Nihon Kohden ZM 540PA, ZM 541PA Users manual

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Transmitter

ZM-540PA/ZM-541PA

0614-902754

Copyright Notice

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.

GENERAL HANDLING PRECAUTIONS

This device is intended for use only by qualiﬁed medical personnel.

Use only Nihon Kohden approved products with this device. Use of non-approved

products or in a non-approved manner may affect the performance speciﬁcations

of the device. This includes, but is not limited to, batteries, recording paper, pens,

extension cables, electrode leads, input boxes and AC power.

Please read these precautions thoroughly before attempting to operate the instrument.

1. To safely and effectively use the instrument, its operation must be fully understood.

2. When installing or storing the instrument, take the following precautions:

(1) Avoid moisture or contact with water, extreme atmospheric pressure, excessive humidity and

temperatures, poorly ventilated areas, and dust, saline or sulphuric air.

(2) Place the instrument on an even, level ﬂoor. Avoid vibration and mechanical shock, even

during transport. (3) Avoid placing in an area where chemicals are stored or where there is danger of gas leakage. (4) The power line source to be applied to the instrument must correspond in frequency and

voltage to product speciﬁcations, and have sufﬁcient current capacity. (5) Choose a room where a proper grounding facility is available.

3. Before Operation

(1) Check that the instrument is in perfect operating order. (2) Check that the instrument is grounded properly. (3) Check that all cords are connected properly. (4) Pay extra attention when the instrument is in combination with other instruments to avoid

misdiagnosis or other problems. (5) All circuitry used for direct patient connection must be doubly checked. (6) Check that battery level is acceptable and battery condition is good when using

batteryoperated models.

4. During Operation

(1) Both the instrument and the patient must receive continual, careful attention. (2) Turn power off or remove electrodes and/or transducers when necessary to assure the

patient’s safety. (3) Avoid direct contact between the instrument housing and the patient.

5. To Shutdown After Use

(1) Turn power off with all controls returned to their original positions. (2) Remove the cords gently; do not use force to remove them. (3) Clean the instrument together with all accessories for their next use.

Operator’s Manual ZM-540PA/541PA i

6. The instrument must receive expert, professional attention for maintenance and repairs. When the instrument is not functioning properly, it should be clearly marked to avoid operation while it is out of order.

7. The instrument must not be altered or modiﬁed in any way.

8. Maintenance and Inspection

(1) The instrument and parts must undergo regular maintenance inspection at least every 6

months.

(2) If stored for extended periods without being used, make sure prior to operation that the

instrument is in perfect operating condition.

(3) Technical information such as parts list, descriptions, calibration instructions or other

information is available for qualiﬁed user technical personnel upon request from your Nihon Kohden representative.

9. When the instrument is used with an electrosurgical instrument, pay careful attention to the application and/or location of electrodes and/or transducers to avoid possible burn to the patient.

10. When the instrument is used with a deﬁbrillator, make sure that the instrument is protected against deﬁbrillator discharge. If not, remove patient cables and/or transducers from the instrument to avoid possible damage.

ii Operator’s Manual ZM-540PA/541PA

WARRANTY POLICY

Nihon Kohden Corporation (NKC) shall warrant its products against all defects in materials and workmanship for one year from the date of delivery. However, consumable materials such as recording paper, ink, stylus and battery are excluded from the warranty.

NKC or its authorized agents will repair or replace any products which prove to be defective during the warranty period, provided these products are used as prescribed by the operating instructions given in the operator’s and service manuals.

No other party is authorized to make any warranty or assume liability for NKC’s products. NKC will not recognize any other warranty, either implied or in writing. In addition, service, technical modiﬁcation or any other product change performed by someone other than NKC or its authorized agents without prior consent of NKC may be cause for voiding this warranty.

Defective products or parts must be returned to NKC or its authorized agents, along with an explanation of the failure. Shipping costs must be pre-paid.

This warranty does not apply to products that have been modiﬁed, disassembled, reinstalled or repaired without Nihon Kohden approval or which have been subjected to neglect or accident, damage due to accident, ﬁre, lightning, vandalism, water or other casualty, improper installation or application, or on which the original identiﬁcation marks have been removed.

In the USA and Canada other warranty policies may apply.

CAUTION

United States law restricts this product to sale by or on the order of a physician.

Operator’s Manual ZM-540PA/541PA iii

Equipment Authorization Requirement

This device complies with Part 15 of the FCC (Federal Communications Commission) Rules. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause

undesired operation.

This device complies with Part 95 Subpart H of the FCC Rules to be used in wireless medical telemetry service.

Operation of this equipment requires the prior coordination with a frequency coordinator designated by FCC for the Wireless Medical Telemetry Service.

CAUTION

To comply with the FCC radio frequency (RF) exposure compliance requirements, no change to the antenna or the device is permitted. Any change to the antenna or the device could result in the device, exceeding the RF exposure requirements and void user’s authority to operate this device.

NOTE

• Use this device only indoors.

• This device has been tested and complies with FCC radiation exposure limits set forth

for an uncontrolled environment. The RF transmission power from the antenna conforms to the general public FCC RF Exposure Guidelines in Supplement C to OET65 limit of Speciﬁc Absorption Rate (SAR) 1.6 W/kg. The maximum SAR value measured from this device was extremely smaller than 1.6 W/kg. This device must not be located together with or operated in conjunction with any other unspeciﬁed antenna or transmitter.

• The devices require registration and deployment by an authorized frequency coordinator.

The ASHE (American Society for Healthcare Engineering) has been designated by the FCC to manage the WMTS frequencies. This device has frequency bands which may not be used in some areas. For details, contact your Nihon Kohden representative. For details on the guidelines, refer to the ASHE home page.

iv Operator’s Manual ZM-540PA/541PA

EMC RELATED CAUTION

This equipment and/or system complies with IEC 60601-2 International Standard for electromagnetic compatibility for medical electrical equipment and/or system. However, an electromagnetic environment that exceeds the limits or levels stipulated in IEC 60601-1-2, can cause harmful interference to the equipment and/or system or cause the equipment and/or system to fail to perform its intended function or degrade its intended performance. Therefore, during the operation of the equipment and/or system, if there is any undesired deviation from its intended operational performance, you must avoid, identify and resolve the adverse electromagnetic effect before continuing to use the equipment and/or system.

The following describes some common interference sources and remedial actions:

1. Strong electromagnetic interference from a nearby emitter source such as an authorized radio station or cellular phone:

Install the equipment and/or system at another location. Keep the emitter source

such as cellular phone away from the equipment and/or system, or turn off the cellular phone.

2. Radio-frequency interference from other equipment through the AC power supply of the equipment and/or system:

Identify the cause of this interference and if possible remove this interference

source. If this is not possible, use a different power supply.

3. Effect of direct or indirect electrostatic discharge:

Make sure all users and patients in contact with the equipment and/or system are

free from direct or indirect electrostatic energy before using it. A humid room can help lessen this problem.

4. Electromagnetic interference with any radio wave receiver such as radio or television:

If the equipment and/or system interferes with any radio wave receiver, locate the

equipment and/or system as far as possible from the radio wave receiver.

5. Interference of lightning:

When lightning occurs near the location where the equipment and/or system is

installed, it may induce an excessive voltage in the equipment and/or system.

In such a case, disconnect the AC power cord from the equipment and/or

system and operate the equipment and/or system by battery power, or use an uninterruptible power supply.

Operator’s Manual ZM-540PA/541PA v

6. Use with other equipment:

When the equipment and/or system is adjacent to or stacked with other equipment,

the equipment and/or system may affect the other equipment. Before use, check that the equipment and/or system operates normally with the other equipment.

7. Use of unspeciﬁed accessory, transducer and/or cable:

When an unspeciﬁed accessory, transducer and/or cable is connected to this

equipment and/or system, it may cause increased electromagnetic emission or decreased electromagnetic immunity. The speciﬁed conﬁguration of this equipment and/or system complies with the electromagnetic requirements with the speciﬁed conﬁguration. Only use this equipment and/or system with the speciﬁed conﬁguration.

8. Use of unspeciﬁed conﬁguration:

When the equipment and/or system is used with the unspeciﬁed system

conﬁguration different than the conﬁguration of EMC testing, it may cause increased electromagnetic emission or decreased electromagnetic immunity.

Only use this equipment and/or system with the speciﬁed conﬁguration.

9. Measurement with excessive sensitivity:

The equipment and/or system is designed to measure bioelectrical signals with

a speciﬁed sensitivity. If the equipment and/or system is used with excessive sensitivity, artifact may appear by electromagnetic interference and this may cause mis-diagnosis. When unexpected artifact appears, inspect the surrounding electromagnetic conditions and remove this artifact source.

If the above suggested remedial actions do not solve the problem, consult your Nihon Kohden representative for additional suggestions.

vi Operator’s Manual ZM-540PA/541PA

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 speciﬁc information.

WARNING

A warning alerts the user to the 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.

Operator’s Manual ZM-540PA/541PA vii

Explanations of the Symbols in this Manual and Instrument

The following symbols found in this manual/instrument bear the respective descriptions as given.

On Panel

Symbol Description Symbol Description

Change screen

Attention, consult operator’s manual

Deﬁbrillation proof type BF applied part

Deﬁbrillation proof type CF applied part

Moves cursor, scrolls data Serial number

Direction for attaching battery cover

Direction for inserting battery

Year of manufacture

RF transmitter Non-ionizing radiation

Direct current CSA mark

On LCD

Symbol Description Symbol Description

Full battery

Battery very weak Replace battery

Battery 2/3 full Alarm suspended

Low battery NIBP cannot be measured

QRS/pulse sync mark

viii Operator’s Manual ZM-540PA/541PA

Intended Use

General

The ZM-540PA and ZM-541PA transmitter transmits ECG, respiration and pulse waveforms, SpO2 and NIBP data from a patient to a Nihon Kohden monitor for continuous monitoring. The front LCD displays ECG (or pulse wave), numeric values of monitoring parameters, NIBP measuring mode and interval, messages and battery condition.* It also displays the compressed waveform and numeric data of the latest 10 minutes. * Essential performance of this transmitter.

The difference between the ZM-540PA and ZM-541PA is the transmission frequency range. ZM-540PA: 608.0250 MHz (channel number 9002) to 613.9750 MHz (channel number 9478) ZM-541PA: 1395.0250 MHz (channel number E002) to 1399.9750 MHz (channel number E398)

1427.0250 MHz (channel number E502) to 1431.9750 MHz (channel number E898)

The transmitter channel can be changed with a QI-901PK channel writer.

Read the operator’s manual for the receiving monitor together with this manual before use.

WARNING

Do not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter.

CAUTION

• Do not use the same channel for different patients. If the same channel is used for two patients, the two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen.

• Do not use two transmitters with adjacent channels in the same hospital. If transmitters with adjacent channels are used, their radio waves interfere with each other.

CAUTION

Be aware that signal loss and artifact may occur because of the multipath cancellation* when using a transmitter.

* Multipath Cancellation (Standing Wave Interference) When a radio wave reﬂects off a surface, there may be some points in the room where the

Operator’s Manual ZM-540PA/541PA 1

reﬂected and direct waves are exactly out of phase. At these points in the room, the reﬂected and direct waves cancel each other out so that the signal strength is 0. This is called “multipath cancellation” or “standing wave interference”. Locations where signal loss occurs are called “null spots”. If the transmitter is moving or nearby people or objects are moving, null spots can occur anytime and anywhere.

NOTE

• To prevent interference between channels, assign a channel administrator in the hospital and only he or she should manage channel assignment.

• Use Nihon Kohden parts and accessories to assure maximum performance from your instrument.

• For stable signal reception, it is recommended to use a diversity antenna system on the receiving monitor. Otherwise, spike noise from transient fading of electric ﬁeld strength (for example, people moving) may interfere with the transmitter signal and may be mistaken as an arrhythmia on the receiving monitor.

• For details on antennas and antenna construction, contact your Nihon Kohden representative. You can also refer to the Telemetry System Installation Guide.

• Do not diagnose a patient based on only part of the monitoring data on the transmitter or only on the data acquired by the transmitter. Overall judgment must be performed by a physician who understands the features, limitations and characteristics of the transmitter by reading this operator’s manual thoroughly and by reading the biomedical signals acquired by other instruments.

Receiving Monitor

Any Nihon Kohden receiving monitor (central monitor with multiple patient receiver) can receive signals from this transmitter as long as the protocol version and channel setting are the same on the receiving monitor and transmitter.

NOTE

• For details on the receiving monitor and upgrade information, contact your Nihon Kohden representative.

• The transmitter does not give any patient alarm, only a “no battery” alarm. Patient alarms must be managed on the receiving monitor.

2 Operator’s Manual ZM-540PA/541PA

Panel Description

Front Panel

1

4

5

2

6

3

7

Refer to the WARNING on the next page.

8

No. Name Description

1 LCD Displays numeric values, ECG or pulse wave, NIBP measuring

mode and interval, messages and battery status. For details, refer to the “Screen Descriptions” section.

2 Infrared receiver Used for upgrading the transmitter software.

3 Screen key Toggles the screen in the following order.

After power on: Start up → Check electrodes → Numeric and

waveform → Waveform review → Numeric review → Display off → Check electrodes …

After auto display off: Numeric and waveform → Waveform

review → Numeric review → Display off → Check electrodes → Numeric and waveform …

On a SETUP or CHECK screen, this key cancels changing setting

or exits the screen.

Operator’s Manual ZM-540PA/541PA 3

1

4

5

2

6

3

7

Refer to the WARNING below.

8

No. Name Description

4 Function key Depending on the setting on the transmitter, this key suspends

alarms, pauses monitoring on the receiving monitor or transmits “Patient conﬁrmed” message.

On a SETUP screen, this key registers the selected setting and

moves the cursor to the next setting item.

On a CHECK screen, this key starts or stops maintenance test.

5 NIBP Start/Stop key Starts/stops NIBP measurement in selected mode.

6 NIBP Interval key Selects NIBP measurement mode.

7 Lead/Scroll keys On the numeric and waveform screen, these keys change the ECG

lead.

On the waveform review screen, these keys scroll data.

On a SETUP screen, these keys move the cursor.

8 Battery case Contains three 1.5 V dry cell batteries (AA TYPE).

WARNING

Close the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when deﬁbrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data.

4 Operator’s Manual ZM-540PA/541PA

Rear Panel

Lock plate

Fastens the transmitter to an NIBP cuff.

Refer to the symbol page.

Refer to the WARNING below.

WARNING

This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.

Operator’s Manual ZM-540PA/541PA 5

Top Panel

Refer to the WARNING on the next page.

NIBP socket:

Connects the cuff hose.

Refer to the symbol page.

Bottom Panel

Channel number label:

Indicates the channel number of the transmitter. Attach the channel number label to the panel of the receiving monitor.

Refer to the WARNING on the next page.

Refer to the symbol page.

ECG/impedance RESP socket:

Connects the electrode lead for measuring ECG and/or respiration (impedance).

Refer to the symbol page.

Refer to the WARNING on the next page.

6 Operator’s Manual ZM-540PA/541PA

SpO2 socket:

Connects the SpO2 probe.

WARNING

Before deﬁbrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury.

WARNING

When performing deﬁbrillation, discharge as far as possible from electrodes, patches and any gel, cream or medicine on the chest of the patient. If there is a possibility that the deﬁbrillator paddle could touch these materials, remove them from the patient. If the deﬁbrillator paddle directly contacts these materials, the discharged energy may cause skin burn to the patient.

WARNING

When the transmitter 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 transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.

CAUTION

Do not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.

Operator’s Manual ZM-540PA/541PA 7

Important Safety Information

General

WARNING

Never use the transmitter in the presence of any ﬂammable anesthetic gas or high concentration oxygen atmosphere. Failure to follow this warning may cause explosion or ﬁre.

WARNING

Do not take this transmitter into the MRI test room. This transmitter is not designed to be used during MRI tests.

WARNING

Before deﬁbrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury.

WARNING

Never use the transmitter in a hyperbaric oxygen chamber. Failure to follow this warning may cause explosion or ﬁre.

WARNING

When performing MRI test, remove all electrodes, probe and cuff from the patient which are used with this transmitter. Failure to follow this warning may cause skin burn on the patient. For details, refer to the MRI manual.

WARNING

When performing deﬁbrillation, discharge as far as possible from electrodes, patches and any gel, cream or medicine on the chest of the patient. If there is a possibility that the deﬁbrillator paddle could touch these materials, remove them from the patient. If the deﬁbrillator paddle directly contacts these materials, the discharged energy may cause skin burn to the patient.

8 Operator’s Manual ZM-540PA/541PA

WARNING

When the transmitter 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 transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.

WARNING

This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.

WARNING

Close the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when deﬁbrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data.

CAUTION

Only use Nihon Kohden speciﬁed electrodes, electrode leads, SpO probes, and NIBP cuffs. Otherwise, the maximum performance from the transmitter cannot be guaranteed.

2

CAUTION

The measurement values and displayed waveforms on the transmitter and receiving monitor may be different due to timing delay of the display or difference in detection settings.

WARNING

Do not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter.

CAUTION

Do not reuse disposable parts and accessories.

CAUTION

Do not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.

Operator’s Manual ZM-540PA/541PA 9

CAUTION

Be aware that signal loss and artifact may occur because of the multipath cancellation* when using a transmitter.

* Multipath Cancellation (Standing Wave

Interference)

When a radio wave reﬂects off a surface,

there may be some points in the room where the reﬂected and direct waves are exactly out of phase. At these points in the room, the reﬂected and direct waves cancel each other out so that the signal strength is 0. This is called “multipath cancellation” or “standing wave interference”. Locations where signal loss occurs are called “null spots”. If the transmitter is moving or nearby people or objects are moving, null spots can occur anytime and anywhere.

CAUTION

Turn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.

CAUTION

• Do not use the same channel for different patients. If the same channel is used for two patients, the two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen.

• Do not use two transmitters with adjacent channels in the same hospital. If transmitters with adjacent channels are used, their radio waves interfere with each other.

Output Signal

WARNING

Do not use the output signal from the receiving monitor as the synchronization signal for other equipment such as IABP, MRI, echocardiography or deﬁbrillator. There may be time delay between the monitor and the other equipment caused by waveform transmission delay and spike noise may interfere on the output signal and be mistaken as a trigger.

10 Operator’s Manual ZM-540PA/541PA

Battery

CAUTION

Battery replacement must be performed by the operator. When replacing the batteries of a transmitter that is currently used for a patient, disconnect the electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.

Refer to the battery and battery charger manuals for details on handling the batteries.

CAUTION

Transmitter Channel Management

WARNING

The following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.

• Assign a channel administrator in the hospital and only he or she should manage channel assignment.

• The channel administrator must manage the channels in the facility so that there is no signal interference.

• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.

• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.

Operator’s Manual ZM-540PA/541PA 11

For Patients Using Implantable Pacemaker

WARNING

Interaction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac Monitoring and Diagnostic Equipment* The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor. If this occurs, disconnect the electrode leads from the patient or change the setting on the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker representative or Nihon Kohden representative.

* Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectric

impedance measurement (BIM). Many medical devices in addition to pacemakers use this technology. When one of these devices is used on a patient with an active, minute ventilation rateadaptive pacemaker, the pacemaker may erroneously interpret the mixture of BIM signals created in the patient, resulting in an elevated pacing rate.

For more information, see the FDA web site. http://www.fda.gov/cdrh/safety.html

ECG Monitoring

CAUTION

Only use Nihon Kohden speciﬁed electrodes and electrode leads. When other electrodes or electrode leads are used, the “CHECK ELECTRODES” message may appear and monitoring may stop.

12 Operator’s Manual ZM-540PA/541PA

When the “ELECTRODE OFF” or “CHECK ELECTRODES” message is displayed on the receiving monitor, ECG is not monitored properly and the ECG alarm does not function. Check the electrode, electrode leads, and if necessary, replace with new ones.

CAUTION

SpO2 Monitoring

WARNING

SpO2 measurement may be incorrect in the following cases.

• When the patient’s carboxyhemoglobin or methemoglobin increases abnormally.

• When dye is injected in the blood.

• When using an electrosurgical unit.

• During CPR.

• When measuring at a site with venous pulse.

• When there is body movement.

• When the pulse wave is small (insufﬁcient peripheral circulation).

WARNING

• When using the TL-201T ﬁnger probe, do not fasten the probe and cable to the ﬁnger by wrapping with tape. This may cause burn, congestion or pressure necrosis from poor blood circulation.

• When using probes other than the TL-201T ﬁnger probe, to avoid poor circulation, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation.

WARNING

When not monitoring SpO2, disconnect the SpO transmitter. Otherwise, noise from the probe sensor may interfere and incorrect data is displayed on the screen.

cable from the

2

WARNING

Check the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.

• Patient with a fever

• Patient with peripheral circulation insufﬁciency

• Neonate or low birth weight infant with delicate skin

Operator’s Manual ZM-540PA/541PA 13

WARNING

When monitoring SpO2 of a patient who is receiving photodynamic therapy, the light from the ﬁnger probe sensor may cause a burn. Photodynamic therapy uses a photosensitizing agent that has a side effect of photosensitivity.

CAUTION

Refer to the probe instruction manual for details.

CAUTION

NIBP and SpO2 can be measured on the same limb, but the SpO monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO

* Monitoring SpO2 during NIBP Measurement When the SpO

probe is attached to the

2

same limb as the NIBP cuff, the blood ﬂow decreases during NIBP measurement and pulse wave cannot be detected and SpO

cannot be monitored properly. When

2

“INHIBIT SpO

DURING NIBP” on the

2

PARAMETER SETUP screen is set to ON (factory default setting), SpO paused during NIBP measurement to avoid SpO

alarm occurrence. However, when

2

monitoring SpO

on the same limb as the

2

NIBP, be careful when reading SpO

2

values.*

2

monitoring is

2

values.

2

CAUTION

The disposable probe is not sterilized. Use the disposable probe only for a single patient. Never reuse the disposable probe for another patient because it causes cross infection.

CAUTION

While a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO

value might not be

2

displayed.

CAUTION

Normal external light does not affect monitoring but strong light such as a surgical light or sunlight may affect monitoring. If affected, cover the measuring site with a blanket.

CAUTION

When a message indicates a faulty probe, stop monitoring and replace the probe with a new one.

14 Operator’s Manual ZM-540PA/541PA

CAUTION

Do not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.

CAUTION

Do not use a probe which is deteriorated by aging. Accurate measurement cannot be performed.

CAUTION

If the attachment site is dirty with blood or bodily ﬂuids, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases, and measured value may be incorrect or measurement cannot be performed.

CAUTION

Do not pull or bend the probe cable, and do not put caster feet on the probe cable. Do not immerse the disposable probe cable in chemical solutions or water. Failure to follow these instructions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one.

CAUTION

If the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe. Take extreme care for the patients with delicate skin.

CAUTION

When the probe is attached on an appropriate site with sufﬁcient circulation and the error message conﬁrming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.

Operator’s Manual ZM-540PA/541PA 15

NIBP Monitoring

WARNING

Be careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.

WARNING

When performing NIBP measurements in STAT mode or 5 minute intervals, periodically remove the cuff from the patient for ventilation. The skin temperature may increase at the cuff attachment site by 2 or 3°C (4 or 5°F). When measuring a patient with a fever or peripheral circulation insufﬁciency, it may cause a burn.

CAUTION

Do not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause reﬂux of blood and stop injection.

WARNING

NIBP measurement may be incorrect in the following cases.

• When using an electrosurgical unit

• When there is body movement

• When the pulse wave is small (insufﬁcient peripheral circulation)

• Too many arrhythmias

• When there is vibration

• When there is a rapid blood pressure change

• During CPR

CAUTION

Do not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may increase.

CAUTION

Do not attach the cuff to the site where there is injury or inﬂammation. If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff. Take extreme care on the patients with delicate skin.

16 Operator’s Manual ZM-540PA/541PA

When using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inﬂate or deﬂate. If the cuff cannot deﬂate, it may cause congestion on the patient at the cuff attachment site.

CAUTION

When performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.

Maintenance

CAUTION

This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning or disinfecting it and contact your Nihon Kohden representative. The transmitter needs to be checked for safety and function before use.

CAUTION

Never disassemble or repair the transmitter. Disassembly and repair must be performed by qualiﬁed service personnel.

Operator’s Manual ZM-540PA/541PA 17

Preparation on Transmitter

Batteries

WARNING and CAUTION for Handling Batteries

CAUTION

Refer to the battery and battery charger manuals for details on handling the batteries.

CAUTION

Do not handle the batteries with wet hands.

When the transmitter is not in use, remove the batteries. When the batteries are installed, battery power is consumed even when measurement is not performed. When NiMH batteries are left in the transmitter when it is not used, the batteries may overdischarge and leak liquid which makes the batteries unusable and damages the transmitter.

CAUTION

NOTE

Remove the batteries from the transmitter before disposing of it.

Battery Lifetime

Use three AA type alkaline dry cell batteries. NiMH batteries can also be used but the lifetime of alkaline batteries is longer. The lifetime of NiMH batteries is about 1/2 of alkaline batteries (when fully charged).

With new Nihon Kohden recommended alkaline batteries, the transmitter can continuously measure ECG, respiration, SpO temperature, NIBP is measured in auto mode at 60 minute intervals and SpO index ﬁnger of a male patient with weight 60 kg. Operation time depends on the thickness of the SpO

probe attachment site.

2

and NIBP for approximately 1 day. The measurement is performed at room

2

is measured on an

2

Recommended batteries

NiMH secondary: SANYO HR-3UF (W) Battery charger: SANYO NC-M55 Alkaline primary: Nihon Kohden Medipower (equivalent to Panasonic LR6 (G))

18 Operator’s Manual ZM-540PA/541PA

Installing (Replacing) Batteries

CAUTION

Battery replacement must be performed by the operator. When replacing the batteries of a transmitter that is currently used for a patient, disconnect the electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.

If electrode leads are attached to the patient and the person replacing batteries touches the patient during battery replacement, excess patient leakage current may ﬂow into the patient.

NOTE

• Replace all batteries at the same time.

• Do not use different types of batteries together.

• Insert the batteries with the correct polarity (+ and –).

• The capacity of rechargeable NiMH batteries is reduced if the batteries are recharged before they are fully discharged. For details, refer to the battery operator’s manual.

1. Remove the battery case cover.

2. Insert three new or fully charged batteries into the battery case observing the correct polarity.

Operator’s Manual ZM-540PA/541PA 19

3. Close the cover.

The transmitter is automatically turned on when the batteries are installed and the cover is closed.

Situations Requiring Battery Replacement

Replace the batteries when any of the following occurs:

• The transmitter displays the “BATTERY WEAK” message or “

• The transmitter generates a constant alarm (continuous “peep” sound).

• The transmitter LCD does not display anything when the power is turned on.

• The receiving monitor displays a battery replacement message.

Battery Level Indication

The following icons on the LCD indicate the battery level. When “PROTOCOL” on the SYSTEM SETUP screen is set to 57, the battery level indication is transmitted to the receiving monitor.

Indication Battery Level Message on the Receiving Monitor

Fully charged batteries

” icon.

No indication

Batteries are 2/3 full.

Batteries are low. NIBP cannot be measured. Replace batteries.

Batteries are very weak.

Dead batteries

There is no message on the monitor.

Message requiring battery replacement is displayed.

No signal can be transmitted to the monitor. There is no indication on the monitor.

Turning On the Transmitter

When the batteries are installed correctly, the power is turned on. A one second “peep” sounds and the startup screen appears, then the check electrodes screen appears. (There is no “peep” sound when there is no battery power.)

20 Operator’s Manual ZM-540PA/541PA

After checking that the ECG is stable on the check electrodes screen, press the Screen key to display the numeric and waveform screen.

For details on the screen, refer to the “Screen Descriptions” section.

Check Items Before Use

Before turning on the transmitter power, check the following to conﬁrm that the transmitter can be used in normal and safe condition.

Appearance

• There are no damaged or dirty parts on the outside of the transmitter (LCD, keys, sockets, battery case cover, battery case, lock plate, etc.).

• The transmitter is completely dry.

• The electrodes, electrode lead, SpO

probe and NIBP cuff are not broken.

2

Batteries

• The battery polarity is correct.

• The battery case spring is ﬁrmly attached and the battery is not loose.

• The battery case cover is ﬁrmly closed.

Channel Setting

• The transmitter channel matches the receiving monitor channel.

• There is no nearby transmitter with the same channel.

Operator’s Manual ZM-540PA/541PA 21

Check Items After Power On

After turning on the power, check the following.

Power On

• The transmitter generates a one second “peep” sound and the startup screen appears.

• The transmitter displays the check electrodes screen.

• The transmitter is not too hot.

• The transmitter does not display the “BATTERY WEAK” message.

• The transmitter does not interfere with the operation of other medical instruments.

Daily Check

• The “signal loss” message is not displayed on the receiving monitor when the transmitter is inside the receiving range of the monitor.

• The battery replacement message is not displayed on the monitor.

• The keys on the transmitter function properly.

• The LCD brightness is appropriate. To adjust brightness, refer to the “Changing SYSTEM SETUP Settings” section.

Check Items After Use

To use the transmitter in safe and optimum condition for next time, check the following.

Before Turning Power Off

• Temporarily changed settings are changed back to the previous settings.

• There was no malfunction on the transmitter.

Storage

• ECG electrode leads, SpO

probe and NIBP cuff are cleaned and disinfected.

2

• If the transmitter got wet, liquid is wiped off and the transmitter is thoroughly dried.

• There are enough consumables, such as disposable electrodes.

• The transmitter power is turned off by removing batteries from the transmitter.

• Dead batteries are disposed of properly.

Turning Off the Transmitter

To turn off the power, remove batteries. When the power is turned off, the saved waveform and numeric data are deleted.

22 Operator’s Manual ZM-540PA/541PA

Changing the Transmitter Channel

The channel of the transmitter can be changed with an optional QI-901PK Channel Writer.

WARNING

The following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.

• Assign a channel administrator in the hospital and only he or she should manage channel assignment.

• The channel administrator must manage the channels in the facility so that there is no signal interference.

• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.

• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.

NOTE

• The software version of the QI-901PK channel writer must be 02-01 or later to change the channel on the transmitter.

• The channel writer must be used outside the patient environment.

The channel is displayed in the upper left corner of the screen.

Channel

Operator’s Manual ZM-540PA/541PA 23

Changing Parameter and System Setup Settings

The initial settings on the PARAMETER SETUP and SYSTEM SETUP screens can only be changed before monitoring. Changing these settings during monitoring interrupts monitoring.

NOTE

Changing Parameter and System Setup settings must be done by qualiﬁed personnel.

Notes on Parameter Settings

When monitoring NIBP and SpO2, the following setting must be set as indicated in the table to properly transmit the monitoring data to the receiving monitor. Otherwise, SpO monitored properly during NIBP measurement.

Some receiving monitors require the software to be upgraded. For details, contact your Nihon Kohden representative.

SpO2 probe attachment site INHIBIT SpO2 DURING NIBP setting

Probe attached to the same limb as the cuff* ON

Probe attached to the limb without cuff OFF

* When the SpO2 probe is attached to the same limb as the NIBP cuff and the cuff is inﬂated,

the SpO

value becomes unstable and SpO2 or PR alarm may occur.

2

cannot be

2

24 Operator’s Manual ZM-540PA/541PA

Changing PARAMETER SETUP Settings

Parameter Setup Setting List

The factory default settings are underlined.

Setting Item Description Settings

ECG ELECTRODES Select the electrode lead type.

LEAD TYPE Select the type of ECG leads.

Turn ECG monitoring on or off. When electrodes are attached to the patient and ECG leads are connected, ECG monitoring starts even when this setting is set to OFF.

If this setting is set to OFF, the same setting on the ECG MEASUREMENT

receiving monitor must also be set to OFF.

NOTE

When “PROTOCOL” on the transmitter is set to

57 and the receiving monitor is able to receive

protocol 57, ECG measurement on the receiving

monitor is automatically set to OFF when this

setting is set to OFF on the transmitter.

RESP MEASUREMENT

Turn respiration monitoring on or off.

When this setting is set to OFF, the same setting on the

receiving monitor is automatically set to OFF.

Select the SpO2 response mode.

FAST: Select this for special applications that

require a fast response. FAST is suitable

RESPONSE

SpO

2

for detecting short apnea. NORMAL: For normal monitoring. SLOW: Select this when you need to suppress a

rapid change in SpO

INHIBIT SpO DURING NIBP

SELECTABLE INTERVALS (min)

INITIAL INTERVAL (min)

NIBP MODE AFTER STAT (min)

START/FINISH SOUND

2

Turn SpO2 monitoring on or off during NIBP measurement.

Select the NIBP measurement modes for the mode selection.

Select the initial NIBP measurement mode at power on.

Select the NIBP measurement mode after completing STAT measurement.

Turn ON or OFF the sound for NIBP measurement start/ﬁnish.

.

2

IEC, AHA

AUTO, 6 LEADS

ON, OFF

FAST, NORMAL, SLOW

ON, OFF

STAT, 5, 10, 15, 30, 60, 120, 240

MANUAL, 5, 10, 15, 30, 60, 120, 240

START: ON, OFF FINISH: ON, OFF

Operator’s Manual ZM-540PA/541PA 25

Setting Item Description Settings

OLD NIBP DATA/ AFTER (min)

INITIAL CUFF PRESSURE (mmHg)

Displaying the PARAMETER SETUP Screen

Cursor

Select whether to hide or dim the NIBP data after measurement and how long to wait after measurement to dim or hide it.

Select the NIBP cuff inﬂation pressure.

1. Turn off the transmitter by removing one battery.

2. While pressing the Function key, turn on the transmitter (install the battery). The MENU screen appears.

DATA: HIDE, DIM AFTER: 5, 10, 30

120, 150, 180, 210, 240

3. Press the

4. Press the Function key to enter

MENU screen

Cursor

PARAMETER SETUP screen - page 1

7. Press the ▼ or ▼ key to move the cursor to “EXIT”.

Setting item

Setting

5. Change settings:

6. When changing settings on the

▼

key to move the cursor to

“PARAMETER SETUP”.

PARAMETER SETUP. The current settings are highlighted.

• To move the cursor and select the setting

item, press the the Function key.

• To select and register the setting, press

▼

the

or ▼ key then press the Function

key.

• To cancel changing the setting of the

selected item, press the Screen key.

PARAMETER SETUP screen is complete, press the Screen key to return to the MENU screen.

▼

or ▼ key then press

8. Press the Function key. The numeric and waveform screen appears.

26 Operator’s Manual ZM-540PA/541PA

Changing Parameter Setup Settings

ECG ELECTRODES

Select the electrode lead type.

Cursor

Setting item

1. On the PARAMETER SETUP screen,

▼

press the “ECG ELECTRODES”.

2. Press the Function key. The cursor moves to the selection item.

key to move the cursor to

Cursor

LEAD TYPE

Select the type of ECG leads. In normal use, select “AUTO”. When using DIN type lead with 6 electrodes, select “6 LEADS”.

1. On the PARAMETER SETUP screen, press the

2. Press the Function key.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “LEAD TYPE”.

Selected setting

▼

key to select “AUTO” or “6 LEADS”.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “ECG ELECTRODES”.

▼

key to move the cursor to “LEAD TYPE”.

▼

key to select “IEC” or “AHA”.

Operator’s Manual ZM-540PA/541PA 27

ECG MEASUREMENT

Turn ECG monitoring on or off. When electrodes are attached to the patient and ECG leads are connected, ECG monitoring starts even when this setting is set to OFF.

If this setting is set to OFF, the same setting on the receiving monitor must also be set to OFF.

NOTE

When “PROTOCOL” on the transmitter is set to 57 and the receiving monitor is able to receive protocol 57, ECG measurement on the receiving monitor is automatically set to OFF when this setting is set to OFF on the transmitter.

1. On the PARAMETER SETUP screen, press the MEASUREMENT”.

2. Press the Function key.

▼

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “ECG MEASUREMENT”.

RESP MEASUREMENT

Turn respiration monitoring on or off. When this setting is set to OFF, the same setting on the receiving monitor is automatically set to OFF.

1. On the PARAMETER SETUP screen, press the MEASUREMENT”.

2. Press the Function key.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “RESP MEASUREMENT”.

key to select “ON” or “OFF”.

▼

key to select “ON” or “OFF”.

▼

key to move the cursor to “ECG

▼

key to move the cursor to “RESP

28 Operator’s Manual ZM-540PA/541PA

SpO2 RESPONSE

Select the SpO

response mode.

2

FAST: Select this for special applications that require a fast response. FAST is suitable for

detecting short apnea. NORMAL: For normal monitoring. SLOW: Select this when you need to suppress a rapid change in SpO

.

2

1. On the PARAMETER SETUP screen, press the

▼

key to move the cursor to “SpO2 RESPONSE”. “SpO2 RESPONSE” is on the second page of the PARAMETER SETUP screen.

2. Press the Function key.

3. Press the

▼

key to select “FAST”, “NORMAL” or “SLOW”.

PARAMETER SETUP screen - page 2

4. Press the Function key to register the selected setting. The cursor returns to “SpO2 RESPONSE”.

INHIBIT SpO2 DURING NIBP

Turn SpO

When the SpO pulse may become unstable and SpO to ON so that SpO

When the SpO

monitoring on or off during NIBP measurement.

2

probe is attached to the same limb as the NIBP cuff and this setting is set to OFF, the

2

or PR alarm may occur. It is recommended to set this setting

2

is not measured during NIBP measurement.

2

probe is attached to the other limb from the NIBP cuff, this setting can be set to

2

OFF.

NOTE

When this “INHIBIT SpO2 DURING NIBP” is set to OFF, refer to the “Monitoring SpO2 during NIBP Measurement” section.

1. On the PARAMETER SETUP screen, press the SpO2 DURING NIBP”. “INHIBIT SpO2 DURING NIBP” is on the second page of the PARAMETER SETUP screen.

▼

key to move the cursor to “INHIBIT

2. Press the Function key.

3. Press the

▼

key to select “ON” or “OFF”.

Operator’s Manual ZM-540PA/541PA 29

4. Press the Function key to register the selected setting. The cursor returns to “INHIBIT SpO2 DURING NIBP”.

SELECTABLE INTERVALS (min)

When the NIBP INTERVAL key is pressed, the measurement mode changes according to the modes selected in this item. MANUAL mode is already selected for the mode selection.

1. On the PARAMETER SETUP screen, press the to “SELECTABLE INTERVALS”. “SELECTABLE INTERVALS” is on the third page of the PARAMETER SETUP screen.

2. Press the Function key.

▼

key to move the cursor

3. Press the

PARAMETER SETUP screen - page 3

INITIAL INTERVAL (min)

Select the initial NIBP measurement mode at power on.

1. On the PARAMETER SETUP screen, press the INTERVAL”. “INITIAL INTERVAL” is on the third page of the PARAMETER SETUP screen.

2. Press the Function key.

▼

3. Press the INTERVALS” are available.

4. Press the Function key to register the selected setting. The cursor returns to “INITIAL INTERVAL”.

NIBP MODE AFTER STAT (min)

Select the NIBP measurement mode after completing the STAT measurement.

key to select the mode. Only the mode or interval selected for “SELECTABLE

mode. The selected modes are highlighted.

4. Press the Function key to register the selected setting. The cursor returns to “SELECTABLE INTERVALS”.

▼

key to move the cursor to “INITIAL

▼

key to select or unselect the

1. On the PARAMETER SETUP screen, press the AFTER STAT”. “NIBP MODE AFTER STAT” is on the third page of the PARAMETER SETUP screen.

30 Operator’s Manual ZM-540PA/541PA

▼

key to move the cursor to “NIBP MODE

2. Press the Function key.

▼

3. Press the INTERVALS” are available.

4. Press the Function key to register the selected setting. The cursor returns to “NIBP MODE AFTER STAT”.

START/FINISH SOUND

Turn on or off the sound for NIBP measurement start and ﬁnish.

key to select the mode. Only the mode or interval selected for “SELECTABLE

1. On the PARAMETER SETUP screen, press the “START/FINISH SOUND”. “START/ FINISH SOUND” is on the fourth page of the PARAMETER SETUP screen.

2. Press the Function key. The cursor moves to “START”.

▼

key to move the cursor to

3. Press the sound for NIBP measurement start.

PARAMETER SETUP screen - page 4

OLD NIBP DATA/AFTER (min)

Select whether to dim or hide the NIBP data after measurement and how long to wait after NIBP measurement to dim or hide it.

1. On the PARAMETER SETUP screen, press the DATA/AFTER”. “OLD NIBP DATA/AFTER” is on the fourth page of the PARAMETER SETUP screen.

2. Press the Function key. The cursor moves to “DATA”.

4. Press the Function key to register the setting for “START”. The cursor moves to “FINISH”.

5. Press the sound for NIBP measurement ﬁnish.

6. Press the Function key to register the selected setting. The cursor returns to “START/FINISH SOUND”.

▼

key to move the cursor to “OLD NIBP

▼

key to turn “ON” or “OFF” the

▼

key to turn “ON” or “OFF” the

Operator’s Manual ZM-540PA/541PA 31

▼

3. Press the

4. Press the Function key to register the setting for “DATA”. The cursor moves to “AFTER”.

5. Press the

6. Press the Function key to register the selected setting. The cursor returns to “OLD NIBP DATA/ AFTER”.

INITIAL CUFF PRESSURE (mmHg)

Select the NIBP cuff inﬂation pressure.

1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “INITIAL CUFF PRESSURE”. “INITIAL CUFF PRESSURE” is on the fourth page of the PARAMETER SETUP screen.

2. Press the Function key.

key to select “HIDE” or “DIM” the NIBP data.

▼

key to select the interval after NIBP measurement to dim or hide.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “INITIAL CUFF PRESSURE”.

▼

key to select the inﬂation pressure.

Changing SYSTEM SETUP Settings

System Setup Setting List

The factory default settings are underlined.

Setting Item Description Settings

Select the transmitting protocol. 57: New protocol. A central monitor with ORG-

9100A/9110A/9700A multiple patient receiver whose software version 02-01 or later can receive this protocol.

PROTOCOL

42: Old protocol. A central monitor with ORG-

9100A/9110A/9700A multiple patient receiver can receive this protocol.

NOTE

When 57 is set, the receiving monitor must be able to receive protocol 57. Otherwise, signals from the transmitter cannot be received.

57, 42

32 Operator’s Manual ZM-540PA/541PA

Setting Item Description Settings

BRIGHTNESS Select the screen brightness.

PRESSURE UNIT Select the unit for NIBP.

Select the function of the Function key. SUSPEND ALARM & PAUSE: Suspends alarm on the receiving monitor for 2

minutes. Pauses monitoring on the transmitter and

receiving monitor. SUSPEND ALARM: Suspends alarm on the receiving monitor for 2

FUNCTION KEY

minutes. CONFIRM: Displays the “PATIENT CONFIRMED” message

on the transmitter screen and transmits the

message to the receiving monitor. OFF: No function.

DARK, BRIGHT

mmHg, kPa

SUSPEND ALARM & PAUSE, SUSPEND ALARM, CONFIRM, OFF

NOTE

“SUSPEND ALARM & PAUSE” and “CONFIRM” can only be set when PROTOCOL is set to 57.

AUTO RESUME AFTER PAUSE

Select the interval to resume monitoring after PAUSE.

10 s, 30 s, 1 min, 2 min, 3 min, OFF

Operator’s Manual ZM-540PA/541PA 33

Displaying the SYSTEM SETUP Screen

Cursor

MENU screen

Setting item

Setting

1. Turn off the transmitter by removing one battery.

2. While pressing the Function key, turn on the transmitter (install the battery). The MENU screen appears.

▼

3. Press the “SYSTEM SETUP”.

4. Press the Function key to enter SYSTEM SETUP. The current settings are highlighted.

5. Change settings.

• To move the cursor and select the setting

item, press the the Function key.

• To select and register the setting, press

the key.

• To cancel changing the setting of the

selected item, press the Screen key.

key to move the cursor to

▼

or ▼ key then press

▼

or ▼ key then press the Function

The SYSTEM SETUP screen has two

pages. To display the second page, press the “PRESSURE UNIT”.

SYSTEM SETUP screen - page 1

6. When changing settings on the SYSTEM SETUP screen is complete, press the Screen key to return to the MENU screen.

▼

key when the cursor is at

▼

7. Press the “EXIT”.

8. Press the Function key. The numeric and waveform screen appears.

34 Operator’s Manual ZM-540PA/541PA

or ▼ key to move the cursor to

Changing System Setup Settings

PROTOCOL

Select the transmitting protocol. For differences between protocols, refer to the table below. 57: New protocol. A central monitor with ORG-9100A/9110A/9700A multiple patient receiver

whose software version 02-01 or later can receive this protocol.

42: Old protocol. A central monitor with ORG-9100A/9110A/9700A multiple patient receiver can

receive this protocol.

NOTE

When 57 is set, the receiving monitor must be able to receive protocol 57. Otherwise, signals from the transmitter cannot be received.

Differences Between Protocols

Function Protocol 42 Protocol 57

Setting ECG MEASUREMENT to OFF on the transmitter automatically turns off the ECG measurement setting on the receiving monitor

Pause monitoring on the receiving monitor from the transmitter

Transmit “PATIENT CONFIRMED” message No Yes

Display battery level of the transmitter on the receiving monitor

Transmit SpO

messages

2

No (ECG measurement must be turned off on

Ye s

the receiving monitor)

No Yes

Some messages (refer to the “Indication and

All messages

Message List” section)

Cursor

Setting

1. Press the ▼ key to move the cursor to “PROTOCOL”.

2. Press the Function key.

▼

3. Press the

key to select “57” or “42”.

Operator’s Manual ZM-540PA/541PA 35

BRIGHTNESS

Select the screen brightness.

NOTE

FUNCTION KEY (on the second page of the SYSTEM SETUP screen) can be set to “SUSPEND ALARM & PAUSE” or “CONFIRM” only when PROTOCOL is “57”. If PROTOCOL is changed to “42”, FUNCTION KEY is automatically changed to “OFF”.

4. Press the Function key to register the selected setting. The cursor returns to “PROTOCOL”.

1. Press the

2. Press the Function key.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “BRIGHTNESS”.

PRESSURE UNIT

Select the unit for NIBP.

1. Press the

2. Press the Function key.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “PRESSURE UNIT”.

▼

key to move the cursor to “BRIGHTNESS”.

▼

key to select “DARK” or “BRIGHT”.

▼

key to move the cursor to “PRESSURE UNIT”.

▼

key to select “mmHg” or “kPa”.

36 Operator’s Manual ZM-540PA/541PA

FUNCTION KEY

Select the function of the Function key. SUSPEND ALARM & PAUSE: Suspends alarm on the receiving monitor for 2 minutes. Pauses

monitoring on the transmitter and receiving monitor. SUSPEND ALARM: Suspends alarm on the receiving monitor for 2 minutes. CONFIRM: Displays the “PATIENT CONFIRMED” message on the

transmitter screen and transmits the message to the receiving

monitor. OFF: No function.

NOTE

“SUSPEND ALARM & PAUSE” and “CONFIRM” can only be set when PROTOCOL is set to

57.

1. On the SYSTEM SETUP screen, press the

▼

key to move the cursor to “FUNCTION KEY”. “FUNCTION KEY” is on the second page of the SYSTEM SETUP screen.

2. Press the Function key.

3. Press the

4. Press the Function key to register the

SYSTEM SETUP screen - page 2

AUTO RESUME AFTER PAUSE

Select the interval to resume monitoring after PAUSE.

1. Press the AFTER PAUSE” is on the second page of the SYSTEM SETUP screen.

2. Press the Function key.

3. Press the

4. Press the Function key to register the selected setting. The cursor returns to “AUTO RESUME AFTER PAUSE”.

▼

key to move the cursor to “AUTO RESUME AFTER PAUSE”. “AUTO RESUME

▼

key to select interval.

selected setting. The cursor returns “FUNCTION KEY”.

▼

key to select the function.

Operator’s Manual ZM-540PA/541PA 37

Initializing Settings

Do the following procedure to initialize all settings, except for channel, to the factory default settings.

Cursor

1. Turn off the transmitter by removing a battery.

2. While pressing the Function key, turn on the transmitter (put back the battery). The MENU screen appears.

3. Press the “SYSTEM INITIALIZE”.

4. Press the Function key to enter SYSTEM INITIALIZE screen.

5. Press the Function key to initialize settings. The conﬁrmation message appears.

To return to the MENU screen without

initializing, press the Screen key.

▼

key to move the cursor to

6. Press the Function key to initialize settings.

To cancel initializing, press the

screen returns to the MENU screen.

38 Operator’s Manual ZM-540PA/541PA

▼

key. The

Attaching Electrodes, SpO2 Probe and NIBP Cuff

to the Patient

The transmitter can be attached to an arm of the patient or placed on the bedside. The required length of the electrode leads and SpO to the patient.

Monitoring SpO2 during NIBP Measurement When the SpO

probe is attached to the same limb as the NIBP cuff, the blood ﬂow

2

decreases during NIBP measurement and pulse wave cannot be detected and SpO cannot be monitored properly. When “INHIBIT SpO SETUP screen is set to ON (factory default setting), SpO NIBP measurement to avoid SpO the same limb as NIBP, be careful when reading SpO

probe cable depends on how the transmitter is to be attached

2

NOTE

2

DURING NIBP” on the PARAMETER

2

monitoring is paused during

2

alarm occurrence. However, when monitoring SpO2 on

2

values.

2

When monitoring SpO

is important, attach the probe to the limb to which the

2

NIBP cuff or catheter is not attached.

Attachment Examples

When transmitter is attached on an arm When transmitter is placed on a bedside

NOTE

When placing the transmitter on a bedside, place it on a stable and ﬂat place. If the transmitter falls off, it may be damaged.

Operator’s Manual ZM-540PA/541PA 39

Attaching Electrodes

Selecting Electrode Lead

CAUTION

Only use Nihon Kohden speciﬁed electrodes and electrode leads. When other electrodes or electrode leads are used, the “CHECK ELECTRODES” message may appear and monitoring may stop.

The following electrode leads can be used on the transmitter (option).

BR-903PA, 3 electrodes, clip type BR-906PA, 6 electrodes, clip type

Connecting the Electrode Lead to the Transmitter

Connect the electrode lead to the ECG/RESP socket on the transmitter.

When transmitter is attached on an arm

CAUTION

Do not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.

40 Operator’s Manual ZM-540PA/541PA

Hold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrode lead by pulling the lead, it damages the electrode lead.

CAUTION

Electrode Position

Follow the physician’s instructions for electrode placement when available.

For ECG monitoring, electrodes are attached only on the chest to allow patient movement and obtain continuous stable ECG. The following leads are examples. When also monitoring respiration, refer to the “Electrode Position for Respiration Monitoring” section.

NOTE

The optimum electrode positions for ECG measurement are not always optimum for respiration measurement. Select positions that are suitable for both ECG and respiration measurement or positions which give priority to either ECG or respiration measurement.

Electrode Positions for ECG Monitoring

Six Electrodes

The 6-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. Va and Vb can be at any position of the standard 12 leads V1 to V6, but V4 and V5 are most appropriate for myocardial ischemic monitoring.

RA/R

Va/Ca

RL/RF

Electrode Position

LA/L

Vb/Cb

LL/F

Symbol Lead Color

AHA IEC AHA IEC

Left infraclavicular fossa LA L Black Yellow

Right infraclavicular fossa RA R White Red

Below lowest rib on the left anterior axillary line LL F Red Green

Right anterior axillary line at the same level as LL/F RL RF Green Black

Fifth intercostal space on the left midclavicular line. (V4 position of standard 12 leads)

Left anterior axillary line at the same level as Va. (V5 position of standard 12 leads)

Va Ca Brown-blue

Vb Cb

Brown-

orange

White-

brown

White-black

Operator’s Manual ZM-540PA/541PA 41

Lead Position

Lead I

V

Standard limb leads

Lead I

Lead II Lead III

N (RL)

RA

LA

LL

N (RL)

RA

LA

LL

N (RL)

RA

LA

LL

Monopolar limb leads

aV

R lead aVL lead aVF lead

LA

RA

LL

N (RL)

RA

LA

LL

N (RL)

LA

LL

Monopolar chest leads

1 to V6 leadsV1 to V6 leads

to

LA

RA

LL

N (RL)

Three Electrodes

• Lead MII, which is similar to standard lead II, used when ECG measurement has priority

Electrode Position

Left infraclavicular fossa

Right infraclavicular fossa

Symbol Lead Color

AHA IEC AHA IEC

LA L Black Yellow

RA R White Red

Below lowest rib on the left anterior

LL F Red Green

axillary line

42 Operator’s Manual ZM-540PA/541PA

• Lead MI, which is similar to standard lead I Change F/LL and L/LA of lead MII.

• Lead MIII, which is similar to standard lead

III

Change R/RA and L/LA of lead MII.

If the electrode positions above are not available due to chest surgery, attach the electrodes to the root of the limbs or below the clavicles for stable ECG monitoring.

Electrode Positions for Respiration Monitoring

Place the R/RA and F/LL electrodes so that the lungs are between the electrodes.

Position 1 In this position, respiration measurement is available; however, there is a difference in amplitude between different patients.

R or RA F or LL

NN

Right infraclavicular fossa

Fifth intercostal space on the left midclavicular line, V4

Position 2 In this position, the waveform amplitude is usually large and the ECG lead is similar to Lead MII. This position can be generally recommended.

R or RA F or LL

NN

Right infraclavicular fossa

Fifth intercostal space on the left midaxillary line, V6

Operator’s Manual ZM-540PA/541PA 43

Position 3 In this position, the respiration waveform is optimum, but the ECG lead is unusual.

R or RA F or LL

NN

Position 4 In this position, the respiration measurement is inﬂuenced by the impedance variation of the abdomen, so the cardiac pulse wave included in the respiration wave is reduced. Note that the waveform is inverted in phase compared with the chest movement (the waveform goes down during inspiration). It is difﬁcult to measure the ECG at the same time.

NN

Attaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable Electrodes

Prepare the Patient Skin

Shave off excessive body hair.

Right midaxillary at the horizontal level of V6

R or RA F or LL

Lowest rib on the right anterior axillary line

Fifth intercostal space on the left midaxillary line, V6

Lowest rib on the left anterior axillary line

To reduce skin impedance, clean the electrode site with cream or with a cotton pad moistened with alcohol. Thoroughly dry the skin with a clean cotton pad.

NOTE

• For a patient with frequent body movement, rub the sites with Skinpure skin preparation gel. However, do not use Skinpure skin preparation gel on sensitive skin.

• Do not place electrodes on a wound or on an inﬂamed, wrinkled or uneven skin surface.

Attaching Electrodes to the Patient

CAUTION

Do not reuse disposable parts and accessories.

NOTE

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

44 Operator’s Manual ZM-540PA/541PA

disposable electrode is not dry.

• When contact between the disposable electrode and skin becomes poor, replace electrodes with new ones immediately. Otherwise, contact impedance between the skin and the electrode increases and accurate ECG cannot be obtained.

Refer to the electrode operator’s manual for details.

1. Carefully remove the backing paper from the electrode. Avoid touching the adhesive surface.

2. Place the electrode on the previously cleaned skin. Pay attention to the electrode lead color and symbol.

3. Clip the electrode lead to the electrode.

4. Fasten the electrode lead wire with surgical tape with an extra length of wire between the tape and the electrode. This lessens the movement of electrode leads by body movement and helps stable monitoring.

Checking ECG on the Transmitter Screen

After attaching electrodes and connecting ECG leads, check that the electrodes are properly attached to the patient and the ECG waveform is acquired on the check electrodes screen. For details on the screen, refer to the “Screen Descriptions” section.

Attaching the SpO2 Probe

Selecting the SpO2 Probe

Select an appropriate probe for the patient.

CAUTION

Only use Nihon Kohden speciﬁed electrodes, electrode leads, SpO probes, and NIBP cuffs. Otherwise, the maximum performance from the transmitter cannot be guaranteed.

Operator’s Manual ZM-540PA/541PA 45

2

Do not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.

CAUTION

Reusable Probes

When using a TL-201T ﬁnger probe, choose the appropriate cable length for attachment.

Probe Cable Length Patient Attachment Site

Finger probe TL-201T

0.6 m

1.6 m

Adult or child 20 kg or more

Finger

Multi-site probe TL-220T

Finger probe TL-630T1, TL-630T3, TL-631T1, TL-631T3

Attachment tape

Disposable Probes

Attachment tape

TL-630T1, TL631T1: 0.6 m

TL-630T3, TL631T3: 1.6 m

Adult or infant 3 kg or more

Neonate 3 kg or less

TL-630T1/630T3: Adult or child 50 kg or more

TL-631T1/631T3: Adult or child 20 kg or more

Finger or toe

Instep and sole

Finger or toe

CAUTION

The disposable probe is not sterilized. Use the disposable probe only for a single patient. Never reuse the disposable probe for another patient because it causes cross infection.

46 Operator’s Manual ZM-540PA/541PA

TL-251T

Probe Patient Attachment Site

Adult

Finger or toe

30 kg or more

TL-252T Child

3 to 40 kg

TL-253T

Neonate 3 kg or less

TL-051S, TL-052S

Adult 50 kg or more

40 mm

Neonate 3 kg or less

Cable length TL-051S: 0.8 m TL-052S: 1.6 m

TL-061S, TL-062S

Adult or child 15 to 50 kg

Finger or toe

Instep and sole

Finger

Instep and sole

Finger

35 mm

Infant

Toe

3 to 15 kg

Cable length TL-061S: 0.8 m TL-062S: 1.6 m

Operator’s Manual ZM-540PA/541PA 47

Probe Patient Attachment Site

TL-271T, TL-271T3

Cable length TL-271T: 0.8 m TL-271T3: 1.6 m

TL-272T, TL-272T3

Cable length TL-272T: 0.8 m TL-272T3: 1.6 m

TL-273T, TL-273T3

Adult 30 kg or more

Child 10 to 50 kg

Neonate 3 kg or less

Finger or toe

Instep and sole

Adult 40 kg or more

Cable length TL-273T: 0.8 m TL-273T3: 1.6 m

TL-274T, TL-274T3

Cable length TL-274T: 0.8 m TL-274T3: 1.6 m

48 Operator’s Manual ZM-540PA/541PA

Infant 3 to 20 kg

Finger or toe

Connecting the SpO

Connect the probe to the SpO2 socket on the transmitter.

Probe to the Transmitter

2

When transmitter is attached on an arm

CAUTION

Do not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.

Attaching the Probe to the Patient

Attach the probe to the patient by referring to the probe’s manual. Make sure that the light emitter and photo detector of the probe face each other at the attachment site.

Operator’s Manual ZM-540PA/541PA 49

Do not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.

CAUTION

WARNING

• When using the TL-201T ﬁnger probe, do not fasten the probe and cable to the ﬁnger by wrapping with tape. This may cause burn, congestion or pressure necrosis from poor blood circulation.

• When using probes other than the TL-201T ﬁnger probe, to avoid poor circulation, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation.

WARNING

When monitoring SpO2 of a patient who is receiving photodynamic therapy, the light from the ﬁnger probe sensor may cause a burn. Photodynamic therapy uses a photosensitizing agent that has a side effect of photosensitivity.

WARNING

Check the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.

• Patient with a fever

• Patient with peripheral circulation insufﬁciency

• Neonate or low birth weight infant with delicate skin

50 Operator’s Manual ZM-540PA/541PA

CAUTION

If the attachment site is dirty with blood or bodily ﬂuids, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases, and measured value may be incorrect or measurement cannot be performed.

CAUTION

When the probe is attached on an appropriate site with sufﬁcient circulation and the error message conﬁrming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.

CAUTION

If the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe. Take extreme care for the patients with delicate skin.

CAUTION

Refer to the probe instruction manual for details.

CAUTION

Do not use a probe which is deteriorated by aging. Accurate measurement cannot be performed.

Operator’s Manual ZM-540PA/541PA 51

Attaching the NIBP Cuff

Selecting the NIBP Cuff

Select the NIBP cuff appropriate for the patient.

NOTE

NIBP cannot be measured on neonates using this transmitter.

Reusable Cuffs

When attaching the transmitter to the patient arm, a special NIBP cuff is required. An optional YN-990P extension hose (1.5 m) is available to extend the length between the NIBP socket on the transmitter and NIBP cuff (e.g. when not attaching the transmitter to the patient arm and placing the transmitter on a bedside).

Reusable Cuff Model Width (cm) Air Hose Length (cm)

For adult

Standard YP-503P 13 15

Large YP-504P 15 15

Air hose

Width

When not attaching the transmitter to the patient arm, the following cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.

Reusable Cuff Model Width (cm) Air Hose Length (cm)

For infant YP-960T 5

For child

For adult

52 Operator’s Manual ZM-540PA/541PA

Small YP-961T 7

Standard YP-962T 10

Standard YP-963T 13

Large YP-964T 15

Width

Air hose

15

Disposable Cuffs

CAUTION

Disposable cuffs are not sterilized. If necessary, sterilize the cuff using glutaraldehyde solution.

When not attaching the transmitter to the patient arm, the following disposable cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.

Reusable Cuff Model Width (cm) Air Hose Length (cm)

For infant YP-810P 6 17

For child YP-811P 8 17

Small YP-812P 10 17

For adult

Standard YP-813P 14 20

Medium large YP-814P 15 20

Large YP-815P 17 20

Width

Air hose

Extension Hose

CAUTION

When using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inﬂate or deﬂate. If the cuff cannot deﬂate, it may cause congestion on the patient at the cuff attachment site.

YN-990P extension hose, 150 cm

Operator’s Manual ZM-540PA/541PA 53

Reference for selecting a cuff

The AHA (American Heart Association) recommends that the cuff width be 40% of the circumference of the upper arm. Refer to the following graph and select the cuff which suits the patient’s arm.

NOTE

• If a range of arm circumference appropriate for the cuff is prescribed, use a cuff within that range.

• To obtain accurate measured values, select a wide cuff which can be attached to the upper arm. Measuring with a very narrow cuff may result in measured values higher than the actual values.

• The YP-503P NIBP cuff is for standard size adult. Do not use this cuff when it does not ﬁt the patient.

Cuff Width and Arm Circumference

Reusable Cuffs

Cuff width (cm)

Disposable Cuffs

Cuff width (cm)

Adults large YP-504P (cuff for transmitter)

15

10

Children small YP-961T

5

0

20

15

10

5

Infants YP-960T

10 20 30

Infants YP-810P

YP-964T

Adults standard YP-503P (cuff for transmitter) YP-963T

Children standard YP-962T

40

Adults large YP-815P

Adults medium large YP-814P

Adults standard YP-813P

Adults small YP-812P

Children standard YP-811P

50

Arm circumference (cm)

60

0

10 20 30

40

50 60

Arm circumference (cm)

54 Operator’s Manual ZM-540PA/541PA

Connecting the NIBP Cuff to the Transmitter

When Using YP-503P/YP-504P NIBP Cuff

To attach the YP-503P/YP-504P NIBP cuff to the transmitter, the lock plate is required.

YP-503P/YP-504P NIBP cuff

Lock plate

Front cover

Belt for the strap

Lock plate pocket

Top tab

Air hose

D ring

Belt

Front cover open

For attaching the NIBP cuff to the transmitter

NOTE

Do not roll up or put weight on the cuff when the lock plate is attached to it. The lock plate may break if the cuff is rolled up or weight is put on it when the lock plate attached.

Bottom tab

Operator’s Manual ZM-540PA/541PA 55

1. Remove the lock plate from the transmitter.

2. Insert the lock plate into the lock plate pocket on the NIBP cuff.

3. Attach the transmitter to the lock plate by inserting the tabs on the lock plate into the slots on the transmitter.

4. Cover the transmitter with the front cover of the NIBP cuff.

5. Connect the air hose to the NIBP socket on the transmitter. Turn the cuff connector joint until it

2

121

clicks.

56 Operator’s Manual ZM-540PA/541PA

When Using Disposable Cuffs or YP-960T series Reusable Cuffs

To use these NIBP cuffs, an optional YN-990P extension hose (1.5 m) is required.

NOTE

Connect the joints properly. If there is an air leak, NIBP cannot be measured properly.

1. Connect the NIBP cuff to the extension hose.

2. Connect the other end of the extension hose to the NIBP socket on the transmitter. Turn the joint clockwise until it clicks.

To disconnect the cuff from the transmitter,

turn the hose joint counterclockwise.

Attaching the NIBP Cuff to the Patient

WARNING

Be careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.

CAUTION

Do not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause reﬂux of blood and stop injection.

Do not attach the cuff to the site where there is injury or inﬂammation. If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff. Take extreme care on the patients with delicate skin.

CAUTION

Do not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may increase.

Operator’s Manual ZM-540PA/541PA 57

Do not reuse disposable parts and accessories.

CAUTION

* Monitoring SpO2 during NIBP Measurement

CAUTION

NIBP and SpO2 can be measured on the same limb, but the SpO monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO

2

values.*

2

When the SpO

same limb as the NIBP cuff, the blood ﬂow decreases during NIBP measurement and pulse wave cannot be detected and SpO

cannot be monitored properly. When

2

“INHIBIT SpO

probe is attached to the

2

DURING NIBP” on the

2

PARAMETER SETUP screen is set to ON (factory default setting), SpO

monitoring is

2

paused during NIBP measurement to avoid SpO

alarm occurrence. However, when

2

monitoring SpO NIBP, be careful when reading SpO

on the same limb as the

2

values.

2

NOTE

• Measuring NIBP at a site other than the upper arm gives different values from those measured at the upper arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm.

• To accurately detect the pulsatile ﬂow of the artery, the cuff should be wrapped around a bare upper arm.

• Do not use an abnormal cuff. The cuff deteriorates from use and cleaning. Before use, check the cuff and conﬁrm that there is no ﬂaw, crack or hole in it. Be careful not to damage the inﬂation bag. If the inﬂation bag has a hole or a ﬂaw, it may burst during use. Dispose of an abnormal cuff and replace it with a new one.

• Refer to the NIBP cuff manual for details.

Cuff Position

Place the cuffed upper arm (brachium) at the same height

When placing the transmitter on

When placing the transmitter on a bed, make sure that the hose is

a bed, make sure that the hose is not bent.

not bent.

as the patient’s heart. If the cuff is not at the same level as the heart, the weight of the blood affects the blood pressure reading. The pressure difference per unit height is 0.7 mmHg/cm. The blood pressure reading decreases when the arm is higher than the heart and increases when lower. The best measuring condition is when the patient is lying on

Heart

his/her back with arms and legs relaxed. If the cuff position cannot be on the same level as the heart, the displayed blood pressure reading must be mathematically adjusted.

58 Operator’s Manual ZM-540PA/541PA

Attaching the Transmitter on an Arm (Using the YP-503P/504P NIBP Cuff)

1. Attach the NIBP cuff to the transmitter. Refer to the “Connecting the NIBP Cuff to the Transmitter” section.

2. Before putting the cuff over the arm, insert the end of the cuff into the belt and then through the D ring as shown at left.

Belt

D ring End of cuff

3. Put the patient arm through the cuff. Fold back the cuff at the D ring and fasten it using the velcro tape.

Make sure that the cuff is not attached on a joint.

NOTE

The cuff must not wrap around the elbow.

Operator’s Manual ZM-540PA/541PA 59

Attaching the Strap to the Transmitter

NOTE

• Use the strap to prevent the transmitter from falling.

• Do not attach the clip to hard objects such as thick cloth or zipper. It will break the clip.

Attach a strap provided with the transmitter to the NIBP cuff and patient clothes.

To open the clip, ﬁrmly pull out the tab in direction of the arrow.

1. Adjust the length of the strap.

2. Clip one end of the strap to the belt for the strap on the NIBP cuff.

3. Clip the other end of the strap to the patient’s clothes as shown left.

Belt for the strap on the NIBP cuff

To adjust the strap length, push down the tab on the adjuster and slide.

60 Operator’s Manual ZM-540PA/541PA

Placing the Transmitter on the Bed (Using the Disposable Cuffs or YP-960T series Reusable Cuffs)

ARTERY ▼

RANGERANGE

1. Put the cuff on the upper arm so that the of “ARTERY patient.

2. Wrap the cuff so that “INDEX ” comes within the “

If “Index

”, change the cuff size.

▼” aligns with the artery of the

RANGE ”.

” is not within the “ RANGE

▼ mark

Operator’s Manual ZM-540PA/541PA 61

Locking the Keys on the Transmitter

To prevent the patient from pressing the keys on the transmitter during monitoring, you can lock the keys.

▼

Press the appears.

When there is no key operation for one minute after locking the keys, the display turns off.

and ▼ keys at the same time and hold for more than 3 seconds. The key lock screen

To unlock the keys: Press the

62 Operator’s Manual ZM-540PA/541PA

▼

and ▼ keys at the same time and hold for more than 3 seconds.

Monitoring

CAUTION

The measurement values and displayed waveforms on the transmitter and receiving monitor may be different due to timing delay of the display or difference in detection settings.

Screen Descriptions

When the transmitter is turned on, the startup screen appears, then the check electrodes screen appears to check the electrode attachment.

The screen changes in the following order each time the Screen key is pressed. Check electrodes → numeric and waveform → waveform review → numeric review → display off→ numeric and waveform → waveform review → numeric review → display off numeric and waveform → waveform review → numeric review → display off→ waveform review → numeric review → display off waveform review → numeric review → display off→ numeric review → display off numeric review → display off→ display off display off → check electrodes . . . check electrodes . . .

Screen key

The screen automatically turns off when there is no key operation for 2 minutes on the check electrodes screen or 1 minute on other screens.

When the display is off and the Screen key is pressed, the numeric and waveform screen appears. When the Screen key is pressed within 5 minutes after the display off, the screen before the display off appears.

Operator’s Manual ZM-540PA/541PA 63

Check Electrodes Screen

You can check whether the electrodes are properly attached to the patient and the ECG waveform is acquired.

When 6 leads are used, I, II, Va and Vb lead waveforms are displayed.

When 3 leads are used, only II lead waveform is displayed.

Battery level

Channel number

Lead

ECG waveform

Filter: off Sweep speed: 12.5 mm/s Waveform sensitivity: 0.5 cm/1 mV

Message

Detached electrode position

When electrodes are detached, the “CHECK ELECTRODES” message and detached electrode position appear on the screen.

NOTE

When ECG measurement is set to OFF on the PARAMETER SETUP screen, the check electrodes screen does not appear.

64 Operator’s Manual ZM-540PA/541PA

Numeric and Waveform Screen

Numeric values and waveforms of the monitoring parameters are displayed. You can change the ECG lead with the

▼

and ▼ keys.

Respiration rate

SpO

Pulse bar graph

2

QRS sync mark

Heart rate

NIBP measurement mode

NIBP values

ECG waveform

Filter: on Sweep speed: 12.5 mm/s Waveform sensitivity: auto

When ECG and respiration measurement is turned off

Pulse rate

Pulse sync mark

NIBP measurement mode

Pulse waveform

Sweep speed: 12.5 mm/s Waveform sensitivity: auto

SpO

Pulse bar graph

2

ECG lead

Waveform sensitivity

NIBP values

Pulse wave sensitivity

Operator’s Manual ZM-540PA/541PA 65

NOTE

The pulse wave amplitude varies according to the ratio of the pulsation component to the entire transmitted IR signal. When the pulsation component ratio is 1%, the pulse wave amplitude is about 5 mm at ×1 sensitivity on the screen.

Waveform Review Screen

ECG full disclosure for up to 10 minutes can be saved and reviewed. When ECG measurement is turned off and SpO

When ECG lead is changed on the numeric and waveform screen, the ECG full disclosure of the changed lead is saved.

The saved data is deleted when the transmitter is turned off.

Older data

is monitored, the pulse waveform is saved.

2

Time range of the displayed waveform (time before the waveform review screen is displayed)

Displayed page

Newer data

Compressed ECG waveform

Waveform sensitivity

ECG lead

7.5 s x 4 traces per page, total of 20 pages

To scroll the waveform, press the ▼ or ▼ key. The waveform is scrolled by 30 seconds.

66 Operator’s Manual ZM-540PA/541PA

Numeric Review Screen

Numeric data of heart rate (or pulse rate when ECG is turned off), SpO to 10 minutes are saved at 1 minute intervals.

NOTE

NIBP measured values are not saved.

The saved data is deleted when the transmitter is turned off.

Older data

Time before the numeric review screen is displayed

Newer data

and respiration rate for up

2

Display Off

The display can be turned off any time. To turn off the display, press the Screen key several times until the following screen appears then wait 5 seconds.

Operator’s Manual ZM-540PA/541PA 67

Basic Monitoring Operation

Using the Function Key

Function key

One of the following functions can be assigned to the Function key on the SYSTEM SETUP screen. Refer to the “Changing SYSTEM SETUP Settings” section.

SUSPEND ALARM: Suspends alarms on the receiving monitor before they occur for 2 minutes. PAUSE: Pauses monitoring on the transmitter and receiving monitor. CONFIRM: Transmits the signal that the patient is conﬁrmed and displays the “PATIENT

CONFIRMED” message on the transmitter.

NOTE

To use the Function key for PAUSE or CONFIRM, you must set “PROTOCOL” on the SYSTEM SETUP screen of the transmitter to 57 and the receiving monitor must be able to receive protocol 57.

68 Operator’s Manual ZM-540PA/541PA

Suspending Alarms on the Receiving Monitor

When the FUNCTION KEY is set to “SUSPEND ALARM” or “SUSPEND ALARM & PAUSE” on the SYSTEM SETUP screen, alarms can be suspended for 2 minutes on the receiving monitor before they occur.

To suspend alarms:

1. Press the Function key. The “Suspend alarms” conﬁrmation screen appears.

2. Press the ▼ key to suspend alarms. To cancel suspending alarms and return to the previous screen, press the Screen key.

When the alarms are suspended, the “ALARMS SUSPENDED” message and alarm suspended icon with the remaining minutes in alarm suspension appear on the transmitter screen.

Message

Icon

To cancel suspending alarms during 2 minute alarm suspension:

1. Press the Function key while the “ALARMS SUSPENDED” message is displayed. The conﬁrmation screen appears.

Operator’s Manual ZM-540PA/541PA 69

2. Press the ▼ key to cancel alarm suspension.

Press the Screen key to not cancel alarm suspension.

Pause Monitoring

When the FUNCTION KEY is set to “SUSPEND ALARM & PAUSE” on the SYSTEM SETUP screen, you can pause monitoring on the receiving monitor from the transmitter when the patient cannot be monitored, such as during X-ray examination.

NOTE

To use the Function key for PAUSE, you must set “PROTOCOL” on the SYSTEM SETUP screen of the transmitter to 57 and the receiving monitor must be able to receive protocol

57.

To pause monitoring:

1. Press the Function key. The “Suspend alarms” conﬁrmation screen appears.

2. Press the Function key for 3 seconds to display the “Pause monitoring” conﬁrmation screen.

70 Operator’s Manual ZM-540PA/541PA

3. Press the ▼ key to pause monitoring.

To cancel pause monitoring, press the Screen key.

4. Wait about 5 seconds until the “Turn power off” screen appears.

5. Turn off the transmitter.

If the transmitter is not turned off and monitoring continues for the interval set for “AUTO

RESUME AFTER PAUSE” on the SYSTEM SETUP screen, pause monitoring is cancelled and monitoring continues.

Resume Monitoring after Pause

To resume monitoring after pause, check that the electrodes, electrode leads and probe are attached to the patient then turn on the transmitter.

Operator’s Manual ZM-540PA/541PA 71

Conﬁrming Patient

When the FUNCTION KEY is set to “CONFIRM” on the SYSTEM SETUP screen, you can transmit signal to the receiving monitor to indicate that the patient is conﬁrmed by a medical staff by pressing the Function key.

Message

Turning the Display Off

The display can be turned off any time. To turn off the display, press the Screen key several times until the following screen appears then wait 5 seconds.

5 second time bar until the display turns off

Turning the Display On after It was Turned Off

Press the Screen key. The numeric and waveform screen appears. If the screen is turned off on the “Keys locked” screen, the “Keys locked” screen appears.

When the Screen key is pressed within 5 minutes after the display was turned off, the previous screen appears.

72 Operator’s Manual ZM-540PA/541PA

ECG and Respiration Monitoring

When the electrodes are attached and the ECG leads are connected, the heart rate, ECG waveform, respiration rate and respiration waveform appear on the receiving monitor. Refer to the operator’s manual of the receiving monitor for details.

When 6 leads are used on this transmitter, up to 8 lead (I, II, III, aVR, aVL, aVF, Va and Vb) of ECG waveforms can be displayed on the receiving monitor. The heart rate is also measured. When 3 leads are used, one channel ECG waveform of lead II can be displayed on the receiving monitor. Refer to the operator’s manual of the monitor for details.

QRS sync mark

ECG waveform

Heart rate

Filter: on Sweep speed: 12.5 mm/s Waveform sensitivity: auto

Respiration rate

ECG lead

You can change the ECG lead with the

▼

and ▼ keys.

WARNING

Interaction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac Monitoring and Diagnostic Equipment* The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor. If this occurs, disconnect the electrode leads from the patient or change the setting on the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker representative or Nihon Kohden representative.

* Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectric

Operator’s Manual ZM-540PA/541PA 73

impedance measurement (BIM). Many medical devices in addition to pacemakers use this technology. When one of these devices is used on a patient with an active, minute ventilation rateadaptive pacemaker, the pacemaker may erroneously interpret the mixture of BIM signals created in the patient, resulting in an elevated pacing rate. For more information, see the FDA web site. http://www.fda.gov/cdrh/safety.html

WARNING

When the transmitter 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 transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.

CAUTION

Turn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.

NOTE

• Noise generated from an electrosurgical unit may interfere on an ECG waveform, but will

not damage it.

• If an electric blanket is used and incorrect heart rate is displayed on the monitor, turn off

the pacing spike detection on the monitor.

• Turn the pacing spike detection to ON on the receiving monitor when monitoring a

pacemaker patient. Pacing pulse is detected by the transmitter and transmitted to the monitor. If the pacing spike detection is turned OFF, QRS and pacemaker spike might not be distinguished and pacemaker failure might not be recognized.

• ECG cannot be monitored on a neonate using this transmitter.

74 Operator’s Manual ZM-540PA/541PA

Turning ECG Measurement On/Off

ECG measurement can be turned on or off on the PARAMETER SETUP screen. When electrodes are attached to the patient and ECG leads are connected, ECG monitoring starts even when ECG is turned off.

When PROTOCOL on the SYSTEM SETUP screen is set to 57:

ECG measurement on the receiving monitor is automatically set to off.

NOTE

ECG measurement on the transmitter cannot be turned on or off from the receiving monitor.

When PROTOCOL on the SYSTEM SETUP screen is set to 42:

If ECG measurement is turned off on the transmitter, ECG measurement on the receiving monitor must also be turned off.

Turning Respiration Measurement On/Off

Respiration measurement can be turned on or off on the PARAMETER SETUP screen. If respiration measurement is turned off, respiration measurement on the receiving monitor is also turned off.

Electrode Detachment

In the following conditions, the “CHECK ELECTRODES” message is displayed on the transmitter and receiving monitor.

• Electrode is detached from skin.

• Electrode lead is disconnected from the electrode.

• Polarization voltage between the electrode and skin is excessively high.

In these cases, check the cause and if necessary, replace electrodes with new ones.

CAUTION

When the “ELECTRODE OFF” or “CHECK ELECTRODES” message is displayed on the receiving monitor, ECG is not monitored properly and the ECG alarm does not function. Check the electrode, electrode leads, and if necessary, replace with new ones.

Operator’s Manual ZM-540PA/541PA 75

SpO2 Monitoring

When monitoring starts, SpO2 and pulse waveform are sent to the monitor and SpO2 and pulse level bar graph are displayed on the transmitter screen. When ECG is not measured, pulse waveform and pulse rate are also displayed.

Filter: on Sweep speed: 12.5 mm/s Waveform sensitivity: auto

2

Pulse bar graphSpO

76 Operator’s Manual ZM-540PA/541PA

WARNING

SpO2 measurement may be incorrect in the following cases.

• When the patient’s carboxyhemoglobin or methemoglobin increases abnormally.

• When dye is injected in the blood.

• When using an electrosurgical unit.

• During CPR.

• When measuring at a site with venous pulse.

• When there is body movement.

• When the pulse wave is small (insufﬁcient peripheral circulation).

WARNING

Check the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.

• Patient with a fever

• Patient with peripheral circulation insufﬁciency

• Neonate or low birth weight infant with delicate skin

WARNING

When monitoring SpO2 of a patient who is receiving photodynamic therapy, the light from the ﬁnger probe sensor may cause a burn. Photodynamic therapy uses a photosensitizing agent that has a side effect of photosensitivity.

Operator’s Manual ZM-540PA/541PA 77

When not monitoring SpO2, disconnect the SpO transmitter. Otherwise, noise from the probe sensor may interfere and incorrect data is displayed on the screen.

WARNING

cable from the

2

CAUTION

Turn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.

CAUTION

Do not pull or bend the probe cable, and do not put caster feet on the probe cable. Do not immerse the disposable probe cable in chemical solutions or water. Failure to follow these instructions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one.

CAUTION

Normal external light does not affect monitoring but strong light such as a surgical light or sunlight may affect monitoring. If affected, cover the measuring site with a blanket.

CAUTION

When a message indicates a faulty probe, stop monitoring and replace the probe with a new one.

When the probe is attached on an appropriate site with sufﬁcient circulation and the error message conﬁrming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.

While a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO displayed.

CAUTION

value might not be

2

NOTE

In order to maintain sufﬁcient blood circulation, keep the measurement site warm by covering it with a blanket or something similar. Warming the site is effective, especially for a patient with a small pulse amplitude.

78 Operator’s Manual ZM-540PA/541PA

Monitoring SpO

during NIBP Measurement

2

CAUTION

NIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO

When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood ﬂow decreases during NIBP measurement and pulse wave cannot be detected and SpO properly. When “INHIBIT SpO (factory default setting), SpO occurrence. However, when monitoring SpO SpO

values.

2

DURING NIBP” on the PARAMETER SETUP screen is set to ON

2

monitoring is paused during NIBP measurement to avoid SpO2 alarm

2

on the same limb as NIBP, be careful when reading

2

cannot be monitored

2

values.

2

When monitoring SpO

is important, attach the probe to the limb to which the NIBP cuff or catheter

2

is not attached.

When SpO2 monitoring is paused during NIBP measurement, the SpO2 value just before the start of NIBP measurement and an When NIBP measurement is not completed after 30 seconds, “– – –” is displayed for the SpO

mark are displayed on the transmitter for 30 seconds.

value.

2

The same data also appears on the monitor screen.

NOTE

• When continuous SpO2 monitoring is necessary, attach the probe to the limb to which the NIBP cuff is not attached and set “INHIBIT SpO SETUP screen to OFF.

• When the probe is attached to the same limb as the NIBP cuff, set the sync source to a parameter other than SpO

• When monitoring SpO

on the receiving monitor.

2

during STAT NIBP measurement, attach the probe to the limb to

2

which the NIBP cuff is not attached.

DURING NIBP” on the PARAMETER

2

Operator’s Manual ZM-540PA/541PA 79

NIBP Monitoring

Selecting the Initial Cuff Inﬂation Pressure

The initial cuff inﬂation pressure can be changed on the PARAMETER SETUP screen. The default setting is 180 mmHg. To change the setting, refer to the “Changing PARAMETER SETUP Settings” section.

Selecting the Measurement Mode and Interval

Measurement Modes

There are three measurement modes: manual, auto and STAT. The selected mode or interval is displayed on the screen.

The measurement mode and interval can be changed by pressing the NIBP Interval key. When the key is pressed, the NIBP mode setting screen appears. The measurement modes selected at “SELECTABLE INTERVALS” on the PARAMETER SETUP screen are displayed (key color: white). Select the measurement mode with the Function key.

Selected mode (key color: blue)

▼

and ▼ keys or NIBP Interval key and press the

Modes selected at “SELECTABLE INTERVALS” on the PARAMETERS SETUP screen (key color: white)

To select the modes to be displayed on the NIBP mode setting screen, refer to the “Changing PARAMETER SETUP Settings” section.

Manual Measurement

In Manual mode, a single NIBP measurement is performed when the NIBP Start/Stop key is pressed.

STAT (Continuous) Measurement

In STAT mode, measurement is continuously repeated for 15 minutes after the NIBP Start/Stop key is pressed.

When the STAT measurement for 15 minutes is completed, the measurement mode automatically changes to the Manual mode or Auto mode of selected interval depending on the “NIBP MODE

80 Operator’s Manual ZM-540PA/541PA

AFTER STAT” setting on the PARAMETER SETUP screen. The default setting is Manual mode. Refer to the “Changing Parameter Setup Settings” section.

The STAT measurement completes within 15 minutes. When more than 12 minutes elapse from the start of measurement, there will be no more measurement performed and the measurement mode changes to the mode selected for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen.

Auto Measurement

In Auto mode, measurement is performed automatically at the preset time intervals.

In Auto mode, a single measurement can be performed by pressing the NIBP Start/Stop key between auto measurements.

Measuring NIBP

WARNING

Be careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.

WARNING

When performing NIBP measurements in STAT mode or 5 minute intervals, periodically remove the cuff from the patient for ventilation. The skin temperature may increase at the cuff attachment site by 2 or 3°C (4 or 5°F). When measuring a patient with a fever or peripheral circulation insufﬁciency, it may cause a burn.

CAUTION

When performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.

WARNING

NIBP measurement may be incorrect in the following cases.

• When using an electrosurgical unit

• When there is body movement

• When the pulse wave is small (insufﬁcient peripheral circulation)

• Too many arrhythmias

• When there is vibration

• When there is a rapid blood pressure change

• During CPR

Operator’s Manual ZM-540PA/541PA 81

NOTE

• When measuring patients who are conscious, help the patient to relax. Measurement may not be accurate if the patient’s arm is tense or if the patient talks.

• The data for measurement on a leg tends to be higher than measurement on the arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm.

• Do not apply pressure to the cuff or air hose. NIBP may not be measured correctly because of noise or NIBP measurement may stop due to the NIBP safety circuit.

• When the transmitter is attached to the patient arm and the NIBP measurement is performed when moving, tell the patient to relax and keep quiet. Otherwise, measurement may be stopped or remeasurement is repeated due to body movement.

• If there is an abnormal noise generated during measurement, stop using the transmitter and contact your Nihon Kohden representative.

• Do not measure NIBP of a patient on whom an IABP is being used. Measurement may be incorrect due to the mixing of the patient’s own pulse and IABP pulse.

• NIBP cannot be measured on a neonate using this transmitter.

1. Press the NIBP Interval key to display the NIBP mode setting screen.

NIBP Interval key

2. Select the measurement mode by pressing the NIBP Interval key or

Selected mode (key color: blue)

3. Press the Function key.

4. Press the NIBP Start/Stop key to perform measurement.

82 Operator’s Manual ZM-540PA/541PA

and ▼ keys.

▼

NIBP Start/Stop key

The cuff is inﬂated and the inﬂation pressure is displayed on the screen.

Inﬂation pressure

In manual mode: Measurement is performed once. In STAT mode: Measurement is performed repeatedly for 15 minutes. In auto mode: The ﬁrst measurement is performed when the NIBP Start/Stop key is

pressed. The second measurement is performed when the current time in the transmitter reaches the selected time interval.

To stop measurement during measurement, press the NIBP Start/Stop key again.

In STAT mode, after completing the STAT measurement, the measurement mode changes to the

mode set for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen.

In auto mode, to stop measurement in auto mode, change the mode to manual. To cancel one

measurement, press the NIBP Start/Stop key during measurement.

After the measurement is complete, the measured data is displayed on the screen and is transmitted to the monitor.

Operator’s Manual ZM-540PA/541PA 83

Systolic value

NIBP measurement mode

When ECG and SpO2 are not monitored (ECG measurement is turned off and SpO2 probe is not connected to the transmitter), the pulse rate at the end of NIBP measurement is displayed.

A buzzer can be set to sound at the start and end of NIBP measurement. Refer to the “Changing PARAMETER SETUP Settings” section.

Auto Mode Measurement

When auto mode measurement is selected, “STANDBY” message is displayed on the screen until the NIBP Start key is pressed for the ﬁrst time.

Diastolic value

MAP value

STANDBY message

84 Operator’s Manual ZM-540PA/541PA

A time bar appears to indicate the interval between auto mode measurements.

Time bar indicating the interval between measurements

During auto mode measurement, the measurement mode can be changed. During the interval, press the NIBP Interval key to change the mode. When “MANUAL” is displayed for more than one second, the measurement in auto mode is stopped.

Data Display After NIBP Measurement

When the time set at “OLD NIBP DATA” on the PARAMETER SETUP screen elapses after the last measurement, the NIBP data is dimmed or hidden. Whether to dim or hide the old data can also be selected at “OLD NIBP DATA”. Refer to the “Changing PARAMETER SETUP Settings” section.

Data Display on the Receiving Monitor

When the “BATTERY” message is displayed on the receiving monitor, NIBP might not have been measured according to the NIBP interval setting. Therefore, the NIBP data displayed on the receiving monitor might not be updated. In this case, check the measurement time of the NIBP data displayed on the receiving monitor.

Monitoring SpO

When the SpO during NIBP measurement and pulse wave cannot be detected and SpO properly. When “INHIBIT SpO ON (factory default setting), SpO alarm occurrence. However, when monitoring SpO reading SpO

during NIBP Measurement

2

probe is attached to the same limb as the NIBP cuff, the blood ﬂow decreases

2

cannot be monitored

2

DURING NIBP” on the PARAMETER SETUP screen is set to

2

monitoring is paused during NIBP measurement to avoid SpO2

2

on the same limb as the NIBP, be careful when

2

values.

2

Operator’s Manual ZM-540PA/541PA 85

Indication and Message List

Indication

Indication Cause Countermeasure

Fully charged batteries

Batteries are 2/3 full.

Batteries are low. NIBP cannot be measured.

Batteries are very weak.

Replace batteries.

——

Alarms on the receiving monitor were suspended by pressing the Function key on the transmitter.

Alarms resume when the suspend interval elapses. To cancel alarm suspension, press the Function key again.

Messages

When PROTOCOL on the SYSTEM SETUP screen is set to 57, all messages are transmitted. When PROTOCOL is set to 42, the messages marked with * are not transmitted.

Message Cause Countermeasure

The cuff and extension hose are not properly connected.

AIR LEAK

ALARMS SUSPENDED

BATTERY WEAK

The cuff hose (or extension hose) is not properly connected to the NIBP socket.

The cuff or extension hose is damaged. Replace with a new one.

Alarms on the receiving monitor is suspended by pressing the Function key on the transmitter.

Dead batteries

Connect them properly.

Alarms resume when the 2 minute suspend interval elapses. To cancel alarm suspension, press the Function key again.

Replace batteries.

86 Operator’s Manual ZM-540PA/541PA

Message Cause Countermeasure

Check the patient condition, probe attachment or change the attachment site.

Reattach the probe.

Attach the probe to the patient properly.

Refer to the cause and countermeasure for each message in this Messages table and remove the cause.

Measure by palpation or auscultation.

Wrap the cuff on the patient properly.

Firmly connect the electrode lead to the electrode.

Firmly connect the electrode lead to the transmitter.

Replace the electrode lead with a new one.

CANNOT DETECT PULSE* (displayed in blue)

CANNOT DETECT PULSE (displayed in pink)

CHECK ELECTRODES

Poor blood circulation for measuring the SpO

value.

2

The probe is attached too tightly and is obstructing the blood circulation.

The probe is not attached to the patient properly.

“LIGHT INTERFERENCE”, “CHECK PROBE SITE” or “DETECTING PULSE” message is displayed for more than 30 seconds.

The patient’s pulse wave is too small to measure NIBP.

The cuff is not wrapped on the patient properly.

Electrode lead is disconnected from the electrode.

Electrode lead is disconnected from the transmitter.

Electrode lead discontinuity.

Electrode is not ﬁrmly attached to the skin.

Polarization voltage is abnormally

Replace the electrode with a new one.

high.

CHECK PROBE

The probe is not attached to the patient properly.

The probe is not attached at the appropriate site.

The probe is disconnected from the transmitter.

Attach the probe to the patient properly.

Attach the probe to an appropriate site indicated in the probe manual.

Connect the probe cable to the transmitter.

The probe is past its expiration date. Replace the probe with a new one.

CHECK PROBE SITE*

CUFF OCCLUSION

The probe is not attached at the appropriate site.

The probe is deteriorated.

The probe is past its expiration date.

Transmitter malfunction.

Attach the probe to an appropriate site indicated in the probe manual.

Replace the probe with a new one.

Immediately remove the cuff from the patient and contact your Nihon Kohden representative.

Operator’s Manual ZM-540PA/541PA 87

Message Cause Countermeasure

DETECTING PULSE

Searching for the correct pulse wave for SpO

The SpO

monitoring.

2

value cannot be obtained

2

because the waveform is unstable.

The probe is not attached to the patient

Wait until the pulse wave is detected.

Attach the probe to the patient properly.

properly.

HIGH CUFF PRESS

INFLATION PRESS LOW

LIGHT INTERFERENCE

MEAS TIMEOUT

NIBP MODULE ERROR

NO NIBP CHANGE BATTERIES

Enormous pressure was applied by the pressure of the cuff.

Insufﬁcient cuff inﬂation pressure.

The SpO

measurement site is under

2

ﬂuorescent light, surgical light, sunlight, or other strong light.

Considerable body movement.

The probe is not attached to the patient properly.

SpO

monitoring is paused for NIBP

2

measurement.

The NIBP measuring time exceeded the speciﬁed time due to arrhythmia, body movement, vibration or, cuff or air hose being squeezed.

Module malfunction.

NIBP cannot be measured due to low battery.

Remove the cause.

Wait for the remeasurement to be performed with increased cuff inﬂation pressure.

Cover the measurement site with a blanket or cloth.

When the message is displayed frequently, check the patient condition and, if necessary, change the attachment site.

Wait for NIBP measurement to ﬁnish.

Remove the cause if the cause is body movement, vibration or squeezing of cuff or hose.

Contact your Nihon Kohden representative.

Replace batteries with new ones.

Function key is pressed and the

“PATIENT CONFIRMED” signal is PATIENT CONFIRMED*

transmitted to the receiving monitor.

(When “PATIENT” is assigned as the

——

function for the Function key on the

SYSTEM SETUP screen.)

PROBE FAILURE*

The probe is past its expiration date.

Probe is damaged or short-circuited.

Replace the probe with a new one.

88 Operator’s Manual ZM-540PA/541PA

Message Cause Countermeasure

If the message still appears after remeasurement, remove the cause if the cause is body movement, vibration or squeezing of cuff or

REMEASURING

NIBP is being remeasured due to

arrhythmia, body movement, vibration

or, cuff or air hose being squeezed.

hose.

SAFETY CIRCUIT ERROR

SAFETY CIRCUIT

The NIBP safety circuit error.

Immediately remove the cuff from the patient and contact your Nihon Kohden representative.

Check that the hose is not bent or

squeezed. RUNNING (When this message is displayed, measurement cannot be

NIBP measurement stopped by the safety circuit.

Wait 40 seconds, then perform

remeasurement. If the message still

appears, contact your Nihon Kohden

representative. performed for 40 seconds.)

SpO

MODULE

2

ERROR*

Transmitter failure.

Contact your Nihon Kohden

representative.

The maximum blood pressure cannot SYS OUT OF RANGE

be measured even when the cuff

inﬂation pressure exceeded 280 mmHg

Measure by palpation or auscultation.

when using adult cuff.

Check the patient condition and change the probe attachment site.

Check the probe attachment condition and if necessary, reattach the probe.

Measure NIBP by palpation or auscultation.

WEAK PULSE* (displayed in blue)

WEAK PULSE (displayed in pink)

Poor peripheral circulation.

The probe is attached too tightly and is

obstructing the blood circulation.

The patient’s pulse wave is too small

to measure NIBP.

The cuff is wrapped too loosely. Wrap the cuff properly.

The cuff size is not appropriate. Use the appropriate cuff.

ZEROING NIBP zero balance is being adjusted.

Do not touch the cuff during zeroing. Wait for the message to disappear.

Operator’s Manual ZM-540PA/541PA 89

Message Display Priority

When more than one message condition occurs on the transmitter, only the message with the highest priority is displayed.

Priority Message

Highest PATIENT CONFIRMED

SAFETY CIRCUIT RUNNING

CUFF OCCLUSION

PROBE FAILURE

CHECK ELECTRODES

NIBP MODULE ERROR

SYS OUT OF RANGE

HIGH CUFF PRESS

AIR LEAK

MEAS TIME OUT

CANNOT DETECT PULSE (NIBP)

SpO

MODULE ERROR

2

CHECK PROBE

CHECK PROBE SITE

CANNOT DETECT PULSE (SpO

)

2

LIGHT INTERFERENCE

REMEASURING

INFLATION PRESS LOW

WEAK PULSE (NIBP)

ZEROING

NO NIBP CHANGE BATTERIES

DETECTING PULSE

WEAK PULSE (SpO

)

2

ALARMS SUSPENDED

Lowest BATTERY WEAK

90 Operator’s Manual ZM-540PA/541PA

Nihon Kohden ZM 540PA, ZM 541PA Users manual

Specifications and Main Features

Frequently Asked Questions

User Manual