Philips Telemetry System User manual

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Philips Telemetry System

M2600-9001C

Instructions for Use

Part Number M2600-9001C

Printed in the U.S.A. May 2002

Edition 2

Notice

Proprietary Information

This document contains proprietary information that is protected by copyright. All Rights Reserved. Reproduction, adaptation, or translation without prior written permission is prohibited, except as allowed under the copyright laws.

Philips Medical Systems 3000 Minuteman Road Andover, MA 01810-1099 (978) 687-1501

Publication number M2600-9001C, Edition 2 Printed in USA May 2002

Warranty The information contained in this document is subject to change without notice.

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

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

Trademark EASI™ is a registered trademark of Zymed, Inc.

Copyright Copyright © 2002 by Philips Medical Systems

Printing History

New editions of this document incorporate all material updated since the previous edition. Update packages may be issued between editions and contain replacement and additional pages to be merged by a revision date at the bottom of the page. Pages that are rearranged due to changes on a previous page are not considered revised.

The documentation printing date and part number indicate its current edition. The printing date changes when a new edition is printed. (Minor corrections and updates which are incorporated at reprint do not cause the date to change.) The document part number changes when extensive technical changes are incorporated.

M2600-90201, First Edition.................................................... August 1998

Printing History

Model M2604A Viridia Mainframe, revision D.01/D.02/D.03 Model M2601A Viridia Transmitter, revision A.00/A.01/A.02 Model M2605A Viridia Wave Viewer, revision A.00/A.01/A.02 Model M1403A Digital UHF Telemetry System with Option C03, revision D.01/D.02/D.03

M2600-90201, Second Edition............................................... February 1999

M2600-9001B, First Edition.................................................. February 2000

HP Telemetry System, Release B Model M2604A Viridia Mainframe, revision D.01/D.02/D.03 Model M2601A Viridia Transmitter, revision A.00/A.01/A.02/A.03 Model M2605A Viridia Wave Viewer, revision A.00/A.01/A.02 Model M1403A Digital UHF Telemetry System with Option C03, revision D.01/D.02/D.03

iii

Printing History

M2600-9001C, First Edition.................................................. July 2000

Agilent Telemetry System, Release C Model M2604A Agilent Mainframe, revision E.00 Model M2601A Agilent Transmitter, revision B.00 Model M2605A Agilent Wave Viewer, revision B.00

M2600-9001C, Second Edition.................................................. May 2002

Philips Telemetry System, Release C Model M2604A Philips Mainframe, revision E.00 Model M2601A Philips Transmitter, revision B.00 Model M2605A Philips Wave Viewer, revision B.00

Details about the specific releases are contained in Appendix C.

About this Book

These Instructions for Use cover the use of the Philips Telemetry System Release C with the Philips Information Center.

The Instructions for Use contain information on performing day-to-day tasks and troubleshooting common problems as well as detailed information about all clinical applications. It includes lists of alarm and inoperative (INOP) messages, and configuration choices. Your purchased system may not include all of the functionality described in this manual. When information pertains only to the EASI

User information for the Philips Telemetry System is also contained in the Philips Information Center On-line Help. Help focuses on how to complete basic tasks and troubleshoot problems.

About this Book

transmitters, the following EASI chest icon appears next to the title:

2 3

EASI

Appendix C, “System Releases” summarizes the differences between the current version of the Philips Telemetry System and earlier system releases.

About this Book

Document Conventions

Procedures

Procedures are indicated in text by the heading Task Summary followed by the following table:

Step Action

Bold Typeface

Objects of actions in procedures appear in

bold typeface. Note the following

example:

Click the

Update button.

Warnings

Warning

Warnings are information you should know to avoid injuring patients and personnel.

Cautions

Caution

Cautions are information you should know to avoid damaging your equipment and software.

Notes

Note—Notes contain additional information on Philips Telemetry System usage.

1. Introduction to the Philips Telemetry System . . . . . . . . . . . . . . . . . . .1-1

Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2

Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Prescription Versus Over-the-Counter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Part of the Body or Type of Tissue with which the Device Interacts. . . . . . . . . 1-2

Frequency of Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Physiological Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

System Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4

Dual-band Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

Transmitters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-6

Philips Transmitters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-7

Philips Telemetry Battery Extender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-9

Transmitter Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-12

Transmitter Button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12

Water Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12

Pouch Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

Automatic Shutoff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

Battery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

Use of Zinc-Air Batteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15

Maximizing Battery Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15

Disposal of Batteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15

Nominal Battery Life Expectancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16

Inserting Batteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18

Receiver Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-21

Receiver Mainframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-22

Turning the Receiver Mainframe On or Off . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22

Receiver Mainframe Malfunction Light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22

Channel Frequencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22

Retaining Telemetry Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22

Antenna System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-23

Turning Telemetry On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-24

Contents 1

2. ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

Lead Sets & Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

Standard ECG Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

Philips EASI Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4

Preparing for ECG Telemetry Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5

EASI 12-lead Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6

Making ECG Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

Bandwidth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

Changing Lead/Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

Adjusting Wave Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

Making Other Monitoring Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8

Turning the Transmitter Button On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8

Standby Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9

Monitoring During Leads Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

Fallback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

Multilead Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

Singlelead Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

Fallback for EASI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

Extended Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11

Optimizing System Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

The Telemetry Signal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Frequent Signal Strength and RF INOPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Signal Strength . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Radio Frequency Interference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Muscle and Movement Artifact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

ECG Alarm Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Telemetry Alarm & INOP Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17

Contents 2

3. ST/AR ST Segment Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-1

ST/AR ST Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

Intended Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2

Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

The Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-3

How the Algorithm Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Displayed ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

EASI ST Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

Adjusting Measurement Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

Establishing ST Reference Beats (Baseline). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Turning ST On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

ST Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-8

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-8

ST Alarm Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-9

ST Alarm and INOP Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-10

4. SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-2

Preparing for Telemetry SpO

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4

Making SpO

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Automatic Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Manual Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6

Measurement Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

SpO

Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Disposable Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Reusable Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9

Selecting the Appropriate Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

Applying the Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-11

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-11

Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12

Adult Finger Transducer (M1191A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-13

Small Adult/Pediatric Finger Transducer (M1192A) . . . . . . . . . . . . . . . . . . . . . . . .4-14

Ear Clip Transducer (M1194A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-15

Disposable Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-15

Optimizing Transducer Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-16

Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4

Contents 3

Turning the SpO

Parameter On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17

SpO

Parameter Auto ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-18

Turning SpO

Alarms On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

Turning the Pulse Parameter On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

SpO

Alarm and INOP Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20

5. Telemetry System Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

Cleaning and Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2

Cleaning the Receiver Mainframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

Cleaning the Transmitter & Battery Extender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Wiping the Transmitter Exterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Wiping the Battery Compartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Wiping the Battery Extender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

Soaking the Transmitter & Cradle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7

Cross-infection Prevention for the Transmitter & Battery Extender . . . . . . . . . . . . . . . . 5-8

Cross-infection Prevention and Aeration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9

Equipment and Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9

Cross-infection Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10

Aeration Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12

Making Sure the Equipment Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13

Cleaning the Hewlett-Packard 200LX Palmtop Computer . . . . . . . . . . . . . . . . . . . . . . 5-15

Cleaning ECG Patient Cables and Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-16

Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-16

Disinfecting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17

Sterilizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17

Cleaning SpO

Philips Adapter Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-18

Philips Reusable Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-19

Adapter Cable & Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-18

Contents 4

6. Telemetry System Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1

About Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-2

Configuration Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

M2604A Mainframe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Philips M2601X Series Transmitter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5

Changing the Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-6

Configuring Replacement Philips Transmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

Changing Frequencies for Philips Transmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-8

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

7. System Safety and Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-1

Safety Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-2

Philips Telemetry System Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-3

Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-4

M2600A Philips Telemetry System Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-4

EN61000-4-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

IEC 801-4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Philips Telemetry System Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5

Avoiding EMI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

FCC Compliance (USA only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5

Canadian Radio Equipment Compliance (Canada Only) . . . . . . . . . . . . . . . . . . . . .7-6

System Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-7

Type CF Defibrillation Proof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-12

Installation and Maintenance Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13

Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-13

Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13

Grounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13

Condensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14

Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-14

Receiver Mainframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15

Antenna Amplifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-16

Patient Monitor/Holter Interface Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-16

Preventive Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-16

End of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-17

Additional Safety Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-18

Software Hazard Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18

System Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-19

System Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-19

Environmental Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20

Contents 5

For Philips Transmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-20

For Hewlett-Packard 200LX Palmtop Computer . . . . . . . . . . . . . . . . . . . . . . . 7-20

For Reusable Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-21

Electrical Power Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22

M2601A Transmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22

M2604A Receiver Mainframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-23

M2604A Receiver Main Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-24

M2603A Receiver Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-25

M2611A Battery Extender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-25

Patient Monitor Holter Recorder Interface (Analog Output) Option J01 . . . . . 7-25

Antenna System Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27

M1406A Line Amplifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27

M1407A Multiple Unit Power Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-27

M1408A Active Antenna Combiner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-28

M2606A Line Amplifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-28

M2607A Multiple Unit Power Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-29

M2608A Active Antenna/Combiner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-29

M2609A Attenuator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-30

M2612A Bandpass Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-30

M2616A External Frequency Converter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-31

Measurement Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-31

ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-31

SpO

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-32

Pulse Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-32

Contents 6

APPENDICES

A. Optional Patient Monitor/Holter Interface (Analog Output) . . . . . . . A-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Correct Labeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Analog Output Bedside Monitor Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

Lead Placement and Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Using Non-standard Lead Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

Controls for Telemetry Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-6

Functionality with Paced Waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-6

Inoperative (INOP) Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7

Holter Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-8

B. Accessories and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . B-1

C. System Releases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1

Release Features and Upgrade Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1

Release C Enhancement Details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4

EASI 12-lead Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4

What You Need to Know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4

During INOPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-5

EASI Electrode Placement with a5-wire leadset for 12-lead ECG . . . . . . . . . . C-6

Viewing EASI Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-7

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-7

Additions to Hard INOP Messages at Central. . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-8

WaveViewer INOP Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-8

ST Segment Monitoring with EASI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-9

Multilead Alarms with EASI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-9

SpO

Parameter Auto ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-10

Other Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-10

D. Wave Viewer Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1

Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Prescription Versus Over-the-Counter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Part of the Body or Type of Tissue with Which the Device Interacts . . . . . . . . D-2

Frequency of Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Physiological Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-3

Contents 7

Introducing the Wave Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-5

Environmental Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-6

Installing the Wave Viewer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7

Connecting to the Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-9

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-9

Connecting Directly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-10

Connecting with a Light Pipe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11

Battery Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-13

Battery Types and Battery Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-13

Battery Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-14

When to Replace Palmtop Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-14

Removing and Installing Palmtop Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-14

Changing the Main Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-15

Changing the Backup Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-16

Software License Agreement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-17

Philips Medical Systems Software License Terms . . . . . . . . . . . . . . . . . . . . . . . . D-17

E. Wave Viewer Instructions for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . E-1

Wave Viewer Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-2

Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-2

Main Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-2

Using the Wave Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-3

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-3

Checking ECG Signal Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-4

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-4

Viewing Other Standard ECG Leads. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-5

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-5

Viewing EASI Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-6

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-6

Changing the Lead (Standard ECG only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-7

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-7

Adjusting ECG Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-7

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-7

Estimating the Heart Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-8

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-8

Checking SpO

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9

Changing the SpO

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-10

Making a STAT SpO

Signal Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9

Sample Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-10

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-11

Contents 8

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-11

Using Help. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-12

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-12

Deactivatingthe Wave Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13

Power Save Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13

Exiting the Wave Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13

Task Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-14

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-14

Wave Viewer Inoperative Messages (INOPs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-15

F. Using Your Transmitter with Release C . . . . . . . . . . . . . . . . . . . . . . . F-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-1

Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-2

Locate the appropriate section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-3

Clinical functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-4

Documents available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-4

When using a Revision B.00.05 Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-5

When using a Revision A.03.02 Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-6

When using a Revision A.02.03 Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-7

When using a Revision A.02.01 Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-8

When using a Revision A.01.02 Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-9

When using a Revision A.00.22 Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-10

When using a M1400A/B/J Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-11

Reference Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-12

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-12

Water resistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-12

Disconnecting the lead set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-13

Battery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-14

Lead Sets and Capabilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-16

Making Monitoring Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-17

INOPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-19

Analog Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-19

Configuration Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-20

Safety Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-20

Electro-magnetic Capability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-21

System Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-22

HP M1402A Receiver Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-23

Accessories for M1400A/B/J Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-24

G. Sales and Support Offices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-1

Contents 9

Contents 10

Introduction to the

Philips Telemetry System

This chapter introduces the Philips Telemetry System. It includes the following sections:

• Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

• System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

• Transmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6

• Receiver Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-21

• Receiver Mainframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-22

• Antenna System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-23

• Turning Telemetry On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-24

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1 System Introduction

Introduction to the Philips Telemetry System 1-1

Indications for Use

The paragraphs below are the elements of the indications for use statement for the Philips Telemetry System (M2600A).

Condition The licensed clinician decides that the Philips Telemetry System should be used

to monitor the patient.

Prescription

Versus Over-

the-Counter

Part of the

Body or Type

of Tissue with

which the

Device

Interacts

Frequency of

Use

Physiological

Purpose

Patient

Population

The Philips Telemetry System is a prescription device.

The ECG signal is obtained from accessory electrodes in contact with the patient’s skin. The SpO

signal is obtained from an accessory sensor in contact

with the patient’s skin.

The Philips Telemetry System is indicated for use when prescribed by a licensed clinician.

The Philips Telemetry System is indicated when the physiological purpose is to monitor the ECG or SpO

of patients on the order of a licensed clinician.

Adult and pediatric patients.

1-2 Introduction to the Philips Telemetry System

Indications for Use

Intended Use The Philips Telemetry System is a comprehensive ambulatory system solution

for the intermediate care unit for adult and pediatric patients. The foundation of the system is a transmitter that can capture and transmit ECG signals and SpO values (if available) that are then processed and displayed on the Philips Information Center. The information center generates alarms and recordings, thus notifying clinicians of changes in patients' conditions. The Telemetry System communicates with other devices via the Philips patient care system.

Warning

United States law restricts this device to sale by or on the order of a physician. This product is intended for use in health care facilities by trained health care professionals. It is not intended for home use.

1 System Introduction

Introduction to the Philips Telemetry System

1-3

System Overview

The Philips Telemetry System (M2600A) is used with the Philips Information Center to provide multi-parameter measurements for transitional care and other ambulatory monitoring environments. The system:

• Monitors adult and pediatric patients’ ECG.

• Measures pulsatile arterial oxygen saturation (SpO

• Enables viewing of ECG and SpO

• Makes ST segment measurements.

The Philips Telemetry System consists of:

• A transmitter for each patient.

• An antenna system.

• A receiver for each transmitter.

• A mainframe housing up to eight receivers.

Other possible items include:

• An HP™ Palmtop Personal Computer with Wave Viewer software. See

• M2636B TeleMon

• Telemetry Configuration Tool. See the

) and pulse rate.

measurements and waveforms at the

patient’s side.

Appendix D, “Wave Viewer Basics” and Appendix E, “Wave Viewer Operation” for additional information

Service Configuration Guide for how

to use the Telemetry Configuration Tool (PN M2600-9523C)

Note—The M2605 Wave Viewer, which enables you to perform selected system

support functions and view patient information at the bedside, has been discontinued. The following system support functions formerly available on Wave Viewer can now be performed using the Telemetry Configuration Tool.

• Set RF frequency

• Change SpO

sample rate

• Change transmitter settings

See the

Philips Telemetry System Service Guide or your local trained service

professional for assistance.

Other Wave Viewer functions, such as viewing wave forms and heart rate, can be performed using the Philips M2636B TeleMon Monitor. The TeleMon can also be used to measure SpO

M2636B TeleMon Monitor Instructions for Use

1-4 Introduction to the Philips Telemetry System

and NBP. For more information see the Philips

System Overview

1 System Introduction

Dual-band

Operation

The frequency range of the Philips Telemetry System (M2600A) allows operation in both the 590-632 MHz and the 406-480 MHz frequency bands. This provides more options for users in countries where radio rule changes in recent years have made higher band operating frequencies more desirable for medical telemetry. For example, in the U.S.A., an FCC rule change provides co-primary operation for medical telemetry at UHF TV Channel 37 (608-614 MHz). The antenna system enables operation up to 650 MHz, addressing the needs of these newer rules, and allows operation of transmitters in both bands simultaneously.

M2600A Philips Telemetry System

Philips Telemetry System

Introduction to the Philips Telemetry System

1-5

Transmitters

The following Philips transmitters can be used with the Philips Telemetry System:

• standard - ECG and SpO

• standard - ECG only

• EASI - ECG and SpO

• EASI - ECG only

To aid in identification, standard ECG transmitters have dark green labels and EASI transmitters have purple labels.

Note—The HP M1400A/B Transmitter (ECG only) can also be used. For

operating information, refer to the user guide for your HP M1403A Telemetry System.

Warning

Pacemakers can be susceptible to radio frequency (RF) interference from devices such as telemetry transmitters which may temporarily impair their performance.

The output power of telemetry transmitters and other sources of radio frequency energy, when used in the proximity of a pacemaker, may be sufficient to interfere with the pacemaker’s performance. Due to the shielding effects of the body, internal pacemakers are somewhat less vulnerable than external pacemakers. However, caution should be exercised when monitoring any paced patient.

In order to minimize the possibility of interference, position electrodes, electrode wires, and the transmitter as far away from the pacemaker as possible.

Consult the pacemaker manufacturer for information on the RF susceptibility of their products and the use of their products with the telemetry transmitters.

See the Philips Information Center User’s Guide for additional information on monitoring paced patients.

1-6 Introduction to the Philips Telemetry System

Transmitters

1 System Introduction

Philips Transmitters

The Philips Transmitter (EASI and standard ECG version) is battery powered and worn by the patient. It acquires the patient's ECG and SpO

signals (if

available), processes them, and sends them via the antenna system to the receiver. Measurements are then displayed at the Philips Information Center. The transmitter can also be connected via an infrared link to the Wave Viewer or TeleMon to provide display of patient measurements and waveforms at the patient’s side.

SpO

Transducer Connection

ECG Lead Set Connection

Combiner Clip

Infrared Link to Wave Viewer and TeleMon

Transmitter Button

Transmitter Label

Battery Compartment

Chest Diagram with

LEADS

OFF Lights

For Standard ECG Transmitter (label is dark green)

EASI Chest

EASI

2 3

Diagram with

LEADS OFF Lights

For EASI Transmitter (label is purple)

Transmitter Button

Transmitter Label

Introduction to the Philips Telemetry System

1-7

Transmitters

ECG Connection: The Philips Transmitter supports a 3- or 5-wire ECG cable compatible with Philips CMS/24 ECG trunk cables. The Philips EASI Transmitter supports 5-wire ECG cables only (use of a 3-wire cable set generates an INOP condition). CMS trunk cables must include telemetry combiners. In addition to keeping dirt out of the connectors, the combiner has a locking mechanism to keep the lead set attached securely to the transmitter. For safety, every lead should be secured to an electrode on the patient.

Warning

Conductive parts of electrodes should not contact earth or other conductive parts.

Disconnection of Leadset: When you’re ready to disconnect the leadset, lift the clip of the combiner to release the lock. Then, holding the combiner firmly, rock the leadset free. Do not pull on the lead wires or push on the combiner clip.

SpO

Connection: In addition, both the standard ECG and EASI transmitter

support a SpO

transducer (sensor) connection. SpO2 can be measured

continuously, intermittently at 1 or 5 minute intervals, or manually. Reusable sensors in adult finger, small adult/pediatric finger, and ear clip models can be used, as well as Oxisensor II™ disposable sensors. See Appendix B, “Accessories and Ordering Information” for a list of sensors.

Chest Diagram & LEADS OFF Lights: The diagram on the front of the standard ECG transmitter shows lead placement for a 5-wire lead set. The white, black and red electrode positions represent standard AAMI 3-lead placement; the red, yellow and green electrode positions represent standard IEC 3-lead placement. Non-standard 3-wire lead placement diagrams are available at the Wave Viewer.

The diagram on the front of the EASI transmitter shows EASI lead placement for a 5-wire lead set. The AAMI colors that are used for EASI are brown (E), red (A), black (S), white (I), and green (reference). The IEC equivalents for EASI are white (E), green (A), yellow (S), red (I), and black (reference).

On both transmitters, each electrode position has a light that illuminates if the corresponding electrode becomes detached. In a LEADS OFF situation, this indicator will help you identify quickly which leads are off and re-attach them. If the reference lead is off, after you correct the situation you may find other lights illuminated as well.

1-8 Introduction to the Philips Telemetry System

Transmitters

A second function of the Leads Off lights is to indicate successful power-up of the transmitter. When you insert a battery into the transmitter, all five lights should flash once. This indicates that the battery has adequate power for monitoring and that there is no transmitter malfunction. See “Inserting Batteries” on page 1-18 for details.

1 System Introduction

Philips Telemet ry Battery Extender

The electrode lights are also used as an indicator that a manual SpO measurement has been initiated at the transmitter.

The Philips Telemetry Battery Extender (M2611A) enables operation of the transmitter with an external power source when a patient is not ambulating. The battery extender can be used with Release B and C Philips transmitters, and earlier transmitters that have been upgraded.

The battery extender consists of a cradle, which is fitted over the battery compartment of the transmitter, and a cable connecting to a wall-mounted DC power module. When the battery extender is in use, no battery power is used (battery save mode).

Note—The purpose of the battery extender is to conserve battery life; the

extender does not recharge the battery.

Power Module

Alignment Groove

Cradle

Connector

Cradle Wire

Philips Telemetry Battery Extender

Introduction to the Philips Telemetry System

Power Cable

1-9

Transmitters

Connecting to the Battery Extender

To use a transmitter in battery-save mode, connect the transmitter to the battery extender in the following steps:

Step Action

1 Align the grooves on the transmitter battery door and battery

extender cradle. Slip the cradle onto the base of the transmitter, and press until you hear a click.

Note—For accurate functioning, the battery cover must remain

closed when the extender is in use. In addition, Philips Medical Systems recommends that the battery remain in the transmitter while the extender is in use.

2 Connect the aqua connector between the cradle wire and the power

cable. Be sure the connection is secure; the yellow band of the connector should be completely covered.

3 Insert the power module into a wall power source.

1-10 Introduction to the Philips Telemetry System

Transmitters

Disconnecting from the Battery Extender

To disconnect the transmitter from the battery extender for ambulatory monitoring, perform the following steps:

Step Action

1 Disconnect the aqua connector between the cradle wire and the

power cable.

Note—The connector is designed to come apart on its own if the

patient gets up without disconnecting the connector.

2 Tuck the loose end of the cradle wire into the pouch.

Warning

DO NOT UNPLUG THE POWER MODULE BEFORE REMOVING THE CRADLE OR DISCONNECTING THE AQUA CONNECTOR.

If you unplug the power module before you disconnect the aqua connector (or remove the cradle):

1 System Introduction

- The transmitter may reset automatically before switching to battery power, making data unavailable at the Philips Information Center for a brief interval.

- Or, the transmitter may stop sending signals, and a NO SIGNAL INOP will be displayed at the Philips Information Center. In this case, restart monitoring manually by removing and reinserting the transmitter battery.

Introduction to the Philips Telemetry System

1-11

Transmitters

Transmitter Features

Transmitter

Button

Water

Resistance

The transmitter has a transmitter button (see page 1-7). Depending on how it is configured, pressing this button produces:

• A “Nurse Call” message and tone

• A “Nurse Call” message and tone, plus a delayed recording

• A delayed recording

• No response at the Philips Information Center.

Note—Delayed recordings generated by the transmitter button are stored in

Alarm Review.

If desired, you can turn the transmitter button off for individual patients at the Philips Information Center by using the Telemetry Setup Window. See “Turning the Transmitter Button On/Off” on page 2-8 for additional information.

The transmitter button can also be used to initiate an SpO “Making SpO

Measurements” on page 4-6 for more information.

measurement. See

The transmitters and the battery extender (except the power module) can withstand submersion in water for 5 minutes and exposure in a shower for 10 minutes. If the battery compartment gets wet, remove the battery and wipe the compartment dry before monitoring. See “Chapter 5. Telemetry System Cleaning” for details.

Caution

Disconnect the battery extender cradle from the power module prior to a patient’s showering.

Earlier Philips transmitters are also resistant to water. If either transmitter is exposed to liquids, remove the battery and dry the battery compartment thoroughly before monitoring.

If the transmitter or battery extender needs cleaning, follow the instructions in “Cleaning the Transmitter & Battery Extender” on page 5-4.

1-12 Introduction to the Philips Telemetry System

Transmitters

Pouch Use During normal use, the transmitter should be worn over clothing, in a pocket, or

preferably in a pouch.

Warning

Place the transmitter in a pouch or over clothing, or both, during patient use. The transmitter should not touch the patient’s skin during normal use.

1 System Introduction

Automatic

Shutoff

Battery Information

A service feature of the transmitter is RF Automatic Shutoff, which causes the transmitter to stop broadcasting a radio signal if there is no ECG signal for 10 minutes. This prevents interference with other transmitters in use. The INOP message at central is TRANSMITTER OFF. To restart monitoring, attach leads to the patient. Automatic Shutoff can be configured off. When configured off, batteries must be removed and the battery extender should be disconnected when the transmitters are not in use to prevent RF interference and unnecessary battery drain.

The Philips Transmitter battery compartment is capable of accommodating any type of standard 9 volt battery. An 8.4 volt Zinc-Air battery can be used with the both the EASI ECG and standard ECG-only version of the transmitter. The transmitter was not designed for use with rechargable batteries.

The battery compartment is located at the bottom of the transmitter. The length of time the battery lasts depends on:

• The type of transmitter.

• The battery.

• The parameters being monitored - ECG only, ECG and continuous SpO or ECG and intermittent SpO

When battery power is running low, the INOP message BATTERY WEAK appears in the patient sector to indicate there is at least 15 minutes of battery life remaining.

When there is no battery life remaining, the INOP message REPLACE BATTERY is displayed.

Introduction to the Philips Telemetry System

1-13

Transmitters

Note—If the BATTERY WEAK message appears when you are making a STAT

SpO

measurement, or changing the SpO2 sample rate out of Manual, it may be

necessary to replace the battery immediately in order to continue monitoring.

Be careful not to short circuit the battery. Short circuiting is caused when a piece of metal touches both buttons (positive and negative terminals) at the top of the battery simultaneously (for example, carrying batteries in a pocket with loose change). More than a momentary short circuit will generally reduce the battery life.

Warning

Certain failure conditions, such as extended short circuiting, can cause a battery to overheat during normal use. High temperatures can cause burns to the patient and/or user, or cause the battery to flame. If the transmitter becomes hot to the touch, place it aside until it cools. Then remove the battery and discard it. It’s a good idea to place a piece of tape across the contacts of the battery to prevent inadvertent shorting. Have transmitter operation checked by service to identify the cause of overheating.

The battery should be removed when the transmitter is stored.

Warning

Batteries should be removed from the transmitter at the end of the battery’s useful life to prevent leakage.

Warning

If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Clean the battery compartment according to instructions in “Chapter 5. Telemetry System Cleaning”.

1-14 Introduction to the Philips Telemetry System

Transmitters

1 System Introduction

Use of Zinc-Air

Batteries

Maximizing

Battery Life

Zinc-Air batteries can be used with ECG-only models of the transmitter, revision A.01.02 and later. A Zinc-Air battery cannot be used with an ECG/ SpO

transmitter.

For maximum performance, observe the following guidelines:

• Use Zinc-Air batteries within 1 year of manufacture.

• Use Zinc-Air batteries within three months of opening the sealed package.

• Store and use Zinc-Air batteries at near room temperature. They can lose 50% of their capacity at low temperatures (0

C /32oF and below).

• Do not put Zinc-Air batteries in an environment with restricted air flow (e.g., a plastic bag). Restriction of air flow can affect battery capacity. During normal use, the battery compartment provides adequate air flow.

• Zinc-Air batteries may take up to 1 minute to get to working voltage after removal from the airtight wrapper. Shaking the battery can speed this.

By observing the following guidelines, you can optimize battery life in the Philips transmitter:

• REMOVE THE BATTERY (or turn it over/up-end it) when the transmitter is not in use.

Note—Automatic Shutoff does not save battery life. In order to allow an

automatic turn-on, the transmitter ECG and SpO

functions are not

completely disabled in this mode.

•For SpO the SpO

transmitters, when the SpO2 function is not in use, make sure

sample rate is set to Manual. See “Changing the SpO2 Sample

Rate” on page E-10 for directions.

• If using Wave Viewer, be sure to press End STAT at the end of every STAT SpO

measurement that is initiated at the Wave Viewer and wait

for the red sensor light to go out before removing the transducer.

• If using TeleMon, see the TeleMon Instructions for Use page 3-7.

Disposal of

Batteries

Philips Medical Systems recommends that you remove the battery when the transmitter is not in use.

Caution

The battery must be removed if a transmitter will be stored for an extended period of time.

Important—When disposing of batteries, follow local laws for proper disposal.

Dispose of batteries in approved containers. If local regulations require you to recycle batteries, recycle batteries in accordance with regulations.

Introduction to the Philips Telemetry System

1-15

Transmitters

Nominal Battery Life Expectancy

Recommended Battery Types

Lithium

(supplied)

Alkaline

Zinc-Air

1 day, 18 hours 8 hours 1 min. intervals:

Battery life is determined by the transmitter’s serial number prefix date code, which is located inside the transmitter’s battery compartment.

Following are tables for Transmitters with:

Prefix Date Codes 3836A through 4014A - (Transmitter Serial Number Prefix Date Code greater than or equal to 3836A but less than 4015A.)

Nominal Life Expectancy ECG Only

3 days, 20 hours 14 hours 1 min. intervals:

Nominal Life Expectancy ECG & Continuous

SpO

Nominal Life Expectancy ECG & Intermittent SpO

Nominal Life Expectancy ECG with SpO Transducer Detached

2 days, 12 hours

1 day, 19 hours

5 min. intervals:

2 days, 22 hours

1 day, 4 hours

20 hours

5 min. intervals:

1 day, 10 hours

4 days, 18 hours Not Applicable Not Applicable Not Applicable

Tested with ULTRALIFE U9VL batteries.

Tested with DURACELL MN1604 batteries.

Tested with DURACELL DA146 batteries.

Life expectancy is based on transmitter current draw of 52.4 mA.

1-16 Introduction to the Philips Telemetry System

Transmitters

Prefix Date Codes 3751A through 3835A - (Transmitter Serial Number Prefix Date Code greater than or equal to 3751A but less than 3836A.)

1 System Introduction

Recommended Battery Types

Lithium

Nominal Life Expectancy ECG Only

3 days 16 hours 1.5 - 2.5 days

Nominal Life Expectancy ECG & Continuous

SpO

Nominal Life Expectancy ECG & Intermittent SpO

(supplied)

Alkaline

Zinc-Air

Tested with DURACELL battery.

1 day, 8 hours 8 hours 1 day

3 days, 18 hours Not Applicable Not Applicable

Prefix Date Codes 3732A through 3750A - (Transmitter Serial Number Prefix Date Code greater than or equal to 3732A but less than 3751A.)

Nominal Life Expectancy ECG & Intermittent SpO

Recommended Battery Types

Nominal Life Expectancy ECG Only

Nominal Life Expectancy ECG & Continuous

SpO

Lithium

3 days, 6 hours 16 hours 1.5 - 2.5 days

(supplied)

Alkaline

Tested with DURACELL battery.

1 day, 8 hours 8 hours 1 day

Introduction to the Philips Telemetry System

1-17

Transmitters

Inserting Batteries

Task Summary

Insert a battery into a transmitter by performing the following steps:

Step Action

1 Remove the battery extender, if present, by squeezing the tops of the

tabs (1) and sliding the cradle away from the transmitter (2).

1-18 Introduction to the Philips Telemetry System

Step Action

2 Open the battery compartment by pressing down on the

compartment door and swinging it 45° into an open hinged position.

Caution

Forcefully opening the compartment door to a full 90° will break the hinges.

3 Insert the battery, matching the battery polarity with the +/-

indication inside the compartment.

1 System Introduction

Transmitters

Introduction to the Philips Telemetry System

1-19

Transmitters

Step Action

4 When the battery is active after a few seconds, all five of the lights

on the chest diagram flash once, then each light flashes individually. Next, if no leadset is attached, one light remains on, or if the transmitter is connected to a patient, no lights remain on.

• If no lights flash, use a second new battery. If there are still no lights, the transmitter memory may be corrupt. Contact Service.

• If the lights come on but do not behave as described above, the transmitter has malfunctioned. Contact Service.

IMPORTANT: When you replace the battery in a transmitter connected to a patient, if either abnormal condition is in effect, no monitoring will be occurring for the patient until either a new battery or a replacement transmitter is used.

1-20 Introduction to the Philips Telemetry System

Receiver Module

The Philips receiver modules are housed in the receiver mainframe. Each receiver module is dedicated to a specific transmitter by an internal identity code. This prevents another patient's waveform from being erroneously transmitted and displayed. The receiver acquires the ECG and SpO from the transmitter and sends them to the receiver mainframe.

Receiver Mainframe

Receiver Module

signals

1 System Introduction

Receiver Module

Front Cover

Introduction to the Philips Telemetry System

1-21

Receiver Mainframe

The Philips receiver mainframe houses up to eight receiver modules. For each receiver, the receiver mainframe calculates the heart rate, and sends the waveform, alarms, inoperative messages (INOPs), and status messages over the Philips patient care system to the Philips Information Center for display and recording. If SpO the Philips Information Center via the network as well.

is available, the transmitter processes the data and sends it to

Turning the

Receiver

Mainframe On

or Off

Receiver

Mainframe

Malfunction

Light

Channel

Frequencies

Retaining

Telem e t ry

Settings

The receiver mainframe must be turned on for individual transmitters and receivers to work. To turn the receiver mainframe on, the power cord must be attached and connected to an ac outlet. A green LED on the rear of the Mainframe will light then.

If the receiver mainframe is turned off, the light and all receiver modules are off.

A red light on the front panel of the mainframe illuminates when either the mainframe or one of the receivers has malfunctioned. Depending on the problem, you may see the message, NO DATA FROM BED, in single or multiple patient sectors. Contact your Philips Medical Systems Service Representative.

When the mainframe is first turned on, the red light flashes. If no problems are detected, the flashing stops and the light turns off.

The frequency of Philips transmitters and receivers are programmable, thus enabling changes in frequency if interference is detected. In case of interference, contact service.

If power to the receiver mainframe is interrupted or turned off, settings controlled by the mainframe such as leads may be affected.

• If the receiver mainframe is turned off for less than three hours, your settings should still be in effect.

• If the mainframe is turned off for more than three hours, your settings revert to default, that is, to the configured settings at installation.

1-22 Introduction to the Philips Telemetry System

Antenna System

The telemetry antenna system is custom-designed for your unit to ensure adequate coverage, therefore the telemetry signal can only be received where there are receiving antennas. After it is received by the antenna system, it is sent to the receiver which recovers the patient's ECG and optional SpO information is then sent to a monitoring display.

Antenna System

. This

1 System Introduction

Introduction to the Philips Telemetry System

1-23

Turning Telemetry On/Off

Turning Telem et ry On /Off

Telemetry monitoring can be turned on or off in one of several ways:

• Manually, by activating Monitoring Standby at the Philips Information Center (click on Patient Window, then Standby). This action creates a TELEMETRY STANDBY message on the display. To restart monitoring, click on

• Automatically, if Auto Shutoff is enabled at the transmitter and if there is no ECG signal for 10 minutes. This situation creates a TRANSMITTER OFF inop at central. To restart monitoring, re-attach the lead wires.

• Manually, by removing the transmitter battery. This action creates a NO SIGNAL inop at central. To restart, insert the battery.

Resume Monitoring in the Patient Sector.

1-24 Introduction to the Philips Telemetry System

ECG Monitoring

This chapter provides information on setting up and managing ECG monitoring. It includes the following sections:

• Lead Sets & Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2

• Preparing for ECG Telemetry Monitoring . . . . . . . . . . . . . . . . . .2-5

• Making ECG Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-7

• Making Other Monitoring Adjustments . . . . . . . . . . . . . . . . . . . .2-8

• Monitoring During Leads Off. . . . . . . . . . . . . . . . . . . . . . . . . . .2-10

• Optimizing System Performance . . . . . . . . . . . . . . . . . . . . . . .2-12

• ECG Alarm Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-16

• Telemetry Alarm & INOP Summary . . . . . . . . . . . . . . . . . . . . .2-17

2 ECG Monitoring

ECG Monitoring 2-1

Lead Sets & Capabilities

Standard ECG Transmitter

The standard ECG Transmitter supports 3- and 5-wire cables. The table below provides a summary of the capabilities of each cable.

Note—For details of electrode placement, see the Philips Information Center or

TeleMon online Help. For 3-wire electrode placement with Lead Select turned off, see also the Wave Viewer Help.

Lead Set

3-wire

-Lead Select Off

Number of Leads

1 • Position electrodes for desired

Lead/Label Choices

lead. Standard placement gives Lead II. See the on-line help in the Wave Viewer for information on electrode placement.

• Select

Warning

Philips Medical Systems recommends you change the lead label only to reflect the physical placement of the electrodes. This ensures that the monitored lead and the label match, and prevents any possible confusion.

Label to match

electrode placement.

Primary

I, II, III, MCL

Secondary

Not available

2-2 ECG Monitoring

Lead Sets & Capabilities

Lead Set

3-wire Lead Select On

5-wire 2 • Position electrodes in standard

Number of Leads

1 • Position electrodes in standard

Lead/Label Choices

placement.

• Use the Wave Viewer to change the lead that is transmitted to the Philips Information Center (see “Changing the Lead (Standard ECG only)” on page 6-7). Lead selection at the Philips Information Center is disabled.

placement. Standard placement provides V1 or MCL1. To monitor a different chest lead, for example, V6 or MCL6, position chest electrode appropriately.

• Select

Lead.

Primary

I, II, III

Secondary

Not available

2 ECG Monitoring

Primary

I, II, III, aVL, aVR, aVF, V, MCL

Secondary

I, II, III, aVL, aVR, aVF, V, MCL

ECG Monitoring

2-3

Lead Sets & Capabilities

Philips EASI Transmitter

2 3

EASI

The Philips EASI Transmitter supports 5-wire cables. The table below provides a summary of this cable’s capabilities.

Note—For details of EASI electrode placement, see the Philips Information

Center Online Help.

Lead Set

5-wire 2 • Position electrodes in EASI

Number of Leads

Lead/Label Choices

Primary

placement. EASI placement provides a derived Lead II for overview.

•Click 12-Lead ECG to display a 2.5 second ECG wave of each of the 12 derived leads. If there is an INOP condition in any lead, it is not possible to display the 12-lead waves.

Note—With EASI, although you

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

Secondary

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

can view and do ST analysis on all 12 derived leads, arrhythmia monitoring can only be done on 2 leads.

2-4 ECG Monitoring

•Click 3 EASI Leads to view the AI, AS, and ES leads and troubleshoot ECG waveform quality problems.

Preparing for ECG Telemetry Monitoring

Overview The Philips Telemetry System provides remote monitoring of the patient’s ECG

for adult and pediatric patients.

Task Summary

Note—For SpO

Perform the following steps to set up for telemetry ECG monitoring:

Step

1 Insert a battery into the transmitter, following the +/- diagram on the

2 Connect the lead set to the transmitter by pushing it down firmly

3 Prepare the skin by:

4 Attach the electrodes to the lead wires.

5 Remove electrode backing and check for moist gel.

setup, see Chapter 4, “SpO2 Monitoring”

Action

inside of the compartment. See “Inserting Batteries” on page 2-18.

until it “locks.” You should hear a click.

1. Shaving the hair from electrode sites if necessary.

2. Washing the sites (preferably with soap and water), and rinsing well.

3. Drying briskly to remove skin cells and oils.

Note—Use electrodes that are all the same brand and change all the

electrodes every 24 hours.

2 ECG Monitoring

6 Apply electrodes to the skin by placing the edge down, then “rolling

down” the rest of the pad. Press firmly around the adhesive edge toward the center. See the on-line help for information on electrode placement. Or, for 3-wire cables only with Lead Select off, see the Wave Viewer ECG screen or TeleMon on-line Help for lead placement information.

7 If available, verify lead placement using the TeleMon.

ECG Monitoring

2-5

Preparing for ECG Telemetry Monitoring

EASI 12-lead Monitoring

2 3

4 5

Step

Action

8 Verify the lead placement using the Wave Viewer. See “Checking

ECG Signal Quality” on page 2-4.

9 Support the transmitter by using a pouch, and if necessary, tape the

lead wires to the chest.

10 Teach the patient how and when to press the transmitter button.

11 Make adjustments to ECG wave(s) and alarm limits in the Patient

Window. See “Making ECG Adjustments” on page 2-7.

12 If using EASI, turn arrhythmia monitoring on for this patient. See

the Philips Information Center User Guide for instructions. Refer to the next section for additional information on EASI monitoring.

During monitoring, respond promptly to INOP conditions to prevent loss of monitoring.

EASI 12-lead ECG monitoring (for use only on adult and pediatric patients) allows you to derive all 12 standard ECG leads, using a 5-wire electrode cable and special electrode placement (see the online Help on the Philips Information Center for lead placement information or refer to the diagram in Appendix C). EASI monitoring also enables the monitoring of ST changes with a full 12-lead ECG.

EASI

2-6 ECG Monitoring

When using EASI monitoring,

• Any telemetry EASI bed must be arrhythmia-monitored. If arrhythmia is not on, the INOP “ARRHY REQUIRED” is shown and no waves or parameters are displayed.

• When placing electrodes, be careful to place the electrodes as accurately as possible or the derived leads may be incorrect.

Making ECG Adjustments

Overview You can make the following adjustments from the Philips Information Center:

• Change the lead or the lead label.

• Change the wave size.

With 5-wire lead sets, you can monitor two leads. With a 3-wire lead set you can monitor one lead. When monitoring two leads, the first lead is the primary lead. Single lead arrhythmia analysis uses this lead. It is also the lead used for alarm and delayed recordings. Multilead analysis uses both leads.

If you are not receiving a good ECG wave and the electrodes are securely attached, you should try changing the lead in which you are monitoring.

Bandwidth Bandwidth is not user adjustable, but is assigned automatically by the

information center. The settings are:

Setting Bandwidth

ST off Monitor (0.5-40 Hz)

ST on ST (0.05 to 40 Hz)

2 ECG Monitoring

Changing Lead/Label

Adjusting Wave Size

To change the lead/label place your cursor over the wave in the Patient Window and select the lead or label from the pop-up box to match the placement.

To change the amplitude of the ECG wave on the display or for recordings, place your cursor over the wave in the Patient Window and select the size you want from the pop-up box. There are five sizes available: 1/4 (smallest), 1/2, 1, 2, and 4 (largest).

You can use the 1 mV cal bar on the Patient Window to check the height of the R-wave. If the wave is not at least 0.5 mV high (one-half the size of the cal bar), change the lead.

0.5 mV

1 mV

ECG Monitoring

2-7

Making Other Monitoring Adjustments

Turning the Transmitter Button On/Off

Overview You can turn the Transmitter Button on the transmitter on or off by using the

Telemetry Setup Window. Turning the Transmitter Button off inhibits Nurse Call alarms and/or recordings depending on how your system is set up.

Task Summary Turn the

following steps:

Step Action

1 On the Patient Window click the

2 On the All Controls Window click the

3 On the Telemetry Setup Window turn the

Note—Manual SpO

button even when the button is turned off at the central. See “Making SpO Measurements” on page 4-6.

Transmitter Button on the transmitter on or off by performing the

All Controls button.

Telemetry Setup button.

Transmitter Button on or

off by clicking in the

Transmitter Button Allow Calls checkbox. A

check mark in the checkbox indicates that the transmitter button is on.

measurements can still be made using the transmitter

2-8 ECG Monitoring

Making Other Monitoring Adjustments

Standby Mode

Task Summary Place a patient in Standby by performing the following steps:

When a patient is temporarily off the unit or out of antenna range you can suspend monitoring by placing telemetry in Standby Mode. Standby suspends monitoring, and you won’t get any waveforms or alarms.

If a patient leaves the unit without a transmitter, place telemetry in Standby.

Note—If you remove the leads before putting a patient into Standby, you’ll get a

LEADS OFF INOP, and reminders if configured.

Warning

If you put telemetry in Standby Mode, you must remember to turn monitoring back on when the patient returns to the unit.

Note—When you take an EASI transmitter out of Standby, the lead settings

revert back to the central’s default lead settings (i.e., II and V2).

Step Action

1 On the Patient Window click the Standby button.

2 Select the patient’s location from the pre-defined list.

2 ECG Monitoring

3 Click the Suspend Monitoring button. This indefinitely suspends

all monitoring and displays the following messages in the Patient Sector NO DATA FROM BED and TELEMETRY STANDBY and the location (for example, X-Ray).

Note—Be sure to take the bed out of Standby before discharging.

Since Standby is associated with the equipment assigned to a bed, if a patient is discharged and the bed is in Standby Mode, that equipment will be in Standby for the next patient, and monitoring will continue to be interrupted.

4 When the patient comes back, restart monitoring by clicking on

Resume Monitoring in the Patient Sector.

ECG Monitoring

2-9

Monitoring During Leads Off

2 3

EASI

Monitoring During Leads Off

Fallback

Multilead

Analysis

Singlelead

Analysis

Fallback for

EASI

If there is a Leads Off INOP in the primary lead for >10 seconds, the active secondary lead becomes the primary lead. This is known as lead fallback. In lead fallback, the arrhythmia system switches the leads on the display. When the Leads Off condition is corrected, the leads are switched back.

For single lead analysis, if there are two leads available, the other lead is made the primary lead (until the Leads Off condition is corrected).

If one of the derived EASI leads has an INOP condition (for example, LEADS OFF), a flat line is displayed. After ten seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is displayed with the label “ECG” and is analyzed by the arrhythmia system.

• Whenever there is an INOP condition (i.e., LEADS OFF), the arrhythmia algorithm performs a Relearn, using the available leads.

Warning

Since Relearn happens automatically, if learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-Fib. For this reason, you should:

1. Respond promptly to the INOP message (for example, re-connect the electrodes.

2-10 ECG Monitoring

2. Ensure that the arrhythmia algorithm is labeling beats correctly.

Note—If there is artifact in the ECG waves or a CANNOT ANALYZE ECG

INOP condition, you can use the three EASI leads to troubleshoot.

 Click 12-Lead ECG on the Patient Window, then on 3 EASI Leads.

2. The three directly acquired EASI leads will be displayed so that you can determine which electrodes are causing the problem and need to be replaced.

Monitoring During Leads Off

Extended Monitoring

When both the primary and secondary leads have a Leads Off condition, if another lead is available it becomes the primary lead and the system does a relearn. This is called extended monitoring.

Extended monitoring applies if:

• Telemetry is configured for extended monitoring ON.

• The leadset provides more than two leads (i.e., when using a 5-wire

leadset).

2 ECG Monitoring

ECG Monitoring

2-11

Optimizing System Performance

While telemetry monitoring offers many advantages, it can be a challenge. The reliability and quality of the signal transmission through the air and hospital walls is governed by a number of variables which can be difficult to control. A telemetry system cannot be as dependable as a hardwired bedside monitor that transmits its signal through a wire.

The effect of interference on the telemetry system ranges from a momentary loss of ECG to complete inoperability, depending on the situation. The strength, frequency, and proximity of the source of interference to transmitters or the antenna system are factors that determine the degree of severity. In cases where the source of interference is known - for example, cellular phones, magnetic equipment such as MRI, other radio or motorized equipment - removing or moving away from the source of interference will increase the system's dependability.

Warning

Telemetry should not be used for primary monitoring in applications where the momentary loss of the ECG is unacceptable.

The Telemetry Signal

2-12 ECG Monitoring

In this section, we'll investigate some of the problems affecting ECG signal clarity and when possible, show you how you can greatly enhance performance.

Note—The telemetry system also emits radio frequencies (defined in “System

Specifications” on page 7-19) that may affect the operation of other devices. Contact the manufacturer of other equipment for possible susceptibility to these frequencies.

The transmitter worn by the patient acquires the patient's physiological data, amplifies and digitizes it, detects pace pulses and broadcasts this information via radio waves to the antenna system. Since the signal passes through the air, it is susceptible to interference from many sources.

Optimizing System Performance

Frequent Signal Strength and RF INOPs

Signal

Strength

Because the telemetry system is a wireless system, under certain conditions RF “dropouts” can occur. Dropouts result from a weak signal or RF interference. There will be signal drops to the bottom of channel for a minimum of 200 ms to indicate to the clinical user that it is a non-physiological event. If dropouts are frequent enough to affect the heart rate count, the TEL CANNOT ANALYZE INOP occurs. The following recording strip is an example of dropouts.

2 ECG Monitoring

If frequent dropouts are occurring, the following section describes some steps you can take to improve performance.

The antenna system is custom designed for your unit, so reliable signal reception is only possible where there are receiving antennas. When the signal is too low, the following INOPS occur:

• TEL CANNOT ANALYZE

• WEAK SIGNAL

• NO SIGNAL

To correct, first check the location of the patient. If not in the coverage area, do one of the following.

• Return the patient to the specified antenna coverage area.

• Put telemetry in Standby Mode. See “Standby Mode” on page 2-9.

Warning

If you put telemetry in Standby Mode, you must remember to turn monitoring back on when the patient returns to the unit. See “Standby

Mode” on page 2-9.

• If the patient is in the coverage area and is stationary, try moving the

location of the transmitter or patient about six inches.

ECG Monitoring

2-13

Optimizing System Performance

Radio

Frequency

Interference

Radio frequency (RF) interference is caused by anything that intrudes into the transmitted electrical signal, such as paging transmitters and walkie-talkies. We are all familiar with electrical interference in our homes and cars when it causes “snow” on the television and static on the radio station. These same types of interference can occur with the transmitted telemetry signal. Even though the Philips Telemetry System is designed to resist these effects, interference can occasionally be seen in the form of “dropouts”. To improve performance, the source of the interference must be identified and eliminated.

Muscle and

Movement

Artifact

Muscle and movement artifact differ from radio frequency interference since you can prevent much of the occurrence. Noise on the ECG signal can be caused by many sources, such as interference from other electrical equipment, muscle artifact and respiration variation. It is up to the clinician to use certain techniques to minimize these types of noise. Use the following table to help you troubleshoot the most common sources of ECG noise.

Problem Cause Remedy

60-Cycle (AC) Interference

Poor electrode placement.

Re-apply electrodes

Disconnect electrical appliances near Possible non-grounded instrument near patient

patient (one at a time) by pulling wall

plugs, to determine faulty grounding.

Have engineering check grounding.

Muscle Artifact Tense, uncomfortable

patient.

Poor electrode placement.

Tremors.

Diaphoresis

Irregular Baseline Poor electrical contact.

Respiratory interference.

Faulty electrodes.

Dry electrodes.

2-14 ECG Monitoring

Make sure patient is comfortable.

Check that electrodes are applied on flat

non-muscular areas of the torso; dry the

skin and re-apply the electrodes if

necessary.

Re-apply electrodes, using proper

technique.

Move electrodes away from areas with

greatest movement during respiration.

Problem Cause Remedy

Optimizing System Performance

Baseline Wander Movement of patient.

Improperly applied electrodes.

Respiratory interference.

Poor Electrode Contact Loose electrodes.

Defective cables.

Lead set not firmly connected.

Make sure patient is comfortable.

Re-apply electrodes. Check that patient cable is not pulling electrodes.

Move electrodes away from areas with greatest movement during respiration.

Change electrodes, using good skin prep.

Replace cables.

2 ECG Monitoring

ECG Monitoring

2-15

ECG Alarm Summary

The following table lists the ECG alarms that can be generated by the Telemetry System when using the standard ECG transmitter. These are announced at the Philips Information Center when arrhythmia monitoring is turned off at central.

Note—When arrhythmia monitoring is turned on at central, ECG alarms are

generated by the ST/AR algorithm. Please refer to the Philips Information Center User Guide for information about these alarms.

Alarm Message Alarm Level Audible

Indication

***ASYSTOLE Cardiotach alarm *** Sound No QRS in 4 seconds

***VENT FIB Cardiotach alarm *** Sound Ventricular Fibrillation

** HR > upper limit Cardiotach alarm ** Sound HR greater than the

** HR < lower limit Cardiotach alarm ** Sound HR less than the lower

Description

upper heart rate limit

heart rate limit

2-16 ECG Monitoring

Telemetry Alarm & INOP Summary

There is one non-parameter alarm in the Telemetry System.

Telemetry Alarm & INOP Summary

Alarm Message Alarm Level Audible

Indication

** NURSE CALL Manual -

Telemetry System

The following table lists (in alphabetical order) the telemetry INOPs that can be announced at the Philips Information Center. It also provides suggestions on what to do when an INOP occurs.

Note—A Hard INOP is more severe than a soft INOP. Hard INOPS have an

audible tone, and monitoring and alarms are disabled. In a soft INOP, no audible tone is generated; monitoring and alarms remain active.

Message Type Description Action

ARRHY REQUIRED Hard INOP Arrhythmia monitoring was

turned off for an EASI transmitter.

BATTERY WEAK Soft INOP Battery low, at least 15

minutes left.

** Sound (short)

Description

Patient-generated alarm (at transmitter button). Must be configured on.

Turn arrhythmia monitoring on or change to a standard ECG transmitter if arrhythmia monitoring is not desired.

Replace battery.

2 ECG Monitoring

Note—Certain transient

conditions such as manual SpO

measurement, unaligned

transmitter, or heavy infrared use may cause battery weak situation.

ECG Monitoring

2-17

Telemetry Alarm & INOP Summary

Message Type Description Action

ECG EQUIP MALF Hard INOP ECG PC board in the

transmitter is malfunctioning

An EASI transmitter is being used with equipment that is not capable of accepting EASI data (pre-release C), creating a software incompatibility.

INTERFERENCE Hard INOP Interference due to outside

source.

INVALID LEADSET Hard INOP Leadset is connected

improperly, or an invalid leadset is being used for the transmitter type and is connected to the patient (e.g., EASI transmitter must use a 5wire leadset.)

Replace transmitter. Contact Service.

Contact Service.

Check that there are no transmitters stored with batteries inserted.

Change the Philips transmitter and receiver frequency.

Contact service.

Reconnect leadset, pressing until latch clicks.

Attach correct leadset.

If problem persists, call service.

INVALID SIGNAL E01

Hard INOP Receiver is picking up a

duplicate frequency.

When the transmitter is not being used, turn telemetry monitoring off for the bed. If the situation continues, contact service.

If this is a new transmitter, the system must learn the new transmitter ID code contact service.

LEADS OFF Hard INOP Lead(s) not connected. Reconnect lead(s). Use

transmitter lights or the Wave Viewer to confirm.

2-18 ECG Monitoring

Telemetry Alarm & INOP Summary

Message Type Description Action

NO RECEIVER Hard INOP Receiver absent or

malfunctioning.

NO SIGNAL Hard INOP Patient beyond antenna range,

no battery, battery is inserted backwards, or battery extender is unplugged.

RECEIVER MALF Hard INOP Receiver is malfunctioning. Contact service.

REPLACE BATTERY

##nnn/nnn(nnn)nnn (RF INOP)

TEL CANNOT ANALYZE

Hard INOP Battery is unable to power the

transmitter, or battery is inserted backwards.

Soft INOP Used by service in

troubleshooting the radio signal.

Hard INOP Shorts bursts of data

corruption inhibiting an accurate HR count. (Often accompanied by WEAK SIGNAL, NO SIGNAL, or INTERFERENCE INOPs.)

This message appears after the mainframe is turned on and indicates the absence of a receiver or a receiver is faulty. Contact service.

Return patient to antenna range/check battery for correct insertion/remove and reinsert battery.

Replace battery/check battery for correct insertion.

Contact service.

Check that there are no transmitters stored with batteries.

Check to see if the patient is in the coverage area, and return patient if needed.

2 ECG Monitoring

If the patient is in the coverage area and is stationary, move the transmitter or patient about 6 inches (15 cm.).

If the situation persists, contact service.

ECG Monitoring

2-19

Telemetry Alarm & INOP Summary

Message Type Description Action

TRANSMITTER

Hard INOP Transmitter malfunctioning Replace transmitter.

MALF

TRANSMITTER OFF

Hard INOP Transmitter detected all leads

off for 10 minutes and turned itself off.

WEAK SIGNAL Soft INOP Patient at outer range of the

antenna system.

Contact service.

Connect leadset to patient.

Check to see if the patient is in the coverage area, and return patient if needed.

If the patient is in the coverage area and is stationary, move the transmitter or patient about 6 inches (15 cm.).

If the situation persists, contact service.

2-20 ECG Monitoring

ST/AR ST Segment Monitoring

This chapter describes the ST/AR ST algorithm for telemetry of the Philips Information Center. It includes the following sections:

• ST/AR ST Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

• Adjusting Measurement Points. . . . . . . . . . . . . . . . . . . . . . . . . .3-5

• Establishing ST Reference Beats (Baseline) . . . . . . . . . . . . . . .3-7

• Turning ST On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7

• ST Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-8

3 ST Monitoring

ST/AR ST Segment Monitoring 3-1

ST/AR ST Algorithm

Intended Use

Patient Population

The intended use of the ST/AR ST algorithm for M3150A Philips Information Center Server (not available for M3153A) is to monitor ST segment elevation or depression for each available telemetry ECG lead and produce events/alarms simultaneously. ST values update with every measurement period and enunciate, depending upon the severity of the change, events and alarms as they are detected.

You can perform ST analysis on both non-paced and atrially paced patients. The ST/AR ST algorithm is only available for adult telemetry-monitored patients. With EASI monitoring, ST analysis is performed on up to 12 leads.

Note—Studies have validated the maximal EASI derived ST measurements on

male and female patients with ages from 33 to 82, heights 147 to 185 cm (58 to 73 in), weights 53 to 118 kg (117 to 261 lb) and height-to-weight ratios of 1.41 to 2.99 cm/kg (0.25 to 0.54 in/lb).

3-2 ST/AR ST Segment Monitoring

ST/AR ST Algorithm

The Measurement

The ST measurement for each beat complex is the vertical difference between two measurement points. The isoelectric point provides the baseline for the measurement and the ST point provides the other measurement point. It is positioned with reference to the J-point.

R-WAVE PEAK

AT 0 MSEC

ISO ELECTRIC

POINT

DEFAULT =

-80 MSEC

J POINT

MEASUREMENT

DEFAULT = J+60 MSEC

POINT

DIFFERENCE =

ST VALUE

Warning

This device provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.

3 ST Monitoring

ST/AR ST Segment Monitoring

3-3

ST/AR ST Algorithm

How the Algorithm Works

Displayed ST Data

When ST analysis is being performed on two leads, the averaged derived and reconstructed ST waves and associated ST segment values are given for up to six leads, depending on the type of patient cable:

• 3-wire: one lead

• 5-wire: up to two leads if monitoring a chest and a limb lead

• 5-wire: up to six leads if monitoring two limb leads with the Philips Transmitter (without EASI monitoring)

• 5- wire: up to 12 leads if monitoring using EASI

Note—No ST analysis is done on a patient if an electrode falls off.

ST analysis uses the ST/AR arrhythmia beat classification to select only normal and atrially paced beats for its analysis.

The ST/AR ST algorithm processing includes special ST filtering, beat selection and statistical analysis, calculation of ST segment elevations and depressions, and lead reconstruction and wave generation.

ST data displays as values in the Patient Sector and Patient Window. A positive value indicates ST segment elevation; a negative value indicates depression. You can view ST data in ST Review, Trend Review, and Event Review windows.

EASI ST Analysis

ST/AR ST analysis for EASI derived transmitters is done on all 12 leads. The value presented in the patient sector and Patient Window is “STindx”. STindx is a summation of three ST segment measurements, using the leads that can

2 3

4 5

indicate ST segment changes in the different locations of the heart:

• anterior lead V2

• lateral lead V5

EASI

• inferior lead aVF

Caution

Be sure not to duplicate the lead labels. This can result in incorrect ST values being displayed for those leads.

3-4 ST/AR ST Segment Monitoring

Adjusting Measurement Points

Overview The ST Setup Window allows you to adjust the ST measurement points to

ensure accurate data.

There are three measurement cursors:

• The ISO measurement cursor positions the isoelectric point in relation to

the R-wave peak.

• The J-point cursor positions the J-point in relation to the R-wave peak.

The purpose of the J-point is to correctly position the ST measurement point.

• The ST measurement cursor positions the ST point a fixed distance from

the J point.

Note—The ST measurement points may need to be adjusted if the patient's heart

rate or ECG morphology changes significantly.

Task Summary

Perform the following steps to adjust the ST measurement points:

Step

Action

1 Access the ST Setup window by clicking on the All Controls button

in the Patient Window then clicking on the

ST Setup button.

2 If you need to adjust the ISO (isoelectric) point, position the bar in

the middle of the flattest part of the baseline (between the P and Q waves or in front of the P wave) and use the arrow keys to make the adjustment.

ISO point

ST/AR ST Segment Monitoring

3 ST Monitoring

3-5

Adjusting Measurement Points

Step

Action

3 Adjust the J point, if necessary, by positioning the bar at the end of

the QRS complex and the beginning of the ST segment.

SQJ point

4 Adjust the ST point, if necessary, by using the J point as an

“anchor” and using either J + 60 or J + 80 so that the bar is at the midpoint of the ST segment.

ST point

3-6 ST/AR ST Segment Monitoring

Establishing ST Reference Beats (Baseline)

After adjusting the measurement points, you can establish baseline reference beats for all available leads in the ST Review window at the Philips Information Center. Reference beats enable you to compare waveform changes, for example from admission, or prior to or after treatment. The reference continues to be saved beyond the 24 hour review window, but you can update it to any beat within the last 24 hours. Please refer to the Philips Information Center User’s Guide or on-line Help for directions.

Turning ST On/Off

Overview The ST Setup Window allows you to turn ST monitoring on/off for all available

ECG leads. You would turn ST monitoring off if:

• You are unable to get any lead that is not noisy.

• Arrhythmias such as atrial fib/flutter cause irregular baseline.

• The patient is continuously ventricularly paced.

• The patient has left bundle branch block.

3 ST Monitoring

Task Summary

To turn ST monitoring on/off perform the following steps:

Step

Action

1 Access the ST Setup Window by clicking the All Controls button on

the Patient Window then clicking the

2 If you want to turn all ST monitoring on/off click

ST Setup button.

ST On.

ST/AR ST Segment Monitoring

3-7

ST Alarms

Overview All Philips Information Center alarm settings (limits and on/off status) have unit

default settings. The Philips Information Center however, lets you set the high and low ST alarm limits for individual patients based on:

• Your assessment of the patient's clinical condition.

• Unit protocols.

• Physician orders or medication specified limits.

You can make the following adjustments to ST alarm limits to accommodate the clinical condition of individual patients:

• Turn all alarms off/on.

• Adjust the alarm limits:

– to specific high and low limits – to Smart Limits (see the Philips Information Center User’s Guide for

information on Smart Limits)

– back to unit default settings.

You adjust the ST alarm limits in the ST Alarms Window. Each ST parameter has its own alarm limit. The alarm is triggered when the ST value exceeds its alarm limit for more than 1 minute. The alarm will be a yellow alarm.

When more than one ST parameter is in alarm, only one alarm message displays. For multilead alarms when using an EASI transmitter, an alarm is generated if two or more ST leads exceed the alarm limits. The default setting is +/-1.0. The alarm message indicates the two leads that are in greatest violation of the limits, for example, “**MULTI ST AVR, V6”. If another lead becomes deviant, the message changes but it is considered the same alarm (no new alarm sounds and it is not listed as a new event).

Note—See the Philips Information Center User’s Guide for specifics on alarm

management and behavior.

3-8 ST/AR ST Segment Monitoring

ST Alarms

ST Alarm Adjustments

Make adjustments to ST alarms on the ST Alarms window.

Step

Action

1 Access the ST Alarms window by clicking on the All Controls

button in the Patient Window then clicking the ST Alarms button under Alarm Management and Setup.

2 Make the adjustments on the ST Alarms window. Choices for setting

the ST alarm limits are:

Unit Settings—Click on this button if want to have the specific

limits that are pre-set for your unit.

Smart Limits—Click on this button to set high and low limits around

your patient's current ST value. The difference above and below the patient's ST value are pre-set for your unit.

Note—Smart Limits can be configured to automatically be activated

when the patient is connected. See the Philips Information Center User’s Guide for additional information on using smart limits.

Specified limits—Use these to set the high and low alarm limits

based on your assessment of the patient's clinical condition, unit protocols, or physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patient's ST, or follow your unit protocol.

3 ST Monitoring

ST/AR ST Segment Monitoring

3-9

ST Alarms

ST Alarm and INOP Summary

Message Level Sound Description

** STx > nnn Yellow Continuous ST (for lead x) greater than the upper limit (nnn)

** STx < nnn Yellow Continuous ST (for lead x) lower than the lower limit (nnn)

**MULTI ST x,y Yellow Continuous Two or more ST leads exceed the alarm limits.

The following table lists the ST alarm messages and the description of the conditions required to generate these alarms. These alarms are not active when arrhythmia/ST monitoring is turned off at the Philips Information Center. In the table below:

x = ST lead y= ST lead when multilead nnn = limit that was exceeded.

The default setting is +/-1.0. The alarm message indicates the two leads (x, y) that are in greatest violation of the limits. For EASI only.

The following table lists the ST INOP messages

Note—A Hard INOP indicates a more severe situation than a soft INOP. Hard

INOPS have an audible tone, and monitoring and alarms are disabled. In a soft INOP, no audible tone is generated; monitoring and alarms remain active.

Message Type Description Action

CANNOT ANALYZE ST

3-10 ST/AR ST Segment Monitoring

Soft INOP

(No sound)

The algorithm cannot generate a valid ST value because:

• the variation between measured ST values exceeded the limits for valid data, or

• the algorithm cannot reliably analyze the ST data on any monitored leads.

Review the ECG signal quality and correct if necessary. Reposition the Iso and J points.

SpO

This chapter provides an introduction to the SpO2 measurement and its application. It includes the following sections:

• Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-2

• Preparing for Telemetry SpO

• Making SpO

• Measurement Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-8

•SpO

• Selecting the Appropriate Transducer . . . . . . . . . . . . . . . . . . .4-10

• Applying the Transducer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-11

• Optimizing Transducer Performance . . . . . . . . . . . . . . . . . . . .4-16

• Turning the SpO

• Turning SpO

• Turning the Pulse Parameter On/Off . . . . . . . . . . . . . . . . . . . .4-19

•SpO

Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9

Alarm and INOP Summary . . . . . . . . . . . . . . . . . . . . . . .4-20

Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . .4-6

Parameter On/Off . . . . . . . . . . . . . . . . . . . .4-17

Alarms On/Off . . . . . . . . . . . . . . . . . . . . . . . . . .4-19

Monitoring . . . . . . . . . . . . . . . . .4-4

Monitoring

SpO2 Monitoring 4-1

4 SpO

Monitoring

Overview

The SpO2 parameter measures the arterial oxygen saturation. That is, the percentage of oxygenated hemoglobin in relation to the total hemoglobin.

If, for example, a total of 97% of the hemoglobin molecules in the red blood cells of the arterial blood combine with oxygen, then the blood has an oxygen saturation of 97%. The SpO 97%. The SpO

numeric indicates the percentage of hemoglobin molecules

numeric that appears on the monitor will read

which have combined with oxygen molecules to form oxyhemoglobin.

• The oxygen saturation is measured using the pulse oximetry method. This is a continuous, noninvasive method of measuring the arterial hemoglobin oxygen saturation. It measures how much light, sent from light sources on one side of the transducer, travels through patient tissue (such as a finger or an ear), to a receiver on the other side.

• The amount of light getting through depends on many factors, most of which are constant, such as tissue or venous blood). However one of the factors, the blood flow in the arterioles, varies with time - because it is pulsatile.

4-2 SpO

Monitoring

This measurement principle is used to derive the SpO

measurement. The

numeric that is displayed at the Philips Information Center is the oxygen saturation of the arterial blood - the measurement of light absorption during a pulsation.

Overview

Warning

When the specified Nellcor® transducers are used, the application must be consistent with the manufacturer's own guidelines.

Prolonged, continuous monitoring may increase the risk of changes in skin characteristics, such as irritation, reddening, blistering or pressure necrosis, particularly on patients with impaired perfusion and varying or immature skin morphology. Specific attention must be given to sensor site inspection for changes in skin quality, proper optical path alignment and attachment. Check the application site at regular intervals and change the site if any compromise in skin quality should occur. More frequent checking may be required due to an individual patient's condition.

Setting the high SpO

alarm limit to 100% is equivalent to switching off the

high alarm limit. Therefore the upper alarm limit for oxygen saturation must be carefully selected in accordance with accepted clinical practices.

Pulse oximetry can overestimate the SpO

value in the presence of Hb-CO,

Met-Hb or dye dilution chemicals.

Note—The SpO

alarm delay built into the system is ten seconds. That means

that the monitor generates an alarm if the averaged numeric value on the display stays beyond the alarm limit for more than 10 seconds.

4 SpO

Monitoring

Monitoring 4-3

SpO

Preparing for Telemetry SpO2 Monitoring

Overview The Philips Telemetry System provides remote monitoring of SpO

measurement for adult and pediatric patients. You need to prepare your telemetry patient and perform setup tasks for the measurement to display at the Philips Information Center, the Wave Viewer, or the TeleMon.

Task

Perform the following steps to set up for telemetry SpO2 monitoring:

Summary

Step

Action

1 Select the site and appropriate transducer (see “Selecting the

Appropriate Transducer” on page 4-10).

• Adult Finger - use for most adults.

• Small Adult/Pediatric - use for small adults.

• Ear Clip - use when neither hand has an appropriate site.

2 Attach the transducer cable to the transmitter.

Plug reusable transducers directly into the transmitter. Plug disposable transducers into the adapter cable, then plug the adapter cable into the transmitter.

4-4 SpO

Monitoring

Preparing for Telemetry SpO2 Monitoring

Step

Action

3 Prepare the transducer (if disposable, remove the protective

backing), and attach the transducer to the appropriate part of the patient's body.

Avoid sites with:

• Decreased Arterial Flow, such as edematous tissue or distal to arterial catheters, intravenous catheters and blood pressure cuffs

• Poor Skin Integrity, such as skin discoloration or nail polish.

• Excessive Motion

Additionally, avoid:

• Placing the sensor in an environment with bright lights. If necessary, cover the sensor with opaque material.

• Use of excessive pressure at the application site, for example, transducer applied too tightly, excessive adhesive tape to secure the transducer, clothing or restraints that are too tight. These result in venous pulsations and inaccurate measurements, and may severely obstruct circulation.

4 Use the pleth wave to check the signal quality at the patient’s side

using the Wave Viewer or the TeleMon.

5 Adjust SpO

alarms in the Patient Window.

6 Make other adjustments in the Telemetry Setup Window.

7 Inspect the site regularly to ensure skin integrity and correct optical

alignment. Proper sensor placement is critical to accurate SpO

monitoring.

Monitoring 4-5

SpO

4 SpO

Monitoring

Making SpO2 Measurements

SpO2 measurements can be made automatically at pre-determined times, or manually on an as-needed basis.

Automatic Measurements

Automatic SpO

measurements can be generated on a continuous basis, or

intermittently at 1 or 5 minute intervals. Automatic measurement intervals are set at the Wave Viewer or the TeleMon. Please see “Changing the SpO Rate” on page E-10 to set up the transmitter for automatic measurements. Procedures for the TeleMon can be found in the TeleMon B Monitor Instructions for Use on page 3-7.

Manual Measurements

Manual measurements can be initiated at the transmitter or at Wave Viewer. SpO

must be turned on at central for alarms, and for display and trending. For

measurements at the transmitter or Wave Viewer, the sample rate must be set to any choice except “Continuous”.

To initiate an SpO

measurement at Wave Viewer, see “Making a STAT SpO2”

on page E-11.

If you have a TeleMon, see the TeleMon Instructions for Use, page 3-7.

Note—The Wave Viewer should not be connected to the transmitter when you

are using the transmitter button to initiate an SpO

Task Summary To initiate a manual SpO

steps.

Step Action

Sample

measurement.

measurement at the transmitter, perform the following

4-6 SpO

Monitoring

1 Plug the transducer cable into the transmitter.

2 Attach the transducer to the patient.

3 Press and hold (~6 seconds) the Transmitter Button until the LA

(standard ECG) or S (EASI) light begins flashing.

Making SpO2 Measurements

Step Action

4 When the transducer light turns off (~ 30 seconds later), the

measurement value and time stamp will be displayed at central for up to one hour or until the next measurement is made, whichever comes first.

5 Remove the transducer from the patient after the transducer light

goes out.

Note—When an SpO

measurement is initiated, if the transmitter button is

turned ON in the Patient Window, the transmitter button will also function according to its function defined during system configuration. For example, if the patient button is configured for Nurse Call/Record or Record, a recording will be generated when a manual SpO recording will include the last SpO

reading is initiated at the transmitter. The

reading, but not the current reading, which

is still in process.

Note—If the transmitter button is turned OFF in the Patient Window, a manual

SpO

measurement can still be made.

Note—No measurement will be made if a Battery Weak condition exists. A

measurement initiated before a Battery Weak INOP is displayed will be completed, but no further manual measurements can be made until the battery is replaced.

Note—If a LEADS OFF condition occurs during a manual SpO

measurement,

the appropriate lead light will be lit upon completion of the measurement.

Monitoring 4-7

SpO

4 SpO

Monitoring

Measurement Limitations

Refer to this section on problem situations if you have difficulty getting a signal or obtaining accurate measurements.

Distortion

Ambient light, motion, perfusion or incorrect sensor placement may affect the accuracy of the derived measurements.

Arterial Blood Flow

The measurement depends on the pulsatile nature of blood flow in the arteries and arterioles; with the following conditions arterial blood flow may be reduced to a level at which accurate measurements cannot be made:

•shock

• hypothermia

• use of vasoconstrictive drugs

•anemia

Wavelength Absorption

The measurement also depends on the absorption of particular light wavelengths by the oxyhemoglobin and reduced hemoglobin. If other substances are present which absorb the same wavelengths, they will cause a falsely high, or falsely low SpO

• carboxyhemoglobin

• methemoglobin

• methylene blue

• indocyanine green*

• indiocarmine*

*These chemicals are used in dye dilution cardiac output calculations.

value to be measured. For example:

4-8 SpO

Monitoring

Ambient Light

Very high levels of ambient light can also affect the measurement; an SpO

INTERFERENCE message will appear on the display. The measurement quality can be improved by covering the transducer with suitable non see-through material.

Note—If you are using Nellcor® transducers, see the directions for use supplied

with these transducers.

For care and cleaning instructions, see “Philips Reusable Transducers” on page 5-19.

SpO2 Transducers

Disposable Transducers

Reusable Transducers

Only use disposable transducers once and then discard. However, you can relocate them to a different patient-site if the first location does not give the desired results. Do not reuse disposable transducers on different patients. Disposable transducers are not available as Philips Medical Systems parts in the USA or Canada. Contact Nellcor® Incorporated at 1-800-635-5267 or 1-888744-1414.

You can use reusable transducers on different patients after cleaning and disinfecting them. See “Philips Reusable Transducers” on page 5-19 for cleaning instructions. Reusable sensors should be changed to another site regularly.

See Appendix B, “Accessories and Ordering Information” for ordering information.

Monitoring 4-9

SpO

4 SpO

Monitoring

Selecting the Appropriate Transducer

The following chart provides a guideline to select the most appropriate transducer for your patient.

Select the most appropriate transducer by finding the patient's weight on the vertical axis, and drawing a horizontal line across the chart. Each shaded area that the line passes through represents a transducer that you can use on this patient.

Areas of dark shading indicate that the transducer is the most appropriate one in that weight range.

Areas of light shading indicate that you can use the transducer in this weight range, even though it is not the most appropriate transducer.

Greater

than

Adult

Finger

50 kg

Clip

4-10 SpO

Monitoring

Preferred

Transducer

Alternative

Transducer

Finger

Small Adult/Pediatric

2.5

D-20 D-25 M1192A

Disposable

Transducers

100x140

M1191A M1194A

Reusable Transducers

Applying the Transducer

Overview A minimum pulsatile flow must be present at the application site of your patient

to obtain measurements.

Select an appropriate transducer and apply the transducer properly to avoid incorrect measurements. Applying a small amount of pressure at the application site can improve the measurement. Use one of the preferred application sites for your transducer. Selecting the most suitable transducer and application site will help you to ensure that:

• The light emitter and the photodetector are directly opposite each other and that all the light from the emitter passes through the patient's tissues,

• The application site is of the correct thickness for light to pass through. If the application site is too thick or too thin, an SpO INOP will occur. You should then select another site as appropriate.

NON-PULSATILE

Light Source

Photo detector

Positioning of the Light Emitters and Photodetector

Inspect the application site every 2 to 3 hours to ensure skin integrity and correct optical alignment. If skin integrity changes, move the transducer to another site.

Monitoring 4-11

SpO

4 SpO

Monitoring

Applying the Transducer

Warnings • Failure to apply the transducer properly may cause incorrect

measurement of SpO

• Specific attention must be given to sensor site inspection for changes in skin quality, proper optical path alignment and attachment. Check the application site at regular intervals and change the site if any compromise in skin quality should occur.

• Using a transducer during MR imaging can cause severe burns. To minimize this risk, ensure that the cable is positioned so that no inductive loops are formed. If the transducer does not appear to be operating properly, remove it immediately from the patient.

• Using a transducer in the presence of bright lights may result in inaccurate measurements. In such cases, cover the site with opaque material.

• Injected dyes, such as methylene blue, or intravascular dyshemoglobins, such as methemoglobin, may lead to inaccurate measurements.

• Performance may be compromised by excessive motion. This can lead to inaccurate SpO

readings.

4-12 SpO

Monitoring

• Avoid placing the SpO

transducer on any extremity with an arterial

catheter, or intravascular venous infusion line.

• Do not use disposable transducers on patients who exhibit allergic reactions to the adhesive.

Applying the Transducer

Adult Finger Transducer (M1191A)

Push the transducer over the fingertip in such a way that the fingertip touches but does not protrude from the end of the transducer. The fingernail must be uppermost and the cable must lie on the back of the hand. This ensures that the light sources cover the base of the fingernail giving the best measurement results. The cable can be held in place by the accompanying wristband.

Warning

Failure to apply the transducer properly may cause incorrect measurement of SpO finger can result in inaccurate SpO

. For example, not pushing the transducer far enough over the

readings. Pushing the transducer too

far, so that the finger protrudes from the transducer, can pinch the finger, resulting in inaccurately low SpO2 readings.

Monitoring 4-13

SpO

4 SpO

Monitoring

Applying the Transducer

Small Adult/ Pediatric Finger Transducer (M1192A)

Push the transducer over the fingertip in such a way that the fingertip touches but does not protrude from the end of the transducer.

Warning

Failure to apply the transducer properly may reduce the accuracy of the SpO2 measurement.

4-14 SpO

Monitoring

Applying the Transducer

Ear Clip Transducer (M1194A)

Clip the probe onto the fleshy part of the ear lobe as shown in the diagram below. The plastic fixing mechanism helps to minimize artifact generated by patient motion. Do not position the probe on cartilage or where it presses against the head.

The clip transducer can be used as an alternative if the adult finger transducer does not provide satisfactory results. The preferred application site is the ear lobe, although other application sites with higher perfusion (such as the nostril) can be used. Due to the physiologically lower perfusion in the ear lobe, you should be aware of the reduced accuracy of the measurement and more frequent INOPs.

Warning

Failure to apply the clip transducer properly may reduce the accuracy of the SpO2 measurement.

Disposable Transducers

See the Directions for Use supplied by Nellcor® Incorporated for instructions on preparation and application of disposable transducers.

Warning

When the specified Nellcor® transducers are used, the application must be consistent with the manufacturer's own guidelines.

Monitoring 4-15

SpO

4 SpO

Monitoring

Optimizing Transducer Performance

To get the best results from your SpO2 reusable transducer:

• Always handle the transducer and cable with care. The soft finger sleeve houses a sensitive electronic device that can be damaged by harsh treatment. Always protect the cable from sharp-edged objects.

• Use the wristband that is supplied with your M1191A transducer. By keeping the cable between the finger transducer and the wristband fairly loose, you will maintain good monitoring conditions.

Normal wear and tear associated with patient movement and regular transducer cleaning naturally mean that your transducer will have a limited lifetime. However, provided you handle the transducer and its cable with care, you can expect useful service from it for up to two years. Harsh treatment will drastically reduce the lifetime of the transducer. Moreover, Philips Medical Systems’ warranty agreement shall not apply to defects arising from improper use.

4-16 SpO

Monitoring

Turning the SpO2 Parameter On/Off

Overview The SpO

using the Telemetry Setup Window.

Turning the SpO

•SpO

After you turn SpO patient’s acuity by using the Wave Viewer or the TeleMon.

After you turn SpO Viewer or the TeleMon will help you conserve the transmitter’s battery life.

SpO

Parameter Auto ON

The SpO if a manual SpO mode or the SpO is in continuous SpO

When a patient is discharged and the transmitter is in Continuous mode, the SpO

parameter is turned off. To reactivate the SpO2 parameter Auto ON

feature from the transmitter, remember to do one of the following when a patient is discharged:

parameter is turned on or off at the Philips Information Center by

parameter off at the Information Center also turns off:

alarms

display of numerics

trending.

on, you should adjust the sample rate to match your

off, setting the sample rate to Manual using the Wave

parameter is automatically turned on at the Philips Information Center

– remove the SpO

measurement is initiated at the transmitter while in Manual

transducer is inserted into the transmitter while the transmitter

mode.

cable from the transmitter, wait 15 seconds, then

reinsert the cable

– reset the transmitter to Manual mode.

Note—The SpO

parameter Auto ON feature only needs to be reactivated when

the transmitter is in Continuous mode at discharge.

Note— SpO

can always be turned on and off at the Philips Information Center.

Monitoring 4-17

SpO

4 SpO

Monitoring

Turning the SpO2 Parameter On/Off

Task Summary

Turn the SpO2 parameter on or off manually by performing the following steps:

Step

Action

1 On the Patient Window click the All Controls button.

2 On the All Controls Window click the

3 On the Telemetry Setup Window, turn SpO

clicking in the checkbox indicates that SpO

Parameter ON checkbox. A check mark in the

monitoring is on.

Telemetry Setup button.

parameter on or off by

4-18 SpO

Monitoring

Turning SpO2 Alarms On/Off

Overview You can turn SpO

Task

Turn SpO2 alarm on or off by performing the following steps:

alarms on or off by using the Telemetry Setup Window.

Summary

Step Action

1 On the Patient Window click the

2 On the All Controls Window click the

3 On the Telemetry Setup Window turn SpO

clicking in the indicates that SpO

Alarm ON checkbox. A check mark in the checkbox

alarms are on.

Turning the Pulse Parameter On/Off

Overview You can turn the SpO

Window.

Task

Turn the pulse parameter on or off by performing the following steps:

Summary

Step Action

pulse parameter on or off by using the Telemetry Setup

All Controls button.

Telemetry Setup button.

alarms on or off by

1 On the Patient Window click the

2 On the All Controls Window click the

3 On the Telemetry Setup turn pulse parameter on or off by clicking

in the

Parameter ON checkbox. A check mark in the checkbox

indicates that pulse monitoring is on.

All Controls button.

Telemetry Setup button.

Monitoring 4-19

SpO

4 SpO

Monitoring

SpO2 Alarm and INOP Summary

SpO2 alarms are non-latching. That is, when an SpO2 limit is exceeded, if the alarm is not silenced, it will reset automatically if the patient’s alarm condition returns within the limits. This reduces the number of times you will need to reset alarms at the information center when an alarm condition has been corrected at the patient’s side (for example, movement-induced artifact alarms).

The following table lists the SpO

alarms and the description of the conditions

required to generate these alarms.

Message Level Sound Description

**SpO

> upper limit Yellow Continuous SpO2 value greater than the upper SpO2

measurement limit.

Important—Setting the high SpO

100% is equivalent to switching off the high alarm.

**SpO

< low limit Yellow Continuous SpO2 value less than the lower SpO2

measurement limit.

alarm limit to

4-20 SpO

Monitoring

SpO2 Alarm and INOP Summary

The following table lists the SpO2 INOPs. The Action column includes recommendations on what to do when one of these INOPs occurs.

Note—A Hard INOP indicates a more severe situation than a soft INOP. Hard

INOPS have an audible tone, and monitoring and alarms are disabled. In a soft INOP, no audible tone is generated; monitoring and alarms remain active.

Message Type Description Action

SpO

EQUIP MALF Hard INOP Malfunction in the SpO

Change transducer. hardware, or transducer/ adapter cable damaged

Change adapter cable.

If INOP persists, replace

transmitter.

SpO

ERRATIC Hard INOP Erratic SpO2 measurements,

often due to a faulty transducer or incorrect positioning of the transducer

May also be caused by optical shunting if sensor too big or too small.

Line up light source and

photo detector - they must

be opposite each other and

light must pass through the

arteriolar bed.

Reposition transducer to

site with higher perfusion.

Replace transducer or

adapter cable.

Use different sensor with

correct fit.

4 SpO

Monitoring

Monitoring 4-21

SpO

SpO2 Alarm and INOP Summary

Message Type Description Action

SpO2 INTERFERENCE

SpO

TRANSDUCER

Hard INOP Level of ambient light is so

high that the SpO cannot measure SpO

transducer

pulse rate.

Transducer or adapter cable is damaged.

May also be due to electrical interference.

May also be generated by a defective transmitter.

Hard INOP SpO2 transducer is

disconnected.

connector on

SpO

transducer or transmitter is dirty.

Cover sensor with nonwhite opaque material (for example, pulse oximeter probe wraps - Posey wrap or equivalent) to reduce ambient light.

If INOP persists, inspect and replace transducer or adapter cable as needed.

Reduce sources of electrical interference.

If the above corrective actions are ineffective, use a different transmitter, and call service to replace the defective one.

Reconnect sensor.

Replace sensor.

Replace transmitter and call service.

SpO

NOISY

SIGNAL

4-22 SpO

Monitoring

Hard INOP Excessive patient movement

or electrical or optical interference is causing irregular pulse patterns

Locate sensor at site with less movement.

Reduce sources of electrical or optical interference.

Call service.

SpO2 Alarm and INOP Summary

Message Type Description Action

SpO

NON-

PULSATILE

Hard INOP Pulse too weak or not

detectable

Relocate sensor to site with

improved circulation.

Warm area to improve May also be generated by a

circulation. defective transmitter.

Try another sensor type.

If the above corrective

actions are ineffective, use

a different transmitter, and

call service to replace the

defective one.

SpO

TRANS

MALFUNC

Hard INOP The SpO2 transducer is

malfunctioning.

connector on the

SpO

transducer or transmitter is dirty or corroded.

Replace the transducer or

adapter cable.

Change the transmitter and

call service to repair.

4 SpO

Monitoring

Monitoring 4-23

SpO

SpO2 Alarm and INOP Summary

4-24 SpO

Monitoring

Telemetry System Cleaning

This chapter describes cleaning of the telemetry equipment. It includes the following sections:

• Cleaning and Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2

• Cleaning the Receiver Mainframe . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

• Cleaning the Transmitter & Battery Extender . . . . . . . . . . . . . . . . .5-4

• Cross-infection Prevention for the Transmitter & Battery Extender 5-8

• Cleaning the Hewlett-Packard 200LX Palmtop Computer . . . . . .5-15

• Cleaning ECG Patient Cables and Leads . . . . . . . . . . . . . . . . . . .5-16

• Cleaning SpO

Adapter Cable & Transducers . . . . . . . . . . . . . . .5-18

5 Cleaning

Telemetry System Cleaning 5-1

Cleaning and Disinfection

Warning

To prevent fire, provide adequate ventilation and do not permit smoking when cleaning the transmitter or the receiver mainframe with a flammable liquid, such as alcohol, or sterilizing with ethylene oxide (EtO).

Disconnect line power from the receiver mainframe to prevent electrical shock and accidental turn-on.

Caution

Do not use any abrasive cleaning materials on any part or component of the Philips Telemetry System.

Do not clean any part or component of the Philips Telemetry System in any overly vigorous or abrasive fashion.

Using abrasive cleansers and abrasive cleaning actions will damage the components.

5-2 Telemetry System Cleaning

Cleaning the Receiver Mainframe

The receiver mainframe should be kept free of dust and dirt. You can only clean the outside of the receiver mainframe. Wipe the outside of the receiver mainframe clean by wetting a damp cloth or rag with one of the following approved cleaning agents:

• Soap and Water

Cleaning the Receiver Mainframe

5 Cleaning

• Isopropyl Alcohol (>

• Ethyl Alcohol (>

• Hydrogen Peroxide

• Sodium Hypochlorite (chlorine bleach), 5% solution

• Sodium Hypochlorite (chlorine bleach), 10% solution prepared within 24 hours

•Cidex®

• Windex®

• Lysol®

Wipe all cleaned surfaces with distilled water to remove any residue. Allow to air-dry, or dry with a non-lint producing cloth before use.

70%)

Telemetry System Cleaning

5-3

Cleaning the Transmitter & Battery Extender

The outside of the transmitter and battery extender should be kept free of dirt and dust.

The transmitter and battery extender can be cleaned by two methods: wiping or soaking.

Caution

Remove the battery and any cables or accessories before you clean and/or soak the transmitter.

Wiping the Transmitter Exterior

Task Summary Wipe the outside of the transmitter by performing the following steps:

Step Action

1 Remove the battery and any cables or accessories.

2 Wipe the outside of the transmitter clean by using a cloth dampened

5-4 Telemetry System Cleaning

modestly with one of the following approved cleaning agents:

• Isopropyl Alcohol (>

• Ethyl Alcohol (>

• Hydrogen Peroxide, 3% solution

• Sodium Hypochlorite (chlorine bleach), 5% solution

• Sodium Hypochlorite (chlorine bleach), 10% solution prepared within 24 hours

• Antibacterial soap and water.

•Cidex®

•Windex®

• Lysol®

70%)

Cleaning the Transmitter & Battery Extender

Step Action

3 Wipe all cleaned surfaces with distilled water to remove any

residue.

4 Allow to air-dry, or dry with a non-lint producing cloth.

5 Cleaning

Wiping the Battery

Under normal operation, the battery compartment should not require frequent cleaning. However, if it must be cleaned, follow the following procedure.

Compartment

Task Summary Wipe the battery compartment by performing the following steps:

Step Action

1 Remove the battery and any cables or accessories.

2 Wipe the battery compartment clean by using a cloth dampened

modestly with one of the following approved cleaning agents:

• Isopropyl Alcohol (>

• Ethyl Alcohol (>

• Hydrogen Peroxide, 3% solution

• Sodium Hypochlorite (chlorine bleach), 5% solution

• Sodium Hypochlorite (chlorine bleach), 10% solution

prepared within 24 hours

3 Wipe all cleaned surfaces with distilled water to remove any

residue.

4 Allow to air-dry, or dry with a non-lint producing cloth.

70%)

Caution

Do not use soap and water, Cidex®, Windex®, or Lysol® inside the battery compartment. These cleansers will damage the battery compartment.

Telemetry System Cleaning

5-5

Cleaning the Transmitter & Battery Extender

Wiping the Battery

The battery extender should be removed from the transmitter and power source before cleaning or disinfection.

Extender

Task Summary Wipe the battery extender by performing the following steps:

Step Action

1 Disconnect the power module from the power source, and

remove the cradle from the transmitter.

2 Wipe the battery extender with a cloth dampened modestly

with one of the following approved cleaning agents:

• Isopropyl Alcohol (>

• Ethyl Alcohol (>

• Hydrogen Peroxide, 3% solution

• Sodium Hypochlorite (chlorine bleach), 5% solution

• Sodium Hypochlorite (chlorine bleach), 10% solution prepared within 24 hours

3 Wipe all cleaned surfaces with distilled water to remove any

residue.

4 Allow to air-dry, or dry with a non-lint producing cloth.

70%)

Caution

Do not use soap and water, Cidex®, Windex®, or Lysol® on the cradle, wires, or aqua connector, because they will damage these parts of the extender.

5-6 Telemetry System Cleaning

Philips Telemetry System User manual

Specifications and Main Features

Frequently Asked Questions

User Manual