Nihon Kohden ZS 940PA User Manual

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TRANSMITTER

ZS-940PA

0614-009355

Model: ZS-940PA

Manual code no.: 0614-009355

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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 battery-

operated 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.

Operator's Manual ZS-940PA i

(3) Clean the instrument together with all accessories for their next use.

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 distributor.

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 ZS-940PA

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 device to sale by or on the order of a physician.

Equipment Authorization Requirement

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

Operator's Manual ZS-940PA iii

EMC RELATED CAUTION

This equipment and/or system complies with the International Standard IEC60601-1-2 for electromagnetic compatibility for medical electrical equipment and/or system. However, an electromagnetic environment that exceeds the limits or levels stipulated in the IEC60601-1-2, 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 if it is interfered with by an emitter source such as an authorized radio station. Keep the emitter source such as cellular phone away from the equipment and/or system.

2.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.

3.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.

If the above suggested remedial actions do not solve the problem, consult your Nihon Kohden Corporation subsidiary or distributor for additional suggestions.

iv Operator's Manual ZS-940PA

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 ZS-940PA v

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

Defibrillation proof type BF applied part

Defibrillation proof type CF applied part

Attention, consult operator’s manual

Direction for attaching battery cover

Inside Battery Case

Direct current

Serial number

Year of manufacture

CSA mark

Symbol Description Symbol Description

Battery position

On LCD

Attention, consult operator’s manual

Symbol Description Symbol Description

Full battery

Replace battery NIBP cannot be measured

Replace battery Check electrode

vi Operator's Manual ZS-940PA

Introduction

The ZS-940PA transmitter transmits ECG, respiration, SpO2, NIBP and pulse waveform from a patient to a Nihon Kohden monitor for continuous monitoring. The transmitter can change channels when connected to the QI-901PK channel writer. The front LCD displays SpO NIBP, pulse rate, pulse waveform amplitude, electrode condition mark, battery condition and NIBP measuring mode and interval.

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

CAUTION

• Do not use the same channel for different patients. Otherwise, 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 transmitters of adjacent channels in a hospital. Otherwise, radio waves from one transmitter affect the receiver of the adjacent channel’s transmitter and there may be interference.

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.

• NIBP cannot be measured on a neonate. (ECG, respiration and SpO monitored on a neonate.)

can be

Operator's Manual ZS-940PA 1

Panel Description

Front Panel

LCD:

Displays measuring data, settings and other information.

NIBP START/STOP key:

Starts/stops NIBP measurement in selected mode.

NIBP INTERVAL key:

Selects NIBP measurement mode.

Refer to the WARNING below. (This symbol is attached to the rear of the battery case cover.)

Battery case:

Contains three 1.5 V AA batteries.

WARNING

Close the battery case cover during operation. If the transmitter is used with the battery case cover open, the patient may get an electrical shock when defibrillation is performed, and electrostatic discharge by the patient may intermittently interfere with the waveform or data.

2 Operator's Manual ZS-940PA

Rear Panel

Lock plate:

Fastens the transmitter to an NIBP cuff.

Refer to the WARNING below.

WARNING

If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden distributor. If a wet transmitter is used, the patient or anyone in contact with the transmitter may receive an electric shock or patient leakage current over the allowed amount may flow.

Operator's Manual ZS-940PA 3

Top Panel

NIBP socket:

Connects the cuff hose.

Refer to the WARNING on the next page.

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 monitor.

Refer to the WARNING on the next page.

ECG/impedance RESP socket:

Connects the electrode lead for measuring ECG and/or respiration by the impedance method.

Refer to the symbol page.

SpO

socket:

Connects the SpO

probe.

4 Operator's Manual ZS-940PA

WARNING

• Before performing defibrillation, check that the electrode leads and SpO probe attached to the patient are properly connected to the transmitter. Touching the metal parts of disconnected leads and probes causes serious electrical shock or injury by discharged energy.

• When performing defibrillation, all persons must keep clear of the bed and must not touch the patient, any equipment connected to the patient or the metal parts of leads and probes connected to the patient. Failure to follow this warning may result in serious electrical burn, shock or other injury.

• When performing defibrillation, discharge as far as possible from electrodes and medicine on the chest of the patient. If there is a possibility that the defibrillator paddle could touch electrodes and medicine, remove electrodes and medicine from the patient. If the defibrillator contacts these materials, the discharged energy may cause serious electrical burn on the patient.

• When using this transmitter with an ESU, the ESU return plate and the electrodes for monitoring must be firmly attached to the patient. If the return plate is not attached correctly, it may burn the patient’s skin where the electrodes are attached. Refer to the instruction manual for the ESU.

CAUTION

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

Operator's Manual ZS-940PA 5

LCD

1234

LOCK KEYS

No. Name Description

1 NIBP SYS Displays NIBP systolic value. 2 NIBP DIA Displays NIBP diastolic value. 3 NIBP MEAN Displays NIBP mean value.

“CUFF” is displayed with the cuff inflation pressure during measurement.

4 Check electrode mark Appears when an electrode or electrode lead becomes

detached during ECG measurement.

5 Battery replacement mark Appears when the batteries are weak. For details, refer to

the “Battery Condition Indication” section. 6 Message display area Displays messages. 7 NIBP measurement mode Displays NIBP measurement mode. When set to auto mode,

the measurement interval is displayed. 8 NIBP interval bar graph In auto NIBP measurement, the remaining time from the last

measurement to the next measurement is displayed as a bar

graph. 9 Pulse level bar graph Displays pulse level in 7 steps.

10 %SpO

11 PR Displays pulse rate when NIBP or SpO

Displays SpO2 data.

the SpO

probe is attached to the patient, the real time pulse

rate is displayed. When the SpO

patient, the pulse rate at the end of NIBP measurement is

displayed.

is measured. When

probe is not attached to the

6 Operator's Manual ZS-940PA

Notes on Parameter Settings

When monitoring NIBP and SpO2, the following settings must be set as indicated in the table to properly transmit the monitoring data to the receiving monitor. Otherwise, data cannot be displayed on the receiving monitor even when NIBP and SpO

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

TYPE setting INHIBIT SpO2 DURING NIBP setting SpO2 probe attachment site

OFF

*1Always set to “A”.

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.

are measured on the transmitter.

Probe can be attached to the same limb as the cuff Probe must be attached to the limb without cuff*

Operator's Manual ZS-940PA 7

Important Safety Information

General

WARNING

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

• Never use this transmitter in a high-pressure oxygen medical care tank. Failure to follow this warning may cause explosion or fire.

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

• If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden distributor. If a wet transmitter is used, the patient or anyone in contact with the transmitter may receive an electric shock or patient leakage current over the allowed amount may flow.

• Before cleaning or disinfecting the transmitter, remove the batteries from the transmitter.

• The transmitter cannot be sterilized.

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 because 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.

8 Operator's Manual ZS-940PA

Preparation

Installing (Replacing) Batteries

WARNING and CAUTION for Battery Handling

WARNING

• Do not dispose of the battery in fire because it may explode.

• Do not use a disassembled or damaged battery. The contents of the battery are harmful and the battery may catch fire.

• If the contents of the battery contact the skin or clothes, immediately wash it thoroughly with water.

• Never short-circuit the + and – terminals. The battery may overheat and catch fire.

• Take care that the patient does not swallow batteries.

CAUTION

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

• Do not handle the batteries with wet hands.

• When the transmitter is not in use, remove batteries. When batteries are installed, battery power is consumed even if measurement is not performed. Especially, when NiMH batteries remain in the transmitter when the transmitter is not in use, the battery may become unusable from overdischarge and leak liquid which will damage the transmitter.

• The battery charger must be used outside the patient environment.

Battery Lifetime

Use three AA type alkaline dry cell batteries. NiMH rechargeable batteries can also be used.

Type Lifetime (Measuring parameters)

ECG, SpO2, NIBP ECG, SpO

ECG only

NiMH secondary 2 days 2 days 2.5 days Alkaline primary 1 day 2.5 days 3 days

The above data is when new batteries are used at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO

is measured on an index finger of a male patient with

weight 60 kg. Operation time depends on the thickness of SpO

Operator's Manual ZS-940PA 9

probe attachment site.

NOTE

When using rechargeable NiMH batteries, shallow charging/discharging shortens battery capacity. For details, refer to the battery operator’s manual.

Installing (Replacing) Batteries

CAUTION

Battery replacement must be performed by medical staff. When replacing batteries of the transmitter currently used for a patient, disconnect 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 a person replacing batteries touches the patient during battery replacement, patient leakage current over the allowed amount may flow.

CAUTION

• Replace all batteries at the same time.

• Do not use different types of batteries together.

NOTE

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

Procedure

1. Remove the battery case cover.

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

10 Operator's Manual ZS-940PA

3. Close the cover.

NOTE

Remove the batteries before disposing of the transmitter.

Situations Requiring Battery Replacement

Replace the batteries when any of the following occurs.

• The transmitter LCD displays the “

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

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

• The monitor displays the battery replacement message on the screen.

Battery Condition Indication

The battery condition is indicated as follows.

Indication Condition Receiving Monitor

Fully charged battery

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

indication

Dead batteries

” or “ ”mark.

Batteries are full. There is no indication on the monitor.

Message requiring battery replacement is displayed.

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

Operator's Manual ZS-940PA 11

Turning the Transmitter On/Off

Turning On the Power

Peep

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.

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

NOTE

Replace the batteries when the LCD displays the “

Turning Off the Power

To turn off the power, remove batteries.

” or “ ”mark.

Appearance

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

• The transmitter is completely dry.

• The electrode lead, SpO

• There are no damaged or dirty parts on the disposable SpO

probe and NIBP cuff are not broken.

probe, disposable electrodes or

disposable NIBP cuff.

Batteries

• The battery polarity is correct.

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

• The battery case cover is firmly closed.

Channel Setting

• The transmitter channel corresponds to those of the receiving monitor.

• There is no transmitter in the surrounding area with the same channel.

12 Operator's Manual ZS-940PA

Check Items After Power On

After turning on the power, check the following.

Power On

• The Power switch is not broken.

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

• The transmitter does not generate a continuous “peep” sound.

• The transmitter does not give excessive heat.

• The transmitter LCD displays a “

” mark.

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

Basic Operation

• 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.

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.

• When the transmitter gets 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.

• The batteries are removed from the transmitter when it will not be used for a long time.

• Dead batteries are disposed of properly.

Operator's Manual ZS-940PA 13

Changing the Transmitter Channel

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

WARNING

The following action 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 on his or her responsibility.

• 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 ZS-940PA transmitter.

To check the transmitter channel, refer to “CHANNEL/TYPE” in the “Changing System Setup Settings” section.

14 Operator's Manual ZS-940PA

Changing Parameter Setup Settings

The initial settings on the PARAMETER SETUP screen must be changed before monitoring. Changing these settings during monitoring interrupts monitoring.

Parameter Setup Setting List

The factory default settings are underlined.

Setting Item Description Settings

SELECTABLE INTERVALS

INITIAL INTERVAL

INITIAL CUFF PRESS

NIBP MODE AFTER STAT START/FINISH SOUND

OLD NIBP DATA AFTER

INHIBIT SpO DURING NIBP 2ND PARAMETER Set SpO2 and PR display order. SpO2, PR

Select the NIBP measurement modes for the mode selection.

Select the initial NIBP measurement mode at power on.

Select the NIBP cuff inflation pressure.

Select the NIBP measurement mode after completing STAT measurement. Turn ON or OFF the sound for NIBP measurement start/finish. Select whether to hide or dim the NIBP data after measurement and how long to wait after measurement to dim or hide it.

Turn SpO NIBP measurement.

monitoring on or off during

STAT, 5, 10, 15, 30, 60, 120, 240 MAN., 5 min, 10 min, 15 min, 30 min, 60 min, 120 min, 240 min 120 mmHg, 150 mmHg, 180 mmHg, 210 mmHg, 240 mmHg MAN., 5 min, 10 min, 15 min, 30 min

ON, OFF/ON, OFF

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

ON, OFF

Displaying the PARAMETER SETUP Screen

1. Remove one battery.

2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears.

Operator's Manual ZS-940PA 15

3. Press the NIBP START/STOP key to enter the PARAMETER SETUP screen.

When the cursor is moved to “EXIT” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the startup screen appears, then the monitoring screen appears.

4. To select or change a setting, press the NIBP START/STOP key. To move the cursor, press the NIBP INTERVAL key.

Selects or changes setting

Moves cursor

When the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the SETUP screen appears.

Changing Settings

SELECTABLE INTERVALS

During monitoring, 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. Press the NIBP INTERVAL key to move the cursor to the desired mode.

2. Press the NIBP START/STOP key to select or unselect the mode. Selectable modes are: STAT, 5, 10, 15, 30, 60, 120 and 240 min.

16 Operator's Manual ZS-940PA

INITIAL INTERVAL

Select the initial NIBP measurement mode at power on.

1. Press the NIBP INTERVAL key to move the cursor to “INITIAL INTERVAL”.

2. Press the NIBP START/STOP key to select the mode. Selectable modes are the modes selected for “SELECTABLE INTERVALS” and “STAT” and “MAN.” (MANUAL).

INITIAL CUFF PRESS

Select the NIBP cuff inflation pressure.

1. Press the NIBP INTERVAL key to move the cursor to “INITIAL CUFF PRESS”.

2. Press the NIBP START/STOP key to select the inflation pressure from 120, 150, 180, 210 and 240 mmHg.

NIBP MODE AFTER STAT

Select the NIBP measurement mode after completing the STAT measurement.

1. Press the NIBP INTERVAL key to move the cursor to “NIBP MODE AFTER STAT”.

2. Press the NIBP START/STOP key to select the mode. The selected mode is automatically selected for “SELECTABLE INTERVALS” as well.

Operator's Manual ZS-940PA 17

START/FINISH SOUND

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

Start sound

End sound

1. Press the NIBP INTERVAL key to move the cursor to “START/FINISH SOUND”.

2. Press the NIBP START/STOP key to turn ON or OFF.

OLD NIBP DATA/AFTER

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. Press the NIBP INTERVAL key to move the cursor to “OLD NIBP DATA/AFTER”.

2. Press the NIBP START/STOP key to select the setting.

DATA: DIM NIBP data is dimmed after the “AFTER” interval.

HIDE NIBP data is hidden after the “AFTER” interval. “– – –” is displayed on the

screen.

AFTER: Select the interval after NIBP measurement to dim or hide.

Dimmed Hidden

18 Operator's Manual ZS-940PA

INHIBIT SpO2 DURING NIBP

Set whether or not to monitor SpO

during NIBP measurement.

When the SpO OFF, the pulse may become unstable and SpO set this setting to ON so that SpO

When the SpO

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

or PR alarm may occur. It is recommended to

is not measured during NIBP measurement.

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

OFF.

NOTE

• When the “CHANNEL/TYPE” on the SYSTEM SETUP screen is set to “8”, this “INHIBIT SpO during NIBP measurement.

• When this “INHIBIT SpO SpO

during NIBP Measurement” section.

ON: Stops SpO OFF: SpO

2ND PARAMETER

Set the display order of SpO

DURING NIBP” setting becomes invalid and SpO2 is monitored

DURING NIBP” is set to OFF, refer to the “Monitoring

1. Press the NIBP INTERVAL key to move the cursor to “INHIBIT SpO

DURING NIBP”.

2. Press the NIBP START/STOP key to select “ON” or “OFF”.

monitoring during NIBP measurement.

is monitored during NIBP measurement.

and PR.

1. Press the NIBP INTERVAL key to move the cursor to “2ND PARAMETER”.

2. Press the NIBP START/STOP key to select “SpO2” or “PR”.

When set to SpO

Operator's Manual ZS-940PA 19

When set to PR

Changing System Setup Settings

NOTE

Changing System Setup settings must be done only by a qualified personnel.

System Setup Setting List

The factory default settings are underlined.

Setting Item Description Settings

CHANNEL/TYPE

PRESSURE UNIT Select the units for NIBP. mmHg, kPa LANGUAGE Select the language for screen display. JPN, ENG SYSTEM INITIALIZE

Displays the transmitter channel and select the TYPE.

Initializes all settings to the factory default settings.

Displaying the SYSTEM SETUP Screen

1. Remove one battery.

2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears.

A, 8

3. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”.

4. Press the NIBP START/STOP key to enter the SYSTEM SETUP screen.

When the cursor is moved to “EXIT” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the startup screen appears, then the monitoring screen appears.

20 Operator's Manual ZS-940PA

5. To select or change a setting, press the NIBP START/STOP key. To move the cursor, press the NIBP INTERVAL key.

Selects or changes setting

Moves cursor

When the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the SETUP screen appears.

Changing Settings

CHANNEL/TYPE

Select “A” for TYPE. The channel of this transmitter is also displayed.

1. On the SYSTEM SETUP screen, press the NIBP START/STOP key to select “A”.

Channel of this transmitter

NOTE

Always select “A” for TYPE. If “8” is selected, NIBP data cannot be properly transmitted to the receiving monitor.

PRESSURE UNIT

Select the unit for NIBP.

1. Press the NIBP INTERVAL key to move the cursor to “PRESSURE UNIT”.

2. Press the NIBP START/STOP key to select “mmHg” or “kPa”.

Operator's Manual ZS-940PA 21

LANGUAGE

Select the language for screen display.

1. Press the NIBP INTERVAL key to move the cursor to “LANGUAGE”.

2. Press the NIBP START/STOP key to select the language.

SYSTEM INITIALIZE

Do the following procedure to initialize the settings to the factory default settings.

1. Press the NIBP INTERVAL key to move the cursor to “SYSTEM INITIALIZE”.

2. Press the NIBP START/STOP key. The “EXECUTE” message appears.

3. Press the NIBP START/STOP key to initialize the settings to the factory default settings.

22 Operator's Manual ZS-940PA

Attaching NIBP Cuff, Electrodes and SpO2 Probe

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 attached 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 decreases during NIBP measurement and pulse wave cannot be detected and SpO

cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on

the PARAMETER SETUP screen is set to ON (factory default setting), SpO monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO careful when reading SpO

probe cable depends on how the transmitter is to be

NOTE

on the same limb as NIBP, be

values.

When monitoring SpO

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

NIBP cuff or catheter is not attached.

Attachment Examples

When transmitter is attached on an arm

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 ZS-940PA 23

When transmitter is placed on a bedside

NOTE

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-943P 13 15

Large YP-944P 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 infants YP-960T 5

For children

For adults

24 Operator's Manual ZS-940PA

Small YP-961T 7

Standard YP-962T 10

Standard YP-963T 13

Large YP-964T 15

Width

Air hose

Disposable Cuffs

CAUTION

The disposable cuffs are not sterilized. If necessary, sterilize the disposable cuffs using glutaraldehyde solution by following the instructions for the glutaraldehyde.

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 infants YP-910P 6

For children YP-912P 9

For adults

Small YP-913P 12

Standard YP-914P 14

Large YP-915P 16

Width

Air hose

Extension Hose

CAUTION

When using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff may 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 ZS-940PA 25

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-943P 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)

Children small YP-961T

Infants YP-960T

Adults large YP-944P (cuff for transmitter)

YP-964T

Adults standard YP-943P (cuff for transmitter)

YP-963T

Children standard YP-962T

Disposable Cuffs

Cuff width (cm)

10 20 30

Children standard YP-912P

Infants YP-910P

10 20 30

Adults large YP-915P

Adults standard YP-914P

Adults small YP-913P

Arm circumference (cm)

50 60

Arm circumference (cm)

26 Operator's Manual ZS-940PA

Connecting the NIBP Cuff to the Transmitter

When Using YP-943P/944P NIBP Cuff

To attach the YP-943P/944P NIBP cuff to the transmitter, the lock plate is required.

YP-943P/944P NIBP cuff

Lock plate

Front cover

Belt for the strap

Lock plate pocket

Top tab

For attaching the NIBP cuff to the transmitter

Air hose

Front cover open

NOTE

Do not roll up or put weight on the cuff with the lock plate attached to it. Otherwise, the lock plate may break.

D ring

Belt

Bottom tab

Operator's Manual ZS-940PA 27

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 clicks.

28 Operator's Manual ZS-940PA

When Using YP-960T series or YP-910P series NIBP Cuff

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 was 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 a reflux of blood and stop injection.

• 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 be increased.

• If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff.

Operator's Manual ZS-940PA 29

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

values.*

• Do not reuse disposable cuffs.

* Monitoring SpO2 during NIBP Measurement

When the SpO during NIBP measurement and pulse wave cannot be detected and SpO properly. When “INHIBIT SpO set to ON (factory default setting), SpO avoid SpO NIBP, be careful when reading SpO

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

cannot be monitored

DURING NIBP” on the PARAMETER SETUP screen is

monitoring is paused during NIBP measurement to

alarm occurrence. However, when monitoring SpO2 on the same limb as the

values.

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 as

When placing the transmitter on a bed, make sure that the hose is not bent.

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.

Heart

The best measuring condition is when the patient is lying on 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.

30 Operator's Manual ZS-940PA

Using the YP-943P/944P NIBP Cuff

Belt

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

2. Insert the end of the cuff into the belt and then through the D ring as shown at left.

D ring

End of cuff

3. 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 ZS-940PA 31

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.

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

Belt for the strap on the NIBP cuff

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.

32 Operator's Manual ZS-940PA

Using the YP-960T series Reusable Cuffs or YP-910P series Disposable Cuffs

ARTERY

1. Put the cuff on the upper arm so that the

mark of “ARTERY ” aligns with the artery

of the patient.

2. Wrap the cuff so that “INDEX ” comes

within the “ RANGE ”.

RANGE

If “Index

”, change the cuff size.

” is not within the “ RANGE

Attaching Electrodes

Selecting Electrode Lead

CAUTION

Use Nihon Kohden specified electrodes and electrode leads. With electrodes and electrode leads other than specified ones, the “CHECK ELECTRODE” message appears and monitoring may stop.

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

BR-903PA, 3 electrodes, clip type

Operator's Manual ZS-940PA 33

BR-913PA, 3 electrodes, snap type

BR-902PA, 2 electrodes, clip type

BR-912PA, 2 electrodes, snap type

Connecting the Electrode Lead to the Transmitter

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

When the transmitter is attached on an arm

CAUTION

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.

Selecting the 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. 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 of a patient are not always optimum for respiration measurement of the patient. Select positions suitable for both ECG and respiration measurements, or positions which have priority for one measurement.

34 Operator's Manual ZS-940PA

Three Electrodes

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

Electrode Position

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

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

LL F Red Green

• Lead MIII, which is similar to standard lead III. Change R/RA and L/LA of the lead MII.

MII.

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

Operator's Manual ZS-940PA 35

Two Electrodes

With the optional BR-912PA and BR-902PA electrode leads, measurement with two electrodes is available. L/LA electrode is not used. This is effective for a neonate or a patient whose body area is small and difficult to attach three electrodes.

(ex.) Lead MII, which is similar to standard lead II

Electrode Position

Right infraclavicular fossa RA R White Red Below lowest rib on the left anterior axillary line

Difference between measurement with two electrodes and three electrodes Measurement with two electrodes is less stable than measurement with three electrodes because of noise and body movement. Pay attention to this point. If ECG of necessary quality cannot be obtained, measure with three electrodes.

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

Prepare the Patient Skin

Shave off excessive body hair. 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.

Symbol Lead Color

AHA IEC AHA IEC

LL F Red Green

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.

36 Operator's Manual ZS-940PA

Attaching Electrodes to the Patient

CAUTION

Do not reuse disposable products.

NOTE

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

Operator's Manual ZS-940PA 37

Electrode Position for Respiration Monitoring

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

NOTE

Electrode Position Examples

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

Right infraclavicular fossa

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

Right infraclavicular fossa

Fifth intercostal space on the left midclavicular line, V4

Fifth intercostal space on the left midaxillary line, V6

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

R or RA F or LL

Right midaxillary at the horizontal level of V4

38 Operator's Manual ZS-940PA

Fifth intercostal space on the left midaxillary line, V6

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.

R or RA F or LL

Lowest rib on the right anterior axillary line

Lowest rib on the left anterior axillary line

Attaching the SpO2 Probe

Selecting the SpO2 Probe

Select an appropriate probe for the patient.

CAUTION

• Use Nihon Kohden specified SpO2 probe to assure maximum performance from your instrument.

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

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

Adult or children 20 kg or more

Finger

1.6 m

Attachment tape

Adult or Infant

Finger or toeMulti-site probe TL-220T

3 kg or more

Neonate

Instep and sole

3 kg or less

Operator's Manual ZS-940PA 39

Disposable Probes

CAUTION

• Use the disposable probe only for one patient. Never reuse the disposable probe for another patient because it causes cross infection.

• Disposable probes are not sterilized.

Probe Patient Attachment site

TL-251T Adult

30 kg or more

Finger or toe

TL-252T Child

3 to 40 kg

TL-253T Neonate

3 kg or less

Multi-site Y probe TL-260T

Attachment tape

Low birth weight infant 1 kg or less Neonate or Child 3 kg or more Neonate 3 kg or less Adult 50 kg or more

40 mm

Neonate 3 kg or less

Cable length TL-051S: 80 cm

TL-052S: 160 cm

Child or Adult 15 to 50 kg

Finger or toe

Instep and sole

Attachment tape S

Finger or toe Attachment

tape S Instep and sole

Attachment

tape L FingerTL-051S/052S

Instep and sole

FingerTL-061S/062S

35 mm

Infant

Toe

3 to 15 kg

Cable length TL-061S: 80 cm

TL-062S: 160 cm

40 Operator's Manual ZS-940PA

Connecting the SpO

Connect the probe to the SpO

Probe to the Transmitter

socket on the transmitter.

When the transmitter is attached on an arm

CAUTION

Hold the connector when connecting/disconnecting the probe. If you disconnect the SpO

probe by pulling the cable, it damages the cable.

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.

WARNING

• When using a TL-201T finger probe, do not fasten it to a finger by wrapping the probe to the site with some tape. It may cause poor blood circulation, congestion, pressure necrosis or burn.

• When using probes other than a TL-201T finger probe, 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 shortterm 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.

Operator's Manual ZS-940PA 41

• Check the circulation condition by observing the skin color of the measuring site and the pulse waveform. Change the measuring site every 8 hours for disposable probes and every 4 hours for reusable probes. 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.

• A patient with a fever

• A patient with a peripheral circulation insufficiency

• Neonate or low birth weight infant with delicate skin

CAUTION

• If the attachment site is dirty with blood, 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 the measured data may be incorrect or measurement cannot be performed.

• If the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe.

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

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

• When using probes other than a TL-201T finger probe on a neonate, be careful when removing the adhesive tape from neonatal skin.

• When removing a probe taped to the skin, do not pull the cable. Otherwise the cable may break.

• When removing the probe from the attachment tape, do not pull the sensor cable. Otherwise the cable may get damaged.

• Before using the TL-260T multi-site Y probe, be sure to attach the probe to the sponge attachment tape S or L. Do not use the probe without the sponge attachment tape attached. It causes incorrect measurement and may damage the attachment site on the skin.

• When fixing the TL-260T multi-site Y probe with the sponge attachment tape, confirm that the adhesive part of the tape is not on the skin. The adhesive may cause oversensitive symptoms on the skin such as redness or itch. If the adhesive touches the skin, remove it carefully and slowly because neonatal skin is very delicate.

• Do not use a dirty sponge attachment tape. The measurement value may be incorrect.

• Refer to the probe instruction manual for details.

42 Operator's Manual ZS-940PA

Locking the Keys on the Transmitter

To prevent the patient from pressing the keys on the transmitter during monitoring, you can lock the NIBP START/STOP and NIBP INTERVAL keys.

1. Press the NIBP INTERVAL key for about 3 seconds.

2. A “pip, pip” sounds and the “LOCK KEYS” message is displayed on the LCD.

Pip, pip

LOCK KEYS

When the NIBP START/STOP key or NIBP INTERVAL key is pressed while the keys are locked, the “PRESS INT. KEY 3S TO UNLOCK” message appears.

To unlock the keys:

1. Press the NIBP INTERVAL key for about 3 seconds.

2. A “pip, pip” sounds and the keys are unlocked. The “UNLOCK KEYS” message appears and the keys are unlocked.

Operator's Manual ZS-940PA 43

Monitoring

When preparation is done, monitoring starts.

NIBP Oscillometric Method

NIBP is measured from the change in amplitude pattern of pulsatile oscillation in cuff pressure as the cuff pressure is reduced from above systolic to below diastolic pressure. The occlusiveoscillometry method uses this to determine the systolic, diastolic and mean arterial pressure.

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 at the lower right of the screen.

The measurement mode and interval can be changed by pressing the NIBP INTERVAL key. When the key is pressed, the measurement mode changes according to the modes selected at “SELECTABLE INTERVALS” on the PARAMETER SETUP screen. MANUAL mode is already selected for the mode selection.

To select the modes for the mode selection, 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

44 Operator's Manual ZS-940PA

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 cuff is attached.

• NIBP measurement may be incorrect in the following cases.

• When using an electrical surgery unit.

• When there is body movement.

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

• Too many arrhythmia.

• When there is vibration.

• When there is a rapid blood pressure change.

• During CPR.

• When performing NIBP measurements in STAT mode or 5 minute intervals,

periodically remove the cuff from the patient for ventilation. Otherwise, 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.

Operator's Manual ZS-940PA 45

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 distributor.

• 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. Select the measurement mode by pressing the NIBP INTERVAL key.

2. Press the NIBP START/STOP key to perform measurement.

46 Operator's Manual ZS-940PA

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.

When SpO2 is not monitored, the pulse rate at the end of NIBP measurement is displayed.

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.

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

Operator's Manual ZS-940PA 47

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.

Monitoring SpO

When the SpO during NIBP measurement and pulse wave cannot be detected and SpO properly. When “INHIBIT SpO to ON (factory default setting), SpO SpO

alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, be

careful when reading SpO

during NIBP Measurement

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

cannot be monitored

DURING NIBP” on the PARAMETER SETUP screen is set

monitoring is paused during NIBP measurement to avoid

values.

ECG and Respiration Monitoring

When the electrodes are attached and the ECG leads are connected to the electrodes, heart rate, ECG, respiration rate and respiration waveform appear on the monitor.

WARNING

Interaction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac monitoring and Diagnostic Equipment* The bioelectric impedance measurement sensor of a minute ventilation rateadaptive implantable pacemaker may be affected by the 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 distributor or Nihon Kohden distributor.

* 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 rate-adaptive 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

48 Operator's Manual ZS-940PA

WARNING

When using this transmitter with an ESU, the ESU return plate and the electrodes for monitoring must be firmly attached to the patient. If the return plate is not attached correctly, it may burn the patient’s skin where the electrodes are attached. Refer to the instruction manual for the ESU.

CAUTION

Turn off the power of cell telephones, small wireless devices and other devices which produce strong electromagnetic interference. Otherwise, the waveforms and measurements are affected by such interference and the displayed data may be incorrect.

NOTE

• Noise generated from an electrosurgery 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 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 may not be distinguished and pacemaker failure may not be recognized.

Electrode Detachment

The “

message is displayed on the screen of the monitor in the following conditions.

• 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.

” mark is displayed on the LCD of the transmitter or the “CHECK ELECTRODE”

CAUTION

When the “ELECTRODE OFF” or “CHECK ELECTRODE” message is displayed on the receiving monitor, check electrodes and electrode leads and remove the cause. While the “ELECTRODE OFF” or “CHECK ELECTRODE” message is being displayed, there is no ECG monitoring and no alarms.

Operator's Manual ZS-940PA 49

SpO2 Monitoring

When monitoring starts, SpO2 and pulse waveform are sent to the monitor and SpO2, pulse rate and pulse level bar graph are displayed on the transmitter LCD.

WARNING

• 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 electrical surgery unit.

• During CPR.

• When there is body movement.

• When there is vibration.

• When measuring at a site where there are venous pulses.

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

• When using an IABP (intra-aortic balloon pump).

• Check the circulation condition by observing the skin color of the measuring site and pulse waveform. Change the measuring site every 8 hours for disposable probes and every 4 hours for reusable probes. 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.

• A patient with a fever

• A patient with peripheral circulation insufficiency

• Neonate or low birth weight infant with delicate skin

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

, disconnect the SpO2 cable from the transmitter.

CAUTION

• Turn off the power of cell telephones, small wireless devices and other devices which produce strong electromagnetic interference. Otherwise, the waveforms and measurements are affected by such interference and the displayed data may be incorrect.

• Normally external light does not affect monitoring, however, strong light such as an operating lamp or sunlight may affect monitoring. If affected, cover the measuring site with a blanket.

• Do not pull or bend the probe cable, and do not run over the probe cable with

50 Operator's Manual ZS-940PA

caster feet. Do not immerse the probe cable in detergents or water. Failure to follow these cautions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken 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.

• When the probe failure message appears on the screen, replace it with a new one. Otherwise SpO

data may not be accurate.

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

value may not be displayed.

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.

SpO

and PR Display Order

You can select the display order for SpO “Changing Parameter Setup Settings” section.

and PR (pulse rate) on the LCD. Refer to the

Monitoring SpO

When the SpO during NIBP measurement and pulse wave cannot be detected and SpO properly. When “INHIBIT SpO to ON (factory default setting), SpO SpO

alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be careful

when reading SpO

When monitoring SpO

during NIBP Measurement

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

cannot be monitored

DURING NIBP” on the PARAMETER SETUP screen is set

monitoring is paused during NIBP measurement to avoid

values.

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

catheter 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. The same data also appears on the monitor screen.

Operator's Manual ZS-940PA 51

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 the PARAMETER 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

during STAT NIBP measurement, attach the probe to

on the receiving monitor.

the limb to which the NIBP cuff is not attached.

DURING NIBP” on

52 Operator's Manual ZS-940PA

Display and Message List

Battery Indication

Indication Cause Countermeasure

Fully charged battery

Batteries are low.

indication

Batteries are low. NIBP cannot be measured.

Dead batteries

Replace batteries.

ECG

Indication Cause Countermeasure

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 high.

Firmly connect the electrode lead to the electrode. Firmly connect the electrode lead to the transmitter. Replace the electrode lead with a new one.

Replace the electrode with a new one.

Operator's Manual ZS-940PA 53

SpO

Message Cause Countermeasure

During NIBP measurement

Detecting body movement

SpO2 CHECK PROBE

SpO2 CHECK PROBE SITE

SpO2 DETECTING PULSE

SpO2 monitoring is paused for NIBP measurement.

Considerable body movement.

The probe is not attached to the patient properly.

The probe is not attached to the patient properly. The probe is disconnected from the SpO

socket on the

transmitter. The probe is not attached at the appropriate site.

Wait for NIBP measurement to finish. When the message is displayed frequently, check the patient condition and, if necessary, change the attachment site. Attach the probe to the patient properly.

Connect the probe to the SpO socket.

Attach the probe to a site 6 to 14 mm thick.

Probe is expired. Replace the probe with a new one.

Searching for the correct pulse wave.

Wait until the pulse wave is

detected. The SpO2 value cannot be obtained because the waveform is unstable. The probe is not attached to

Attach the probe to the patient

properly.

the patient properly. SpO

measurement site is

SpO2 LIGHT INTERFERENCE

SpO2 PROBE FAI LU RE

SpO2 WEAK PULSE

under fluorescent light, surgical light, sunlight, etc.

Probe is expired. Replace the probe with a new one.

Probe is damaged or shortcircuited.

Poor peripheral circulation.

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

Cover the measurement site with a

blanket or cloth.

Replace the probe with a new one.

Check the patient condition and

change the attachment site.

Check the probe attachment

condition and if necessary,

reattach the probe.

54 Operator's Manual ZS-940PA

NIBP

Message Cause Countermeasure

The cuff and extension hose are not

NIBP AIR LEAK

NIBP CANNOT DETECT PULSE

NIBP CUFF OCCLUSION

NIBP HIGH CUFF PRESS

NIBP INFLATION PRESS LOW

NIBP MEAS TIMEOUT

NIBP MODULE FAI LU RE

NIBP REMEASURING

NIBP SAFETY CIRCUIT RUNNING (When this message is displayed, measurement cannot be performed for 40 seconds.)

NIBP SYS OUT OF RANGE

NIBP WEAK PULSE

NIBP ZEROING

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

The patient’s pulse wave is small. Measure by palpation or auscultation.

The cuff is not wrapped on the patient properly.

Transmitter malfunction.

Enormous pressure was applied by the pressure of the cuff.

Insufficient cuff inflation pressure.

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

Module malfunction.

NIBP is being remeasured due to arrhythmia, body movement, vibration or, cuff or air hose being squeezed.

Measurement stopped by the safety circuit.

The maximum blood pressure cannot be measured even when the cuff inflation pressure exceeded 280 mmHg when using adult cuff. The patient’s pulse wave is too small.

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

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

NIBP zero balance is being adjusted.

Connect them properly.

Replace with a new one.

Wrap the cuff on the patient properly.

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

Remove the cause.

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

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

Contact your Nihon Kohden distributor. If the message still appears after remeasurement, remove the cause if the cause is body movement, vibration or squeezing of cuff or hose. Check that the hose is not bent or squeezed. Wait 40 seconds, then perform remeasurement. If the message still appears, contact your Nihon Kohden distributor.

Measure by palpation or auscultation.

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

Operator's Manual ZS-940PA 55

Troubleshooting

If the problem still remains after checking the following, contact your Nihon Kohden distributor.

Transmitter

Problem Cause Countermeasure

displayed on the LCD after turning the power on.

displayed on the monitor after turning the transmitter power on.

Signal receiving condition is

oor.

Batteries are not installed correctly. The battery polarity is wrong. Batteries are completely discharged. The channel of the transmitter and monitor does not match. The “TYPE” on the SYSTEM SETUP screen is not set to “A”.

Another transmitter of the same channel is used nearby.

Signals are mixing. Follow the instructions of your channel

The transmitter is damaged.

Install the batteries correctly.Nothing is

Replace the batteries with new ones.

Set the correct channel on the monitor.Nothing is

Check that the “TYPE” is set to “A”. Refer to the “Notes on Parameter Settings” and “Changing System Setup Settings” sections. Turn the transmitter power off. If the monitor still receives a signal, there is a high probability that another transmitter of the same channel is used nearby. Follow the instruction of your channel administrator and use another transmitter of a different channel.

administrator and use another transmitter of a different channel. Contact your Nihon Kohden distributor.

56 Operator's Manual ZS-940PA

ECG

Problem Cause Countermeasure

The heart rate is unstable.

The “CHECK ELECTRODE” message appears on the receiving monitor.

ECG baseline is thick. (Hum is overlapping)

Respiration waveform measurement is unstable.

Pacing detection setting on the monitor is not correct.

Turn off the pacing detection setting on the monitor. When monitoring a pacemaker

patient, turn on pacing detection. Electrode lead is disconnected from the electrode.

Firmly connect the electrode lead to

the electrode. Electrode lead discontinuity Replace the electrode lead with a new

one. Electrode is not firmly

Replace the electrode with a new one. attached to the skin. Polarization voltage is abnormally high. The gel on the electrode is

Use Nihon Kohden specified

electrodes.

Replace the electrode with a new one. dried out. The gel on the electrode is coming off. Electric blanket is used. Cover the blanket with a shield cover. Hum filter is set to OFF on the

Set the filter to ON. monitor The gel on the electrode is

Replace the electrode with a new one. dried out. The gel on the electrode is coming off.

SpO

Problem Cause Countermeasure

SpO2 data is unstable and not reliable.

The probe size is not appropriate for the patient. Probe attachment condition is poor. Probe is partly

Use the appropriate probe for the patient.

Firmly attach the probe according to the

procedure in the probe operator’s manual. detached from the skin. External light gets in. Measurement site is dirty.

Remove dirt and nail polish. Patient is wearing nail polish. Probe is attached to the same limb that is used for NIBP measurement.

When the probe and cuff are attached to

the same limb, set “INHIBIT SpO

DURING NIBP” setting on the

PARAMETER SETUP screen to ON.

Attach the probe to the opposite limb.

Avoid a site where blood circulation

condition changes greatly.

Operator's Manual ZS-940PA 57

NIBP

Problem Cause Countermeasure

Cuff inflation pressure is less than 10 mmHg.

The cuff does not inflate when the NIBP START/STOP key is pressed.

Abnormal measurement results are displayed.

The cuff is suddenly deflated during inflation.

Auto mode measurement does not start even when the time interval has passed. The cuff suddenly inflates.

Cannot connect cuff to the air hose.

The cuff hose is not connected to the NIBP socket properly. The cuff is not wrapped around the arm or is wrapped too loosely. The cuff hose is not connected to the NIBP socket. The cuff hose or extension hose may be folded or squeezed when the cuff pressure display on the screen increases quickly but the actual cuff does not inflate.

The cuff size is not correct. Select the cuff which fits the

The cuff is not wrapped around the arm correctly.

NIBP data is not correct because of body movement.

Vibration on the cuff.

The NIBP START/STOP key is pressed during inflation.

The NIBP INTERVAL key is pressed and the measurement mode is changed.

The measurement mode is set to auto mode.

Unspecified cuff is used. Use a cuff specified by Nihon

Connect the cuff hose to the socket properly. Wrap the cuff around the upper arm.

Connect the cuff hose to the socket firmly. Check the cuff hose and air hose.

patient’s limb circumference. Wrap the cuff around the upper arm, not too tightly or too loosely.

Prevent the patient from moving during measurement. Check that nothing is touching the cuff during measurement. Change the measuring site.

Check the measurement mode and interval.

Check the time interval. If necessary, stop measurement.

Kohden.

58 Operator's Manual ZS-940PA

Problem Cause Countermeasure

Cannot measure NIBP.

Vibration on the cuff.

The cuff hose or extension

Check that nothing is touching the cuff during measurement.

Remove the cause. hose is bent or squeezed. The cuff has worn out. Use a new cuff. Measuring over a long

occurs.

period of time at short intervals.

Thrombus occurs. Measuring on a patient

with known bleeding

Increase the measuring interval.Blood congestion

Do not measure NIBP over a long

time.

Do not perform NIBP measurement

on such a patient. disorders or coagulation.

NIBP data on the screen is --- or dark.

The time set for “OLD NIBP DATA” on the PARAMETER SETUP

When NIBP is measured again, the

data is displayed in normal

brightness. screen elapsed from the last measurement.

Three loud pip sounds indicting NIBP measurement

The cuff is not deflated enough to start another measurement.

Wait 30 seconds and measure again.

cannot be started. Numeric data is displayed but NIBP messages are not displayed on the

The “TYPE” on the SYSTEM SETUP screen is not set to “A”.

Check that the “TYPE” is set to “A”.

Refer to the “Notes on Parameter

Settings” and “Changing System

Setup Settings” sections.

monitor.

Operator's Manual ZS-940PA 59

Maintenance

To use the instrument in safe and optimum condition, perform maintenance check once every six months.

CAUTION

Do not disassemble the transmitter when performing maintenance and inspection. Do not repair the transmitter. When there is any problem with the transmitter after maintenance and inspection, contact your Nihon Kohden distributor.

A maintenance check sheet is provided at the end of this section. Make a copy of this check sheet before performing maintenance check.

1. External Check

• There are no damaged or dirty parts on the outside of the transmitter.

• The battery case cover is not damaged, the spring is firmly fixed and the battery case cover can be closed firmly.

• NIBP socket is not damaged.

• Keys are not damaged.

• Electrode leads are not damaged.

• There is no blood or chemicals on the transmitter.

2. Transmitter Channel

Check that the channel of the transmitter and the label match.

1. Check that the channel number label attached to the transmitter is not torn or removed.

Channel label

60 Operator's Manual ZS-940PA

2. Remove one battery.

3. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears.

4. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”.

5. Press the NIBP START/STOP key to enter the SYSTEM SETUP screen. The channel of this transmitter is displayed.

Channel

6. Check that the channel displayed on the LCD matches the label on the transmitter.

Operator's Manual ZS-940PA 61

3. LCD Display

Check that there are no dots missing on the LCD.

1. Remove one battery.

2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears.

3. Press the NIBP INTERVAL key twice to move the cursor to “MANUAL CHECK”.

4. Press the NIBP START/STOP key to enter the MANUAL CHECK screen.

5. Check that the cursor is on “LCD TEST” and press the NIBP START/ STOP key.

62 Operator's Manual ZS-940PA

6. Every time the NIBP INTERVAL key is pressed, the screen changes as below. Check that there are no dots missing.

When the NIBP START/STOP key is pressed, the screen returns to the MANUAL CHECK screen.

4. Switch and Key Operation

Power Switch

Check that the Power switch turns the power on and off.

NIBP START/STOP Key

1. Attach the NIBP cuff to your upper arm.

2. Press the NIBP START/STOP key. Check that the cuff inflates and deflates properly.

3. Press the NIBP START/STOP key again. During inflation, press the NIBP START/STOP key to check that the cuff deflates properly.

NIBP INTERVAL Key

1. Press the NIBP INTERVAL key and check that the NIBP measuring mode can be changed.

2. Select any interval and press the NIBP START/STOP key to perform auto measurement. Check that the NIBP is measured at the selected interval.

Operator's Manual ZS-940PA 63

5. NIBP Cuff for Attaching Transmitter to Patient Arm

The NIBP cuff is a consumable. Check the following and when necessary, replace it with a new one.

Appearance

• There are no dirty parts.

• There are no broken stitches on the cuff.

• The label on the cuff is readable.

• The velcro tape on the cuff is not removed and there are no broken stitches.

• The lock plate is not damaged and functions properly.

Inflation bag

• The inflation bag is not torn or damaged.

• There is no water inside the inflation bag.

• The connector on the inflation bag is not damaged.

64 Operator's Manual ZS-940PA

Hospital/Organization:

Service Personnel:

Maintenance Check Sheet

Instrument Name:

Instrument Model:

Instrument Serial Number:

Hardware Revision Number:

Software Revision Number:

1. External Check OK No

2. Transmitter Channel OK No

3. LCD Display OK No

4. Switch and Key Operation OK No

5. NIBP Cuff for Attaching Transmitter to Patient Arm OK No

Overall Judgement

Transmitter

ZS-940PA

Can be used but needs maintenance

Maintenance required. Cannot be used.

Operator's Manual ZS-940PA 65

Repair Parts Availability Policy

Nihon Kohden Corporation (NKC) shall stock repair parts (parts necessary to maintain the performance of the instrument) for a period of 8 years from the date of delivery. In that period NKC or its authorized agents will repair the instrument. This period may be shorter than 8 years if the board or part necessary for the faulty section is not available.

66 Operator's Manual ZS-940PA

Lifetime and Disposal

Disposing of Used Batteries

Battery Lifetime

Replace the batteries when the battery replacement indication appears on the transmitter. When using rechargeable batteries, recharge them.

Type Lifetime (Measuring parameters)

ECG, SpO2, NIBP ECG, SpO

NiMH secondary 2 days 2 days 2.5 days Alkaline primary 1 day 2.5 days 3 days

The above data is when new batteries are used at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO weight 60 kg.

Operation time depends on the thickness of SpO2 probe attachment site.

Disposal

is measured on an index finger of a male patient with

NOTE

Remove the batteries before disposing of the transmitter.

Before disposing of the batteries, check with your local solid waste officials for details in your area for proper disposal. It may be illegal to dispose of these batteries in the municipal waste stream.

ECG only

Disposing of Electrodes, SpO2 Probes and NIBP Cuffs

Refer to the manual of each item.

Operator's Manual ZS-940PA 67

Cleaning, Disinfection and Sterilization

Transmitter and Electrode Leads

CAUTION

• Before cleaning or disinfecting the transmitter, remove the batteries from the transmitter.

• The transmitter cannot be sterilized.

Cleaning

Wipe the transmitter and electrode leads with a soft cloth moistened with disinfecting alcohol or neutral detergent diluted with water. After cleaning, dry them completely.

Disinfection

CAUTION

• Do not immerse the electrode lead connector in liquid.

• Do not disinfect with hypochlorous acid.

• Use the recommended concentration.

Wipe the outside surface of the transmitter and electrode lead with a non-abrasive cloth moistened with any of the disinfectants listed below. Use the recommended concentration.

Disinfectant Concentration (%) Glutaraldehyde solution 2.0 Hydrochloric alkyl diaminoethylglycine 0.5 Benzalkonium chloride 0.2 Benzethonium chloride solution 0.2 Chlorohexidine gluconate solution 0.5

68 Operator's Manual ZS-940PA

SpO2 Probe

Refer to the probe manual.

YP-943P/944P NIBP Cuffs

CAUTION

• Do not autoclave.

• Use only glutaraldehyde solution.

• Never allow liquid to get inside the rubber cuff.

• Do not sterilize or disinfect the cuff with ultraviolet light or ozone.

Cleaning

To clean the cuff, remove the lock plate and carefully pull out the inflation bag from the cloth cover. Cloth cover: Wash with neutral detergent and water. Thoroughly dry it. When washing in a

washing machine, put it in a net.

Inflation bag: Wipe with a soft cloth or cotton moistened with disinfecting alcohol.

Thoroughly dry it.

Disinfection

To disinfect the cuff, use glutaraldehyde solution. Use the recommended concentration of the disinfectant. Refer to the disinfectant manual for details. After disinfection, clean the cuff as described above.

Operator's Manual ZS-940PA 69

Specifications

Measuring Parameters

Measuring waveforms: ECG, Respiration in impedance method, pulse Measuring numeric data: SpO

Transmitting Data

Waveform data: ECG, respiration, pulse wave Numeric data: SpO Status information: Battery replacement, channel ID, type of transmitter, check

Displayed Data

SpO2, NIBP, pulse rate, pulse wave bar graph, check electrode, battery replacement, NIBP measurement mode and status information

ECG Measurement

Channels: 1 Input range: ±5 mV or more DC offset: ±500 mV or more Input impedance: 5 MΩ or more (5 Hz) Pacing pulse detection: ANSI/AAMI EC13

, NIBP, pulse rate

and NIBP

electrodes, abnormal polarization voltage, pacing data, SpO light interference

Based upon Pacemaker pulse rejection Capability

Respiration Measurement

Measuring method: Impedance method Impedance range: 0 to 2 kΩ or less

SpO

Measurement

Display range: Depends on the receiving monitor Measuring range: 0 to 100%, in 1% steps Minimum display range: 1%

Measuring accuracy (When the measuring accuracy of the SpO

±1 (80% ≤ SpO

±2 (50% ≤ SpO

≤ 100%)

< 80%)

probe is not considered):

Less than 50% is not specified.

(When considering the measuring accuracy of the SpO

±2 (80% ≤ SpO

±3 (70% ≤ SpO

probe):

≤ 100%)

< 80%)

Less than 70% is not specified.

70 Operator's Manual ZS-940PA

NIBP Measurement

Displayed items: Systolic, diastolic, mean Cuff pressure display range: 0 to 300 mmHg Measurement modes: Manual, STAT, auto at 5, 10, 15, 30, 60, 120 or 240 minute

interval

Pulse Rate

Measuring range: 30 to 200 beats/minute ±8 beats/min (NIBP)

30 to 200 beats/min ±3% ±1 beat/min (SpO

)

Transmitter

FCC regulation: FCC part 95 Subpart H

Wireless Medical Telemetry Service (WMTS) Field strength limits: <200 mV/m (at 3 m) Undesired emission: below 960 MHz: 200 µV/m (at 3 m)

above 960 MHz: 500 µV/m (at 3 m) Antenna: Internal Transmission channel: indicated on the transmitter Transmission frequency range: 608.0125 to 613.9875 MHz Channel spacing: 25 kHz (12.5 kHz when interleave) Type of emission: F1D Occupied bandwidth: <8.5 kHz Effective radiated power: 1.0 mW (conducted)

Power Requirements

Operating voltage: 3.2 to 4.8 V Battery type: Three AA type NiMH secondary batteries

Three AA type alkaline dry cell primary batteries Battery lifetime:

Type Lifetime (Measuring parameters)

ECG, SpO2, NIBP ECG, SpO

ECG only

NiMH secondary 2 days 2 days 2.5 days Alkaline primary 1 day 2.5 days 3 days

The above data is when new batteries are used at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO

is measured on an index

finger of a male patient with weight 60 kg. Operation time depends on the thickness of SpO

probe attachment site.

Dimension and Weight

Dimension: 114 W × 103 H × 58 D (mm) Weight: about 350 g (including batteries)

Operator's Manual ZS-940PA 71

Environment

Operating environment

Operating temperature: 5 to 40°C, 41 to 104°F

When using NIBP cuff, 10 to 40°C, 50 to 104°F Operating humidity: 30 to 85% (non-condensing) Operating atmospheric pressure: 70 to 106 kPa

Storage environment

Storage temperature: −20 to 65°C, −4 to 149°F Storage humidity: 10 to 95% Storage atmospheric pressure: 70 to 106 kPa

Electromagnetic Compatibility

IEC 60601-1-2 (1993) - Collateral Standard: Electromagnetic compatibility - Requirement and

tests

Emissions: CISPR11 Group 1, Class B

Safety Standards

Safety standard: CAN/CSA-C22.2 No. 601-1 M90 (1990)

CAN/CSA-C22.2 No. 601-1. 1S1-94 (1994) CAN/CSA-C22.2 No. 601-1. 1B-90 (R2002) IEC 60601-1 (1988) IEC 60601-1 Amendment1 (1991) IEC 60601-1 Amendment2 (1995) IEC 60601-1-2 (1993) IEC 60601-2-27 (1994)

IEC 60601-2-30 (1999) According to the type of protection against electrical shock: INTERNALLY POWERED EQUIPMENT According to the degree of protection against electrical shock:

ECG and impedance method respiration: DEFIBRILLATION-PROOF TYPE CF APPLIED

PA RT

SpO

and NIBP: DEFIBRILLATION-PROOF TYPE BF APPLIED

PA RT According to the degree of protection against harmful ingress of water: IPX0 (Ordinary equipment) According to the degree of safety of application in the presence of a FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE: Equipment not suitable for use in the presence of

FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE

According to the mode of operation: CONTINUOUS OPERATION

72 Operator's Manual ZS-940PA

Standard Accessories

No. Name Model Q’ty Supply Code No.

1 NIBP cuff for adult, standard YP-943P 1 S938B 2 Strap --- 1 Y236

The following parts are available for replacement.

Lock plate is a standard accessory of the YP-943P/944P NIBP cuff.

No. Name Model Q’ty Supply Code No.

3 Battery case cover 1 6144-012004 4 Lock plate 1 6113-049585

Operator's Manual ZS-940PA 73

Options

CAUTION

Use only Nihon Kohden electrodes, electrode leads, SpO2 probes and NIBP cuffs to assure maximum performance from your instrument.

Transmitter

Channel writer, QI-901PK

ECG/RESP

Name Application Model Q’ty Supply Code No.

Electrode lead

3 electrodes,clip type, lead length 80 cm 3 electrodes, snap type, lead length 80 cm 2 electrodes,clip type, lead length 80 cm 2 electrodes,snap type, lead length 80 cm

BR-903PA 1 K911A

BR-913PA 1 K910B

BR-902PA 1 K907B

BR-912PA 1 K908B

74 Operator's Manual ZS-940PA

SpO

Name

Finger probe (reusable)

Cable

length

0.6 m P225H

1.6

Model/

Code No.

TL-201T

Multi-site probe (reusable) TL-220T

Q’ty

Supply

Code No.

P225F

P225G SpO2 probe (for adult, disposable) TL-251T P201A SpO2 probe (for child, disposable) TL-252T P201B SpO2 probe (for neonate, disposable)

1.6 m

TL-253T P201C

Multi-site Y probe (for low birth weight infant/child/

TL-260T P205A

neonate, disposable) SpO2 probe(for adult/neonate, disposable) SpO2 probe (for child/infant, disposable)

0.8 m TL-051S P228A

1.6 m TL-052S P228B

0.8 m TL-061S P229A

1.6

TL-062S

P229B COTTONY tape 340703 20 P259 Foam tape for TL-051S/052S/ 061S/062S Attachment tape for TL-220T/ 251T/252T/253T

---

Attachment tape S for TL-260T P260A Attachment tape L for TL-260T

4 × 25 package

3 × 30 package

P260

P263

P260B

NIBP

Name

Cuff for adult, for attaching transmitter to patient arm

Width

(cm)

Standard 13 YP-943P* S938B

Large 15

Air Hose

Length

(cm)

Model Q’ty

YP-944P*

Supply

Code

No.

S938C

Cuff for infants 5 YP-960T S943A

Cuff for children

Cuff for adult

Small 7 YP-961T S943B Standard 10 YP-962T S943C

1 Standard 13 YP-963T S944B Large 15

YP-964T

S944C Disposable cuff for infants 6 YP-910P --Disposable cuff for children 9 YP-912P ---

Disposable cuff for adults

Small 12 YP-913P --Standard 14 YP-914P --Large 16

YP-915P

---

Extension hose 150 YN-990P 1 S903

* The lock plate is provided with these NIBP cuffs.

Operator's Manual ZS-940PA 75

Transmission Frequencies

USA

BAND

Transmission

frequency

(MHz)

608.0000 --- 608.3750 9030 608.7500 9060

608.0125 9001 608.3875 9031 608.7625 9061

608.0250 9002 608.4000 9032 608.7750 9062

608.0375 9003 608.4125 9033 608.7875 9063

608.0500 9004 608.4250 9034 608.8000 9064

608.0625 9005 608.4375 9035 608.8125 9065

608.0750 9006 608.4500 9036 608.8250 9066

608.0875 9007 608.4625 9037 608.8375 9067

608.1000 9008 608.4750 9038 608.8500 9068

608.1125 9009 608.4875 9039 608.8625 9069

608.1250 9010 608.5000 9040 608.8750 9070

608.1375 9011 608.5125 9041 608.8875 9071

608.1500 9012 608.5250 9042 608.9000 9072

608.1625 9013 608.5375 9043 608.9125 9073

608.1750 9014 608.5500 9044 608.9250 9074

608.1875 9015 608.5625 9045 608.9375 9075

608.2000 9016 608.5750 9046 608.9500 9076

608.2125 9017 608.5875 9047 608.9625 9077

608.2250 9018 608.6000 9048 608.9750 9078

608.2375 9019 608.6125 9049 608.9875 9079

608.2500 9020 608.6250 9050 609.0000 9080

608.2625 9021 608.6375 9051 609.0125 9081

608.2750 9022 608.6500 9052 609.0250 9082

608.2875 9023 608.6625 9053 609.0375 9083

608.3000 9024 608.6750 9054 609.0500 9084

608.3125 9025 608.6875 9055 609.0625 9085

608.3250 9026 608.7000 9056 609.0750 9086

608.3375 9027 608.7125 9057 609.0875 9087

608.3500 9028 608.7250 9058 609.1000 9088

608.3625 9029 608.7375 9059 609.1125 9089

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

76 Operator's Manual ZS-940PA

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

609.1250 9090 609.5375 9123 609.9500 9156

609.1375 9091 609.5500 9124 609.9625 9157

609.1500 9092 609.5625 9125 609.9750 9158

609.1625 9093 609.5750 9126 609.9875 9159

609.1750 9094 609.5875 9127 610.0000 9160

609.1875 9095 609.6000 9128 610.0125 9161

609.2000 9096 609.6125 9129 610.0250 9162

609.2125 9097 609.6250 9130 610.0375 9163

609.2250 9098 609.6375 9131 610.0500 9164

609.2375 9099 609.6500 9132 610.0625 9165

609.2500 9100 609.6625 9133 610.0750 9166

609.2625 9101 609.6750 9134 610.0875 9167

609.2750 9102 609.6875 9135 610.1000 9168

609.2875 9103 609.7000 9136 610.1125 9169

609.3000 9104 609.7125 9137 610.1250 9170

609.3125 9105 609.7250 9138 610.1375 9171

609.3250 9106 609.7375 9139 610.1500 9172

609.3375 9107 609.7500 9140 610.1625 9173

609.3500 9108 609.7625 9141 610.1750 9174

609.3625 9109 609.7750 9142 610.1875 9175

609.3750 9110 609.7875 9143 610.2000 9176

609.3875 9111 609.8000 9144 610.2125 9177

609.4000 9112 609.8125 9145 610.2250 9178

609.4125 9113 609.8250 9146 610.2375 9179

609.4250 9114 609.8375 9147 610.2500 9180

609.4375 9115 609.8500 9148 610.2625 9181

609.4500 9116 609.8625 9149 610.2750 9182

609.4625 9117 609.8750 9150 610.2875 9183

609.4750 9118 609.8875 9151 610.3000 9184

609.4875 9119 609.9000 9152 610.3125 9185

609.5000 9120 609.9125 9153 610.3250 9186

609.5125 9121 609.9250 9154 610.3375 9187

609.5250 9122 609.9375 9155 610.3500 9188

Operator's Manual ZS-940PA 77

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

610.3625 9189 610.7750 9222 611.1875 9255

610.3750 9190 610.7875 9223 611.2000 9256

610.3875 9191 610.8000 9224 611.2125 9257

610.4000 9192 610.8125 9225 611.2250 9258

610.4125 9193 610.8250 9226 611.2375 9259

610.4250 9194 610.8375 9227 611.2500 9260

610.4375 9195 610.8500 9228 611.2625 9261

610.4500 9196 610.8625 9229 611.2750 9262

610.4625 9197 610.8750 9230 611.2875 9263

610.4750 9198 610.8875 9231 611.3000 9264

610.4875 9199 610.9000 9232 611.3125 9265

610.5000 9200 610.9125 9233 611.3250 9266

610.5125 9201 610.9250 9234 611.3375 9267

610.5250 9202 610.9375 9235 611.3500 9268

610.5375 9203 610.9500 9236 611.3625 9269

610.5500 9204 610.9625 9237 611.3750 9270

610.5625 9205 610.9750 9238 611.3875 9271

610.5750 9206 610.9875 9239 611.4000 9272

610.5875 9207 611.0000 9240 611.4125 9273

610.6000 9208 611.0125 9241 611.4250 9274

610.6125 9209 611.0250 9242 611.4375 9275

610.6250 9210 611.0375 9243 611.4500 9276

610.6375 9211 611.0500 9244 611.4625 9277

610.6500 9212 611.0625 9245 611.4750 9278

610.6625 9213 611.0750 9246 611.4875 9279

610.6750 9214 611.0875 9247 611.5000 9280

610.6875 9215 611.1000 9248 611.5125 9281

610.7000 9216 611.1125 9249 611.5250 9282

610.7125 9217 611.1250 9250 611.5375 9283

610.7250 9218 611.1375 9251 611.5500 9284

610.7375 9219 611.1500 9252 611.5625 9285

610.7500 9220 611.1625 9253 611.5750 9286

610.7625 9221 611.1750 9254 611.5875 9287

78 Operator's Manual ZS-940PA

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

611.6000 9288 612.0125 9321 612.4250 9354

611.6125 9289 612.0250 9322 612.4375 9355

611.6250 9290 612.0375 9323 612.4500 9356

611.6375 9291 612.0500 9324 612.4625 9357

611.6500 9292 612.0625 9325 612.4750 9358

611.6625 9293 612.0750 9326 612.4875 9359

611.6750 9294 612.0875 9327 612.5000 9360

611.6875 9295 612.1000 9328 612.5125 9361

611.7000 9296 612.1125 9329 612.5250 9362

611.7125 9297 612.1250 9330 612.5375 9363

611.7250 9298 612.1375 9331 612.5500 9364

611.7375 9299 612.1500 9332 612.5625 9365

611.7500 9300 612.1625 9333 612.5750 9366

611.7625 9301 612.1750 9334 612.5875 9367

611.7750 9302 612.1875 9335 612.6000 9368

611.7875 9303 612.2000 9336 612.6125 9369

611.8000 9304 612.2125 9337 612.6250 9370

611.8125 9305 612.2250 9338 612.6375 9371

611.8250 9306 612.2375 9339 612.6500 9372

611.8375 9307 612.2500 9340 612.6625 9373

611.8500 9308 612.2625 9341 612.6750 9374

611.8625 9309 612.2750 9342 612.6875 9375

611.8750 9310 612.2875 9343 612.7000 9376

611.8875 9311 612.3000 9344 612.7125 9377

611.9000 9312 612.3125 9345 612.7250 9378

611.9125 9313 612.3250 9346 612.7375 9379

611.9250 9314 612.3375 9347 612.7500 9380

611.9375 9315 612.3500 9348 612.7625 9381

611.9500 9316 612.3625 9349 612.7750 9382

611.9625 9317 612.3750 9350 612.7875 9383

611.9750 9318 612.3875 9351 612.8000 9384

611.9875 9319 612.4000 9352 612.8125 9385

612.0000 9320 612.4125 9353 612.8250 9386

Operator's Manual ZS-940PA 79

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

USA

BAND

Transmission

frequency

(MHz)

CHANNEL

SPACING

12.5kHz step Channel No.

612.8375 9387 613.2500 9420 613.6625 9453

612.8500 9388 613.2625 9421 613.6750 9454

612.8625 9389 613.2750 9422 613.6875 9455

612.8750 9390 613.2875 9423 613.7000 9456

612.8875 9391 613.3000 9424 613.7125 9457

612.9000 9392 613.3125 9425 613.7250 9458

612.9125 9393 613.3250 9426 613.7375 9459

612.9250 9394 613.3375 9427 613.7500 9460

612.9375 9395 613.3500 9428 613.7625 9461

612.9500 9396 613.3625 9429 613.7750 9462

612.9625 9397 613.3750 9430 613.7875 9463

612.9750 9398 613.3875 9431 613.8000 9464

612.9875 9399 613.4000 9432 613.8125 9465

613.0000 9400 613.4125 9433 613.8250 9466

613.0125 9401 613.4250 9434 613.8375 9467

613.0250 9402 613.4375 9435 613.8500 9468

613.0375 9403 613.4500 9436 613.8625 9469

613.0500 9404 613.4625 9437 613.8750 9470

613.0625 9405 613.4750 9438 613.8875 9471

613.0750 9406 613.4875 9439 613.9000 9472

613.0875 9407 613.5000 9440 613.9125 9473

613.1000 9408 613.5125 9441 613.9250 9474

613.1125 9409 613.5250 9442 613.9375 9475

613.1250 9410 613.5375 9443 613.9500 9476

613.1375 9411 613.5500 9444 613.9625 9477

613.1500 9412 613.5625 9445 613.9750 9478

613.1625 9413 613.5750 9446 613.9875 9479

613.1750 9414 613.5875 9447 614.0000 ---

613.1875 9415 613.6000 9448

613.2000 9416 613.6125 9449

613.2125 9417 613.6250 9450

613.2250 9418 613.6375 9451

613.2375 9419 613.6500 9452

80 Operator's Manual ZS-940PA

Nihon Kohden ZS 940PA User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual