Novametrix 860 User manual
®
TCO
M
2
Transcutaneous CO2/O2 Monitor
User’s Manual
Model 860
October 4, 1996
Catalog No. 6590-23-00
March 25, 1997
Catalog No. 6590-23-01
Copyright ©1997. Novametrix Medical Systems Inc.
5 Technology Drive
Wallingford, Connecticut, U.S.A. 06492
All rights reserved.
Revision History
04-Oct-96 Release Version Rev.00
25-Mar-97 Revision 01
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Revision History
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16Guarantee
Equipment manufactured or distributed by Novametrix Medical Systems Inc., is fully
guaranteed, covering materials and workmanship, for a period of one year from the
date of shipment, except for certain disposable products and products with stated
guarantees other than one year. Novametrix reserves the right to perform guarantee
service(s) at its factory, at an authorized repair station, or at the customer’s
installation.
Novametrix’ obligations under this guarantee are limited to repairs, or at
Novametrix’ option, replacement of any defective parts of our equipment, except
fuses, batteries, and calibration gasses, without charge, if said defects occur during
normal service.
Claims for damages during shipment must be filed promptly with the transportation
company. All correspondence concerning the equipment must specify both the model
name and number, and the serial number as it appears on the equipment.
Improper use, mishandling, tampering with, or operation of the equipment without
following specific operating instructions will void this guarantee and release
Novametrix from any further guarantee obligations.
Call toll free: 1-800-243-3444
To Call Direct: (203) 265-7701
Facsimile (203) 284-0753
http://www.novametrix.com
Caution: Federal (U.S.A.) law restricts this device to sale, distribution, or use by or
on the order of a licensed medical practitioner.
Copyright 1997. Novametrix Medical Systems Inc. 5 Technology Drive,
Wallingford, Connecticut, 06492. This document contains information which is
proprietary and the property of Novametrix Medical Systems Inc., and may not be
reproduced, stored in a retrieval system, translated, transcribed, or transmitted, in any
form, or by any means, without prior explicit written permission from Novametrix
Medical Systems Inc.
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Table of Contents
Revision History ...................................................................................................... iii
Table of Contents ..................................................................................................... v
Introduction ............................................................................................................... 1
About this manual ................................................................................................ 1
Indications for Use ............................................................................................... 1
Summary of features ............................................................................................ 2
Principles of Operation ......................................................................................... 2
Oxygen .............................................................................................................. 2
Carbon Dioxide ................................................................................................. 2
Local Power ...................................................................................................... 3
Technical Description ........................................................................................... 3
Safety ......................................................................................................................... 5
Patient Safety ....................................................................................................... 5
Contraindications ................................................................................................. 6
Warnings .............................................................................................................. 6
Cautions ............................................................................................................... 7
Quick Start Guide ..................................................................................................... 9
Connect Sensor ................................................................................................ 9
Power Up ........................................................................................................ 10
Calibrator Setup ..............................................................................................10
Calibration ....................................................................................................... 10
Alert Limits ...................................................................................................... 10
Apply to Patient ............................................................................................... 10
Handling Alerts ................................................................................................ 10
Removal from Patient ...................................................................................... 10
Monitor Shutdown ...........................................................................................10
System Overview .................................................................................................... 11
M Monitor Front Panel .............................................................................. 11
TCO
2
or Power ......................................................................................................... 11
Low Bat ...........................................................................................................11
AC ON ............................................................................................................. 11
Two Minute Silence ......................................................................................... 12
Audio key ........................................................................................................ 12
Audio Icon .......................................................................................................12
Alert Reset ...................................................................................................... 12
Alert Icon ......................................................................................................... 12
Softkeys .......................................................................................................... 12
Event ............................................................................................................... 12
Contrast ........................................................................................................... 12
M Monitor Rear Panel ............................................................................... 12
TCO
2
Symbols ............................................................................................................. 13
Equipotentiality ............................................................................................... 13
Ground ...........................................................................................................13
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Table of Contents
Dangerous Voltage ........................................................................................ 13
Patient Isolation ..................................................................................... 13
Attention ......................................................................................................... 13
Mains Fuse ...................................................................................................... 13
Mains Power ................................................................................................... 13
M Monitor Display ..................................................................................... 13
TCO
2
Transcutaneous Sensor Overview ..................................................................... 14
Select sensor .................................................................................................. 14
Connect sensor ............................................................................................... 14
TCO2M Calibrator, Model 868 ........................................................................... 14
Setting up the Calibrator ................................................................................. 15
Disconnecting Gas Cylinders .......................................................................... 16
Connect the calibrator ..................................................................................... 16
Operating the Monitor ............................................................................................17
TCO2M Power-up .............................................................................................. 17
Power On/Off .................................................................................................. 17
AC/Battery operation ....................................................................................... 17
AC Line Power ................................................................................................18
Battery Power .................................................................................................. 18
Operating on battery ....................................................................................... 18
Low battery alert .............................................................................................. 18
Charging the battery ........................................................................................ 18
Long Term Storage .........................................................................................18
Battery replacement ........................................................................................ 18
Monitoring CO
and O2 Tension ........................................................................ 19
2
Sensor Stabilization ........................................................................................ 19
Carbon Dioxide and Oxygen Alerts ................................................................. 19
Sensor Temperature Alerts ............................................................................. 19
PtcCO2 Display Values ...................................................................................... 19
Menu Operation and Setup .................................................................................... 21
Menu Structure ................................................................................................... 21
LIMIT — CO2 and O2 Alert Limits ..................................................................... 21
Set Alert Limits ................................................................................................ 22
Auto Alert Limits .............................................................................................. 23
Limit Alerts ...................................................................................................... 23
TRND — Real time trend displays ..................................................................... 24
Real Time Trend ............................................................................................. 24
Show CO
/O2/LP ........................................................................................... 24
2
Set Trend Time ............................................................................................... 24
Set CO2/O2 scale ...........................................................................................25
Local Power
(LP and LPR) .................................................................................................. 26
TRND — Trend Page (stored trend memory) displays ...................................... 27
Show trend page ............................................................................................. 28
Moving in trend ................................................................................................ 28
Select trend page parameter ........................................................................... 29
Select trend scale ............................................................................................ 29
Show histogram .............................................................................................. 29
Erase trend memory ........................................................................................ 30
Trend Data Compression ................................................................................ 31
CAL — Sensor calibration .................................................................................. 31
Calibrate sensor .............................................................................................. 31
Set temperature .............................................................................................. 32
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Table of Contents
Site Timer ........................................................................................................ 33
Reset site timer ...............................................................................................33
Adjust site timer ............................................................................................... 34
Last Calibration information ............................................................................ 35
DELAY — Suppress limit alerts ......................................................................... 35
Set Alert Delay ................................................................................................35
Cancel Alert Delay .......................................................................................... 36
LITE — Display brightness ................................................................................. 36
AUDIO — Adjust alert volume ............................................................................ 36
Sensor Calibration .................................................................................................. 37
Sensor Calibration with the TCO2M Calibrator Model 868 ................................ 37
Manual Calibration of the O2 Sensor ................................................................. 39
O2 Sensor Initial Calibration ........................................................................... 39
O2 Sensor Recalibration ................................................................................. 40
Apply Sensor to Patient .........................................................................................43
Sensor Site Selection ......................................................................................... 43
Sensor to Patient Application ............................................................................. 44
Removing the Sensor from the Patient .............................................................. 45
Combination O
Sensor Identification ........................................................................................ 47
Sensor Construction ........................................................................................ 47
Sensor Operation ............................................................................................ 47
Membrane Schedule ....................................................................................... 47
4474-00 Sensor Membraning Procedure ........................................................ 48
Long Term Combination Sensor Storage ........................................................ 50
Cleaning the Combination Sensor face ........................................................... 50
4474-39 Sensor Membraning Procedure ........................................................ 51
Carbon Dioxide Sensor .......................................................................................... 55
CO2 Sensor Construction ...............................................................................55
CO2 Sensor Operation .................................................................................... 55
Membrane Schedule ....................................................................................... 55
CO2 Sensor Membraning Procedure .............................................................. 55
Long Term CO2 Sensor Storage .................................................................... 57
Cleaning the CO2 Sensor face ....................................................................... 57
Oxygen Sensor ....................................................................................................... 59
O2 Sensor Construction .................................................................................. 59
O2 Sensor Operation ......................................................................................59
Membrane Schedule ....................................................................................... 59
Cleaning and Membraning the O2 Sensor face .............................................. 59
Long Term O2 Sensor Storage ....................................................................... 61
Advanced Controls and Features ......................................................................... 63
Display Menu ..................................................................................................... 63
Temperature or Power Display ....................................................................... 63
Limit Display .................................................................................................... 64
Display Colors ................................................................................................. 64
Display Units ...................................................................................................65
System Menu ..................................................................................................... 65
Serial Out ........................................................................................................65
Set Clock ......................................................................................................... 66
Site Timer (Maximum Duration) ......................................................................66
Metabolic Correction Factor ............................................................................ 67
Barometric pressure determination ................................................................. 67
/CO2 Sensor .................................................................................47
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Alerts Menu ........................................................................................................ 68
Latch Alerts .....................................................................................................68
10 second Alert Delay Option ......................................................................... 69
Retain Alert Limits ........................................................................................... 69
Red Alert Bar ................................................................................................... 69
Audio Menu ........................................................................................................ 70
Allow Audio Off ................................................................................................ 70
Keyclick Volume .............................................................................................. 70
Sensor Menu ...................................................................................................... 71
Restoring factory defaults settings ..................................................................... 71
External Devices ..................................................................................................... 73
NovaCARD ......................................................................................................... 73
NovaCARD Configuration ...............................................................................74
Using NovaCARD ........................................................................................... 74
Analog Output Module ....................................................................................... 75
Connecting the Analog Output Module ...........................................................75
Calibrating an External Recorder .................................................................... 76
Printer ................................................................................................................. 77
Setup Printer ...................................................................................................77
Setup TCO2M .................................................................................................78
Types of Printouts ...........................................................................................78
Displayed Trend printout ................................................................................. 78
Compressed Trend printout ............................................................................ 79
Zoom Trend printout ........................................................................................ 79
Stopping a printout .......................................................................................... 80
Trend Printout ................................................................................................. 81
Tabular Printout ............................................................................................... 85
NovaCOM .......................................................................................................... 86
NovaCOM Configuration ................................................................................. 86
NovaCOM Data Format .................................................................................. 86
Real Time ........................................................................................................ 86
Trend Dump ....................................................................................................87
Date and Time ................................................................................................. 89
Clear Trends ................................................................................................... 89
Exit Command ................................................................................................. 89
Flexport .............................................................................................................. 90
Terminal ............................................................................................................. 90
Maintenance ............................................................................................................ 91
Cleaning and Disinfecting .................................................................................. 91
Monitor ............................................................................................................91
Sensors ........................................................................................................... 91
Calibrator ......................................................................................................... 91
Battery Maintenance .......................................................................................... 92
Long Term Storage .........................................................................................92
Charging the battery ........................................................................................ 92
Battery replacement ........................................................................................ 92
Line Cord ......................................................................................................... 92
Fuses ................................................................................................................. 92
Specifications ......................................................................................................... 95
Monitor Model 860 ............................................................................................. 95
Sensors .............................................................................................................. 96
Gas Calibrator Model 868 .................................................................................. 96
Guarantee ................................................................................................................ 97
Accessories ............................................................................................................. 99
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1 Introduction
The TCO2M® Transcutaneous CO2/O2 Monitor, Model 860 is designed to be an easyto-operate stand-alone transcutaneous monitoring system. It is intended to be used in
patient monitoring environments by technically skilled clinical personnel.
About this manual
This manual is written for clinical personnel using the TCO2M® Transcutaneous
CO
transcutaneous sensors and accessories intended for use with the monitor and
calibrator from Novametrix Medical Systems Inc.
This document contains information which is proprietary and the property of
Novametrix Medical Systems Inc., and may not be reproduced, stored in a retrieval
system, translated, transcribed, or transmitted, in any form, or by any means, without
the prior explicit written permission of Novametrix Medical Systems Inc.
Monitor, Model 860, the Transcutaneous Calibrator, Model 868, and the
2/O2
Novametrix reserves the right to change specifications without notice. TCO
NOVADISK are registered trademarks, and NovaCARD and NovaCOM are
trademarks of Novametrix Medical Systems Inc.
M and
2
Indications for Use
The TCO2M Transcutaneous CO2/O2 Monitor, Model 860 is indicated for use as a
trend monitor for CO
an adjunct to arterial CO
blood gas device.
Regulatory review (U.S.A.) of safety and effectiveness for transcutaneous oxygen
monitors is not required at this time. However, the oxygen-monitoring portion of this
device has been found to be substantially equivalent to devices marketed in interstate
commerce prior to May 28, 1976.
and O2 tension at the skin surface for neonates and adults as
2
and O2 blood gas measurements. This equipment is not a
2
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1 Introduction Summary of features
Summary of features
The TCO2M Transcutaneous CO2/O2 Monitor provides reliable, continuous
measurement, displays and alerts for transcutaneous oxygen tension (PtcO
transcutaneous carbon dioxide tension (PtcCO
) and sensor temperature. Sensor
2
heater power is also trended and can be displayed. The monitor’s real time graphic
onscreen trends along with the numeric values provide truly continuous CO
monitoring. A simple menu system with helpful messages guides the user through
setup and alert conditions. Built-in 24-hour trend memory with graphic and
histogram displays are available for viewing of patient history. The lightweight
portable monitor can operate from AC power or from its internal battery. Sensor
calibration is quick, fully automatic, barometric pressure compensated, and uses a
true two-point method for accurate calibrations. The Calibrator is completely
powered from the Monitor and the sensor can be inserted and removed from the
calibrator with a single hand. TCO
as CO
only or O2 only sensors for optimum versatility. Sensors provide superior
2
M accepts combination CO2/O2 sensors as well
2
performance, fast response, are rugged, reliable and can be membraned in seconds.
An automatic site timer enhances patient safety.
and O
2
2
),
2
Principles of Operation
Oxygen Transcutaneous oxygen is measured with an oxygen sensor consisting of two parts;
1) a modified Clark-type polarographic electrode, a silver anode and platinum
cathode, electrolyte and an oxygen permeable membrane, and 2) a heating section
with two precision thermistors for measuring and controlling the sensor temperature.
When the sensor is subjected to oxygen, the oxygen molecules diffuse through the
membrane and create an electro-chemical reaction which causes current to flow
through the cathode. An amplifier connected to the cathode measures current flowing
and converts it to a value proportional to the oxygen tension at the sensor/membrane
interface. This is PtcO
selected by the user).
Carbon Dioxide Transcutaneous carbon dioxide is measured with a sensor that utilizes a unique pH
electrode based on the Stow-Severinghaus principle. The carbon dioxide sensor is
composed of two parts; 1) a carbon dioxide sensor consisting of a pH electrode,
reference electrode, electrolyte and a carbon dioxide permeable membrane, and 2) a
heating section with two precision thermistors for measuring and controlling the
sensor temperature. When the sensor is subjected to carbon dioxide, the carbon
dioxide molecules diffuse through the membrane and react with the electrolyte. This
reaction alters the pH of the electrolyte solution, which in turn changes the voltage
across the pH and reference sensors. Since carbon dioxide is the only gas that can
affect the pH of the electrolyte, there is a direct correlation between pH and the
amount of CO
present. This relationship is expressed by the Henderson-Hasselbach
2
and is displayed as a O2 value (in either mmHg or kPa as
2
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Technical Description Introduction 1
0.03 pCO
2
equation:
HCO
pH = pKa + log
3
An amplifier measures this voltage change and converts it to a value corresponding
to the carbon dioxide tension at the sensor/membrane interface. This is PtcCO
and
2
is displayed as a CO2 value (in either mmHg or kPa as selected by the user).
Local Power Local Power is the measure of electrical power, measured in milli-watts (mW),
required by the sensor to maintain the selected sensor temperature setting. The Local
Power value is proportional to the blood flow beneath the sensor site. Because the
sensor set temperature is above blood temperature, blood flowing past the sensor site
provides a cooling action. As blood flow (and its associated cooling action) increases,
the sensor requires more power to maintain its temperature setting and the LP value
increases. Conversely, as blood flow decreases, sensor heater power and LP also
decrease.
Abrupt changes in PtcO
blood flow at the sensor site, while abrupt changes in PtcO
significant LP changes may indicate consistent blood flow but a change in PaO
coupled with significant LP changes may indicate reduced
2
unaccompanied by
2
.
2
Important: Sensor heater power requirements (LP) are also influenced by body
temperature and ambient temperature changes. Body temperature changes tend to be
gradual over time and produce minor changes in LP. Ambient temperature changes
from air-conditioners, patient warmers, radiant heaters, etc., can have significant
effects on the LP value. If monitoring the LP value, it may be necessary to insulate
the sensor from ambient temperature changes with a light covering such as a
bedsheet, or with material designed to reflect radiant heat energy.
Technical Description
Per requirements of IEC 601-1, TCO2M is classified as class I equipment, internally
powered, with type BF applied part, and IPX0.
The TCO
serviceable parts. Refer servicing to qualified service personnel.
See “Accessories” on page 99 for listings of the Service Manual and Service Test kit
for use by technical personnel.
M Transcutaneous CO2/O2 Monitor, Model 860, contains no user
2
Transport and storage conditions: -10 to +55° C (14-131° F) < 90% relative humidity
non-condensing. Operating conditions:10-40° C (50-104° F).
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1 Introduction Technical Description
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2 Safety
Patient Safety
• The location of the sensor on the patient should be changed periodically to
minimize the risk of heat induced skin damage. The risk of such skin damage
is dependent upon the sensor temperature, duration of application and
physiological parameters including local perfusion, body temperature, and
skin thickness.
• TCO
• In areas where electromagnetic devices (i.e., electrocautery) are used, patient
• The PtcCO
• Components of this product and its accessories which have patient contact
• Connect only Novametrix supplied transcutaneous sensors and gas
M monitor has electrically isolated inputs. Patient leakage current
2
flowing from the instrument to ground is limited to less than 10
60 Hz. Patient isolation is greater than 10 M
maximum patient and operator safety, the following procedures are
recommended;
•Keep the TCO
•Do not operate the TCO
•Do not touch the patient while making adjustments on the TCO
monitor.
•Whenever possible, the TCO
circuit as other equipment in use on the same patient. Outlets that are on
the same circuit can be identified by your hospital’s engineering
department.
monitoring may be interrupted due to electromagnetic interference.
Electomagnetic fields up to 3 V/m will not adversely affect system
performance.
factor for pCO
not during calibration. See “PtcCO2 Display Values” on page 19.
are latex free.
calibrators to the TCO
Refer to “Accessories” on page 99 for listings and catalog numbers.
M and its accessories clean.
2
M when it is wet due to spills or condensation.
2
M monitor should be connected to the same
2
display reading (CO2) is factory set to reflect the metabolic
2
and the value is corrected only during patient monitoring—
2
M Model 860 monitor front panel input connectors.
2
Ω, 2500 V rms at 60 Hz. For
µA at 120 V,
2
M
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2 Safety Contraindications
Contraindications
• In patients who are hemodynamically compromised, transcutaneous gas
values may no longer reflect arterial gas values due to changes in blood flow
to the tissue.
• Patients with extremely sensitive skin should be carefully evaluated prior to
monitoring as sensor heat or adhesive ring application may cause skin
irritation. Skin irritation due to the adhesive ring can be minimized by
loosening the adhesive with alcohol or water prior to its removal from the
patient.
• HALOTHANE INTERFERENCE. Halothane is the only known anesthetic
gas affecting the reliability of transcutaneous oxygen (PtcO
as demonstrated in in-vitro testing of the Transcutaneous Combination O
CO
Sensor (PN:4474). The affect of halothane on transcutaneous oxygen
2
measurements in-vivo has not been determined. Halothane does not affect
the transcutaneous carbon dioxide (PtcCO
Transcutaneous Combination O
/CO2 Sensor. No known anesthetic gasses
2
) measurement of the
2
affect the performance of the Transcutaneous Oxygen Sensor (PN:6754) or
the Transcutaneous Carbon Dioxide Sensor (PN:6752).
) measurement
2
2
/
• PtcO
levels in excess of 150 mmHg may cause drift of PtcCO2 portion of
2
the 4474-00 Combination O
NOVADISK
O
/CO2 Sensor and 8575 NOVADISK, nor with the Transcutaneous Oxygen
2
. This drift is not experienced with the 4474-39 Combination
/CO2 Sensor using an 8900 Split Membrane
2
Sensor (PN:6754) or the Transcutaneous Carbon Dioxide Sensor (PN:6752).
Warnings
WARNING: Indicates a potentially harmful condition that can lead to personal injury.
• Explosion Hazard: Do NOT use the TCO2M in the presence of flammable
anesthetics. Use of this instrument in such an environment may present an
explosion hazard.
• Electrical Shock Hazard: Always turn the monitor off before cleaning it.
Do NOT use a damaged sensor or one with exposed electrical contacts. Do
NOT remove covers or panels. Refer servicing to qualified service
personnel.
• Failure of Operation: If the monitor fails to respond as described, do not
use it until the situation has been corrected by qualified personnel.
• Fire Hazard: The TCO
oxygen levels at elevated pressures. Use of this instrument in such an
environment may present a fire hazard.
M and its sensors should not be exposed to elevated
2
6 TCO
• For installations where the integrity of the external protective earth
conductor arrangement is in doubt, the equipment should be operated from
its internal battery only.
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Cautions Safety 2
• No user serviceable parts inside. Refer servicing to qualified service
personnel.
Cautions
CAUTION: Indicates a condition that may lead to equipment damage or malfunction.
• Federal (U.S.A.) law restricts this device to sale, distribution, or use by or on
the order of a licensed medical practitioner.
• No tension should be applied to the sensor cable.
• Avoid storing the monitor and sensors at temperatures less than -10
greater than +55
° C (<14° F or >131° F).
• Do NOT immerse the monitor or sensors in liquids.
• Do NOT sterilize the monitor or the sensors.
• Electric Shock Hazard. Always turn the monitor off before cleaning it. Do
NOT use a damaged sensor or one with exposed electrical contacts. Do NOT
remove covers or panels. Refer servicing to qualified service personnel.
° C or
• Connect the line cord only to a grounded hospital-grade outlet.
• For continued protection against fire hazard, replace fuses only with those of
the same type and rating.
• No user serviceable parts inside. Refer servicing to qualified service
personnel.
• Operate at temperatures between +10° C to +40° C (50-104° F), < 90%
relative humidity (non-condensing).
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2 Safety Cautions
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3 Quick Start Guide
This section summarizes and highlights the key steps and processes required to
properly configure the TCO
sensor, apply the sensor to the patient, handle any associated alerts, and remove the
sensor from the patient.
This section is an adjunct to other sections of this manual where these steps or
processes are explained in more detail. Refer to the appropriate sections for more
information. Use of equipment other than mentioned here may yield different results.
M® monitor for operation, connect and calibrate the
2
Calibrator connection
Sensor connection
Sensor Port
Connect to TCO
Connect Sensor
25-Mar-97 Rev. 01 TCO
1 Attach an appropriate sensor to the TCO2M’s front panel connector. The
sensor will “click” into place when properly installed.
Ensure the sensor is in good physical condition and that the NOVADISK
membrane assembly is intact and clean—use an alcohol wipe if needed.
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User’s Manual9
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M
2
3 Quick Start Guide
Power Up 2 Press the key to turn the TCO
AC ON illuminates if the monitor is connected to the AC line and the
rear panel power switch is set to “|”. This also causes the internal battery
to charge.
A battery icon appears on the display if the monitor is operating from its
internal battery.
3 The base menu display appears after the power-up and self-test messages.
4 Press the (Contrast) key to adjust the display for optimum viewing.
M on.
2
Calibrator Setup 5 Connect the Model 868 Calibrator to the small connector on the monitor’s
front panel.
Ensure that the gas cylinders are properly installed. They are color coded
to make it easy. Check that the cylinders are not empty. Both gauges
should be registering pressure.
If using an O2 only sensor, the Model 868 Calibrator is not required.
Calibration 6 Place the sensor into the Calibrator’s Sensor Port.
If using an O2 only sensor, refer to the appropriate section of the manual
for calibration.
7 Press the CAL softkey. Verify the calibration settings, including site timer
duration and temperature are correct. Press START to begin calibration.
If calibration settings need adjustment, press SET to adjust them.
Calibration will not begin if the sensor is not yet up to operating
temperature. Wait until temperature is achieved and try calibration again.
8 When the TCO2M beeps and the CALIBRATION DONE message appears,
press RUN and remove the sensor from the calibrator.
Alert Limits 9 Verify the alert limits are properly set. If needed, press LIMITS to adjust.
Apply to Patient 10 Attach an adhesive ring to the sensor face, apply a drop of contact gel, and
apply the sensor to a properly prepared site.
Handling Alerts 11 To temporarily silence an audible alert and to keep the red alert bar from
flashing for two minutes, press the key.
12 Once the parameter comes back within limits (or limits are widened), press
ALERT RESET to clear the displayed message and flashing limit display.
Removal from
Patient
Monitor Shutdown 14 To turn the TCO
13 To remove the sensor from the skin, gently peel the adhesive ring from the
skin. Wiping the ring with water or alcohol will loosen the adhesive and aid
removal.
M off, press the key.
2
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4 System Overview
This section provides an overview of the TCO2M Transcutaneous Monitoring System
including the Model 860 Monitor, Model 868 Calibrator, and transcutaneous sensors.
TCO2M Monitor Front Panel
The TCO2M Monitor, Model 860 front panel includes dedicated function keys, menu
dependent “softkeys” and illuminating icon symbols. A Red Alert Bar, sensor, and
Model 868 Calibrator input connections also appear on the front panel.
Sample Display
TCO2M Calibrator Model 868 connection
or Power Turn the monitor power on and off.
Low Bat Icon illuminates red when operating on battery power and 15 minutes of battery life
remain.
• A similar icon appears in the display when the monitor is running on battery
power and gives a visual indication of the charge left on the battery.
Red Alert Bar
Sensor input
AC ON Icon illuminates green when the monitor is connected to AC power and the rear panel
power switch is set to “|” (ON). Also indicates the battery is charging.
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4 System Overview TCO
M Monitor Rear Panel
2
Two Minute
Silence
Icon illuminates yellow when the audio has been temporarily silenced using the Two
Minute Silence feature.
Audio key Enable or disable audible alerts.
Audio Icon Flashes yellow to indicate an Audio Off condition in which audible limit alerts will
be prevented.
Alert Reset Acknowledge and reset alerts.
Alert Icon Flashes red to indicate an alert condition.
Softkeys Five keys that function according to the command shown above each key in the
display.
Event Mark a user defined “Event” in trend memory (viewed from Trend Page).
Contrast Press to vary the display’s contrast setting for optimum viewing.
TCO2M Monitor Rear Panel
1 2
3
4 5 6
1 Ground stud. Use to connect monitor’s chassis to earth ground.
2 Indicates fuse rating information for mains fuse.
3 Data Input/Output port for external peripherals.
4 Power cord receptacle and power cord retaining clip. Plug power cord into
this receptacle. Use only hospital grade three wire plugs for connection via
supplied power cord.
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Symbols System Overview 4
5 AC Line Power (Mains) Switch. Set to “|” allows AC mains to power the
monitor, set to “O” switches AC mains power off.
6 Voltage select/fuse compartment - Sets mains operating voltage and houses
mains fuses.
Symbols
Equipotentiality Connection to monitor’s chassis.
Ground Protective earth ground connection.
Dangerous
High voltages present.
Voltage
Patient
Identifies patient isolation connection as type BF.
Isolation
Attention Consult manual for detailed information.
Mains Fuse Mains fuse rating for replacement fuses
250V
Mains Power AC mains switch “|” ON-connection to mains; “O” OFF-disconnection from mains.
TCO2M Monitor Display
The display is arranged in different sections; parameter information for PtcCO2 and
PtcO
, real time waveform display, and the menu display. A full screen trend display
2
is also available. TCO
M allows great flexibility in the way that data is displayed, so
2
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4 System Overview Transcutaneous Sensor Overview
your screen may not match this one; especially if you are using a single parameter
(CO
or O2) sensor.
2
indentifier & value
PtcO
2
PtcCO
identifier & value
2
Alert Limits
Sensor Temperature Menu softkey identifiersBattery Icon
Real Time Waveform Display
Trend Parameter & Display Time
Transcutaneous Sensor Overview
Select sensor Select a sensor based on monitoring need and availability. Several transcutaneous
sensors can be used with the TCO
split membrane
Transcutaneous O
NOVADISK 4474-00, Combination O
Sensor 6754-00, and Transcutaneous CO2 Sensor 6752-00.
2
M including; Combination O2/CO2 Sensor with
2
/CO2 Sensor 4474-39,
2
Ensure the selected sensor is mechanically sound; with no broken, frayed, or exposed
wiring. Ensure the
NOVADISK membrane assembly is intact and clean, use a alcohol
wipe to clean the sensor and membrane face if necessary. Refer to the appropriate
sections of this manual for specific sensor preparation instructions.
Connect sensor Connect a sensor to the TCO
M, by aligning the pins of the sensor connector with
2
those on the monitor’s front panel input connector and pushing the sensor connector
into place. The sensor should “click” into place when correctly seated.
TCO2M Calibrator, Model 868
The TCO2M Calibrator, Model 868 is intended to be used with the TCO2M
Transcutaneous Monitor, Model 860. The calibrator is used to expose a
transcutaneous sensor to two precision gas mixtures as part of the sensor’s
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TCO2M Calibrator, Model 868 System Overview 4
calibration. The Monitor controls the actions of the Calibrator as well as providing
power to the Calibrator.
Sensor port with cover
Gas
gauges
Setting up the
Calibrator
Connection to
TCO2M
To install calibration gas cylinders:
1 Check the cylinder part number and label color against the part number and
color identifier on the rear panel.
High Point Gas
Cat. No. 8965
(Yellow)
Tighten
Low Point Gas
Cat. No. 8964
(Orange)
2 Insert a Low Point Calibration Gas (Cat. N0. 8964) cylinder into the
appropriate opening at the rear of the calibrator. Hand tighten the cylinder by
rotating it in a clockwise direction until is firmly seated against the in the
calibrator, then 1/4 turn more. The cylinder should turn easily, if not, remove
and try again. Do not force it.
3 Install High Point Calibration Gas (Cat. N0. 8965) cylinder in the same
manner.
4 Verify that both front panel pressure gages indicate pressures above zero.
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4 System Overview TCO2M Calibrator, Model 868
Disconnecting Gas
Cylinders
Connect the
calibrator
When the front panel pressure gauge reads 0 (while a cylinder is connected) the
cylinder is empty and must be replaced. Do not attempt to calibrate a sensor with an
empty cylinder.
To remove a cylinder:
1 Rotate the cylinder in a counter clockwise direction until free.
2 Dispose of cylinder in accordance to local regulations.
CAUTION: Do not attempt to refill empty cylinders or to dispose of in fire.
Refer to labeling on cylinder for proper handling and disposal.
Connect the calibrator to the TCO2M by aligning the red dot on the calibrator cable
connector with the red dot on the monitor’s front panel calibrator input connector and
pushing the calibrator connector into place. It “clicks” into place when correctly
seated.
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5 Operating the Monitor
This section includes information on operating the TCO2M Transcutaneous Monitor, Model
860 including power on/off and AC/Battery operation. This section also details the
monitoring of oxygen and carbon dioxide tension, and the principles of sensor operation.
TCO2M Power-up
Power On/Off Press the front panel key to turn the monitor on or off. At power-up the monitor will:
• Perform a “lamp test” where the display and indicators light
(AC ON icon will not light when powered by battery).
• Produce an audible “beep” indicating the audio is functional.
• Performs a self test; “MONITOR PERFORMING SELF TEST” is displayed.
• Display the base menu.
AC/Battery operation The TCO
panel AC ON icon illuminates green when operating from the AC line, and remains off
when TCO
Press to turn monitor on and off
Lights green when on
AC power (battery charging)
Low battery alert lights
when 15 minutes remain
M can be powered from the AC line (Mains) or from its internal battery. The front
2
M is being powered from its battery.
2
Icon appears only when on battery power
Full charge (>3 hours)
Half charge
Nearly depleted
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5 Operating the Monitor TCO2M Power-up
AC Line Power To power TCO2M from the AC line power source:
1 Set the rear panel power switch to the “|” (ON) position.
2 Plug the line cord into the rear panel power cord receptacle and into a
properly grounded 3-wire outlet.
3 Verify the green AC ON icon illuminates.
Battery Power To power TCO2M from its internal battery:
1 Do either or both of the following;
— Set the rear panel power switch to the “O” (OFF) position, or
— Unplug the line cord from the rear panel power cord receptacle or AC
outlet.
2 Verify the green AC ON icon is NOT illuminated.
Operating on battery A fully charged battery will power the monitor for over three hours. While on battery
power, the display shows a battery icon that “drains” as battery charge is depleted;
from a full charge , to half-charge , to nearly depleted .
power up on battery power if the battery is not sufficiently charged. See “Charging
the battery” below.
The monitor may not
NOTE: Excessive alerting reduces battery life when operating on battery power.
Low battery alert When 15 minutes of battery life remain, the LOW BAT low battery indicator
illuminates red. If the monitor continues to be powered from its internal battery for
more than 15 minutes after a low battery alert occurs, the monitor’s display blanks
except for the message
BATTERY VERY LOW PLUG IN AC POWER. All indicators
(except AC ON ) illuminate and a continuous audible tone sounds. Reconnect the
AC power or the monitor will automatically shut itself off.
Charging the battery To recharge the battery, plug in the line cord and set the rear panel power switch to
the (|) ON position. A discharged battery will be fully recharged within 12 hours. The
monitor may be operated, on AC power, while the battery is being recharged.
Long Term Storage If the TCO
M has not been used or connected to AC power (AC ON icon
2
illuminated) for an extended time (e.g., 3 months or more) allow the battery to charge
for 12 hours before use.
Battery replacement The internal TCO
M battery is not user replaceable. Should replacement become
2
necessary, contact qualified technical service personnel. Replace only with a battery
of the same type and rating.
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Monitoring CO2 and O2 Tension Operating the Monitor 5
!
Monitoring CO2 and O2 Tension
Sensor Stabilization After the properly membraned and calibrated sensor is appropriately applied to the
skin, the CO
value will drop from its room air value, then slowly increase to a stabilized value.
Stabilization typically occurs within 10-15 minutes.
will gradually rise from its room air value to a stabilized value. The O
2
2
Carbon Dioxide and
Oxygen Alerts
Sensor
Temperature Alerts
The TCO
M has audible and visual alerts for both carbon dioxide and oxygen
2
tension. Refer to “LIMIT — CO2 and O2 Alert Limits” on page 21.
Any time the actual sensor temperature differs from the user-selected temperature by
more than 0.2
° C, a temperature alert will occur. If a temperature alert occurs, the
alert indicator and the red alert bar start to flash. The message center displays
TEMP > 0.2° C and audible alarm (that overrides Audio Off) sounds. The visible and
audible alarms will automatically reset if the temperature returns within the 0.2
° C
limits. The temperature audio is disabled for the first three minutes after the monitor
is turned on—allowing the sensor to heat up without generating an alarm condition.
Do not confuse a Site Timer Expired induced sensor heater power shutdown with a
temperature fault. Refer to “Site Timer” on page 33.
A temperature fault condition may occur if the sensor is damaged or if the monitor
fails. The message center will display “
MONITOR ERROR TEMPR. ERR-HTR OFF”
and an audible alarm (that overrides Audio Off) will sound. The monitor will
automatically shut down the heater power to the sensor, thus eliminating the risk of a
sensor-induced heat-related skin damage. A temperature fault can only be reset by
turning the monitor off and then back on.
WARNING: If a temperature fault occurs, the sensor should
immediately be removed from the patient. Contact qualified service
personnel before putting either the monitor or sensor back into use
.
PtcCO2 Display Values
The CO2 display reading is factory set to reflect the metabolic factor for pCO2. This
means that the CO
of CO
and the anaerobic temperature coefficient induced by the application of a
2
heated sensor. The CO
significantly greater than the pCO
• Anaerobic temperature coefficient of blood for carbon dioxide.
1. Monaco, F., McQuitty, J.C., Nickerson, B.G. Calibration of a Heated Transcutaneous CO2 Electrode to Reflect Ar-
2. Am. Rev. Resp. Dis. 1983; 127:322.
terial CO
25-Mar-97 Rev. 01 TCO
values have been adjusted for the increased metabolic production
2
value measured with a heated transcutaneous sensor is
2
in the arteries for the following reasons:
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1
5 Operating the Monitor PtcCO2 Display Values
• Increased local CO2 production due to increased metabolism of heated
epidermal tissue beneath the sensor.
• The arteriole-cellular CO
The TCO
M automatically corrects the PtcCO2 during patient monitoring (not during
2
difference.
2
sensor calibration) to compensate for these metabolic factors related to the
temperature effect and CO
following formula;
2
pCO2(37°C) = PtcCO2 × (10
production. The correction is accomplished via the
2
0.019× (37-Tsensor °C)
) - 4
pCO2(37° C) - PtcCO2 value in mmHg corrected to 37° C
assuming a patient temp of 37
PtcCO
- value of PtcCO2 in mmHg measured by the sensor
2
° C
If the correction factor has been disabled, the message “OFF” (metabolic correction
factor off) flashes beside and to the right of the displayed CO
value. Refer to
2
“Metabolic Correction Factor” on page 67 for details.
20 TCO
2. Severinghaus, J.W. Transcutaneous Blood Gas Analysis Respiratory Care 1983; 27(2): 152
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