Philips PageWriter Trim User manual

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Page 1

INSTRUCTIONS FOR USE

Page 2

Notice

About This Edition

Publication number M4992-91150 Edition 1

2004 Koninklijke Philips Electronics N.V. All rights are reserved.

All other product names are the property of their respective owners.

Permission is granted to copy and distribute this document for educational purposes.

Warranty

Philips Medical Systems makes no warranty of any kind with regard to this material, including, but not limited to, the implied warranties or merchantability and fitness for a particular purpose.

Philips Medical Systems shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material.

WARNING

As with electronic equipment, Radio Frequency (RF) interference between the cardiograph and any existing RF transmitting or receiving equipment at the installation site, including electrosurgical equipment, should be evaluated carefully and any limitations noted before the equipment is placed in service.

Radio frequency generation from electrosurgical equipment and close proximity transmitters may seriously degrade performance.

WARNING

Like all electronic devices, this cardiograph is susceptible to electrostatic discharge (ESD). Electrostatic discharge typically occurs when electrostatic energy is transferred to the patient, the electrodes, or the cardiograph. ESD may result in ECG artifact that may appear as narrow spikes on the cardiograph display or on the printed report. When ESD occurs, the cardiograph ECG interpretation may be inconsistent with the physician interpretation.

Philips Medical Systems assumes no liability for failures resulting from RF interference between Philips Medical Systems medical electronics and any radio frequency generating equipment at levels exceeding those established by applicable standards.

CAUTION

The use of parts or accessories other than those approved by Philips Medical Systems may compromise product performance.

United States federal law restricts this device to use by or on the order of a physician.

THIS PRODUCT IS NOT INTENDED FOR HOME USE.

Medical Dev ice Directive

The PageWriter Trim Cardiograph complies with the requirements of the Medical Device Directive 93/42/EEC and carries the

mark accord-

0123

ingly.

Authorized EU-representative:

Philips Medizinsysteme Böblingen GmbH Hewlett Packard Str. 2 71034 Böblingen Germany

Page 3

Contents

Safety Summary

Safety Symbols Marked on the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

Safety Symbols Marked on the Cardiograph Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Conventions Used in the Instructions for Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Important Patient and Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

The PageWriter Trim Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Intended Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

The Philips 12-Lead Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Intended Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Getting Started

PageWriter Trim Cardiograph Learning Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

About the PageWriter Trim Learning Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Attaching the Cardiograph to the Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

PageWriter Trim I Cardiograph Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

PageWriter Trim II and III Cardiograph Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7

Installing the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

Battery Charging Indicator, PageWriter Trim II and III . . . . . . . . . . . . . . . . . . . . . 1-10

Battery Charging Indicator, PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10

Loading the Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11

Tips for loading printer paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11

Patient Interface Module (PIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12

Inserting the Lead Wires into the PIM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

Connecting the PIM to the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14

Placing the PIM in the Holder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15

Using the PC Card Slot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16

Using the PC Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16

Using the Modem Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17

Using the LAN Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17

Inserting or Removing a PC Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18

Using the Barcode Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18

Using the Magnetic Card Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19

Using the SmartCard Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19

Powering On the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-20

Using the On/Standby Button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21

Using the Trim Knob. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22

Contents-1

Page 4

PageWriter Trim I Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-22

Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-23

LCD Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-24

Function Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-25

PageWriter Trim II and III Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-26

PageWriter Trim II and III Status Bar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-27

PageWriter Trim II and III Command Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-28

The Patient Session

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-1

Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

Instructing the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

Preparing the Skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Attaching the Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Attaching the Lead Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-7

Checking Signal Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-7

Using the PageWriter Trim I Signal Quality Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . .2-7

Heart Beat Detector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-8

Leads Off Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-8

Signal Quality Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-8

Troubleshooting Signal Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-9

Using the PageWriter Trim II and III Signal Quality Indicators . . . . . . . . . . . . . . . . . . . . .2-9

Using the Leads off indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-9

Color-coded waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-10

Troubleshooting Signal Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-11

Using Filters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-11

Artifact Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-12

Baseline Wander Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-12

Frequency Response Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-13

About High and Low Pass Frequency Filter Settings . . . . . . . . . . . . . . . . . . . . . . . .2-13

Changing Filter Settings on the PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-13

Changing Filter Settings on the PageWriter Trim II and III . . . . . . . . . . . . . . . . . . . . . . .2-15

Artifact and Baseline Wander Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-16

Display Filter Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-17

Entering Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-17

Entering Patient ID Information on the PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . .2-18

Entering Patient ID Information on the

PageWriter Trim II and III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19

Entering Patient ID Information with the Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19

Opening a Pending Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-20

Entering Patient ID Information with the Barcode Reader . . . . . . . . . . . . . . . . . . . . . . .2-21

Entering Patient ID Information with the

Magnetic Card Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-21

Entering Patient ID Information with the

SmartCard Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-22

Editing Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-23

Emergency (STAT) ECGs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-23

Contents-2 PageWriter Trim Cardiograph Instructions for Use

Page 5

Taking an Auto ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-24

Taking an Auto ECG with the PageWriter Trim I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-24

Taking an Auto ECG with the PageWriter Trim II and III. . . . . . . . . . . . . . . . . . . . . . . 2-25

The Preview Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25

Changing Auto Report Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25

Using the Metronome with Auto ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-26

Rhythm ECG Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Taking a Rhythm Report on the PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

Taking a Rhythm Report on the PageWriter Trim II and III . . . . . . . . . . . . . . . . . . . . . 2-28

Disclose ECG Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-29

Pacing Detection Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-30

Getting Help on the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-32

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-32

Reading the Printed ECG Report

Interpretive, Reason, and Severity Statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2

Severity Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3

Basic Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

Patient ID Clinical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Additional Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

Institution Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

Configurable Clinical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

ECG Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Physician Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10

Report Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10

Calibration Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11

Time Separator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13

Pacing Detection Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13

Algorithm Version Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16

Speed and Sensitivity Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16

Device Identification Number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17

12-Lead ECG Report Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-18

Extended Measurements Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25

PageWriter Trim III only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25

Rhythm Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25

Disclose Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28

PageWriter Trim II and III only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28

PageWriter Trim II and III Orders and Archive

About Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

About the Archive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

PageWriter Trim Cardiograph Instructions for Use Contents-3

Page 6

Using the Order Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-2

Entering New Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4

Deleting an Order. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4

Editing an Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-5

Using the Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Saving Auto Reports to the Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Opening the Archive Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-7

Transferring Auto Reports to a TraceMaster ECG Management System. . . . . . . . . . . . . . . .4-9

Viewing and Printing Auto Reports in the Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-11

Faxing Auto Reports in the Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-12

Editing Patient ID Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-13

Exporting 12-lead Reports in XML Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-14

Printing a List of Auto Reports in the Archive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-14

Searching a TraceMaster Remote Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-15

Searching a Remote Site with the Wildcard Character . . . . . . . . . . . . . . . . . . . . . . . . .4-15

Deleting Auto Reports from the Archive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-16

PageWriter Trim II and III Configuration

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1

Configuring Multiple Cardiographs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1

Password Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1

Configuration with a Philips TraceMaster ECG Management System . . . . . . . . . . . . . . .5-1

Restoring Cardiograph Configured Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1

Opening the Configuration Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2

Analysis Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2

Patient ID Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

Patient ID Configuration Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

Configuring Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

User Defined Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7

Configuring Clinical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7

User Defined Clinical Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9

Configuring Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10

User Defined Order Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12

Configuring Auto Report Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12

Editing the Profile Report Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-15

Editing Profile Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16

Editing Profile Scale Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16

Editing Report Type Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16

Saving the Report Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-17

Setting the Default Auto Report and Copy Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-17

Setting Other Print Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-18

System Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-18

Battery Power Saving Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-19

Simulated Waveform Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-20

Filter Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-21

Contents-4 PageWriter Trim Cardiograph Instructions for Use

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About High and Low Pass Frequency Filter Settings . . . . . . . . . . . . . . . . . . . . . . . 5-21

Setting Default Rhythm Filter Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-22

Remote Sites Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-22

Remote Site Fax and Modem Connection

(USA and Canada only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-24

Remote Sites Network Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-25

Network Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-27

Networking Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-27

DHCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-27

Fixed IP Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-28

Auto Negotiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-28

Password Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-30

Lost Passwords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-30

Locale Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-31

Cardiograph Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-31

Metronome Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-34

Magnetic Card Reader Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-35

Saving Configured Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-36

Loading the Configuration Settings File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-36

Restoring Factory Default Configuration Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-37

Troubleshooting

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

Troubleshooting Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2

Barcode Reader. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

Battery and AC Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

LAN and Modem Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

Leads Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9

Magnetic Card Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

Signal Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-14

System Freeze . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-16

Resetting the Cardiograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-17

Cardiograph Care and Maintenance

Cardiograph Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Approved Cleaning Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

PIM, Patient Data Cable and Lead Wire Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Reusable Electrode Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Changing the Date and Time on the PageWriter Trim I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Changing the Date and Time on the PageWriter Trim II and III . . . . . . . . . . . . . . . . . . . . . . 7-3

Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Tips for changing printer paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

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Battery Maintenance and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

Charging the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-6

Battery Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-6

Replacing the Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-7

Replacing the AC Fuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-8

Replacing the Lead Wires on the PIM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-9

Maintenance Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-10

PIM Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-12

Barcode Reader Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-12

Magnetic Card Reader Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-13

Printer Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-13

Network Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-16

Important Patient and Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-16

Supplies and Ordering Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Ordering Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

PageWriter Trim Cardiograph Supply Part Numbers. . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Patient Interface Module (PIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Replacement Fuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Complete Lead Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Replacement Lead Sets and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-21

Printer Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-21

Optional Cardiograph Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-22

Optional Cardiograph Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-22

Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-22

Contacting a Philips Response Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-23

North America Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-23

South America Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-23

Europe Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-23

Asia Response Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-24

Specifications

Technical Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

ECG Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Screen Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Patient Interface Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Cardiograph Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Signal Processing/Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Sampling Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Auto Frequency Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Rhythm Frequency Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Printer Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Report Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

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Battery Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Recharge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Network Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

FAX Capability (optional). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Modem (optional for USA and Canada) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Barcode Reader (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Magnetic Card Reader (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

ECG Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

ECG File Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Power and Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Line Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Environmental Operating Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Environmental Storage Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Shipping Container Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Shipping Container Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Cart Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Cart Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

Cardiograph Cart Shipping Container Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Cardiograph Cart Container Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Safety and Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Electromagnetic Compatibility (EMC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Reducing Electromagnetic Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Assembling the Patient Cable Arm

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1

Assembly Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-2

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Safety Symbols Marked on the Cardiograph

1Safety Summary

Safety Symbols Marked on the Cardiograph

Symbol Name Description

Attention See PageWriter Trim Instructions for Use for

Type CF ECG physio isolation is type CF, defibrillator proof.

Alternating current Indicates that the cardiograph is receiving alternating

On/Standby Pressing the button with this symbol on it turns on the

information.

Electrical leakage current is suitable for all patient applications including direct cardiac application.

currents.

cardiograph or puts the cardiograph into Standby (power saving mode).

Do not touch exposed pins. Touching exposed pins can

Electrostatic Discharge

cause electrostatic discharge that can damage the cardiograph.

Equipotential grounding post Equipotential grounding post used for establishing

common ground between instruments.

Fuse Cardiograph contains a 1.5 amp (250V) time-delay

fuse.

Input The connector near this symbol receives an incoming

signal.

Serial Number The number next to this symbol is the serial number of

the cardiograph.

Product model number The number next to this symbol is the product model

number of the cardiograph

Entry of liquids The cardiograph is not protected against splashing

water.

Entry of liquids The PIM (Patient Interface Module) is protected

against splashing water. Water splashed against the PIM from any direction shall have no harmful effect.

PageWriter Trim Cardiograph Instructions for Use i

Page 11

Safety Symbols Marked on the Cardiograph Packaging

AC power indicator light When lit, indicates that AC power is on. The battery is

charging when inserted into the cardiograph.

Safety Symbols Marked on the Cardiograph Packaging

Symbol Description

Keep dry.

Ambient temperature range of 0

to 50

C (122o F) (non-condensing) for

transport and storage.

Atmospheric pressure range of 466 hPa to 1014 hPa for transport and storage.

C (32o.F)

Relative humidity range of 25% to 80% (non-condensing) for transport and storage.

Move and store packaging this end up.

Fragile.

Sealed lead acid battery. Do not dispose of in trash. Follow local regulations for disposing of as small chemical waste.

Recycle the packaging materials after use.

ii PageWriter Trim Cardiograph Instructions for Use

Page 12

Conventions Used in the Instructions for Use

WARNING Warning statements describe conditions or actions that may result in personal injury or

loss of life.

CAUTION Caution statements describe conditions or actions that may result in damage to equipment or

software.

NOTE Notes contain additional important information about a topic.

TIP A Tip contains suggested information on using a particular feature.

Menu item Button name

Menu items and button names appear in a bold no-serif font.

Example: Highlight the

Config button.

Important Patient and Safety Information

The PageWriter Trim cardiograph isolates all connections to the patient from electrical ground and all other conductive circuits in the cardiograph. This reduces the possibility of hazardous currents passing from the cardiograph through the patient’s heart to ground, and from other equipment connected to the patient passing through the leads into the cardiograph to ground.

WARNING Failure to follow these warnings could affect both patient and operator safety.

 When operating the cardiograph on AC power, ensure that the cardiograph and all other

electrical equipment connected to or near the patient are effectively grounded.

 Use only grounded power cords (three-wire power cords with grounded plugs) and

grounded electrical outlets. Never adapt a grounded plug to fit an ungrounded outlet by removing the ground prong. Use the equipotential post when redundant earth ground is necessary according to IEC 60601-1-1.

 If a safe ground connection is not ensured, operate the cardiograph on battery power only.

 The use of equipment that applies high frequency voltages to the patient (including

electrosurgical equipment and some respiration transducers) is not supported and may produce undesired results. Disconnect the patient data cable from the cardiograph, or detach the leads from the patient prior to performing any procedure that uses high frequency surgical equipment.

 Do not perform ST analysis on the R/T ECG screen display or on Rhythm reports when

the 0.5 Hz Baseline Wander filter is applied.

PageWriter Trim Cardiograph Instructions for Use iii

Page 13

Important Patient and Safety Information

 If abnormal ECG data appears on the printed report, and the abnormal data does not have

a physiological origin, perform the printer diagnostic test to assess printer performance (see page 7-13).

 When printing a Rhythm report, there may be a slight delay before the Rhythm report

begins to print on the cardiograph. Rhythm printing is not completed in real-time.

 Pace pulse tick marks will not print on an Auto report that uses simultaneous acquisition.

WARNING Do not touch accessible connector pins and the patient simultaneously.

Electrical shock hazard. Keep cardiograph, Patient Interface Module (PIM) and all cardiograph accessories away from liquids. Do not immerse cardiograph, PIM, or other accessories in any liquids.

 Periodically inspect the patient data cable, lead wires, and AC power cord for any worn or

cracked insulation to ensure that no inner conductive material is exposed. Discard worn accessories and replace them only with Philips Medical Systems accessories (see page 7-

20).

 Keep the patient data cable away from power cords and any other electrical equipment.

Failure to do so can result in AC power line frequency interference on the ECG trace.

 The Philips Medical Systems patient data cable (supplied with cardiograph) is an integral

part of the cardiograph safety features. Use of any other patient data cable may compromise defibrillation protection, degrade cardiograph performance, and may result in distorted ECG data.

 Only qualified personnel may service the cardiograph or may open the cardiograph

housing to access internal cardiograph components. Do not open any covers on the cardiograph. There are no internal cardiograph components that are serviced by the operator.

 Do not use this cardiograph near flammable anesthetics. It is not intended for use in

explosive environments or in operating rooms.

 Do not touch the patient, the patient data cable, any unused patient leads, or the

cardiograph during defibrillation. Death or injury may occur from the electrical shock delivered by the defibrillator.

 The PageWriter Trim I is not recommended for diagnostic cardiograph use during

defibrillation. It does not provide less than 10 seconds of real-time data.

 Always use electrode gel with reusable electrodes during defibrillation as ECG recovery

will be greater than 10 seconds. Philips Medical Systems recommends the use of disposable electrodes at all times.

 Ensure that the electrodes or lead wires do not come in contact with any other conductive

materials (including earth-grounded materials) especially when connecting or disconnecting electrodes to or from a patient.

iv PageWriter Trim Cardiograph Instructions for Use

Page 14

Important Patient and Safety Information

 Connecting multiple medical electrical equipment to the same patient may pose a safety

hazard due to the summation of leakage currents. Any combination of instruments should be evaluated by local safety personnel before being put into service.

 Portable medical equipment such as X-rays and MRI may produce electromagnetic

interference that produces noise in the ECG signal. Move the cardiograph away from these potential sources of electromagnetic interference.

 Do not pull on the paper while an ECG report is being printed. This can cause distortion of

the waveform and can lead to potential misdiagnosis.

 Only use the Philips Medical Systems AC power cord supplied with the cardiograph.

Periodically inspect the AC power cord and AC power connector (rear of cardiograph, see figure 1-2 on page 1-8) to ensure that both are in a safe and operable condition. If the AC power cord or AC power connector is not in a safe or operable condition, operate the cardiograph on battery power and contact Philips Medical Systems for service.

 The cardiograph has been safety tested with the recommended accessories, peripherals,

and leads, and no hazard was found when the cardiograph is operated with cardiac pacemakers or other stimulators.

 Do not connect any equipment or accessories to the cardiograph that are not manufactured

or approved by Philips Medical Systems or that are not IEC 60601-1 approved. The operation or use of non-approved equipment or accessories with the cardiograph is not tested or supported, and cardiograph operation and safety are not guaranteed.

 The list of cables and other accessories with which Philips claims compliance with the

emissions and immunity requirements of IEC standard 60601-1-2 are listed in “Supplies and Ordering Information” on page 7-20.

WARNING When using additional peripheral equipment powered from an electrical source other

than the cardiograph, the combination is considered to be a medical system. It is the responsibility of the operator to comply with IEC 60601-1-1 and test the medical system according to the requirements. For additional information contact Philips Medical Systems.

WARNING Do not use non-medical peripherals within 1.83 meters or 6 feet of a patient unless the

non-medical peripherals receive power from the cardiograph or from an isolation transformer that meets medical safety standards.

 Only install Philips Medical Systems software on the cardiograph. The installation or use

of software not approved by Philips Medical Systems is strictly prohibited and cardiograph safety and performance are not guaranteed.

 Only use Philips Medical Systems replacement parts and supplies with the cardiograph.

The use of non-approved replacement parts and supplies with the cardiograph is strictly prohibited. Cardiograph safety and performance are not guaranteed when non-approved replacement parts and supplies are used with the cardiograph.

PageWriter Trim Cardiograph Instructions for Use v

Page 15

The PageWriter Trim Cardiograph Intended Use

 Manual measurements of ECG intervals and magnitudes should be performed on printed

ECG reports only. Do not make manual measurements of ECG intervals and magnitudes on the R/T ECG display since these ECG representations are scaled.

 Only use patient electrodes that are approved by Philips Medical Systems. The use of non-

approved patient electrodes may degrade cardiograph performance.

 The Philips Medical Systems warranty is applicable only if you use Philips Medical

Systems approved accessories and replacement parts. See “Supplies and Ordering Information” on page 7-20 for more information.

 Before using the Patient Cable Arm with the cardiograph cart, properly install the counter

balance on the cardiograph base.

 Only use the shielded LAN cable provided with the PageWriter Trim cardiograph, Philips

Part Number 989803138021. Do not use any other LAN cables with the PageWriter Trim cardiograph. Use of unapproved LAN cables may result in radiated emissions that exceed the limit specified by CISPR11 Class B.

 The combined maximum weight that can be placed on the cardiograph cart shelf and the

top surface of the cart cannot exceed 20 kg (44 lbs). Do not place more than the specified weight on the cardiograph top surface and shelf.

 Do not connect any device to the RS-232 port on the rear of the cardiograph when the

patient data cable is connected to a patient.

 There are no cardiograph parts that can be sterilized.

 The cardiograph is not intended for direct, or invasive cardiac monitoring purposes.

 Excessive, repetitive use of the cardiograph keyboard and the cardiograph Trim Knob may

result in a risk of developing carpal tunnel syndrome.

 Ensure that the patient data cable is tucked away from the cardiograph cart wheels when

transporting the cardiograph. Ensure that the patient data cable does not present a hazard when pushing the cardiograph cart.

The PageWriter Trim Cardiograph

Intended Use

The intended use of the cardiograph is to acquire multi-channel ECG signals from adult and pediatric patients from body surface ECG electrodes and to record, display, analyze, and store these ECG signals for review by the user. The cardiograph is to be used in healthcare facilities by trained healthcare professionals. Analysis of the ECG signals is accomplished with algorithms that provide measurements, data presentations, graphical presentations, and interpretations for review by the user.

The interpreted ECG with measurements and interpretive statements is offered to the clinician on an advisory basis only. It is to be used in conjunction with the clinician's knowledge of the patient, the results of the physical examination, the ECG tracings, and other clinical findings.

vi PageWriter Trim Cardiograph Instructions for Use

Page 16

Indications for Use The Philips 12-Lead Algorithm

A qualified physician is asked to overread and validate (or change) the computer-generated ECG interpretation.

Indications for Use

The cardiograph is to be used where the clinician decides to evaluate the electrocardiogram of adult and pediatric patients as part of decisions regarding possible diagnosis, potential treatment, effectiveness of treatment, or to rule out causes for symptoms.

The Philips 12-Lead Algorithm

The PageWriter Trim Cardiograph software uses the Philips 12-Lead Algorithm. The algorithm in the software analyzes the morphology and rhythm on each of the 12 leads and summarizes the results. The set of summarized measurements is then analyzed by the clinically-proven ECG Analysis Program.

12-lead Reports may include or exclude ECG measurements, reasons, or analysis statements.

Intended Use

The intended use of the Philips 12-Lead Algorithm is to analyze multi-channel ECG signals from adult and pediatric patients with algorithms that provide measurements, data presentations, graphical presentations, and interpretations for review by the user.

Indications for Use

The Philips 12-Lead Algorithm is to be used where the clinician decides to evaluate the electrocardiogram of adult and pediatric patients as part of decisions regarding possible diagnosis, potential treatment, effectiveness of treatment, or to rule out causes for symptoms.

PageWriter Trim Cardiograph Instructions for Use vii

Page 17

1Getting Started

Welcome to the PageWriter Trim Cardiograph! With its intuitive operation, clearly labeled PIM and lead wires, and convenient cart, it is the ideal cardiograph for processing large volumes of ECGs quickly and easily.

The PageWriter Trim supports multiple ECG acquisition modes, display settings, and report formats. Signal quality indicators provide instant feedback to the user to help ensure a quality ECG each and every time.

This PageWriter Trim Cardiograph Instructions for Use provides comprehensive information on the cardiograph and all of its components. It is intended to be used with the other materials included in the PageWriter Trim Cardiograph Learning Kit.

NOTE Read and complete the materials included in the PageWriter Trim Cardiograph Learning Kit before

using the cardiograph. Read all Patient Safety information and pay close attention to all warnings and cautions. For more information, see “Important Patient and Safety Information” on page -iii.

1-1

Page 18

Getting Started PageWriter Trim Cardiograph Learning Kit

PageWriter Trim Cardiograph Learning Kit

Philips Medical Systems provides detailed instructional and reference materials in the PageWriter Trim Learning Kit

The PageWriter Trim Learning Kit contains the Getting Started Guide, a Quick Help Card, and the User Documentation and Interactive Training CDs.

Figure 1-1 The PageWriter Trim Cardiograph Learning Kit

About the PageWriter Trim Learning Kit

 Getting Started Guide (A)

This guide includes important information that must be read before operating the cardiograph. It includes an overview of cardiograph features and functions, assembly and setup instructions, how to configure the cardiograph, and how to order supplies.

 Quick Help Card (B) This card provides quick reference information about basic

cardiograph features, lead placement, and signal quality indicators. It is also provided as a PDF file on the PageWriter Trim User Documentation CD.

 PageWriter Trim Cardiograph Interactive Training Program CD (C)

The interactive training CD contains a computer-based training program about the proper recording of ECGs and how to operate the cardiograph.

Use this program to train the entire ECG staff in the proper operation of the cardiograph.

To run the interactive training program:

X Insert the CD into a PC CD-ROM drive. The CD only works on PCs with a Windows

operating system.

The interactive training program starts automatically.

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Getting Started Attaching the Cardiograph to the Cart

 PageWriter Trim User Documentation CD (D)

The User Documentation CD contains the following files:

– Philips 12-Lead Algorithm Physician’s Guide

This PDF file describes the Philips 12-Lead Algorithm, and lists all of the interpretive statements included in the 0A criteria.

– PageWriter Trim Instructions for Use

This PDF file includes complete information on all aspects of using and maintaining the cardiograph.

– PageWriter Trim Quick Help Card

A PDF version of the Quick Help Card provided in the Learning Kit.

– PageWriter Trim Cardiograph XML Schema (English only)

The schema for the XML ECG data exported from the PageWriter Trim cardiograph.

To view user documentation:

X Insert the CD into a PC CD-ROM drive. The CD only works on PCs with a Windows

operating system.

The user documentation CD main menu opens automatically. Click on a blue button or the file name to open the file.

NOTE Adobe Acrobat Reader does not need to be installed on the PC to view the PDF files on the CD. If

PDF files from the CD are saved to a PC hard drive, Acrobat Reader will need to be installed on the PC in order to view the files. For a free install go to: www.adobe.com.

If the menu does not automatically appear, open the CD in Windows Explorer.

2 Double-click the file menu.pdf on the CD. The PDF menu appears. Any of the files on the

CD may be printed or saved to a PC hard drive.

Attaching the Cardiograph to the Cart

The PageWriter Trim cardiograph is available with an optional cart that includes a storage shelf and a holder for the PIM (Patient Interface Module).

CAUTION Follow the procedure below to ensure that the cardiograph is securely fastened to the cart before

use.

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Page 20

Getting Started Attaching the Cardiograph to the Cart

To attach the cardiograph to the cart:

Align the front feet of the cardiograph with the front locking holes on the cart. Align the

rear feet of the cardiograph with the rear screw holes on the cart. Lower the cardiograph onto the cart.

2 Slide the cardiograph back to lock the front and rear feet into place. Insert the screws

through the bottom of the cart and through the screw holes. Tighten the screws with a Phillips head screwdriver.

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Page 21

Getting Started PageWriter Trim I Cardiograph Parts

PageWriter Trim I Cardiograph Parts

The following sections show front, side, and rear views of the PageWriter Trim I cardiograph.

Figure 1-1 PageWriter Trim I Cardiograph and Cart (Front View)

A Patient Interface Module (PIM) E PIM Leads

B Printer paper/report storage slot F Wheel Brake C Storage Shelf G Control Panel

D AC Power Cord H Printer Paper Drawer

CAUTION Always lock the wheel brake (F) when the cart is not in use. Press down on the wheel brake to set or

to release the wheel brake.

PageWriter Trim Cardiograph Instructions for Use 1-5

Page 22

Getting Started PageWriter Trim I Cardiograph Parts

Figure 1-2 PageWriter Trim I Cardiograph (Rear View)

I Reset Button M Battery Door

J AC Power Cord Connector N PIM Connector

K Equipotential Post O Serial Connector (not supported)

L Fuse Door

WARNING Do not connect a LAN cable connector to the PIM connector.

Do not plug a telephone connector into the PIM connector.

1-6 PageWriter Trim Cardiograph Instructions for Use

Page 23

Getting Started PageWriter Trim II and III Cardiograph Parts

PageWriter Trim II and III Cardiograph Parts

The following sections show front, side, and rear views of the PageWriter Trim II and III cardiographs.

Figure 1-1 PageWriter Trim II and III Cardiograph and Cart

(Front View)

A Patient Interface Module (PIM) F Wheel Brake

B Printer paper/report storage slot G Control Panel C Storage Shelf H Keyboard

D AC Power Cord I Trim Knob E PIM Leads J Printer Paper Drawer

CAUTION Always lock the wheel brake (F) when the cart is not in use. Press down on the wheel brake to set or

to release the wheel brake.

PageWriter Trim Cardiograph Instructions for Use 1-7

Page 24

Getting Started PageWriter Trim II and III Cardiograph Parts

Figure 1-2 PageWriter Trim II and III Cardiograph (Rear View)

K Reset Button Q Battery Door

L PC Card Eject Button R PIM Connector

M PC Card Slot S SmartCard Reader (USB) Connector

N AC Power Connector T Barcode Reader or Magnetic Card

Reader Connector

O Equipotential Post U Serial Connector (not supported)

P Fuse Door

WARNING Do not connect the LAN cable connector into the PIM connector.

Do not plug a telephone connector into the PIM connector.

1-8 PageWriter Trim Cardiograph Instructions for Use

Page 25

Getting Started Installing the Battery

Installing the Battery

The cardiograph is shipped with one removable battery. Install the battery before plugging the cardiograph into AC power.

Figure 1-3 Installing the Battery

To install the battery:

Open the battery door on the rear of the cardiograph. Push the recessed tab in and pull it down to open the battery door.

2 Insert the battery into the compartment with the connector facing down and the pull tab

facing out.

3 Push in the pull tab to lock it.

4 Reattach and close the battery door.

5 Attach the AC power cord to the rear of the cardiograph.

PageWriter Trim Cardiograph Instructions for Use 1-9

Page 26

Getting Started Installing the Battery

6 Plug the AC power cord into a grounded electrical outlet. Check that the green AC power

indicator light is on (front of cardiograph).

7 Charge the battery for at least 24 hours before mobile use.

Battery Charging Indicator, PageWriter Trim II and III

On the PageWriter Trim II and III, a lightening bolt icon ( ) appears on the Battery Level Indicator on the Status Bar when the cardiograph is plugged into AC power and the battery is charging. Check the Battery Power Indicator on the Status Bar to ensure that the battery is fully charged, see “PageWriter Trim II and III Status Bar” on page 1-27. The cardiograph can operate on AC power while the battery is charging, but the battery will charge at a slower rate.

Battery Charging Indicator, PageWriter Trim I

On the PageWriter Trim I, the following battery icon ( ) flashes on the LCD display when the cardiograph is plugged into AC power and the battery is charging, see “LCD Display” on page 1-24. The battery level indicator displays the following battery icon ( ) when the battery is fully charged. The cardiograph can operate on AC power while the battery is charging, but the battery will charge at a slower rate.

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Page 27

Getting Started Loading the Printer Paper

Loading the Printer Paper

Replace the printer paper when a red stripe appears on the printed ECG report. Only use Philips Medical Systems replacement printer paper. For part number and ordering information, see page 7-20.

Tips for loading printer paper

 Always load less than 100 sheets of printer paper into the paper tray

 Ensure that the entire first page of the new paper roll is fully draped over the roller before

closing the printer door

PageWriter Trim II and III:

 Ensure that the paper size configured for the cardiograph is the same size paper being

loaded into the paper drawer (see page 5-18)

Figure 1-4 Loading Printer Paper

A Paper sensor hole

To change the printer paper:

Open the paper drawer on the front of the cardiograph.

2 Insert a new pack of printer paper with the printed side facing up. Ensure that no more

than 100 sheets are being inserted into the paper tray.

3 Ensure that the paper sensor hole (A) is positioned as shown in Figure 1-4.

4 Drape the entire first sheet over the roller. Ensure that the perforated edge of the paper

aligns with the edge of the paper drawer.

5 Close the paper drawer.

6 Tear off the first sheet as shown in Figure 1-4.

PageWriter Trim Cardiograph Instructions for Use 1-11

Page 28

Getting Started Patient Interface Module (PIM)

Patient Interface Module (PIM)

The Patient Interface Module (PIM) is a hand-held device that connects to the cardiograph. The lead wires on the PIM attach to the electrodes placed on the patient. The exterior of the PIM is labeled and color-coded for quick and easy lead identification.

Figure 1-5 Patient Interface Module

A Lead Wire Labeling C Limb Lead Wires

B Patient Data Cable D Precordial (Chest) Lead Wires

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Page 29

Getting Started Patient Interface Module (PIM)

Inserting the Lead Wires into the PIM

The exterior of the PIM is color-coded for quick and easy lead identification. The lead wires that are included with the cardiograph must be inserted into the correct lead wire connector on the PIM.

Figure 1-6 PIM connector and lead wire labeling

A Lead Wire Connector C Lead Wire Labeling

B Lead Wire

To insert the lead wires into the PIM:

Locate the lead wires in the cardiograph packaging.

2 Match the lead wire to the correct lead wire connector on the PIM.

3 Insert each lead wire into the correct lead wire connector on the PIM.

4 Push down on the lead wire to ensure that there is no gap between the lead wire and the

connector.

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Page 30

Getting Started Patient Interface Module (PIM)

Connecting the PIM to the Cardiograph

Connect the patient data cable on the PIM to the PIM connector port ( ) on the rear panel of the cardiograph.

To connect the PIM to the cardiograph:

X Connect the patient data cable to the PIM connector port on the rear of the cardiograph.

WARNING To ensure safety and prevent damage to the system, only connect the patient data cable

to the PIM connector port on the rear of the cardiograph.

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Page 31

Getting Started Patient Interface Module (PIM)

Placing the PIM in the Holder

Place the PIM in the holder when not in use. The PIM holder is located on the rear of the optional cardiograph cart. Ensure that the lead wires are facing down.

Figure 1-7 Inserting the PIM into the holder

CAUTION Ensure that the PIM patient data cable and lead wires do not drag on the ground or become tangled in

the cart wheels.

PageWriter Trim Cardiograph Instructions for Use 1-15

Page 32

Getting Started Using the PC Card Slot

Using the PC Card Slot

PageWriter Trim II and III only

The PC Card slot (rear of cardiograph) is used with the optional PC Card, LAN Card, or Modem Card. All of these are optional accessories available with the cardiograph and are inserted into the PC Card slot. For information on ordering any of these accessories, see “Supplies and Ordering Information” on page 7-20.

Using the PC Card

The PC Card is an optional accessory available with the cardiograph. The PC Card contains a 128 MB removable memory card that can be used to transfer Auto reports to and from the cardiograph. For information on transferring Auto reports, “Transferring Auto Reports to a TraceMaster ECG Management System” on page 4-9.

Figure 1-8 The PC Card

A PC Card Adapter B 128 MB Removable Memory Card

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Page 33

Getting Started Using the PC Card Slot

Using the Modem Card

The modem card is an optional accessory used with the cardiograph to fax Auto reports, or to transfer Auto reports by modem to a TraceMaster ECG Management System (version A.04.02 or higher) or to a TraceMasterVue ECG Management System (version A.01 or higher). For information on ordering the modem card, “Supplies and Ordering Information” on page 7-20.

The modem card used either as a fax or as a modem must be configured before initial use with the cardiograph, see page 5-24. For information on faxing reports or transferring reports by modem, see page 4-9.

Figure 1-9 The Modem Card

Using the LAN Card

The LAN Card is used with the cardiograph to provide a network connection between the cardiograph and a network. The LAN Card must be configured before using it with the cardiograph, see page 5-27. For information on ordering the LAN card, see “Supplies and Ordering Information” on page 7-20.

CAUTION Only use the shielded LAN cable provided with the PageWriter Trim cardiograph. Do not use LAN

cables with the cardiograph that have not been approved by Philips Medical Systems.

Figure 1-10 LAN Card

PageWriter Trim Cardiograph Instructions for Use 1-17

Page 34

Getting Started Using the Barcode Reader

Inserting or Removing a PC Card

The PC Card, modem card, and LAN card are all inserted into the PC Card slot.

Figure 1-11 Removing the PC Card from the cardiograph

A PC Card eject button

To insert or remove a card from the PC Card slot:

Insert the card into the PC Card slot (rear of cardiograph) and gently push it in.

2 Push the PC Card eject button to the left of the card slot to eject the card.

3 Pull out the card.

Using the Barcode Reader

PageWriter Trim II and III only

The barcode reader is an optional accessory available with the cardiograph. The barcode reader is used to quickly enter Patient ID information by scanning a barcode.

The barcode reader attaches to the barcode reader connector ( ) on the rear panel of the cardiograph. For information on ordering the barcode reader, see “Supplies and Ordering Information” on page 7-20.

Figure 1-12 The Barcode Reader

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Page 35

Getting Started Using the Magnetic Card Reader

Using the Magnetic Card Reader

PageWriter Trim II and III only

The magnetic card reader is an optional accessory available with the cardiograph. The magnetic card reader is used to quickly enter Patient ID information. The Patient ID fields that are entered when a magnetic card is scanned are configurable, see page 5-35.

The magnetic card reader attaches to the magnetic card reader connector ( ) on the rear panel of the cardiograph. For information on ordering the magnetic card reader, see “Supplies and Ordering Information” on page 7-20.

Figure 1-13 The Magnetic Card Reader

Using the SmartCard Reader

PageWriter Trim II and III only

The SmartCard Reader is an optional accessory available with the cardiograph. The SmartCard Reader is used to quickly enter Patient ID information.

The SmartCard Reader attaches to the USB connector ( ) on the rear panel of the cardiograph. For information on ordering the SmartCard Reader, see “Supplies and Ordering Information” on page 7-20.

Figure 1-14 The SmartCard Reader

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Page 36

Getting Started Powering On the Cardiograph

Powering On the Cardiograph

Ensure that the battery is inserted into the cardiograph before turning on AC power to the cardiograph. See “Installing the Battery” on page 1-9. The cardiograph runs on battery or on AC power. The battery must be inserted into the cardiograph at all times. The cardiograph printer will not function without the battery installed.

With the battery fully charged, the cardiograph will print up to 30 Auto ECGs or provide 30 minutes of continuous Rhythm printing. The green AC indicator light shows that the battery is charging when the cardiograph is plugged into AC power. Plug the cardiograph into AC power whenever possible.

To disconnect the cardiograph from AC power, unplug the AC power cord from the grounded electrical outlet.

Check the Battery Power Indicator on the Status Bar to ensure that the battery is fully charged before operating the cardiograph on battery power only. On the PageWriter Trim I the following icon ( ) displays on the LCD display to indicate that the battery is fully charged. On the PageWriter Trim II and III the following icon ( ) displays on the Status Bar to indicate that the battery is fully charged.

For information about PageWriter Trim II and III power management options, see “Using the On/Standby Button” on page 1-21.

A On/Standby button B AC Power Indicator Light

To turn on the cardiograph:

Plug the AC power cord into the AC power connector on the rear of the cardiograph.

2 Plug the AC power cord into a grounded electrical outlet with appropriate electrical

ratings. The AC power indicator light on the front panel of the cardiograph is illuminated when the cardiograph is plugged into AC power.

3 Press the On/Standby or On button on the front of the cardiograph.

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Page 37

Getting Started Using the On/Standby Button

Using the On/Standby Button

PageWriter Trim II and III only

The On/Standby button is used to put the cardiograph into Standby and to shut off the cardiograph.

Table 1-1 Standby and Shut Down Description

Mode Description

Standby

Shut Down

 The cardiograph is in a “sleep” mode

 The display screen is black

 Patient ID information is not saved when the

cardiograph is put into Standby

 Temporary report settings are saved when the

cardiograph is put into Standby

 The battery charges when the cardiograph is

plugged into AC power

 The green Standby indicator light (front of

cardiograph) is lit

 The cardiograph returns to the previously viewed

screen when taken out of Standby

 Use between brief periods of inactivity to save

battery power

 The cardiograph is shut down

 The display screen is black

 The battery charges when the cardiograph is

plugged into AC power

 The cardiograph starts up from the reboot screen

when turned on

 Use for extended periods of cardiograph inactivity

TIP There are configurable features on the cardiograph that can be used to help prolong battery life (see

page 5-18). Proper battery care and maintenance will also help to prolong battery life (see page 7-5).

To put the cardiograph into Standby:

X Press the On/Standby button. A message appears that the cardiograph is entering Standby.

The green Standby indicator light (front of cardiograph) is lit. The battery is charging in Standby when the cardiograph is plugged into AC power.

NOTE The cardiograph cannot be put into Standby if the Patient ID screen is open or if the cardiograph is

printing a report.

PageWriter Trim Cardiograph Instructions for Use 1-21

Page 38

Getting Started Using the Trim Knob

To exit Standby:

X Press the On/Standby button. The splash screen appears. The previously viewed screen

appears.

To shut down the cardiograph:

X Press and hold the On/Standby button for 3 seconds. Release the button. A message

appears that the cardiograph is shutting down.

To turn on the cardiograph:

X Press the On/Standby button. The cardiograph displays a series of startup screens and then

the R/T (real-time) ECG screen displays.

Using the Trim Knob

All models of the PageWriter Trim cardiograph have a Trim Knob that is used to scroll through and select items on any display menu.

Figure 1-15 The Trim Knob

To use the Trim Knob:

Turn the Trim Knob left or right to scroll through the selections in a menu list.

2 Push the Trim Knob to select an item on the menu.

PageWriter Trim I Features

The PageWriter Trim I has an LCD display that shows all operating information. The buttons on the main panel of the cardiograph are used for all cardiograph functions. Simply select the buttons on the main panel to use the different functions on the cardiograph.

NOTE Complete the Interactive Training Program on CD before operating the cardiograph. The Interactive

Training program includes instructional information on what an ECG is, patient preparation techniques, how to operate the cardiograph, and quality assessment techniques to ensure high-quality ECGs. For information on using the training program, see page 1-2.

1-22 PageWriter Trim Cardiograph Instructions for Use

Page 39

Getting Started PageWriter Trim I Features

Control Panel

The control panel contains all of the main functions on the cardiograph. For more information on any feature, see “The Patient Session" on page 2-1.

Figure 1-16 PageWriter Trim I Control Panel

A On/off button D Function Buttons

B AC power on indicator light E Trim Knob

C LCD Display

PageWriter Trim Cardiograph Instructions for Use 1-23

Page 40

Getting Started PageWriter Trim I Features

LCD Display

The LCD display shows the current settings on the cardiograph.

Figure 1-17 PageWriter Trim I LCD Display

Table 1-2 PageWriter Trim I LCD Display

Label Description

 Heart Beat Detector

 For more information, see page 2-8.

 Leads Off Indicator

 For more information, see page 2-8.

 Signal Quality Indicator

 For more information, see page 2-8.

 Battery Level Indicator

 For more information, see page 1-9.

FGHI

Waveform Speed (mm/sec)

Waveform Size (mm/mV)

 Filter Settings

 For more information, see page 2-13.

 Rhythm Lead

 For more information, see page 2-27.

 Report Format

 For more information, see page 2-24.

1-24 PageWriter Trim Cardiograph Instructions for Use

Page 41

Getting Started PageWriter Trim I Features

Function Buttons

All of the functions on the PageWriter Trim I cardiograph are controlled by the function buttons located on the main panel of the cardiograph.

Figure 1-18 Function Buttons on PageWriter Trim I cardiograph

AB DCEF

Table 1-3 Function Button description

Label Button Push button to...

ID  Enter Patient ID information (age, gender).

 For more information, see page 2-18.

Auto  Take a 3x4, 1R Auto report.

 For more information, see page 2-24.

Rhythm  Print out a continuous Rhythm report (3 or 6 leads)

until the Stop button (

 For more information, see page 2-27.

F) is pressed.

Copy Print out a copy of the last recorded Auto 12-lead

report.

Page Advance the printer paper to the beginning of the next

page.

Stop  Stop the printing of a Rhythm report.

 Return to the previous screen on the LCD display.

PageWriter Trim Cardiograph Instructions for Use 1-25

Page 42

Getting Started PageWriter Trim II and III Features

PageWriter Trim II and III Features

For more information on any feature, see “The Patient Session" on page 2-1.

Figure 1-19 PageWriter Trim II and III Control Panel

Table 1-4 PageWriter Trim II and III Control Panel

Label Feature Name Description

A On/Standby

button

 Push to turn on the cardiograph or to put the

cardiograph into Standby (power save) when the cardiograph is not in use.

 Push and hold for 3 seconds, then release to shut down

the cardiograph for extended periods of inactivity.

B Standby

indicator

When lit, the cardiograph is in Standby (power save) mode and the screen is black.

C AC Power

When lit, the cardiograph is plugged into AC power.

Indicator

D Status Bar

E Waveform

 Displays current cardiograph settings including: Leads

 For more information, see page 1-27.

 Displays real-time waveforms (waveforms are color-

Display

 For more information, see page 2-10.

F Command

 Buttons contain the major functions of the

Toolbar

 For more information, see page 1-28.

1-26 PageWriter Trim Cardiograph Instructions for Use

off, battery level indicator, filters, pacing detection settings, and Patient name and ID.

coded by signal quality on the PageWriter Trim III).

cardiograph, with the current date and time at the right.

Page 43

Getting Started PageWriter Trim II and III Features

Table 1-4 PageWriter Trim II and III Control Panel (continued)

Label Feature Name Description

G ID button

 Press button to enter Patient ID information at the

beginning of a patient session.

 For more information, see page 2-19.

H Auto button

I Rhythm button

 Press button to print out an Auto 12-lead report.

 For more information, see page 2-24.

 Press button to print out a continuous Rhythm report

(up to 12 leads) until the Stop button (

 For more information, see page 2-27.

J Copy button

Press button to print out a copy of the last recorded Auto 12-lead report.

K Page button

Press button to advance the printer paper to the beginning of the next page.

L Stop button

Press button to stop the printing of a Rhythm report or any other printing function.

PageWriter Trim II and III Status Bar

L) is touched.

The Status Bar includes all current operating information for the cardiograph.

Figure 1-20 Status Bar

ADCEB

60~

0.15 - 150 Hz

ID: NAME

Table 1-5 Status Bar Description

Label Feature Name Description

A Leads Off

Indicator

B Battery Level

Indicator

C Filter Settings

 Displays the name of any loose or

disconnected leads or electrodes.

 For more information, see page 2-9.

Displays the current battery level and if the batteries are charging ( ).

 Displays the filter settings for the current

patient session.

 For more information, see page 2-11.

PageWriter Trim Cardiograph Instructions for Use 1-27

Page 44

Getting Started PageWriter Trim II and III Features

Table 1-5 Status Bar Description (continued)

Label Feature Name Description

D Pacing Detection

Settings

E Patient Name

and ID

 Displays the Pacing Detection Setting

used for the current patient session.

 For more information, see page 2-30.

Displays the patient name and ID for the current patient session.

PageWriter Trim II and III Command Toolbar

The Command Toolbar includes all of the main functions of the cardiograph. Turn the Trim Knob to highlight a button. Press the Trim Knob to select the button.

Figure 1-21 Command Toolbar

REPORT FILTER DISCLOSE ORDER ARCHIVE HELPCONFIG

Table 1-6 Command Toolbar

Button Select this Button to...

 Change Auto report settings.

 Change pacing detection settings.

REPORT

 Change the leads on a Rhythm report.

 Change the lead on a Disclose report.

 Turn on or turn off optional filters (Baseline Wander,

FILTER

DISCLOSE

ORDERS

Introduction

A patient session is the period of time when waveform data is acquired and processed from a single patient. A patient session begins by entering accurate Patient ID information. Patient ID information is linked with all waveform data acquired during the patient session.

CAUTION Enter accurate and complete Patient ID information if using the Philips 12-Lead Algorithm to

generate ECG interpretation. For more information see the Philips 12-lead Algorithm Physician’s Guide on the PageWriter Trim User Documentation CD or download the file from

www.medical.philips.com.

The steps in a typical patient session are described below.

Table 2-1 The Patient Session

The Patient Session

Prepare the Patient

Step Description More Information See...

1 Prepare the patient for the procedure. “Patient Preparation” on page 2-2.

2 Prepare the electrode sites and attach the

electrodes.

3 Attach the lead wires. “Attaching the Lead Wires” on page 2-7.

Enter Patient ID Information

Step Description More Information See...

1 Press the On/Standby button. “Using the On/Standby Button” on page 1-21.

2 Enter Patient ID information for the patient. “Entering Patient ID Information” on

Check the Signal Quality

Step Description More Information See...

1 Check the signal quality to ensure a quality

ECG.

“Preparing the Skin” on page 2-3.

page 2-17.

“Checking Signal Quality” on page 2-7.

2-1

Page 47

The Patient Session Patient Preparation

Table 2-1 The Patient Session (continued)

The Patient Session

Select an ECG Acquisition Mode

Step Description More Information See...

1 Do any of the following:

 Print an Auto 12-lead Report “Taking an Auto ECG” on page 2-24.

 Print a Rhythm report “Rhythm ECG Acquisition” on page 2-27.

PageWriter Trim II and III only:

 Print a 1-minute continuous report of one

“Disclose ECG Acquisition” on page 2-29.

selected lead

End the Patient Session

Step Description More Information See...

1 Disconnect the patient and replace the PIM in its

holder with the lead wires facing down.

The patient session ends when:

 The On/Standby button is pressed

 New Patient ID information is entered

 The patient is disconnected or leads are off for more than 10 seconds

“Inserting the PIM into the holder” on page 1-15.

Patient Preparation

For complete information on patient preparation, proper electrode placement, and other patient preparation issues see Lesson 2 of the PageWriter Trim Cardiograph Interactive Training Program on CD.

TIP Good ECG technique is very important to achieve the best quality results.

Instructing the Patient

Before attaching the electrodes, greet the patient and explain the procedure. Explaining the procedure decreases anxiety and informs the patient about what to expect.

 Privacy is important to relaxation. When possible, take the ECG in a quiet room or area

where others can’t see the patient. Draw the curtains around the bed when taking the ECG in a room with other people.

 Reassure the patient that the procedure is painless.

2-2 PageWriter Trim Cardiograph Instructions for Use

Page 48

The Patient Session Patient Preparation

 Make sure the patient is lying down and is comfortable. The patient’s arms and hands must

be relaxed. If the table is too narrow, place the patient’s hands under the buttocks to prevent muscle tension in the arms.

Once the electrodes and lead wires are attached, instruct the patient to:

 Remain still and do not talk

 Breathe normally

 Try not to shiver

 Do not chew or clench teeth

The more relaxed the patient, the less the ECG will be affected by noise.

Preparing the Skin

Thorough skin preparation is very important. The skin is a poor conductor of electricity and frequently creates artifact that distorts the ECG signal. There is a natural resistance on the skin surface due to dry, dead epidermal cells, oils, and dirt.

To prepare the skin:

Shave hair from electrode sites if necessary (excessive hair prevents a good connection).

2 Wash thoroughly with soap and water.

3 Dry the skin vigorously to increase capillary blood flow to the tissues and to remove the

dead, dry skin cells and oil.

TIP Do not use alcohol to clean the skin because it dries the skin. If there is no time to follow the

procedure above, rub the site with gauze to remove dead, dry skin and to increase capillary flow.

Attaching the Electrodes

Review the male and female electrode placement diagrams in Figures 2-1 and 2-2 to ensure proper electrode placement.

WARNING Do not use disposable electrodes on more than one patient. Using disposable electrodes on

multiple patients may cause infectious materials to be transferred between patients. Always discard disposable electrodes after patient use.

WARNING Always clean and disinfect reusable electrodes before patient use. See “Reusable Electrode

Cleaning” on page 7-2 for information on cleaning and disinfecting reusable electrodes. Failure to properly clean and disinfect reusable electrodes may cause infectious materials to be transferred between patients.

PageWriter Trim Cardiograph Instructions for Use 2-3

Page 49

The Patient Session Patient Preparation

Review the following lead wire labeling and electrode placement information to ensure a quality ECG.

Table 2-2 AAMI and IEC Lead Labeling and Electrode Placement

AAMI Lead IEC Lead Electrode Position

On the right leg (inside calf, midway between knee and ankle)

On the left leg (inside calf, midway between knee and ankle)

On the right arm (on the inside)

On the left arm (on the inside)

Right side of the sternum in the 4th intercostal space

Left side of the sternum in the 4th intercostal space

Midway between V2 and V4

Left midclavicular line in the 5th intercostal space

Anterior axillary line at the same level as V4, midway between V4 and V6

Left midaxillary line at the same level as V4

2-4 PageWriter Trim Cardiograph Instructions for Use

Page 50

The Patient Session Patient Preparation

Figure 2-1 Male 12-Lead Electrode Placement (AAMI/IEC)

V2/C2

V1/C1

RA/R

V3/C3

V4/C4

V5/C5

V6/C6

LA/L

PageWriter Trim Cardiograph Instructions for Use 2-5

LL/FRL/N

Page 51

The Patient Session Patient Preparation

Figure 2-2 Female 12-Lead Electrode Placement (AAMI/IEC)

V2/C2

V1/C1

RA/R

V3/C3

V4/C4

V5/C5

V6/C6

LA/L

RL/N

To attach the electrodes:

Expose the arms and legs of the patient (to place the limb electrodes).

2 Place the electrodes on flat, fleshy parts of the arms and legs.

3 Place the electrodes on the inside of each arm (between the wrists and elbows).

4 Place the electrodes on the inside of each calf (between the knee and the ankle).

5 Place the limb electrodes equal distance from the heart. Position the electrodes at the same

place on each limb.

2-6 PageWriter Trim Cardiograph Instructions for Use

LL/F

Page 52

The Patient Session Checking Signal Quality

6 For female patients, place the precordial electrodes on top of the breast (not underneath

the breast tissue).

7 If a limb site is not available (amputation, injury) place the electrodes closer to the torso.

8 Attach the electrodes to the skin. A good test for firm electrode contact is to try to move it.

If it moves easily, the electrode connection is too loose. Do not allow the electrodes to move in any way.

Attaching the Lead Wires

Each lead wire tip is labeled and color-coded for easy identification.

To attach the lead wires:

X Attach the lead wire to the corresponding electrode.

Checking Signal Quality

Review Lesson 4 “Quality Assessment” of the PageWriter Trim Interactive Training Program on CD for complete information on signal quality assessment techniques to use with the PageWriter Trim cardiograph. This information is essential for taking quality ECGs each and every time.

Each PageWriter Trim cardiograph has built-in signal quality indicators that provide instant signal quality feedback. Be sure to check the signal quality indicators before printing the ECG.

Using the PageWriter Trim I Signal Quality Indicators

The signal quality indicators on this cardiograph include:

 Heart beat detector

 Leads off indicator

 Signal quality indicator

Figure 2-3 PageWriter Trim I Signal Quality Indicators

AB C

A Heart Beat Detector C Signal Quality Indicator B Leads off Indicator

PageWriter Trim Cardiograph Instructions for Use 2-7

Page 53

The Patient Session Checking Signal Quality

Heart Beat Detector

The heart beat detector icon ( ) appears on the LCD display when a patient heart beat is detected by the cardiograph. If the icon does not appear on the LCD display, check that the patient data cable on the PIM is securely attached to the PIM connector on the cardiograph (see page 1-14).

Leads Off Indicator

The leads off indicator displays the name of any loose or disconnected leads or electrodes.

Table 2-3 Leads Off Indicators

Leads Off Code Indicates...

RL or N

LL or F (left leg)

RA or R (right arm)

LA or L (left arm)

V1-6 or C1-6

 The RL or N electrode or lead wire are loose or

disconnected

 RL or N is the only lead wire or electrode

connected

 All 12 leads or electrodes are loose or

disconnected

 Two limb leads (I, II, III) are loose or

disconnected

 LL or F electrode or lead wire are loose or

disconnected

 RA or R electrode or lead wire are loose or

disconnected

 LA or L electrode or lead wire are loose or

disconnected

 One or more chest electrodes or lead wires are

loose or disconnected

 V13 or C13 indicates that electrodes or lead

wires V1and V3 or C1and C3 are loose

Signal Quality Indicator

This feature displays the overall signal quality for all leads and electrodes. This indicator provides information on the amount of overall noise in the patient signal.

Table 2-4 Signal Quality Indicator

Symbol Indicates...

No symbol

2-8 PageWriter Trim Cardiograph Instructions for Use

A good connection

Slight noise or interference in signal

Moderate noise or interference in signal

Page 54

The Patient Session Checking Signal Quality

Table 2-4 Signal Quality Indicator (continued)

Symbol Indicates...

****

 Extreme noise or interference

 Lead wires or electrodes are disconnected

Troubleshooting Signal Quality

For information on troubleshooting signal quality see:

 “Using Filters” on page 2-11

 Table 6-8 on page 6-10

 Lesson 4 of the PageWriter Trim Interactive Training Program on CD

Using the PageWriter Trim II and III Signal Quality Indicators

The signal quality indicators on the PageWriter Trim II and III cardiographs include:

 Leads off indicator

 Color-coded waveforms (PageWriter Trim III only)

 Preview screen

Using the Leads off indicator

The leads off indicator is located on the Status Bar.

Figure 2-4 Leads off Indicator on Status Bar

A Leads off indicator

60~

0.15 - 150 Hz

ID: NAME:

PageWriter Trim Cardiograph Instructions for Use 2-9

Page 55

The Patient Session Checking Signal Quality

The leads off indicator displays the name of any loose or disconnected leads or electrodes.

Table 2-5 Leads Off Indicators

Leads Off Code Indicates...

RL or N

LL or F (left leg)

RA or R (right arm)

LA or L (left arm)

V1-6 or C1-6

 The RL or N electrode or lead wire are loose or

disconnected

 RL or N is the only lead wire or electrode

connected

 All 12 leads or electrodes are loose or

disconnected

 Two limb leads (I, II, III) are loose or

disconnected

 LL or F electrode or lead wire are loose or

disconnected

 RA or R electrode or lead wire are loose or

disconnected

 LA or L electrode or lead wire are loose or

disconnected

 One or more chest electrodes or lead wires are

loose or disconnected

 V13 or C13 indicates that electrodes or lead

wires V1and V3 or C1and C3 are loose

Color-coded waveforms

PageWriter Trim III only

When the lead wires are attached to the patient, color-coded waveforms appear on the main R/T (real-time) ECG screen. The color of the waveform indicates the ECG signal quality.

Table 2-6 Color-coded Waveform Quality Indicators

Waveform Color Indicates... Possible Causes

Green waveform

Yellow waveform

2-10 PageWriter Trim Cardiograph Instructions for Use

 Good connection

 Moderate noise level, artifact,

electrical interference, or a poor electrode connection

 12-lead report quality will be

affected

 Inadequate patient

preparation

 Electrical interference

from another device

 Moderate patient

movement, tense patient

 Improperly gelled

electrode (dried gel)

Page 56

The Patient Session Using Filters

Table 2-6 Color-coded Waveform Quality Indicators (continued)

Waveform Color Indicates... Possible Causes

Orange Waveform

 Severe noise, artifact, electrical

interference, or a very poor electrode connection

 12-lead report quality will be

significantly affected

Red dotted line

 Loose electrode connection

 ECG waveform data that cannot

be analyzed

Troubleshooting Signal Quality

 Inadequate patient

preparation

 Significant electrical

interference from another device

 Severe patient

movement

 Very poorly gelled

electrode (dried gel)

 Inoperative electrode,

electrode that has fallen off the patient

 Defibrillation has been

performed too recently to take ECG measurements

 Other cause that renders

waveform data useless

For information on troubleshooting signal quality see:

 “Using Filters” on page 2-11

 Table 6-8 on page 6-10

 Lesson 4 of the PageWriter Trim Interactive Training Program on CD

Using Filters

Filters are configurable on all models of the PageWriter Trim cardiograph. Filters can be used when all other troubleshooting methods to reduce signal quality problems fail. Before using filters:

 Check patient and skin preparation techniques

 Ensure that the patient is comfortable, lying still, and breathing normally

 Check that the electrodes are correctly placed on the patient and are adhering to the skin

 Check if any surrounding devices are causing electrical interference. Switch any

surrounding devices to battery power.

Filters should be applied only after all other potential causes of interference do not resolve a signal quality problem. The filter settings are displayed on the cardiograph and are also printed on the bottom of the report inside the Filter Box.

PageWriter Trim Cardiograph Instructions for Use 2-11

Page 57

The Patient Session Using Filters

Figure 2-5 The Filter Box on the 12-lead Report

A Filter Box

Table 2-7 Filter Symbols

Filter symbol Description

60 ~

0.05

150

Artifact Filter

AC Filter

High Pass Frequency Filter

Low Pass Filter Setting

Artifact Filter

The Artifact filter removes skeletal muscle artifact. This noise source is the most difficult to eliminate because it has the same frequencies as ECG signals. The Artifact filter eliminates skeletal muscle artifact, but also reduces all high frequency components of the ECG.

Figure 2-6 Artifact Filter Symbol

Baseline Wander Filter

Baseline wander is the slow drifting of the ECG baseline up or down during ECG recording. Baseline wander may result from patient respiration or from other sources.

NOTE With the Baseline Wander filter turned on, the High Pass Frequency Filter automatically sets to 0.5.

2-12 PageWriter Trim Cardiograph Instructions for Use

Page 58

The Patient Session Using Filters

Figure 2-7 Baseline Wander Filter Symbol on the 12-lead Report

Frequency Response Filters

These filters suppress frequencies at the high and low ends of the ECG signal spectrum. The available low frequency response filter settings are 40, 100, and 150 Hz. Changing the low frequency filter to 40 or 100 Hz results in a smoother-looking ECG waveform while eliminating some fine detail in the signal. Small deflections, notches, and slurs may be distorted or may disappear if one of these filters is applied.

About High and Low Pass Frequency Filter Settings

 The 0.5 Hz High Pass frequency filter setting provides the highest level of baseline

wander suppression

 The 0.15 Hz High Pass frequency filter setting provides a moderate amount of baseline

wander suppression (suitable for most ECGs) without distorting the ST segment

 The 0.05 Hz High Pass frequency filter setting provides the highest fidelity signal with the

least amount of baseline wander suppression

 The 40 Hz Low Pass frequency filter setting provides the maximum amount of noise

suppression at low fidelity

 The 100 Hz Low Pass frequency filter setting provides a moderate amount of noise

suppression while providing accurate waveform representation

 The 150 Hz Low Pass frequency filter setting provides the highest fidelity with a minimal

amount of high-frequency noise suppression

Changing Filter Settings on the PageWriter Trim I

The following filters are available on the PageWriter Trim I cardiograph:

 AC

 Artifact

 High and Low Pass Frequency

All filter settings used in a patient session are shown on the LCD display.

PageWriter Trim Cardiograph Instructions for Use 2-13

Page 59

The Patient Session Using Filters

Figure 2-8 Filter settings on the LCD Display

A Filter settings

Table 2-8 Filter symbols on the LCD Display

Filter symbol Description

0.05

150

To change the AC filter setting:

Turn the Trim Knob until the ~ symbol is highlighted.

2 Press the Trim Knob. A new screen appears with the current AC filter setting (50Hz,

60Hz, 0) highlighted.

3 Push the Trim Knob to change the setting.

NOTE Press the Stop button on the Control Panel to exit the screen without changing the AC filter setting.

4 Turn the Trim Knob to scroll through the available settings.

NOTE Selecting 0 turns off the AC filter.

5 Press the Trim Knob to select the setting.

6 Turn the Trim Knob to highlight the arrow .

7 Press the Trim Knob to save the setting and to exit the screen. The new setting is applied.

Artifact Filter

AC Filter

High Pass Frequency Filter

Low Pass Filter Setting

To change other filter settings:

Turn the Trim Knob until the filter setting to be changed is highlighted.

2 Push the Trim Knob.

3 Turn the Trim Knob to scroll through the available filter settings.

4 Push the Trim Knob to select a setting.

5 Turn the Trim Knob to change additional filter settings.

NOTE The Artifact filter (F) may be turned on or turned off. No symbol appears on the LCD display when

the Artifact filter is turned off.

2-14 PageWriter Trim Cardiograph Instructions for Use

Page 60

The Patient Session Using Filters

NOTE When the High Pass Frequency Filter is set to 0.5 the Baseline Wander filter (W) is automatically

turned on.

Changing Filter Settings on the PageWriter Trim II and III

The following filters are available on the PageWriter Trim II and III cardiographs:

 AC

 Artifact

 Baseline Wander

 High and Low Pass Frequency

All filter settings used in a patient session are shown on the Status Bar.

Figure 2-9 Filter settings on the Status Bar

RL F W 60~

0.15 - 150 Hz

ID: NAME:

A Filter settings

Table 2-9 Filter symbols on the Status Bar

Filter symbol Description

60~

0.15

150

Artifact Filter

Baseline Wander Filter

AC Filter

High Pass Frequency Filter

Low Pass Filter Setting

There are two sets of configured filters available on the PageWriter Trim II and III cardiographs:

Main Settings and Rhythm Settings. These filters are applied to both the

printed report and to the real-time waveforms that display on the R/T ECG screen. These filter settings may only be changed in Configuration (see page 5-21).

PageWriter Trim Cardiograph Instructions for Use 2-15

Page 61

The Patient Session Using Filters

The table below describes these filter settings.

Table 2-10 Filter Settings

Filter Setting Description

Main Settings

Rhythm Settings

 These filter settings are applied to all Auto and

Disclose Reports

 These filter settings may only be changed in

Configuration

 These filter settings include: High and Low

Pass Frequency, Artifact, and Baseline Wander

 The Artifact and Baseline Wander filters may

be turned on or turned off for individual patient sessions; the High and Low Pass Frequency filters are turned on for all patient sessions

 These filter settings can be applied to the real-

time waveform display on the R/T ECG screen

 These filter settings are used for all Rhythm

reports

 These filter settings may only be changed in

Configuration

 These filter settings include Artifact, and High

and Low Pass Frequency

 The Artifact filter may be turned on or turned

off for individual patient sessions

 These filter settings may be applied to the real-

time waveform display on the R/T ECG screen

The AC filter may be configured to be turned on or turned off for all patient sessions. The AC frequency Hertz is also set in Configuration (see page 5-21).

Artifact and Baseline Wander Filters

During a patient session, the Artifact and Baseline Wander filters (if configured) may be turned on or turned off.

To turn on or to turn off the artifact or baseline wander filter:

FILTER

NOTE Press the Esc key on keyboard to exit the Filter window without changing filter settings.

Turn the Trim Knob to highlight the Filter button on the Command Toolbar.

2 Push the Trim Knob. The Filter window appears.

Turn the Trim Knob to highlight the Filter On text under Report Filter.

2-16 PageWriter Trim Cardiograph Instructions for Use

Page 62

The Patient Session Entering Patient ID Information

4 Push the Trim Knob to select the setting. When the check box is selected, the Artifact and

Baseline Wander filters are enabled. Clear the check box to turn off the Artifact and Baseline Wander filters.

5 Press the Enter key on keyboard to save the filter settings and to exit the window.

The new filter settings are applied. The Artifact Filter (

F) or Baseline Wander (W) symbol

appear on the Status Bar.

NOTE When the High Pass Frequency Filter is set to 0.5 the Baseline Wander filter (W) is automatically

turned on.

Display Filter Settings

The Display Filter settings are applied to the real-time waveforms that appear on the R/T ECG screen. The Main Settings or Rhythm Settings may be applied to the waveforms on the R/T ECG screen.

The Display Filter settings do not affect printed reports. The configured Main Settings are applied to printed Auto reports, and the configured Rhythm Settings are applied to printed Rhythm reports.

To change the display filter settings:

Turn the Trim Knob to highlight the Filter button on the Command Toolbar.

FILTER

NOTE Press the Esc key on keyboard to exit the Filter window without changing filter settings.

2 Push the Trim Knob. The Filter window appears.

3 Turn the Trim Knob to highlight Main Settings or Rhythm Settings under Display Filter.

4 Push the Trim Knob to select the setting.

5 Press the Enter key on keyboard to save the filter settings and to exit the window.

The new filter settings are applied to the real-time waveforms on the R/T ECG screen and appear on the Status Bar.

NOTE The Rhythm Settings Low Pass Frequency filter setting will not appear on the R/T ECG screen. The

Main Settings Low Pass Frequency setting will be applied.

NOTE When the High Pass Frequency Filter is set to 0.5 the Baseline Wander filter (W) is automatically

turned on.

Entering Patient ID Information

Patient ID information is very important and must be entered for each patient session.

CAUTION Enter accurate and complete Patient ID information if using the Philips 12-Lead Algorithm to

generate ECG interpretation. For more information see the Philips 12-lead Algorithm Physician’s Guide on the PageWriter Trim User Documentation CD or download the file from

www.medical.philips.com.

PageWriter Trim Cardiograph Instructions for Use 2-17

Page 63

The Patient Session Entering Patient ID Information

Entering Patient ID Information on the PageWriter Trim I

The PageWriter Trim I requires that Patient ID information be entered before printing an Auto report.

The following Patient ID information is entered on the PageWriter Trim I:

 patient age

 patient gender

Patient age may be entered in either adult and pediatric units.

To enter Patient ID information:

Press the ID button on the Control Panel. The Patient ID entry screen appears.

2 The default age of 50 (years) is highlighted. Push the Trim Knob to change the patient age.

3 Turn the Trim Knob to highlight an age.

4 Push the Trim Knob to select the age.

5 Turn the Trim Knob to highlight the age unit, if necessary. The following age units are

available.

Table 2-11 PageWriter Trim I Age Units

Age Unit Description

6 Push the Trim Knob to select an age unit.

7 Turn the Trim Knob to highlight a patient gender icon ( female or male).

8 Push the Trim Knob to select the patient gender.

9 Turn the Trim Knob to highlight the arrow .

NOTE Push the Stop button on the Control Panel to exit the Patient ID screen without saving the settings.

Push the Trim Knob to save the Patient ID settings and to exit the screen.

Ye ar s

Months

Weeks

Days

Hours

2-18 PageWriter Trim Cardiograph Instructions for Use

Page 64

The Patient Session Entering Patient ID Information on the PageWriter Trim II and III

Entering Patient ID Information on the PageWriter Trim II and III

Patient ID information is very important and must be entered for each patient session.

CAUTION Enter accurate and complete Patient ID information if using the Philips 12-Lead Algorithm to

generate ECG interpretation on the PageWriter Trim III. For more information see the Philips 12-lead Algorithm Physician’s Guide on the PageWriter Trim User Documentation CD or

download the file from www.medical.philips.com.

The amount and type of Patient ID information that is entered on the cardiograph is configurable (see page 5-4). There are three main types of Patient ID information: patient information, clinical information, and order information. Patient ID information that is required to be complete before an Auto report can be transferred to a TraceMaster or TraceMasterVue ECG Management System is also configurable (see page 5-4).

Patient ID information is entered by:

 Keyboard

 Selecting a Pending Order

 Barcode reader (optional)

 Magnetic card reader (optional)

 SmartCard reader (optional)

Entering Patient ID Information with the Keyboard

To enter Patient ID information with the keyboard:

Press the ID button on the right side of the cardiograph. The Patient ID screen appears

with the Patient Info. tab (top of screen) selected.

2 The ID field is selected. Enter the Patient ID number.

3 Turn the Trim Knob to select the next field on the screen. Enter the information.

4 For Gender, turn the Trim Knob to highlight the text. Push the Trim Knob to select the

patient gender.

5 If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold

down the Alt key on the keyboard.

6 Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab,

press and hold down the Alt key, and then press the C key on the keyboard.

7 Continue to enter information on the screen.

8 When all Patient ID information has been entered, press the Enter key on the keyboard to

save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.

PageWriter Trim Cardiograph Instructions for Use 2-19

Page 65

The Patient Session Entering Patient ID Information on the PageWriter Trim II and III

NOTE A message appears if the Patient ID screen is exited before completing the required Patient ID

information.

Opening a Pending Order

Pending Orders consist of pre-loaded Patient ID information. This information is entered on the Orders screen using the cardiograph keyboard. Once entered onto the cardiograph, these

ORDERS

NOTE The Orders button only appears on the Patient ID screen when there are Pending Orders loaded on

Pending Orders may be selected on the Patient ID screen.

For more information on using the Orders screen, see page 4-2.

To open a Pending Order:

Press the ID button on the right side of the cardiograph. The Patient ID screen appears.

2 Turn the Trim Knob to highlight the Orders button (top left of screen).

3 Push the Trim Knob to select the button. The Select Pending Order window appears.

the cardiograph.

The available Pending Orders appear on the screen as a list. Turn the Trim Knob to highlight the

Left, Right, Up, or Down buttons at the bottom of the screen.

5 Push the Trim Knob to select one of these buttons in order to navigate left, right, up, or

down through the Pending Orders list. The highlighted Pending Order appears in gray.

6 Turn the Trim Knob to highlight the Select button.

7 Push the Trim Knob to select the highlighted Pending Order. A selected Pending Order is

deleted from the Pending Order list. The Pending Order window closes and the Patient ID screen appears. The information from this Pending Order will be loaded on the Patient ID screen.

8 Enter any missing Patient ID information with the keyboard. Turn the Trim Knob move

between the different fields.

9 If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold

down the Alt key on the keyboard.

10 Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab,

press and hold down the Alt key, and then press the C key on the keyboard.

11 When all Patient ID information has been entered, press the Enter key on the keyboard to

save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.

NOTE A message appears if the Patient ID screen is exited before completing the required Patient ID

information.

2-20 PageWriter Trim Cardiograph Instructions for Use

Page 66

The Patient Session Entering Patient ID Information on the PageWriter Trim II and III

Entering Patient ID Information with the Barcode Reader

The barcode reader is an optional cardiograph feature available for purchase (see page 1-18). The barcode reader is used to automatically enter Patient ID information on the Patient ID screen by scanning a barcode. The barcode reader is shipped preconfigured for use with the PageWriter Trim cardiograph.

Attach the barcode reader to the barcode connector port ( ) on the rear of the cardiograph (see page 1-18).

To enter Patient ID information with the barcode reader:

Press the ID button on the right side of the cardiograph. The Patient ID screen appears.

The ID field is highlighted.

2 Hold the barcode reader at a 45

the information and it appears in the press the button on the top of the scanner.

NOTE The barcode reader will only operate when held at a 45o angle.

3 Turn the Trim Knob to highlight the next Patient ID field.

4 Hold the barcode reader at a 45

The information appears in the field.

angle over the barcode. The barcode automatically scans

ID field. If the barcode does not automatically scan,

angle over the barcode. The barcode automatically scans.

5 Enter any missing information with the keyboard.

6 If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold

down the Alt key on the keyboard.

7 Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab,

press and hold down the Alt key and then press the C key on the keyboard.

8 When all Patient ID information has been entered, press the Enter key on the keyboard to

save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.

NOTE A message appears if the Patient ID screen is exited before completing the required Patient ID

information.

Entering Patient ID Information with the Magnetic Card Reader

The magnetic card reader is an optional cardiograph feature that is available for purchase (see page 1-19). The magnetic card reader is used to automatically enter up to four fields of Patient ID information by scanning a magnetic card. The four fields that are entered onto the Patient ID screen are configurable (see page 5-31).

Attach the magnetic card reader to the magnetic card reader port ( ) on the rear of the cardiograph (see page 1-19).

To enter Patient ID information with the magnetic card reader:

Press the ID button on the right side of the cardiograph. The Patient ID screen appears.

2 Turn the Trim Knob to highlight the MagCard button (top left of screen).

PageWriter Trim Cardiograph Instructions for Use 2-21

Page 67

The Patient Session Entering Patient ID Information on the PageWriter Trim II and III

3 Push the Trim Knob to select the button. The Magnetic Card Reader window appears.

4 Insert the magnetic card all the way into the slot. Leave the card in the slot for five seconds

before removing it. The scanned information appears on the screen.

5 The OK button (bottom of window) is highlighted. Push the Trim Knob to save the

displayed Patient ID information and close the window. Turn the Trim Knob to highlight the Cancel button if the Patient ID information did not scan correctly. Push the Trim Knob to close the window. Repeat steps 2 through 5.

6 Enter any missing information with the keyboard.

7 If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold

down the Alt key on the keyboard.

8 Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab,

press and hold down the Alt key and then press the C key on the keyboard.

9 When all Patient ID information has been entered, press the Enter key on the keyboard to

save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.

NOTE A message appears if the Patient ID screen is exited before completing the required Patient ID

information.

Entering Patient ID Information with the SmartCard Reader

The SmartCard reader is an optional cardiograph feature that is available for purchase (see page 1-19). The SmartCard reader is used to automatically enter up to two fields of Patient ID information (ID number and patient name) by scanning a SmartCard.

Attach the SmartCard reader to the USB connector ( ) on the rear of the cardiograph (see page 1-19).

To enter Patient ID information with the SmartCard reader:

Press the ID button on the right side of the cardiograph. The Patient ID screen appears.

2 Turn the Trim Knob to highlight the Smart Card button (top left of screen).

3 Push the Trim Knob to select the button. The Smart Card Reader window appears.

4 Insert the SmartCard all the way into the slot. The scanned information appears on the

screen in the

5 The OK button (bottom of window) is highlighted. Push the Trim Knob to save the

displayed Patient ID information and to close the window. Turn the Trim Knob to highlight the Trim Knob to close the window. Repeat steps 2 through 5.

ID: and Name: fields.

Cancel button if the Patient ID information did not scan correctly. Push the

6 Enter any missing information with the keyboard.

7 If other tabs appear at the top of the screen (Clinical Info, Order Info), press and hold

down the Alt key on the keyboard.

2-22 PageWriter Trim Cardiograph Instructions for Use

Page 68

The Patient Session Emergency (STAT) ECGs

8 Press the letter key in parenthesis on the tab. For example, to select the Clinical Info tab,

press and hold down the Alt key and then press the C key on the keyboard.

9 When all Patient ID information has been entered, press the Enter key on the keyboard to

save the information and to exit the screen. Press the Esc key on the keyboard to exit the screen without saving the Patient ID information.

NOTE A message appears if the Patient ID screen is exited before completing the required Patient ID

information.

Editing Patient ID Information

Patient ID information may be edited at any time during the patient session, or may be edited after the patient session ends by editing the saved ECG in the Archive. The Archive provides temporary storage for ECGs until they are transferred to an external ECG Management System. For more information on editing Patient ID information in the Archive, see page 4-13. On the PageWriter Trim III, a message appears if changes made to Patient ID information could affect ECG interpretation.

Changes to Patient ID information are applied to all reports taken during the current patient session.

NOTE The magnetic card reader or Pending Orders cannot be used to edit existing Patient ID

information.These buttons will not appear on the top of the Patient ID screen when editing existing Patient ID information.

To edit Patient ID information during the patient session:

Press the ID button on the right side of the cardiograph.

2 The message Is this a New Patient? appears. Turn the Trim Knob to highlight the No

button.

3 Push the Trim Knob to select the button. The Patient ID screen appears.

4 Edit the Patient ID information.

5 Press the Enter key on keyboard to save the edits. Press the Esc key on keyboard to exit

the screen without saving the edits.

Emergency (STAT) ECGs

PageWriter Trim II and III only

Patient ID information does not have to be entered in an emergency situation in order to take an Auto report. An emergency or STAT ECG can include a configurable STAT designation on the printed report (see page 3-10). A STAT pull-down list may be configured to appear on the Patient ID screen under the Configuration (see page 5-10).

Order Info. tab. The STAT pull-down list is enabled in

Complete all Patient ID information after the emergency ECG is taken, but before the patient session ends. All required Patient ID information must be complete in order to transfer an Auto report to a TraceMaster or TraceMasterVue ECG Management System (see page 4-9).

PageWriter Trim Cardiograph Instructions for Use 2-23

Page 69

The Patient Session Taking an Auto ECG

To take an emergency ECG:

Press the Auto button on the right side of the cardiograph. A message appears that Patient

ID is missing required fields

2 Turn the Trim Knob to highlight the Cancel button.

3 Push the Trim Knob to select the button.

4 The Auto report prints (if configured) and appears on the Preview screen. Check the

quality of the Auto report. If the quality is good, press the Enter key (on keyboard) to print the report. Press the Copy button to print out a copy of the Auto report. Press the Esc key (on keyboard) to exit the Preview screen without printing the report.

5 Press the Auto button again at any time to take another ECG.

NOTE On the PageWriter Trim III, if no Patient ID information is entered a statement is included on the

Auto report that interpretation used a default age (50 years) and gender (male). The default age for interpretation is configurable (see page 5-5).

NOTE Patient ID information is required to transmit an Auto report from the Archive to an ECG

Management System (see page 4-9).

Taking an Auto ECG

The Auto feature is used to quickly print a 12-lead Report. The Auto report captures the most recent 10-seconds of waveform data. Follow the procedures below to take an Auto report.

Taking an Auto ECG with the PageWriter Trim I

The Auto 12-lead report format available on the PageWriter Trim I is the 3x4, 1R report. The Rhythm lead may be changed.

To change the Rhythm lead:

Ensure that the 3x4 1R report is selected in the Format field. If the report is not selected,

turn the Trim Knob to highlight the displayed report format. Push the Trim Knob. Turn the Trim Knob to highlight the 3x4 1R report. Push the Trim Knob to select the report format.

2 Turn the Trim Knob to highlight the Rhythm lead selected in the Leads field.

3 Push the Trim Knob.

4 Turn the Trim Knob to highlight the Rhythm lead to be selected for the report.

5 Push the Trim Knob to select the Rhythm lead.

To take an Auto report:

Press the Auto button on the Control Panel. The Patient ID entry screen appears.

2 Follow the procedure to enter Patient ID information, see page 2-18.

The Auto report progress bar appears ( ) on the LCD display under Auto report prints.

2-24 PageWriter Trim Cardiograph Instructions for Use

Leads-off. The

Page 70

The Patient Session Taking an Auto ECG

Taking an Auto ECG with the PageWriter Trim II and III

The Auto report captures the most recent 10-seconds of waveform data. When the Auto button is pressed, the Auto report appears on the Preview screen. Auto reports can be configured to be automatically saved to the Archive (see page 5-18).

The Preview Screen

The Preview screen displays the waveforms of the Auto report exactly as they appear when printed. The waveforms on the Preview screen can be checked for normal quality indicators to ensure a quality ECG.

CAUTION Only the waveforms shown on the report preview are an accurate representation of what is printed

on the report. Interpretation, Patient ID, or other information may appear truncated or not appear at all on the report preview, but will appear on the printed report.

For information on ECG quality indicators, see Lesson 4 of the PageWriter Trim Interactive Training Program on CD.

TIP Reviewing Auto reports on the Preview screen before printing saves printer paper and ensures a

quality report.

REPORT

To take an Auto ECG:

On the R/T ECG screen, press the Auto button on the right side of the cardiograph. The

Auto report displays on the Preview screen and prints (if configured).

2 Review the quality of the Auto report on the Preview screen. If the report quality is good,

press the Enter key (on keyboard) to print the report. If the report quality is poor, press the Esc key (on keyboard) to exit the Preview screen and not print the report.

3 Press the Copy button to print out a report copy.

Changing Auto Report Settings

The Auto report settings may be changed at any time during a patient session. To review printed examples of the available Auto report formats, see page 3-18.

To change Auto report settings:

Turn the Trim Knob to highlight Report button on the Command Toolbar.

2 Push the Trim Knob to display the Report settings window.

Auto tab (top of screen) is selected and the current Auto report settings are displayed

The on the screen.

3 The Format: drop-down list is highlighted.

4 Push the Trim Knob to display the drop-down list of available Auto report formats.

NOTE The Pan-12 report format prints with Cabrera lead sequence and Time-Sequential acquisition. For

more information, see page 3-24.

NOTE The 12x1 report format prints with Simultaneous acquisition. For more information, see page 3-22.

PageWriter Trim Cardiograph Instructions for Use 2-25

Page 71

The Patient Session Taking an Auto ECG

5 Turn the Trim Knob to highlight an Auto report format.

6 Push the Trim Knob to select an Auto report format.

7 Continue to select Auto report settings by following the same procedure.

NOTE The Size (VLeads) selection sets the precordial leads to full or half the scale of the limb and

augmented leads, see page 3-11.

For information on Pacer Detect settings, see page 2-30.

8 To save the new Auto report settings, press the Enter key on the keyboard. To exit the

Auto report settings screen without saving the new settings, press the Esc key on the keyboard.

Using the Metronome with Auto ECG

PageWriter Trim II and III only

The cardiograph can be configured to automatically display the Metronome each time the

Auto button is pressed (see page 5-31). A typical use of the Metronome is during a Masters’

Two-Step stress test: the patient exercises at a rate indicated by the metronome chime, and the cardiograph records an Auto report after the exercise session is complete.

The Metronome feature must be enabled in Configuration before using it with the Auto ECG feature. The procedure below is a recommend example of how to use the Metronome.

To use the Metronome feature:

Prepare the patient for the procedure.

2 Press the ID button on the right side of the cardiograph and enter the Patient ID

information (see page 2-19).

3 Press the Auto button on the right side of the cardiograph. The Metronome window

appears.

The default Metronome settings appear on the screen. The displayed settings may be changed.

4 The Number of Steps field is highlighted. Type in the number of steps (16-70) that the

patient will complete during the test.

5 Turn the Trim Knob to select a setting under Stress Test Protocol. Highlight the Master

Single

(90 seconds) or Master Double (180 seconds) test.

6 Push the Trim Knob to select a test setting.

7 Turn the Trim Knob to highlight the Start button.

8 When the patient is ready, press the Trim Knob to start the Metronome.

The Metronome “beeps” and the icon moves to indicate each time that the patient should take a step. The Metronome window displays the number of steps completed.

A long “beep” indicates that the metronome cycle is complete. The message

Test Completed

appears at the top of the Metronome window.

Timed ECG

2-26 PageWriter Trim Cardiograph Instructions for Use

Page 72

The Patient Session Rhythm ECG Acquisition

9 To adjust the volume of the Metronome, turn the Trim Knob to highlight the << or >>

buttons. Push the Trim Knob to lower or to raise the volume.

10 Connect the electrodes on the patient to the lead wires. Ensure that the lead wires are

securely attached.

11 Turn the Trim Knob to highlight Cancel button.

12 Push the Trim Knob to close the Metronome window.

The R/T ECG screen appears. The Auto ECG is acquired and appears on the Preview screen.

13 Review the quality of the Auto report on the Preview screen. If the report quality is good,

press the Enter key (on keyboard) to print the report. If the report quality is poor, press the Esc key (on keyboard) to exit the Preview screen and not print the report. Press the Copy button to print out a report copy.

Rhythm ECG Acquisition

Rhythm ECG acquisition is used to print continuous rhythm strips until the Stop button is pressed. Rhythm reports are not saved and are not interpreted (see page 3-25).

Taking a Rhythm Report on the PageWriter Trim I

Rhythm reports may be printed with three or six preconfigured lead groups.

To select Rhythm report format and leads:

Turn the Trim Knob to highlight the displayed report format above Format (on the LCD

display).

2 Push the Trim Knob to display the available report formats.

3 Turn the Trim Knob to highlight 3 (three lead) or 6 (six lead) Rhythm report.

4 Push the Trim Knob to select the Rhythm report format.

5 Turn the Trim Knob to highlight the displayed Rhythm leads above Leads.

6 Push the Trim Knob to display the available preconfigured Rhythm lead groups.

Table 2-12 Preconfigured Rhythm Lead Selections

Rhythm report Lead selections

3 lead report  II-aVF-V2 (C2)

 I-II-III

 aVR-L-F (aVR, aVL, aVF)

6 lead report

PageWriter Trim Cardiograph Instructions for Use 2-27

 V1-V6 (C1-C6)

 I-aVF (I, II, III, aVR, aVL, aVF)

Page 73

The Patient Session Rhythm ECG Acquisition

7 Turn the Trim Knob to highlight a Rhythm lead group.

8 Push the Trim Knob to select the Rhythm lead group.

To record a Rhythm ECG:

Press the Rhythm button on the Control Panel.

2 The Patient ID entry screen appears. Enter the Patient ID information for the patient (see

page 2-19).

The Rhythm report progress bar appears ( ) on the LCD display under

Leads-off.

The Rhythm report prints.

3 Press the Stop button on the Control Panel to stop printing the Rhythm report.

4 Press the Page button on the Control Panel to advance the paper to the top of the next

page.

Taking a Rhythm Report on the PageWriter Trim II and III

Rhythm reports may be printed with up to 12 selected leads. The leads that appear on the Rhythm report may be individually selected, and the size and speed of waveforms appearing on the report may also be selected.

REPORT

To select Rhythm report leads:

Turn the Trim Knob to highlight Report button on the Command Toolbar.

2 Push the Trim Knob to display the Report settings window. Three tabs appear at the top of

the screen.

3 To select the Rhythm tab, press and hold down the Alt key on the keyboard.

4 Press the R key. The Rhythm screen appears.

5 Turn the Trim Knob to highlight the Lead Groups button to select a preconfigured group

of three or six leads.

6 Push the Trim Knob to display the lead group list.

7 Turn the Trim Knob to scroll through the list.

8 Push the Trim Knob to select a lead group. The selected leads appear on the screen under

Lead Groups button.

the

9 To select leads individually, turn the Trim Knob until the I lead on the lead list is

highlighted.

10 Push the Trim Knob to select the individual lead. The check box for that lead is selected.

11 Continue to select leads individually, or turn the Trim Knob to highlight the Select All

check box. Push the Trim Knob to select all twelve leads.

To set the size and speed of waveforms:

On the Rhythm settings screen, turn the Trim Knob to highlight the drop-down list under

Speed.

2 Push the Trim Knob to display the drop-down list.

2-28 PageWriter Trim Cardiograph Instructions for Use

Page 74

The Patient Session Disclose ECG Acquisition

3 Turn the Trim Knob to highlight a speed setting.

4 Push the Trim Knob to select the speed setting.

5 Follow the same procedure to set the Size (mm/mV) and Size (V Leads) settings.

NOTE Size (V leads) sets the precordial leads to full or half the scale of the limb and augmented leads.

6 Press the Enter key on keyboard to save the Rhythm lead settings and exit the screen.

Press the Esc key to exit the screen without saving the settings.

To record a Rhythm ECG:

Press the ID button to enter the Patient ID information for the patient.

2 Press the Rhythm button on the right side of the cardiograph.

Printing Rhythm Report progress window appears. The Rhythm report prints.

The

3 Press the Stop button on the right side of the cardiograph to stop printing the Rhythm

report.

4 Press the Page button on the right side of the cardiograph to advance the paper to the top

of the next page.

Disclose ECG Acquisition

PageWriter Trim II and III only

Disclose ECG acquisition prints a continuous 1-minute report of one selected lead. Disclose reports are not saved to the Archive and are not interpreted, see page 3-28.

To change the Disclose lead:

REPORT

DISCLOSE

Turn the Trim Knob to highlight Report button on the Command Toolbar.

2 Push the Trim Knob to select the button. The Report settings window appears.

Three tabs appear at the top of the screen.

3 To select the Disclose tab, press and hold down the Alt key on the keyboard.

4 Press the D key. The Disclose screen appears.

5 The Lead drop-down list is highlighted. Press the Trim Knob to display the drop-down

list.

6 Turn the Trim Knob to highlight a lead.

7 Press the Trim Knob to select the lead for the Disclose report.

To print a Disclose report:

Turn the Trim Knob to highlight the Disclose button on the Command Toolbar.

2 Push the Trim Knob to select the button.

3 The Printing Disclose Report progress window appears. The Disclose report prints.

PageWriter Trim Cardiograph Instructions for Use 2-29

Page 75

The Patient Session Pacing Detection Settings

Pacing Detection Settings

PageWriter Trim II and III only

The Pacing Detection Settings are found on the Status Bar and may be changed for an individual patient session. The default Pacing Detection Setting is set in Configuration (see page 5-2).

Figure 2-10 Pacing Detection Setting on the Status Bar

RL 60~

0.15 - 150 Hz

P? ID:

NAME:

A Pacing Detection Setting

Pacemaker pulses that are detected by the cardiograph are marked on the Auto report with small vertical tick marks. These marks enable the overreader to identify false pacemaker pulse detections, or if true pulses are not being detected.

Table 2-13 Pacing Detection Settings

Setting Description Symbol on Status Bar

Not known if paced

 This is the default setting and

normally is used for both paced

and non-paced patients

 Pacemaker pulse detection is on

and is at normal sensitivity

 Occasional false pacemaker pulse

detections may occur in ECGs with excessive noise

 False detections may result in an

incorrect interpretive statement appearing on the report

 Small amplitude pacemaker pulses

may not be detected using this setting

Non-paced

 Pacemaker pulse detection is off

 Use this setting if there are false

pacemaker pulse detections from noise, or if incorrect interpretive statements or inappropriate paced ECG complexes appear on the report

2-30 PageWriter Trim Cardiograph Instructions for Use

No code appears on the Status Bar if the Non-paced setting is selected

Page 76

The Patient Session Pacing Detection Settings

Table 2-13 Pacing Detection Settings (continued)

Setting Description Symbol on Status Bar

Paced

Paced (magnet)

 Pacemaker pulse detection is on

and is set at a higher sensitivity

 Use this setting if small amplitude

pacemaker pulses are not being detected at the default (Not Known if Paced) setting

 False pacemaker pulse detections

may occur if the ECG is noisy

 Use this setting if the ECG is

acquired with an active pacemaker magnet or programmer in place

 Pacemaker pulse detection is on

and is at a higher sensitivity

 Magnets or programmers often put

the pacemaker into a fixed-rate, non-sensing mode

 The statement ECG ACQUIRED

WITH MAGNET IN PLACE is printed on the 12-lead Report notifying the overreader that a magnet or programmer was used and would explain the fixed rate behavior of the pacer

REPORT

To change the pacing detection setting:

Turn the Trim Knob to highlight Report button on the Command Toolbar.

2 Push the Trim Knob to select the button. The Report settings window appears. Three tabs

appear on the top of the screen. The

3 Turn the Trim Knob until the Not Known if Paced (recommended setting) is highlighted

Pacer Detect.

under

4 Turn the Trim Knob to highlight a setting.

5 Push the Trim Knob to select the setting.

6 Press the Enter key on keyboard to save the Pacing Detection Setting and to exit the

Auto tab is selected.

screen. Press the Esc key to exit the screen and without saving the new setting.

The new pacing detection setting is applied and appears on the Status Bar. After the patient session ends, the default pacing detection setting (set in Configuration) is restored and will appear on the Status Bar.

PageWriter Trim Cardiograph Instructions for Use 2-31

Page 77

The Patient Session Getting Help on the Cardiograph

Getting Help on the Cardiograph

PageWriter Trim II and III only

The Help button on the Command Toolbar may be selected at any time while using the cardiograph. Help provides basic information on cardiograph operation and on signal quality troubleshooting.

To open Help:

Turn the Trim Knob to highlight the Help button on the Command Toolbar.

HELP

2 Push the Trim Knob to select the button.

3 The Help screen appears. Turn the Trim Knob to go forward or back through the screens.

Press the Esc key on keyboard to exit the Help.

2-32 PageWriter Trim Cardiograph Instructions for Use

Page 78

Reading the Printed ECG Report

The following chapter describes the printed report formats available on the PageWriter Trim I, II and III cardiographs. Figure 3-1 describes the 3x4 1R report format that is available on all cardiograph models. For information on additional report formats, see page 3-18.

Figure 3-1 A 12-Lead 3x4, 1R Report (page one)

H I

A Interpretive, Reason, and Severity Statements (see page 3-2) J Calibration Information (see page 3-11) B Basic Measurements (see page 3-4) K Time Separator (see page 3-13)

C Patient ID Clinical Information (see page 3-5) L Pacing Detection Setting (see page 3-13) D Patient ID Information (see page 3-6) M Algorithm Version (see page 3-16)

E Institution Information (see page 3-7) N Speed and Sensitivity Settings (see page 3-16) F Configurable Clinical Information (see page 3-8) O Patient Name (see page 3-7)

G ECG Order Information (see page 3-9) P Patient ID Number (see page 3-7) H Physician Information (see page 3-10) Q Device Identification Number (page 3-17)

I Report Information (see page 3-10)

(see page 2-11)

LNM

3-1

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Reading the Printed ECG Report Interpretive, Reason, and Severity Statements

Additional Patient ID Clinical Information may appear on the top of a second page of the ECG report if more than two clinical fields (Rx, Dx, Sx, Hx) are entered with the Patient ID information.

Additional Configurable Clinical Information may also appear on the top of a second page of the ECG report if more than two fields are entered.

Figure 3-2 A 12-Lead 3x4, 1R Report (page two)

R Additional Patient ID Clinical Information (see page 3-5)

S Additional Configurable Clinical Information (see page 3-8)

Interpretive, Reason, and Severity Statements

This area of the report contains the interpretive, reason, and severity statements generated by the Philips 12-Lead Algorithm. This feature is only available on the PageWriter Trim I and III.

Figure 3-3 Interpretive, Reason, and Severity Statements on the ECG Report

Interpretive Statements

Severity

Statement

Reason Statements

Interpretive statements may include a reason statement that summarizes the criteria that generated the interpretive statement.

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Interpretive, Reason, and Severity Statements Reading the Printed ECG Report

NOTE The interpretive statements may include quality statements that describe a signal quality problem that

occurred during recording, such as

ARTIFACT IN LEAD(S) I, III, aVL.

For a complete listing (in alphabetical order and by diagnostic category) of all of the criteria included in the Philips 12-lead Algorithm, see Appendices B and C of the Philips 12-lead Algorithm Physician’s Guide on the User Documentation CD or download the file from www.medical.philips.com.

Severity Statement

Each interpretive statement included on the ECG report has an associated severity. Severities that are more abnormal override lesser severities. The severities of all selected interpretive statements are combined to determine the overall severity of the ECG. This severity code is printed on the front page of the ECG report.

Table 3-1 Overall ECG Severity with Code

Severity Code

No Severity NS

Normal ECG NO

Otherwise Normal ECG ON

Borderline ECG BO

Abnormal ECG AB

Defective ECG DE

PageWriter Trim Cardiograph Instructions for Use 3-3

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Reading the Printed ECG Report Basic Measurements

Basic Measurements

These measurements provide standard interval and duration measurements in milliseconds, and limb lead axis measurements in degrees. These are the values measured from the representative beat pattern in the ECG. This feature is only available on the PageWriter Trim II and III.

Figure 3-4 Basic Measurements on the ECG Report

Table 3-1 Basic Measurements

Label Description Units

RATE Heart rate beats per minute

PR PR interval milliseconds

QRSD QRS duration milliseconds

QT QT interval milliseconds

QTc QT interval corrected for rate milliseconds

P Frontal P axis degrees

QRS Frontal QRS axis degrees

T Frontal T axis degrees

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Patient ID Clinical Information Reading the Printed ECG Report

Patient ID Clinical Information

This area of page one or page two of the report contains clinical patient information that is entered with the Patient ID. This includes information about the patient’s Medications (Rx), Diagnoses (Dx), Symptoms (Sx), History (Hx), and a Diagnosis Related Group (DRG) code. This information is optional and configurable (see page 5-7). The example below is for informational purposes only. This feature is only available on the PageWriter Trim II and III.

Figure 3-5 Patient ID Clinical Information on the ECG Report (page one)

If more than two Patient ID Clinical Information fields are entered, the third and subsequent fields appear at the top of a second page of the report.

Figure 3-6 Patient ID Clinical Information on the ECG Report (page two)

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Reading the Printed ECG Report Patient ID Information

Patient ID Information

This section contains patient identification information. This block of information is configurable (see page 5-4). The example below is for informational purposes only.

Figure 3-7 Patient ID Information on the ECG Report

Table 3-2 Patient ID Information

Label Description

125-43-3247  Patient identification number

03/15/2003; 12:27:11 PM

Doe, John T.

Born 1936

 Date and time of ECG acquisition

 Cannot be edited

 Patient name

 Patient date of birth (may be configured to

display patient age)

Male

Race

247 lbs, 70 in.

BP: 133/90

 Patient gender

 Patient ethnicity (see table below for codes)

 Patient weight and height

 Patient blood pressure (mm/Hg)

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Institution Information Reading the Printed ECG Report

Additional Patient ID Information

Additional Patient ID information can be configured to appear at the bottom of the report (see page 5-18). This may be helpful if the patient name and ID is being cut off in the printed report format. This feature is only available on the PageWriter Trim II and III.

Figure 3-8 Patient Name and ID information on the bottom of report

Institution Information

This block of identification information is optional and is fully configurable (see page 5-31). The example below is for informational purposes only. This feature is only available on the PageWriter Trim II and III.

Figure 3-9 Institution Information on the ECG Report

Table 3-3 Institution Information

Label Description

Community Hospital (21)  Name and ID number of institution

Dept: ICU (13)

 Name and ID number of department

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Reading the Printed ECG Report Configurable Clinical Information

Table 3-3 Institution Information (continued)

Label Description

Room: 228  Room number of patient or room number where

ECG was acquired

Oper: Williams

Fac: West Campus (5)

 Operator identification

 Name and ID number of facility or other unit

within an institution

Configurable Clinical Information

This information is configurable to fit specific clinical needs (see page 5-7). Up to six configurable drop-down fields are available. This feature is only available on the PageWriter Trim II and III.

The first four text fields appear on page one of the ECG report. The fifth and subsequent text fields appear on page two of the ECG report. The examples below are for informational purposes only.

Figure 3-10 Configurable Clinical Information on the ECG Report (page one)

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ECG Order Information Reading the Printed ECG Report

Figure 3-11 Configurable Clinical Information on the ECG Report (page two)

ECG Order Information

This area of the report is configurable to meet the requirements of an order management system (see page 5-10). This feature is only available on the PageWriter Trim II and III.

Figure 3-12 ECG Order Information on the ECG Report

Table 3-4 ECG Order Information

Label Description

Order: 0-123  Institution-defined order number, part of order

management system

Enc: E-123

 Institution-defined encounter number, part of

order management system

Reason: Annual Physical

 The reason for acquiring the ECG, may be part

of an order management system

PageWriter Trim Cardiograph Instructions for Use 3-9

Page 87

Reading the Printed ECG Report Physician Information

Physician Information

This information block is configurable (see page 5-10) and contains physician identification information, including the name of the ordering physician and UPIN (Universal Physician Identification Number). This feature is only available on the PageWriter Trim II and III.

Figure 3-13 Physician Information on the ECG report

Report Information

Information about the status of the ECG report is included in this section. The statement indicating that the ECG report has not been overread by a physician is configurable (see page 5-2). This feature is only available on the PageWriter Trim II and III.

Figure 3-14 Report Information on the ECG Report

Table 3-5 Report Information

Label Description

Unconfirmed Diagnosis  Indicates that the ECG report has not been

COPY The ECG report is a printed copy of an original

STAT The ECG report is designated as STAT

3-10 PageWriter Trim Cardiograph Instructions for Use

overread by a qualified physician

Page 88

Calibration Information Reading the Printed ECG Report

Table 3-5 Report Information (continued)

Label Description

Non-standard lead gains

Calibration Information

The calibration pulse is the rectangular waveform shown in each line of ECG trace. It shows the hypothetical deflection of the trace in response to a 1 mV calibration pulse applied to the acquisition circuitry.

Figure 3-15 Calibration Pulse on the ECG Report

 The limb leads or precordial leads were

recorded at a gain other than the standard 10mm/mV

 See "Calibration Information" on page 3-11

Calibration Pulse

The shape of the calibration pulse reflects the scaling of the trace.

 If the calibration pulse is square the precordial leads and limb leads were recorded at

the same scale.

 If the calibration pulse is stepped the precordial leads were recorded at half the scale

of the limb leads.

Table 3-6 Calibration Pulse Shapes

Calibration Pulse Shape Limb

(mm/mV)

Precordial

(mm/mV)

52.5

10 10

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Reading the Printed ECG Report Calibration Information

Table 3-6 Calibration Pulse Shapes (continued)

Calibration Pulse Shape Limb

(mm/mV)

10 5

20 20

20 10

Precordial

(mm/mV)

NOTE For ECG recordings where the precordial leads or limb leads were recorded at a gain other than

10mm/mV, the statement section on the printed report.

Figure 3-16 Calibration information on the ECG report

Non-standard lead gains appears in the Report Information

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Page 90

Time Separator Reading the Printed ECG Report

Time Separator

The time separator marks indicate whether the ECG data is displayed simultaneously or time-sequentially. These settings are configured as part of a report or copy profile (see page 5-

12). The data for each lead is always acquired simultaneously.

Figure 3-17 Simultaneous time separator on ECG report

Simultaneous Time Separator

The double line indicates that the ECG data for each lead is displayed simultaneously. The starting point of each lead is the same time even though they may appear to start at different times on the printed report.

Figure 3-18 Time sequential separator on ECG report

The single line indicates that the ECG data for each lead is displayed over a continuous period of time. For example, on a 3x4 grid all signals start at 0 in the first column, 2.5 seconds in the second column, 5.0 seconds in the third column, and 7.5 seconds in the fourth column.

Pacing Detection Settings

This area of the report contains information about the pacing detection settings that were selected when the ECG report was printed.

Pacemaker pulses that are detected by the cardiograph are marked on the ECG report with small vertical tick marks. These marks enable the overreader to identify false pacemaker pulse detections, or if true pulses are not being detected.

Time Sequential Separator

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Reading the Printed ECG Report Pacing Detection Settings

WARNING Pace pulse tick marks do not appear on any PageWriter Trim II and III report that

include simultaneous (not time-sequential) acquisition settings. For information on simultaneous acquisition, see page 3-13. For information on report settings, see page 2-

25.

Figure 3-19 Pacing Detection Setting on the ECG report

The table below describes the available Pacing Detection Settings with the pacing detection code that appears on the printed ECG report.

Table 3-7 Pacing Detection Settings

Setting Description ECG Report Code

Not known if paced  This is the default setting and

normally is used for both paced and non-paced patients.

 Pacemaker pulse detection is on

and is at normal sensitivity.

 Occasional false pacemaker pulse

detections may occur in ECGs with excessive noise.

 False detections may result in an

incorrect interpretive statement appearing on the report.

 Small amplitude pacemaker

pulses may not be detected using this setting.

Non-paced

 Pacemaker pulse detection is off.

 Use this setting if there are false

pacemaker pulse detections from noise, or if incorrect interpretive statements or inappropriate paced ECG complexes appear on the report.

 No code appears on the

ECG report if the Nonpaced setting is selected.

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Page 92

Pacing Detection Settings Reading the Printed ECG Report

Table 3-7 Pacing Detection Settings (continued)

Setting Description ECG Report Code

Paced  Pacemaker pulse detection is on

and is set at a higher sensitivity.

 Use this setting if small amplitude

pacemaker pulses are not being detected at the default (Not Known if Paced) setting.

 False pacemaker pulse detections

may occur if the ECG is noisy.

Paced (magnet)

 Use this setting if the ECG is

acquired with an active pacemaker magnet or programmer in place.

 Pacemaker pulse detection is on

and is at a higher sensitivity.

 Magnets or programmers often

put the pacemaker in a fixed-rate, non-sensing mode.

 On the PageWriter Trim I and III,

the statement ECG ACQUIRED WITH MAGNET IN PLACE is

printed on the ECG report. This statement notifies the overreader that a magnet or programmer was used and would explain the fixed rate behavior of the pacer.

PageWriter Trim Cardiograph Instructions for Use 3-15

Page 93

Reading the Printed ECG Report Algorithm Version Number

Algorithm Version Number

The version number of the Philips 12-Lead Algorithm is printed at the bottom of the ECG Report. This feature is only available on the PageWriter Trim I and III.

Figure 3-20 Algorithm Version Number on the ECG Report

Table 3-8 Algorithm Version Number

Label Description

PH080A  PH refers to Philips

 08 refers to the version of the measurement

program

 0A refers to the criteria version installed on the

cardiograph

Speed and Sensitivity Settings

This area contains information about the speed and sensitivity settings that were used for the ECG recording.

Figure 3-21 Speed and Sensitivity Settings on the ECG Report

Table 3-9 Speed and Sensitivity Settings

Label Description

Speed  The speed at which the ECG was printed

 Available settings:

– 25mm/sec

–50 mm/sec

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Device Identification Number Reading the Printed ECG Report

Table 3-9 Speed and Sensitivity Settings (continued)

Label Description

Limb  The limb lead sensitivity setting

 Available settings:

– 5, 10, or 20 mm/mV

Chest

 Precordial lead sensitivity setting

 Available settings:

– 2.5, 5, 10, or 20 mm/mV

NOTE For ECG recordings where the precordial leads or limb leads were recorded at a gain other than

10mm/mV, the statement section on the printed report.

Non-standard lead gains appears in the Report Information

Device Identification Number

This number is entered in Configuration (see page 5-31). This number is used to identify the individual cardiograph that was used to acquire the ECG. This feature is only available on the PageWriter Trim II and III.

Figure 3-22 Device ID on the ECG Report

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Page 95

Reading the Printed ECG Report 12-Lead ECG Report Examples

12-Lead ECG Report Examples

The following section includes examples of other 12-Lead report formats available on the PageWriter Trim II and III cardiographs.

 3x4, 3R report with Standard Leads

 3x4, 1R report with Cabrera Leads

 6x2 report (5-second waveform segments) with Cabrera Leads

 12x1 report with Cabrera Leads. The 12x1 report shows 10 seconds of continuous

waveform data for 12 leads and includes a second page with interpretive, reason, and severity statements (if configured).

 Panoramic (Pan-12) report with Cabrera Leads. The Pan-12 report shows a one-second

representative complex for each Cabrera Lead with three pre-selected rhythm strips at the bottom (aVF, V2, V5).

NOTE The available PageWriter Trim I report formats are 3x4 1R with Standard lead sequence and 3 and 6

lead Rhythm reports.

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12-Lead ECG Report Examples Reading the Printed ECG Report

Figure 3-23 3x4, 3R Report with Standard Leads

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Reading the Printed ECG Report 12-Lead ECG Report Examples

Figure 3-24 3x4, 1R Report with Cabrera Leads and Simultaneous Acquisition

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12-Lead ECG Report Examples Reading the Printed ECG Report

Figure 3-25 6x2 Report with Cabrera Leads

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Reading the Printed ECG Report 12-Lead ECG Report Examples

Figure 3-26 12x1 Report with Cabrera Leads (page one)

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12-Lead ECG Report Examples Reading the Printed ECG Report

Figure 3-27 12x1 Report with Cabrera Leads (page two)

PageWriter Trim Cardiograph Instructions for Use 3-23

Philips PageWriter Trim User manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Safety Symbols Marked on the Cardiograph

1Safety Summary

Safety Symbols Marked on the Cardiograph Packaging

Conventions Used in the Instructions for Use

Important Patient and Safety Information

The PageWriter Trim Cardiograph

Intended Use

Indications for Use

The Philips 12-Lead Algorithm

Intended Use

Indications for Use

1Getting Started

PageWriter Trim Cardiograph Learning Kit

About the PageWriter Trim Learning Kit

Attaching the Cardiograph to the Cart

PageWriter Trim I Cardiograph Parts

PageWriter Trim II and III Cardiograph Parts

Installing the Battery

Battery Charging Indicator, PageWriter Trim II and III

Battery Charging Indicator, PageWriter Trim I

Loading the Printer Paper

Tips for loading printer paper

Patient Interface Module (PIM)

Inserting the Lead Wires into the PIM

Connecting the PIM to the Cardiograph

Placing the PIM in the Holder

Using the PC Card Slot

Using the PC Card

Using the Modem Card

Using the LAN Card

Inserting or Removing a PC Card

Using the Barcode Reader

Using the Magnetic Card Reader

Using the SmartCard Reader

Powering On the Cardiograph

Using the On/Standby Button

Using the Trim Knob

PageWriter Trim I Features

Control Panel

LCD Display

Function Buttons

PageWriter Trim II and III Features

PageWriter Trim II and III Status Bar

PageWriter Trim II and III Command Toolbar

Introduction

The Patient Session

Patient Preparation

Instructing the Patient

Preparing the Skin

Attaching the Electrodes

Attaching the Lead Wires

Checking Signal Quality

Using the PageWriter Trim I Signal Quality Indicators

Heart Beat Detector

Leads Off Indicator

Signal Quality Indicator

Troubleshooting Signal Quality

Using the PageWriter Trim II and III Signal Quality Indicators

Using the Leads off indicator

Color-coded waveforms

Troubleshooting Signal Quality

Using Filters

Artifact Filter

Baseline Wander Filter

Frequency Response Filters

About High and Low Pass Frequency Filter Settings

Changing Filter Settings on the PageWriter Trim I

Changing Filter Settings on the PageWriter Trim II and III

Artifact and Baseline Wander Filters

Display Filter Settings

Entering Patient ID Information

Entering Patient ID Information on the PageWriter Trim I

Entering Patient ID Information on the PageWriter Trim II and III

Entering Patient ID Information with the Keyboard

Opening a Pending Order

Entering Patient ID Information with the Barcode Reader