Philips PageWriter XLi User reference guide

PageWriter XLi

User’s Reference Guide

Notice

About This Edition

Edition 8 Printed in the USA Publi cation nu m ber M1 70 0 92909 The information in this guide applies to th e PageWriter XLi cardiograph. This information is subject to change without notice. Hewlett-Packard shall not be liabl e for errors conta i n e d herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material.

Edition History

Edition 1 May 1990 Editio n 2 July 1991 Editio n 3 January 1992 Edition 4 April 1993 Editio n 5 July 1993 Edition 6 June 1994 Editio n 7 January 1995 Edition 8 April 2000

This do cument m a y no t b e photoco pied, rep roduce d, or translated to another language without pr ior written consent of HewlettPackard.

WARNING

As with electronic equipment, Radio Frequency (RF) inter ference 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 electrosur gical equipment and close proximity transmitters may seriously degrade performance.

Like al l el ec tronic de v ic es, this cardiograph is suscep tib le to electrostatic discha rge (ESD). Electrostatic discharge typically occurs when electrostatic energy is transferred to the patient, the elec trodes, or t h e cardiograph. ESD may result in ECG artifact that may appear as narrow spikes on the cardiograph displa y or on the printed report . Wh en ESD occurs, the card iograph’s ECG inter p retation ma y be inconsistent with the physic ia n’s inte rp retation.

Hewlett-Packard assumes no liabil ity fo r fa ilures resulting from RF interference between HP

medical electronics and any radio frequency generating equipm e n t at le ve ls exceedi ng those established by applicable standards.

CAUTION

Use of accessories other than th ose recom men ded by Hewlett-Pac kard may comprom ise product performance.

THIS PRODUCT IS NOT INTENDED FOR HOME USE.

IN THE U.S., FEDERAL LAW RESTRICTS THIS DEVICE TO SALE ON OR BY THE ORDER OF A PHYSICIAN.

Medical Device Directive

The PageWriter XLi Cardiograph complies with the requ irements of the Medical Device Directive 93/42/EEC and carries the

mark accordingly.

0123

Author iz e d E Urepresentative: Hewle tt-Packar d Deutschland GmbH Herrenbergerstrasse 130 D-71034 Boeblingen Germany Fax: +49-7031-14-2346

Safety Summary

Safety Symb ols Marked on the Cardiogr aph

The following symbols are used on the cardiograph.

Caution - See operating instructi ons

Type CF, defib r illation prote cted

Alternating current

Equipotential (this is on the ground lug)

The following symbols appear on the cardiograph packaging.

Keep dry

:$51,1*

iii

Temperature and relative humidity

ranges

Fragile

Conventions Used in This M anual

:DUQLQJVWDWHPHQWVGHVFULEHFRQGLWLRQVRUDFWLRQVWKDWFDQUHVXOWLQSHUVRQDOLQMXU\ RUORVVRIOLIH

&$87,21

Caution state ments describe conditions or actions that can result in damage to the equipment or software.

12 7(

Notes contain additio nal information on cardiograph usage.

Softkey

represents the temporary key labels that appear on the keyboard

display.

represents keys on the front panel.

Key

Documentation Map

If you want to: Use this manual:

Verify that al l eq uipment is included Packing List

Record ECG’s Operating Guide Enter pat ient ID Make copies of ECG’s Store ECG’s Transmit or receive ECG’s Troubleshoot problems Maintain the car d iograph Set up the cardiogra ph Install the battery Install the software Load paper Change applic ations Install or use Pr ev iew Plus Config u r e the cardiograph User’s Reference Guide Prepare the patient Maintain the car d iograph Install and use the modem

Documentation Map

If you want to: Use this manual:

Configure and use Special Applications User’s Reference Guide Order supplies Use filters Understand an alysis Physician’s Guide

Contents

Safety Summary ...................................................................................................................... iii

Safety Symbols Marked on the Cardiograph .................................................................... iii

Conventions Used in This Manual ....................................................................................iii

Documentation

Map ...........................................................................................................................................v

Introduction

About This Manual ...............................................................................................................1-1

Acquiring an ECG

ECG Technique ..................................................................................................................... 2-1

Relaxing the Patient ........................................................................................................2-2

Preparing the Patient ....................................................................................................... 2-2

Preparing the Skin at the Electrode Positions ................................................................. 2-3

Securing the Electrodes ..................................................................................................2-4

Monitoring ECG Quality ......................................................................................................2-6

Quality Messages on the Cardiograph’s Display ............................................................2-7

Understanding the PageWriter XLi Special Applications

Overview ..............................................................................................................................3-1

Indic at ions for Use ........................ ........ .............. .............. ....... .............. .............. ........ ...3 -1

Understanding TPI Variables ..........................................................................................3-2

Understanding ACI TIPI Variables ................................................................................ 3-3

Using the TPI and ACI-TIPI Applications .....................................................................3-3

Analyzing an ECG with the Predictive Instruments .......................................................3-4

Generating Reports with the Special Applications Off .................................................. 3-5

Generating Reports with the Special Applications On ................................................... 3-6

Auto Analysis and the Default Choice ........................................................................... 3-7

Generating a STAT ECG Report .................................................................................... 3-8

Choosing Report Features

vii

Contents

ECG Formats ........ .............. ........ .............. .............. ........ ............. .............. ........ ...................4-1

The Auto Report ............................................................................................................. 4-1

Auto Report Information ................................................................................................4-1

Manual Formats ..............................................................................................................4-6

The Manual Lead Sets ....................................................................................................4-6

ECG Storage

Advantages of Disk Storage ................................................................................................. 5-1

Storing Reports with the Special Applications Off ........................................................ 5-2

Storing Reports Using Auto Analysis and the Default Choice .......................................5-2

Automatically Storing Reports Using Forced Auto-Store .............................................. 5-2

Disk Handling and Maintenance Instructions ....................................................................... 5-3

Using the ECG-Log and Store-Log ...................................................................................... 5-4

Printing ECG Logs ..........................................................................................................5-7

Configuring Your Cardiograph

Using Configuration Menus ..................................................................................................6-1

Selecting Configuration Parameters .....................................................................................6-3

Understanding Global Configuration .................................................................................... 6-4

Interpretation Parameters. ............................................................................................. 6-10

Line Frequ ency .... ................................ ........................ ......................... ........................ 6-11

Selecting Custom Lead Groups .................................................................................... 6-11

Selecting AutoCopy ......................................................................................................6-11

Selecting ECG Management Parameters ...................................................................... 6-12

Selecting Battery Timeout Periods ............................................................................... 6-12

Setting a Password ........................................................................................................6-13

Turning Off Unused ID Fields ............................................................................................6-13

Storing the Configuration Information ......................................................................... 6-14

Using a Stored Configuration ....................................................................................... 6-15

Printing the Configuration ............................................................................................6-16

Setting Up Your Cardiograph for Transmitting ECGs

Transmitting ECGs Directly .......................................................... .......... .......... .......... .........7-3

Configuring the Cardiograph to Transmit ECGs Directly .............................................. 7-4

viii

Contents

Transmitting ECGs by Telephone to Another Site ............................................................... 7-5

Installing the Modem (For United States use only) ........................................................ 7-5

Connecting a Telephone to the Same Line as the Modem ............................................. 7-7

Configuring the Cardiograph for Modem Usage ............................................................ 7-7

Entering the Phone Number ............................................................................................ 7-9

Configuring the Cardiograph for AutoDial .................................................................... 7-9

Installing the Modem on the Cart ................................................................................. 7-10

Transmitting ECGs by FAX to Another Site ......................................................................7-11

Installing the FAX/Modem ........................................................................................... 7-12

Connecting a Telephone to the Same Line as the FAX/Modem .................................. 7-14

Configuring the Cardiograph for FAX Usage .............................................................. 7-14

Entering the Phone Number .......................................................................................... 7-15

Transmitting an ECG via FAX .....................................................................................7-16

Printing an ECG on an HP LaserJet Printer ........................................................................ 7-17

Setting up the LaserJet Printer ............................................................................................7-18

Configuring the Cardiograph to Print ECGs on the HP LaserJet .................................7-18

Receiving ECGs ..................................................................................................................7-20

Configuring the Cardiograph to Receive ECGs Directly ............................................. 7-20

Configuring the Cardiograph to Receive ECGs via Modem ........................................ 7-21

Receiving an ECG via FAX ..........................................................................................7-21

Configuring the Cardiograph to Receive via FAX ....................................................... 7-22

Receiving ECG Reports from an HP 5600C ECG Management System ..................... 7-22

Receiving ECGs from an HP M1730A or M3700A TraceMaster ECG Management System

7-23

Troubleshooting

Troubleshooting Leads Off ...................................................................................................8-1

Troubleshooting ECG Noise ................................................................................................. 8-1

Understanding Error Messages ............................................................................................. 8-3

Calling for Assistance ..................................................................................................... 8-3

Solving Eq u i p m e n t Pr o b l e m s .... ................ ........................ ................................. .................. 8-3

Supplies

Availability ...........................................................................................................................9-1

Contents

Lead Systems

Frank Le a d s ...................... ........................ ........................ ................................. ................... A-1

Special Lead Configurations ................................................................................................ A-2

V3R, V4R, V7 and V8 ...................................................................................................A-2

VX1, VX2, VX3 and VX4 .............................................................................................A-2

Glossary

1 Introduction

About This Manual

This guide contains reference information and configuration instructions for experienced PageWriter XLi cardiograph users. If you are unfamiliar with using this cardiograph, please view the videotape tutorial Using the Hewlett- Packar d PageWriter XL Cardiographs. For additional help on using your cardiogra p h refer to the HP PageWriter XLi Operating Guide.

1-1

About This Manual

1-2 Introduction

2 Acquiring an ECG

One of the most important aspects of recording a clear ECG is good ECG technique. This chapter include s a review of recommended ECG technique as well as information about using the pat ient module.

12 7(

Computerized ECG analysis should always be reviewed by a qualified physician.

ECG Te chnique

ECG technique is very important, both to avoid difficulty when taking the ECG and to achieve the best quality result. There are three key aspects of good ECG technique:

Helping the patient to relax.

Preparing the patient for electrode connection.

Using the patient module to check lead connections.

For best results, perform the following steps in the order given. More details on good technique follow this li st.

Check that the patient is comfortable and relaxed. Reassure the patient that the procedur e is painless.

If possible, place the patient away from electrical fixtures and their power cords, and away from the cardiograph’s power cord if AC pow er is on.

Expose the patient’s forearms, lowe r legs, and chest.

Beginning with the right leg position, apply electrolyte and atta ch electrodes.

2-1

ECG Technique

12 7(

Disposable ele ctrodes , when used properly, may be used for a cceptable E CGs. For best results, prepare the skin and carefully follow manufactur er’s usa ge instructions .

Relaxing the Patient

The more the patient relaxes, the less the ECG will be affected by noise. Your good technique he lps the pati ent relax. You can help the patien t to rela x by the following:

Make sure the patient is lying down and 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.

When possible, take the ECG in a quiet room or area where others can’t see the patient. Privacy is important to relaxation. Draw the curtains around the bed area when taking the ECG in a room with other people.

Gain the patient’s confidence by expla ining the test and that it won’t hurt.

Your calm, relaxed attitude will help put the patient at ease.

Don’t let the patient move unnecessarily. It’s also best to avoid all conversation during the actual ECG recording to keep the patient as still as possible.

Preparing the Patient

Selecting th e Electrode Positio ns m, Table 2-1, shows the proper electrode positions for taking an ECG. Put the electrodes in the correct anatomical locations accordi ng to inf ormation in Figure 2-1.Additional information concerning other lead systems may be found in Appendix A.

The tip of each lead wire is lettered and color cod ed for easy lead identification. For example, make sure that the RA lead wire and electrode connect to the right arm and the RL lead wire and electrode connect to the right leg.

2-2 Acquiring an ECG

ECG Technique

T able 2-1 Standard 12-Lead Electrode Positions

Lead Position

RL On the right leg (inside calf, midway betw een knee and ankle) LL On the left leg (inside calf, mid way between knee and ankle) RA On the right arm (on the inside) LA On the left arm (on the inside ) V1 Fourth intercostal sp ace, at right sternal margin V2 Fourth intercostal space, at left sternal margin V3 Midway between V2 and V4 V4 Fifth intercostal space at lef t midclavicu lar line V5 Same transverse level as V4 , o n an terior axillary l in e V6 Same transverse level as V4, at left midaxillary line

)LJXUH6WDQGDUG/HDG(OHFWURGH3RVLWLRQV

Preparing the Skin at the Electrode Positions

Since dry skin is a relatively poor elec trical conductor, you must prepare the skin to assure good contact between the skin and the electrode. Before

2-3

ECG Technique

securing the electr odes, you must lower the skin resistance at the electrode site by:

Making sure that all electrodes are clean and bright. (Dirty or corroded electro des pre vent a good electrical connection.)

Avoiding bony areas. Select flat , f le shy sites. You don’t have to shave hair from the skin unless the hair is very thick.

Rubbing the skin briskl y with t he edge of the electr ode or a gauz e pad until the skin is slightly r ed, but not bruised.

Applying electrol yte to the prepared areas on the skin. Rub some electrolyte into the skin, but leave a slightly moist residue. Do not spread electroly te o n the ch est area between electrodes . This will cause distorted waveforms on the ECG.

127(

Do not use alcohol or acetone pads in place of the electroly te because they impair the electrode con tact with the skin.

Securin g the Electro des

We have included two types of electro des in the accessory box:

Metal plate limb electrodes, held in place on the patient by rubber straps.

Welsh cup chest electrode s, he ld in place by suction.

Securing the electrode s is a key part of good ECG technique and getting a good ECG trace. To avoid jittery wavef orms, make sure th at the ele ctrodes are secure. Do not overtighten limb plate electrodes, since this might cause discomfort which results in muscle artifact on the waveforms.

Fasten the electrodes to the chest positions by squeezing the rubber bulb of the suction cup. See Figure 2-3. The bulb should be partially deflated when the electrode is firmly attached to the chest.

A good test for firm ele ctrode contact i s to gras p the electr ode and tr y to move it. If it moves easily, the elect rod e connection is too loose. If it digs into the flesh, the electrode is too tight. Do not allow the chest electrodes to move in any way . Check the patient module display for indic at ions that the connections are good. Ideally , the noise bar should remain in the green zone.

2-4 Acquiring an ECG

ECG Technique

Do not leave suction electrodes connected to the chest for prolonged periods. The suction can cause intrade rmal hemorrhaging.

)LJXUH&RQQHFW/HDGZLUHVWR(OHFWURGHV

2-5

Monitoring ECG Quality

)LJXUH)DVWHQ(OHFWURGHV

Monitoring ECG Quality

There are three ways that the PageWriter XLi helps you monitor the quality of your ECG recordings.

Using the patient module displa y

Using the preview screen

Observing quality messages on the cardiograph’s display

2-6 Acquiring an ECG

Monitoring ECG Quality

You can stop the recording before or during printing if you see arti fac t or other ECG waveform problems on the screen. Modify lead placement or improve patient preparation and resume recording the ECG.

For further instructions on using the patient module display and the preview screen, refer to the PageWriter XLi Operating Guide.

Quality Messages on the Cardiograph’s Display

After you start an Auto ECG recording, the cardiograph’s display will show messages which indic ate the quality of the recording. If t here is m inimal noise and all electrod es are s ecu r el y attach e d, the me ssa ge "‘EC G ok’’ will appear.

Some messages indicate problems with the leads. They list the condition and the action to take. There are four conditions which affect the ECG:

Leads off

AC noise

Artifact

Baseline wander

If any of these conditions are severe, the mess ag e dire ct s you to retry the recording. Correct the problem and then resume recording the ECG.

2-7

Monitoring ECG Quality

2-8 Acquiring an ECG

3 Understanding the PageW riter XLi Special

Applications

Overview

The ACI TIPI (Acute Cardiac Ischemia - Time Insensitive Predictive Instrument) and the TPI (Thrombolytic Predictive Instrument) are software products that enhance the computer-assisted ECG analysis capabilities of the PageWriter XLi Cardiograph. These "Predictive Instruments" generate 0100% Predicted Probabili ty scores of ACI (Acute Cardiac Ischemia) and patient outcome with and without thrombolytic therapy for acute myocardial infarction (AMI). These pr edicted probabilities are based on ECG featur es, patient age, gender, blood pressure, chest pain status and time since ischemic symptom onset. The cardiograph can be configured to automatically print these probabilit ies on the Auto ECG report.

Indications for Use

The ACI-TIPI is intended for use as an aid to clinicians in the diagnosis and triaging decision process of patients with ACI, which includes unstable angina pectoris and acute myocardial infarction (AMI).

The TPI is intended for use as an aid to clinicians identifying which patients with AMI are appropriate candidate s for thrombolytic ther apy . TPI is intended for adult patients, aged 35-75, diagnosed with symptoms of acute myocardial infarction.

These programs can be used in real-time and retrospective settings since they rely on information that is rea dily available in the emergency depar tment

(ED), or by retrospective review of the patient’s medical record. The emergency physi cian’s real-time decision making process is aided by havin g the predictive instruments incorporated into the electrocardiograph. The predictive scores, once acquired, can then be used along with actual patient outcome to help improve patient management practices retrospectively.

3-1

Overview

The predictive instr uments provide the physician with tools to:

Aid diagnosis and triage of some patients with symptoms suggestive of ACI

Identify those patie nts most likely to benefit from thrombolytic therapy

Facilitate the earliest possible administration of thrombolytic therapy

127(

12 7(

For intended use and contraindication information, consult the Predictive Instrument Physician’s Guide for important information.

Understanding TPI Variables

There are nine predictors of thro mbolytic-related benefits and risks which include six clinical factors and detailed information on three ECG features.

The six clinical factor s are:

Time since ischemic onset

Patient age

Patient gender

Patient Blood Pressure (systolic and diastolic)

Patient’s history of diabetes

Patient’s history of hypertension

For each of the clinical factors listed above, patient data must be entered in order to produce a TPI report.

3-2 Understandin g the P ageWriter XLi Speci al Applications

Overview

The three ECG features are:

the presence or absence of pathological or significant Q waves

the presence and degree of ST segment elevati on or depression

the presence and degree of T wave elevation or inversion

Understanding ACI TIPI Variables

Seven variables are used to predict Acute Cardiac Ischemia. These variables include four clinical factors and detailed information on three ECG features.

The four clinical factor s are :

the presence or absence of chest pain or pressur e, or left arm pain

whether chest pain or pressur e, or lef t arm pain is the patient’s most important present ing symptom

patient age

patient gender

127(

For each of the clinical factors listed above, patient data must be entered in order to produce the ACI-TIPI report.

The three ECG features are:

the presence or absence of pathological or significant Q waves

the presence and degree of ST segment elevati on or depression

the presence and degree of T wave elevation or inversion

The exclusionary cases for both the TPI and ACI-TIPI applications are listed in the Predictive Instrument Physician’s Guide. Please refer to this document for this information.

Using the TPI and ACI-TIPI Applications

To use the TPI and ACI-TIPI applications, you must configure the cardiograph and enable the appli cations. There are several types of reports that are produced by the cardiograph. These reports are summarized in Table 3-1.

3-3

Overview

T able 3-1 PageWriter XLi Reports

Report Type Contents of Report Notes

Standard 09 (Std 09) ECG waveforms, mea-

surements, ECL 09 Adult Interpretation

Standard P4 (Std P4) ECG waveforms, mea-

surements, ECL P4 Pediatric Interpretation

ACI-TIPI (T0) ECG waveforms, TIPI

Analysis, No Risk Management Report

Risk Managemen t Risk Management Report

—1 page summarizing clinical information and can be used by the Clinician to docu ment clinical decisions

TPI (H0) ECG waveforms, TPI

Analysis

Only available when T0 is enabled The ACI-TIPI Report will also be printed.

Analyzing an ECG with the Predictive Instruments

The flexibility of the Page Writer XLi allows you to configure the Predictive Instruments based on the type of patients presenting in your clinical setting. Using the Configuration Menu, you can set up your cardiogr aph to provide the desired analysis .

When first turned on the PageWriter XLi cardiograph will have the Special Applications turne d off. The Special Application choices are part of the Global Configuration Menu and enable access to the following settings.

3-4 Understandin g the P ageWriter XLi Speci al Applications

T able 3-2 Special Applications Setti ngs

Overview

Parameter Choices

Research Leads Off/VX 1-V X 4 / V 4 R-V 8 Off Default Adul t Cr iteria 09/P4 09 Default Pediatric Criteria 09/P4 P4 Patient ID Criteria On/Off Off ACI-TIPI On/Off Off Risk Mgmt. On/Off Off Risk Range 0%-100% TPI On/Off Off Screening On/Off Off Leads Normal/Cabrera Normal Storage Mode Standard/Special Normal VCG Off/vcg1/vcg2/vcg3/vcg4 Off Default Storage Cri teria Def Adult/Ped, TIPI, TPI Def Adult/Ped

Default value when Special Apps =

off

It is important to under stand that it is possi ble to set the Defaul t Adult Crite ria and the Default Pediatric Criteria to be either 09 or P4. This flexibility is designed for unusual clinical settings, and you should always be aware of just how your cardiograph is set up.

Generat ing Reports with the Special Applications Off

This method of working enables any kind of report to be generated, however it does not allow for generation of multiple simul taneous reports. Through the top level "Auto Analysis" menu, you can specify the kind of report to be made. There are five choices availa ble: Adult, Pediatric, TIPI, or TPI, or Default.

3-5

Overview

For each of these report options, here are the resulting reports given that Special Applications are Off and the Auto button has been pressed:

Adult - The XLi will do an 09 report (regardless of patient age).

Pediatric - The XLi will do a P4 report (regardless of patient age).

TIPI - The XLi will do a TIPI report. A Risk Management report wi ll not be generated.

TPI - The XLi will do a TPI report. TPI screening will not occur.

Default - The XLi will do an 09 report if the age is unspecified or above 15 years. The XLi will do a P4 report if the age is 15 years or less.

1. From the main display, press the key until ’Auto Analysis’ appears.

2. Press the key to select the desired report format.

Generat ing Reports with the Special Applications On

It is possible to configure the PageWriter XLi to produce multiple reports. When the settin g for Specia l Applic ation s is turned t o On, and t he Auto butt on is pressed, there are five choices of reports available - Adult , Pedia tric, ACITIPI, TPI or Default. The first four choices and their resulting outcomes are described below:

Adult - The XLi wil l do the Default Adult Criteria Report (regardless

of the patient’s age).

Pediatric - The XLi will do the Default Pediatric Criteria Report (regardless of the patient’s age).

ACI-TIPI - The XLI will do a TIPI report. Also, if the Risk Management Report i s set to o n in the S pecial Applicati ons M enu and the ACI-TIPI Report risk factor falls within the limits set up, a Risk Management Report will be produced.

TPI - The XLi will do a TPI report. TPI Screening will not occur.

3-6 Understandin g the P ageWriter XLi Speci al Applications

Overview

Auto Analysis and the Default Choice

If the Default choice is selected from the Auto Analysis menu, multiple reports may be produced when the Auto button is pressed, depending on what has been enabled in the Special Applications in the Global Configuration Menu.

TPI - If TPI is on and TPI Screening is off, a TPI report will be generated. If TPI is on and TPI Screening is On and the TPI Analysis Criteria are met, a TPI report will be gene rate d. If both TPI and TPI Screening are on, but the TPI Analysis Crite ria are not met, a TPI report will not be generated.

ACI-TIPI - I f ACI-TIPI is on, this will be the next report produced. If the Risk Management Report is also on and the ACI-TIPI calculated risk is between the low and high risk limits as set up in the Special Applications, then a Risk Management report will be produced.

Standard ECG (consisting of one of the following): Patient ID Criteria Off - The XLi will do the Default Adult Repor t if

the patient’s age is spe cifie d as ove r 15. If the patie nt’s age is 15 years or under, the Default Pediatric Report will be produc ed. Patient ID Criteria On and Patient ID Criteria Loaded - This custom interpretation report will be generated. Patient ID Criteria On but Patient I D Criteria No t Loaded - A Null report will be produced.

Patient ID Criteria On but Patient I D Criteria No t Entered by the User - The XLi will do the Default Adult Report if the patie nt’s age is

specified as ove r 15. If the patie nt’s age 15 yea rs or under, the Defa ult Pediatric Report will be produc ed.

Vectorcardiography - If VCG is on and at least one of the X, Y or Z leads is included as a rhythm lead in the repor t type , a nd Research leads is set to off, then the XLi will produce a VCG report.

3-7

Overview

Generating a STAT ECG Report

If your cardiograph has been configured with the Special Applications On, and with TPI and/or TIPI interpre ta tions enabled, you may omit these interpretations by running a "STAT" ECG. A STAT ECG is guaranteed to generate a single stand ard repor t (typically 09 Adult Criteria or P4 Pediatric Criteria) without the need for Patient ID information. A STAT ECG is initiated by pressing the AUTO key twice in succession. A STAT report is produced even if "Print Auto = OFF" in the global configuration menu.

3-8 Understandin g the P ageWriter XLi Speci al Applications

4 Choosing Report Featu res

This chapter describe s the vari ous ECG reports and how to print the Extended Measurements report.

ECG Formats

The Auto Report

Twelve-lead Auto reports display a ten second ECG in an Auto 3 x 4, Auto 3 x 5, Auto 4 x 4 or Auto 6 x 2 format. The Auto 3 x 4 format displays consecutive 2.5 second segments of 12 leads, three leads at a time. The Auto 3 x 5 format displays consecutive 2 second segments of 12 leads with the 5th lead column showing the extended pediatric leads, V3R, V4R, and V7. The Auto 4 x 4 format displays consecutive 2.5 sec ond segments of 12 leads with the 4th row consisting of the extende d rese arch leads VX1-VX4 or V3R, V4R, V7, and V8. The Auto 6 x 2 format displays consecutive 5 second segments of 12 leads, six leads at a time. One or three leads c an be displa yed as rhythm strips at the bottom of Auto 3 x 4 and Auto 3 x 5 reports. The rhythm strips show the same 10 second s egments as in the Auto 3 x 4 or Auto 3 x 5 section of the report. The Auto 4 x 4 report can show 1 rhythm strip.

Auto Report Information

The Auto report may be printed with patient I D inform ation only or with various types of analysi s information included. You can select which information appear s on the printe d report. See Chapter 6, Configuri n g Your Cardiograph, for informat ion on choosing which features will be printed on the report.

4-1

ECG Formats

Basic Measurements Re port. The Basic Measu rements report has pat ient ID information and basic measurements for the ECG. These measurements, which include heart rate, interval and axis measurements, are in the table below with their abbreviations on the report.

T able 4-1 Basic Measurements

Symbol Description Units

Rate heart rate beats per minute PR PR interval milliseconds QRSD QRS duration m illiseconds QT QT interval milliseconds QTc QT interval corrected for rate milliseconds P Frontal P axis degrees QRS Frontal mean QRS axis degrees T Frontal T axis degrees

4-2 Choosing Report Feat ures

ECG Format s

Severity Report. This report shows a summary statement of the severity derived from the ECG interpret ation. There are five ECG severities:

Normal

Otherwise Normal

Borderline

Abnormal

Defective Data

Interpretive R ep o rt. The Interpr etive report includes basic measurement information as well as statements from the analysis of the extended measurements derived from medica l and technical criteria. This report a lso shows a summary statement of the severity of the ECG interpretation.

Reasons Report. The Reasons report includes all of the features included on the Interpretiv e report as well as summarized reasons for each interpretative statemen t. The reason for each state me n t prov ide s a sum m ary of the cri te ria which were met in order to print the interpretive statement.

4-3

ECG Formats

Find

Extended M ea su rem ents Report. The Extended Measurements report lists the measurements which determine a suggested interpretation. This two page report summarizes the morphology and rhythm characteristics for the individual lead waveforms and rhythm groups in the ECG.

To print the Extended Measurements report for a stored ECG:

1. Insert the disk wit h the ECG for which you want extended measurements.

2. Press until the following display appears.

Transmit Store Config CheckDisk Files

3. Press . The display becomes:

4. Press . The display becomes:

5. Press or until the correct patient ID number appears.

Files

Delete Log Edit Print Files

123456 09-23-90 11:25:51 AM Select Print Next Previous More

Then press . Or:

If you know the ID number of the ECG you want to print, press ,

Select

then .

ore

4-4 Choosing Report Feat ures

ECG Format s

Extended

T ype the patient ID number, then press . The most recent ECG

Enter

with that patient ID number appears. If you want a different ECG for that patient, you must scroll through the list by pressing . Then press .

Select

Continue with the followin g steps .

6. Press and then . If your cardiograph has been configured to

Select

print "Choice", the following display appears.

Choose desired analysis for print. None Measure Interp. Reasons More

Press and the following display appears.

Choose desired analysis for print. Extended Sev.only More

See Chapter 6, Configuring Your Cardiograph for information on configuring your cardiograph to print the Extended Measurements report if it hasn’t been set up to do so.

7. Press .

8. The message, "Printing 1 of 1 ECG(s)’’ will appear and the two-page Extended Measurements report will be printed on the cardiograph.

You can also configure the cardiograph for "Choice" in order to print this report when copying an ECG.

4-5

ECG Formats

Manual Formats

Manual ECGs print continuously after you press until you press

Stop

. Manual ECGs are printed as the ECG waveform occurs.

Manual

The Manual Lead Sets

Manual mode is used for monitorin g rh ythm over an e xtended pe riod. Besides standard lead combinations, you can configure your own lead combinations for Custom Manual 3 or 6 leads. See Chapter 6, Configuri ng Your Cardiograph for information a bout selecting different lead combinations in Manual mode. Besides the conventio nal 12 leads, you may use one of the following sets of supple mental leads:

pediatric leads V4R, V3R, V7 or Frank leads X, Y, Z or generic research le ads VX1, VX2, VX3, VX4 or right chest / post erior research

leads

V4R, V3R, V7, V8

The following tables show lead selec tion choices.

T able 4-2 Manual Standard Leads

Number of

Leads

3 I, II, III

aVR, aVL, aVF V1, V2, V3 V4, V5, V6

6 I, II, III, aVR, aVL, aVF

V1, V2, V3, V4, V5, V6

12 I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

4-6 Choosing Report Feat ures

Lead Cho ices

Default Custom Lead

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

T able 4-3 Manual Standard + Pediatri c Leads

ECG Format s

Number

of Leads

3 I, II, III

aVR, aVL, aVF V1, V2, V3 V4, V5, V6 V3R, V4R, V7

6 I, II, III, aVR, aVL, aVF

V1, V2, V3, V4, V5, V6 I, aVF, V2, V3R, V4R, V7

12 |I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

I, II, aVF, V4R, V3R, V1, V2, V3, V4, V5, V6, V7

Number

of Leads

3 I, II, III

aVR, aVL, aVF V1, V2, V3 V4, V5, V6 X, Y, Z

Lead Cho i ce s

T able 4-4 Manual Standard + Frank Leads

Lead Cho i ce s

Default Custom Le ad

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

Default Custom Le ad

Choices

I, aVF, V2

6 I, II, III, aVR, aVL, aVF

V1, V2, V3, V4, V5, V6 I, aVF, V2, X, Y, Z

12 I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

I, II, aVF, V1, V2, V3, V4, V5, V6, X, Y, Z

II, aVF, V1, V2, V4, V6

4-7

ECG Formats

T able 4-5 Manual Standard + Generic Research Leads

Number

of Leads

Lead Cho i ce s

3 I, II, III

aVR, aVL, aVF V1, V2, V3 V4, V5, V6 VX1, VX2, VX3

6 I, II, III, aVR, aVL, aVF

V1, V2, V3, V4, V5, V6 I, aVF, VX1, VX2, VX3, VX4

12 I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

I, II, V1, V2, V3, V4, V5, V6, VX1, VX2, VX3, VX4

Table 4-6 Manual Standard + Right Chest / Posterior Research Leads

Number

of Leads

Lead Cho i ce s

3 I, II, III

aVR, aVL, aVF V1, V2, V3 V4, V5, V6 V4R, V3R, V1 V6, V7, V8

Default Custom Le ad

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

Default Custom Le ad

Choices

I, aVF, V2

6 I, II, III, aVR, aVL, aVF

II, aVF, V1, V2, V4, V6 V1, V2, V3, V4, V5, V6 I, aVF, V4R, V3R, V7, V8 I, aVF, V2, V6, V7, V8

12 I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

I, II, V4R, V3R, V1, V2, V3, V4, V5, V6, V7, V8

4-8 Choosing Report Feat ures

T able 4-7 Manual Cabrera Leads

ECG Format s

Number

of Leads

3 aVL, I, -aVR

II, aVF, III V1, V2, V3 V4, V5, V6

6 aVL, I, -aVR, II, aVF, III

V1, V2, V3, V4, V5, V6

12 aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6

Number

of Leads

3 aVL, I, -aVR

II, aVF, III V1, V2, V3 V4, V5, V6 V3R, V4R, V7

6 aVL, I, -aVR, II, aVF, III

V1, V2, V3, V4, V5, V6 I, aVF, V2, V3R, V4R, V7

Lead Cho i ce s

T able 4-8 Manual Cabrera + Pediatric Leads

Lead Cho i ce s

Default Custom Le ad

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

Default Custom Le ad

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

12 aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6

I, II, aVF, V4R, V3R, V1, V2, V3, V4, V5, V6, V7

4-9

ECG Formats

T able 4-9 Manual Cabrera + Frank Leads

Number

of Leads

Lead Cho i ce s

3 aVL, I, -aVR

II, aVF, III V1, V2, V3 V4, V5, V6 X, Y, Z

6 aVL, I, -aVR, II, aVF, III

V1, V2, V3, V4, V5, V6 I, aVF, V2, X, Y, Z

12 aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6

I, II, aVF, V1, V2, V3, V4, V5, V6, X, Y, Z

T able 4-10 Manual Cabrera + Generi c Research Leads

Number

of Leads

Lead Cho i ce s

3 aVL, I, -aVR

II, aVF, III V1, V2, V3 V4, V5, V6 VX1, VX2, VX3

Default Custom Le ad

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

Default Custom Le ad

Choices

I, aVF, V2

6 aVL, I, -aVR, II, aVF, III

II, aVF, V1, V2, V4, V6 V1, V2, V3, V4, V5, V6 I, aVF, VX1, VX2, VX3, VX4

12 aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6

I, II, V1, V2, V3, V4, V5, V6, VX1, VX2, VX3, VX4

4-10 Choosing Report Feat ures

ECG Format s

Table 4-11 Manual Cabrera + Right Chest / Posterior Research Leads

Number

of Leads

3 aVL, 1, -aVR

II, aVF, III V1, V2, V3 V4, V5, V6 V4R, V3R, V1 V6, V7, V8

6 aVL, I, -aVR, II, aVF, III

V1, V2, V3, V4, V5, V6 I, aVF, V4R, V3R, V7, V8 I, aVF, V2, V6, V7, V8

12 aVL, I, _aVR, II, AVF, III, V1, V2, V3, V4, V5, V6

I, II, V4R, V3R, V1, V2, V3, V4, V5, V6, V7, V8

Lead Cho i ce s

Default Custom Le ad

Choices

I, aVF, V2

II, aVF, V1, V2, V4, V6

4-11

ECG Formats

4-12 Choosing Report Feat ures

5 ECG Storage

This chapter contains inform ation about storing ECGs on a flexible disk. Information about usi ng and printing the ECG-Log and the Store-Log is also included.

Advantages of Disk Stora ge

Storing ECGs to disk allows you to recall the ECGs later as needed. Individual ECGs can be reca lled for editi ng patien t infor mation, re-analyzing, or printing. Groups of ECGs can be recalle d from disk for re-analyzing or printing.

ECGs are stor ed in two ways, Standard mode and Special mode. ECGs in Standard mode are store d at 250 s amples pe r second; in Spe cial mode the y are stored at 500 sample s per second. ECGs stor ed in S tand ard mode cont ain only the waveform segments print ed on the Auto repor t; ECGs stored in Special mode contain a full ten seconds of information for all leads. More than 100 ECGs can be stored on a disk in Standard mode; approximately 35 ECGs can be stored on a disk in Special mode. Only ECGs stored in Special mode can be re-anal yzed or re-formatted. Refer to the Global Configuration Fields table in Chapter 6, Configuring Your Cardiograph for information about how to configure the storage mode on your cardiograph.

5-1

Advantages of Dis k Storage

12 7(

ECGs stored to disk on a PageWriter XLs cardiograph in Special mode, can be analyzed on a PageWriter XLi. To analyze the ECG from the disk, press

from the main menu, then press . You may then select the

Files

Analyze

ECGs to analyze.

Storing Reports with the Special Applications Off

Should you decide to store the ECG report just taken, press Store. The report stored will always be the one just generated.

This will not change the global cardiograph configuration. The cardiograph will revert to the last saved storage/transmission configuration options if the cardiograph is powered off.

Storing Reports with the Special Applications On

For the report choices of, Adult, Pediatric, TIPI, and TPI, if you press Store, the report stored wil l always be the one just generated, with the exception that the Risk Management Report is never stored.

Storing Reports Using Auto Analysis and the Default Choice

If Auto Analysis is set to Default, and if the user presses Store, the report stored will be the Default Store report type that the user has previously defined in the Gl obal Menu settings. In the ca se where a TPI report is not produced, and the choice for Default Store type is TPI, the "Standard" ECG report will be stored instead.

Automatically Storing Reports Using Forced Auto-Store

The PageWriter XLi may be configured, under the Global Configuration Menu, to store an ECG even if patient ID information has not been entered. If the answer to the Global Configuration question, "AutoStore?" [Ye s | No | Force] is entered as "Force", the ECG will be stored with an ID of "Unknown".

5-2 ECG Storage

Disk Handling and Maintenance Instructions

Disk Handling and Maintenance Inst ructions

The following instruc tions will prevent ECG disk damage and data loss.

Never manually open the silver shutter on the disk.

Do not expose the disk to direct sunlight, extremes of temper at ure or humidity, magnetic fiel ds or dust .

Place the disk in a protective cover when the disk is not inside the drive.

Store disks in a clean, dry place.

Do not eject the disk, move the cardiograph or turn off the cardiograph when the disk is active in the drive. The disk is active when the drive access light is on.

Clean the disk drive with a wet-dry cleaning kit regularly. Wetdry cleaning kits are available from local computer stores.

Clean the disk drive every six months unless the working environment is parti cul arly dusty or dirty. Clean the drive more often in dusty or dirty environment s.

TraceMaster ECG Management System users:

If you transfer ECGs to the TraceMaster System by disk, clean the TraceMaster drive every six months unless the working environment is particularly dusty or dirty. Clean the drive more often in dusty or dirty environments.

Replace the disk s regularly. The recommended inte rval is every three months. If the disks are used for more than 50 ECGs per day, replace the disks more frequently.

For best results, use only Hewlett-Packard recommended disks. (HP part number M1700-89004)

For more information, contact your Hewlett-Packard service representati ve.

5-3

Using the ECG-Log and Store -Log

Using the ECG-Log and Store-Log

The cardiograph automatically maintains two ECG logs. The ECG-Log is a list of the last 60 Manual and Auto ECGs recorded on the cardiograph. The latest ECG has the highest number. When more than 60 ECGs fill the list, the earliest ECGs disappea r from the list.

The Store-Log lists all Auto ECGs stored on the flexible disk which is in the cardiograph’s disk drive. The Store-Log is updated automatically when you store an ECG and when you delete a stored ECG from the flexible disk.

5-4 ECG Storage

Using the ECG-Log and Store -Log

A The last 60 ECGs which have been recorded. B Location number which includes the institution, department an d cardiograph codes. C Date and time of the report.

)LJXUH7KH(&*/RJ

T able 5-1 The ECG-Log.

GHI

Description

D Numerical ord er in which the ECG was recorded. E Date and time when the ECG was recorded. F Patient name and identification number. G ECG format and mode. H Initial s of the person who recorded the EC G. I Department in which the ECG was recorded. J Institution, department and cardiograph identification number. K ECG storage indication.

5-5

Using the ECG-Log and Store -Log

AB D

A The ECGs which are stor ed on the flexible disk which is in the ca r diograph. B Number of ECGs stored on the flexible disk. C Percentage o f space available o n th e disk D Date and t i me of the repor t. E Numerical order in which the ECG was stored. F Date and time when the ECG was recorded.

)LJXUH7KH6WRUH/ RJ

T able 5-2 The Store-Log

HI J

Description

MNO

G Patient name and ide n tification number. H ECG format. I Initials of the person who recorded the ECG. J Department in which the ECG was recor d ed. K Institution, department and cardiogr aph identificati on numb er. L S - ECG storage mode. (Standard is 250, Special is 500; 3x5 and 4x4 Reports are 500; SAECG is SAE) M T - Indication that ECG was transmitted. For 3x5 and 4x4 Reports a "-" will appear. N E - Patient ID information edited, Yes or No. O A - Criteria used to interpret the ECG.

5-6 ECG Storage

Using the ECG-Log and Store -Log

Manual

Log

Store-Log

Printing ECG Logs

T o print an ECG-Log or Store-Log:

1. Press until the following display appears.

Transmit Store Config CheckDisk Files

2. Press the softkey. The following display appears.

Delete Log Edit Print Exit

3. Press the softkey. The following display appears.

ECG-Log Store-Log Exit

4. Press the softkey to print a list of recorde d ECGs. Press the

Files

Log to Print

ECG-Log

softkey to print a list of stored ECGs.

5-7

Using the ECG-Log and Store -Log

5-8 ECG Storage

6 Configuring Your Cardio g rap h

Config.

Your cardiograph can be configured to meet the requirements of your institution . Typically the cardiograph is configured only during ini tial installati on. This c hapter describes overall (Global ) configuration, patient ID entry configurat ion, and how to print and save the configuration information that you have selected.

127(

Before changing your cardiogr aph’s configurati on, you might want to print the current configuration settings. Refer to instructions on printing configuration at the end of this chapter.

Using Configuration Menus

This section describes how to configure the cardiograph’s operating features. Each configuratio n menu choice is described briefly in a list, then in more detail in the section that follows the list.

1. Press until the following display appears:

Trans mi t Store Config CheckDisk Files

2. Press The main configuration menu will appear:

Configuration File Jobs

Global ID Trans mi t Files Exit

If this is not the initial configuration, you may need to type the configured password before you can make any changes to the configuration.

6-1

Using Configuration Menus

Global

Tran smit

Here are the basic descriptions for each softkey in this menu:

Allows you to set the oper ating pa rameters for the cardiograph. The Global configuration affects all cardiograph operations.

12 7(

Files

Exit

Allows you to choose which patient ident ificati o n en tries are requested before recording an ECG.

Allows you to set the communication parameters required for transmitting and receiving ECGs.

Allows you to store a copy of the cardiograph configuration and software to flexibl e dis k, or to print the configuration settings.

Returns you to the main menu.

When you make changes to the system configuration, it is recommended that you save the configuration on a fle xible disk. If you must reload the configuration , restoring a custom configuration is much quicke r and easie r from a flexible disk than by re-entering the changes manually. Refer to "Storing the Config uration Information" late r in this chapter for more information.

T wo cases where you would need to use the configuration infor mation from the disk are if you lose battery power or if different configurati ons are regularly used in your institution.

6-2 Configuring Your Cardiograph

Selecting Configuration Parameters

Choose

Selecting Configuration Para me ters

When you select or change configuration parameters, the method is generally the same whether you are selecting Global, Transmit, or ID parameters. The display will be similar to this f irst parameter in the Global list:

Initial Interpretation? Reasons Enter Choose Previous Exit

The message line on top displays the parameter and its current setting. The softkey labels are displa ye d on the bottom line.

Enter

Tab

Leads

Accepts curre nt se tting, then a dvan ces to t he next param eter in the lis t ; o r returns to th e menu if p r ess e d wh en the last param e t er in th e list is dis p la yed.

Advances through the list of choices for the specified parameter.

Appears only for the custom lead group parameters in the Global list. Used to select the leads for the custom format.

Used to se lect rhyth m lea ds in " Def ault Auto? " pa ramet er in Global configuration.

Returns to t he previous display (does not appear on the first display).

Exit

Returns to the ma in menu.

6-3

Understanding Global Configura tion

Config.

Global

Understanding Global Configurat ion

T o change any configuration se ttings, follow these steps. Detailed informati on about the parameters fol lows these instructions in Table 5-1.

1. Press until the following display appears:

2. Press The main configuration menu will appear:

3. Press and the following display will appear.

Trans m i t St ore Config CheckD isk Files

Configuration

Global ID Transmit Files Exit

Initial Interpretation? Reasons Enter Choose Previous Exit

T able 6-1 lists each Global parameter and its choices. The factory default settings are shown in boldface type. There are explanations following the table for those parameter s tha t cannot be fully explained in the table’s Comments column.

6-4 Configuring Your Cardiograph

T able 6-1 Global Configuration Fields

Parameter Setting Choi ces Comments

Initial Interpretation? Re asons

None Measure Interpret Severity only

Understanding Global Configuration

See "Interpretation Parameters" section following table.

Copy Interpretation? Reasons

Extend Measure None Severity only Choice Measure Interpret

AutoStore? Yes

No Force

Patient ID required?

Yes

Auto Frequency Respons e? .15-150 Hz

.05-150 Hz .5-150 Hz W .15-40 Hz .5-40 Hz W .05-100 Hz .15-100 Hz .5-100 Hz W

See "Interpretation Parameters" section following table.

Determines whether an Auto ECG is automatically stored without operator intervention.

Appears only if AutoS tor e is "No". Deter m i n es w h et he r th e cardiograph wil l require patient ID information before recording an Auto ECG. If AutoStore is "Yes", this parameter is "Yes".

W = Baseline Wander filter. See Hewlett-Packard Interpretive Cardiogr aph Physic ian’s Guide for more information.

6-5

Understanding Global Configura tion

Parameter Setting Choi ces Comments

Manual Frequenc y Response? .5-40 Hz W

.05-40 Hz

.5-100 Hz W .05-100 Hz .5-150 Hz W .05-150 Hz

Line Power Filter? Off

Line Power Frequency? 60 Hz

50 Hz

Filter Key? BaselineWander & Artifact

BaselineWander Artifact

Auto print speed? 25 mm/sec

50 mm/sec

Default Auto? 3 x 4

3 x 4,1R (I) 3 x 4,3R (I, II, III) 6 x 2 3 x 5 3 x 5,1R (I) 3 x 5, 3R(I, II, III) 4 x 4 4 x 4,1R (I)

W = Baseline Wander filter. See

Hewlett-Packard Interpretive Cardiogr aph Physic ian’s Guide for

more information

A software filter that removes power line (AC) interference.

No default -- selected during software installa tion fo r use by l ine power filter.

Determines which filter combinations are active when

Filter

Default Auto ECG print s peed, can be overridden from the front key panel.

Default format for Auto ECGs.

H Plug Shorted

Special Apps . = Yes, Research Set

key is "On"

Default Manual? 3

6 12

Leads? AHA

IEC

6-6 Configuring Your Cardiograph

Default format for Manual ECGs.

Sel ects betw e e n two lead naming conventions. Af fects lead l abels on reports.

Understanding Global Configuration

Parameter Setting Choi ces Comments

Custom 3 lead group? I aVF V2 You can set any combin ation o f th e

available leads fo r routine usage. See explanations following table.

Custom Manual 6? II aVF V1 V2 V4 V6 You can set any combin ation o f th e

available leads fo r routine usage. See explanations following table.

Units of Measure? English (lb/in)

Metric (kg/cm)

Print Int er pretation? Reasons

Extend Measure None Severity only Choice Measure Interpret

Tim e format? AM/PM

24 Hr

Tim e s e parato r? HH:MM:SS

HH.MM.SS

Date format? M M/DD/YYYY

DD/MM/YYYY YYYY/MM/DD

Date separator? MM/DD/YYYY

MM.DD.YYYY MM-DD-YYYY MM DD YYYY

Decimal format? XXX,XXX.XX

XXX.XXX,XX

Used for height and weight entry

See "Interpretation Parameters" section following table.

Paper size?

A (8.5 x 11 in) A4 (210 x 297 mm)

6-7

Understanding Global Configura tion

Parameter Setting Choi ces Comments

Auto Print?

Yes

AutoCopy? Yes

Allows or suppresses the printing of an Auto ECG. If Auto Stor e = No, the Auto Print Choice of No is invalid.

See explanation following table.

Copies? (1-5) Type number between 1 and 5 If AutoCopy is "Yes", selects

number of automatic copies after original recording.

Location code? Type a 5-letter

alphanumeric code. Cart ID? Type a 4-digit code. See explanations following table. Institution Name? Type name,

40 characters maximum Confirmation? PRELIMINARY -

MD MUST REVIEW.

Type a label,

30 characters maximum User A label? T ype a label,

8 chara ct er s maximum

See explanations following table.

User B label? Type a label,

8 chara ct er s maximum Battery timeout?

Set keyboard? lower case

Special applications? No

Resear c h le ads? * No (= Frank Leads)

6-8 Configuring Your Cardiograph

Type minutes between

and 999.

UPPER CASE

Yes

Yes (= Research Leads)

See explanations following table.

See explanation following table.

Allows config ur ation of resea r ch leads, ECG storage mode, and lead system.

Used for four additional le ads.

Understanding Global Configuration

Parameter Setting Choi ces Comments

Default Adul t Cr iteria?*

Default Pediatric Criteria?*

ID criteria version entry?*

Yes

Default ID criteria ve rsi on?* Typ e version,

2 character maximum

ECG storage mode?* Standard

(250 samples/sec ond)

Special

(500 samples/second)

Lead syst e m?

VCG? Off | VCG1 | VCG2 | VCG3 |

HP ACI-TIPI? Off | On Risk Mgmt Report? Off | On

Standard

Cabrera

VCG4

09, P4, T0, H0 or custom.

Special al lows ECGs to be reanaly zed o n a P ag e Write r XL i.

If available.

Low Limit for Risk Mgmt? 0-100 | 10 High Limit for Risk Mgmt? 0-100 | 90 HP TPI? On | Off Auto-TPI Candidate Screen? On | Off Store Analysis Type?

Std Adult/Ped | ACI-TIPI |

HP-TPI

Power on application? XLi

Preview +

SAECG

Allows your cardiograph to start up in the selected ap plication.

6-9

Understanding Global Configura tion

Parameter Setting Choi ces Comments

Password? Type a password, 8 characters

maximum; no spaces

This parameter appears only if "Special Applications" is set to "yes."

Interpretation Parameters.

These parameters deter mine whic h analysis information is included in an ECG report.

Initial Inte rpretation controls the information that appear s on the ECG when it is first taken.

Copy Inter pretati o n controls the information that appears on ECG copies. A copy may be made automatically or when the button is pressed.

Print Interpretation controls the information that appears on a printout of a stored ECG.

The settings are:

None Prints waveform and patient ID. Severity only Prints waveform and ID, severity.

See explanation following table.

Copy

Measure Prints waveform and ID, basic measure ments

summary.

Interpret Prints waveform and ID, basic measurement s

summar y, ECG computer-gener ated interpretation.

Reasons Prints waveform and ID, basic measurements

summar y, computer- g enerated ECG inte r pr e tation wi th in terpret a t io n re as o n statements.

Extend Measure Prints a tabular summar y of all measurements

performed on ECG data.

6-10 Configuring Your Cardiograph

Understanding Global Configuration

Choose

Enter

Choice Allows the u ser to sele ct the le vel of inf or mati on

included when the copy is ma de without having to change the overall instrument configuration.

Line Frequency

This parameter selects the frequency of the filter enabled by the line power filter. The user usually selects the frequency during initial insta llation in response to a prompt . Howe ver, the user will not be prompted when a custom configuration is installed. Including this parameter in Global configuration allows the user to change the frequency selection after initial software installati on.

Selecting Custom Lead Groups

Besides the pre-define d lead gr oups, you can configure one group of three leads and one group of six leads that may be selected for Auto 3 x 4,3R, Manual 3 or Manual 6 reports. These lead groups will appear and be recor de d when you select Custom 3-lead group and Custom Manual 6-lead group reports from the main display.

1. Configure custom lead groups f rom global configurat ion when the display as shown below appears.

Custom 3 lead group I Enter Choose Tab Previous Exit

2. Press to change leads.

3. Use to move to the next lead field. In t his ca se, the ne xt lead f ield is

4. Press to save the selections.

Tab

aVF.

aVF V2

Selecting AutoCopy

When AutoCopy is set to Yes, the cardiograph automatically prints one or more copies (depending on the "Copies" parameter setting) of the Auto ECG

6-11

Understanding Global Configura tion

after the original is rec orded. You may choose interpreta tion features for the copies in the "Copy Interpretation" parameter. When AutoCopy is set to No,

the user must press to receive each additional printed copy.

Selecting ECG Manageme nt Parameters

These parameters eith er tr igger processing protocols on the ECG Management system and ECG WorkStat ion, or provide information for ECG tracking. These parameters include:

Location code A 5-digit code. The first three digits

Cart ID A 4-digit code identifying which

Instit ution Name Identifies the inst itution, such as "City

Copy

represent the ins titution and the last two digits rep r esent the depar tment.

cardiograph recorded the ECG.

General Hospital." Limited to 40 characters.

User A lab el Label such as "Smok er?" or "Temp?" that

appears in ID entry process. Limited to eight c h aracters.

User B label Label such as "Smoker ?" or "Temp?" that

appears in ID entry process. Limited to eight c h aracters.

Selecting Battery Timeout Periods

T o conser ve batt ery power , the cardiogr aph tur ns of f afte r the period spe cified by this parameter. The time is measured from the completi on of the las t operation, the la st key press , or disc onnection of all pa tient l eads. The ti meout function is disabled when the cardiograph is plugged into AC power and the AC switch is on. I f the c ar diograph tu rns off, curren t ID i nformat ion and Copy memory are lost.

6-12 Configuring Your Cardiograph

Turning Off Unused ID Fields

Config

Setting a Password

To protect your configuration settings from casual changes, you can require password entry to access the configuration. This password is set in global configuration .

&$ 87,21

If the password is set and forgotten, you will be unable to change the cardiograph configur ation without re-installing the supplied software.

Turning Off Unused ID Fields

You don’t have to step through all the possible patient ID information each time you enter patient ID. You can turn off the ID fields tha t you don’t use. To turn off ID fields :

1. Press from the main display. The following display appears.

Configuration

Global ID Transmit Files Exit

2. Press the softkey and the following display appears.

Allow NAME entry? Yes Enter Choose Exit

The following list pres ents each configuration opt ion. You choose either "Y es’’ to include or "No’’ to exclude that item from the patient ID informat ion printed on the EC G. "Yes’’ is the defau lt ch oic e fo r all excep t the las t th ree items.

Allow NAME entry?

Allow AGE entry?

Allow SEX entry?

Allow CHEST PAIN entry?

Allow HX DIABETES entry?

6-13

Turning Off Unuse d ID Fields

Allow HX HYPERTENSION entr y?

Allow AC ISCHEMIC Sx TIME entry?

Allow BP entry?

Allow WEIGHT entry?

Allow HEIGHT entry?

Allow RACE entry?

Allow DX entry?

Allow RX entry?

Allow OPERATOR entry?

Allow DEPARTMENT entry?

Allow ROOM entry?

Allow REQUESTED BY entry?

Allow USER A entry? ("USER A" is replaced by the label define d in global configuration.)

Allow USER B entry? ("USER B" is replaced by the label defined in global configuration.)

Allow ECG Mgr Priority entry? used to tell the ECG Management system to process this ECG first.

Storing the Configuration Information

When you press from the main Configuration menu, the following

Files

menu appears on the display:

Configuration File Jobs

Store Print Exit

Store

6-14 Configuring Your Cardiograph

Stores t he ca rdiogra ph confi gura tion on flexible disk.

Prints a copy of the cardi ograph configurati on.

Turning Off Unused ID Fields

Store

Yes

127(

Exit

Store the cardiograph configuration each time it is changed. If the cardiograph’s configuration is lost due to loss of battery power, you will be able to easily restore the cardiograph to its latest configurat ion.

Storing the configuration on a flexible disk allows you to load known configuration settings into the cardiograph.

To store the configuration:

1. Insert a disk with no other information on it into the disk drive.

2. Press , the prompt Enter Disk Label: appears.

This optional label, can be up to 16 char acters long a nd is display ed while the operating system is being installed. Examples of labels are "11/90 Config." or "Dr. Jones Disk."

3. T ype the label and press . The cardiograph displays "Storing cardiograph ’configuration" until storing is complete.

Returns to the main configuration menu.

127(

If the flexible disk you inser ted in the disk drive is new and has not yet been formatted, a question will appear asking if you want the flexible disk

formatted. Press if you want the disk fo rmatted. T his wi ll take a bout 90 seconds. You may also insert a formatted flexible disk at this time.

Using a Stored Configuration

T o use a stor ed configur atio n on another PageW r iter XLi c ardiog raph or if the configuration must be reload ed:

1. Turn off the cardiograph.

2. Insert the configura tion disk.

6-15

Turning Off Unuse d ID Fields

Config

3. Turn on the cardiograph. A display with a disk label similar to the following will appear. The disk label will vary.

Load configuration?

Yes No

4. Press if the label displayed matches the configuration you want to

Yes

11/90 config.

load. Press and the cardiograph configuration will not be altered. Find

Yes the configuration disk tha t you prefer and follow the instructions fr om step 1 again.

5. Remove the configuration disk.

The cardiograph wi ll now operate with the configuration parameters from the disk.

Printing the Configuration

1. Press from the main display. The following displa y appears.

Configuration

Global ID Transmit Files Exit

2. Press . The following display appears.

Files

Configuration file jobs

Store Print Exit

3. Press . The message "Printing cardiograph Configuration’’ appears

on the display until the two page print out is co mplete.

You then return to the Configuration Files menu.

6-16 Configuring Your Cardiograph

7 Setting Up Your Cardiograph for Transmitting

ECGs

This chapter describes how to set up your PageWriter XLi cardiograph for transmitting and receiving ECGs.

127(

Trans mission of 3 x 5 and 4 x 4 ECG Reports to an HP Trac eMaster ECG Management System is not possible . FAX transmission and LaserJet printing of 3 x 5 and 4 x 4 formats is allowed. The LaserJet printer must have a seri al port.

For instructions on how to transmit an ECG, refer to the PageWriter XLi Operating Guide.

PageWr iter XLi cardiographs can send ECGs to the following HewlettPackard pro duc t s:

Another PageWr iter XLi cardiograph

12 7(

HP M1730A and M3700A TraceMaster ECG Management Systems

Class III FAX Machines

All PCL5 printers

The PageWriter XLi cardiograph can receive text reports from the HP M1730A and M3700A TraceMaster ECG Management Systems.

You will only be able to select fro m transmittable ECGs when you

Transmit

press . You cannot transmit Manual ECGs, ECGs recorded with research leads, or ECGs interpreted with a different criteria program version than on the trans mit ting cardiograph. The criteria program is the software used to interpret the ECG.

The receiving instru ment must have the same criteria version installed as the sending Page Writer XLi cardiograph.

7-1

When you configure your cardiograph for transmitting or receiving ECGs, you can configure four possib le sites. This accommodates the various ways that ECGs can be managed. Three typical transmitting situations are:

An ECG can be transmitted from the bedside to an HP ECG Management System for printin g, an al yzing, and storing.

ECGs can be recor ded on rounds and then transmitted t o another area of the institution to a PageWriter XLi cardiograph or an HP TraceMaster ECG Management System.

ECGs can be sent by modem to anothe r institution for overreading or further analysis.

ECGs can be sent by FAX/modem to a FAX machine for overreading or further analysis.

7-2 Setting Up Your Cardiograph for Transmitting ECGs

Transmitti ng ECGs Dir ectly

Transmitting ECGs Direct ly

You may transmit ECGs directly by cable to a Hewlett-Packard TraceMaster ECG Management System. Figure 7-1 shows how to connect the cables you need to connect the ca rd iograph directly.

)LJXUH& RQ QHFWLQJWKH&DE OHVIRU 'LUHFW7UDQVPLVVLRQ

A. PageWriter XLi Cardiograph B. Transmission Cable C. HP ECG Management System Connection

7-3

Transmitti ng ECGs Dir ectly

Config

Transmit

Choose

Configuring the Cardiograph to Transmit ECGs Directly

After connecting the cables, you must configure the cardiograph for direct transmission.

1. Press until the following display appears:

Trans m i t St ore Config C h e c kDisk Files

2. Press . The main configura tion menu will appear:

Configuration

Global ID Transmit Files Exit

3. Press and the Transmit Configurati on menu appears in the display.

Configuration

Transmit Receive AutoDial Exit

4. Press to configure any of four transmission sites.The Configure Site menu will appear:

Configurat ion Site

#1 #2 #3 #4 Exit

5. Select a site number and the following display appears.

Connection? None Global Choose Exit

6. Press until you see the choice Direct Connection, then press

Enter

. The next display will allow you to select the baud rate. When you

choose direct connect ion, the default baud rate will be 9600.

7-4 Setting Up Your Cardiograph for Transmitting ECGs

Transmitti ng ECGs by Telephone to Another Site

Transmitting ECGs by Telephone to Another Site

You can also use a modem to transmit ECGs by telephone to another PageWriter XLi cardiograph or to a Hewlett-Packard Tracemaster ECG Management System.

Installing the Modem (For United States use only)

Before using the M1706B modem you must connect the cables. Figure 7-2 shows how to connect the cables for transmitting ECGs using a modem.

)LJXUH& RQQHFWLQJWKH0 RGHP&DEOHV

7-5

Transmitti ng ECGs by Telephone to Another Site

A. PageWriter XLi Cardiograph B. Modem Pow er Cor d C. Modem D. Phone Line Connector E. Modem Data Cable

Refer to Figure 7-2 and perform the following steps to install the modem.

1. Turn the cardiograph to Standb y.

2. Turn the modem power switch off.

:$51,1*

127(

12 7(

(TXLSPHQW FRQQHFWHG WRWKHFDUGLRJUDSK·V56FRQQHFWRUFDQF DXVHJURXQG OHDNDJHFXUUHQ WH[FHHGLQJWKHP D[LPXPVSHFLILHGLQ8/,(&VDIHW\ VWDQGDUGV'R QRWFRQQHFW DQ\HTXLSPHQWWRWKH56FRQQHFWRUGXU LQJ FDUGLRJUDSKRSH UDWLRQZKHQWKHSD WLHQWFDEOHLVFRQQHFWHGWRDSDWLHQW 

Make sure that the battery level is sufficient to prevent any loss of configuration settings and software in the cardiograph when AC power is removed. Check the "Battery Level" indicator lights on the cardiograph’s key panel to ensure that they are all on.

3. Turn the cardiograph AC switch off.

4. Insert the lar ger connecto r end of the modem cable (24252M) into the RS232C plug on the back of the modem. Tighten the retaining screws.

5. Insert the smaller end of the modem cable into the plug on the back of the cardiograph marked "Data Comm’’. Ti ghten the retaining screws.

Connect the modem to the cardiograph and to the telephone line in the following order. This will avoid the possible electr ical haza rds from the outl et and telephone line.

6. Plug the modem power cable into the plug on the modem marked "9.0V ~AC".

7-6 Setting Up Your Cardiograph for Transmitting ECGs

Transmitti ng ECGs by Telephone to Another Site

Config

7. Plug the other end of the modem power cable into the cardiograph.

8. Insert either end of the telephone cable into the connector on the back panel of the modem marked "To Line".

9. Insert the free end of the telephone cable into the telephone wall jack.

10. Plug the cardiogr aph power ca ble int o the car diograph a nd an AC ou tlet if they are not already plugged in.

11. Turn the cardiograph’s AC power switch on.

12. Turn the modem on.

13. Turn the cardiograph on.

Connecting a Telephone to the Same Line as the Modem

To connect a telephone to the same line as the modem:

1. Connect one end of the telephone cable to the telephone.

2. Plug the free end of the cable into the modem connector marked "To Phone".

The modem is now installed and ready for use. You must configure the cardiograph for modem usage before transmitting ECGs.

Configuring the Cardiograph for Modem Usage

T o transmit ECGs by te le phone from the cardiogr aph, you must configure the cardiograph in the following way:

1. Press until the following display ap pears:

Transmit Score Config CheckDisk Files

2. Press . The main configuration menu will appear:

Configuration

Global ID Transmit Files Exit

7-7

Transmitti ng ECGs by Telephone to Another Site

Transmit

3. Press and the Transmit Configuration menu appears on the display.

Transmit Receive AutoDial Exit

4. Press to configure any of four transmission sites. The Configure Site menu will appear:

#1 #2 #3 #4 Exit

5. When you select a site number, the following display appears .

Connection? None Enter Choose Exit

The following table lists which settings to choose when using a modem. Each site may have differe nt requirements.

Configurat ion Site

Parameter Choice

Baud Rate? 9600 Connection? Programmable Modem Phone #? Type phone number, 36 characters m ax. Dial Type ? Tone

Pulse

Pause Length? 2, 4, 6, 8, 10 (secs)

7-8 Setting Up Your Cardiograph for Transmitting ECGs

Entering the Phone Number

Choose

Transmit

Transmitti ng ECGs by Telephone to Another Site

When you enter the phone nu mber for a site , there are three c haracters,

T one

",", "w", and "X" you might need to use with the numbers. These characters are inser ted in the phone number by pressing for "," and

for "w".

Tone

"," inserts a pause in the number dialing seq uence to avoid dialing

Pause errors if the number is sent too rapidly. An example would be "1,234,567,8900. " Select the length of the pause with the pause length parameter.

"w" instructs the modem to wait for a dial tone before complet ing the

T one dialing sequence. You will typically use this when you must dial for an outside line before dialing the called number. For example, "9w567,8900" instructs t he modem to dial t he "9," then wait for a dial tone before it dials the rest of the number.

Entering an "X" from the keypanel instructs the modem not to wait for a dial tone. This might be required when you dial through a PBX system or with some non-U.S. modems. For example, "X567,8900" instructs the modem not to wait for a dial tone before it dials the rest of the number.

Pause

Configuring the Cardiograph for AutoDial

AutoDial is for users who always transmit to the same site. To configure the cardiograph for AutoDial:

1. Select from the Transmit Configuration menu. The cardiograph

2. Press to select the site (#1, #2, #3, or #4) to which the

AutoDial

displays the following menu:

AutoDial Site? None

Enter Choose Exit

cardiograph will automatically transmit when the operator presses

7-9

Transmitti ng ECGs by Telephone to Another Site

3. Press and the selected site will be set. The displ ay will return to the

Enter

transmission configur ation menu. If you have not already configured the transmission site , you can co nfigure it from this menu.

Installing the Modem on the Cart

After the M1706B modem is c onfigured, you can insta ll it on the cardiogr aph cart as shown in Figure 7-3.

)LJXUH$WWDFKLQJWKH0RGHPWRWKH&DUW

To attach the mode m t o the cart :

1. Thread the knobscrew into the threaded hole on the underside of the

crossbar on the cart but do not tighten it.

2. From the back of the cart, set the modem on top of the crossbar with the

front of the modem (the display end) to your left. Make sure that it fits between the two guides molded into the paper tray on the cart.

3. Install the modem bracket and tighten the knobscrew.

7-10 Setting Up Your Cardiograph for Transmitting ECGs

Transmitting ECGs by FAX to Another Site

You can use the M1706B FAX/modem to transmit ECGs by telephone to another PageWriter XLi cardiograph or to any Class III FAX machine. The FAX/modem can be used for transmitting as a normal modem as well.

:$51,1*

6RPH*URXS,,,ID[PDFKLQHVGLVWRUWWKHUHFHLYHGID[WUDQVPLVVLRQE\FRPSUHVVLQJ WKHLPDJHWRILWWKHYLHZLQJRUSULQWLQJGHYLFH7KLVGLVWRUWLRQFDQDIIHFWWKH DPSOLWXGHDQGWLPHVFDOHRIDQ(&*WUDQVPLWWHGE\ID[

)RUH[DPSOH3&EDVHGID[PRGHPVDQGID[FDUGVZLOOQRUPDOO\FRPSUHVVWKH UHFHLYHGLPDJHZKHQGLVSOD\LQJWKHID[WUDQVPLWWHG(&*RQWKH3&PRQLWRUDQGFDQ FRPSUHVVWKHLPDJHZKHQWKHID[LVSULQWHG

7RGHWHUPLQHZKHWKHUDID[PDFKLQHGLVWRUWVWKHUHFHLYHG(&*ID[\RXZLOOQHHGWR PHDVXUHWKH(&*UHSRUWVJULGVSDFLQJRUWKHFDOLEUDWLRQSXOVHDQGFKHFNWKHVH PHDVXUHPHQWVDJDLQVWWKHSULQWHGVFDOHIDFWRUVVKRZQDWWKHERWWRPRIDSULQWHG (&*UHSRUW7KHJULGLVQRPLQDOO\SULQWHGDWPPLQWHUYDOVLQERWKWKHWLPHDQG DPSOLWXGHGLUHFWLRQV7KHZLGWKRIWKHFDOLEUDWLRQSXOVHLVPVHFDQGLWVKHLJKW UHSUHVHQWVP97KHUHIRUHDQ(&*UHSRUWZLWKD PPP9DPSOLWXGHVFDOHDQG PPVHFWLPHVFDOHVKRXOGKDYHDFDOLEUDWLRQSXOVHWKDWLV PPWDOODQGPPZLGH

7-11

Transmitti ng ECGs by FAX to Anot her Site

Installing the FAX/Modem

Before using t he FAX/modem you must connect t he cabl es as s hown i n Figur e 7-4.

)LJXUH&RQQHFWLQJWKH0RGHP&DEOHV

A. PageWriter XLi Cardiograph B. Modem Pow er Cor d C. Modem D. Phone Line Connector E. Modem Data Cable

Refer to Figure 7-4 and perform the following steps to install the modem.

7-12 Setting Up Your Cardiograph for Transmitting ECGs

1. Turn the cardiograph to Standb y.

2. Turn the modem power switch off.

Transmitting ECGs by FAX to Another Site

127(

&$ 87,21

3. Turn the cardiograph AC switch off.

4. Insert the lar ger connecto r end of the modem cable (24252M) into the RS-

232C plug on the back of the modem. Tighten the retaining screws.

5. Insert the smaller end of the modem cable into the plug on the back of the

cardiograph marked "Data Comm’’. Ti ghten the retaining screws.

Connect the modem to the cardiograph and to the telephone line in the following order. This will avoid the possible electr ical haza rds from the outl et and telephone line.

6. Plug the modem power cable into the plug on the modem marked "9.0 V

~ A C ’’.

7. Plug the other end of the modem power cable into the cardiograph.

8. Insert either end of the telephone cable into the connector on the back

panel of the modem marked "To Line’’.

9. Insert the free end of the telephone cable into the telephone wall jack.

10. Plug the cardiogr aph power ca ble int o the car diograph a nd an AC ou tlet if

they are not already plugged in.

11. Turn the cardiograph’s AC power switch on.

12. Turn the modem on.

13. Turn the cardiograph on.

7-13

Transmitti ng ECGs by FAX to Anot her Site

Config

Transmit

Connecting a Telephone to the Same Line as the FAX/Modem

To connect a telephone to the same line as the FAX/modem:

1. Connect one end of the telephone cable to the telephone.

2. Plug the free end of the cable into the unused modem connector.

The FAX/modem is now installed and ready for use. You must configure the cardiograph for FAX/modem usage bef ore FAXing ECGs.

Configuring the Cardiograph for FAX Usage

T o F AX ECGs by teleph one from the cardiograph, you must configure the cardiograph in the following way:

1. Press until the following display appears:

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The main configuration menu will appear:

Configuration

Global ID Transmit Files Exit

3. Press and the Transmit Configuration menu appears on the

display.

Configuration

Transmit Receive AutoDial Exit

4. Press to configure any of four transmission sites. The

Configure Site menu will appear:

Configurat ion Site

#1 #2 #3 #4 Exit

7-14 Setting Up Your Cardiograph for Transmitting ECGs

Transmitting ECGs by FAX to Another Site

Enter

Exit

5. When you select a site number, the following display appears .

Connection? None Enter Choose Exit

If you wish to step through setting choices, press .

If you wish to select the displayed choice and move to the next field,

Choose

press .

If you wish to finish configuring and select the displayed choice, press .

The following table list s which settings to choose when transmitting a FAX using a FAX/modem. Each site may have different requirements.

Parameter Choice

Connection? FAX Programmable Modem Baud Rate 9600

Phone #? Type phone number ,

36 characters max.

Dial Type ? Tone

Pulse

Pause Length? 2, 4, 6, 8, 10 (secs) Destination? T ype name, 22 characters max . Print Grid on Report? Yes

Entering the Phone Number

When you enter t he phone num ber for a sit e, th ere are th ree c haract ers,

T one

",", "w", and "X" you might need to use with the numbers. These

Pause

7-15

Transmitti ng ECGs by FAX to Anot her Site

characters are inser ted in the phone number by pressing for "," and

T one

for "w".

"," inserts a pause in the number dialing se quence to avoid dialing

Pause

errors if the number is sent too rapidly. An example would be "1,234,567,8900. " Select the length of the pause with the pause length parameter.

Tone

"w" instructs the modem to wait for a dial tone before complet ing the dialing sequence. You will typically use this when you must dial for an outside line before dialing the called number. For example, "9w567,8900" instructs t he modem to dial t he "9," then wait for a dial tone before it dials the rest of the number.

Transmitting an ECG via FAX

After a sit e has be en c onfigure d on the cardi ograph for FAX transmission, you can FAX an ECG to the site. The F AX/modem must also be installed to FAX to a FAX site. See Chapter 5 in the PageWriter XLi Operating Guide for the steps to FAX an ECG to the configured FAX site.

7-16 Setting Up Your Cardiograph for Transmitting ECGs

Printing an ECG on an HP LaserJet Printer

You can print stored ECGs on an HP PCL5 Lase rJet printer. Figure 7-5 shows how to connect the cables between the cardiograph and the printer.

)LJXUH& RQQHFWLQJWKH3U LQWHU&DEOH

A. PageWriter XLi Cardiograph B. HP LaserJet Printer C. HP LaserJe t Print er Se ri al Interf ace Por t D. LaserJet Cable (HP 24542G)

7-17

Setting up the LaserJet Printer

:$51,1*

7KH3DJH:ULWHU; /L$VRIWZDUHDOORZV\RXWRSU LQW(&*VRQD/DVHU-HW7KH /DVHU-HWSULQWH ULV127LVRODWHGWR8/,(&OHDNDJHFXUUHQWVSHFLILFDWLRQV %HVXUHWR GLVFRQQHFW WKH/DVHU-HWIURPWKHFDUGLRJUDSKZKHQ\RXZDQWWRUHFRUG (&*V

Setting up the LaserJet Print er

You must set up the LaserJet print er for serial printing before using it to print stored ECGs from t he cardiogr aph. To configure the printer f or serial p rinting , perform the following steps.

1. With the pr inter on, press the ON LINE key until the light is off.

2. Press the MENU key on the printer to step through the settings until I/

O=PARALLEL* appears.

If I/O=SERIAL* appears, the printer is already set for serial printing.

3. Press the + key until I/O=SERIAL appears.

4. Press the ENTER key on the print er. An asterisk will apear on the dis play:

I/O=SERIAL*.

5. Press the MENU key and the BAUDRATE setting will appear.

6. Press the + key until BAUDRATE=19200 appears.

7. Press the ENTER key on the printer. An asterisk will appear on the

display: BAUDRATE=19200*.

8. Press the ON LINE key.

The printer is ready to use with your cardiograph.

Configuring the Cardiograph to Print ECGs on the HP LaserJet

After connecting the cables, you must configure the cardiograph for printing on the HP LaserJet.

7-18 Setting Up Your Cardiograph for Transmitting ECGs

Setting up the LaserJet Printer

Config

Transmit

Choose

1. Press until the following displ ay appear s:

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The main configuration menu will appear:

Configuration

Global ID Transmit Files Exit

3. Press and the Tr ansmit Configuration menu appears in the

display.

Configuration

Transmit Receive AutoDial Exit

4. Press to configure any of four transm ission sites.

Configurat ion Site

#1 #2 #3 #4 Exit

5. Select a site number and the following display appears.

Connection? None Enter Choose Exit

6. Press until you see the choice "LaserJet’’, then press . The

Enter

baud rate display will appea r.

7. Press until you see the baud rate 19200, then press .

Enter

8. Select whether to print a grid.

If you have unlined paper in the printer, this selection will print the grid with the ECG.

7-19

Receiving ECGs

Config

Tran smit

Your cardiograph is now set up to print to an HP LaserJet when you select the configured site from the Transmit menu. See the PageWriter XLi Operating Guide for information about transmitting ECGs.

Receiving ECGs

When configured and connected for receiving, the cardiograph can receive ECGs whenever it is turned on. ECG reports are printed immediately when they are received. These repo rt s cannot be copied or stored on the flexible disk.

Configuring the Cardiograph to Receive ECGs Directly

After connecting the cable s, you must conf igure the recei ving cardio graph for direct reception.

1. Press until the following display appears:

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The main configuration menu will appear:

Configuration

Global ID Transmit Files Exit

3. Press and the Transmit Configuration menu appears in the

display.

Configuration

Transmit Receive AutoDial Exit

4. When you press the following display will appear.

Connection? None Enter Choose Exit

7-20 Setting Up Your Cardiograph for Transmitting ECGs

Receive

Receiving ECGs

Config

Transmit

Receive

5. Choose Direct Co nnection, then press to proceed to baud rate

selection. When you choose direct connection, the default baud rate will be 9600.

Transmit

Configuring the Cardiograph to Receive ECGs via Modem

To configure the cardiograph for receiving ECGs by telephone:

1. Press until the following displ ay appear s:

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The main configuration menu will appear:

Configuration

Global ID Transmit Files Exit

3. Press and the Tr ansmit Configuration menu appears in the

display..

Configuration

Transmit Receive AutoDial Exit

4. Press . The following display will appear.

Connection? None Enter Choose Exit

Choose the programmable modem select ion fo r connection type. The default baud rate for the programmable modem is 2400.

Receiving an ECG vi a FAX

The cardiograph is able to rece ive ECGs via the FAX/modem any time the cardiograph is configured for FAX/modem usage and idle.

7-21

Receiving ECGs

Transmit

Receive

Configuring the Cardiograph to Receive via FAX

T o configure the cardiograph for rece iving via FAX, perform the following steps.

1. Press until the following displ ay appear s:

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The main configuration menu will appear:

Configuration

Global ID Transmit Files Exit

3. Press and the Transmit Configuration menu appears in the

display.

Configuration

Transmit Receive AutoDial Exit

4. Press . The following display will appear.

Connection? None Enter Choose Exit

Choose the FAX programmable modem selection for connection type. The default baud rate for the FAX programmable modem is 2400.

Receiving ECG Reports from an HP 5600C ECG Management System

After you have configur ed a site number f or the HP 5600C ECG Manage ment System with the appropriate connection parameters, you can receive reports from that system.

7-22 Setting Up Your Cardiograph for Transmitting ECGs

Receiving ECGs

Tran smit

Query

T o receive reports from that system:

1. Press until the following displ ay appears.

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The following display appears.

Selected All NewGroup Query Files

3. Press . You may then select the site number which is assigned to

the 5600C ECG Management System.

4. After you press the site number, the cardiograph will call the system,

ECGs will be transmitted from the ECG Management System to the cardiograph, and the cardiogr aph will print the reports as they are received.

Receiving ECGs from an HP M1730A or M3700A TraceMaster ECG Management System

127(

PageWr iter cardiograph users can receive ECGs from the M1730A and M3700A on request by using the Query f unc tion. The M1730A and M3700A will send the ECGs in batch or individually de pe nding on how the cardiograph use r respon ds to syste m que stions on th e car diogra ph as shown in the instructions be low.

There are two types of Query, standard query and interactive query.

In standard query, reports must be queued at the system for output to the cardiograph. Only diagnostic and extended measurements reports c an be sent in standard query.

In interactive quer y, the cardiogr aph user selects the ECG to receive. A full ECG (report and waveform) can be received this way.

Query will timeout after an idle period. The length of this period is determined by how the ECG Management system is configur ed .

7-23

Receiving ECGs

Tran smit

From the cardiograph:

1. Press until the following displ ay appears.

Trans m i t St ore Config CheckDi s k Fil e s

2. Press . The following display appears.

Transmit

Selected All NewGroup Query Files

3. Press . If interactive query is configured on the system, the

Query following display appe ars on the cardiograph. If interacti ve query is not configured on the system, consult the system administrator for the ECG Management system for assistance.

Select an online report?

Yes No

a. Pressing will start a batch query. All reports queued for your

location will now be printed.

4. Press to select interactive quer y. You will be asked for your ID

Yes number. Your ID number is the same as your password. See your system administrator if you do not know your ID number.

5. After you type a va lid ID number and press , you will be asked for

Enter

an institution number. a. Type a three digit number for the desired institution or type "All".

Typing "All" can result in an extended search if you do not specify a patient ID.

b. Press .

6. After you enter a valid institution number, you will be asked for patient ID. Type either a patient ID or a patient name no more than 16 characters long.

7-24 Setting Up Your Cardiograph for Transmitting ECGs

Receiving ECGs

Newest

7. Press . The message ‘‘Searching database, please wait ...’’ appears during a pause. The duration of the search depends on how many ECGs are stored on the database and how specific your search criteria are.

If the search is unsuccessful, the foll owing display appears and you can start a new search.

No ECGs for this patient

New Inst New ID

Transmit

New ID

returns you to step 5.

retains the institution you entered earlier, and returns

you to step 6.

If the search is successful, a display similar to the following appears.

2 ECGs found for: PATIENT IDNUMBER

Newest Oldes t New Inst New ID

Newest

Oldest

shows the mo st rece n t stor ed ECG in the list.

shows the oldest stored ECG in the list.

8. Press or and a display similar to the following appears .

III PATIENTID 01/26/91 06:21:52

Next Previous Select More

Oldest

From this display you can scroll through a list of selected ECGs. The top line contains:

Institution number (III)

Patient ID number or the first 16 characters of the patient name

Date and time that this ECG was recorded

7-25

Receiving ECGs

Select

New Inst

9. Press to recei ve and pri nt the displ ayed ECG.

Press or to view other ECGs.

10. Press and the softkey selections will change as shown below.

III PATIENTID 01/26/91 06:21:52

Name New Inst New ID More

If you wish to change the di spla yed ECGs from patie nt ID numbe rs to names, press . The display returns to the set of keys shown in

Name

step 8.

If names are already displaye d, you will see instead of . If

Name

you wish to change the displayed ECGs from patient names to ID numbers, press .

If you wish to start a new search through another institution, press

If you wish to start a new search for other patient ID numbers, press

If you wish to return to the set of keys shown in step 8, press .

You may end the in terac tive quer y session any time by pr essi ng the key

Stop

on the cardiograph. The transmission link will end immediately.

Consult your system administ rator for more information about interactive query and how your system operates.

7-26 Setting Up Your Cardiograph for Transmitting ECGs

8 Troubleshooting

This chapter describe s ways to improv e ECG quality by correcting electrode contact problems as well as equip ment pro blems. The tables in this chapter list possibl e actions to take for difficu lties encountered when recording ECGs.

Troubleshooting Leads Off

You can identify which electrode is off by using the pa tient module as well as the preview screen . Poor electr ode cont act or a disco nnected wire is shown on the patient module display by an X, on the preview screen by a flat dotted line, and on the printed report by a flat line.

T able 8-1 Leads Off Indications

Lead

RL Dotted line on all leads X on all leads Flat line on all leads RA,

LA, and/or LL

Chest lead(s)

Dotted li ne on all leads X on lead which is off and

Dotted line on lead(s) which is off

Preview

Screen

X on chest leads

X on lead(s) which is off Flat l ine on lead(s) which

Patient

Module

Printed

Report

Flat lin e on al l leads

is off

Troubleshooting ECG Noise

Use the ele ctrode status indicators (nois e bars) on the pa tient module to check the quality of the ECG signal. The preview screen is anot her way to check the ECG signal quality befor e recording the ECG. Noise on the ECG recording is

8-1

Troubleshooting ECG Noise

often due to poor electrode contact or to environmental interference. Try improving the conditions surrounding the recording before using filters. As a last resort when you c annot eliminate or reduce noise at its source, use one or more of the configurable filters on your cardiograph.

There is some tradeoff bet ween fidelity and clarity on the ECG trace when using any of the filters besides the line power (AC) filter.The more filters applied to the signal, the greater the possibility of removing details of the ECG signal besides removing noi se. Thi s is why filter s should only be used a s a last resort after attempting to improve the ECG technique.

T able 8-2 PageWriter XLi Cardiograph Filters

Filter Type Configurable Settings Interference Sources In the Filter Box

Auto low frequency response

Auto high frequency response

Manual low frequency response

Manual high frequency response

Line Power (AC) 50 Hz

Baseline Wander BaselineWander setting

Artifact Artifact setting & press Muscle tremor. F

0.15 Hz

0.05 Hz

0.5 Hz W

150 Hz

100 Hz 40 Hz

0.5 Hz W

0.05 Hz

40 Hz

100 Hz 150 Hz

60 Hz

& press

Filter

Electrode movement, patient movement or r e spirat io n

Movement of skeletal mus cles 150,

Electrode movement, patient movement or r e spirat io n

Movement of skeletal mus cles 40, 100,

AC power lines, equipment operating near the patient

Electrode movement or poor contact and skin preparation.

Filter

.15 , .5 or .05

100, or 40

.5 or .05

or 150

8-2 Troubleshooting

Understanding Error Messages

The error messages that appear on the display will instruct you as to what action to take. If it is som ething tha t you can corr ect, the message will inst ruct you what to do.

If an error number appears, note the number and then perf orm the following steps.

1. Cycle the power — set the button to Standby and back to

On.

2. If the error reappears, re-install the System disk — see Setting Up Your

Cardiograph for the First Time in the PageWriter XLi Cardiograph Operating Guide.

3. If the error continues, try another System disk.

4. If the error recurs, call your Hewlet t-Packard service representative.

Calling for Assistance

Refer to Calling for Service in the PageWriter XLi Cardiograph Operating Guide.

On-Standby

Solving Equipment Problems

The following tables list symptoms of equipment problems grouped by functions with suggested solutions. Many of the suggestions recommend that you try a sequence of actions until the problem is resolved. If the first action solves the problem, you do not need to try further actions.

8-3

Solving Equipment Problems

T able 8-3 Battery Problems

Symptom

Message: No battery. Load battery. Cardiograph won’t turn on.

AC indicator not lit 1. Plug in power cord.

Cardiograph doe sn’t run on AC, but runs on battery

Cardiograph doe sn’t run on battery, but runs on AC.

Cardiograph won’t power up on AC or battery

Battery char ge level indicator never indicates full capacity.

Battery charge level indic ator always indicates full capacity on AC power with battery.

Install the batte ry, then try turning on the cardiograph.

2. Turn on AC switch.

3. Call your Hewlett-Packard service representative. Call your Hewlett-Packa r d service representative .

1. Charge batt ery for 24 hours.

2. Replace battery.

3. Call your Hewlett-Packard service representative. Call your Hewlett-Packa rd service representative .

1. Wi th the c ardiogra ph connecte d t o AC powe r, turn on the cardiograph. If only a s ingle battery level indicator is lit (other than the Battery Low Warning), reload the operating system, insuring the paper compartment door is closed. If the operating system is loaded with this door open, only a single indicator will light.

2. If after completing the step above, all battery level indicators are not lit, the battery requires further charging. When checking the battery level, always turn the cardiograph on whil e connected to AC power.

3. Replace battery.

4. Call your Hewlett-Packard service representative.

What to Do

8-4 Troubleshooting

Solving Equipment Problems

127(

When dealing with noise problems, remember that most noise is the result of technique or poor electrode con tact. If noise persists after chec king the electrode placement and other elements of technique, the noise may be the result of faulty electrode wires. Only when you eliminate technique and electrode wires as the cause s of the noise should you consider calling your Hewlett-Pa ck ar d serv i ce re pr esen t ative.

T able 8-4 Patient Module and Connecting Cabl e Problems

Symptom What to Do

No display on patient module display.

"Leads off" displ ayed o n pre view scree n , but pati ent modu l e appears blank or sh ows stars, blanks, and boxes.||

"Leads off" not indicated when wire is off.

1. Adjust contrast.

2. Call your Hewlett-P ackard service representative. Call your Hewlett-Pac kard service representati ve.

1. Remove electrode wire from patient module.

2. Ensure the co n tacts on t h e patient module are clean and dry.

3. If "Leads off" is not indicated, call your Hewlett-Packard service representative.

"Leads off" indicated when wire is not off.

No response to start button. 1. Ve rify cardiograph not in configuration mode or

1. Remove electrode wire and install shorting plug. If "Leads off" is indicated, call your Hewlett-Packard servic e r epresentative.

2. If "Leads off" is not indicated, replace electrode

wire.

busy.

2. Try pus hing the button harder.

3. Suspect patient module if cardiogra ph st arts from front panel but not from patient module button.

4. Call your Hewlett-P ackard service representative.

8-5

Solving Equipment Problems

Table 8-4 Patient Module and Connecting Cable Problems (continued)

Symptom What to Do

Bad ECG: Good calibration pulse in lead(s) where trace(s) is (ar e) not good.

A lead is missing — On Auto reports: Electrode off on bottom of report. On Manual reports: "le ad off" on trace.

Electrode off on E CG when no elec trode is off.

Noisy lead(s): "AC" (regular pattern) — for 60 Hz, 12 peaks/5 mm at 25 mm/ sec; for 50 Hz, 10 peaks/5 mm

Noisy lead(s): Muscle artifact. 1. See Table 6-1 in the PageWriter XLi Cardiograph

Noisy lead(s): I, III, aVL Noisy lead(s): II, III, aVF

1. See Table 6-1 in the PageWriter XLi Cardiograph Operating Guide.

2. Isolate defecti ve wires and replace.

3. Call your Hewlett-P ackard service repres entative.

1. Be sure STAT ECG is not taken within 15 seconds of cardiograph power-up.

1. See Table 6-1 in the PageWriter XLi Cardiograph Operating Guide.

2. Reposition patient module cable away from AC power.

3. Try plugging cardiograph into AC outlet.

Operating Guide.

2. Replace disposable electrodes o r lead adapters.

3. Call your Hewlett-P ackard service representative.

Replace LA leadwire. Replace LL leadwire.

Noisy lead(s): I, II, aVR Noise in only one V lead. Noise in

general.

8-6 Troubleshooting

Replace RA le ad wi re.

1. See Table 6-1 in the PageWriter XLi Cardiograph

Operating Guide.

2. Isolate defecti ve wires and replace.

T a ble 8-5 Printer Errors

Page Advance

Symptom What to Do

Solving Equipment Problems

Paper doesn’t move ; printer error message displayed Check paper supply.

Paper moves then stops and displays an error message. Check paper supply.

Printer error message displayed; transient low battery status indication during printing (battery too low for good printing)

Message: Printer door open. 1. Close door.

Paper moves but nothing prints.

Paper moves but printing is faint. Paper stops in the wrong plac e aft er

pressing or . No error message.

Auto

1. Replace paper or clear paper jam.

2. Call your Hewlett-P ackard service representative.

1. Make sure cardio graph is loaded properly with

approved thermal paper.

2. Clean paper sen sor lens. See PageWriter

Cardiograph XLi Operating Guide for instructions.

3. Call your Hewlett-P ackard service representative.

1. Charge battery.

2. Replace battery.

3. Call your Hewlett-P ackard service representative.

2. Call your Hewlett-P ackard service representative.

1. Make sure cardiograph is loaded with approved

thermal paper.

2. Call your Hewlett-P ackard service representative.

1. Make sure cardiograph is loaded with approved ther mal paper.

2. Clean sensor lens.

3. Call your Hewlett-P ackard service representative.

8-7

Solving Equipment Problems

T able 8-5 Printer Errors (continued)

Symptom What to Do

Printed data is garbled. Call your Hewlett-Pack ar d service representative. Poor print quality or some dots not

printing.

1. Clean printhead. See the PageWriter XLi Cardiograph Operating Guide for instructions.

2. Call your Hewlett-Packard service representative.

Some dots always on. Call your Hewlett-Packard service repr es entative. Printing is dark on one side of page

Call your He w lett-Packard service representative.

but faint on the othe r side.

Table 8-6 Disk Drive Errors

Symp t om Wha t to D o

Disk drive inoperative. Call your Hewlett-Packard service representative. Error message Try new disk appears. 1. Try known good disk.

2. Call your Hewlett-Packard service representative.

Error message Unrecognized file type

1. Corrupt file, try known good file.

appears.

8-8 Troubleshooting

Solving Equipment Problems

T able 8-7 Preview Screen Problem s

Symp t om Wha t to D o

Washed out display. Adjust brightness and contrast controls for best display

appearance.

All white screen. All black screen .

No brightness adjust. No contr ast adju st. All blue screen. Garbled data on display.

Backli ght f lickers. Half screen lit. No backlight but characters present.

T able 8-8 Keyboard and Keyboard Display Pro blems

Symptom What to Do

Display stays blank. 1. Adjust contrast or brightness.

Keys won’t work. Unable to enter data or ope r at e co n tro l s .

1. Adjust contrast or brightness or both.

2. Call your Hewlett-Packard service representative.

Call your He w lett-Packard service representative.

1. Adjust brightness.

2. Call your Hewlett-Packard service representative.

2. Call your Hewlett-Packard service representative. Call your Hewlett-Packar d service representative.

8-9

Solving Equipment Problems

T able 8-9 Tra nsm ission Errors

Symptom What to Do

1540, 1541 Call your Hewlett-Packard service representative. Message ERROR 153X: Remote site

failure.

This is a message from the remote site informing the user that the communication link has been terminated.

Unable to transmit or receive. 1. Check to s ee t hat m odem i s turned on and plug ged in,

if using a modem.

2. Call your Hewlett-Packard service representative.

Message No answer at site. Retry? when there is a dial tone . T he cardiograph will

Type an "X" before typing the phone number. The

modem will not wait for a dial tone. not be a bl e to s ta r t th e transm is s i o n because the modem doesn’t recogni ze the dial tone.

3 x 5, 4 x 4 untrans mitt able, F AX only This is a message to indic at e that th e user has attem pted

to transmit reports that are unrecognized by the remote

site.

8-10 Troubleshooting

Philips PageWriter XLi User reference guide

Specifications and Main Features

Frequently Asked Questions

User Manual