P input unit cannot be used for

monitoring respiration in thermistor method.

2.2 User’s Guide Part II BSM-6000

2. RESPIRATION MONITORING

Preparing for Respiration Monitoring in Impedance Method

Preparation Flowchart

The procedure is the same as for monitoring ECG.

1. Select the electrode lead.

2. Connect the electrode lead to the ECG connection cord and connect the ECG

connection cord to the ECG/RESP socket.

3. Attach the disposable electrodes to the patient and attach the electrode lead

to the electrodes. Attach R and F (RA and LL) or R and L (RA and LA) with

the lungs between the electrodes.

4. Monitoring starts. Set necessary settings.

User’s Guide Part II BSM-6000 2.3

2. RESPIRATION MONITORING

Electrode lead and position 162 cm 47 kg female

Electrode Position and Waveform Examples

Respiration can be measured by the impedance method when the R (RA) and F

(LL) or R (RA) and L (LA) electrodes are placed so that the lungs are between

the electrodes.

The optimum electrode positions for ECG monitoring of a patient are not always

optimum for respiration monitoring of the patient. Select the optimum positions

for both ECG and respiration measurements or measure respiration by the

thermistor method.

The amplitude of the respiration waveform differs according to the electrode

position. The following shows different examples of respiration waveforms

according to the electrode position when monitoring with the impedance method.

R/RA

L/LA

F/LL

Standard R-F/RA-LL

R/RA

R-L/RA-LA

R/RA

L/LA

F/LL

L/LA

153 cm 45 kg female

F/LL

R-F/RA-LL with higher F/LL position

2.4 User’s Guide Part II BSM-6000

Electrode Position

170 cm 60 kg male 179 cm 94 kg male

160 cm 50 kg male

2. RESPIRATION MONITORING

R or RA F or LL L or LA

Right infraclavicular fossa

Right infraclavicular fossa — Left infraclavicular fossa

Right infraclavicular fossa

Amplitude

Respiration measurement is inuenced by movement of the chest and abdomen. The

amplitude of the waveform changes greatly according to slight change of the F (LL)

electrode position. It also differs considerably between different patients.

Respiration measurement is inuenced by movement of the chest. Detects thoracic

respiration. There is a great difference in amplitude between different patients.

Respiration amplitude is large, and therefore, detection rate is good. The electrode

position is similar to lead II of the ECG. This position is highly recommended.

Lowest rib on the left anterior axillary line

Fifth intercostal space on the left midaxillary line

—

Connecting Cables and Attaching Disposable Electrodes

Connecting cables and attaching disposable electrodes are the same as for the

ECG monitoring. Refer to “Preparing for ECG Monitoring” in Section 1.

User’s Guide Part II BSM-6000 2.5

2. RESPIRATION MONITORING

Preparing for Respiration Monitoring in Thermistor Method

Preparation Flowchart

1. Select the respiration pickup.

2. Connect the respiration pickup to the MULTI socket.

3. Attach the respiration pickup to the respiration circuit.

4. Monitoring starts. Set necessary settings.

Respiration Pickups

CAUTION

Only use Nihon Kohden speciﬁed electrodes, probes, transducers,

thermistors and catheters. Otherwise, the maximum performance

from the monitor cannot be guaranteed.

Respiration pickup for nose TR-900P*

For measuring at nostrils.

* This part has not been checked for compliance with the MDD (Medical Device

Directive). For EC member countries, Nihon Kohden recommends the use of

parts that comply with MDD.

Respiration pickup for airway TR-910P Airway adapter YG-001P

For measuring with trachea intubation. Use with the TR-910P respiration pickup.

2.6 User’s Guide Part II BSM-6000

Connecting the Cable to the Unit

Connect the respiration pickup to the MULTI socket.

Attaching the Respiration Pickup

When Using Respiration Pickup for Nose

1. Place the tip of the respiration pickup at the front of the nostril.

2. RESPIRATION MONITORING

When connecting the TR-900P respiration pickup for nose

Airway adapter

Respiration pickup

2. Secure the lead wire and respiration pickup rmly to the cheek with surgical

tape.

When Using Respiration Pickup for Airway

1. Firmly insert the tip of the respiration pickup for airway into the small hole

on the airway adapter.

2. Connect the airway adapter to the airway tube (between the mouth and

Y-shaped tube).

User’s Guide Part II BSM-6000 2.7

2. RESPIRATION MONITORING

Monitoring Respiration

When preparation is done properly, the respiration waveform appears on the

screen.

NOTE

Increase in the temperature of the inspired air during monitoring in

thermistor method causes decrease in the temperature difference

between inspiration and expiration, and the amplitude of the respiration

waveform becomes small. When the inspiration temperature increases

higher than the expiration temperature, the phases of expiration and

inspiration may be reversed.

In impedance method, the respiration data do not appear on the screen when

respiration monitoring in impedance method is set to OFF (the “RESP OFF”

message appears). When using an ESU, noise is superimposed on the waveform

and the respiration measurement cannot be monitored accurately. When

respiration monitoring is necessary, use the thermistor method or monitor CO2.

NOTE

• The respiration rate can only be detected from one parameter. When

, respiration and anesthetic gas are monitored at the same time, the

respiration rate is detected in the following priority.

Gas > FLOW > CO2 > thermistor respiration > impedance respiration

• When ON is selected at <DISPLAY IMP-RR AS SECOND

PARAMETER> on the OTHER page of the RESP/CO2 window,

the respiration rate is detected from two parameters. Refer to the

“Displaying Impedance Method Respiration Rate as the Second

Respiration Parameter” section.

2.8 User’s Guide Part II BSM-6000

Respiration Information on the Home Screen

In impedance method

2. RESPIRATION MONITORING

Respiration sync mark

Respiration rate

In thermistor method

Scale of respiration rate trendgraph

Respiration rate trendgraph

Compressed respiration waveform

Sensitivity

Respiration waveform

Sensitivity

Respiration rate

Respiration waveform

User’s Guide Part II BSM-6000 2.9

2. RESPIRATION MONITORING

Changing Respiration Settings

Change settings on the RESP/CO2 window. The following settings can be

changed for respiration monitoring.

For impedance method

• Changing monitoring lead

• Turning respiration monitoring on or off

• Displaying respiration rate as the second parameter

• Respiration sensitivity

• Respiration rate and apnea alarm limits

• Respiration waveform sweep speed

For thermistor method

• Respiration sensitivity

• Respiration rate and apnea alarm limits

• Respiration waveform sweep speed

The noise reduction for impedance respiration monitoring can be turned on or

off and the respiration data display color can be set on the SYSTEM SETUP

window. Refer to Section 3 of the Administrator’s Guide.

The scale of the respiration rate trendgraph on the home screen is the same scale

as the trendgraph of the Review window. Refer to the Operator’s Manual or

Section 6 of the User’s Guide Part I.

If the APNEA alarm occurs and no action is taken for a selected duration, the

alarm level can be escalated. Refer to Section 3 of the Administrator’s Guide.

Changing the Monitoring Lead in Impedance Method

The lead which can be monitored in the impedance method is R-F (RA-LL) or

R-L (RA-LA). The selected lead appears on both the home screen and RESP/CO2

window.

1. Display the MAIN page of the RESP/CO2 window.

Press the [Menu] key → RESP/CO2 key → MAIN tab.

2.10 User’s Guide Part II BSM-6000

Respiration waveform

2. RESPIRATION MONITORING

2. Select the lead in the <IMPEDANCE RESP LEAD> box. Select the lead

with the larger respiration amplitude and smaller heart beat.

3. Press the [Home] key to return to the home screen.

Changing the Respiration Sensitivity

The sensitivity determines the size of the waveform on both the screen and

recording paper.

The respiration waveform amplitude differs according to the sensitivity and the

NOISE REDUCTION ON IMPEDANCE RESP setting on the SYSTEM SETUP

window. The following amplitudes for the respiration rate can be counted. Refer

to Section 3 of the Administrator’s Guide for the NOISE REDUCTION ON

IMPEDANCE RESP setting.

NOISE REDUCTION ON

IMPEDANCE RESP Setting

Sensitivity

× 1/4

× 1/2

× 1

× 2

Countable Amplitudes

for the Respiration Rate

Larger than 0.375 mm

Larger than 0.75 mm

Larger than 1.5 mm

Larger than 3 mm

× 4

Larger than 6 mm

OFF All sensitivities Larger than 10 mm

In thermistor method, countable amplitudes for the respiration rate is the same as

when the NOISE REDUCTION ON IMPEDANCE RESP setting is set to ON.

1. Display the MAIN page of the RESP/CO

window.

Press the [Menu] key → RESP/CO2 key → MAIN tab.

User’s Guide Part II BSM-6000 2.11

2. RESPIRATION MONITORING

2. Select the appropriate sensitivity from ×1/4, ×1/2, ×1, ×2 and ×4 in the

<SENSITIVITY> box.

3. Press the [Home] key to return to the home screen.

Turning Respiration Measurement On or Off in Impedance Method

Even when respiration measurement is set up, you can turn respiration

measurement off if you do not need it. When respiration is turned off, respiration

waveform does not appear and the “RESP OFF” message appears on the home

screen. When respiration is not available, no respiration data appears.

When monitoring respiration in thermistor method and not in impedance method,

turn this setting to OFF.

NOTE

When using an ESU, noise is superimposed on the waveform and

the respiration measurement cannot be monitored accurately. When

respiration monitoring is necessary, use the thermistor method or monitor

CO2.

1. Display the OTHER page of the RESP/CO2 window.

Press the [Menu] key → RESP/CO2 key → OTHER tab.

2. Select ON or OFF in the <IMPEDANCE MEASUREMENT> box to turn

impedance measurement on or off.

3. Press the [Home] key to return to the home screen.

2.12 User’s Guide Part II BSM-6000

Changing the Respiration Rate and Apnea Alarm Limits

2. RESPIRATION MONITORING

CAUTION

When the alarm limit is set to OFF, there will be no alarm for that

limit. Be careful when you set the alarm limit to OFF.

You can set the upper and lower respiration rate and apnea alarm limits on

the RESP/CO2 window. You can set all alarms, including the upper and lower

respiration rate and apnea alarm limits, on the ALARM LIMITS window (See

the Operator’s Manual or Section 5 of the User’s Guide Part I). You can also set

the upper and lower respiration rate and apnea alarm limits on the CO2, GAS and

FLOW/Paw windows. (FLOW/Paw window is not available for BSM-6000A

series.)

Setting Range

Respiration rate upper limit: 2 to 150 counts/min in 2 counts/min steps, OFF

(default setting: OFF)*1*

Respiration rate lower limit: OFF, 0 to 148 counts/min in 2 counts/min steps

(default setting: OFF)*1*

Apnea upper limit: 5 to 40 s in 5 s steps, OFF (default setting: 20)*1*

On BSM-6000A series, if <CRISIS VITAL ALARM MANAGEMENT> on the SYSTEM

CONFIGURATION screen is turned on and “ALARM PRIORITY” on the SYSTEM SETUP

window is set to CRISIS, the alarm setting is set to the alarm master setting.

On BSM-6000A series, if <ALARM CAP> on the SYSTEM CONFIGURATION screen is

turned on, the alarm setting is affected by the “ALARM CAP” setting on the SYSTEM SETUP

window.

1. Display the MAIN page of the RESP/CO2 window.

Press the [Menu] key → RESP/CO2 key → MAIN tab.

2. Touch the RR key to change the respiration rate alarm setting.

Touch the APNEA key to change the apnea alarm setting.

Current value of the selected parameter

Upper limit slider

Upper limit

Setting bar

Lower limit

Lower limit slider

Selected parameter

Current value of the selected parameter

User’s Guide Part II BSM-6000 2.13

2. RESPIRATION MONITORING

3. Touch and drag the sliders to the desired level on the setting bar. Use the

or key to adjust the setting.

If the upper limit is set to a value above the maximum, the upper limit alarm

is set to OFF. If the lower limit is set to a value below the minimum, the

lower limit alarm is set to OFF.

4. Press the [Home] key to return to the home screen.

Changing the Respiration Waveform Sweep Speed

The respiration waveform sweep speed on the screen can be selected. This

setting can also be changed on the WAVES page of the DISPLAY window.

1. Display the OTHER page of the RESP/CO2 window.

Press the [Menu] key → RESP/CO2 key → OTHER tab.

2. Select the sweep speed from the <RESP/CO2 SWEEP SPEED> box.

3. Press the [Home] key to return to the home screen.

2.14 User’s Guide Part II BSM-6000

2. RESPIRATION MONITORING

Displaying Impedance Method Respiration Rate as the Second Respiration Parameter

Respiration rate by impedance method can be displayed as a second respiration

rate parameter together with the rst respiration rate parameter. The method of

the rst respiration rate parameter is displayed in the following priority.

Gas > FLOW > CO2 > thermistor respiration

Turn this setting on when displaying two measured values of respiration rate.

1. Display the OTHER page of the RESP/CO2 window.

Press the [Menu] key → RESP/CO2 key → OTHER tab.

2. Select ON or OFF from the <DISPLAY IMP-RR AS SECOND

PARAMETER> box.

ON: Respiration rate by impedance method is displayed on the home

screen.

OFF: Respiration rate by impedance method is not displayed. Only the rst

respiration rate parameter is displayed on the home screen.

Display example for ON Display example for OFF

First RR parameter only

First RR parameter

RR by impedance method

3. Press the [Home] key to return to the home screen.

User’s Guide Part II BSM-6000 2.15

Section 3 CO2 Monitoring

General ................................................................................................................................................................ 3.2

Mainstream Method ................................................................................................................................... 3.2

Sidestream Method ................................................................................................................................... 3.3

Measurement Error with the TG-900P or TG-920P CO2 Sensor Kit .......................................................... 3.3

Use with Volatile Anesthetic Agents .......................................................................................................... 3.5

Preparing for CO2 Monitoring .............................................................................................................................. 3.6

Preparation Flowchart ............................................................................................................................... 3.6

Mainstream Method ........................................................................................................................ 3.6

Sidestream Method ......................................................................................................................... 3.6

Types of CO2 Sensor Kits for Mainstream Method ....................................................................................3.7

TG-900P CO2 Sensor Kit ................................................................................................................ 3.8

TG-920P CO2 Sensor Kit ................................................................................................................ 3.9

TG-950P CO2 Sensor Kit .............................................................................................................. 3.10

TG-970P and TG-980P CO2 Sensor Kits ...................................................................................... 3.11

Connecting the CO2 Sensor Kit to the Unit .............................................................................................. 3.12

Connecting the CO2 Sensor Kit to the Respiration Circuit .......................................................................3.12

Performing Zero Calibration when Using a TG-950P, TG-970P or TG-980P CO2 Sensor Kit .................. 3.12

Calibrating by Air ........................................................................................................................... 3.13

Calibrating with N2 Gas ................................................................................................................. 3.14

Monitoring CO2 .................................................................................................................................................. 3.15

CO2 Information on the Home Screen ..................................................................................................... 3.16

Changing CO2 Settings ...................................................................................................................................... 3.18

Changing the Scale ................................................................................................................................. 3.18

Changing the CO2, Respiration Rate and Apnea Alarm Limits ............................................................... 3.19

Setting the Inspiration Composition .........................................................................................................3.20

Changing the CO2 Waveform Sweep Speed ........................................................................................... 3.21

Changing Duration for Holding ETCO2 Maximum Value ..........................................................................3.22

Inspection of Measuring Accuracy ..................................................................................................................... 3.24

Daily Inspection of Measuring Accuracy ................................................................................................. 3.24

Inspection of Measuring Accuracy (Precise Method) .............................................................................. 3.24

User’s Guide Part II BSM-6000 3.1

3. CO2 MONITORING

General

On this monitor, CO2 can be measured by either mainstream method or

sidestream method.

To monitor CO2 by the mainstream method, connect the TG-900P, TG-920P,

TG-950P, TG-970P or TG-980P CO2 sensor kit to the patient’s respiration circuit

or directly to the patient and connect the CO2 sensor kit to the MULTI socket or

PRESS CO2 socket.

NOTE

The TG-950P CO2 sensor kit is not available for BSM-6000A series.

To monitor CO2 by the sidestream method, the optional AG-400R CO2 unit,

Oridion portable bedside monitor Microcap® or Covidien Microstream

Micropod™ capnography module is required.

Mainstream Method

To use the AG-400R CO2 unit, the QF-905P interface is required. For details on

the sidestream method, refer to the AG-400R CO2 unit operator’s manual.

To connect the Microcap® monitor, the QF-921P interface is required. Microcap

is a registered trademark of Oridion Medical Ltd.

To connect the Micropod™ capnography module, the QF-801P interface is

required. Micropod™ is a trademark of Covidien.

NOTE

• The AG-400R CO2 unit is not available for BSM-6000A series.

• Oridion Microcap® portable bedside monitor is not available for

BSM-6000K series.

In the mainstream method, the sensor is located directly in the respiration circuit.

There are two types of sensors for different calculation methods.

Semi-quantitative method using the TG-900P or TG-920P CO2 sensor kit

Measurements are based on the assumption of no CO2 gas in the inspiration.

The CO2 concentration in the respiration is calculated by taking the CO2

concentration in the inspiration as 0 mmHg (0 kPa).

Quantitative method using the TG-950P, TG-970P or TG-980P CO2 sensor

kit

The CO2 partial pressure in both inspiration and expiration is measured.

3.2 User’s Guide Part II BSM-6000

3. CO2 MONITORING

The mainstream CO2 measurement method has the following merits and limits

compared to the sidestream method. Understand these points when performing

measurements.

Sidestream Method

Merits

• No delay in the measurement time.

• Measurement is stable over a long period of time.

• Few measurement troubles due to mixture of water droplets.

Limits

• TG-900P, TG-950P, TG-970P or TG-980P CO2 sensor kit cannot be used on

non-intubated patients.

• Due to the weight of the TG-900P, TG-950P, TG-970P or TG-980P CO2 sensor

kit, load is easily imposed on the tracheal tube.

• The dead space volume is relatively large.

A small portion of the breath is continuously sampled from the respiratory circuit

or directly from the patient’s nostril. CO2 molecules in the breath sample absorb

infrared light at 4.3 µm. The absorption is proportional to the concentration

of the CO2 and the concentration can be determined by comparing the level of

absorption to that of a known standard.

The sidestream CO2 measurement method has the following merits and limits

compared to the mainstream method. Understand these points when performing

measurements.

NOTE

• The AG-400R CO2 unit is not available for BSM-6000A series.

• Oridion Microcap® portable bedside monitor is not available for

BSM-6000K series.

Merits

• CO2 sensor adapter can be used on non-intubated patients.

• Lightweight adapter reduces risk of extubations.

Limits

• Delay in the measurement time.

• Sometimes CO2 waveform is distorted.

• Longtermmeasurementisdifcultduetomixtureofwaterdropletsand

secretions in the tube.

Measurement Error with the TG-900P or TG-920P CO2 Sensor Kit

With the TG-900P or TG-920P CO2 sensor kit, measurements are based on the

assumption that the inspiration contains no CO2 gas. If CO2 gas mixes in the

inspiration, measured values will be lower than normal.

User’s Guide Part II BSM-6000 3.3

3. CO2 MONITORING

40 mmHg

5.3 kPa

When CO2 is mixed in inspiration

Measured value becomes lower

8 mmHg (1.1 kPa)

Error

(

mmHg

)

Measurement Error when CO2 is Mixed in the Inspired Air

(10.7 kPa)

CAUTION

Supply adequate oxygen when measuring CO2 partial pressure of

a patient connected to a Jackson Rees, Mapleson D or any other

respiration circuit where CO2 gas may be present during inspiration.

The semi-quantitative method measures CO2 partial pressure based

on the assumption of no CO2 gas in the inspired air; it assumes

CO2 partial pressure 0 mmHg (0 kPa) in the inspiration of every

respiration. If the inspired air contains CO2 gas, the measured CO2

value may be lower than the actual value.

CAUTION

When measuring CO2 partial pressure of a patient with an oxygen

mask, set the oxygen supply to 5 L/min or more. If CO2 gas remains

in the oxygen mask and mixes with the inspired air, the measured

value may be lower than the actual value.

Actual CO2 waveform

0 10 20 30 40 50 60 70 80

(1.3 kPa)

(0.7 kPa)

( 0.7 kPa)

( 1.3 kPa)

( 2.0 kPa)

( 2.7 kPa)

( 3.3 kPa)

(1.3 kPa) (2.7 kPa) (4.0 kPa) (5.3 kPa) (6.7 kPa) (8.0 kPa) (9.3 kPa)

CO2 mixed in inspiration

CO2 mixed in inspired air

40 mmHg

5.3 kPa

ETCO

(

1 mmHg (0.1 kPa)

2 mmHg (0.3 kPa)

4 mmHg (0.5 kPa)

CO2 waveform on the monitor

)

mmHg

3.4 User’s Guide Part II BSM-6000

The TG-900P and TG-920P CO2 sensor kits do not adjust the

measurement value to compensate for different atmospheric

pressure. Be careful when reading the value when using the CO2

sensor kit at high altitudes because the measurement value may be

inaccurate.

The measurement value drops 0.13 kPa (1 mmHg) for 5.33 kPa (40 mmHg) CO2

gas when an atmospheric pressure drops 3.3 kPa.

Use with Volatile Anesthetic Agents

When using an anesthetic instrument with a volatile anesthetic

agent, the CO2 measurement may be inaccurate.

3. CO2 MONITORING

CAUTION

Volatile anesthetic agents affect the CO2 value. Be aware of this when using

volatile anesthetic agent.

Example: At 1 atmospheric pressure and gas mixtures of 5% CO2 (5.1 kPa

(38 mmHg)) and balance N2, dry gas

Anesthetic Gas Concentration

Halothane 4%

Enurane 5%

Isourane 5%

Sevourane 6%

24%

Desurane

15%

Difference

TG-900P TG-920P TG-950P

+0.9 mmHg +0.12 kPa

+1.5 mmHg +0.20 kPa

+1.8 mmHg +0.24 kPa

+2.8 mmHg +0.37 kPa

+7.0 mmHg +0.93 kPa

+6.6 mmHg +0.88 kPa

+0.6 mmHg +0.08 kPa

+1.5 mmHg +0.20 kPa

+1.7 mmHg +0.23 kPa

+2.7 mmHg +0.36 kPa

+6.6 mmHg +0.88 kPa

+5.4 mmHg +0.72 kPa

+0.2 mmHg +0.03 kPa

+0.4 mmHg +0.05 kPa

+0.8 mmHg +0.11 kPa

+1.3 mmHg +0.17 kPa

+3.2 mmHg +0.43 kPa

—

TG-970P,

TG-980P

+0.3 mmHg +0.04 kPa

+0.9 mmHg +0.12 kPa

+1.7 mmHg +0.22 kPa

+2.1 mmHg +0.28 kPa

—

+2.9 mmHg +0.39 kPa

User’s Guide Part II BSM-6000 3.5

3. CO2 MONITORING

Preparing for CO2 Monitoring

• Only one MULTI socket can be used for monitoring CO2. The

sidestream and mainstream methods cannot be monitored at the same

time.

• When the AG-920R, GF-110PA or GF-210R multigas unit or GF-120PA

or GF-220R multigas/ﬂow unit is connected to the monitor, turn off

the AG-920R multigas unit power or disconnect the multi-link cable

of the GF-110PA or GF-210R multigas unit or GF-120PA or GF-220R

multigas/ﬂow unit from the monitor while monitoring CO2 by mainstream

method. The CO2 alarm from mainstream method cannot be indicated

when the multigas unit or multigas/ﬂow unit is turned on. (GF-120PA or

GF-220R multigas/ﬂow unit is not available for BSM-6000A series.)

• When using N2O anesthetic gas (nitrous oxide), set the gas composition

on the GAS COMP window. Refer to the “Setting the Inspiration

Composition” section.

NOTE

Preparation Flowchart

Mainstream Method

1. Select the CO

sensor kit and airway adapter/nasal adapter.

2. Connect the CO2 sensor kit to the MULTI socket.

3. When using a TG-950P, TG-970P or TG-980P CO2 sensor kit, perform zero

calibration (TG-950P CO2 sensor kit is not available for BSM-6000A series).

4. Connect the CO2 sensor to the respiration circuit or attach the CO2 sensor to

the patient.

5. Start measurements and change necessary settings.

Sidestream Method

Using AG-400R CO

Unit

NOTE

The AG-400R CO

unit is not available for BSM-6000A series.

1. Prepare the CO2 unit and connect the unit to the monitor with the QF-905P

interface. Refer to the Administrator’s Guide and QF-905P interface

operator’s manual.

2. Connect the patient and CO2 unit with required sensor. Refer to the

AG-400R CO2 unit operator’s manual.

3. Start measurement and change necessary settings.

For details on the sidestream method, refer to the AG-400R CO

unit manual.

3.6 User’s Guide Part II BSM-6000

Using Oridion Portable Bedside Monitor Microcap® or Covidien

Microstream

Oridion Microcap

BSM-6000K series.

1. Set up the external instrument and connect it to the BSM-6000A series

bedside monitor. Refer to the interface operator’s manual.

2. Connect the external instrument to the patient. Refer to the external

instrument manual.

3. Start measurement and change necessary settings.

Micropod™ Capnography Module

portable bedside monitor is not available for

Types of CO2 Sensor Kits for Mainstream Method

TherearevetypesofCO2 sensor kit for CO2 mainstream monitoring.

Model Method Attachment

TG-900P Semi-quantitative Used on an intubated patient

TG-920P Semi-quantitative

TG-950P Quantitative Used on an intubated patient

TG-970P,

TG-980P

Quantitative

3. CO2 MONITORING

NOTE

Attach to the patient nose or used on an intubated patient

Used on an intubated patient with YG-211T/213T/214T Used on a non-intubated patient with YG-232T/242T/272T/282T

WARNING

When using the airway adapter or nasal adapter

on a patient with low ventilatory volume, the

CO2 may mix in the inspiration due to the airway

adapter’s dead space, resulting in inaccurate

measured values or difﬁculty in detecting apnea.

Perform ventilation taking into consideration the

dead space of the adapters.

CAUTION

The CO2 data may be inaccurate when

monitoring a patient with an extremely high

respiration rate or irregular respiration. Read the

measured values carefully.

CAUTION

When using an anesthetic instrument with a

volatile anesthetic agent, the CO2 measurement

may be inaccurate.

CAUTION

When monitoring CO2, make sure that the

gas composition is entered. Otherwise the

measurement result may be inaccurate.

CAUTION

Select the airway adapter or nasal adapter

taking into consideration the patient weight and

ventilation volume. If an inappropriate airway

adapter or nasal adapter is used, the resistance

in the respiration circuit increases and it causes

incorrect measurement value.

User’s Guide Part II BSM-6000 3.7

3. CO2 MONITORING

Connection example

For intubated patients For non-intubated patients

The measurement may be inaccurate when monitored in the following

conditions. Read the measured values carefully.

• When used in environments with high concentration nitrous oxide gas.

• When used in environments with sudden temperature changes.

• When used in environments with severe humidity.

TG-900P/TG-950P/TG-970P/TG-980P

NOTE

TG-920P

YG-121T nasal adapter

Straight type tracheal tube

TG-920P

YG-111T airway adapter

• For intubated patients, connect the CO2 sensor as in the following

example so that the sensor does not touch the patient.

• The TG-950P CO2 sensor kit is not available for BSM-6000A series.

TG-900P CO2 Sensor Kit

The TG-900P CO

an intubated patient by the semi-quantitative method. It consists of a TG-101T

CO2 sensor and JG-900P CO2 adapter. It requires a YG-101T airway adapter for

monitoring CO2.

Elbow type tracheal tube

TG-970P/TG-980P

YG-232T/242T cap-ONE mask

NOTE

sensor kit measures the partial pressure of the expired CO2 of

TG-101T CO2 sensor

JG-900P CO

adapter

YG-101T airway adapter

Model Weight Dead Space Volume Supply Code

YG-101T 10 kg or more 5 cc R801

3.8 User’s Guide Part II BSM-6000

(for nasal breathing)

Nasal tube

Clip

Mouth guide

(for naso-oral)

oxygen cannula

Mouth guide

TG-121T CO2 sensor

3. CO2 MONITORING

TG-920P CO2 Sensor Kit

The TG-920P CO

sensor kit measures the partial pressure of the expired CO2

of a patient by the semi-quantitative method. This CO2 sensor kit can be used on

both intubated and not intubated patients. It consists of a TG-121T CO2 sensor

and JG-920P CO2 adapter. It requires a YG-120T, YG-121T or YG-122T nasal

adapter when attached on a patient who is not intubated or YG-111T airway

adapter when attached on an intubated patient for monitoring CO2.

JG-920P CO

adapter

Type of Adapter Model Weight

Airway adapter YG-111T 7 kg or more 4 mL R804

Nasal adapter

WARNING

The only oxygen cannula that can be used with

YG-122T is manufactured by HUDSON RCI®. Do

not use any other oxygen cannula. Other oxygen

cannulas cannot be attached and oxygen cannot

be delivered to the patient through the nostrils.

WARNING

Check that the oxygen cannula tube is not bent,

broken, or blocked by the nasal tube. If the ends

of the oxygen cannula tube turn too far up or

down, it causes insufﬁcient O2 supply or the CO2

value may be incorrect.

Dead Space

Volume

YG-120T

YG-121T V922

10 kg or more 1.2 mL

Supply

Code

V921

YG-122T V923

WARNING

• When you use YG-122T together with an

oxygen cannula, check that the oxygen cannula

is correctly attached on the patient by referring

to other parameters and by observing the

patient periodically.

• If arterial oxygen saturation does not increase,

immediately stop using the oxygen cannula

with the CO2 sensor kit and select another way

to supply oxygen.

User’s Guide Part II BSM-6000 3.9

CAUTION

When using the YG-121T/YG-122T nasal adapter

on a patient with bleeding disorder, poor general

medical condition or malnutrition, observe the

patient condition all the time. The mouth guide

touches the mouth and may cause pressure

sores.

YG-111T airway adapter

YG-120T

YG-121T

YG-122T

(for oxygen cannula)

Holder for

3. CO2 MONITORING

When Using an Oxygen Cannula

As the graphs show, the expired volume is decreased at the end of expiration.

If too much oxygen is supplied or oxygen is directly delivered to the nose, the

oxygenowaffectstheexpiredgasow.Therefore,theactualCO2 waveform

will be inaccurate (the solid line in the graph) compared with the typical pattern

(the dashed line).

TG-950P CO2 Sensor Kit

With the TG-950P, TG-970P or TG-980P CO2 sensor kit, measured

value may be incorrect when the operating temperature changes

greatly. In this case, wait for about 30 minutes to acquire correct

measurement.

The TG-950P CO2 sensor kit measures the partial pressure of the expired CO2

of an intubated patient by the quantitative method. It consists of a TG-201T CO2

sensor and JG-950P CO2 adapter. It requires a YG-201T or YG-202T airway

adapter for monitoring CO2.

TG-950P CO2 sensor kit and YG-201T and YG-202T airway adapters are

not available for BSM-6000A series.

TG-201T CO2 sensor

CAUTION

NOTE

JG-950P CO2 adapter

Model Patient Weight

YG-201T/YG-202T airway adapter

Dead Space

Volume

Supply

Code

YG-201T Adult/child 10 kg or more 5 mL R802

YG-202T Child/neonate 3 to 10 kg 2 mL R803

3.10 User’s Guide Part II BSM-6000

3. CO2 MONITORING

TG-970P and TG-980P CO2 Sensor Kits

CAUTION

With the TG-950P, TG-970P or TG-980P CO2 sensor kit, measured

value may be incorrect when the operating temperature changes

greatly. In this case, wait for about 30 minutes to acquire correct

measurement.

The TG-970P and TG-980P CO2 sensor kits measure the partial pressure of the

expired CO2 of an intubated patient by the quantitative method. The CO2 sensor

kits require an airway adapter or cap-ONE mask for monitoring CO2.

The TG-970P CO

sensor kit consists of a TG-221T CO2 sensor and JG-970P

CO2 adapter.

TG-970P CO

TG-221T CO2 sensor

YG-211T airway adapter YG-213T airway adapter

YG-232T pediatric cap-ONE mask YG-242T infant cap-ONE mask

sensor kit

JG-970P CO

adapter

TG-980P CO2 sensor kit

YG-214T airway adapter

YG-272T adult cap-ONE mask YG-282T adult cap-ONE mask (large)

Model Patient Weight

Dead Space

Volume

Supply

Code

YG-211T Adult/child 7 kg or more 4 mL R805

YG-213T Child/neonate 2 to 7 kg 0.5 mL R806

YG-214T Child/neonate 2.5 to 7 kg 1.8 mL R807

YG-232T Child 20 to 40 kg 3.5 mL V933

YG-242T Infant 7 to 20 kg 2.5 mL V935

YG-272T Adult 30 kg or more 7 mL V938A

YG-282T Adult (large) 40 kg or more 10 mL V938C

User’s Guide Part II BSM-6000 3.11

3. CO2 MONITORING

Connecting the CO2 Sensor Kit to the Unit

Connect the CO2 sensor kit to the MULTI or PRESS CO2 socket. Only one

MULTI or PRESS CO2 socket can be used for monitoring CO2.

• Only one MULTI socket or PRESS CO2 socket can be used for

monitoring CO2. The sidestream and mainstream methods cannot be

monitored at the same time.