Philips FM20/30, Avalon CL, FM40/50 Instructions For Use Manual

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Instructions fo r U s e

Avalon Fetal Monitor

FM20/30, FM40/50, Avalon CL

Re l e as e J. 3 wi t h S o ftw a re R evi s ion J. 3 x .x x

Pa t i en t Mo n i to r i ng

1Table of Contents

1 Introduction 9

Who this Book is For 9 Confirm Fetal Life Before Using the Monitor 10 Introducing the Avalon Family of Fetal Monitors 11

2 What's New 19

What's New in Release J.3 19 What's New in Release G.0 22

3 Basic Operation 25

Supported Measurements 26 Avalon FM20 and FM30 27 Avalon FM40 and FM50 28 Avalon CL Transducer System 29 Getting to Know Your Avalon FM20/FM30 30 Getting to Know Your Avalon FM40/FM50 32 Connecting the Monitor to AC Mains 34 Wired Transducers 34 Getting to Know Your Avalon CL 36 Cableless Transducers 39 CL Pods 44 Operating and Navigating 46 Operating Modes 51 Automatic Screen Layouts 52 Settings 52 Preparing to Monitor 55 After Monitoring 88 Switching the Monitor to Standby 88 Disconnecting from Power 89 Power On/Power Off Behavior 89 Monitoring After a Power Failure 89 Troubleshooting 90

4 FM20/30 Battery Option 91

External Power Supply M8023A 92 Using Batteries 92 Optimizing Battery Performance 95 Storing the Battery 98 Cableless Monitoring with FM20/30 Battery Option 98 Patient Transport Within the Hospital 98

5 Alarms 99

Alarm Mode 100 Nurse Call Systems 100 Visual Alarm Indicators 100 Audible Alarm Indicators 101 Acknowledging Alarms 103 Acknowledging Disconnect INOPs 103 Alarm Reminder 103 Pausing or Switching Off Alarms 104 Alarm Limits 107 Reviewing Alarms 108 Latching Alarms 109 Testing Alarms 110 Alarm Behavior at Power On 111

6 Patient Alarms and INOPs 113

Alarm Messages 113 Technical Alarm Messages (INOPs) 115

7 Admitting and Discharging 125

Admit/Discharge on the Monitor 125 New Patient Check 127 OB TraceVue/IntelliSpace Perinatal 127

8 Non-Stress Test Timer 129

Setting NST Autostart/Autostop 129 Viewing the NST Timer 129 Timer Expiry Notification 129 Accessing the NST Setup Pop-up Keys 130

9 Non-Stress Test Report 131

Setting Up an NST Report 131 NST Report Status Window 132 NST Criteria 134

10 Cross-Channel Verification (CCV) 135

Misidentification of Heart Rates 135 Cross-Channel Verification Functionality 136 Overview of Cross-Channel Comparisons 136 Coincidence Examples 138 Recommended Actions for Coincidence INOP 140

11 Monitoring FHR and FMP Using Ultrasound 141

Technical Description 141 Limitations of the Technology 142 Misidentification of MHR as FHR 142

What You Need 142 Cableless Monitoring - Important Considerations 142 Preparing to Monitor 145 Selecting Fetal Heart Sound 146 Changing the Fetal Heart Sound Volume 146 Fetal Movement Profile 147 Troubleshooting 149 Additional Information 150

12 Monitoring Twin FHRs 159

Important Considerations 159 Monitoring Twins Externally 160 Monitoring Twins Internally 161 Separating FHR Traces 161 Troubleshooting 165

13 Monitoring Triple FHRs 167

Important Considerations 167 Monitoring Triplets 168 Separating FHR Traces 168 "Standard" Separation Order 168 "Classic" Separation Order 169 Switching Trace Separation On and Off 170 When Trace Separation is On 171 When Trace Separation is Off 171 Troubleshooting 172

14 Fetal Heart Rate Alarms 173

Changing Alarm Settings 173 Changing Signal Loss Delay 174

15 Monitoring Uterine Activity Externally 175

What You Need 175 External Toco Monitoring 176 Toco Sensitivity 176 Troubleshooting 176

16 Monitoring Uterine Activity Internally 179

What You Need 179 Internal (IUP) Monitoring 181 Troubleshooting 182

17 Monitoring FHR Using DECG 183

Misidentification of MHR as FHR 183 What You Need 185 Making Connections 187

Monitoring DECG 188 Suppressing Artifacts 190 Troubleshooting 190 Testing DECG Mode 191

18 Monitoring Noninvasive Blood Pressure 193

Introducing the Oscillometric Noninvasive Blood Pressure Measurement 193 Preparing to Measure Noninvasive Blood Pressure 194 Starting and Stopping Measurements 197 Enabling Automatic Mode and Setting Repetition Time 197 Enabling Sequence Mode and Setting Up the Sequence 197 Choosing the Alarm Source 198 Assisting Venous Puncture 199 Calibrating NBP 199 Troubleshooting 199

19 Monitoring Maternal Temperature 201

Measuring Tympanic Temperature 201 Entering Temperature Manually 206

20 Monitoring SpO2 207

Selecting an SpO2 Sensor 207 Applying the Sensor 207 Connecting SpO2 Cables 208 Measuring SpO2 209 SpO2 Signal Quality Indicator (FAST SpO2 only) 210 Assessing a Suspicious SpO2 Reading 210 Understanding SpO2 Alarms 210 Setting Up Tone Modulation 211 Setting the QRS Volume 211

21 Monitoring Maternal Heart / Pulse Rate 213

Priority for Maternal Heart / Pulse Rate 213 Misidentification of MHR for FHR 214 MHR from MECG Electrodes 214 Monitoring MECG Wave 217 Pulse Rate from Toco MP 219 Pulse Rate from SpO2 220 Adjusting the Heart Rate / Pulse Alarm Limits 221 Average Pulse Rate from Noninvasive Blood Pressure 221 Testing MECG Mode 221

22 Printing the ECG Waveform 223

23 Paper Save Mode for Maternal Measurements 227

24 Recovering Data 229

Recovering Traces on Paper 229 Recovering Traces on an OB TraceVue/IntelliSpace Perinatal System 230 Manually Recording Stored Data 230

25 Care and Cleaning 233

General Points 233 Cleaning and Disinfecting 234 Cleaning and Disinfecting Monitoring Accessories 235 Cleaning and Disinfecting the Tympanic Temperature Accessories 235 Sterilizing 237

26 Maintenance 239

Inspecting the Equipment and Accessories 239 Inspecting the Cables and Cords 239 Maintenance Task and Test Schedule 241 Recorder Maintenance 241 Cleaning the Print Head 246 Disposing of the Monitor 247

27 Accessories and Supplies 249

Information on Latex 249 Avalon CL Base Station 249 Transducers 250 Fetal Accessories 250 MECG Accessories 252 Noninvasive Blood Pressure Accessories 252 SpO2 Accessories 254 Tympanic Temperature Accessories 259 Recorder Paper 259 Batteries 260

28 Specifications and Standards Compliance 261

Environmental Specifications 261 Physical Specifications 263 Interface Specifications 266 Performance Specifications 267 Recorder Specifications 278 Compatible External Displays: FM40/FM50 Only 280 Manufacturer's Information 280 Trademark Acknowledgment 280 Regulatory and Standards Compliance 281

Environment 290 Monitoring After a Loss of Power 291 ESU, MRI and Defibrillation 291 Cardiac Pacemakers and Electrical Stimulators 291 Fast Transients/Bursts 291 Symbols on the System 291

29 Default Settings Appendix 295

Alarm and Measurement Default Settings 295 Recorder Default Settings 298

Index 299

1Introduction

Who this Book is For

This book is for trained healthcare professionals using the Avalon FM20, FM30, FM40, and FM50 fetal/maternal monitors, and the Avalon CL Transducer System. It describes how to set up and use the monitor and transducers. Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients. Read and keep the Instructions for Use that come with any accessories, as these contain important information about application, care, and cleaning that is not repeated in this book.

If you have received this Instruction for Use because your fetal monitor has been upgraded to a newer software version (J.3), be aware that the standards compliance information contained in the Instructions for Use for (J.3) does not apply to your fetal monitor. Refer to your original Instructions for Use for standards compliance information.

You should be:

• Trained in the use of fetal heart rate (FHR) monitors.

• Trained in the interpretation of FHR traces.

• Familiar with using medical devices and with standard fetal monitoring procedures. For information on how to configure and service the monitor, see the Configuration Guide and the

Service Guides, or contact your authorized service provider. Your monitor may not have all of the features and options described in this guide. The exact

appearance of the monitor may differ slightly from that shown in the illustrations. This guide may contain descriptions of functionality and features that are not implemented in the

equipment currently shipped to Japan and/or of products that are not currently sold in Japan due to limitations and restrictions under the applicable local laws and regulations in Japan. Please contact your local sales representative and/or Philips Customer Support for details.

In this guide:

• A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient.

• A caution alerts you to where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in:

– minor or moderate personal injury, – damage to the product or other property, – possibly in a remote risk of more serious injury.

1 Introduction

• Monitor refers to the entire fetal/maternal monitor. Display refers to the physical display unit. Screen refers to everything you see on the monitor's display, such as measurements, alarms,

patient data, and so forth.

FM30 • Whenever a monitor’s identifier appears to the left of a heading or paragraph, it means that the

information applies to that monitor only. Where the information applies to all models, no distinction is made.

Avalon CL

Avalon CTS

Whenever one of these identifiers appear to the left of a heading or paragraph, it means that the information applies to that cableless transducer system. Where the information applies to both systems, no distinction is made.

For installation instructions and technical description see the corresponding Service Guide of the fetal monitors.

Confirm Fetal Life Before Using the Monitor

Fetal monitoring technology available today is not always able to differentiate a fetal heart rate (FHR) signal source from a maternal heart rate (MHR) source in all situations. Therefore, you should confirm fetal life by independent means before starting to use the fetal monitor, for example, by palpation of fetal movement or auscultation of fetal heart sounds using a fetoscope, stethoscope, or Pinard stethoscope. If you cannot hear the fetal heart sounds, and you cannot confirm fetal movement by palpation, confirm fetal life using obstetric ultrasonography. Continue to confirm that the fetus is the signal source for the FHR during monitoring.

Be aware that:

• an MHR trace can exhibit features that are very similar to those of an FHR trace, even including accelerations and decelerations. Do not rely solely on trace pattern features to identify a fetal source.

• Fetal Movement Profile (FMP) annotations on a fetal trace alone may not always indicate that the fetus is alive. The body of a deceased fetus can move and cause the monitor to annotate fetal body movements.

Here are some examples where the MHR can be misidentified as the FHR.

When using an ultrasound transducer:

• It is possible to pick up maternal signal sources, such as the aorta or other large vessels.

• Misidentification may occur when the MHR is higher than normal (especially when it is over 100 bpm).

When using a fetal scalp electrode:

• Electrical impulses from the maternal heart can sometimes be transmitted to the fetal monitor through a recently deceased fetus via the spiral scalp electrode cable, appearing to be a fetal signal source.

• The recorded MHR (and any artifact) can be misinterpreted as an FHR (especially when it is over 100 bpm).

When Fetal Movement Profile (FMP) is enabled:

FMP annotations in the absence of fetal life may be a result of:

• Movement of the deceased fetus during or following maternal movement.

• Movement of the deceased fetus during or following manual palpation of fetal movement (especially if the pressure applied is too forceful).

1 Introduction

• Movement of the ultrasound transducer.

• The ultrasound transducer detecting a maternal movement source, such as the mother coughing.

See also “Monitoring FHR and FMP Using Ultrasound” on page 141 and “Monitoring FHR Using DECG” on page 183.

To reduce the possibility of mistaking the MHR for an FHR, it is recommended that you monitor both maternal and fetal heart rates. The monitor's cross-channel verification (CCV) feature can help by automatically detecting when an MHR coincides with an FHR. For further details, see “Cross-Channel Verification (CCV)” on page 135.

Introducing the Avalon Family of Fetal Monitors

The Avalon family of fetal monitors consists of the Avalon FM20, FM30, FM40, and FM50. While the FM20/FM30 and the FM40/FM50 have different form factors, the method of operation is very similar for all monitors. The Avalon fetal monitors also share transducers, accessories, software, and are compatible with the Avalon CL, and Avalon CTS Fetal Transducer Systems.

Intended Use

The Philips Avalon FM20 (M2702A), FM30 (M2703A), FM40 (M2704A), and FM50 (M2705A) fetal/ maternal monitors are intended for:

• noninvasive monitoring of fetal heart rates and movements.

• noninvasive monitoring of maternal heart rates, maternal pulse rates, uterine activity, maternal noninvasive blood pressure, maternal oxygen saturation, and maternal temperature.

• invasive monitoring of direct fetal heart rate, intrauterine pressure, and for displaying and recording of fetal and maternal electrocardiogram (ECG) (FM30 and FM50 only).

• displaying, storing, and recording patient data and parameter values, and for generating alarms from fetal and maternal parameters.

• transmitting patient data and parameter values to a patient information and surveillance system.

• use by trained health care professionals.

• use in antepartum testing areas, in labor and delivery rooms, and during postpartum recovery in the hospital environment. They are not intended for use in intensive care units or operating rooms.

• monitoring in a bath or shower (Avalon CL cableless transducers Toco

MP, Ultrasound, and

ECG/IUP only).

• transport situations in healthcare facilities, for healthcare facilities outside hospitals, such as doctors’ offices, and for use in private households (FM20 and FM30 only).

1 Introduction

WARNING

The fetal/maternal monitors are not intended for:

• use during defibrillation, electro-surgery, or magnetic resonance imaging (MRI).

• Electrocardiography (ECG) measurements on patients connected to electrical stimulator or with cardiac pacemakers.

• use of the invasive measurements IUP and fetal DECG, use of the patient module (M2738A) and use of the Avalon CL system in domestic establishments, and those connected directly to the public low-voltage supply network that supplies buildings used for domestic purposes.

• measuring the maternal temperature using the Tympanic thermometer (866149) in private households.

WARNING

No modification of the fetal monitors, transducers, and the Avalon CL base station is allowed.

CAUTION

US federal law restricts this device to sale by, or on the order of, a physician.

All users must read the Instructions for Use before working with the fetal monitor. Disregarding the contents of the Instructions for Use is considered abnormal use.

Indications for Use

Avalon Fetal/Maternal Monitor FM20

Indicated for use by trained health care professionals whenever there is a need for monitoring the physiological parameters uterine activity, heart rate, oxygen saturation, noninvasive blood pressure, pulse rate, and temperature of pregnant women, and the fetal heart rates of single fetuses, twins, and triplets in labor and delivery rooms, in antepartum testing areas, in private households and during transports in healthcare facilities.

Avalon Fetal/Maternal Monitor FM30

Indicated for use by trained health care professionals whenever there is a need for monitoring the physiological parameters uterine activity, heart rate, electrocardiography (ECG), oxygen saturation, noninvasive blood pressure, and pulse rate, and temperature of pregnant women, and the fetal heart rates of single fetuses, twins, and triplets in labor and delivery rooms, in antepartum testing areas, in private households and during transports in healthcare facilities.

Avalon Fetal/Maternal Monitor FM40

Indicated for use by trained health care professionals whenever there is a need for monitoring the physiological parameters uterine activity, heart rate, oxygen saturation, noninvasive blood pressure, and pulse rate, and temperature of pregnant women, and the fetal heart rates of single fetuses, twins, and triplets in labor and delivery rooms and in antepartum testing areas.

1 Introduction

Avalon Fetal/Maternal Monitor FM50

Safety Information

In this guide:

• A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient.

• A caution alerts you to where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.

Electrical Hazards

WARNING

Electrical shock hazard: Do not open the monitor housing. Refer all servicing to qualified service personnel.

• Always use the supplied power cord with the earthed mains plug to connect to an earthed AC mains socket. Never adapt the mains plug from the fetal monitor to fit an unearthed AC mains socket.

• Do not use AC mains extension cords or multiple portable socket-outlets.

• FM20/FM30 only: The protective earth conductor is required for EMC purposes. It has no protective function against electric shock. Double and/or reinforced insulation protects this device against electric shock.

• Do not connect any devices that are not supported as part of a system.

• Any non-medical device placed and operated in the patient’s vicinity must be powered with an approved isolation transformer that ensures mechanical fixing of the power cords, and covering of any unused power outlets.

• The fetal/maternal monitor is NOT intended for use during defibrillation, electro-surgery, or MRI. Remove all transducers, sensors, and accessories before performing electro-surgery, defibrillation, or MRI, otherwise harm to the patient or the user can result.

• Do not touch the charging contacts for the cableless transducers at the Avalon CL base station while you are touching the patient.

Leakage currents: If several items of equipment used to monitor a patient are interconnected, the resulting leakage current may exceed allowable limits.

1 Introduction

Radio Frequency Interference

WARNING

• Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n), and cordless phones. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a

o Host Monitoring INOP (here the host is the fetal monitor)

on the IntelliVue CL NBP or CL SpO

Pods, or a N

o Host Monitoring, or cl NBP Disconnect, or cl

SpO Disconnect

INOP at the fetal monitor. Correct channel configuration is important, refer to

the Service Guides and the Configuration Guide for details.

• To avoid magnetic interference affecting the mode of the pacemaker, ensure that the Avalon CL base station does not come into close contact with implanted pacemakers.

• This equipment generates, uses, and radiates radio-frequency energy, and if it is not installed and used in accordance with its accompanying documentation, may cause interference to radio communications. Operation of this equipment in a residential area may cause interference, in which case the users must take whatever measures may be required to correct the interference.

• Do not use cordless/mobile phones or any other portable RF communication system within the patient vicinity, or within a 1.0 m radius of any part of the fetal monitoring system.

• For paced patients: The radiated SRR power of the CL SpO

and CL NBP Pods, and other

sources of radio-frequency energy, when used in very close proximity of a pacemaker, might be sufficient to interfere with pacemaker performance. Due to shielding effects of the body, internal pacemakers are somewhat less vulnerable than external pacemakers. However, caution should be exercised when monitoring paced patients.

• In order to minimize the possibility of interference, avoid positioning and wearing the Cableless Measurement Devices in very close proximity to a pacemaker. Consult the pacemaker manufacturer for information on the RF susceptibility of their products.

1 Introduction

Use Environment

WARNING

Explosion Hazard:

• Do not use in the presence of flammable anesthetics, such as a flammable anesthetic mixture with air, oxygen, nitrous oxide, or in oxygen rich environment. Use of the devices in such an environment may present an explosion hazard.

• Use only Philips batteries part number M4605A with the FM20 or FM30 with battery option. Use of a different battery may present a risk of fire or explosion.

Environmental Specifications:

• The performance specifications for the monitors, measurements, and accessories apply only for use within the temperature, humidity, and altitude ranges specified in “Environmental Specifications” on page 261.

Liquid Ingress:

• Do not operate the monitor if it is wet. If you spill liquid on the monitor, contact your service personnel, or Philips service engineer.

• Never immerse the fetal monitor or the CL base station in liquid. You must protect them against water sprays or splashes. Place the fetal monitor and the CL base station where there is no chance of contact with, or falling into water or other liquids.

• Do not perform underwater monitoring (for example, in a bath or shower) using wired transducers.

Heat Exposure:

• Do not dry equipment using heating devices such as heaters, ovens (including microwave ovens), hair dryers, and heating lamps.

• Do not put equipment or accessories in autoclave (for sterilization).

Positioning Equipment:

• The device should not be used adjacent to, or stacked with, other equipment unless otherwise specified.

Prohibited Environments:

• The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers).

1 Introduction

Alarms

WARNING

• Do not rely exclusively on the audible alarm system for fetal monitoring. Adjustment of alarm volume to a low level or off during monitoring may result in a dangerous situation. Remember that the most reliable method of fetal monitoring combines close personal surveillance with correct operation of monitoring equipment.

• Alarm systems of the monitor and those of the connected obstetrical information and surveillance system are independent and not synchronized.

• In

NOP only mode, no fetal/maternal patient alarms are enabled or indicated.

Accessories

WARNING

Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved accessories may compromise device functionality and system performance, and cause a potential hazard.

Reuse: Never reuse disposable transducers, sensors, accessories, and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance, and cause a potential hazard.

Electromagnetic compatibility: The use of accessories, transducers, and cables other than those specified may result in increased electromagnetic emissions or decreased electromagnetic immunity of the device.

Damage: Do not use a damaged sensor or one with exposed electrical contacts. Cables and tubing: When connecting devices for acquiring measurements, always position cables and

NBP tubing carefully to avoid entanglement or potential strangulation.

Overview of System Components

New cableless measurements for fetal and maternal monitoring supplement the Avalon fetal monitor family. The Avalon CL system consists of the Avalon CL base station, the Avalon CL transducers, and support of the IntelliVue CL Pods.

The IntelliVue CL Pods are only used for maternal measurements within the Avalon CL solution. To differentiate between the CL transducers and the CL Pods, the CL Pods are also referred to as maternal measurement Pods. The following table provides an overview of all the devices.

1 Introduction

Avalon FM20/FM30 and FM40/ FM50 Wired Transducers

Avalon CL Base Station Avalon CL Transducers

IntelliVue CL Pods

FM20/FM30

M2702A and M2703A

FM40/FM50

M2704A and M2705A

Avalon CL Base Station

866074

US transducer (wired)

M2736A

Avalon CL US Transducer (cableless)

866076

IntelliVue CL NBP Pod (cableless)

865216

Toco/ Toco MP transducer (wired)

M2734A and M2734B

Avalon CL Toco+ MP Transducer (cableless)

866075

IntelliVue CL SpO2 Pod (cableless)

865215

1 Introduction

Toco+ transducer with ECG/IUP capability (wired)

M2735A

Avalon CL ECG/IUP Transducer (cableless)

866077

Patient Module for ECG/IUP

M2738A

Avalon FM20/FM30 and FM40/ FM50 Wired Transducers

Avalon CL Base Station Avalon CL Transducers

IntelliVue CL Pods

2What's New

This section lists the most important new features and improvements to the fetal monitors and their user interface introduced with Release J.3.

You may not have all of these features, depending on the fetal monitor configuration purchased.

What's New in Release J.3

Avalon CL Transducer System

The Avalon CL Transducer System provides cableless monitoring with the Avalon FM20/FM30 and FM40/FM50 with the same functionality and performance as the wired measurement devices (e.g. twin and triplets monitoring). The Avalon CL Transducer System has a straight-forward handling and operating concept. The CL transducers are assigned by simply docking them at the CL base station, no further configuration is necessary.

The Avalon CL Transducer System includes the following features:

• Cableless monitoring of twins and triplets (see “Monitoring Twin FHRs” on page 159 and “Monitoring Triple FHRs” on page 167)

• Cableless maternal measurement Pods CL SpO

and CL NBP (see “CL Pods” on page 44)

• Maternal pulse from a CL Toco

MP (Smart Pulse) transducer (see “Monitoring Maternal Heart /

Pulse Rate” on page 213)

• A cableless ECG/IUP transducer measuring IUP or fetal/maternal ECG (see “Monitoring MECG Wave” on page 217 and “Monitoring FHR Using DECG” on page 183)

• Watertight cableless transducers that can be used to monitor in water (see “Underwater Monitoring” on page 87)

• Patient call that pages an ambulating mother with an audible signal emitted by the worn CL transducers (see “Calling Patients” on page 87)

• Out-of-range audible signal emitted by the worn CL transducers to inform an ambulating mother that she has reached the limit of the active signal area-of-reach (see “Radio Range of CL Transducers” on page 40)

• A transducer finder LED on all CL transducers to help identify the assigned transducer (see “Cableless Transducer LED Indication” on page 42

2 What's New

Support For Use of Maternal Cableless Measurement Devices

The IntelliVue CL measurement Pods are patient-worn, battery-powered measurement devices for SpO

and NBP. The devices provide measurement values on the built-in display and communicate

them to the fetal monitor using the wireless short range radio (SRR) interface of the Avalon CL base station (see “CL Pods” on page 44).

Maternal Temperature Measurement

To measure maternal temperature, the new optional Tympanic thermometer (866149) is available for the Avalon fetal monitors (“Monitoring Maternal Temperature” on page 201). The measurement data is:

• documented and printed out at the local recorder, and transmitted to the obstetrical information and surveillance system.

• displayed as a numeric on the screen.

Manually Entered Maternal Temperature Measurements

Manually measured temperatures can be entered at the fetal monitor and stored in the database. They are also displayed as a numeric on screen, and are printed out on the recorder trace (“Monitoring Maternal Temperature” on page 201).

SpO2 Recordings and Transmissions

SpO2 annotation on local recorder

You can now configure the interval for printing the SpO

numeric values on the recorder trace. With

the new configuration setting

ecord on Trace, you can set the interval to 1 or 5 minutes.

SpO

transmission to an obstetrical information and surveillance system

You can now configure the interval for transmitting the SpO

numeric values to an obstetrical

information and surveillance system. With the new configuration setting

end to OB Sys, you can set the

interval to 1 or 5 minutes.

New Design for the User Interface

The user interface for the fetal monitors has been redesigned to bring the presented information into the foreground, letting the structural elements such as keys and frames retreat into the background. Additionally special regard was given to making the "look and feel" similar to that of standard software products (see “Operating and Navigating” on page 46).

New SmartKeys

• The S

tart ECG SmartKey and menu item is renamed to Record ECG.

• With the

all Patient SmartKey you can now page patients who are ambulating wearing Avalon CL

transducers.

• With the

ele Info SmartKey you can call up the Tele Info window on the fetal monitor display. In

the

ele Info window you can control and view the status of the cableless transducers from the

connected Avalon CL base station.

• With the

nter Temp SmartKey a pop-up window opens showing a numeric pad for entering

manually measured maternal temperature values.

2 What's New

• With the NBP Modes SmartKey you can access the NBP Mode selection and setup, and can directly start and stop a measurement.

• With the

uickAdmit SmartKey you can quick admit a patient to the monitor.

All new SmartKeys are optional, and have to be configured in Configuration Mode for use (see “SmartKeys” on page 49).

Coincidence INOP Tone

When the cross-channel verification detects that the signal of the maternal heart rate coincides with the fetal heart rate, the

oincidence INOP is now issued with a tone at the fetal monitor. The Coincidence

INOP tone has a configurable delay (see “Cross-Channel Verification (CCV)” on page 135).

Increased Internal Back-up Memory

The internal back-up memory is now able to store traces and data from at least the last 3.5 hours with the software revision J.3, and minimum 7 hours with the new mainboard hardware revision A 00.18 (see “Manually Recording Stored Data” on page 230 and “Recovering Data” on page 229).

Dual System Interface Support

If the fetal monitor is connected via a LAN connection to OB TraceVue/IntelliSpace Perinatal or another obstetrical information and surveillance system, the RS232 interface can be used independently to connect e.g. an EMR system on read-only basis. The system connected to the RS232 interface in this case cannot alter any data (such as ADT data, or the date and time setting), or interfere with functions of the monitor, but is able to read output data. The obstetrical information and surveillance system connected via LAN has priority.

USB Interface

An optional USB interface allows the use of bar code readers and input devices such as a keyboard, or mouse (see “Getting to Know Your Avalon FM20/FM30”/“Bottom” on page 31 and “Getting to Know Your Avalon FM40/FM50”/“Rear” on page 32).

Flexible Nurse Call Interface

An optional Flexible Nurse Call interface allows the connection of a nurse call device to the fetal monitors (see “Getting to Know Your Avalon FM20/FM30”/“Bottom” on page 31 and “Getting to Know Your Avalon FM40/FM50”/“Rear” on page 32).

DHCP Support

The DHCP support offers an alternative to BOOTP. DHCP (dynamic host configuration protocol) enables the fetal monitors to request an IP address (internet protocol address) from the connected network (OB TraceVue/IntelliSpace Perinatal) automatically.

Data Export Support

You can now export measurement values from the monitor to other devices via the LAN interface, or with the optional MIB RS232 interface (see “Getting to Know Your Avalon FM20/FM30”/“Bottom” on page 31 and “Getting to Know Your Avalon FM40/FM50”/“Rear” on page 32).

2 What's New

NBP Configurable Measurement Sequence

Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously, you can have regular measurements continue after the sequence has run (see “Enabling Sequence Mode and Setting Up the Sequence” on page 197.

Alarms Enhancements

In addition to the standard cyan INOPs, some INOPs can now be configured as red or yellow INOPs to provide a severity indication (

CG Leads Off, NBP Cuff Overpress, Cuff Not Deflated, Battery Empty,

pO No Pulse) (see “Alarms” on page 99).

Alarm Reminder

In Configuration Mode you can set now an A

larm Reminder. The Alarm Reminder emits an audible

reminder of alarm conditions that remain active after the alarm is acknowledged. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). The interval between silencing the alarm and sounding the reminder tone can be set to one, two, or three minutes (see “Alarm Reminder” on page 22).

Auto Free

In Configuration Mode you can now set an Auto Free setting which discharges a patient automatically when the fetal monitor has been powered off, or is in standby mode for a set time. Only the demographic patient data is deleted, the trace data is not affected.

What's New in Release G.0

Battery Option and Patient Transport Improvements for the Avalon FM20 and FM30

• For the FM20/FM30, you can now switch between battery-powered and mains-powered operation without interrupting monitoring. The monitor is connected to the AC mains power with the external power supply.

• Traces of multiple patients can be recorded during transport and can automatically be uploaded to OB TraceVue/IntelliSpace Perinatal (Rev. G or higher) when reconnected.

• A bed hanger is available as a mounting option, especially for patient transport purposes within healthcare facilities.

Maternal Pulse from Toco MP Transducer

• The new Toco MP transducer can measure the maternal pulse rate, in addition to the other available sources; MECG, SpO

, and NBP. With sensors built-into the bottom cover of the

Toco MP transducer, and using a measurement technology similar to SpO

, it automatically gives

you an additional maternal pulse source for Cross-Channel Verification (CCV).

• The new Toco MP transducer is standard for the whole product family, Avalon FM20 to FM50.

2 What's New

Non Stress Test (NST) Analysis as Clinical Decision Support (CDS) Application

• The optional N

ST Report Trace Interpretation feature allows you to automatically interpret FHR

traces and to generate a printed NST report, equivalent to the NST report functionality in OB TraceVue Rev. F and based on the NICHD guidelines from 1997.

• The application can be adapted to domestic or hospital guidelines. A report of the NST analysis can be printed automatically or on demand.

• This software option is available for the whole product family, Avalon FM20 to FM50.

FHR Sound Source

A newly-connected fetal measurement (FHR or DFHR) automatically becomes the FHR sound source, without the need for manual intervention. If you prefer the previous behavior, this can be changed in Configuration Mode (

udio Select setting).

FHR Numeric Display

The FHR numeric display shows changes in fetal heart rate faster and is updated more frequently.

Improved FHR and DFHR Label Concept

A DFHR numeric (fetal heart rate from DECG measurement) now also has a unique number (D

FHR1,

FHR2, or DFHR3) to allow easier identification of the related trace in OB TraceVue/IntelliSpace

Perinatal.

New SmartKeys

You can control fetal heart sound volume directly with the configurable SmartKeys (F

HR Vol. Up and

HR Vol.Down) on the monitor’s screen.

Now the

oco Baseline SmartKey automatically turns into the Zero IUP SmartKey when switching to

IUP measurement.

Trace Separation On/Off Operation

Now you can switch the T

race Separation on or off in every FHR setup menu.

NBP

• To prevent the NBP measurement from being switched on or off accidentally, this operation is now only available in Configuration Mode.

• You can enter the NBP setup menu by touching the NBP numeric (on the screen) before the first measurement is taken.

• Algorithm enhancements (more tolerant of movement artifacts).

Alarms

• There is an individual Alarm Tone Volume setting for Yellow, Red and Cyan alarms.

• The new alarm settings available in Configuration Mode are: –

utoIncrease Vol and IncreaseVolDelay

– AlarmsOffAtStart

2 What's New

– ConfirmAlarmsOff

For a detailed description of the settings see the Configuration Guide.

CCV INOP

There is a new INOP (technical alarm) C

oincidence after 1 minute of persistent coincidence warning.

New Demographic Fields

• D

ate of Birth and Gestational Age can be entered for complete documentation in an NST Report

(supporting the optional NST Trace Interpretation software feature).

• A

iddle Name field is now available in the admission form - whether it appears is configurable.

• Two additional ID fields

ifetime ID and Encounter ID can also be configured to appear, and their

names can be customized to fit hospital requirements. The default label of the

ifetime ID is MRN.

Recorder

• It can now be configured whether the recorder speed can only be adjusted in Configuration Mode, or also in Monitoring Mode.

• When recorder speed is changed, a new trace header is printed. Date and/or time changes are annotated in real time recording.

Stored Data Recording

Printing progress is shown while printing a trace from the internal back-up memory.

FHR Sound Volume

Volume steps are optimized in the low range to allow finer FHR sound volume adjustments.

Avalon CTS

An antenna symbol is displayed next to MECG waves if an Avalon CTS is used.

3Basic Operation

This chapter gives you an overview of the monitor and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on, changing some monitor settings, and setting up the recorder). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment.

3 Basic Operation

Supported Measurements

The following Fetal measurements are supported:

The following Maternal measurements are supported:

Measurements FM20 FM30 FM40 FM50

Fetal Heart Rate (FHR) via US (including Twins)

Standard Standard Standard Standard

Triple FHR via US

Optional Optional Optional Optional

Toco

Standard Standard Standard Standard

FHR via Direct ECG (DECG)

- Standard - Standard

Intrauterine Pressure (IUP)

- Standard - Standard

Measurements FM20 FM30 FM40 FM50

Maternal Heart Rate (MHR) via Maternal ECG Electrodes

Standard Standard Standard Standard

Maternal ECG (MECG)

- Standard - Standard

Maternal Pulse from Toco

Standard Standard Standard Standard

Non-invasive Blood Pressure with Pulse Rate

Optional Optional Standard Standard

Pulse Oximetry (Maternal SpO

) with Pulse Rate

- Optional Standard Standard

Maternal Temperature

Optional Optional Optional Optional

3 Basic Operation

Avalon FM20 and FM30

This section outlines the capabilities of your monitor.

Avalon FM20

The Avalon FM20 fetal/maternal monitor provides a solution for external fetal monitoring applications, and optional noninvasive maternal vital signs.

You can monitor fetal heart rates (FHRs) externally using ultrasound, uterine activity and maternal pulse using an external Toco transducer, and the maternal heart rate (MHR) with maternal ECG electrodes, and optionally, noninvasive blood pressure and maternal oxygen saturation (SpO2).

Measurements are displayed on a 6.5 inch color display as numerics. The display is a touchscreen, and you operate the monitor using this touchscreen interface. The integrated recorder documents fetal and maternal measurements as well as the user-defined annotations.

You can connect the monitor to an OB TraceVue/IntelliSpace Perinatal system via the RS232 connection, or over a LAN connection (with OB TraceVue Revision E.00.00 and later, or IntelliSpace Perinatal Revision H.0 and later).

Avalon FM30

The Avalon FM30 fetal/maternal monitor offers a solution for both external and internal fetal monitoring applications, and optional noninvasive maternal vital signs.

The Avalon FM30 shares all the features and capabilities of the Avalon FM20. In addition, you can monitor one FHR internally with a direct fetal electrocardiogram (DECG), uterine activity internally

using an intra-uterine pressure (IUP) catheter together with a Toco

transducer or patient module.

The Avalon FM30 carries the IP label, indicating that it is capable of intrapartum monitoring.

3 Basic Operation

FM20/30 with

Battery

Option #E25

Only

The battery option for the FM20/30 provides support for the in-transport monitoring of all measurements when disconnected from a power supply. Existing data storage is automatically uploaded to OB TraceVue or IntelliSpace Perinatal after reconnecting it to the system. Trace printing during transport is also possible.

Avalon FM40 and FM50

This section outlines the capabilities of your monitor.

Avalon FM40

The Avalon FM40 fetal/maternal monitor provides a solution for external fetal monitoring applications, and noninvasive maternal vital signs.

You can monitor fetal heart rates (FHRs) externally using ultrasound, uterine activity using an external Toco transducer, and the maternal heart rate (MHR) via maternal ECG electrodes, and non-invasive blood pressure and maternal oxygen saturation (SpO

You can connect the monitor to an OB TraceVue/IntelliSpace Perinatal system with the RS232 connection, or over a LAN connection (with OB TraceVue Revision E.00.00 and later, or IntelliSpace Perinatal Revision H.0 and later).

Avalon FM50

The Avalon FM50 fetal/maternal monitor offers a solution for both external and internal fetal monitoring applications, and noninvasive maternal vital signs.

The Avalon FM50 shares all the features and capabilities of the Avalon FM40. In addition, you can monitor one FHR internally with a direct fetal electrocardiogram (DECG), and uterine activity

internally using an intra-uterine pressure (IUP) catheter together with a Toco

transducer or patient

module.

3 Basic Operation

The Avalon FM50 carries the IP label, indicating that it is capable of intrapartum monitoring.

Avalon CL Transducer System

The Avalon CL Fetal Transducer System lets you monitor the patient continuously with cableless transducers during the antepartum period, labor, and delivery. You can monitor the fetal heart rate (FHR) using noninvasive CL Ultrasound transducers, or invasively using the CL ECG/IUP transducer

or CL Toco+ MP transducer with the direct electrocardiogram (DECG). The uterine activity can be monitored using an external CL Toco

MP transducer. The fetal and maternal parameters are measured and transmitted via radio frequency from the CL transducers to the CL base station, eliminating the need for patient cables. With the Avalon CL Transducer System you can monitor a single fetus, twins and triplets.

The Avalon fetal monitor (FM20-FM50) connected to the CL base station displays and records the parameters. All the CL transducers are watertight. You can continuously monitor patients in a bath or

shower using the CL Toco

MP and the CL Ultrasound transducers.

3 Basic Operation

Getting to Know Your Avalon FM20/FM30

Overview

Right Side

with Battery

Option

1 Touchscreen display (tilt and fold) 2 Power LED 3 Paper drawer 4 Paper drawer release 5 Connectors

1 On/Off switch 2 Power connector

1 On/Standby button with power LED 2 MSL connector

3 Basic Operation

Left Side

Each of the fetal sensor sockets accepts any fetal transducer, one Avalon CL or one Avalon CTS Cableless Fetal Transducer System base station, or an event marker.

Bottom

There are five optional interfaces available for the Avalon FM20/30 monitor:

• LAN/RS232 system interface

• Dual PS/2 interface

• Dual MIB/RS232 interface

• Flexible Nurse Call interface

• USB ports interface You can use two of the five optional interfaces at the same time.

1 SpO

socket (optional)

2 Noninvasive Blood Pressure socket

(optional)

3 Fetal sensor sockets

1 LAN/RS232 system

interface

2 Dual PS/2 system

interface

Optional Interfaces Description

Flexible nurse call interface card

USB ports

3 Basic Operation

Rear

Getting to Know Your Avalon FM40/FM50

Front

Connect any fetal sensor or patient module at the fetal sensor sockets, including an Avalon CL or an Avalon CTS via interface cable (with red connector).

1 Display release 2 Carrying handle 3 Built-in stand

1 Touchscreen color display 2 Transparent paper guide with

tear-off edge

3 Paper eject button 4 Power LED 5 On/Standby button 6 Recorder paper table 7 Fetal sensor sockets 8 Noninvasive blood pressure socket 9 SpO

socket

3 Basic Operation

Rear

Two Avalon CL base stations, or one Avalon CTS can be also connected to the Telemetry interface sockets using the interface cable (with black connector).

Additional Optional Interfaces

1 Reserved for future use: protective

earth intended for use in system installations

2 Equipotential grounding point 3 Power cord connector 4 Loudspeaker 5 Slot 01 for optional LAN/RS232

system interface (for connection to an obstetrical information and surveillance system)

6 Slot 03 reserved for future use 7 Video output (VGA) 8 Telemetry interface 9 Slot 02 for optional interfaces: Either

dual PS/2 system interface (A) for mouse and keyboard connection) Or MIB interface (B) for external touch screen connection, or the optional interfaces for the flexible nurse call or USB ports

Optional Interfaces Description

Flexible nurse call interface card

USB ports

3 Basic Operation

Connecting the Monitor to AC Mains

WARNING

• Always use the supplied power cord with the earthed mains plug to connect to an earthed AC

mains socket. Never adapt the mains plug from the fetal monitor to fit an unearthed AC mains socket.

• Check that the line frequency is correctly configured in the

lobal Settings menu.

• FM20/FM30 only: The protective earth conductor is required for EMC purposes. It has no

protective function against electric shock. Double and/or reinforced insulation protects this device against electric shock.

• Do not use AC mains extension cords or multiple portable socket-outlets.

Always ensure that the monitor is positioned so that the AC mains plug is easily accessible, to allow disconnection of the monitor from the AC mains.

Wired Transducers

Toco (M2734A) and Toco MP Transducer (M2734B)

1 Transducer finder LED - lights up

on the transducer supporting to identify the measurement source

2 "MP" for M2734B "Toco MP"

transducers (additionally capable of providing the maternal pulse measurement)

3 Belt button

Ultrasound Transducer (M2736A)

1 Cable - connects to any of the

four fetal sensor sockets on the monitor

The M2736AA US transducer is identical to the M2736A US transducer, including all specifications

3 Basic Operation

Toco+ Transducer with ECG/IUP capability (M2735A)

1 Connector - for connecting

ECG/IUP adapter cables (M2735A Toco

transducer only)

1 Butterfly belt clip (shown fitted;

for use with belts without button holes)

2 Close-up of MECG adapter cable

connected to Toco

transducer

3 Close-up of active finder LED

Patient Module for ECG/IUP (M2738A)

1 Connector - for connecting ECG/

IUP adapter cables (same as for Toco

transducer)

2 Cable - connects to any of the four

fetal sensor sockets on the monitor

3 Basic Operation

Getting to Know Your Avalon CL

Front

1 Transducer docking slots 2 On/Standby button with LED 3 Device label 4 LED for optional cableless Pods 5 Docking slot for cableless Pods

WARNING

• To avoid magnetic interference affecting the mode of the pacemaker, ensure that the Avalon CL

base station does not come into close contact with implanted pacemakers.

• This equipment generates, uses, and radiates radio-frequency energy, and if it is not installed and

used in accordance with its accompanying documentation, may cause interference to radio communications. Operation of this equipment in a residential area may cause interference, in which case you must take whatever measures may be required to correct the interference.

3 Basic Operation

Docking Slots for Cableless Transducers

The Avalon CL base station has three docking slots to hold the CL transducers. The transducers are charged while docked. The base station has a built-in radio interface with an integrated antenna to communicate with the transducers.

On/Standby Button

Pressing the On/Standby button switches the Avalon CL base station between the two modes On and Standby.

If you switch the base station to On, the LED button lights up green. The base station is ready for use. The CL transducers are charging. When the transducers are picked up from their docking slot, the base station sets up the radio communication to the CL transducer automatically. Wired transducers connected to the fetal monitor are disabled, and the antenna symbol for the CL transducer is displayed on the screen of the fetal monitor.

If you switch the base station to Standby, the LED button turns off. The base station is now in Standby mode. The docked CL transducers continue charging. No radio communication occurs, any existing radio communication is stopped.

If the LED of the On/Standby button turns red, it indicates a technical problem has occurred that needs your attention. Check your monitor for a possible related INOP message.

1 On/Standby button

3 Basic Operation

Docking Slot for Cableless Measurement Pods

The Avalon CL base station has one docking slot to hold an IntelliVue CL Pod. The CL Pod is charged while docked. The LED under the docking slot indicates the battery status of the CL Pod. The base station has a built-in short range radio interface with an integrated antenna to communicate with the CL Pod.

WARNING

Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n), and cordless phones. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a

o Host Monitoring INOP (here the host is the fetal monitor) on the NBP or SpO

Pods, or a

l NBP Disconnect or cl SpO Disconnect INOP at the fetal monitor. Correct channel

configuration is important, see the Configuration Guide for details.

Audio Signal CL Base Station

The Avalon CL base station has two audio signals: If the base station issues a descending tone sequence, the attempt to set up radio communication to a

CL transducer has failed.

• The base station issues a permanent beeping tone if it is disconnected from a fetal monitor, or if

the FM20 or FM30 monitor is switched off, and the base station has transducers currently docked that need to be recharged.

• If an interval tone is played, the battery of one or more the CL transducers or CL Pods need to be

recharged.

Alarming is only available at the Avalon Fetal Monitor, not at the Cableless Measurement Devices, see the Instructions of Use for the IntelliVue Cableless Measurements.

1 Docking slot for CL Pods

3 Basic Operation

Rear and Bottom

Cableless Transducers

The cableless Avalon CL transducers have a built-in radio interface with an on-board, integrated antenna. The fetal monitor connected to the Avalon CL base station can control the transducer using radio communication. The CL transducer transmits measured values, alarms, and status information to the fetal monitor.

The CL transducers are assigned by simply docking them at the Avalon CL base station. If they are picked up from their docking slot at the base station, they are automatically activated.

CAUTION

To ensure the correct assignment of CL transducers to the fetal monitor in use, always dock them at the base station connected to that fetal monitor before use. This is particularly important when you add an additional CL transducer that was previously docked at another base station.

NOTE

Avoid frequent drops of the transducers.

1 Name plate

1 Manufacturer label 2 Cable reel

3 Basic Operation

Radio Range of CL Transducers

The CL transducers have an operating range around the base station of at least 100 m/300 ft in the line of sight. Obstructions such as walls, metal doors, elevators, and other environment structures can lead to signal loss. The Tele symbol indicator and the

ele Info window on the monitor's display (see

“Screen Elements” on page 46 and “Tele Info Window” on page 82) provide information on the status of the signal strength.

When a patient is approaching the end of range, the US sound is replaced by an artificial QRS sound (like DECG), and the DECG and MECG waves are no longer displayed on the monitor.

Out of Range

If the patient walks out-of-range, the CL transducer LED lights up cyan and after 15 seconds a twotone audio signal is emitted. At the monitor the INOP e.g.

l US Disconnect is issued.

1 Transducer finder LED - lights

up on the transducer providing the measurement source.

2 CL Toco

MP transducers (additionally capable of providing the maternal pulse measurement)

3 Belt button

CL Ultrasound transducer

CL ECG/IUP transducer

3 Basic Operation

Radiated Transmission Power

The Avalon CL transducers provide all the benefits and flexibility of cableless operation, but do so with an effective radiated transmission power significantly less than that of a typical remote controlled child’s toy or mobile phone.

Connector Cap for the CL Toco+ MP Transducer

The CL Toco+ MP transducer is delivered with a connector cap covering the MECG/DECG/IUP connector. The connector cap is designed to cover the connector, not to protect it from water. (The connector itself is water-proof and may be immersed in water).

3 Basic Operation

Cableless Transducer LED Indication

The cableless transducers have a multi-color LED that indicates the status of the transducer with specific colors. This LED remains visible when the transducer is correctly attached to the transducer belt (Philips standard belt).

1 LED

LED Status Meaning

White The LED lights up to identify the transducer among other transducers,

and to easily verify the correct transducer assignment (transducer finder). The transducer finder LED is controlled by the fetal monitor. Press the numerics to identify the corresponding transducer.

The LED also lights up when the mother is paged with the

all Patient

SmartKey.

White one short blink The LED shortly lights up to indicate that the transducer successfully

opened a radio communication with the base station and that it is ready to use.

Green The LED lights up green when the transducer is fully charged and docked

at the base station.

Yellow The LED lights up yellow when the transducer is charging and docked at

the base station.

Red The LED flashes red when the transducer is out of battery and has to be

recharged.

Cyan The LED lights up cyan to indicate a technical problem that needs your

attention. Check your fetal monitor for a related INOP.

3 Basic Operation

CL Transducer Battery

Battery replacement is recommended after 500 charge/discharge cycles, or if the battery is older than 4 years whatever is reached first. If the battery of a cableless transducer has aged and an exchange of the battery is highly recommended, a prompt message is displayed at the fetal monitor for ca. 60 seconds. The prompt is repeated whenever the

ele Info window is opened until the battery is

replaced. Depending on the transducer type the following messages are displayed:

l US battery has aged. Replacement strongly recommended

cl Toco battery has aged. Replacement strongly recommended

cl ECG/IUP batt has aged. Replacement strongly recommended

If you are getting this message contact your service personnel so they can replace the CL transducer's battery.

The date of manufacture and number of charge/discharge cycles can be viewed on the connected fetal monitor.

For battery charge/discharge cycles specification of the CL Pods (NBP and SpO

) refer to the Service

Guide of the Cableless Measurements.

Charge Cycle

The CL transducer batteries are designed for frequent recharging. A complete charging cycle is only reached and counted, when all recharging periods equal a 100% charge (900 mAh equal 8 hours continued operation).

Audio Signal CL Transducers

The Avalon CL transducers have two audio signals:

• If an ascending tone sequence is played three times, the transducer was triggered by the fetal monitor to page the patient wearing it, or to locate a not docked transducer.

• An INOP tone indicates that the transducer has detected a technical problem (INOP). Check your fetal monitor for a related INOP message.

3 Basic Operation

CL Pods

The two CL Pods provide measurement values for SpO2 and NBP on the built-in display, and communicate them to the fetal monitor using short range radio (SRR). They are controlled with SRR

from the Avalon CL base station and the connected fetal monitor. The maternal measurement pods are easily assigned by docking them at the Avalon CL base station.

The CL SpO

Pod and the CL NBP Pod have an LCD display and three keys for basic operation e.g.

to assign the device to a patient:

For further details, see the IntelliVue Cableless Measurements Instructions for Use.

NOTE

This monitoring option is not yet available for an FM20/30 #E25. The IntelliVue CL Pods are not supported for the battery option of the FM20/30.

CL NBP Pod

CL SpO

Pod

1 Integrated LCD display 2 Hard keys 3 Measurement identifier

3 Basic Operation

Battery Status LED for CL Pods

The CL Pods do not have their own battery status LED, but a small battery gauge on their display. On the Avalon CL base station the battery status LED for the CL Pods is located directly under the docking slot.

The battery status LED shows five different states:

Audio Signal

The Avalon CL base station has audio signals to let you know when a transducer's battery has to be recharged, or if the base station cannot set up radio communication with a CL transducer or a CL Pod.

• If the base station issues a descending tone sequence, the attempt to set up radio communication to a CL transducer or a CL Pod has failed.

• If an interval tone is played, the battery of one or more the CL transducers or CL Pods need to be recharged.

Alarming is only available at the Avalon Fetal Monitor, not at the Cableless Measurement Devices, see the Instructions of Use for the IntelliVue Cableless Measurements.

1 Battery status LED for CL Pods

Status Meaning

Green The docked CL Pod is fully charged. Yellow The docked CL Pod is charging. Yellow blinking The communication is established with the docked CL Pod. Cyan Indicates that the docked CL Pod or the charging slot has a technical

problem that needs your attention. Check your fetal monitor for a related INOP message.

Off The battery status LED is off, when no CL Pod is docked.

3 Basic Operation

Operating and Navigating

Your monitor has a touchscreen. Everything you need to operate the monitor, except the on and off switch, is contained on its screen. Most screen elements are interactive. Screen elements include measurement numerics, screen keys, information fields, status indicators, alarms fields, and menus.

Operator Position

The typical operator's position is in front of the monitor.

FM40/50 If an optional external touch display is connected to the monitor, you can operate the monitor using

the external touch display.

Screen Elements

Monitor Information Line

1 Monitor Information line 2 Measurement area 3 Key area

1 LAN connection status indicator

only. RS232 system connection is not indicated. The locomotive icon indicates if the fetal monitor is connected to OB TraceVue/ IntelliSpace Perinatal, via a LAN cable or not.

2 Patient identification 3 Date and time 4 Bed label (when connected to a

Philips OB TraceVue/IntelliSpace Perinatal system)

5 Fetal heart sound volume adjust/

indicator

6 Alarm volume adjust/indicator 7 INOP and alarm status area - shows

active alarm messages

3 Basic Operation

Measurement Area

1 Antenna symbol (indicates a cableless measurement from a connected Avalon CL or Avalon CTS

system)

2 Configurable alarm limits 3 NST test 4 Audio source symbol 5 Measurement numeric 6 Alarms off symbol 7 Fetal trace recorder - status indicator 8 Avalon CL or Avalon CTS system - status indicator 9 Battery status indicator 10 Status line - shows status and prompt messages 11 Signal quality indicator: good, acceptable, poor 12 Fetal heart rate measurement label 13 Measurement unit (configurable) 14 Coincidence symbol (see “Cross-Channel Verification (CCV)” on page 135) 15 NST timer, if configured (default is Off)

Screen Details

Icon Description

The antenna symbol indicates a cableless measurement (Avalon CL or Avalon CTS).

Indicates a short range radio measurement (IntelliVue CL Pods).

3 Basic Operation

Key Area

Signal quality indicator:

1 Good 2 Acceptable 3 Poor

Fetal trace recorder - status indicator Fetal recorder is on Fetal recorder is off (when

aper Save Mode is off)

Fetal recorder is off (when

aper Save Mode is on)

There is a user-solvable recorder error (paper out, paper jam, wrong paper scale set)

Fetal recorder is defective: call service

When an Avalon CL or Avalon CTS system is connected to the monitor a

ele symbol is shown. It changes with the states of

the connected cableless device see “Telemetry” on page 84.

Icon Description

1 SmartKeys - these can vary according to

your monitor's configuration

2 M

ain Screen - closes all open menus and

windows and returns to main screen

3 Scroll to display more SmartKeys

4 S

ilence - acknowledges all active alarms by

switching off audible alarm indicators

3 Basic Operation

Keys

The monitor has three different types of keys.

Permanent Keys

A permanent key is a graphical key that remains permanently on the screen, giving you fast access to functions.

SmartKeys

SmartKeys are configurable graphical keys, located at the bottom of the main screen. They give you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration, and on the options purchased.

Key Name Function

ilence Acknowledges all active alarms by switching off audible

alarm indicators.

ain Screen Closes all open menus and windows and returns to the

main screen.

SmartKey Name Function

RStart/Stop Turns the trace recorder on or off

tart Rec Turns the trace recorder on

top Rec Turns the trace recorder off

aper Advance Advances the paper automatically to the next fold

et Marker Marks an event

nter Notes Enters notes

ecord ECG Starts printing the MECG, DECG or both waves, when

both are available

tored Rec Prints trace data from the monitor's memory

ST Report Initiates an NST trace interpretation and obtains a Non-

stress test (NST) report

ound Vol. Up Increases the fetal heart rate volume

ound Vol. Down Decreases the Fetal Heart Rate volume

oco/IUP Bsl Resets Toco baseline

ele Info Calls up the Tele Info window

3 Basic Operation

Call Patient Pages the patient. Only enabled if at least one

CL transducer is currently active

ause Alarms Pauses alarm indicators. Pause duration depends on

monitor configuration. If the pause duration is infinite, this key is labeled

larms Off

Select again to immediately re-enable alarm indicators

efaults Loads User Default

ain Setup Enters main setup menu

Strt/Stp NBP Starts/stops manual noninvasive blood pressure

measurement Starts auto series Stops current automatic measurement within series

tart NBP Starts manual noninvasive blood pressure measurement

Starts auto series

top NBP Stops manual noninvasive blood pressure measurement

Stops current automatic measurement within series

Stop All NBP Stops all noninvasive blood pressure measurements

epeat NBP Sets the time interval between two noninvasive blood

pressure measurements

BP Modes Access NBP mode selection and setup, with direct start/

stop function

nter Temp Allows the manual input of the patient's temperature

Zero IUP Resets the display and trace to 0. If you do not zero the

monitor properly, the pressure trace may exceed the paper scaling.

Timer Enters NST timer window

tandby Enters the Standby mode, suspends monitoring. All

numerics and waves disappear from the display. All settings and patient data information are retained

atient Demogr. Enters the patient identification menu to admit/discharge

uickAdmit Quick admits the patient for monitoring

lank Key Blank key, can be used as divider between a group of keys

SmartKey Name Function

3 Basic Operation

Pop-Up Keys

Pop-up keys are context-sensitive graphical keys that appear automatically on the monitor screen when required. For example, the

onfirm pop-up key appears when you need to confirm a change.

Using the Touchscreen

Select screen elements by pressing them directly on the monitor's screen.

Disabling Touchscreen Operation

1 To temporarily disable the touchscreen operation of the monitor, press and hold the M

ain Screen

permanent key for about three seconds. A red padlock will blink on the

ain Screen permanent

key.

2 Press and hold the M

ain Screen permanent key again for about three seconds to re-enable the

touchscreen operation.

Operating Modes

When you switch on the monitor, it starts up in Monitoring Mode. To change to a different mode:

1 Select the M

ain Setup menu.

2 Select O

perating Modes and select a mode.

Your monitor has four operating modes. Some are passcode protected.

Mode Description Password

Protected

Monitoring Mode The Monitoring Mode is the normal operating mode to

monitor patients. You can change elements such as alarm limits. When you discharge the patient, these elements return to their default values.

You cannot select or change grayed out items. These items are for your information only. To change these items, switch to the Configuration Mode.

Demo Mode The Demo Mode is used for demonstration and training

purposes. Do not change into Demo Mode during monitoring. When transducers are connected to the monitor and the recorder is on, a demo trace is recorded. But the demo trace is not transmitted when the fetal monitor is connected via RS232 to an information and surveillance system such as OB TraceVue/IntelliSpace Perinatal.

yes

3 Basic Operation

A field displayed at the fetal monitor screen indicates if the monitor is in Demonstration Mode, Configuration Mode, or Service Mode. To change to a different mode, select this field.

Automatic Screen Layouts

Your monitor's preconfigured screen layouts define how measurement information is arranged on the screen. The monitor automatically applies the correct screen layout for the measurements you are monitoring. No user action is required.

Connecting or disconnecting transducers, or switching the noninvasive blood pressure measurement on or off, results in an automatic adjustment of the screen layout. When a measurement is off, its numerics are removed from the monitor's screen. The monitor stops acquiring data and generating alarms for this measurement. If you disconnect a transducer while it is performing a measurement, the monitor issues a disconnect INOP (and in the case of SpO

, replaces the measurement numeric with a

question mark).

Settings

This section describes the various settings available on the monitor.

Active Settings

What the monitor displays, and the way it operates, is controlled by its settings. They determine sound volume settings, recorder settings, high and low alarm limits and so forth.

The "active settings" are the current settings the monitor uses, including any adjustments made by the last user. Active settings are not permanent, but are retained after a loss of mains power.

There are also two preconfigured default settings:

• User Default

• Factory Default

Configuration Mode The Configuration Mode is for personnel trained in

configuration tasks. You can change and store the default values and patient profiles permanently in the Configuration Mode. These tasks are described in the Configuration Guide. During installation, the fetal monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on the fetal monitor.

yes

Service Mode The Service Mode is for trained and authorized service

personnel only.

yes

Mode Description Password

Protected

3 Basic Operation

User Default

The U

ser Defaults are a complete configuration stored in the monitor's long-term memory. You can

store the active settings, modified to your preference, in the

ser Defaults (in Configuration Mode).

In Monitoring Mode, you can load the

ser Defaults settings to return to your preferred settings:

1 Select the D

efaults SmartKey

2 Select Confirm in the dialog box to load the User Defaults.

Factory Default

The F

actory Defaults is a complete configuration pre-defined at the factory. You cannot modify it. In

Configuration Mode, you can load the

actory Defaults as the active settings.

CAUTION

This resets all settings to factory defined values, but be aware that some values will differ from those with which the fetal monitor was originally shipped from the factory (recorder speed and paper scale type will need to be corrected, for instance). After loading the

actory Defaults, check the settings, and

if necessary, change them to the settings you normally use.

You can use the Factory Defaults as the basis for producing your User Defaults. See the Configuration Guide for details.

Global Settings

General monitor configuration settings are stored in the G

lobal Settings. These include settings for line

frequency, QRS type, and whether the monitor is automatically reset to the

ser Defaults after a power

interruption of more than one minute. You can change the

lobal Settings in Configuration Mode.

Changing Measurement Settings

Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:

1 with the measurement numeric - select the measurement numeric on the screen to enter its setup

menu. For example, to enter the

etup FHR1 menu, select the FHR1 (fetal heart rate 1) numeric.

2 with the M

ain Setup SmartKey - if you want to setup a measurement when the measurement is

switched off, use the

ain Setup SmartKey and select Measurements. Then select the measurement

name from the pop-up list. With this SmartKey you can access any setup menu in the monitor.

This guide always describes the entry method using the measurement's setup menu. You can use the method you prefer.

Switching the Noninvasive Blood Pressure Measurement On and Off

The noninvasive blood pressure measurement can be manually switched on and off. To do this:

1 Enter the noninvasive blood pressure measurement's setup menu. 2 Select N

BP to toggle between On and Off. The screen display indicates the active setting.

3 Basic Operation

Changing Monitor Settings

To change monitor settings such as brightness, or touch tone volume:

1 Enter the M

ain Setup menu.

2 Select the setting you want to change, or select U

ser Interface to enter a sub menu where you can

change user interface settings.

Adjusting the Screen Brightness

1 Enter the Main Setup menu.

2 Select U

ser Interface.

3 Select B

rightness.

4 Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright.

ptimum is suitable for most situations.

Adjusting Touch Tone Volume

The touch tone is the tone you hear when you select any field on the monitor screen. To adjust the touch tone volume:

1 Enter the M

ain Setup menu.

2 Select U

ser Interface.

3 Select T

ouch ToneVolume, then select the appropriate setting for the touch tone volume: 10 is the

loudest and 1 is the quietest. Selecting zero switches the touch tone volume off.

Setting the Date and Time

The current date and time is displayed in its own element in the information line of the monitor screen.

1 Select the date and time screen element from the monitor's information line to enter the D

ate,

ime

menu.

2 Select, in turn, the Y

ear, Month, Day, Hour (in 24 hour format) and Minute, as necessary.

3 Select Store Date, Time to change the date and time.

WARNING

Do not change the date and time setting, if the fetal monitor is connected to a Philips OB TraceVue/ IntelliSpace Perinatal system. The monitor uses the OB TraceVue/IntelliSpace Perinatal system date and time, including daylight saving time changes. As long as the fetal monitor is connected to the OB TraceVue/IntelliSpace Perinatal system via the LAN-setup (locomotive symbol displayed on the monitor's screen), the option to change the date and time settings at the fetal monitor are disabled, this is not valid for RS232 connections, or the connection to other systems.

3 Basic Operation

When disconnected from AC power, the monitor retains the date and time setting for at least two months. If the monitor is off longer than two months, and the operating system detects that the date and time settings are invalid, the monitor initiates a "cold" start and sets the date to 1 Jan 1997 and the time to 00:00.

Checking Your Monitor Revision

1 Select M

ain Setup, Revisions to open the Monitor Revision menu.

2 From the M

onitor Revision menu, select the monitor component for which you need revision

information.

Preparing to Monitor

Confirm fetal life before you begin fetal monitoring. Familiarize yourself with the basic operation principles before you start to monitor.

CAUTION

Check the fetal monitors housing for damage before you start to monitor as part of your safety precautions.

After you switch on the monitor:

1 Check that you have the correct patient cables and transducers plugged in for the measurement

you want to monitor.

2 If you use an Avalon CL or Avalon CTS system, check if the cableless transducers are ready and

charged (apparent by either a lit up green or yellow LED indicator).

3 Admit your patient to the monitor (see “Admitting a Patient” on page 125). 4 Check that the alarm limits, alarm and fetal heart rate volumes, patient category, and so forth are

appropriate for your patient. Change the settings if necessary.

5 Refer to the appropriate measurement section for details of how to perform the measurements

you require.

6 Start recording.

Switching On: FM20/FM30

FM20/30 1 Connect the monitor to AC mains and switch the monitor on.

– The green power-on LED lights up. – The monitor performs a self-test as it starts up. S

elftest: OK, the serial number, and revisions

for the software and firmware are printed on the fetal trace paper (if recorder

uto Start is

configured to

n).

– The monitor display comes on. – There is a start-up tone from the loudspeaker.

FM20/30

Battery

Option

• If this option has been chosen, the green power-on LED on both the external power supply and the battery LED indicator will light up.

3 Basic Operation

Switching On: FM40/FM50

1 Connect the monitor to AC mains.

– The green LED lights up.

2 Press the On/Standby switch.

– The monitor performs a self-test as it starts up.

elftest: OK, the serial number, and revisions

for the software and firmware are printed on the fetal trace paper (if recorder

uto Start is

configured to

n).

– The monitor display comes on. – There is a start-up tone from the loudspeaker.

Adjusting the Display Angle (FM20/FM30)

You can tilt the display on the FM20 and FM30 to one of five different positions, or you can fold it completely down. The tilt/fold mechanism works on a one-way ratchet system. You hear a click as each of the five positions is reached. The screen can be folded back down only after tilting the display forwards as far as it will go.

To tilt the display from the folded position:

1 Unlock the display by releasing the catch.

2 Lift the display forward. You will hear a click as the first position engages. If you want to tilt the

display further, lift the display further forward until you reach the desired angle.

3 Basic Operation

To fold the display, pull the display forwards as far as it will go

4 Then push the display all the way back until it clicks shut.

If your monitor is wall-mounted, the display should be folded flat.

Fastening Belts and Transducers

You can use more than one belt if, for example, you are monitoring uterine activity and FHR simultaneously. There are two basic ways to fasten belts and transducers:

• Belts with button fixings.

• Velcro belts together with the butterfly belt clip.

What You Need

• Ultrasound transducer

• Toco MP or CL Toco

MP transducer

• Ultrasound gel

• Transducer belt (and optional butterfly belt clip, if applicable)

3 Basic Operation

Using Belts with Button Fixings

1 Place the transducer belt across the bed, so that the fixing button will face away from the mother

when it is fastened.

2 Lie the patient on the bed and arrange the belt around her until it is tight but still comfortable. 3 Fasten the belt by pushing the fixing button through the overlapping section of the belt. Ensure

that the fixing button and the loose ends of the belt are at the patient's side.

4 When you have positioned a transducer satisfactorily, you can attach it to the belt by pushing the

belt button on the transducer through one of the holes in the belt.

3 Basic Operation

Alternatively, attach the butterfly belt clip to the transducer belt button and use this to attach the transducer to the belt. The clip allows you to slide the transducer for easy repositioning.

Using CL Transducers with a Belt Clip

The Avalon CL transducers have their own belt clip.

Using Belt with Velcro Fixings

Insert one end of the belt between the belt guides on one side of the butterfly belt clip, and secure with the velcro fixing. Insert the other end of the belt between the belt guides on the other side of the butterfly belt clip, adjust for the correct tension, then secure with the velcro fixing.

1 Avalon CL belt clip

3 Basic Operation

WARNING

When connecting devices for acquiring measurements, always position cables and NBP tubing carefully to avoid entanglement or potential strangulation.

Repositioning Transducers

A patient possibly wears transducers for long periods without interruption. In rare cases, skin irritations may occur if a transducer is attached to one location for a longer period. To ensure there are no adverse effects on the patient's skin, inspect the transducer application site at least every three hours. If the skin quality changes, move the transducer to another site.

The ultrasound transducer is often repositioned to follow the fetal heart as part of the normal monitoring process, but this is not so for the Toco transducer. Therefore, remember to check its application site (between contractions) at least every three hours.

To reduce the risk of skin irritations, do not allow a cleaning or disinfecting agent to remain on the transducer. Follow all instructions that accompany the specific cleaning and disinfecting agents you are using. Remove agent residues with a cloth dampened in water before applying a transducer to a patient.

See “Care and Cleaning” on page 233 for further information, and a list of approved agents.

1 Velcro fixing 2 Belt guides 3 Velcro fixing

3 Basic Operation

Connecting a Transducer to the Monitor

For the FM20 and FM30, you can connect an Avalon CL Cableless Fetal Transducer system interface cable (red connector) to one of the fetal sensor sockets at the left side of the monitor.

For the FM40 and FM50, you can connect an Avalon CL or Avalon CTS Cableless Fetal Transducer System interface cable (black connector) to one of the two dedicated black sockets marked "Tele" at the rear of the monitor, as an alternative to using one of the fetal sensor sockets (red connector) at the front.

1 SpO

socket

2 Noninvasive blood pressure socket 3 Fetal sensor sockets

You can plug a fetal transducer, an ECG/IUP patient module, an Avalon CL or Avalon CTS Cableless Fetal Transducer System interface cable (red connector), or an external event marker into any of the four fetal sensor sockets marked by the fetal symbol, or "Fetal Sensors" (depending on geography).

For measuring maternal SpO2, connect the sensor to the socket marked with the SpO

symbol or "SpO2" (depending on geography).

For maternal non-invasive blood pressure, connect the cuff to the socket marked with the NBP symbol or "NBP" (depending on geography).

3 Basic Operation

What You See on the Monitor

When you connect a transducer or sensor, the measurement numeric appears on the screen.

Fetal heart rate measurements are labeled in the order in which you plug in the transducers for those measurements. It does not matter which fetal sensor socket you use, as the monitor allocates a channel automatically. For instance, when monitoring triplets, the first transducer you connect is automatically allocated a channel, and the measurement is labeled

HR1, the second FHR2, and the third FHR3. See

also chapters “Monitoring Twin FHRs” on page 159 and “Monitoring Triple FHRs” on page 167. When you touch a measurement numeric on the screen, the setup menu for that measurement opens.

The fetal sensor socket to which the transducer for this measurement is connected is identified by the transducer position indicator in the setup menu header.

1 Interface cable to Avalon CL and

Avalon CTS Cableless Fetal Transducer System.

2 Connect the black connector to one

of the two black sockets (marked "Tele") on the rear of the monitor.

for FM20/FM30

for FM40/FM50

3 Basic Operation

The blue finder LED on a wired fetal transducer lights up when you touch the measurement on the screen, allowing you to identify the corresponding transducer.

The white finder LED on a cableless fetal transducer lights up when you touch the measurement on the screen, allowing you to identify the corresponding transducer.

The recorder prints an annotation showing the date, time, recorder speed, and Monitoring Mode. It repeats this every 10 minutes.

Start Recording

Checking/Setting Paper Scale

You can check the paper Scale Type (US for USA, or Internat'l for other geographies) in the Fetal

ecorder

menu. In Monitoring Mode, you can see these settings (grayed out), but you cannot change

them. They can be changed in Configuration Mode, see the Configuration Guide.

1 Finder LED

1 Finder LED cableless transducer

3 Basic Operation

Paper Guide FM40/FM50

FM40/50 The recorder in the FM40 and FM50 features a transparent paper guide which:

• facilitates correct alignment of the paper, both during loading and while the recorder is running. See “Loading Paper FM40/FM50” on page 73.

• incorporates a tear-off edge, which not only allows you to tear off the trace paper where you like (not necessarily at a fold), but also helps to avoid paper misalignment while doing so (see “Tearing Off the Paper” on page 69).

• is removable (see “Removing the Paper Guide: FM40/FM50” on page 241).

Switching the Recorder On and Off

In addition to the normal recording of real-time traces, you will sometimes see a trace recovery printout from the monitor's internal backup memory at high speed when the recorder is started. For details, see “Recovering Traces on Paper” on page 229.

For an explanation of the various symbols that can appear on the trace recording, see “Recorder Specifications” on page 278.

To switch the recorder on, select in

ain Setup the menu item Fetal Recorder, or press one of the

SmartKeys:

tart/ Stop or Start Recordng.

The "recorder on" status indicator is displayed in the bottom right-hand corner of the screen when you switch on the recorder.

The paper advances quickly for 2 cm and then returns to the set speed. Whenever the recorder is switched on, a trace header is printed vertically on the trace paper, containing the following:

•

elftest: OK: confirmation that the monitor's self-test completed successfully, and that it is ready to

use.

• the software revision and firmware revision

• the serial number

• the time

• the date

• patient name and medical record number (if entered)

• the recorder speed

3 Basic Operation

The current monitoring modes (if any transducers are connected to the monitor) are printed. Whenever a transducer's mode is changed, the following are printed:

• the time

• the date

• trace identification symbols

• the recorder speed

The monitor prints the time, date, recorder speed, and monitoring modes in the trace header when first switched on, in a periodic time stamp every ten minutes after, and if the monitoring modes change. The time stamp begins with the symbol shown below. The data is reprinted in the header if the time and date are locally adjusted, or if an obstetrical information and surveillance system is connected that readjusts the time and date automatically.

1 Fetal heart rate label 2 Uterine activity label

3 Basic Operation

The trace records maternal parameters also. When measuring noninvasive blood pressure, the annotation is made at the end of the measurement. If the noninvasive blood pressure measurement repetition time is short, the noninvasive blood pressure numeric may not always be printed.

The recording of notes (see “Entering Notes” on page 77) or time/date information may be interrupted by connecting, or unplugging a transducer, or by a change in measurement-related setting (for example, artifact suppression, Toco sensitivity, or alarm settings).

A new patient admission or a change to the paper scale setting stops all annotations, and prompts a new vertical trace header to be printed.

To switch off the recorder:

1 Either select S

tart/Stop from the Fetal Recorder menu.

2 Or press one of the SmartKeys (depending on configuration): fetal recorder S

tart/ Stop or Stop

ecordng

If your recorder is configured with

onfirmed Stop on (a Configuration Mode setting), you will

need to confirm that you want to stop the recorder, before it will stop.

When the recorder is off, the "recorder off" status indicator is displayed in the bottom right-hand corner of the screen: When the

aper Save Mode is set to Off the paper symbol shows an x mark,

and when

aper Save Mode is On the icon shows a paper trace icon.

1 Time stamp printed every ten

minutes

3 Basic Operation

Recording Elements

A variety of information can appear on the recorder trace. Here is a sample trace with some of the most common elements and their meaning. Each trace header contains the last name and first name, the patient ID, patient date of birth, the current date and time, patient's bed label, and the gestational age of the pregnancy.

1 Name, patient ID, date of birth, current date and time 2 Recorder speed 3 Gestational age and patient bed label 4 FMP - Fetal Movement Profile 5 Other measurements for the patient such as temperature, arterial oxygen saturation, and pulse 6 Entered notes such as patient repositioned, or MD notified, or others 7 Time stamp 8 Trace separation 9 Recorder speed 10 Maternal ECG 11 Direct ECG 12 Coincidence of heart rate detected 13 HR with Alarms Off symbol 14 Alarm Limits 15 DFHR2 (second fetal heart rate from DECG) 16 FHR1 (first fetal heart rate)

3 Basic Operation

Choosing Recorder Speed

You can choose a recorder speed of 1, 2, or 3 centimeters per minute (cm/min). The default setting is 3 cm/min.

The ACOG technical bulletin on FHR monitoring states that "accurate pattern recognition is difficult if not

impossible at 1 cm/min and that 1 cm/min is only recommended for more economic screening. When FHR abnormalities arise, the faster paper speeds will enhance FHR pattern recognition".

Additionally, because a change in recorder speed results in a change in the appearance of an FHR trace, you are advised to ensure ALL monitors in your institution are set to the same speed.

To set the recorder speed (in Configuration Mode) see the Configuration Guide.

Advancing the Paper

You can advance the paper automatically to the next fold by pressing the Paper Advance SmartKey at any time except during a stored data recording. This is also possible using the

etal Recorder menu.

Marking an Event

You can record significant events on the trace paper (for example, when pain medication is administered or when the mother changes position). The mother can use the remote event marker to mark events herself. You connect the remote event marker to any free fetal sensor socket.

To mark an event on the trace paper you can:

1 Either select the S

et Marker SmartKey.

2 Or press the button on the remote event marker. The remote event marker is connected to the

monitor via any fetal transducer socket.

A small arrow is printed on the heart rate scale on the trace paper.

3 Basic Operation

This reflects exactly when the marker button was first pressed; keeping the button pressed has no influence on the annotation.

Tearing Off the Paper

CAUTION

Never pull on the paper to advance it, as this can cause misalignment of the paper. Always tear off the paper along the perforation.

FM40/FM50 The recorder's paper guide incorporates a tear-off edge, allowing you to tear off the trace paper cleanly

where you like (not necessarily at a fold). When not using the paper guide, always tear off the paper along the perforation.

To tear off the trace paper after monitoring using the paper guide:

1 If the recorder is running (the "recorder on" status indicator is displayed), turn off the recorder by

selecting the fetal recorder

tart/ Stop SmartKey or the Stop Recordng SmartKey.

2 Tear off the paper as shown in the picture. To ensure a clean tear, always tear in an upwards

motion, as indicated by the arrows. You can start tearing from the left or right (right-handed user shown). You may want to use both hands to guarantee that the paper is not misaligned during the tear off.

3 Basic Operation

If you wish to tear off the paper at a fold, select the P

aper Advance SmartKey, wait for the paper to

stop, then tear it off.

FM20/FM30 The FM20/FM30 does not have a paper guide. The procedure is the same as described for the FM40/

FM50 with the exception that you should advance the paper to a perforation. If you wish to tear off the paper at a perforation, select the

aper Advance SmartKey, wait for the paper

to stop, then tear it off.

Paper-Out Indication

Each pack of paper has 150 pages. The monitor issues a paper-out warning in the status line at the bottom of the screen, when there are five pages to go. If you switch on the recorder or press the

aper

dvance

key when there are fewer than five pages remaining, it may take two pages before the alarm is

activated. Load a new pack in time. If the recorder runs out of paper, an audible paper-out alarm is sounded, if so configured. See

“Loading Paper FM40/FM50” on page 73, and “Loading Paper FM20/FM30” on page 70 to learn how to reload paper.

Fetal traces continue to be recorded into the monitor's backup memory, and can be retrieved and printed completely if new paper is loaded within one hour, when the

ridge Paperout setting is enabled

in Configuration Mode. See “Recovering Traces on Paper” on page 229 for further information.

Loading Paper FM20/FM30

CAUTION

Using recorder paper that is not approved by Philips can result in accelerated paper fading and can damage the thermal line printhead. This type of damage is not covered by warranty.

3 Basic Operation

FM20/FM30 To load a pack of paper:

1 If the recorder is on, press the recorder S

tart/ Stop SmartKey or the Stop Recordng SmartKey to

turn it off before loading a new pack of paper.

2 Press the paper table release to unlock the paper drawer and then pull the table forward to open it

fully.

3 Lift out any remaining paper from the tray.

4 Prepare to place the new pack of paper in the tray with the bottom side down. The bottom side is

indicated by the word STOP printed on the final page of the new pack.

3 Basic Operation

Unfold the top page of the pack and position the uterine activity scale on the right.

6 Slide the pack into the tray.

3 Basic Operation

Push the paper drawer back until it "clicks" closed.

8 Press the recorder S

tart/ Stop SmartKey or the Start Recordng SmartKey to switch on the recorder.

Annotations of trace information are printed on the trace paper (see “Switching the Recorder On and Off ” on page 64 for details).

Loading Paper FM40/FM50

CAUTION

Using recorder paper that is not approved by Philips can result in accelerated paper fading and can damage the thermal line printhead. This type of damage is not covered by warranty.

FM40/FM50 To load a pack of paper:

1 If the recorder is on, press the S

tart/ Stop Rec SmartKey or the Stop Recordng SmartKey to turn it

off before loading a new pack of paper.

2 Press the paper eject button to open the paper drawer.

3 Basic Operation

Lift out any remaining paper from the tray.

4 Press and hold the paper eject button to partially eject the paper, thus making it easier to remove.

5 Hinge the transparent paper guide forward. It is held in the closed position by a small protrusion

on each side of the holder.

6 A - Protrusion holds paper guide in closed position.

3 Basic Operation

Prepare to place the new pack of paper in the tray with the bottom side down. The bottom side is indicated by the word STOP printed on the final page of the new pack.

8 Unfold the top page of the pack and position the uterine activity scale on the right. 9 Slide the pack into the tray.

10 Feed the paper evenly through the paper guide. Do not close the paper guide yet.

11 Close the paper drawer.

3 Basic Operation

Now close the paper guide.

13 Press the recorder S

tart/ Stop SmartKey or the Start Recordng SmartKey to switch on the recorder.

Annotations of trace information are printed on the trace paper (see “Switching the Recorder On and Off” on page 64 for details).

3 Basic Operation

Entering Notes

Your monitor has a set of 15 factory pre-configured notes (see below). The maximum length of one single note is 30 characters. It is possible to edit the notes in Configuration Mode (see the Configuration Guide).

To enter a note:

1 Press the E

nter Notes SmartKey to open the Enter Note menu.

2 Scroll if necessary, then select the note you wish to enter. A confirmation dialog box opens: 3 Select C

onfirm to enter the note. The note is then shown in the status line of the display, and is

annotated on the fetal trace if the fetal recorder is on.

4 By default, notes are printed lengthwise in the direction of the trace, in the space between the FHR

grid and the uterine activity grid. If you prefer, you can configure the recorder to print across the trace.

5 You can change this in Configuration Mode by changing the N

otes Recording setting in the Fetal

ecorder

menu from Along (default) to Across (notes print width wise across the trace).

The following are the pre-configured notes from which to choose:

1 Patient Repositioned

2 Vaginal Examination

3 MD Notified

4 Sitting

5 On Back

6 Left Lateral

7 Ambulating

8 Tocolytic Given

9 Membranes Ruptured

10 Amniotomy

11 Amniotic Fluid Clear

12 Amniotic Fluid Not Clear

13 Oxytocin

14 Urinary Catheter

15 Micro Blood Analysis

Up to two notes can be printed directly, and the monitor can temporarily store up to a further two notes, and these are printed after the first two have been recorded. Any further notes are discarded. For example, if you enter six notes in quick succession, the first two notes you entered are recorded right away, the next two are stored in memory and then printed when the first two have been recorded, and the last two are discarded.

If the printing of two notes happens to coincide with the regular recording of the time stamp that takes place once every ten minutes, the time stamp is delayed until the notes have finished printing.

3 Basic Operation

Signal Quality

During monitoring, if the fetal heart rate signal quality fluctuates, and becomes poor, it does not necessarily mean that the transducer needs repositioning. The fluctuation may be caused by fetal movement. Allow time for the signal to stabilize before deciding whether to reposition the transducer (ultrasound), or apply a new electrode (ECG). For the best trace quality, the signal quality indicator should be full, indicating good signal quality, even though it may be possible to make traces at a lower signal quality level.

Cableless Monitoring

Basics of Cableless Systems

Avalon CL

Transducer

System

Avalon CTS

Transducer

System

Assigning Cableless Transducers

The cableless transducers of the Avalon CL are assigned by simply docking them at the base station connected to the patient’s fetal monitor. See the Avalon CTS Instructions for Use for the assignment of the CTS transducers.

Activating Cableless Transducers

The CL transducers of the Avalon CL are activated by picking them up from the base station. If the CL transducer is activated, an antenna symbol is displayed on the fetal monitor screen next to the numeric of the measurement. See the Avalon CTS Instructions for Use for the activation of the CTS transducers.

3 Basic Operation

Deactivating Cableless Transducers

The CL transducers of the Avalon CL are deactivated by redocking them at a base station. To deactivate all cableless transducers at once press the Standby button of the Avalon CL base station. See the Avalon CTS Instructions for Use for the deactivation of the CTS transducers.

Unassigning Cableless Transducers

The CL transducers of the Avalon CL are unassigned by manually removing them in the corresponding setup menu from the group of assigned cableless devices, or by unassigning them directly in the

ele Info window. See the Avalon CTS Instructions for Use for the unassignment of the

CTS transducers.

Connection Options

The fetal monitors FM20/FM30 and FM40/FM50 are compatible with the Avalon CL and Avalon CTS Transducer Systems. Regard the following points for cableless monitoring:

• You can connect one Avalon CL base station with a red connector to an FM20/FM30 or an FM40/FM50 (fetal socket), or one Avalon CL base station with a black connector to an FM40/ FM50 (telemetry socket).

3 Basic Operation

• You can connect two Avalon CL base stations with black connectors to an FM40/FM50 (telemetry sockets)

• You cannot connect two Avalon CL base stations to an FM40/FM50, if one Avalon CL base station has a red connector, and the other Avalon CL base station has a black connector.

• You can connect one Avalon CTS system to an FM20/FM30 or FM40/FM50 at a time (either fetal or telemetry socket).

3 Basic Operation

• You cannot connect an Avalon CTS and an Avalon CL at the same time to the same fetal monitor.

• Monitoring a multiple pregnancy using cableless transducers is supported by the Avalon CL system only.

• Using a mixture of wired and cableless fetal transducers is not supported. You can use either wired or cableless fetal transducers.

• If you cannot get sufficient signal quality using Avalon CTS transducers, switch to wired transducers.

3 Basic Operation

Configuration of Cableless Systems

You have to configure the radio channels of the Avalon CL and Avalon CTS transducer system for communication to work, and not to interfere with any other telemetry devices.

The configuration of a connected Avalon CL system is done in Configuration Mode or Service Mode of the fetal monitor. Service Mode functions can be used to identify channel assignment conflicts in the hospital environment. The configuration should be carried out by authorized and qualified service personnel, either by the hospital's biomedical department, or by Philips Support.

For a detailed description of the configuration see the Avalon CL Service Guide and the Fetal Monitor Configuration Guide. For details regarding the configuration of a connected Avalon CTS system see the Avalon CTS Service Guide.

Tele Info Window

The Tele Info window of the fetal monitors allows you to manage the Avalon CL system. Below is an exemplary view of the

ele Info window. Your window may differ depending on the status of the

connected system. To open the

ele Info window you can:

1 Configure a T

ele Info SmartKey to open the window,

2 press the T

ele symbol on the main screen, or

3 Basic Operation

select the M

ain Setup and then Tele Info.

1 CL Transducer symbol assigned with the parameter label 2 Cableless measurement symbol and equipment ID 3 Base station symbol with docking indication (the white slot indicates a charging transducer) 4 Key R

emove

5 Key Find 6 Key Battery Report (in Service Mode)

7 T

ele symbol

8 Remaining battery time 9 Out of battery symbol 10 Indication of radio signal quality

3 Basic Operation

Telemetry

When the monitor recognizes a connected Avalon CL or Avalon CTS interface cable (red or black connector), it confirms the recognition with the following status indicators displayed in the lower right-hand corner of the screen:

NOTE

A CL transducer is considered still active, even if it has an INOP condition (e.g. cl US Disconnect), until it is either deactivated by docking it at the base station, or until it is manually removed from the

ele

nfo

window.

CL transducers have priority over wired transducers. If an Avalon CL or Avalon CTS base station is connected to the fetal monitor, and both wired and CL transducers are connected to the monitor, the wired transducers are disabled whenever one CL transducer is active. If a CL Pod is activated it does not automatically deactivate all wired transducers, just the one with the corresponding measurement.

To switch back to using wired transducers, switch the base station to Standby mode, or redock the CL transducers at the base station, and continue monitoring with the wired transducers. If you cannot get sufficient ultrasound signal quality using the Avalon CTS base station, try repositioning the transducers, or switch to wired transducers. Using a Avalon CL base station you should get a better signal by reducing the distance between the CL transducer and the base station.

• When using an Avalon CL or Avalon CTS you should be aware that monitoring FMP is not recommended when the mother is likely to move, and you should disable Fetal Movement Profile (FMP) on the fetal monitor (

etal Movement Off) if the mother is walking. Maternal movements are

likely to create artifact in the FMP output. See also “Switching FMP On and Off” on page 148, the sections “Cableless Monitoring - Important Considerations” on page 142 and “Fetal Movement Profile” on page 147.

• With the Avalon CL Transducer System you can now monitor twins and triplets with CL transducers. The Avalon CTS System does not have this option.

Indicator Avalon CL Avalon CTS

A base station is connected to the monitor, but the base station is in Standby mode.

Avalon CTS interface cable is connected to the monitor, but the Avalon CTS base station is not connected to the interface cable, or it is disconnected from AC mains, or is in Standby mode.

A base station is connected to the monitor but no cableless transducers and no cableless Pods are currently active. All are still docked at the base station, or the base station holds no transducers.

Avalon CTS interface cable is connected to the monitor, Avalon CTS base station is connected, powered on, and cableless transducers are ready to use, but no cableless transducers are currently active (all are still docked at the base station).

A base station is connected to the monitor, it is on, and minimum one assigned cableless transducer or cableless Pod is active.

Avalon CTS interface cable is connected to the monitor, Avalon CTS base station is connected, powered on, and at least one cableless transducer is active and assigned.

A CL transducer has moved away from the base station and is approaching the limit of the area of reach (ca. min. 100 m/300 ft in line of sight). The US sound is replaced by an artificial QRS sound (like DECG). The DECG and MECG waves are no longer displayed.

Not applicable for Avalon CTS.

3 Basic Operation

About RF Signal Quality

Signal transmission can be disturbed if:

• the patient is out of range of the receiving area.

• there is interference from another, possibly stronger, RF signal (a broadcasting station, for instance).

• the patient is near material that absorbs electromagnetic waves (for example, metal-reinforced concrete, elevator doors) or the base station is in an enclosed metal rack.

Pop-up Keys

Messages

The fetal monitor issues messages to certain user interactions. For example if the CL SpO2 Pod is picked up from the base station to activate it, the monitor displays the message

l SpO Added and the

equipment label of the CL Pod.

CL Transducer Assignment

The CL transducers are assigned by simply docking them at the Avalon CL base station connected to

the patient’s fetal monitor. Since twins and triplets can be monitored with the Avalon CL base station, it can be delivered with up

to six CL transducers: one CL Toco

MP, three CL US, and two CL ECG/IUP transducers. Only up

to four CL transducer can be assigned at one time to the Avalon CL base station. Four assigned CL transducers enable monitoring combinations such as 1 CL Toco

MP transducer + 3 CL US

transducers for monitoring triplets externally, or 1 CL Toco

MP transducer + 2 CL US transducer +

1 CL ECG/IUP transducer for monitoring twins. Three CL transducers can be docked and charged at the Avalon CL base station at a time. If a fourth

transducer should be assigned to the Avalon CL base station:

1 Remove first the three docked CL transducers from the base station and place them on the patient. 2 Then dock the remaining fourth transducer at the base station and wait until the LED of the

fourth transducer signals that it has communication with the base station.

3 Place the fourth CL transducer on the patient and check on the fetal monitor in the T

ele Info

window if the base station and the monitor have communication with all four transducers, and if their numerics are displayed on the screen of the fetal monitor.

Pop-Up Key Function

emove Selecting the Remove key deactivates and unassigns the selected active

transducer or CL Pod and removes it from the list. This key is disabled if no active device is selected.

ind Selecting the Find key pages the selected active CL transducer. This key is

disabled if no active device is selected.

3 Basic Operation

CL Transducer Unassignment

The cableless transducer needs to be unassigned:

• before being used with another base station on another patient

• to allow cleaning before docking it back onto the base station (e.g. to replace it with a fully charged transducer of the same type)

There are three methods to do this:

1 Open the setup menu of the measurement e.g. F

HR1 by selecting the numeric on the screen.

2 Select R

emove from the open setup menu.

3 A confirmation window opens with the prompt P

lease Confirm and Device will be removed.

4 Select the C

onfirm pop-up key. A message confirms cl US has been removed.

1 Open the T

ele Info window.

2 Select the symbol of the cableless transducer you want to unassign, and select R

emove from the

pop-up menu.

3 A confirmation window opens with the prompt P

lease Confirm and Device will be removed.

4 Select C

onfirm the pop-up key. A message confirms cl US has been removed.

1 Redock the CL transducer at the base station. 2 Switch the base station to stand-by. 3 Remove the CL transducer; it is now unassigned.

NOTE

When a CL transducer is unassigned, all the measurements from this transducer are no longer monitored; e.g. if you unassign a CL Toco

MP, the Toco measurement, SpO2, and MECG are no

longer monitored.

CL Pods Assignment

The CL Pods are assigned by simply docking them at the base station connected to the patient’s fetal monitor.

CL Pods Unassignment

To unassign a CL Pod, there are four methods:

1 Open the setup menu of the measurement e.g. S

pO by pressing the numeric on the screen.

2 Select R

emove from the open setup menu.

3 A confirmation window opens with the prompt P

lease Confirm and Device will be removed.

4 Select C

onfirm the pop-up key. A message states then <cl Measurement> has been removed.

1 Open the T

ele Info window.

2 Select the symbol of the CL Pod you want to unassign, and select R

emove from the pop-up menu.

3 A confirmation window opens with the prompt P

lease Confirm and Device will be removed.

3 Basic Operation

Select C

onfirm the pop-up key. A message states then <cl Measurement> has been removed.

or Unassign the CL Pod with its user interface. See the Cableless Measurement Instructions for Use. or Dock the CL Pod at the base station or charger.

Calling Patients

To call a patient currently not near the fetal monitor and base station select the SmartKey Call Patient at the fetal monitor. The base station will then select one transducer to emit the tone sequence to notify the patient.

Underwater Monitoring

Only the CL transducers of the Avalon CL and Avalon CTS systems can be used to monitor under water. You can use them to monitor patients in a bathtub or shower. This does not apply to the IntelliVue CL SpO

and CL NBP Pods, do not immerse the CL Pods into water.

Cableless transmission distances are shorter when monitoring under water. A metal bathtub is likely to further reduce the operating range.

WARNING

Never immerse the base station in liquid. You must protect it against water sprays or splashes. Place the base station where there is no chance of contact with water, or falling into water or other liquids.

CAUTION

Avoid the use of pulsating water jets in the bath or shower while monitoring, as these can be misinterpreted as an incorrect (or totally artificial) heart rate.

Toco Baseline drift: The accuracy specified for baseline drift cannot be guaranteed for underwater usage. When using transducers under warm water the temperature increase causes a significant baseline change due to internal pressure increase. The depth under water at which the Toco transducer is used also has an effect on the Toco baseline, as the water pressure increases with depth. After immersion, allow one to two minutes for the pressure to stabilize, then adjust the Toco baseline (between contractions), and check it frequently.

When using the transducers underwater, the radio transmission range is reduced, and signal loss may occur.

Water-proof belts like M1562B are recommended for the cableless transducers when monitoring in water.

3 Basic Operation

After Monitoring

1 Discharge the patient. 2 Remove the transducer from the patient and, using a soft tissue, remove any gel from it. Then

clean the transducer.

3 Dock CL transducers to their base station so they can recharge. 4 Tear off the paper at the fold. To avoid misalignment of the recorder mechanism, NEVER pull on

the paper to advance it, or try to tear it other than at a fold (unless using the paper guide with the FM40/FM50).

5 Switch off the monitor.

Switching the Monitor to Standby

To switch the monitor to Standby: Either

1 Select the M

onitor Standby SmartKey.

1 Enter the M

ain Setup menu using the SmartKey.

2 Select M

onitor Standby.

3 Pressing any key or selecting any field on the screen will resume monitoring.

NOTE

If an Avalon CL base station is connected to your FM20/30 monitor, do not turn off the monitor if you need to recharge the batteries of the CL transducers. They can only be recharged if the FM20/30 monitor is on. If an Avalon CL base station is connected to an FM40/50 at the Telemetry ports in the rear, the batteries of the CL transducers can be recharged while the monitor is in Standby mode. If you disconnect a base station from a fetal monitor when the CL transducers are not fully charged, the base station starts beeping. If you want to still disconnect it, confirm your choice by pressing the Standby button of the base station, and the beeping stops.

3 Basic Operation

Disconnecting from Power

FM20/30

To disconnect the monitor from AC power, switch the monitor off using the On/Off switch located on the right side of the device, or unplug the power cord from the AC mains socket.

FM20/FM30 with Battery Option and FM40/FM50

The On/Standby button does not disconnect the monitor from the AC power source. To disconnect, unplug the power cord from the AC mains socket. Note that if the power cord is unplugged from the AC mains socket before the monitor is put into Standby, a beeper is activated. The beeper warns you if the monitor is accidentally disconnected from AC mains.

Power On/Power Off Behavior

The general rules determining the behavior of the fetal monitors when connected to, or disconnected from power are as follows:

• A fetal monitor that was switched on prior to a temporary power loss, switches on again when power is restored.

• A fetal monitor that was switched off prior to a temporary power loss, remains off when power is restored.

• When AC mains power is lost, a battery powered monitor (FM20/30) continues to run without interruption on battery power.

Monitoring After a Power Failure

• A fetal monitor that was switched on prior to a temporary power loss switches on again when power is restored.

• A fetal monitor that was switched off prior to a temporary power loss remains off when power is restored.

• If the fetal monitor is without power for less than one minute, monitoring will resume with all active settings unchanged.

• If the fetal monitor is without power for more than one minute, the behavior depends on your configuration.

– If

utomat. Default is set to Yes, the default profile will be loaded when power is restored.

– If

utomat. Default is set to No, all active settings are retained, if power is restored within

48 hours. The

utomat. Default setting is made in Configuration Mode.

3 Basic Operation

Troubleshooting

Problem Possible Causes Solutions

Light or no trace Wrong paper Use recommended paper

Dirty printhead Clean printhead, see “Cleaning the

Print Head” on page 246

FM20/30 only: Paper misaligned due to drawer not being correctly shut

Shut the drawer fully, pushing evenly with both hands

End of paper noted when pack not finished

Bad paper feed or wrong paper Check paper feed and use

Philips FM20/30, Avalon CL, FM40/50 Instructions For Use Manual

Specifications and Main Features

Frequently Asked Questions

User Manual