Philips Series 50 (M1350) User manual

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Series 50 XM (M1350B) Series 50 XMO (M1350C) Fetal/Maternal Monitors
INSTRUCTIONS FOR USE
M1350-9001S Printed in Germany March 2002 Edition 1
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The information contained in this document is subject to change without notice. Philips assumes no responsibility for the use or reliability of its software on equipment that is
not furnished by Philips.
Responsibility of the Manufacturer
Philips only considers itself responsible for any effects on safety, reliability and performance of the equipment if:
• assembly operations, extensions, re- adjustments, modifications or repa irs are carried out by persons authorized by Philips, and
• the electrical installation of the relevant room complies with national standards, and
• the instrument is used in accordance with the Instructions for Use or User’s Guide.
Intended Use (M1350B)
The Series 50 XM Fetal/Maternal Monitor (M1350B) allows non-invasive or invasive monitoring of an ambulant patient during both antepartum testing and labor and delivery in that the monitoring of the fetal hear t rate (FHR) via ultrasound or direct electrocardiogram (DECG), and uterine activity via an external Toco transducer or an internal intrauterine pressure (IUP) transducer is possible, additionally it allows maternal heart rate recording via the MECG transducer. Alarms are generated from maternal heart rate.
The Series 50 XM allows the non-invasive measurement of the Noninvasive Blood Pressure and the Oxygen Saturation parameters, generate alerts, and the generation of alerts and recordings on matern al patients.
The device is intended to be used in Labor-Rooms and Delivery-Rooms and in Antepartum­Testing-Areas. It is not intended to be u sed for transport monitoring and home use.
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Intended Use (M1350C)
The Series 50 XMO Fetal/Maternal Monitor (M1350C) allows non-invasive or invasive monitoring of an ambulant patient during both antepartum testing and labor and delivery in that the monitoring of the fetal hear t rate (FHR) via ultrasound or direct electrocardiogram (DECG), and uterine activity via an external Toco transducer or an internal intrauterine pressure (IUP) transducer is possible, additionally it allows maternal heart rate recording via the MECG transducer. Alarms are generated from maternal heart rate.
The Series 50 XMO allows the non-invasiv e measurement of the Noninvasive Blood Pressure and the Oxygen Saturation parameters, generate alerts, and the generation of alerts and recordings on maternal patients. Additionally, the Series 50 XMO allows you to record fetal pulse oximetry (FSpO
).
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The device is intended to be used in Labor-Rooms and Delivery-Rooms and in Antepartum­Testing-Areas. It is not intended to be u sed for transport monitoring and home use.
The Series 50 XMO (M1350C) is not available in the U.S.A.
Conventions Used in This Guide
Warning A warning alerts you to a potential serious outcome, adverse event or safety hazard.
Failure to observe a warning may result in death or serious injury to the user or patient.
Caution A caution alerts you where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.
Note—A note
calls your attention to an important point in the text.
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On your monitor, this sign indicates that there is detailed information in this book which you must read before proceeding with your task
The monitor should only be used by, or under the direct supervision of, a licensed physician or other health care practitioner who is trained in the use of fetal and maternal heart rate monitors and in the interpretation of fetal and maternal heart rate traces. US law restricts this device to sale by, or on the order of, a physician.
2002 Philips Medizinsysteme GmbH
All rights are reserved. Reproduction in whole or in part is prohibited without the prior written consent of the copyright holder.
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Contents
1. Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
General Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Electrical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Maximum Input/Output Voltages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Service Socket for Upgrade Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Protective Earth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Spillage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Electromagnetic Compatibility (EMC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
EMC Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
System Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Avoiding Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ESU, MRI and Defibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Leakage Current. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
About This Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
About the Monitors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Major Parts and Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Cardio, Toco a nd FSpO
Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Recorder Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Setting Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Channels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2
3. General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Suspected Fetal Demise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Fastening a Belt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Clipping a Transducer to the Belt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Attaching a Patient Module to the Belt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Connecting a Transducer or Patient Module to the Monitor . . . . . . . . . . . . . . . . . . . . 23
Signal Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Input Channels at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Example Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Marking an Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
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4. Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Before Connecting Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Switching On the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Loading Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Switching on the Recorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Displaying the Time and Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Setting the Time and Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Choosing Paper Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Setting the Paper Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Switching Off After Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
5. Monitoring FHR and FMP Using Ultrasound . . . . . . . . . . . . . . . . 39
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
What You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Fetal Movement Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
FMP Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Switching FMP Off and On. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Using Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Using the Barcode Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
6. Monitoring FHR Using DECG . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
What You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Using the Traditional Open-wire Method to Monitor DECG . . . . . . . . . . . . . . . . . . . . 50
With DECG legplate M1357A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
With Patient Module M1364A or M1365A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Using the DECG Adapter Cable M1362B to Monitor DECG. . . . . . . . . . . . . . . . . . . . . 53
With DECG Legplate M1357A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
With Patient Module M1364A or M1365A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Monitoring DECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Why use Arrhythmia Logic? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
After Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Heart Rate Out of Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
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7. Monitoring Twin FHRs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Things to Remember During Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Monitoring Internally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Monitoring Externally. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Separating Twin FHR Traces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Twins Offset: On. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Twins Offset: Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
8. Monitoring Uterine Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
External Toco Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Internal Toco Monitoring (IUP Monitoring) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
External Toco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Internal Toco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
9. Fetal Pulse Oximetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Before You Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
To Begin Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Understanding the Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Triggering an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Acknowledging an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Turning the Alarm On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Changing Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Inop Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Loss of Pulse Signal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Inaccurate Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
10. Monitoring Using External Devices . . . . . . . . . . . . . . . . . . . . . . 83
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Recording From an External Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
What You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Connecting the External Devices to the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . 85
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Example Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Trace Display on External Monitoring Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
FSpO
2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
External Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
11. Recording Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Recording A Note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Deleting a Barcode Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Recording Several Barcodes as One Note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Recording Several Barcodes as Separate Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Recording a Patient’s Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
12. Fetal Heart Rate Alerting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Alerts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Recognizing an Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Acknowledging an Alert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Turning Alerting ON or OFF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Changing Alert Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
13. Non Stress Test Timer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Setting the NST Timer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
14. Maternal Monitoring - Overview . . . . . . . . . . . . . . . . . . . . . . . . 101
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Maternal Parameters - Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Softkeys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Reset Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Power on Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
To Begin Monitoring Immediately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Maternal Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Returning to the Maternal Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Alarms - Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Acknowledging an Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Reviewing All Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Setting an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
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Warning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Acknowledging a Warning Message. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Volume and Contrast Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
15. Non-invasive Blood Pressure Monitoring. . . . . . . . . . . . . . . . . 111
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
To Begin Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Setup Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Measurement Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Changing Measurement Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Pulse Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Turning Alarms On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Changing Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Warning Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Measuring Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
16. Maternal ECG, Heart and Pulse Rate. . . . . . . . . . . . . . . . . . . . 121
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
To Begin Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Connecting the Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Applying the Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Using MECG transducer M1359A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Using a Patient Module (M1364A or M1365A) . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Cross-Channel Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Displaying the MECG Waveform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Changing Display Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Freezing and Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Maternal Heartrate Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Alarm (MECG and SpO
Turning Alarms On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Changing Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
2
17. Maternal Pulse Oximetry (SpO2) . . . . . . . . . . . . . . . . . . . . . . . 133
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
To Begin Monitoring Immediately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
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Alarm (SpO2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Turning Alarm On and Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Changing Alarm Limit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Alarm (Pulse rate). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Warning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
18. Maintenance and Performance Assurance . . . . . . . . . . . . . . . . 139
Preventive Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Visual Inspection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Routine Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Mechanical Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Calibration and Electrical Safety Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Disposal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Care and Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Care of the Fetal Monitoring System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Transducers and Patient Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Adapter Cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Disinfecting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Sterilizing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Monitor, Patient Modules, Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Adapter cables M1347A, M1362B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Adapter cables M1362A, M1363A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
IUP (1290C/CPJ840J5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
IUP Transducer Adapter Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Belts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Reusable SpO
Non-invasive Blood Pressure Cuff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Storing Recorder Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Self Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Quick Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Parameter Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Testing Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Toco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
IUP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Replacing the Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Replacing the Fuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
2
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19. Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
20. Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Standard Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Fetal Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Maternal Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Optional Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Paper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Gels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Transducers and Patient Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
MECG Electrodes and Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
DECG Cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Disposable Scalp Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Fetal Oxygen Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
IUP Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
IUP Catheters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Domes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
IUP Transducer Holder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Maternal Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
NIBP Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
SpO
Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
2
Adapter Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Belts and Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
21. Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Operating and Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Fetal Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Maternal Non-invasive Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Maternal Pulse Oximetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Maternal ECG and Heart Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Maternal Display Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Numerical Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Maternal Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Mode Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
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Ultrasound, External and Internal Toco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Recorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
FHR (Cardio) Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Testing Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
22. Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Manufacturers Responsibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Warranty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
23. Training Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
M1350 XM, XMO Fetal Monitoring Lab Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Competency Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Performance Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Fetal SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Fetal Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Fetal Monitor Lab Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Fetal SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Fetal Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Maternal Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Fetal SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Fetal Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
xii Contents
Page 13

General Safety Information

1

Safety

This symbol indicates that you should consult the Instructions For Use (this guide), and particularly any warning messages.
Equipotential Terminal
This symbol identifies terminals which are connected together, bringing various equipment or parts of a system to the same potential. This is not necessarily earth potential. The value of potentials of earth may be indicated adjacent to the symbol.
Protective Earth Terminal
This symbol identifies the terminal for connection to an external protective earth system.
2 x 1.5 V
The monitor is de signed to fulfil safety requirements according to IEC 60601-1/EN 60601-1 (Class I), UL 2601-1, CSA-C22.2 No 601.1­M90.
It complies with the essential requirements of the Medical Device Directive 93/42/EEC. The monitor is classed:
Chapter 1 - Safety 1
Battery
This symbol identifies the battery holder conta ining two 1.5 V batteries.
2 x 1.5V
Page 14

Electrical Safety

The Series 50 XMO and the Series 50 XM are not “ECG-Monitors, are not defibrillator-protected, and are not designed for direct cardiac application.
Electrical Safety
Equipment Equipment Type Information
ORDINARY EQUIPMEN T - Enclosed equipment protected against ingress of water.
CONTINUOUS OPERATION - Can be operated continuously.
External Toco transduce r (M135 5A) and IUP quartz transducer (1290C) and IUP transducer (CPJ840J5)
Ultrasound transducer (M1356A)
DECG transducer (M1357A) and MECG transducer (M1359A)
US/MECG combi transducer (M1358A)
SpO
transducer (M1191A)
2
Adapter cable (M1940A) NIPB cuffs (M1574A and M1575 A)
Interco nn ect tubing (M1599A)
FSpO
/ECG patient module
2
(M1365A) ECG only patient module (M1364A)
B
B
CF
B (Ultrasound) CF (MECG)
CF
CF
CF
Patient Connector is electrically isolated. Connecting the transducer to the Toco channel results in CF condition.
Connecting the trans ducer to a Cardio channel results in a B condit i on .
Connecting the transducers to a Cardio channel results in a CF condition.
Connecting the combi transducer to the Cardio 1 channel results in a CF condition for MECG and a B condition for US application.
Connecting the SpO2 transducer results in a CF condition.
Connecting the NIBP tubing results in a CF condition.
Connecting a patient module results in a CF condition.
2 Chapter 1 - Safety
Page 15

Maximum Input/Ou tp ut Volt a ges

The following diagram shows the sockets for peripheral devices.
Maximum Input/Output Volta ge s
Chapter 1 - Safety
3
Page 16
Maximum Input/Output Voltages
1. Mains Socket.
2. Equipotential Grounding P oint. To use the monitor with other equipment in an operating room environment, connect the equipotential grounding point (2) to earth potential. Use the grounding cable supplied with the monitor.
3. +5V input socket for the HBSW8200 Barcode Reader.
4. Socket for the Philips M1310A Series 50 T Fetal Telemetry System. +5V input except for: Pins 1, 14, 15 and 16: ± 12V input Pin 2 -12V output Pin 3 +5V output Pin 4 ±12V output
5. RS232 Digital System Interface: Pin2 ±12V input Pin 3 ±12V output
6. Socket for one of the following:
80225A or 80235A/B Obstetrical Information Management System ( OBMS)
M1370A Obstetrical Display Information System (ODIS)
±12V except for Pins 17, 18 and 22 which are +5V input.
7. Socket (9-pin) for an external device: Pin 3 ±12V
8. Socket (25-pin) for an external device: Pin 2 ±12V Pins 9 and 10 +5 Volt
4 Chapter 1 - Safety
Page 17

Service Socket for Upgrade Key

The Service En gineer can conne ct a compatible PC to this socket (1) to carry out extended configuration and service functions.
Maximum voltage of ±12V.
Service Socket for Upgrade Key

Protective Ea rth

To prote ct hospital personnel and the patien t, the monitor’s casing must be ground ed. Accordingly, the monitor has a 3-wire power cable that grounds it to the power line ground when plugged into an appropriate 3­wire receptacle. Do not use a 3-wire to 2-wire adapter with the monitor. Any interruption of the protective earth grounding will cause a potential shock hazard that could result in serious personal injury.
Whenever it is likely that the protection has been impaired, the monitor must be made inoperative and be secured against any unintended operation.
Chapter 1 - Safety
5
Page 18

Environment

Warning Check each time before use that the monitor is in perfect working
order and properly grounded.
Position the patient cable so that it does not come into contact with any other electrical equipment. The cable connecting the patient to the monitor must be free of electrolyte.
Make sure that during operation, the monitor is free from condensation. This can form when equipment is moved from one building to another, and is exposed to moisture and differences in temperature.
Warning Possible explosion hazard if used in the presence of flammable
anaesthetics.
Environment
Use the monitor in a n environment that is r easonably fr ee from vibration, dust, corrosive or explosive gases, flammable agents, extremes of temperature, humidity and so forth. It operates within specifications at
ambient temperatures between 0 and 55 exceed these limits can affect the accuracy of the monitor and cause damage to the components and circuits. Only products that fulfil the necessary safety and electrical standards should be used in conjunction with the monitor (contact your local response center for details).
Allow at least 5cm (2in) clearance around the monitor for proper air circulation. If the monitor is mounted in a cabinet, allow sufficient space at the front for operation and at the rear for servicing with the cabinet door open.
6 Chapter 1 - Safety
o
C. Ambient temperatures that
Page 19

Spillage

When the maternal display is in a tilted position, take additional care to prevent spillage of liquid. If liquid accidentally enters the monitor through the maternal display recess, you must cease using the monitor immediately. Contact an authorized engineer for a safety inspection.

Electromagnetic Compatibility (EMC)

The electromagnetic compatibility (EMC) validation includes testing performed according to the international standard for EMC with medical devices. See the Manufacturer’s Declaration for details.

EMC Testing

Caution If operating under conditions according to the EMC-st andard
60601-1- 2 (Radiated I mmunity 3 V /m), fi eld st rength s a bove 1 V/m may cause erroneous measurements at various frquencies. Therefore it is recommended to avoid the use of electr ical ly r adiating equipment in close proximity to these measurem en ts.
Spillage
Chapter 1 - Safety
During the test prog ram the monitor was sub j e cted to international standard and Philips proprietary EMC tests. During most of the testing no anomalies were observed. Some reduced performance was observed with the IEC 801-3 Radiated Immunity and IEC 801-4 Fast Transient/ Bursts Immunity tests.
IEC 801-3 specifies that the pro duct must be subjected to a field of 3 V/m over a frequency range of 26 to 1000 MHz with no degradation of performance. At many of the test frequencies over the specified range no anomalies were ob served. However increase d jitter of SpO
values and
2
DECG derived fetal heartrate values was observed at a number of test points. For these test points the radiated field was reduced to the level at which the trace returned to normal. These reduced levels are shown in the following table.
7
Page 20
Electromagnetic Compatibility (EMC)
Parameter Sensor Frequency Range
SpO
2
IEC 801-4 specified that the pro duct is subjected to high speed p ulses up to 1000 V applied to the powe r cord and al l I/O cables. D uring and af ter most of the test pulses, no anomalies were observed. However in rare cases the ultrasound channel had been triggered.
Parameter Sensor
Ultrasound M1356A
SpO
with adapter
2
cable M1940A

System Characteristics

M1191A M1192A M1194A
M1358A M1191A
M1192A M1194A
52 MHz to 70 MHz
Immunity
Level
2.3 V/m
Burst Immunity
Level
600 V
200V
The phenomena discussed above are not unique to the monitor but are characteristic of pat ient monitors in use today. This performance is due to very sensitive high gain front end amplifiers used to process the physiological signals from the patien t. Among the many similarly performing monitors already in use by customers, interference from electromagnetic sources is rarely a problem.
8 Chapter 1 - Safety
Page 21

Avoiding Interference

When electromagnetic interference (EMI) is encountered there are a number of things that can be done to mitigate the problem.
1. Eliminate the source. Possible sources of EMI can be turned off or moved away to reduce their strength.
2. Attenuate the coupling. If the coup ling path is through the patient cables the interference may be reduced by moving and/or rearranging th e cables to a diffe rent location of the monitor. If the coupling path is throu gh the power cord, plugg ing the monitor into a differen t mains circuit may help.
3. Connect the equipotential terminal of the moni tor to the corresponding terminal of your mains installation.
4. Add external attenuators. If EMI becomes an unusually difficult problem, external devices such as an isolation transformer or a transient suppressor may help. An Philips customer engineer can assist you in determining the need for external devices.

ESU, MRI and Defibrillation

ESU, MRI and Defibrillation
Warning Remove all transducers, patient modules, sensors and accessor ies
before performing electrical surgery, defibrillation, and MRI. High frequency current can flow through the equipment and burn the skin.
The equipment has not been tested with defibrillators.
Chapter 1 - Safety
9
Page 22

Leakage Current

Leakage Current
Leakage current can be hazardous to the patient.
Warning If the monitor is connected directly to other equipment, such as an
additional patient monitor, or a second monitor is to be connected directly to the mother, you must carry out all relevant safety tests in accordance with safety standard IEC 60601-1-1.
10 Chapter 1 - Safety
Page 23

About This Guide

This guide tells midwives, nurses and other healthcare professionals how to use the Series 50 XMO fetal/maternal monitor and the Series 50 XM fetal/maternal monitor . I t discusses and ill ustrates all possible featur es and parameters of both mo nitors. Your monitor may not have every one o f these features and may lo ok slightly different to the monito r shown in t he illustrations in this guide. It can be upgraded to incorporate them.

About the Monitors

Both monitors let you observe and record:
2

Overview

Fetal heart rate (inclu ding twins)
Uterine activity
Maternal heart rate (MHR) and ECG waveform
Maternal pulse oximetry (SpO
Fetal movement profile (FMP)
Maternal blood pressure, non-invasively.
The Series 50 XMO also allows you to record fetal pulse oximetry (FSpO
You can monitor fetal heart rate externally with u ltrasound from approximately 20 weeks and with the other parameters internally during labor and delivery.
Not all parame ters and features detai led in this manual are ava ilable on all monitors.
Chapter 2 - Overview 11
).
2
)
2
Page 24

Major Parts and Keys

Major Parts and Keys
.
The display panel can be viewed flat in the monitor, or tilted at an angle.
1. Monitor on/off switch
2. Monitor on/off light
3. Recorder keys
4. Recorder
5. Maternal parameters
6. Cardio 2 channel
7. Toco channel
9. Function key
10. Telemetry indicator
11. FSpO
parameter
2
12. Opening recess
13. Socket for remote event marker
14. Setting keys
15. Service socket
8. Cardio 1/ combi channel
12 Chapter 2 - Overview
Page 25

Cardio, Toco and FSpO2 Channels

Major Parts and Keys
Chapter 2 - Overview
1. Toco Display shows uterine activity.
2. Fetal SpO
display shows fetal pulse indicator, signal quality,
2
alarm status, and cross channel verifi cation plus indicator.
3. Cardio Display shows the FHR.
4. Signal Quality Indicator shows the quality of heart rate signal detected by the transducer:
Green (good). Yellow (fair to potentially poor). Red (unacceptable).
5. Function Key: selects menus for:
– FMP, twins offset, logic, FHR alert and FSpO
.
2
– returns to the normal display.
6. MECG Indicator shows when MECG is being measured through this channel. (Indicator location different for Series 50 XM.)
13
Page 26
Major Parts and Keys
7. Fetal SpO2 display shows current value of FSpO2.
8. Speaker Lamp shows which heartbeat is heard from the loudspeaker.
9. Volume Keys set the volume and select the channel to which you are listening. Changes current setting of FMP, twins offset, logic, FHR alert and FSpO
alarms.
2
10. Recess for use when tilting the display.
11. Remote Event Marker Socket for connecting remote event marker (15249A).
12. Cardio 1/Combi Transducer Socket for connecting:
– FSpO
/ECG combined patient module (M1365A).
2
ECG patient module (M1364A).Ultrasound transducer (M1356A).DECG transducer (M1357A).US/MECG Combi transducer (M1358A).MECG transducer (M1359A).
13. Transducer Socket for connecting:
external Toco transducer (M1355A). IUP transducer (1290C, 13972A, or M1333A).
14. Toco Baseline Key zeroes the Toco display and trace to 20 units (when monitoring uterine activity externally) or 0 units (when monitoring uter ine activity internally).
15. Cardio 2 Transducer Socket for connecting:
ECG patient module (M1364A). US transducer (M1356A).DECG transducer (M1357A).MECG transducer (M1359A).
14 Chapter 2 - Overview
Page 27

Maternal Parameters

1. NBP Transducer Socket for connecting:
2. SpO
Major Parts and Keys
– NBP cuff interconnect tubing (M1599A) and blood pressure
cuff.
Transducer Socket for connecting:
2
–SpO2 transducer (M1940A adapter cable connected to M1191A
transducer).
Chapter 2 - Overview
3. Softkeys for setting maternal parameters.
selects modes and alarm limits for NBP. selects modes and alarm limits for MHR. selects modes and alarm limits for SpO
.
2
4. Reset Key acknowledges al arms and re turns monitor from setting mode to maternal parameter display.
5. SpO
Value indicates the current reading for patients SpO2 level.
2
15
Page 28
Major Parts and Keys
6. Maternal heart/pulse rate icon indicates measurement source of maternal heart/pulse rate.
indicates heart rate value comes from MECG.
indicates pulse rate value comes from SpO
.
2
indicates average pulse rate value comes from NIBP.
7. Maternal Heart Rate shows the current heart/pulse rate .
8. Systolic Value shows the value for the systolic parameter of th e non-invasive blood pressure measurement.
9. Diastolic Value shows the value for the diastolic parameter of the non-invasive blood pressure measurement.
16 Chapter 2 - Overview
Page 29

Recorder Keys

Major Parts and Keys
1. Recorder On/Off Light lights when the recorder is working. Flashes when monitor detects five or fewer pages remaining in the pack, or if the paper runs out.
2. Recorder On/Off Key switches recorder on and off. Also starts NST timer (switch off recorder and press for two seconds).
3. Event Marker Key records event on paper. Acknowledges all alerts and alarms.
4. Paper Advance Key advances paper automatical ly to the next fold. Tear paper at fold. Never pull paper to advance it.
5. Paper-Eject Key unlocks drawer when you press it once. Press a second time and hold when removing paper.
Chapter 2 - Overview
17
Page 30
Major Parts and Keys

Setting Keys

1. Time and Date Key for changing the time and date. Press to show the current time in the Cardio 1/Combi and Toco di splays, to cycle through the settings to be ch anged (hours, minutes, day, month and year ) and to return to the normal display.
2. Paper Speed Key for changing the paper speed. Press to show the current paper speed in the Cardio 1/Combi display, and to return to the normal display.
3. Test Key for starting monito rs self test.
18 Chapter 2 - Overview
Page 31

Introduction

Features

3

General Information

This section contains information common to a number of parameters and discusses the intended use of the monitor. Your monitor may not have all these features.
The Philips Series 50 XMO fetal/maternal mo nitor and the Phili ps Series 50 XM fetal/matern al monitor combine advanced fetal monitoring with integrated maternal non-invasive blood pressure, pulse oximetry and ECG measurement. Easy to use, they offer:
Fetal pulse oximetry (FSpO assessment of fetal oxygenation during labor and delivery.
Nellcors fetal oxygen sensors.
Maternal ECG waveform display.
Automatic printing of maternal and fetal parameters on the trace.
Transmission of maternal and fetal parameters to an obstetrical
overview system.
Audible and visual alarms.
Gross fetal body mo vements (F etal M ovement P rofil e) and statistics
recording for advance information on fetal well being.
Twin heart rate trace separation for easier interpretation.
NST timer and paper-end alarm.
Watertight transducers.
Heart rate/pulse rate from maternal ECG, SpO
Chapter 3 - General Information 19
) measurement for direct, continuous
2
or NIBP.
2
Page 32

Suspected Fetal Demise

The monitors give you flexible monitoring capability for bo th high-risk patients and those with normal labo r and delivery. Both monitors can measure traditional fetal parameters, including twins. Maternal vital signs
- blood pressure, pulse oximetry, and maternal ECG - are monitored non-invasively. These are displayed on a tiltable LCD screen.When monitoring maternal ECG, you can display and freeze the waveform on the LCD screen to assist in interpretatio n . You can also print the waveform on the FHR trace.
The Series 50 XMO also offers measurement of fetal pulse oximetry. Based on proven technology from Nellcor, it monitors fetal oxygen saturation during labour and delivery. Th is is non-invasive to the fetus and non-traumatic to the mother. Fetal pulse oximetry gives status information about fetal oxygenation to help you interpret non-reassuring fetal heart rate traces.
Suspected Fetal Demise
Be very careful when interpreting a trace if you suspect fetal demise. The maternal heartrate may be atypically high and therefore confused with that of a live fetus. Apparent fetal movement may also be detected by the monitor but this may be a result of maternal movement causing the fetus to move within the amniotic fluid. Please refer to “Cross-Channel Verification on page 125.
20 Chapter 3 - General Information
Page 33

Fastening a Belt

Arrange the belt a round the patient u ntil it is tight but still comfortable . Fa sten it by pushing t he fixi ng butt on thr ough th e o verl apping se ction of the belt, with the p oint facing away fro m the patient. Ensure that the fixing button and the loose ends of the belt are at the patient’s side.
You can use more than one belt if, for example you are measuring fetal heart rate using ultrasound and uterine pressure simultaneously.
Fastening a Belt
Chapter 3 - General Information
21
Page 34

Clipping a Transducer to the Belt

Clipping a Tran s du ce r to th e Belt
When you have positioned a transducer satisfactorily, you can clip it to the belt.
Alternatively, you can affix a button to the transducer and use this to attach the transdu cer to the abdominal belt. See the Installation Note that comes with the Transducer Knob Adapter for assembly instructions.
22 Chapter 3 - General Information
Page 35

Attaching a Patient Module to the Belt

Attaching a Patient Module to the Belt
You can attach a patient module to the belt b y sli ding th e pati ent mod ule under the belt and pushing the fixing knob (1) on the patient module through one of the holes in the belt.

Connecting a Transducer o r Patient Module to the Monitor

When you connect a transducer or pa tient modu le to eit her the Car di o 1/ Combi socket, the Toco socket or the Cardio 2 socket, the three da shes in the display go out. The signal quality light for the heart rate display turns red (because the transducer is not yet receiving a good signal from the patient). The monitoring mode is printed on the paper, and repeated every three to four pages.
If you are measuring:
Uterine activity, the display jumps to 20 (the Toco baseline).
Intrauterine pressure, the display shows 0.
Warning NEVER immerse a transducer in liquid when it is connected to the
fetal monitor.
Chapter 3 - General Information
23
Page 36

Signal Quality

Signal Quality
During monitoring, if the signal quality indicator fluctuates between red, yellow and green, it does not necessarily means that the transducer needs repositioning. The fluctuation may be caused by fetal movement. Allow time for the signal to stabilize before deci ding whether to repositi on the transducer (ultrasound) or apply a new electrode (ECG). A trace is possible when the indicator is yellow, but for the best trace it should be continuously green.
Note—Disconnect NON-USED ultrasound transducer, as
continuous mechanical influence of the transducer may result in an artificial trace.
24 Chapter 3 - General Information
Page 37

Input Channels at a Glance

Input Channels at a Glance
This table indicates which combination of transducers and patient modules you can use in the Cardio in put sockets .
Cardio1/Combi Cardio 2 Measurements
US (M1356A)
FSpO2/ECG combined patient module (M1365A):
with DECG adapter cable (M1362A or M1362B)
with MECG adapte r ca ble (M1363A)
ECG only patient module (M1364A):
with MECG adapte r ca ble (M1363A)
DECG adapter cable (M1362A or M1362B)
DECG (M1357A)
MECG (M1359A)
US/MECG (M1358A)
US (M1356A or M1358A) Dual ultrasound. DECG (M1357A or M1364A) Single ultrasound and fetal ECG. US (M1356A) Fetal S pO 2 with fe tal ECG and single ultrasound. MECG
(M1364A or M1359A)
US (M1356A) Fetal SpO 2 with mate rnal ECG a n d single
US (M1356A ) Maternal ECG and single ult rasound. DECG (M1357A or M 1364A)
with DECG adapter cable (M1362A or M1362B)
US (M1356A) Fetal ECG and single ultrasound. MECG (M1359A or M1364A)
with MECG adapter cable (M1363A)
US (M1356A) Fetal ECG and single ultrasound.
US (M1356A ) Maternal ECG and single ult rasound. DECG
(M1357A or M1364A or M1365A)
DECG (M1357A or M1364A) with DECG adapter cable (M1362A or M1362B)
US (M1356A) Single ultrasound with maternal ECG and second
Fetal SpO2 with feta l ECG and maternal ECG.
ultrasound.
Maternal ECG and fetal ECG.
Fetal ECG and maternal ECG.
Maternal ECG and fetal ECG.
Single ultrasound with maternal ECG and fetal ECG.
ultrasound.
You can use the combined US/MECG transducer (M1358A) in the Cardio 2 socket to measure ultrasound only. However if you want to use the combination of US/MECG, you must connect it to the Cardio 1/ Combi socket.
Chapter 3 - General Information
25
Page 38

Example Trace

Example Trace
1. Manufacturers logo.
2. Time, date and paper speed.
3. Barcode notes.
4. Fetal movement profile.
5. Fetal blood oxygen saturation level (FSpO
) trace.
2
6. Uterine activity trace.
7. Maternal heart rate (78 bpm) (either Sp0
or NBP pulse rate).
2
8. Maternal blood pressure:
Systolic blood pressure is 128 mmHg. Diastolic blood pressure is 98 mmHg. Mean arterial pressure is 109 mmHg.
9. Maternal temperature (37.5
o
C). An asterisk * marks measurements
from external devices.
10. Maternal blood oxygen saturation level (97%).
11. Maternal heart rate trace (either MECG or Sp0
12. Fetal heart rate from Ultrasound or DECG.
pulse).
2
Your trace may not look exactly like this - the actual appearance de pe nds on which options you have installed, and which features are in use.
26 Chapter 3 - General Information
Page 39

Marking an Event

Use the event marker key or the remot e event marker to record signifi cant events on the paper (for example, when pain medication is administered or when the mother changes position). To mark an event on the paper:
Press the event marker key on the monitor or
Press the button on the remote event marker.
A small arrow (A) prints on the FHR Scale. The arrow starts with the peak to show the exact time when the key or button is pressed. If the key or button is not releas ed, a black bar is prin ted on the paper. The width of the bar corresponds to the length of time the key or button is pressed.
Marking an Event
pap5bw.hpg
Chapter 3 - General Information
27
Page 40
Marking an Event
28 Chapter 3 - General Information
Page 41

Introduction

This chapter tells you how to prepare your monitor to begin monitoring your first patient. You should:
Ensure that your m onitor is set for the correct voltage fo r your country
Check the time, date, and paper speed
Load paper in to the recorder.

Before Connecting Power

4

Getting Started

Operate the monitor from an ac (alternating current) power source of
100 V (± 10%)
120 V (± 10%)
220 V (± 10%)
240 V (± 10%)
and 50 to 60 Hz (± 5%). The maximum power consumption is 60 VA. Before connecting power, ensure that the voltage selector (A) on the
monitor’s rear panel shows the correct setting for your country.
Chapter 4 - Getting Started 29
Page 42

Switching On the Monitor

To use the monitor with other equipment in an operating room environment, connect the equipotential grounding point (B) to earth potential. Use the grounding cable supplied with the monitor.
Switching On the Monitor
Connect the power cord to the rear of the moni tor. Press to switch on the monitor. When you switch on:
Line~
The monitor on/off light and the displ ays come on.
There are two clicks from the loudspeaker.
The monitor carries out a self test. For details of the self test see
page 150. The error messages that may be displayed are given in Chapter 19, Troubleshooting”.
The maternal display screen shows an egg-timer symbol for a few seconds and then its alarm parameters screen.
All parameter displays show two or three dashes, indicating there is no transducer or patient module plugged in.
The maternal display lights up, showing the default alarm parameters.
30 Chapter 4 - Getting Started
Page 43

Loading Paper

Loading Paper
To load a new pack of paper:
a. Switch off the recorder.
rep5_bw.hpg
b. Push the paper-eject key (1) to unlock the drawer. Make sure
that the drawer is fully open (2).
c. Push and hold the paper-eject key and lift out any remaining
paper.
d. Place the new paper i n the tray with the bottom side down.
The bottom side is indicated by the word STOP on the final page of the new pack.
e. Unfold the top page of the pack.
Chapter 4 - Getting Started
31
Page 44
Loading Paper
f. Position the uterine activity scale on the right.
rep6_bw.hpg
g. Slide the pack into the tray (3).
h. Push the drawer back until it “clicks” closed. Dont push on
the paper when closing the drawer (4).
pega73_bw.hpg
i. Press the recorder on/off key(5) to switch on the recorder. If
the recorder on/off light flashes after the paper is loaded and the recorder is switched on, the drawer is not closed properly.
j. Press and release the paper advance key (6) to advance the
paper automatically to the next fold. Check that the pa per feeds straight.
32 Chapter 4 - Getting Started
Page 45
Caution Using recorder paper that is not ap proved by Philips c an damage
the monitor. This type of damage is not covered by warranty.
If you have difficulty removing the paper, ensure that you have pushed the paper-eject key twice. The first push releases the paper drawer. The second push engages the paper eject mechanism which pushes the remaining paper up the drawer towards you, making it easy to remove.

Switching on the Recorder

Press the r ecor der on /off key to switch on th e r ecord er if necessary. When you switch on:
The recorder on/off light comes on.
The paper advances quickly for 2 cm and then returns to the set
speed.
The time, date and paper speed are printed.
The current monitoring modes (if any t ransducers ar e connected to
the monitor) are printed.
The monitor prints the time, date, paper speed and monitoring modes when first switched on, every ten minutes after, and if the monitoring modes change.
Switching on the Recorder
The recorder on/off light flashes when the monitor detects that there are five pages or fewer remai ning in the pack. I f you switch on the r ecord er or press the paper advance key when there are fewer than five pages remaining, it may take two pages before the recorder on/off light flashes. Load a new pack as soon as possib le.
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Displaying the Time and Date

Displaying the Time and Date
The date and time are printed on the trace. You can choose from a variety of standard date and time formats, such as 12 hour format or 24 hour format, US or European date format. If you have a barcode reader you can change the time and date display format by scanning the desired format from the barcode sheet. If you do not have a barcode reader, you can set the desired format using a service setting. See the Installation and Service Guide for this monitor for instructions.

Setting the Time and Date

Use the following keys to view and change the time and date:
1. Clock key displays the time.
2. Paper speed displays the paper speed.
3. Volume keys change the time, date and paper speed.
After you make changes and return to th e n ormal display, the new time and date are set, and the time, date and paper speed are printed on the paper immediately and then every 10 minutes. You return to the normal display automatically if yo u don’t press any key for a few seconds.
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Choosing Paper Speed

To set the time and date:
1. Press and release to display the current time. The Cardio 1/ Combi display flashes to show that the hour can be changed.
2. Press or to set the hour. Press and hold the keys to change the setting more quickly.
3. Press and release and the Toco display flashes to show that the minutes can be changed.
4. Press or to set the minutes.
5. Repeat the procedure:
a. To set the month (in North America) or the day (in other
countries).
b. To set the day (in North America) or the month (in other
countries).
c. To set the year.
6. Press and release to return to the normal display.
Choosing Pap er Sp eed
You can choose a paper spee d of 1, 2 or 3 centimeters per minute (cm/ min). The default for North America is 3 cm/min; the default for other countries is 2 cm/min.
The ACOG technical bulletin on FHR monitoring states that accurate
pattern recognition is difficult if not imp ossible at 1 cm/ min and that 1 cm/ min is only recommended for more economic screening. When FHR abnormalities arise, the faster paper speeds will enhance FHR pattern recognition”.
Additionally, because a change in paper speed results in a change in the appearance of an FHR trace, you are advised to ensure ALL monitors in your institution are set at the same speed.
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Setting the Paper Speed

Setting the Paper Speed
Use the paper speed key to disp lay the current paper speed and to return to the normal display. You also return to the normal display automatically if you don’t press any key for a few seconds. Use the volume keys to change the speed. When you return to the normal display, the new paper speed is set, and the time, da te, speed and monitoring modes are printed on the paper.
To set the paper speed:
1. Press and release to display the current speed.
2. Press or to set the speed.
3. Press and release to return to the normal display.
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Switching Off After Mo nitoring

1. Switch off the recorder (1).
2. Press and release the paper advance key (2) to advance the paper automatically to the next fold.
3. While you wait for the paper to advance to the next fold, remove the transducers from the patient. Use a soft tissue to remove any gel from the transducers.
4. Tear off the paper at the fold (3). Dont pull on the paper to advance it, and tear off th e paper at the fold only.
5. Switch off the monitor.
Switching Off After Monitoring
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Switching Off After Monitoring
38 Chapter 4 - Getting Started
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Monitoring FHR and FMP Using Ultrasound

Introduction

This chapter describes how to monitor a single fetal heart rate using ultrasound. M onit orin g using ultras ound i s r ecomm ended f rom the 2 5th week of gestation for non-stress or normal routine fetal monitoring. The monitor can also detect fetal movements and display the resulting fetal movement profile (FMP) on the trace.
Warning NEVER immerse the ultrasound transducer in liquid when it is
connected to the monitor.
If you simultaneously monitor a single FHR using both ultrasound and DECG, the ultrasound trace is delayed by approximately two to three beats per m inute.
5
Performing ultrasound imaging or Doppler flow measurements together with the ultrasound fetal monitoring may cause false FHR readings, and the trace recording may deteriorate.

What You Need

Ultrasound transducer
Gel
Transducer belt and button
Chapter 5 - Monitoring FHR and FMP Using Ultrasound 39
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Getting Started

Getting Started
1. Fasten the belt around the patient.
2. Switch on the monitor and the recorder.
3. Connect the transducer to either the Cardio 1/Combi socket, or to the Cardio 2 socket.
4. Find the fetal heart position by palpation, auscultation or ultrasound imaging.
Caution Using ultrasound gel that is not approved by Philips may reduce
signal quality and may dam age the transducer. This type of damage is not covered by warranty.
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Getting Started
5. Apply a small amount of ultrasound gel in a thin layer to the transducer.
6. Apply the transducer to the patient, working it in a circular motion to ensure the gel layer makes good contact.
7. When you have a good signal, clip the transducer in position on the belt.
Note—Disconnect NON-USED ultrasound transducers as the
continuous mechanical influence of the transducer will result in an artificial trace .
Warning Periodically compare the mother ’s pulse with the signal coming from
the monitor’s loudspeaker to ensure that you are monitoring fetal heart rate. Do not mistake a doubled maternal heart rate for FHR. When you monitor maternal heart rate simultaneously with FHR, cross-channel verification alerting warns you if maternal and fetal heart rates coincide.
Please refer to Cross-Channel Verification on page 125.
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Fetal Movement Profile

Fetal Movement Profile
The monitor can detect fetal movements via an ultrasound transducer plugged into the Cardio 1/Combi socket. The resulting fetal movement profile (FMP) appears as “activity blocks (A) along the top of the Toco Scale, the length of each block showing the duration of the activity.

FMP Statistics

FMP Statistics (B) are printed below the activity blocks every 10 minutes.
The first value shows the percentage of detected fetal movements in the previous 10 minutes, and the value in parentheses shows the percentage of detected fetal movements since the recorder was switched on. During the first 10 minutes of monitoring, the values will be identical .
If you plug an ultrasound transducer into the Cardio 1/Combi socket, FMP statistics start again from zero.
The FMP output activates after about half a minute of valid heart rate signals (green or yellow signal quality indicator) to minimize transducer
positioning ar tifact. FMP is pr inted on the pa per to mark the starting point of the FMP statistic.
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Note—The transducer detects gross fetal body movements. Eye
movements are not detected and movement of the feet and hands may not be detected. Positioning or repositioning the transducer i s recorded as fetal movement. Maternal movement, excessive fetal breathin g or feta l hiccups may a lso be recorded as fetal movement. You can mark this artifact on the paper using either the remote event marker or the event marker key. Ignore these movements when you interpret the FMP.
When monitoring twins, remember that movements recorded for twin 1 may also be caused by movement of twin 2.

Switching FMP Off and On

Switching the monitor on also switches FMP on, unless M1310A fetal telemetry is connected. You can use either the function key or the optional barcode reader to switch FMP off and on.
Fetal Movement Profile
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Fetal Movement Profile

Using Keys

You must connect an ultrasound transducer to the Cardio 1/Combi socket before you can change the FMP setting.
1. Press repeatedly until the monitor displays .
The Signal Quality Indicator shows:
RED if FMP is OFF. GREEN if FMP is ON.
2. Press or to change the setting.
3. Press and release to return to the normal display.
4.
FMP is printed on the paper.
You return to the normal display automatically if you do n’t press any key for a few seconds.

Using the Barcode Reader

Enter FMP Off or FMP On from the barcode sheet.
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Troubleshooting

Problem Possible Causes Solutions
Troubleshooting
Erratic trace. Erratic display.
Signal quality indicato r is r ed continuously.
Questionable FHR.
FHR not recorded. FHR is less than 50 bmp or over 300. None. Light or no trace. Wrong paper or dirty printhead. Use recommended paper or clean printhead. End of paper
noted when pack not finished.
Fetal arrhythmia. Obese patient. Transducer wrongly positioned.
Belt loose. Too much gel. Very active fetus. Maternal movement. Insufficient gel.
Transducer wrongly positioned. FHR less than 50 bpm.
Record ing MHR by mistake. Recording periodic signals when the transducer is not applied to the patient.
FHR exceeds 300 bpm. F HR is half-counted (for example 320 bpm is
Bad paper feed or wrong paper. Check paper feed and use recommended paper.
None. None. Reposition transducer until signal quality indicator is green. Tighten belt. Remove excess. None. Relax the patient. Use recommende d amou n t.
Reposition transducer until signal quality indicator is green. None.
Reposition transducer.
recorded as 160 bpm).
Error message is displayed. See Chapter 19, “Troubleshooting” for a table of
error messages, their causes and their solutions.
If you suspect the transducer. Carry out the Parameter Test as described on page
152.
If you suspect the recorder or display. Carry out the Quick Test as described on page
151.
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Troubleshooting
46 Chapter 5 - Monitoring FHR and FMP Using Ultrasound
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Introduction

6

Monitoring FHR Using DECG

This chapter describes how to monitor a single fetal heart rate using a spiral Fetal Scalp Electrode.
Because the tip of the electrode penetrates the fetal epidermis, the possibility of trauma, hemorrhage and infection exists. Use the electrode only under aseptic conditions. Do not apply the electrode:
To the fetal face, to the fontanels, or to the genitalia
When placenta previa is present
When you cannot identify the portion of the fetal body where
application is contemplated
Before the membranes are ruptured
If genital infection exists
When the patient i s less than two centime te rs dilated
When the fetal station is less than minus two.
Chapter 6 - Monitoring FHR Using DECG 47
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What You Need

What You Need
If you are measuring fetal DECG using the traditional open-wire method with a legp late transducer:
DECG legplate transducer (M1357A)Transducer leg belt and buttonOpen-wire Fetal Scalp Electrode (M15133A/M15133C).
If you are measuring fetal DECG using the traditional open-wire
method with a patient module:
– Either ECG only patient module (M1364A) or FSpO
combined patient module (M1365A)
1
/ECG
2
Adapter cable (M1362A)Pre-gelled electrode (40493E)Open-wire Fetal Scalp Electrode (M15133A/M15133C).
If you are measuring fetal DECG using the DECG Adapter Cable
M1362B with a legplate transducer:
DECG legplate transducer (M1357A) DECG adapter (M1347A)DECG Adapter Cable (M1362B)Transducer leg belt and buttonPre-gelled Pad Electrode (M1349A)Fetal Scalp Electrode (15133E/15133D).
If you are measuring fetal DECG using the DECG Adapter Cable
M1362B with a patient module:
– Either ECG only patient module (M1364A) or FSpO
combined patient module (M1365A)
1
/ECG
2
DECG Adapter Cable (M1362B)Pre-gelled Pad Electrode (M1349A)Fetal Scalp Electrode (15133E/15133D).
1. The FSpO2/ECG combined patient module (M1365A) can be used only with the Series 50 XMO Fetal Monitor (M1350C).
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Getting Started

Prepare as you would for a routine sterile vaginal examination. Ensure that the fetus is in a p osition to be monitored by DE CG. Attach the electrode to the fetus a s described in the instructions that come with the Fetal Scalp Electrode.
Attaching the Fetal Scalp Electrode Fetal Scalp Electrode Attached
Getting Started
Warning Do not insert the fetal scalp electrode wires into the AC mains
socket.
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Using the Traditional Open-wire Method to Monitor DECG

Using the Traditional Open-wire Method to
Monitor DECG
(applicable to Fetal Scalp Electrode 15133A and 15133C)

With DECG legplate M1357A

To monitor fetal DECG u si n g the tradition al open-wire method a n d a DECG legplate M1357A, follow these instructions.
1. Fasten the belt around the patients upper thigh. Ensure that the belt is correctl y attached to preve nt tension in the cable from pulling on the Fetal Scalp Elec trode and injur ing the fetus.
2. Slide the transducer under the belt, pointing the connectors towards the abdomen. To get the best signal the transducer must have good contact to th e mothers skin. Do not apply Redux creme or any other conductive gel to the silver plate on the bottom of the DECG transducer.
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Using the Traditional Open-wire Method to Monitor DECG
3. Connect the Fetal Scalp Electrode wires to the DECG transducer.
4. You are now ready to begin monitoring DECG: see the section Monitori n g DE CG” for your next step.

With Patient Module M1364A or M136 5A

To monitor fetal DECG u si n g the tradition al open-wire method a n d either an ECG-only patient module (M1364A), or an FSpO
combined patient module (M1365A), follow these instructions.
1. Fix the DECG cable clip (2) to a pre-gelled electrode 40493E (1).
2. Connect the Fetal Scalp Electrode wires (3) to the DECG cable clip as shown below:
1
/ECG
2
3. Peel the backing from the electrode (40493E) and affix it to the mothers thigh. A good contact between the electrode and the mothers skin will improve the FHR signal. To get the best signal, ensure that the skin is clean and dry before attaching the electrode.
Chapter 6 - Monitoring FHR Using DECG
3
2
51
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Using the Traditional Open-wire Method to Monitor DECG
A
Ensure that the elec trode is correctly p ositioned to prevent tension in the cable from pulling on the Fetal Scalp Electrode and injuring the fetus.
4. Attach the pink connector (1) on the DECG Cable (M1362A) to the ECG pink connector (1) on the patient module (M1364A/ M1365A).
1
M1362
M1364A
M1365A
5. Position the patient module under the abdominal transducer belt wherever it is comfortable for the mother, securing it to the belt using the fixing knob (3).
6. You are now ready to begin monitoring DECG: see the section Monitori n g DE CG” below for your next step.
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Using the DECG Adapter Cable M1362B to Monitor DECG

Using the DECG Adapter Cable M1362B to Monitor DECG
(Applicable to Fetal Scalp Electrode 15133D/15133E)

With DECG Legplate M1357A

To monitor fetal DECG using the DECG Adapter Cable (M1362B) and a DECG legplate transducer (M1357A), follow these instructions.
1. Connect the DECG adapter (M1347A) to the DECG legplate transducer (M1357A):
– With the finger and thumb of one hand, press in the spring clips
on the legplate.
M1357A
– Fit the DECG adapter (M1347A) onto the legplate and release the
spring clips to lock the adapter into place.
M1347A
Chapter 6 - Monitoring FHR Using DECG
M1357A
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Using the DECG Adapter Cable M1362B to Monitor DECG
2. Secure the legplate transducer under the abdominal belt or under the leg belt. To get the best signal the transducer must have good contact to the mother’s skin. Do not apply Redux creme or any other conductive g el to the silver plate on the bottom of the DECG transducer.
3. Attach a pre-gelled electrode (M1349A) to the DECG Adapter Cable (M1362B).
M1349A
M1362B
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Using the DECG Adapter Cable M1362B to Monitor DECG
A
4. Connect the DECG Adapter Cable (M1362B) to the DECG Adapter (M1347A).
M1362B
M1347A
M1357
5. Connect the Fetal Scalp Electrode (15133D/15133E) to the DECG Adapter Cable (M1362B).
M1349A
15133D or
M1362B
15133E
6. Peel the backing from the electrode (M1349A) and affix it to the mothers thigh. Make sure that the skin is clean and dry before attaching the electrode. Ensure that the electrode is correctly positioned to preve nt tension in the cable from pulling on the Fetal Scalp Electrode and injuring the fetus.
7. You are now ready to begin monitoring DECG: see the section Monitori n g DE CG” for your next step.
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Using the DECG Adapter Cable M1362B to Monitor DECG

With Patient Module M1364A or M136 5A

To monitor fetal DECG u si n g the DECG Adapte r Cable M1362B a n d either an ECG-only patient module (M1364A) or an FSpO
combined patient module (M1365A), follow these instructions.
1. Attach a pre-gelled electrode (M1349A) to the DECG Adapter Cable (M1362B).
M1349A
M1362B
2. Connect the Fetal Scalp Electrode (15133E/15133D) to the DECG Adapter Cable (M1362B).
3. Peel the backing from the electrode (M1349A) and affix it to the mothers thigh. A good contact between the electrode and the mothers skin will improve the FHR signal. To get the best signal, ensure that the skin is clean and dry before attaching the electrode. Ensure that the elec trode is correctly p ositioned to prevent tension in the cable from pulling on the Fetal Scalp Electrode and injuring the fetus.
15133E or 15133D
/ECG
2
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Using the DECG Adapter Cable M1362B to Monitor DECG
4. Attach the pink connector (1) on the DECG Adapter Cable (M1362B) to the ECG pink connector (1) on the p atient module (M1364A/M1365A).
M1349A
1
M1362B
M1365AM1364A
5. Fix the patient mod ule to the patients belt using the fixing knob (2).
6. You are now ready to begin monitoring DECG: see the section Monitori n g DE CG” for your next step.
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Using the DECG Adapter Cable M1362B to Monitor DECG
Typical Configuration Showing Fetal Scalp Electrode 15133E/D, DECG Adapter Cable M1362B, and Patient Modul e M1 364A
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Monitoring DECG

1. Switch on the monitor and the recorder.
2. Connect the legplate, or patient module, to the monit or . To
Monitoring DECG
simultaneously measure fetal pulse oximetry and DECG you must connect the patient module to the Ca rdio 1/Combi socket. If you are measuring DECG only you may use either the Cardio 1/ Combi socket or the Cardio 2 socket.
3. Check the arrhythmia logic setting. A red Signal Quality Indicator indicates logic is OFF. Gr een indicates logic is ON. You can
change the setting by pressing until the monitor displays LOG. Use and to change the color of the signal quality
indicator. You must have a DECG transducer connected to either Cardio 1/Combi socket or the Cardio 2 socket.
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Why use Arrhythmia Logic?

Warning
Periodically compare the mothers pulse with the signal coming from the monitors loudspeaker to ensure tha t yo u are monitoring fetal heart rate. Do not mistake a high maternal heart rate for FHR. When you monitor maternal heart rate simultaneously with FHR, cross-channel v erification alerting warns you if maternal an d fetal heart rates coincide.
Why use Arrhythmia Logic?
When arrhythmia logic is on, instantaneo us heart rate change s of 28 bpm or more are not recorded. Recording r esumes when successive beats again fall within predetermi ne d limits. This avoids recording artifacts but does not show genuine arrhythmia. When logic is off, all recorded fetal heartbeats are shown. If you suspect fetal arrhythmia, switch logic OFF. Unless you suspect fetal arrhythmia, we recommend that you use the default setting, with lo gic on, as this makes the trace easier to read and interpret.

After Monitoring

Turn the spiral electrode counter-clockwise to remove it, either with the presenting part crowning and the a pplication sit e visible, or after delivery. Never pull it off or reuse it.
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Troubleshooting

Problem Possible Causes Solutions
Troubleshooting
Erratic trace. Erratic displa y.
Signal quality indicator is red continuously.
nop displayed.
An error message is displayed. See Chapter 19, “Troubleshooting. If you suspect the signal from the transducer. Carry out the Parameter Test as
If you suspect the recorder or display. Carry out the Quick Test as described
No ECG signal. Poor contact between the reference electrode and the mother. Patient module is no t securely fixed.
Fetal arrhythmia. Be sure that logic is off.
Electrode leads not properly connected to cable block.
No contact or poor cont act between reference electrode and mother.
Spiral electrode detached. Reattach the spiral electrode.
Use a new spiral electrode.
Attach the patient module to the patient’s belt with the fixing button.
Check electrode lead connection.
Use a new spiral electrode.
described on page 152.
on page 151.
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Heart Rate Out of Limits

Heart Rate Out of Limits
A questionable heart rate is rare but these are some of the possible causes.
Problem Possible Cause
Questionable heart rate.
FHR less than 30 bpm
FHR is not recorded and the signal quality indicator is red.
FHR between 30 and 50 bpm
50-210 bpm paper records a straight line at 50 bpm. 30-240 bpm paper records the FHR.
FHR is between 210 and 240 bpm
50-210 bpm paper records a straight line at 210 until 240 bpm is exceeded. 30-240 bpm paper records the FHR up to 240 bpm.
FHR exceeds 240 bpm
FHR is not recorded and the signal quality indicator is red.
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Introduction

7

Monitoring Twin FHRs

You can monitor twins throughout labor and delivery after rupture of the membranes by monitoring one twin externally using ultrasound and the other internally using DECG.
If you want to monitor twins externally, you can use two ultrasound transducers, or one ultrasound transducer and a US/MECG transducer. The external method is poss ible on ly if your mo nito r has dual ultras ound capability.
Refer to the appropriate preceding chapters for contra-indications and other information about the measurement methods you have chosen.

Things to Remember During Monitoring

When monitoring you should:
Make sure that you are recording two different heart rates. The cross-channel verification feature alerts you if the two heart rates coincide (that is, if both transducers are recording the same FHR). If this happens, reposition an ultrasound transducer until you detect the second FHR.
Note that the trace recorded for the Cardio 1/Combi channel is thicker (darker) than that recorded for the Cardio 2 channel. This ensures that the two heart rates are easily distinguishable.
Remember that only one fetal heartbeat can be heard from the loudspeaker at any time. To hear the other fetal heartbeat, press either of the volume keys for the channel monitoring that fetus.
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Monitoring Internally

Monitor maternal heart rate , especially during la ter stages of labor, to avoid mistaking mate rnal heart rate for FHR. Cross-channel verification then alerts you if this occurs.
Monitoring Internally
Monitor one twin using the procedures described in Chapter 5, Monitoring FHR and FMP Using Ultrasound. Monitor the second twin using the procedures described in Chapter 6, “Monitoring FHR Using DECG”.
pop43fin.gif

Monitoring Exter nally

Monitor both twins using the procedures described in Chapter 5, Monitoring FHR and FMP Using Ultrasound”. You will need either two ultrasoun d transducers , or one ultraso und transduce r and a US/MECG combi transducer. If you are using two US transducers, removing the white clips from both ends of one transducer will help you
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to distingu ish at a glance the Cardio 1 / Combi US t ransducer f rom the Cardio 2 US transducer.

Separating Twin FHR Traces

To help interpretation of traces with similar baselines, you can separate the baselines, so that one is displayed on the trace as if it is 20 bpm higher than the other. Use either the Function Key or the optional Barcode Reader to separate the traces. This feature is also known as “Twins Offset”.
Usi ng Keys
You must connect transducers to the Cardio 1/Combi and Cardio 2 sockets. You may use either two ultrasound transducers or a combination of one ultrasound and one DECG transducer. You cannot use two DECG transducers.
Separating Twin FHR Traces
1. Press and release to display . The Signal Quality Indicator shows:
REDif the traces are NOT SEPARATED.GREENif the traces are SEPARATED.
2. Press or to change the setting.
3. Press several times to return to the normal display.
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Separating Twin FHR Traces
Using the Barcode Reader
Enter Twins Offset from the barcode sheet.

Twins Offset: On

To indicate that Twins Offset is switched on and the Cardio 1/Combi trace is offset:
A dotted line labeled +20’ prints across the FHR scale.
The Cardio 1/Combi trace is labeled ‘+20’ every 5cm. The
following trace shows Twins Offset switched on.
Only the trace from the Cardio 1/Combi transducer is offset. The numerical FHR value displayed on the monitor r emains unchanged. The Cardio 2 trace and di splay do no t change. Subtract 20 from the Cardio 1/ Combi recorded trace to calculate the true FHR. For example, if the recorded trace shows 160 then the true FHR is 140.
If you disconnect the Cardio 2 transducer, the Cardio 1/Combi trace returns to normal. But if you later reconnect the Cardio 2 transducer, the Cardio 1/Combi tr ace is automatically offset again.
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Twins Offset: Off

Troubleshooting

To indicate that Twins Offset is switched off a dotted line labeled +0 prints across the FHR scale.
Switching off the monitor automatically switches off Twins Offset.
Troubleshooting
The following problem may occur when monitoring twins.
Problem Possible Cause Solution
is printed repeatedly.
Chapter 7 - Monitoring Twin FHRs
Both transducers are recording the same FHR.
Reposition an ultrasound transducer.
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Troubleshooting
68 Chapter 7 - Monitoring Twin FHRs
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Introduction

You can m easure uterine activity externally using a Toco transducer, or internally using an intrauterine catheter. A To co transducer measures the frequency and duration of c ontractions but not thei r intensity. Amplitude and sensitivity depend on various factors such as the position of the transducer, the belt tension and the si ze of the patient. To obtain an absolute measurement, you must monitor intrauterine pressure .

External Toco Monitoring

1. Fasten the abdominal transducer belt around the patient.
2. Connect the Toco transducer to the Toco socket on the monitor.
8

Monitoring Uterine Activity

3. The Toco display shows 20. Toco ext, indicating external uterine measurement, is printed on the trace intermittently.
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Internal Toco Monitoring (IUP Monitoring)

4. Place the transducer o n the patients fundus to ensure the optimum recording of uterine activity.
5. When you have a good signal, clip the transducer in position on the belt.
6. Between contractions, press the Toco Baseline Key . This zeroes the display and trace to 20.
The following example trace shows two contractions.
Internal Toco Monitoring (IUP Monitoring)
You can monitor intrauterine pressure (IUP) using either a reusable or a disposable intrauteri ne catheter. Each catheter comes with its own detailed user instructions. Read the instructions that come with your intrauterine catheter before you start monitoring. Ensure that you zero the monitor when instructed.
Perform a complete clinical evaluation. Catheterize after membrane rupture. Do not catheterize if placenta previa is diagnosed or if uterine bleeding from an undetermined source is present.
1. Insert the catheter according to its accompanying instructions.
2. Connect the catheter to the monitors Toco socket. Some catheters link to a cable that connects to the monitor. The Toco display
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3. Zero the monitor by pressing the Toco Baseline Key . This
4. Flush periodically during monitoring. A pressure spike appears on

Troubleshooting

External Toco

Problem Possible Causes Solutions
Troubleshooting
shows 0. Toco int, indicating internal measurement, is printed intermittently on the trace.
zeroes the display and trace to 0. If you do not zero the monitor properly, the pressure trace may exceed the paper scaling. To correct this, ensure that the transducer is level with the maternal xiphoid (lower end of the sternum), then zero the monitor.
the trace if you flush after connecting the transducer to the monitor.
Quality of the trace deteriorates or the Toco baseline varies.
Toco sensitivity is too high (above 100 units).
An error message is displayed. See Chapter 19, “Troubleshooting. If you suspect the signal from the transducer. Carry out the Parameter Test as
If you suspect the recorder or display. Carry out the Quick Test as described
Chapter 8 - Monitoring Uterine Activity
The belt is incorrectly fastened and is too slack or too tight or the belt has lost its elasticity.
Maternal movement. Relax the patient. Fetal movement. None. Maternal respiration superimposed on
trace. Physical transmission of pressure from
the uterus to the sensor is much higher than the average value.
The belt must be tight enough to ensure good contact between the patient’s skin and the entire surface of the transducer without causing discomfort. Ensure your are using the correct Philips belt. Adjust it as necessary.
Check belt is not too loose.
Ensure a good contact between the patient’s skin and the entire surface of the transducer. Reposition transducer if necessary.
described on page 152.
on page 151.
71
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Troubleshooting

Internal Toco

No trace. Catheter blocked. Flush with sterile solution.
Problem Possible Causes Solutions
No change in pressure during contraction.
Only pressure peaks can be seen (baseline not visible).
- indicator fl a s hes. Trace is a straight line. Transducer is
Trace is superimposed with noise.
An error message is displayed. See Chapter 19, “Troubleshooting. If you suspect the signal from the transducer. Carry out the Parameter Test as described
If you suspect the recorder or display. Carry out the Quick Test as described on
Dry environment or possible extra-ovular placement of sensor tip.
Zero adjustment is incorrect.
defective.
End of catheter is in the uterine wall or dry column.
Flush with sterile solution or reposition sensor.
Zero the system.
Remove and touch the catheter. If the trace does not show up and down movements, use a new transducer.
Retract the catheter a little and flush.
on page 152.
page 151.
72 Chapter 8 - Monitoring Uterine Activity
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Introduction

9

Fetal Pulse Oximetry

Fetal pulse oximetry (FSpO2) gives you a continuous real-time measurement of the percentage of oxygen saturation in the fetal arterial
blood. Identifying adequately oxygenated fetuses and those at risk of hypoxia may help clarify whether or not intervention in the case of a non­reassuring fetal heart rate trace is ne ce ssary.
The FSpO maternal monitor. You can upgrad e the following monitors to
incorporate FSpO
Series 50 XM (M1350B) fetal/maternal monitor.
Series 50 IX (M1350A) fetal monitor.
This parameter is NOT available for monitors purchased in the USA.

Before You Start

Read the accompanying Sensor Placement Guide carefully. It contains full details about how to place the sensor, and any contra-indications. Only clinical professionals trained in the use of sensor placement may place a fetal oxygen sensor. Use only Nellcor-approved FS14 fetal sensors.
Unlike other fetal meas urements, wher e yo u get an almost instant displ ay on the monitor as soon as you apply a transducer correctly, the FSpO
measurement can take several minutes after the sensor is correctl y placed before you see a value displayed on the monitor.
parameter is built into the Series 50 XMO (M1350C) fetal/
2
:
2
2
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To Begin Monitoring

To Begin Monitoring
1. Plug the FSpO2/ECG combined patient module into the Cardio 1/Combi socket.
The monitor displays the symbol:
2. Check, and if necessary change, the alarm settings.
3. Connect the sensor to the patient module, maintaining sterility by exposing only the connector when you open the sensor package. The connector is color coded blue to ensure that you connect to the blue FSpO
4. Make sure that you can see red light coming from the emitter on the sensor body. If there is no light, use a new sensor. The monitor displays the sensor lifted symbol:
connector, not the pink E CG input.
2
5. Apply the sensor to the side of the fetal face closest to the maternal spine, according to the ins tructions in the sensor placement guide. Adjust the sensor until you get skin contact. When you have contact, the monitor displays the pulse search symbol and the pulse bar lights rhythmically as the monitor searches for a signal of sufficient quality to allow it to determine the saturation value.
74 Chapter 9 - Fetal Pulse Oximetry
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6. Wait until the four-step signal quality indicator shows that it is receiving a medium or good signal (with three or four segments lit). It may take up to a minute after this until the monitor displays the fetal o xygen saturation value. Do not reposition the sensor unless you are certain the monitor is not receiving a signal of accepta ble quality.

Understanding the Display

The following diagram shows the elements of the FSpO2 display:
Understanding the Disp la y
1. Pulse indicator
The six segments pulse rhythmically in conjunction with the fetal pulse rate when the pulsatile activity is of acceptable quality.
If the indicator pulses regularly but the monitor does not displa y a fetal oxygen saturation val ue, wait before you repo sition the sen sor.
Chapter 9 - Fetal Pulse Oximetry
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Understanding the Display
The monitor may not yet be able to calculate a saturation value from the signal it is r eceiving.
If the pulse indicator becomes briefly irregular, and then returns to a regular rhythm, do not reposition the sensor. The irregularity is probably caused by fetal or maternal movement.
2. Signal quality indicator
Shortly after the pulse indicator moves rhythmically, the four­segment signal q uality indicator illuminates to show how good a signal the monitor is receiving from the sensor. The more segments that light, the better the quality of the signal. Typically, the monitor needs a medium to good quality signal (with three or four lit segments) f or up to a min ute to calculate and then disp lay the saturation value.
3. Alarm status indicator
When the crossed bell symbol is lit, alarming is switched off. When it is not lit, alarming is switched on.
4. Cross-Channel Verification Plus (CCV+) indicator
The fetal pulse ra te from FSpO
is determined i n ternally by the
2
monitor. It is not displayed, on either the trace or monitor. To warn you if you accidentally record maternal SpO
fetal SpO
(because the sensor is facing the uterine wall instead of
2,
instead of
2
the fetus) the monitor compares the heartrate it d erives from DECG on the Cardio 1/Combi channel, (or from US on the Cardio 2 channel if DECG is not in use) with the pulse rate it derives from FSpO
. The CCV+ indicator illuminates and is
2
printed on the trace if the monitor:
– records a pulse rate from FSpO
and a heart rate from DECG
2
or ultrasound that do not match for more than one minute.
– records more than 80% fetal saturation for more than one
minute.
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Alarm

Alarm Limits

Alarm
You should check the fetus and adjust the sensor until you are sure you are recording fetal oxyg en saturation.
5. Saturation value
This displays the level of oxygen saturation in the fetal blood. Typical fetal values lie within the range 40% to 70%.
See Chapter 3, General Information on page 19 for a sample trace including FSpO
.
2
The monitor makes a “beeping” noise and the saturation display flashes.
FSpO2 has two alarm criteria, whic h you ca n change o nly when a pa tien t module is conne cted to the monit or. If you change an alarm limit, your
change is retained by the monitor, even if you switch the power off. The alarm limits are:
Saturation alarm level
The alarm triggers if the percentage of fetal oxygen saturation falls below this point. The defau lt se tting is 30%.
Time delay
This is the length of time for which fetal oxygen saturation must be at or below the saturation limit before the alarm triggers. The default setting is one minute.
When you change the monitor’s battery, the alarm sett ings return to the factory settings.
Chapter 9 - Fetal Pulse Oximetry
77
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Alarm

Triggering an Alarm

For an alarm to trigger:
The FSpO
2
The percentage sa tura tion must fall below the saturation alarm level for the length of time specified b y the time delay.

Acknowledging an Alarm

Press the acknowledge key on the recorder or the yellow key on the maternal display to acknowledge an FSpO

Turning the Alarm On and Off

1. Connect the ECG/FSpO2 patient module to the Cardio 1/Combi socket.
2. Press until the FSpO
3. Press to toggle between alarming on and off. The signal quality in dicator for th e Cardio1/Combi channel is red when alarming is OFF and green when it is ON.
4. Press to return to normal monitor function. A crossed bell symbol, near the FSpO

Changing Alarm Limits

alarm must be switched on and
alarm.
2
display shows .
2
display, illuminates when the alarm is off.
2
1. Connect the ECG/FSpO2 patient module to the Cardio 1/Combi socket.
2. Press until the FSpO
display shows .
2
3. Press to access the saturation alarm limit setting. The Toco display shows , indicating that you are changing the saturation low alarm limit. The FSpO
display shows the current
2
low limit. There is no high limit.
4. Press or to increase or decrease the FSpO
saturation
2
alarm limit.
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Inop Alarms

Alarm
5. Press to set the time delay. The Toco display shows , indicating that you are chang ing the time delay . The FSpO
2
display shows the current delay, in minutes.
6. Press or to increase or decrease the time delay in increments of 0.5 minutes.
Press to return to normal monitor functi on. If alarming is enabled, the alarm limits are printed on the trace. If it is
disabled, is printed.
If the signal quality has been good for a minute or longer, and then the quality falls below an acceptable level for more than 30 seconds, the monitor beeps. This feature can be enabled or disabled through the service settings. See the Installation and Service Guide for details.
Chapter 9 - Fetal Pulse Oximetry
79
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Troubleshooting

Troubleshooting
Display Problem Solution
Patient module not plugged in.
Pati ent module plugged in but sensor not attached.
Patient module and sensor are both correctly connected but no signal is obtained.
Pulse indicator bar pulses rhythmically but monitor does not display a saturation value.
Plug in patient module.
Check connection of sensor to patient module. Replace patient module or sensor if necessary.
The sensor has lost contact with the patient. Reposition the sensor slightly.
Observe the quality indicator lights. If you do not obtain a medium to good quality signal (three or four segments lit) after waiting for at least one minute, reposition sensor.
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Loss of Pulse Signal

Temporary loss of pulse signal is normal and the clinical professional must judge whether the trace gives enough information for diagnosis. Loss of pulse signal can occur:
If there is excessive or prolonged fetal or maternal movement
During uterine contractions
If the fetus experiences shock, hypotension, severe vasoconstriction,
arterial occlusion proximal to the sensor, or cardiac arrest.

Inaccurate Measurements

Inaccurate measurements may be caused by:
Incorrect placement of the sensor
Significant levels of dysfunctional hemoglobin, such as
carboxyhemoglobin or methemoglobin
Excessive fetal or maternal movement
Uterine contractions
Venous pulsation
Side effects from some drugs.
Loss of Pulse Signal
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81
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Inaccurate Measurements
82 Chapter 9 - Fetal Pulse Oximetry
Page 95

Introduction

10

Monitoring Using External Devices

This chapter describes how to record maternal non-invasive blood pressure (NIBP), maternal blood oxygen saturati on level (SpO
maternal temperature and maternal heart rate (MHR) by connecting a supported extern al device to your monitor. If you have a Series 50 XM you can connect an Nellcor OxiFirst compatible fetal pulse oximeter.
Pulse Oximeter (N-400) or
),
2
Chapter 10 - Monitoring Using External Devices 83
Page 96

Recording From an External Device

Recording From an External Device
If you connect an external device that replicates parameters already installed in your monitor (such as MHR, maternal SpO
FSpO You can connect:
), the external device is ignored.
2
Parameters
, NIBP and
2
Supported External Devices
Philips M1165A/1166A/1175A/
NIBP
2
Yes
Maternal Fetal
SpO
2
Yes
2
Temp
2
Yes
MHR
2
Yes
1
1176A/1167A/1177A CMS Philips 78352C/78354C Compact
Yes
2
Yes
2
Yes
2
Yes
2
Configurable Monitor (CCM) Dinamap 1846/8100 NIBP Monitor Yes No No Yes No Press-Mate/Listmini
YesNoNoYesNo
Model BP-8800 Accutorr 3, 4 Yes No No Yes No Accutorr 3SAT, 4SAT Yes Yes No Yes No Nellcor N-200 SpO
Nellcor N-400 FSpO
1. An MHR measurement is provided in conjunction with maternal NIBP or SpO2 monitoring.
2. Only if this parameter is installed on the external device.
Monitor No Yes No Yes No
2
Monitor No No No No Yes
2
FSpO
No
No
2
84 Chapter 10 - Monitoring Using External Devices
Page 97

What You Need

Recording From an External Devic e
To connect a supported external device you require:
Requirements
Model
1
Option J13
Additional Requirement
Press-Mate/Listmini Model BP-8800
Dual Interface Board
NIBP Dinamap 8100 Dual Interface
Board
Others Dual Interface
Board
1. Includes one interface cable (M1350-61609)

Connecting the External Devices to the Monitor

Connect a supported external device via the dual serial interface at the rear of the monitor.
Caution Before connecting an external device to the monitor, connect the
equipotential grounding point (3) to earth potential. Use the grounding cable supplied with the monitor.
COLIN Interface cable (available from COLIN Corporation)
Model 8801 interface adapter (available from General Electric)
None
Chapter 10 - Monitoring Using External Devices
85
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Recording From an External Device
The Dual Serial Interface has two sockets:
1. Use socket 1 (9 pin) for connecting:
Philips M1165A/1166A/1175A/1176A/1167A/1177A
Dual Serial Interface
CMS.
Philips 78352C/78354C Compact Configurable Monitor.
Dinamap 1846/8100 NIBP Monitor.
Press-Mate/Listmini Model BP-8800.
Accutor 3, 4, 3SAT and 4SAT.
2. Use socket 2 (25 pin) for connecting:
Nellcor N-200 Maternal SpO
Nellcor N-400 Fetal SpO
If you use both sockets 1 and 2, and maternal SpO
Monitor
2
Monitor (M1350B only).
2
can be
2
recorded from the external device connected to socket 1, the measurement from this external device has priority over the measurement from the Nellcor Monitor N-200 in socket 2.
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Recording From an External Devic e
3. Use the interface cable to connect the external device to the appropriate socket.
4. Connect the other end of the interface cable to the external device. (See the service documentation supplied with the external device for the correct socket to use for the connection.)
If you are monitoring maternal SpO
or temperature and the monitor is
2
switched on before the appropriate sensor is applied, the first value documented may be incorrect as it takes up to five minutes for the correct value to be obtained.
To monitor maternal temperature on the M1165A/1166A/1175A/ 1176A/1167A/1177A CMS, you must connect the te mperature sensor to TEMP1.
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Recording From an External Device

Example Trace

1. Maternal blood pressure:
Systolic blood pressure is 128 mmHg. Diastolic blood pressure in 98 mmHg. Mean arterial pressure is 109 mmHg.
2. Maternal heart rate (78 bpm).
3. Maternal oxygen saturation level of blood (97%).
4. Maternal temperature (37.5 coming from external monitors ar e prefixed with an asterisk, “*”.
o
C). Note that trace annotations
What is printed on the trace?
External
Measurement
Maternal NIBP Value at each measurement, unless in automatic mode. Maternal SpO
Maternal temperature
Fetal SpO
88 Chapter 10 - Monitoring Using External Devices
Fetal SpO2 trace and annotation printed on Toco scale.
2
Value every 5 minutes.
2
Value every 5 minutes.
Print on Trace
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