Schiller Argus LCM User Manual

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ARGUS LCM

Patient monitor

ARGUS LCM and ARGUS LCM PLUS

Art. no.: 2.510474 rev.: d

Operating Instruction

Sales and Service Information

The SCHILLER sales and service centre network is world-wide. For the address of your local distributor, contact your nearest SCHILLER subsidiary. In case of difficulty a complete list of all distributors and subsidiaries is provided on our internet site: http://www.schiller.ch.

Sales information can also be obtained from:

sales@schiller.ch

Address Headquarters

SCHILLER AG Phone: +41 (0) 41 766 42 42 Altgasse 68 Fax: +41 (0) 41 761 08 80, CH-6341 Baar, Switzerland E-mail: sales@schiller.ch Web: www.schiller.ch

Article no.: 2.510474 rev.: d Issue date: 10.04.06

ARGUS LCM/PLUS

Operating Instruction

Contents

1 Safety notes ..............................................5

1.1 Responsibility of the user ................................................... 5

1.2 Intended use ........................................................................ 5

1.3 Organisational measures..................................................... 5

1.4 Safety-conscious operation ................................................ 6

1.5 Safety facilities ..................................................................... 6

1.6 Operation with other devices .............................................. 6

1.7 Maintenance.......................................................................... 7

1.8 Safety symbols and pictograms ......................................... 8

1.8.1 Symbols used in this user guide ........................................................ 8

1.8.2 Symbols used on the device .............................................................. 9

1.9 Additional terms ................................................................... 9

1.9.1 Implied authorisation.......................................................................... 9

1.9.2 Terms of Warranty ............................................................................. 9

2 Introduction ............................................10

2.1 Version overview ................................................................ 10

2.1.1 ARGUS LCM (basic) from serial number 781.000-781.999............. 10

2.1.2 ARGUS LCM (basic) from serial number 781.1000 and higher ....... 10

2.1.3 ARGUS LCM PLUS (from 780.001and higher)................................ 11

2.2 Functional overview ........................................................... 12

2.2.1 Buttons of the Argus LCM PLUS...................................................... 12

2.2.2 Description of buttons ..................................................................... 13

2.2.3 Description of display ....................................................................... 14

3 Operation ................................................ 15

3.1 Start-up................................................................................ 15

3.1.1 Connecting and power on ................................................................ 15

3.1.2 Battery operation.............................................................................. 15

3.1.3 Operation with external dc voltage................................................... 16

3.2 Switching off and disconnecting from mains.................. 16

3.2.1 Interruption of the mains supply ....................................................... 16

3.3 Inserting printing paper .................................................... 17

3.4 Initial settings ..................................................................... 18

3.4.1 Selecting the language..................................................................... 18

3.4.2 Saving and restoring default values ................................................ 18

3.4.3 Load factory defaults........................................................................ 18

3.4.4 Alarm limit setting............................................................................. 19

3.4.5 Setting loudness of audible alarm and QRS sound ......................... 20

3.5 Trend or alarm display ....................................................... 21

3.6 Display of additional leads ................................................ 21

Art. no.: 2.510474 rev.: d

3.7 Procedure in case of an alarm .......................................... 22

3.7.1 Display of alarms.............................................................................. 22

3.7.2 Switching off an alarm...................................................................... 22

3.7.3 Suppressing/acknowledging an audible alarm................................. 23

3.7.4 Preventive alarm suppression.......................................................... 24

3.7.5 Overview of physiological alarms..................................................... 24

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ARGUS LCM/PLUS

4 Start monitoring .....................................25

4.1 Connecting the cables for monitoring.............................. 25

4.2 ECG monitoring .................................................................. 25

4.2.1 RRi monitoring with HF-ECG cable ................................................. 25

4.2.2 Pacemaker monitoring..................................................................... 26

4.2.3 Pacemaker monitoring with HF-ECG cable ..................................... 26

4.3 NIBP monitoring ................................................................. 27

4.4 SPO

monitoring................................................................. 28

4.5 IBP monitoring .................................................................... 29

4.5.1 Preparing IBP measurement............................................................ 29

4.5.2 IBP calibration.................................................................................. 30

4.6 CO2 monitoring ................................................................... 30

4.7 Temperature monitoring .................................................... 30

5 Maintenance ............................................31

5.1 Maintenance interval .......................................................... 31

5.1.1 Visual unit check.............................................................................. 31

5.1.2 Button test........................................................................................ 31

5.2 Maintenance interval for the battery ................................. 32

5.2.1 Charging the battery ........................................................................ 32

5.2.2 Battery disposal ............................................................................... 32

5.3 Changing the fuse and mains voltage .............................. 33

5.4 Cleaning the device, cable and sensors........................... 34

5.4.1 Cleaning the device, cables and sensors ........................................ 34

5.5 Zero and two point CO2 calibration .................................. 35

5.5.1 Starting the zero point calibration .................................................... 35

5.5.2 Starting the two point calibration...................................................... 35

5.6 Trouble shooting ................................................................ 36

5.6.1 Accessories and disposables........................................................... 37

6 Technical Data ........................................38

6.1 System data......................................................................... 38

6.2 Technical data - measured values .................................... 40

6.2.1 ECG ................................................................................................. 40

6.2.2 Respiration....................................................................................... 40

6.2.3 Temperature .................................................................................... 41

6.2.4 NIBP - non-invasive blood pressure ................................................ 41

6.2.5 IBP - invasive blood pressure .......................................................... 41

6.2.6 SpO

6.2.7 etCO

- pulsoximetry ........................................................................ 42

- capnography....................................................................... 42

7 Appendix .................................................43

7.1 Settings menu ..................................................................... 43

7.1.1 Main menu ....................................................................................... 43

7.1.2 Special menu “About+” .................................................................... 44

7.2 Factory settings .................................................................. 45

7.3 Connecting the ECG patient cable ................................... 46

7.3.1 3-leads cable for children and neonates.......................................... 46

7.3.2 3-lead cable for respiration .............................................................. 46

7.3.3 3-lead cable for adults...................................................................... 46

7.3.4 3p-lead cable ................................................................................... 48

Art. no.: 2.510474 rev.: d

Page 2

ARGUS LCM/PLUS

Operating Instruction

7.3.5 Three- and five-lead cables for adults and children ......................... 48

7.3.6 10-lead ECG patient cable............................................................... 49

7.3.7 Electrodes identification and colour code IEC/AHA ......................... 50

7.4 CO2 settings........................................................................ 51

7.4.1 Description of CO2 parameters........................................................ 51

7.4.2 Compensation settings..................................................................... 51

7.4.3 Combination of N

7.4.4 Environmental pressure compensation............................................ 52

O and O2 compensation .................................... 52

8 Index ........................................................ 53

Art. no.: 2.510474 rev.: d

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ARGUS LCM/PLUS

Page 4

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Safety notes 1

Operating Instruction Responsibility of the user 1.1

1 Safety notes

1.1 Responsibility of the user

V This device must only be used by qualified doctors or trained medical personnel

under their direct supervision.

V The numerical and graphical results and any interpretation given must be exam-

ined with respect to the overall clinical condition of the patient and the general recorded data quality.

V The indications given by this equipment are not a substitute for regular checking

of vital functions.

V Specify the competencies of the personnel for operation and repair. V Ensure that the personnel have read and understood these operating instructions

and in particular this chapter “safety notes".

V Have damaged or missing components replaced immediately. V The operator is responsible for compliance with all applicable accident prevention

and safety regulations.

1.2 Intended use

V The ARGUS LCM/PLUS is a patient monitoring device used for the measuring of

, CO

the parameters of a patient, including ECG, SpO sure, temperature and respiration.

V The system is suitable for internal hospital transport. V There is no danger for patients with pacemaker. V The device is only intended for single patient use. V Only operate the device in accordance with the specified technical data. V The system is not designed for sterile use nor is it designed for outdoor use. V Do not use this unit in areas where there is any danger of explosion or in the pres-

ence of flammable gases such as anaesthetic agents.

V This unit is CF classified. It is defibrillation protected only when the

SCHILLER original patient cable is used. However, as a safety precaution when possible, remove electrodes before defibrillation.

V This product is not designed for direct cardiac application.

non invasive blood pres-

1.3 Organisational measures

V Before using the unit, ensure that an introduction regarding the unit functions and

the safety precautions has been provided by a medical product representative.

V Keep these operating instructions in an accessible place for reference when re-

quired. Make sure that they are always complete and legible.

V Observe the operating instructions and maintenance instructions.

Art. no.: 2.510474 rev.: d

V These operating instructions do not override any statutory or local regulations, or

procedures for the prevention of accidents and environmental protection.

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1 Safety notes

1.4 Safety-conscious operation

1.5 Safety facilities

ARGUS LCM/PLUS

V Make sure that the staff has read and understood the operating instructions - par-

ticularly the "Safety Notes" chapter.

V Position the device so that there is no possibility of it falling on the patient or floor. V Do not touch the unit casing during defibrillation. V To grant the patient's safety, it must be ensured that neither the electrodes, in-

cluding the neutral electrode, nor the patient, or persons touching the patient, come into contact with conducting objects (e.g. RS-232 interface - see Fig. 3.1 on page 15), even if these are earthed.

V Immediately report any changes that impair safety (including operating behav-

iour) to the person responsible.

V Do not place any liquids on the unit. If liquid should be spilled over the device,

immediately disconnect the device from the mains and wipe it. The device must be serviced before reusing.

V Operating the device without the correctly rated fuse, or with defective cables,

constitutes a danger to life. Therefore:

– Do not operate the unit if the earth connection is suspect or if the mains lead is

damaged or suspected of being damaged. – Damaged cable connections and connectors must be replaced immediately. – The electrical safety devices, such as fuses, must not be modified. – Ruptured fuses must only be replaced with the same type and rating as the orig-

inal.

1.6 Operation with other devices

V Use only accessories and other parts recommended or supplied by SCHILLER

AG. Use of other than recommended or supplied parts may result in injury, inaccurate information and/or damage to the unit.

V Ancillary equipment connected to the analogue and/or digital interfaces must be

certified according to the respective IEC standards (e.g. IEC/EN 60950 for data processing equipment and IEC/EN 60601-1 for medical equipment). Furthermore all configurations shall comply with the valid version of the system standard IEC/ EN 60601-1-1. Everybody who connects additional equipment to the signal input part or signal output part configures a medical system, and is therefore responsible that the system complies with the requirements of the valid version of the system standard IEC/EN 60601-1-1. If in doubt, consult the technical service department or your local representative.

V Any other equipment used with the patient must use the same common earth as

the ARGUS LCM.

V Precautions must be observed when using high frequency devices. Use the fre-

quency SCHILLER patient cable to avoid possible signal interference during ECG acquisition.

V There is no danger when using the ECG unit simultaneously with electrical stim-

ulation equipment. However, the stimulation units should only be used at a sufficient distance from the electrodes. If in doubt, the patient should be disconnected from the monitor.

V If the patient cable should become defective after defibrillation, a lead-off indica-

tion is displayed in the upper right part of the screen and an audible alarm is issued.

Art. no.: 2.510474 rev.: d

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ARGUS LCM/PLUS

Safety notes 1

Operating Instruction Maintenance 1.7

1.7 Maintenance

V Danger of electric shock! Do not open the device. No serviceable parts inside.

Servicing may only be carried out by a qualified technician authorised by Schiller AG.

V Before cleaning and to isolate the mains power supply, switch the unit off and dis-

connect it from the mains by removing the plug.

V Do not use high temperature sterilisation processes

(such as autoclaving). Do not use E-beam or gamma radiation sterilisation.

V Do not use solvent or abrasive cleaners on either the unit or cable assemblies. V Do not, under any circumstances, immerse the unit or cable assemblies in liquid.

Art. no.: 2.510474 rev.: d

Page 7

1 Safety notes

1.8 Safety symbols and pictograms

1.8.1 Symbols used in this user guide

ARGUS LCM/PLUS

The safety level is classified according ANSI Z535.4. The following overview shows the safety symbols and pictograms used in this manual

For a direct danger which could lead to severe personal injury or death.

For a possibly dangerous situation, which could lead to heavy bodily injury or death.

For a possibly dangerous situation which could lead to personal injury. This symbol is also used to indicate possible damage to property.

For general safety notes as listed in this chapter.

Used for electrical dangers, warnings and other notes in regarding operation with electricity.

NOTE For possibly dangerous situations, which could lead to damages to property or system failure or IMPORTANT for helpful user information.

Reference to other guidelines

Page 8

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Safety notes 1

Operating Instruction Additional terms 1.9

1.8.2 Symbols used on the device

Potential equalisation

CF symbol. This unit is classified safe for internal and external use. However, It is only defibrillation protected when used with the original SCHILLER patient cable!

The unit/component can be recycled.

Notified body of the CE certification (TÜV P.S.)

Note: Follow the instructions in the documentation.

1.9 Additional terms

1.9.1 Implied authorisation

Possession or purchase of this device does not convey any express or implied license to use the device with replacement parts which would alone, or in combination with this device, fall within the scope of one or more patents relating to this device.

1.9.2 Terms of Warranty

Your SCHILLER ARGUS LCM/PLUS is warranted against defects in material and manufacture for the duration of one year (as from date of purchase). Excluded from this guarantee is damage caused by an accident or as a result of improper handling. The warranty entitles free replacement of the defective part. Any liability for subsequent damage is excluded. The warranty is void if unauthorised or unqualified persons attempt to make repairs.

In case of a defect, send the apparatus to your dealer or directly to the manufacturer. The manufacturer can only be held responsible for the safety, reliability, and performance of the apparatus if:

• assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorised by him, and

• the ARGUS LCM/PLUS and approved attached equipment is used in accordance with the manufacturer's instructions.

There are no express or implied warranties which extend beyond the warranties hereinabove set forth. SCHILLER makes no warranty of merchantability or fitness for a particular purpose with respect to the product or parts thereof.

Art. no.: 2.510474 rev.: d

Page 9

2 Introduction

2.1 Version overview

ARGUS LCM/PLUS

2 Introduction

The ARGUS LCM/PLUS (Low Weight and Compact Monitor) is a flexible patient monitoring device for the comprehensive monitoring of vital parameters in adults, children and neonates.

Mains power supply (115/230 VAC) is used for stationary use. The LCM also provides full vital data monitoring during transport with the built in battery (one hour), or using a DC voltage supply (11 - 30 VDC).

2.1 Version overview

2.1.1 ARGUS LCM (basic) from serial number 781.000-781.999

The following table shows the equipment of the ARGUS LCM. This basic device cannot be upgraded.

ARGUS LCM ECG SpO

Basic device Only with 3 leads/display one lead (II) x x Options: printer, additional battery (can be updated in the field)

NIBP

2.1.2 ARGUS LCM (basic) from serial number 781.1000 and higher

The ARGUS LCM BASIC with the microprocessor MK19-11 has a new ECG amplifier (3p). It is now possible to to display 6 leads with a 3p-lead cable. The 3p-lead cable is marked with a black connector housing instead of green.

This works only with software 1.24 and higher.

ARGUS LCM version

Axxxx1x B x x x x 1x x Dxxxx1xx E x x x x x x

Monitoring amplifier only with 3p- and 5 lead cable (6 or 7 lead display) Options for all versions: printer, additional battery and nurse call or vehicle power supply Version A can be updated with etCO

Version B/C/D/E can be updated with printer and additional battery

ECG

SpO2 NIBP Respiration Temperature etCO

module, printer and additional battery.

IBP

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Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Introduction 2

Operating Instruction Version overview 2.1

2.1.3 ARGUS LCM PLUS (from 780.001and higher)

ARGUS LCM PLUS version

ECG

SpO2 NIBP Respiration Temperature etCO2IBP

AxxxX1x B x x x x 1x x Dxxxx1xx E x x x x x x

Diagnostic amplifier only with 3- or 5- or 10 lead cable (1- or 7- or 12 lead display) Options for all versions: printer, additional battery and nurse call or vehicle power supply Version A can be upgrade with etCO

module, printer and additional battery.

Version B/C/D/E can be upgrade with printer and additional battery

Art. no.: 2.510474 rev.: d

Page 11

2 Introduction

2.2 Functional overview

ARGUS LCM/PLUS

2.2 Functional overview

2.2.1 Buttons of the Argus LCM PLUS

Audible Alarm suppress/acknowledge

ECG

Alarm OFF

This is the LCM plus version E.

Patient connections

CO IBP

SPO

NIBP

Access to the menu IBP and NIBP alarm on/off and IBP calibration.

Direct buttons for :

1. NIBP s

tart/stop

2. Trend display

3. Print

4. Setting alarm limits

Menu access button

LED indicating battery operation

LCM ON/OFF button

LED indicating main supply operation

°C/°F

Navigation buttons down/up, /leftright

Program and enter button

IBP connection instead of Temperature

This is the LCM plus version D.

Page 12

Fig. 2.1 ARGUS LCM front view

IBP connection instead of CO

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Introduction 2

Operating Instruction Functional overview 2.2

2.2.2 Description of buttons

ON/OFF

The LED indicates if the LCM is running from mains power or battery.

Button for suppression/acknowledgement of audible alarms The alarm can be suppressed or acknowledged in two ways. This is defined in set-

tings About+/Alarm setup menu.

See detailed description in paragraph 3.7.3

Direct buttons for:

(1) NIBP start/stop or, if pressed for 2 s, switch between auto and manual

(2) Trend and alarm displays

(3) Printout of the current display

(4) Alarm limit settings

Art. no.: 2.510474 rev.: d

Enter

Navigation

Alarm off

These buttons disable alarms of the individual parameters. Acknowledgement is displayed on the top left e.g. ECG Alarm OFF. The LED above the corresponding button is lit (for details refer to section 3.7.4).

Menu access

Opens the main menu. Navigate through the menus with the right/left buttons. Press the menu button to again leave the menu.

The navigation and enter buttons have different functions dependent on operating mode:

Normal single lead display:

Pressing the enter button shows the first 3 leads instead of the single lead display.

By pressing the up/down buttons, the next lead, or lead group is displayed.

Press the left button to adjust the loudness of the audible alarm and the QRS signal.

Programming mode:

1. Activating the programming mode with the menu button.

2. Selecting the menu with the left/right buttons.

3. Selecting a value with the up/down buttons.

4. Press the enter button.

5. Change a value using the up/down buttons.

6. Retrieve a value by pressing enter.

Trend display mode:

Activate the trend display mode with the trend display button. Use the left/right buttons to move forward/backward in the trend display. Use the trend button to toggle between the trend display, alarm display and normal monitor display.

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2 Introduction

2.2 Functional overview

ARGUS LCM/PLUS

2.2.3 Description of display

Alarms

(1) Status field for physiological alarms (2) Status field for technical alarms

Curve field

(3) 1 or 3 channel leads display. With enter display 1 or 3 leads, with

up/down select the following/previous lead/lead group.

System status field

(4) System status field (5) Symbol for battery operation. (6) Loudness (3-step) for alarm- and QRS-sound. Adjust with left button. (7) Symbol of the selected patient type.

Blood pressure

(8) < 0:12 A = remaining time (h/min) to the next automatic blood pressure meas-

urement. > 0:12 = Time since the last manual blood pressure measurement Remark: During blood pressure measuring the actual system pressure in mmHg will be displayed.

Measurement field

(9) Various displayed values e.g. HR, Sp02, IBP, CO2, RRi, temperature.

aVR, III,...

I,II, …

Alarm HR Low ECG lead off

I II III

III

P P

11 :04 28-10-04

NIBP

mmHg <0:12A

>0:12

127/77

SYS/DIA

(100

(MAP)

PM detection

/ min

PM ON

SpO

/ min

RRi

/ min

)

°C

RRi Alarm switch off

98 60

36.8

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ARGUS LCM/PLUS

Operation 3

Operating Instruction Start-up 3.1

3Operation

3.1 Start-up

V Danger of electrical shock. Do not operate the unit if the earth connection is sus-

pect or if the mains lead is damaged or suspected of being damaged.

3.1.1 Connecting and power on

(1) RS-232 (2) Mains connection (100 -115 or 220 -240 VAC) (3) Potential equalisation (4) Nurse call or DC in 11 - 30 VDC (option)

Fig. 3.1 ARGUS LCM back panel

1. Voltage setting (2) 115 or 230 V. Refer to chapter 5.3 for the mains voltage. Connect the power cable at the rear of the unit (2).

2. Connect the potential equalisation cable (3) to the central potential equalisation socket.

3. Press the on/off button.

4. Check that all LEDs flash shortly and there is a beep on start-up.

5. Check the settings according to sections 3.4 and 7.1.

3.1.2 Battery operation

Important

The Battery operation is indicated by the LED below the battery symbol.

When the battery charge is low, the alarm message Battery low appears or

Art. no.: 2.510474 rev.: d

– the LED (1) blinks – the Battery symbol in the bottom left display field blinks

for Battery recharging refer to chapter 5.2

Page 15

3Operation

3.2 Switching off and disconnecting from mains

3.1.3 Operation with external dc voltage

Important

Before initial operation with external dc voltage, check voltage supply. (The voltage must be in the range of 11-30 VDC). On connection, make sure that the polarity is correct.

3.2 Switching off and disconnecting from mains

1. Press the on/off button. A dialogue window appears.

2. Select with the left button YES and confirm the selection with the enter button.

3. Remove the mains cable from the mains supply socket (2) (see Fig. 3.1) to isolate the device from the mains.

Important

If no dialogue window appears, it is possible to switch off the device by keeping the On/Off button pressed for 10 seconds.

ARGUS LCM/PLUS

3.2.1 Interruption of the mains supply

If the mains supply is interrupted, the device automatically switches over to battery operation. The user settings are maintained. These settings can be saved in the menu About+/Software.

Page 16

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Operation 3

Operating Instruction Inserting printing paper 3.3

3.3 Inserting printing paper

Important

The device is delivered without printing paper installed. Only use original SCHILLER printing paper. The thermo-paper is sensitive to heat, humidity and chemical vapours. Store the paper in a cool and dry area.

1. Press the locking catch (1) upwards. The printer door opens downward

2. Insert paper and pull it up. Be sure that the paper lies behind the cover (2).

3. Close the cover. Be sure that the paper lies exactly between the rails (3).

Art. no.: 2.510474 rev.: d

Page 17

3Operation

3.4 Initial settings

ARGUS LCM/PLUS

3.4 Initial settings

This chapter details the most important and typical programming sequences.

V Only authorised personnel, trained in the operation of this device, are permitted

to do the setups in the following menu.

The extended menu is displayed by pressing the following button combination:

Press ; select About; press and then .

3.4.1 Selecting the language

1. Open the menu About/Device.

2. Confirm with the enter button.

3. Press the down button and select the language.

4. Confirm with the enter button.

5. Press right/left to move to the next menu and continue with more setups.

6. Save the user settings. Open the Software panel, select Save as Default and confirm with the enter button.

7. Return to the normal display mode by pressing the menu button.

For system settings, see detailed list in the sections 7.1.1and 7.1.2.

3.4.2 Saving and restoring default values

Changed values can be saved permanently and restored. See section 7.1.2.

1. Open the About+ panel and select Device.

2. Select Save as Default or Restore Defaults and confirm with enter. The default values will then be saved or restored.

3. Press the menu button to exit the programming mode.

3.4.3 Load factory defaults

When the factory defaults are loaded, the system language will be German.

The SCHILLER factory defaults are listed in section 7.2. When you load these defaults, they will overwrite the user settings.

1. Open the About+ panel and select Device.

2. Select Factory Defaults and confirm with the enter button. The factory defaults will be loaded.

3. Press the menu button to exit the programming mode.

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ARGUS LCM/PLUS

Operation 3

Operating Instruction Initial settings 3.4

3.4.4 Alarm limit setting

All alarm limits are reset to the default or user specific system settings after switching the unit off/on, if they have not been stored as default. (see menu About+/Soft- ware)

1. Press alarm limit button.

2. Press up/down or left/right buttons to select an alarm parameter and confirm with enter. The entry field appears blue.

3. Press up/down to change the value and confirm with the enter button.

4. Press the up/down or left/right buttons to select other parameters or press the alarm limit button to exit the menu.

The following table gives the default alarm limits settings for adults. A changed value can be stored as default in the menu About+/Software.

The factory defaults are listed in the sections 7.1 and 7.2..

Alarm Low High Unit

Prio.

HR 50 140 /min High Off ASYS - 2 s High Off

RRi

APNi

SpO

8 35 min Low Off

- 25 s High Off

90 101 % Low Off

PP 50 140 min High Off SYS 100 140 mmHg Low Off DIA 40 95 mmHg Low Off MAD 70 140 mmHg Low Off Ps 95 180 mmHg Low Off Pm 50 100 mmHg Low Off Pd 40 100 mmHg Low Off eCO

CO2 i

35 45 mmHg Low Off

0 2 mmHg Low Off

RRc 8 35 /min Low Off APNc - 25 s High Off

a. "High" priority = audible signal with 2 x 5 impulses.

"Low" priority = audible signal with 1 x 2 impulses and 20 s pauses between the impulse sequences.

Art. no.: 2.510474 rev.: d

b. Print "On" = Default printout containing a warning message when the min./max.

value is exceeded.

c. If the RRi alarm option is Off in the ECG settings panel, the "Low" and "High" val-

ues for RRi and APNi will be "Off".

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3Operation

3.4 Initial settings

ARGUS LCM/PLUS

Printing alarm limits

1. Press the alarm limit button.

2. Press the print button. The displayed table is printed.

3.4.5 Setting loudness of audible alarm and QRS sound

1. Select normal monitor mode. Press menu if in programming mode or trend if in trend display.

2. Press the left button to adjust the loudness. The pictogram in the status display on the bottom left shows the current setting.

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Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Operation 3

Operating Instruction Trend or alarm display 3.5

3.5 Trend or alarm display

The trend values are measured every minute and additionally on every manual NIBP measurement. The trends can be displayed in graphical or tabular form for all parameters over 24 hours.

The display interval for the table can be selected in the menu About+/Trend. The displayed trend table or not acknowledged alarms can be printed out by pressing the print button. The displayed graph cannot be printed.

Table display

1. Press the trend button. The trend will be displayed in a table in 1, 5 ,15, 30, 60,

120 or 240 minute intervals. Change the displayed interval using the up/down button. Move the display forward/backward on the time axis using the left/right

button.

Graph display (cannot be printed)

2. To display the graph, press the trend button once again. The graph's time frame

corresponds to 3 hours. Display the next 3 h by pressing the up/down button. Move the cursor on the top right corner using the right/left button to display the exact measured values for the selected position on the right. The cursor can be positioned on the NIBP value by pressing ENTER .

Display of not acknowledged alarms

3. To display the last twelve not acknowledged alarms, press the trend button a third

time.

3.6 Display of additional leads

The basic LCM basic serial number 0-999 can only display one lead.

1. Select the normal monitor mode. Press menu if in programming mode or trend if in trend display.

2. Press the enter button to switch between the normal display mode containing one lead and the 3-lead display.

3. By pressing the up/down buttons, the next leads are displayed.

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3Operation

3.7 Procedure in case of an alarm

3.7.1 Display of alarms

3.7.2 Switching off an alarm

ARGUS LCM/PLUS

During initial switching on

The alarms are suppressed for a defined time (programmable in the menu About+/ Alarm. Alarm suppr. time standard is 3 minutes)

The message Alarm suppressed 3:00 appears.

During monitoring

There are two alarms:

• Technical alarm, displayed in the alarm status field on the top right. In the case of a technical alarm, an audible alarm sounds and the measurement field for the respective value flashes.

• Physiological alarms, displayed in the alarm status field on the top left. In the case of a physiological alarm, an acoustic alarm sounds and the measurement field for the respective value flashes.

Each alarm off function is password protected. Read carefully the following warning and information:

V When the acoustic alarm is switched off, the patient acoustic physiological

alarms are silenced and suppressed indefinitely. Use this function only if disconnecting a sensor from the patient for a long period of time.

• When the alarm off button is pressed, the audible alarm for the respective parameter is suppressed. This is indicated by the LED above the button and a message on the monitor, e.g. Alarm ECG OFF. If an alarm occurs as long as the alarm off button is pressed, a visual alarm is displayed in the respective measurement field.

• With the LCM plus version E the access to the NIBP and IBP alarm off function will be executed by the NIBP alarm button. A menu with blood pressure alarm off (common for NIBP and IBP) and IBP calibration function appears.

BP Alarm On/Off

Connect zero mmHg

Start IBP calibration

End / Escape

Page 22

Enter Password

Press [Enter] to cancel

Entering alarm OFF password

1. Press the desired alarm off button. The password dialog appears.

2. Press following button to enter the password:

, , ,

1. The password protection can be disabled in the special menu see chapter 7.1.2 page 44

I,II, II

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Operation 3

Operating Instruction Procedure in case of an alarm 3.7

3.7.3 Suppressing/acknowledging an audible alarm

There are two ways to proceed in the case of an alarm. The procedure depends on the set alarm stop mode (On/Off) and the alarm suppression time in the menu About+/Alarm:

(1) Alarm stop off (suppression)

This function suppresses an audible alarm for a defined period of time. However, the flashing measurement field (red measured value and coloured field) will remain.The audible alarm is reactivated after the defined period of time has elapsed.

(2) Alarm stop on (acknowledging)

This function will suppress an audible alarm as long as the defined limits are exceeded. However, the flashing measurement field (red measured value and coloured field) remains.

Art. no.: 2.510474 rev.: d

Page 23

3Operation

3.7 Procedure in case of an alarm

3.7.4 Preventive alarm suppression

3.7.5 Overview of physiological alarms

ARGUS LCM/PLUS

The preventive alarm suppression is used to deactivate in advance all alarms that may be caused by disconnecting patient cables, lose electrodes and relocation of

the patient.

« Press the alarm button and confirm with the enter button before an alarm is dis-

played.

Message Alarm suppressed 3:00 is displayed. The time can be programmed in the menu About+/Alarm/Alarm suppr. time.

The alarms are reactivated after the defined period of time has elapsed.

Removing the patient cables When a cable is removed, the message Cable off or no Sensor is displayed.

« Press the alarm suppressing button. The alarm is deleted and the measurement and wave field is no longer displayed.

Alarm abbreviation Description

Asys limit Asystole time limit exceeded SpO2 Low/High

PP Low/High

Oxygen saturation of the blood

Peripheral pulse of SpO

RRi Low/High Respiration rate impedance (from ECG electrode) Apnea limit Apnea time limit exceeded CO2i low/high Inspiratory CO

RRc low/high Capnographic respiration rate eCO2 low/high End-tidal expiratory CO

SYS low/high Systolic pressure DIA low/high Diastolic pressure MAD low/high Mean atrial pressure HR low/high Heart reat Ps low/high Invasive systolic blood pressure Pm low/high Invasive mean blood pressure Pd low/high Invasive diastolic blood pressure

When the temperature is outside the measuring range,

Temp low/high

this is indicated by “<<“(15 below °C) or “>>” (above 45 °C). This limit is fixed.

Page 24

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Start monitoring 4

Operating Instruction Connecting the cables for monitoring 4.1

4 Start monitoring

Values are only displayed when the ECG cable or at least one sensor is connected. If a sensor is disconnected, a technical alarm is issued. The measured value will no longer be displayed if the sensor is disconnected and the alarm is acknowledged.

4.1 Connecting the cables for monitoring

1. Connect the ECG cable, the NIBP cuff, the SpO2 sensor, the CO2 sensor or the temperature sensor to the patient.

2. Press the menu button and select System. Select between adult, child or neonate.

3. Check the settings in the ECG, NIBP, IBP, SpO

4. Connect the cable to the LCM. As soon as an ECG cable or another sensor cable is connected, the corresponding indication appears on the display.

5. Press the alarm limits button and check the settings.

6. Check the alarm and the system statuses. (See section 2.2.3.)

and CO2 panels.

4.2 ECG monitoring

V In order to minimise interference and the danger of burns to the patient, only use

the original SCHILLER HF ECG cables against high-frequency radiation. Keep the ECG cable as far away as possible from the operated area and the electrosurgical cables. Make sure that the electro-surgical return conductor (neutral) is well attached to the patient and that a good contact is guaranteed.

V Patients with a pacemaker must be observed continuously because the heart rate

from the pacemaker might still be registered in case of a cardiac arrest or some arrhythimas.

– SCHILLER recommends to attach, in addition to ECG measurement, a SpO

sensor and adjust the alarm range of PP near to peripheral pulse.

« Refer to section 7.3 for ECG electrode placement.

The ECG curve field is only displayed when the ECG cable is connected and the electrodes are applied. As soon one derivation is detected the curve field will be displayed.

4.2.1 RRi monitoring with HF-ECG cable

An RRi monitoring with HF-ECG cable against high frequncy signals is not possible. The used HF-signal for the RRi measuring will be filtered by the HF protection in the ECG cable.

Art. no.: 2.510474 rev.: d

Page 25

4 Start monitoring

4.2 ECG monitoring

ARGUS LCM/PLUS

4.2.2 Pacemaker monitoring

HF 60

/ min

PM On

Set the PM monitoring in the menue ECG/Pacemaker On to display the pacemaker pulses as vertical lines (1) on the ECG display. When pacemaker signals are detected, the heart symbole is replaced by a diamond (2). These vertical lines represent neither magnitude nor duration of the pacemaker pulse but are purely time relative.

The RRi curve field is switched of when Pacemaker detection is on.

4.2.3 Pacemaker monitoring with HF-ECG cable

Pacemaker monitoring with HF-ECG cable against high frequncy signals is not possible. The used pacemaker impulse will be filtered by the HF protection in the ECG cable.

Page 26

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Operating Instruction NIBP monitoring 4.3

4.3 NIBP monitoring

V To prevent extensive pressure on the extremity, it is very important to choose the

correct cuff size and to check the setting in the panel System/Patient (Adult, Pediatric, Neonatal).

V In case of long-term monitoring or automatic operation, the connected body areas

of the patient and the extremity to which the cuff is attached must be checked regularly for signs of ischaemia, purpura and/or neuropathy.

V The cuff must not be attached to a limb that is already used for interventions such

as infusions.

V To prevent incorrect measurement results, make sure that the tube is not com-

pressed.

V Applie the cuff always on the same level as the right atrium to be able to measure

a correct arterial pressure.

• To prevent errors if the SpO2 saturation is measured on the same limb as the NIBP,

the SpO (see Menu NIBP/SpO

• The deflation rate has an importand influence to the accuracy of the messuring

special at patient with low puls. It is recommended to reduce the deflation rate for patient with bradicardia and hypotonia from 5 mmHg to 3 mmHg.

alarm is suppressed during NIBP measurement.

suppression page 43.)

Start monitoring 4

« The cuff is attached to the left or right upper arm. « Note the cuff size for the respective patient type.

Art. no.: 2.510474 rev.: d

Page 27

4 Start monitoring

4.4 SPO

monitoring

good perfusion

poor perfusion

ARGUS LCM/PLUS

4.4 SPO2 monitoring

• The pulsoximeter enables the continuous non-invasive monitoring of the functional oxygen saturation of the arterial hemoglobin and the pulse rate. When the signal is received from the patient sensor, the Masimo SET signal extraction technology is used to calculate the patient's functional oxygen saturation and pulse rate.

• The display shows the continuous progress of the numeric SpO2, pulse rate, plethysmographic waveform and signal quality values.

• The displayed plethysmographic waveform is not proportional to the pulse volume.

• The update period of the measurement readings on the display is 0.2 seconds.

• According to the relevant standards, the temporary alarm suppression must be set to maximally 2 minutes.

• Check low/high setting of the SpO2 sensor see chapter 7.1.2 page 44. Low sensitivity mode provides the best combination of sensitivity and sensor off detection performation. this mode is recommended for the majority ofr patients. High sensitivity mode should be used for patients, where optaining a reading is most difficult. This mode is only recommended during procedures and when clinican and patient contact is continuous.

V Only use sensors recommended from SCHILLER for SpO2 measurement with

the Argus LCM. Other oxygen transducers (sensors) may lead to improper performance.

V The information in this manual does not overrule any instructions given in the

Masimo operating manual, which must be consulted for full instructions.

V Do not use the pulsoximeter or Masimo sensors during magnetic resonance im-

age scanning. Induced current could potentially cause burns, and the pulsoximetry may affect the image and the accuracy of the measurements.

V Before using the sensor, carefully read the sensor directions for use. V Tissue damage can be caused by incorrect application or use of a sensor. Inspect

the sensor site as described in the sensor directions for use to ensure skin integrity and correct positioning and adhesion of the sensor.

V Do not use damaged patient cables, damaged sensors or sensor with exposed

optical components.

V Substances causing disturbances: Carboxyhemoglobin can lead to falsely high

measurement readings. The degree of the deviation approximately corresponds to the quantity of carboxyhemoglobin. Colours or substances containing colours that influence the natural blood pigments can also lead to incorrect measurement readings.

V Exposure to excessive illumination, such as surgical lamps (especially those with

xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps or direct sunlight, can affect the performance of an SpO2 sensor. To prevent exposure to excessive illumination, ensure that the sensor is correctly applied and that it is covered with an opaque material, if required. If these measures are neglected, excessive illumination can lead to incorrect measurements.

V Change the sensor's position at least every 4 hours.

Page 28

Alarm test

1. Apply the SpO

2. Set the lower SpO

3. When the SpO

4. Reset the alarm limit to its original value.

sensor to the patient.

alarm limit to 99%.

value is lower than the alarm limit, an alarm is issued.

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Start monitoring 4

Operating Instruction IBP monitoring 4.5

4.5 IBP monitoring

V Carefully read the manufacturer's instructions before using the invasive blood

pressure kit.

V When applying the kit to the patient, make sure that absolutely no air penetrates

the system.

V To achieve correct arterial pressure measurement, the pressure sensor must be

installed on the level of the right atrium.

V If the pressure sensor's position is moved after calibration, this might lead to

wrong low or high values.

V If an invasive catheter for blood pressure measurement is introduced into an ar-

terial vessel, the circulation in the terminal vessels must be checked in regular intervals.

V Single-use sensors and valves must not be reused. V To grant the patient's safety, it must be ensured that neither the electrodes nor

the patient, or persons touching the patient, come into contact with conducting objects, even if these are earthed.

V Precautions must be observed when using high frequency surgical equipment.

Use high frequency protected sensors to avoid wrong IPB measurements.

• The kit and operating procedure vary according to manufacturer. Please consult the manufacturer's documentation for connection.

• For warm-up time/ready for measurement and displacement for invasive transducers, refer to the documentation of the transducer manufacturer.

4.5.1 Preparing IBP measurement

The rinse must be contained in a flexible container. This container must be surrounded by a pressure bag which should exert a pressure of 300 mmHg ± 30 mmHg on the container. This is in order to ensure a minimum flow of rinse of approximately 6 ml per hour to prevent occlusion of the catheter tip.

1. Unpack the disposable measuring kit and check all tube connections for tight-

ness.

2. Secure the infusion bag and connect the infusion tube to the bag.

3. Hang the measuring kit in the holder and secure the holder.

4. Connect the cable of the transducer to the adapter cable.

5. Connect the cable to the unit.

Art. no.: 2.510474 rev.: d

Page 29

4 Start monitoring

4.6 CO

monitoring

Rinse

ARGUS LCM/PLUS

4.5.2 IBP calibration

• Calibration must be carried out before every application.

• Zero point calibration is automatically carried out when the pressure sensor cable is plugged in. However, it can also be initiated manually via the IBP setting screen.

• In order to avoid wrong results based on physiological zero-point drift of the used sensor, recalibrate the sensor every 24 hours.

Note

If the pressure sensor's position is moved after or during calibration, this might lead to wrong low or high values.

1. In accordance with the manufacturer's instructions, open the relevant valve(s) to equalise the system pressures as is shown in this example.

Sensor

LCM

Set three-way valve to atmospheric pressure.

Patient

2. Press the IBP alarm button. or NIBP alarm button with LCM version E.

3. Select Start IBP Calibration.

4. Confirm with enter.

4.6 CO

V Side stream waste products and the CO2 watertrap should be treated as hazard-

V To ensure that children and neonates have sufficient air to breathe, it is vital that

IBP Alarm On/Off

Connect zero mmHg

Start IBP calibration

End / Escape

monitoring

ous waste.

the "System > Patient" ("Adult", "Pediatric", "Neonatal") and the CO checked. The flow rate for CO

measurement must be 120 ml/min for children and

90 ml/min for neonates.

settings be

Page 30

4.7 Temperature monitoring

• Depending on the sensor type, the sensor can be applied to the ear, the skin or per rectum.

• The minimum measurement duration to achieve a measured value, independent of the measuring site, amounts to at least 2 minutes.

Art. no.: 2.510474 rev.: d

When the temperature is outside the measuring range, this is indicated by “<<“(15 below °C) or “>>” (above 45 °C). This limit is fixed.

ARGUS LCM/PLUS

Maintenance 5

Operating Instruction Maintenance interval 5.1

5 Maintenance

5.1 Maintenance interval

The software controlled devices have undergone a software risk analysis to minimise any hazards connected to software defects.

The regular system maintenance must include a software check according to the manufacturer's instructions. The test results must be recorded and compared to the values in the accompanying documents.

Maintenance work not described in this chapter, e.g. battery replacement, may only be accomplished by a qualified technician authorised by SCHILLER AG.

The following table indicates the intervals and responsibilities of the maintenance work required. Country specific regulations can prescribe additional or other intervals and examinations.

Interval Maintenance Responsible

•CO

Every two weeks

Every 6 months

Every 12 months

Every 24 months

zero point calibration

• Visual inspection of the unit and cables

• LED test (see section 3.1.1)

• Keys and alarm test (see section 5.1.1) two point calibration (see section 5.5.2)

•CO

• All services performed in six months' intervals

• Function inspections according to the instructions in the service

handbook

• NIBP calibration

• ECG calibration

• Safety test according to EN 60601-1 (1990), clauses 18 and 19

• All service work performed in six- and twelve-months' intervals

• All measurement inspections and calibration according to the instruc-

tions in the service handbook

(see section 5.5.1)

« User

« Service staff authorised by

SCHILLER AG

« Service staff authorised by

SCHILLER AG

5.1.1 Visual unit check

Defective units or damaged cables must be replaced immediately.

Visually inspect the unit and cables for the following damages:

« Device casing not deformed? « Sheathings of sensor, mains and potential equalisation cables undamaged? « Signal input sockets undamaged? « Type plate on the rear of the unit readable? « Keyboard and designation on the front of the unit readable?

Art. no.: 2.510474 rev.: d

5.1.2 Button test

Press all buttons and check if they work properly.

Page 31

5 Maintenance

5.2 Maintenance interval for the battery

Important

The battery is maintenance free during its normal life.

The battery should remain charged during storage. If the storage period exceeds three months, recharge the battery.

• During normal operation no maintenance necessary.

• If not used every 3 months. Replace the battery approx. every 4 years (depending upon application) if the actual

running time falls substantially under 30minutes.

5.2.1 Charging the battery

Important

A totally discharged battery requires approx. 5 hours to be 90% recharged.

It is possible to use the unit when the battery is being charged. However, when this is the case, the charging time of the battery will be substantially extended!

ARGUS LCM/PLUS

1. Connect the device to the mains but do not switch it on.

2. The LED for mains supply (1) is lit.

3. Charge the battery for at least 5 hours.

5.2.2 Battery disposal

V Danger of explosion! Battery may not be burned or disposed of domestic refuse. V Danger of acid burns! Do not open the battery.

The battery is to be disposed of in municipally approved areas or sent back to SCHILLER AG.

Page 32

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Maintenance 5

Operating Instruction Changing the fuse and mains voltage 5.3

5.3 Changing the fuse and mains voltage

V The mains voltage may only be changed by qualified personnel. V Before changing the fuse and mains voltage, disconnect the device from the

mains and remove the mains plug. See section 3.2.

V Ruptured fuses must only be replaced with the fuse types indicated in the below

table.

Fuse types

Voltage range Number Fuse types

220 - 240 VAC 2 250 V 200 mA (T) 100 - 115 VAC 2 115 V 315 mA (T)

Changing the fuse

1. Disconnect the device from the mains and remove the mains plug. See chapter

3.2.

2. Loosen the fuse using a screwdriver and remove it.

3. Replace both fuses (see "Fuse types" table).

4. Reinsert the fuse inset.

Changing the mains voltage

1. Disconnect the device from the mains and remove the mains plug. See section

3.2.

2. Loosen the fuse using a screwdriver and remove it.

3. Remove the grey inset, turn it by 180° and reinsert it.

4. Check the voltage indication in the window.

5. Replace both fuses (see "Fuse types" table).

6. Reinsert the fuse inset.

Fig. 5.1 Fuse inset

Art. no.: 2.510474 rev.: d

Page 33

5 Maintenance

5.4 Cleaning the device, cable and sensors

V Disconnect the device from the mains and remove the mains plug before clean-

ing. See section 3.2.

V Do not immerse the unit or the cable and sensors in liquid! V Do not use aggressive cleaners. V Reusable sensors must be treated as biologically dangerous material after usage

and sterilised according to the manufacturer's instructions.

V Observe the manufacturer's notes when cleaning the sensors and cables.

5.4.1 Cleaning the device, cables and sensors

1. Disconnect the device from the mains and remove the plug and sensors.

2. Wipe the equipment, cable and sensors with a dampened cloth and a mild cleaning solution. The manufacturer recommends using 70 % alcohol.

3. Dispose of single-use sensors and protective coverings according to the relevant regulations.

Notes regarding the cleaning of NIBP cuffs

The manufacturer recommends using 70% alcohol to clean the NIBP cuff and tube.

ARGUS LCM/PLUS

Notes regarding the cleaning of the SPO

The manufacturer recommends using 70% alcohol to clean the cable and sensor. Dry the sensor before reuse.

Notes regarding the cleaning of the ECG cable and electrodes

The cable can be wiped with a mild cleaning agent or with 70% alcohol. If required, sterilisation should be carried out with gas only (Alhydex or Vygon) but not with steam. Electrodes can be cleaned with soapy water after every use. Make sure that no water is left in the suction cups of suction electrodes.

sensor

Page 34

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Maintenance 5

Operating Instruction Zero and two point CO

5.5 Zero and two point CO2 calibration

•CO2 scrubber not more than one year old.

• Watertrap

• Calibration gas 10% CO

• Or calibration kit including above items and accessory Art.no. 2.100741

• Calibrate the sensor's zero point voltage at dry, clean air and at room temperature.

• Zero point calibration must be carried out every two weeks. A zero point calibration

is successful if the CO

• Two point calibration must be carried out every six months. A two point calibration

automatically includes zero-point calibration. A two point calibration is successful if the CO

value is 10% after one minute.

• The calibration date is saved by the LCM and displayed in the CO

When the calibration interval has elapsed, a message is displayed. To reduce the calibration time, you can change the respiration source to CO menu About+/Param. The pump starts as soon as the menu is closed.

Bal. N

value is in the range of 0.0% to 0.3%.

calibration 5.5

settings panel.

in the

5.5.1 Starting the zero point calibration

1. Connect the watertrap (1) to the CO

2. In the CO

screen, select Start zero point calibration and confirm with enter.

The pump is started.

3. Continue with enter. You are prompted to connect the CO

4. Connect the CO

scrubber (2) to the watertrap (1).

5. Press enter to continue. The pump must run five min. before the calibration is carried out automatically.

6. When the calibration is finished, a message is displayed. Finish the calibration by pressing enter.

socket.

scrubber.

5.5.2 Starting the two point calibration

1. Connect the watertrap (1) to the CO

2. In the CO

screen, select Start two point calibration and confirm with enter. The

pump is started.

3. Continue with enter. You are prompted to connect the CO

4. Connect the CO

scrubber (2) to the watertrap (1).

5. Press enter to continue. The pump must run five min. before the calibration is carried out automatically. When the zero point calibration is finished, you are prompted to connect the calibration gas.

6. Remove the CO2 scrubber and connect the calibration gas (3) to the watertrap (4) using a T-piece (5).

7. Open the valve of the gas bottle. An eCO the calibration is carried out.

8. When the calibration is finished, a message is displayed. Finish the calibration by

Art. no.: 2.510474 rev.: d

pressing enter.

socket. (See zero point calibration.)

scrubber.

value of about 10% is indicated, and

Page 35

5 Maintenance

5.6 Trouble shooting

ARGUS LCM/PLUS

5.6 Trouble shooting

Alarm Cause Remedy

ECG cable off • ECG cable disconnected « Connect the ECG cable. ECG lead off • Electrode lose/defective « Check and reapply/replace electrodes.

Low Perfusion • Bad sensor positioning « Check the sensor and reapply.

SpO

SpO2 Sensor off • Sensor off « Check the contact between the sensor and the patient.

SpO

no sensor • SpO2 sensor failed or disconnect-ed« Replace the sensor.

NIBP no module detect. • NO NIBP module detected « Switch device Off/On or replace device. NIBP error • NIBP module failed « Replace the device. NIBP no/off cuff • No cuff connected or insufficiently

fitted.

• Pump is not running

• Pump is running

• Pressure offset above 10 mm/Hg see page 14

NIBP signal low • Cuff not applied correctly

• Pulse too low for good measurement

• Tube too long for neonates

NIBP pressure range • Pressure min. 15 mm/Hg max.

310 mm/Hg below or above the limit

NIBP time too long • Pumping running time exceeded

(40 s for neonates, 60 s for adults)

CO2 No watertrap • Watertrap not connected

• Microswitch defective

module failure • CO2 module defective « Replace the device.

CO2 Communication • Communication interrupted « Replace the device.

Environment dist. • Temperature, or barometric pres-

sure of the CO

sensor outside

the range

• Pump damaged

• Air or vacuum source connected to the CO

input

CO2 Occlusion • Tube system clogged « Check the tube system and watertrap for occlusion.

Temp. Sensor off • Sensor removed. « Reconnect the sensor. Temp. out of range • Temperature out of range of 15

°C to 45 °C.

Temp. failed • Sensor failed « Replace the sensor. IBP no sensor • IBP sensor failed « Replace the sensor. IBP not calibrated • Zero point sensor too high/low

pressure higher then ± 30 mmHg or pressure variations.

« Check the cuff position.

« Pump is mechanical blocked (call service) « Pump not or wrong connected (call service) « Internal tubes off (call service) « Adjust the zero point of the NIBP module. Call service.

« Reposition/check the cuff.

« Use a tube for neonates (max. 1.5 m).

« Check cuff and connection.

« Check cuff and connection for leaks « Pressure approx. 50 mmHg when pump is running check

valve

« Internal tubings « Check the watertrap.

« Check the microswitch.

« Check the environmental conditions. (call service)

« Inspect the pump. « Inspect the connection.

« This limit is fixed. The display shows “<<“(15 below °C)

or “>>” (above 45 °C).

« Check tube system, sensor and ventil « Calibrate the sensor.

Table page 1 of 2

Art. no.: 2.510474 rev.: d

Page 36

Maintenance 5

ARGUS LCM/PLUS

Operating Instruction Trouble shooting 5.6

Alarm Cause Remedy

IBP Artefact • Loose sensor contact

• A manipulation at the sensor, such as rinsing, has caused variation peaks ± 150 mmHg

IBP wrong value • Constant pressure ( ± 30 mmHg)

during calibration

Paper insert • Paper finished « Insert new paper. Check paper • Paper jammed « Check the paper. Battery low • Battery capacity too low « Connect the device to the mains and recharge the bat-

Respiration curve field is not shown

Respiration curve is not displayed

No QRS sound • Setup QRS source « Set QRS source to SpO Pacemaker pulse is not dis-

played

• Pacemaker is On and respiration source is ECG

• HF ECG cable connected « Connect standard ECG cable

• The pacemaker impulse will be filtered by the HF protection in the ECG cable.

« Inspect the sensor and cable connection. « After rinsing, calibrate the sensor.

« Check tube system, sensor and ventil. Set the sensor to

ambient pressure

« Calibrate the sensor.

tery.

« Set respiration source to CO

« Connect standard ECG cable

or pacemaker to Off.

or ECG

Table page 2 of 2

5.6.1 Accessories and disposables

V Always use SCHILLER replacement parts and disposables, or products ap-

proved by SCHILLER. Failure to do so may endanger life and invalidate the guarantee.

Your local representative stocks all the disposables and accessories available for the Argus LCM. A full list of all SCHILLER representatives can be found on the SCHILLER website (www.schiller.ch). In case of difficulty, contact our head office in Switzerland. Our staff will be pleased to help process your order or to provide any details for all SCHILLER products.

Art. no.: 2.510474 rev.: d

Page 37

6 Technical Data

6.1 System data

ARGUS LCM/PLUS

6 Technical Data

6.1 System data

Manufacturer

Device type

Dimensions

Weight

Protection case

Power supply

Voltage Power consumption Battery operation Fuses Boardnet supply

Environmental conditions

Operating temperature Storage temperature Atmospheric pressure

Display

Resolution Dimension diagonal

SCHILLER AG

ARGUS LCM/PLUS monitoring system

290 x 275 x 180 mm (h x l x w)

4.6 kg

IP20

100 - 115 VAC or 220 - 240 VAC 50/60 Hz 28 VA Up to 1 hour, option with additional battery 2 hours 2 x 200 mA (T) at 250 VAC, 2 x 315 mA (T) at 115 VAC 11-30 VDC max. 2.5 A The unit is suitable for use in networks according to CISPR 11.

10 ºC .. 40 Cº relative humidity at 25-95% (noncondensing)

-10 ºC ... 50 Cº relative humidity at 25-95 % (noncondensing) 700 ... 1060 hPa

Colour TFT-LCD, backlit

SVGA 800 x 600 dots 27 cm, 10.4″

Printer

Resolution Paper Print speed Printout length Recording tracks

Battery

Battery type Recharging time Life

Connections

Interfaces

High resolution thermo-printer

8 dots/mm (amplitude-axis), 40 dots/mm (time-axis) at 25 mm/s, Thermoreactive, Z-folded, 72 mm width, length approx. 20 m 25 mm/s 10 second ECG records (equal 4 pages) 3-channel display, with optimal width of 72 mm, automatic baseline adjustment

Leakproof, rechargeable lead acid battery 90% full: Approx. 5 hours, 100% full: Approx. 15 hours Approx. 4 years

ECG patient cable, SpO

•RS-232

• Nurse call (alarm delay at the signal output component < 0.5 s)

Table 1 of 2

NIBP, CO

temperature, invasive pressure,

Art. no.: 2.510474 rev.: d

Page 38

ARGUS LCM/PLUS

Monitoring functions

Display Trend

Alarm limits

Technical Data 6

Operating Instruction System data 6.1

• All vital data numerical and/or graphical

• All vital data are stored for up to 24 h and can be displayed in tabular or graphical form in intervals of 1, 5, 15, 30, 60, 120 or 240 minutes.

• The upper and lower limits can be defined freely for all vital data (exception for temperature: only numerical display).

Safety standard

EMC

Additional requirements

Conformity

• IEC/EN 60601-1, protection class I, CF classified (with internal power supply)

• IEC/EN 60601-2-27

IEC/EN 60601-1-2

EN 1060-1 and 3 (non-invasive blood pressure recorders part 1)

CE according to directive 93/42/EEC class IIb

Art. no.: 2.510474 rev.: d

Page 39

6 Technical Data

6.2 Technical data - measured values

6.2.1 ECG

ARGUS LCM/PLUS

Leads

Patient cable

Heart rate

Lead display

Sensitivity

ECG amplifier

Sampling frequency Pacemaker detection HF calculation Line frequency filer

ECG baseline drift (LCM plus) Pacemaker

ECG Filters

Diagnostic (Hardware filter) Monitoring 1 (Hardware filter) Monitoring 2 (Hard & Software) Artefact (Hard- and Software) Mains filter

Simultaneous, synchronous recording of all 9 active electrodes giving 12 leads

3p-, 3-,5-, 10-lead cable

20 – 250 beats/min

Selection of 1 or 3 simultaneous leads

5/10/20/40 mm/mV programmable

1000 Hz ≥± 2 mV/≥0.1 ms 8 beats Distortion-free suppression of superimposed 50 or 60 Hz sinusoidal interferences by

means of adaptive digital filtering << 0.5 mV

Amplitude 1...2 mV, atrial and ventricular

High/low-pass: hp = 0.05 Hz, lp = 150 Hz for LCMplus and LCMbasic SN < 1000 High/low-pass: hp = 0.5 Hz, lp = 40 Hz for LCMbasic SN > 1000 Hardware see above, SW

Hardware see above, SW 50/60 Hz

= 0.6 Hz, SWlp = 35 Hz

= 2.4 Hz, SWlp = 20 Hz

Pacemaker detection

Amplitude Puls width

Measuring method

Sampling frequency

Measurement range

Calculation

Trigger point calculation

Impedance range

> 2 mV > 0.1 ms

6.2.2 Respiration

Impedance method with 3p-, 3-,5-, 10-lead cable

250 Hz

Apnea, respiration rate 0-200 inspirations/min

8 breats

32 s

0.1 - 3 Ohm

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ARGUS LCM/PLUS

Technical Data 6

Operating Instruction Technical data - measured values 6.2

6.2.3 Temperature

Sensor

Measurement interval

Measurement range

Resolution

Minimum measurement duration

Measurement

Measuring method

Measurement range

Accuracy

Max. mean error Max. standard deviation

Deflation rate

YSI 401, rectal, skin or ear

1x per second

15 °C to 45 °C

0.1 °C

2 min until a measured value is achieved

6.2.4 NIBP - non-invasive blood pressure

Automatic or manual

Oscillometric

15 to 300 mmHg

± 5 mmHg ± 8 mmHg

3 to 9 mmHg

6.2.5 IBP - invasive blood pressure

Measurement range

Sampling rate

Accuracy

Calibration

Pulse calculation

Art. no.: 2.510474 rev.: d

-20 ... 300 mmHg

500 Hz

• 1 mmHg at 0...100 mmHg or

• ±1% at 100...300 mmHg

• other sensors may cause lower accuracy

Manual

8 beats

Page 41

6 Technical Data

6.2 Technical data - measured values

6.2.6 SpO2 - pulsoximetry

ARGUS LCM/PLUS

Amplifier

Operation

Sampling rate

Accuracy

Calibrated range

Measurement range

Displayed range

PP calculation

Measuring method

Displayed range

Masimo™ MS-3, MS-7, NELL-1

Normal and sensitive

62.5 Hz

SpO

• Adults 70 to 100% ± 2 digits

• Neonates 70 to 100% ± 3 digits

• 30 ... 199/min ± 4 digits

70 ... 100% (calibraton is fixed, no calibration required)

SpO21 ... 100% PP 25 ... 240/min

1 ... 100%

8 s

6.2.7 etCO

Side stream

0 ... 99 mmHg

- capnography

Suction rate

Accuracy

Respiration rate

Environmental pressure compensation

90/120/200 ml/min

± 3 mmHg at 0 ... 40 mmHg ± 8 mmHg at 41 ... 76 mmHg ± 10 mmHg at 77 ... 99 mmHg

0 ... 99 inspirations/min

Automatic when the unit is switched on and when the watertrap is inserted.

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Page 42

Appendix 7

ARGUS LCM/PLUS

Operating Instruction Settings menu 7.1

7Appendix

7.1 Settings menu

7.1.1 Main menu

Bold marked values are factory settings.

Main menu Parameter Values

ECG Display sensitivity 5/10/20/40 mm/mV

ECG - Filter

QRS beep source Off/ ECG/ SpO

Pacemaker Off /On (If pacemaker on, it is no RRi measuring possible) RRi Alarm On /Off Cable mode Automatic /3-/5-/10-or 3p electrodes Mains filter Off/ 50 or 60 Hz

NIBP Initial pressure Adult 180, pediatric 150, neonatal 120 mmHg (0..300)

Autom. measuring Off/ On Interval time 2/3/5/10/15/ 30/60 min Deflation speed 5 (3..9) SpO2 suppression Off/ On

IBP Scale 0..300/200/100/50/30/Auto

Start IBP Calibration Function

System Patient Adult/Pediatric/Neonatal

About Device info see section 7.7.2

Art. no.: 2.510474 rev.: d

a. Diagnostic (Hardware filter): High/low-pass: hp = 0.05 Hz, lp = 150 Hz for LCMplus and LCMbasic SN < 1000

Monitoring 1 (Hardware filter): High/low-pass: hp = 0.5 Hz, lp = 40 Hz for LCMbasic SN > 1000 Monitoring 2 (Hard & Software):Hardware see above, SW

Artefact (Hard- and Software): Hardware see above, SW

Flow Rate 200/120/90 ml/min (See chapter 7.4 for more details)

O2-Compensation Off/ On (Off = O2 ≤ 60% / On = O2 > 60%)

O Compensation Off/ On (Off = 0% N2 O /On = ≥ 12%)

Desflurane compensation Off/ On (On = Desflurane ≥ 12%) Steam compensation Off/ On BTPS compensation Off/ On Zero point cal. date ddmmjj Two point cal. date ddmmjj Start zero Point Calibration Function Start two-Point Calibration Function

Date ddmmjj Time hhmm

Diagnostic/ Monitoring 1 / Monitoring 2 / Artefact

= 0.6 Hz, SWlp = 35 Hz

= 2.4 Hz, SWlp = 20 Hz

Page 43

7 Appendix

7.1 Settings menu

ARGUS LCM/PLUS

7.1.2 Special menu “About+”

V Only authorised personnel trained in the operation of this device are allowed to

do the setups in this menu.

The extended menu About+ is displayed by pressing the following button combination:

Press ; select About; press and then

Main menu extended Parameter Value

About+ Alarm Alarm stop mode On/Off

Alarm suppr. time 2 min (2 ... 10) Alarm sound DIN EN 475/Standard Nurse call Immediately/in 5 sec. Alarm restriction (see page 22 ) On/Off

Param Lead II

Lead speed 12.5/25/50 mm/s

Respiration source

Respiration speed 6.25/12.5 mm/s

Pulse

SpO

SpO2 sensitivity

NIBP adult Initial 180 NIBP pediatric Initial. 150 NIBP neonatal Initial 120 NIBP MAP On Temperature unit °C /°F CO2 mmHg/kPA/Vol%

Trend View time 1, 5, 15, 30, 60, 120, 240 min

Device Language

Software Save as default

Restore defaults

Factory defaults

Service

Program update For service only

a. When the set respiration source is ECG and the pacemaker is on, respiration measurement via the ECG is not possible. The respi-

ration wave field is not displayed in this case.

b. The Russian language requires a separate software.

ECG/CO

4/8 or 16 s

Low /High

English/Deutsch/

Français/Svenska/American/Ital-

iano/Español/Portuges/Norge With this function, changed values can be perma-

nently saved. (See section 3.4.2.) With this function, the saved default values can be re-

stored. (See section 3.4.2.) Restores the SCHILLER factory settings. The display

language is changed to German. (See section 3.4.3.). For service only

NIBP update or ECG electrode test.

Art. no.: 2.510474 rev.: d

Page 44

ARGUS LCM/PLUS

Appendix 7

Operating Instruction Factory settings 7.2

7.2 Factory settings

These values can be loaded from the menu About+/Software. See chapter 7.1.2.

Parameter Abbrev. Unit Type Limit Step Alarm

Adult Child Neonat

Prio.

Heart rate HR min High 80...220 5 Low 140 180 200

min Low 15...100 5 50 70 90 Asystole s 2...20 1 High 2 2 2 Respiration RR min High 25...120 5 Low 35 35 60

min Low 1...20 5 6 12 20 Apnea s 15...45 1 Low 20 15 10 NIBP SYS mmHg High 80...300 5 Low 180 180 80

mmHg Low 10...150 5 100 100 50

DIA mmHg High 30...120 5 Low 95 95 45

mmHg Low 0...80 5 40 40 30

MEAN mmHg High 0...200 5 Low 140 140 45

mmHg Low 0...100 5 70 70 30

Pulse min High 80...220 5 Low 140 180 200

min Low 15...100 5 50 70 90

Pulsoximetry

SpO

% High 80...101 1 High 101 101 98

% Low 70...99 1 90 89 88

PP min High 80...220 5 Low 140 180 200

min Low 15...100 5 50 70 90

Capnography

eC0

Vol% High 4.5...10 0.1 Low 6.0 6.0 6.0

Vol% Low 0...6.0 0.1 4.5 4.5 4.5

Vol% High 0.1...1.5 0.1 Low 0.2 0.2 0.2

Vol% Low 0...1 0.1 0 0 0

eCO

kPa High 4.5...10 0.1 Low 6.0 6.0 6.0

kPa Low 0...6.0 0.1 4.5 4.5 4.5

kPa High 0.1...1.5 0.1 Low 0.2 0.2 0.2

kPa Low 0...1 0.1 0 0 0

eCO

mmHg High 35....76.0 0.5 Low 45.0 45.0 45.0

mmHg Low 0...45.0 0.5 35.0 35.0 35.0

mmHg High 1...10.0 0.5 Low 1.5 1.5 1.5

mmHg Low 0...8.0 0.5 0 0 0 IBP Ps mmHg High 0...300 1 Low 180 180 180

mmHg Low -20...150 1 95 95 95

Pm mmHg High 0...200 1 Low 100 100 100

mmHg Low -20...150 1 50 40 40

Art. no.: 2.510474 rev.: d

Pd mmHg High 0...120 1 Low 100 100 100

mmHg Low -20...80 1 40 40 40 T

°C or °F No alarm No settings - - - - -

Page 45

7 Appendix

)

1 2 3 4 5

)

1 2 3 4 5

)

7.3 Connecting the ECG patient cable

ARGUS LCM/PLUS

Important

The guidelines for patient electrode placement are provided as an overview only. They are not a substitute for medical expertise.

RRi

An RRi monitoring with HF-ECG cable against high frequncy signals is not possible. The used HF-signal for the RRi measuring will be filtered by the HF protection in the ECG cable.

Pacemaker monitoring with HF-ECG cable

Pacemaker monitoring with HF-ECG cable against high frequncy signals is not possible. The used pacemaker impulse will be filtered by the HF protection in the ECG cable.

V Danger of destroying the device during defibrillation! The device is only type CF

protected if the original SCHILLER patient cables are used.

7.3.1 3-leads cable for children and neonates

Red (R)

Black (N)

Yellow (L)

Red (R)

7.3.2 3-lead cable for respiration

Red (R

Black (N

1 2 3 4 5

Yellow (L)

7.3.3 3-lead cable for adults

Yellow (L)

Black (N

Page 46

Red (R

Black (N

1 2 3 4 5

Yellow (L)

see note

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ARGUS LCM/PLUS

Appendix 7

Operating Instruction Connecting the ECG patient cable 7.3

Note

When the signal amplitude is < 0.5 mV, place the yellow electrode according the following picture instead to adjust the resolution to 40 mm/V. Because of that the artefacts can be reduzed.The signal amplitude is influenced by the electrical heart axis.

Art. no.: 2.510474 rev.: d

Page 47

7 Appendix

)

7.3 Connecting the ECG patient cable

7.3.4 3p-lead cable

ARGUS LCM/PLUS

The ARGUS LCM BASIC Serial number > 1000 with the microprocessor MK19-11 has a new ECG amplifier (3p). It is now possible to display 6 leads with a 3p-lead cable. The 3p-lead cable is marked with an black connector housing instead of green. This works only with software 1.24 and higher.

Red (RA

Yellow (LA)

Green (LL

7.3.5 Three- and five-lead cables for adults and children

Red (R)

Black (N)

The colours shown here are according to code 1 (European) requirements. In paragraph 7.3.7, you can find a table with the colour codes of the American Heart Association (AHA).

Yellow (L)

white

Green (F

Page 48

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

1 2 3 4 5

Appendix 7

Operating Instruction Connecting the ECG patient cable 7.3

7.3.6 10-lead ECG patient cable

The following illustration indicates the placement locations for the electrodes of a ten-lead patient cable.

Yellow (L)

White/Green C3

Red (R)

White/red C1

White/Yellow C2

Black (N)

1 2 3 4 5

White/Braun C4

White/Black C5

White/Violet C6

Green (F)

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7 Appendix

7.3 Connecting the ECG patient cable

ARGUS LCM/PLUS

7.3.7 Electrodes identification and colour code IEC/AHA

The electrode placements shown in this handbook are labelled with the colours according to code 1 requirements. The equivalent code 2 colours are given below.

CODE 1 (usually European) CODE 2 (usually American)

System Electrode identifier Colour code Electrode identifier Colour code

R Red RA white

Limb L Yellow LA Black

F Green LL Red CwhiteVBrown

C1 White/red V1 Brown/red Chest C2 White/yellow V2 Brown/yellow according C3 White/green V3 Brown/green to Wilson C4 White/brown V4 Brown/blue

C5 White/black V5 Brown/orange

C6 White/violet V6 Brown/violet Neutral N Black RL Green

Page 50

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Operating Instruction CO

7.4 CO2 settings

7.4.1 Description of CO2 parameters

Parameter Setup Description Flow rate

O2-Compensation

O-Compensation

Desflurane

Comp.

Steam

Compensation

BTPS compensation

200/120/90 ml/min

Off/On

On/Off

To ensure that children and neonates have sufficient air to breathe, it is vital that the "System > Patient" ("Adult", "Pediatric", "Neonatal") and the CO

tings be checked. The flow rate for CO children and 90 ml/min for neonates.

Correction factor for O2 = 1.03

Additional oxygen O the sensor. This leads to too low results when the CO rection is activated when the O

Correction factor for N2O (laughing gas) = factor 0.952

Additional N ence the IR absorption directly but reduces the CO energy. The CO

Correction factor for desflurane = 0.952, as for N2O.

The compensation is activated when the desflurane concentration is greater than 12%. However, it has the same effect as N

Steam affects the IR absorption by CO ed mathematically.

The compensation is activated during normal side-stream measurement. During control loop measurement, e.g. CO

tion is deactivated.

Body temperature, ambient pressure, saturated with steam.

Appendix 7

settings 7.4

set-

measurement must be 120 ml/min for

in the CO2 gas mixture reduces the IR absorption in

is measured. The cor-

values are greater than 60%.

O increases the IR absorption. However, N2O does not influ-

molecule's absorption

molecule can therefore absorb more energy (IR radiation).

O compensation.

molecules. Its influence is calculat-

in the incubator, the compensa-

On/Off

This factor compensates differences regarding humidity saturation in inspired and expired air. This compensation is used for side-stream measurement, as the device assumes 100% humidity and a temperature of 37 °C for expired air.

7.4.2 Compensation settings

O2<-Compensation

Off Off Off

On Off Off

Off On Off

Off Off On Desflurane greater than 12%

On On Off

Art. no.: 2.510474 rev.: d

N2<O-Compensation

Desflurane Comp.

Condition

less than 60%, no N2 O or

25% N

O and 75% O

O2 grater than 60%, no N2O

O greater than 12%

greater than 60%, N2O greater than

12%

Page 51

7 Appendix

7.4 CO

settings

7.4.3 Combination of N2O and O2 compensation

As the influence on N2O is greater than on O2, the influences can cancel each other out in a gas mixture of 25% N be deactivated. The overall correction when both compensations are active is 0.99.

O and 75% O2. In that case, both compensations can

7.4.4 Environmental pressure compensation

The environmental pressure is automatically compensated when the unit is switched on or the watertrap is connected.

ARGUS LCM/PLUS

Page 52

Art. no.: 2.510474 rev.: d

ARGUS LCM/PLUS

Index 8

Operating Instruction

8 Index

A32 Accessories and Disposables37 Alarm

Alarm limit setting Alarm suppr. time22 Default settings for alarm limits19

Calibration date35

Display

3 Leads

Battery operation14 Language18 Loudness14 Normal21 Patient type14

Entering alarm OFF password22

Factory defaults18 Fuse types33

Save as default18

Two point calibration35

Zero point calibration35

Initial settings18

Language18 Language setup18 Loudness of audible alarm and QRS sound20

Maintenance interval31

NIBP

Switch between auto and manual

Alarms, not confirmed Trend table21

Printing alarm limits20

Art. no.: 2.510474 rev.: d

Restore defaults18

Page 53

8 Index

ARGUS LCM/PLUS

Page 54

Art. no.: 2.510474 rev.: d

Schiller Argus LCM User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

1 Safety notes

1.1 Responsibility of the user

1.2 Intended use

1.3 Organisational measures

1.4 Safety-conscious operation

1.5 Safety facilities

1.6 Operation with other devices

1.7 Maintenance

1.8 Safety symbols and pictograms

1.8.1 Symbols used in this user guide

1.8.2 Symbols used on the device

1.9 Additional terms

1.9.1 Implied authorisation

1.9.2 Terms of Warranty

2 Introduction

2.1 Version overview

2.1.1 ARGUS LCM (basic) from serial number 781.000-781.999

2.1.2 ARGUS LCM (basic) from serial number 781.1000 and higher

2.1.3 ARGUS LCM PLUS (from 780.001and higher)

2.2 Functional overview

2.2.1 Buttons of the Argus LCM PLUS

2.2.2 Description of buttons

2.2.3 Description of display

3Operation

3.1 Start-up

3.1.1 Connecting and power on

3.1.2 Battery operation

3.2 Switching off and disconnecting from mains

3.1.3 Operation with external dc voltage

3.2.1 Interruption of the mains supply

3.3 Inserting printing paper

3.4 Initial settings

3.4.1 Selecting the language

3.4.2 Saving and restoring default values

3.4.3 Load factory defaults

3.4.4 Alarm limit setting

3.4.5 Setting loudness of audible alarm and QRS sound

3.5 Trend or alarm display

3.6 Display of additional leads

3.7 Procedure in case of an alarm

3.7.1 Display of alarms

3.7.2 Switching off an alarm

3.7.3 Suppressing/acknowledging an audible alarm

3.7.4 Preventive alarm suppression

3.7.5 Overview of physiological alarms

4 Start monitoring

4.1 Connecting the cables for monitoring

4.2 ECG monitoring

4.2.1 RRi monitoring with HF-ECG cable

4.2.2 Pacemaker monitoring

4.2.3 Pacemaker monitoring with HF-ECG cable

4.3 NIBP monitoring

4.4 SPO2 monitoring

4.5 IBP monitoring

4.5.1 Preparing IBP measurement

4.5.2 IBP calibration

4.7 Temperature monitoring

5 Maintenance

5.1 Maintenance interval

5.1.1 Visual unit check

5.1.2 Button test

5.2 Maintenance interval for the battery

5.2.1 Charging the battery

5.2.2 Battery disposal

5.3 Changing the fuse and mains voltage

5.4 Cleaning the device, cable and sensors

5.4.1 Cleaning the device, cables and sensors

5.5 Zero and two point CO2 calibration

5.5.1 Starting the zero point calibration

5.5.2 Starting the two point calibration

5.6 Trouble shooting

5.6.1 Accessories and disposables

6 Technical Data

6.1 System data

6.2 Technical data - measured values

6.2.1 ECG