Schiller AT-1 User Manual

AT-1

Art.-no.: 2.510171 rev.: g *2.510171*

3-Channel Electrocardiograph

3-Kanal-Elektrokardiograph Electrocardiographe à 3 canaux

User Guide

Gebrauchsanweisung

Mode d’emploi

	AT-1	ENGLISH
		DEUTSCH
	Electrocardiographe à 3 canaux
	3-Channel Electrocardiograph
	3-Kanal-Elektrokardiograph

FRANÇAIS

AT-1 User Guide - English

AT-1Gebrauchsanweisung -Deutsch

Mode d'emploi pour l’AT-1 - Français

Article Number	2.510171g
a Sept. 1995, b Jun. 1999, c Feb. 2000, d		Feb. 2001, e Jan. 2002
f Aug. 2004, g	Nov. 2005
Associated Document
Guide to the SCHILLER Interpretation and Measurement Program E/ D/ F			Article Number 2.510179

SCHILLER AG

Altgasse 68

CH - 6341 Baar, Switzerland

Phone: ++ 41 41 766 42 42

Fax: ++ 41 41 761 08 80

www.schiller.ch

Where to Obtain Service and Sales Advice Kundendienst und Verkaufs-/Beratungsstellen

Coordonnées de nos services d’assistance technique et commerciale

The SCHILLER sales and service centre network is worldwide. 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

SCHILLER besitzt ein weltweites Netz von Kundendienst-, Verkaufsund Beratungsstellen. Fragen Sie bei der nächsten SCHILLERNiederlassung nach Ihrer lokalen Vertretung. Eine vollständige Liste aller Vertreter und Niederlassungen finden Sie auf unserer Internet-Site:

http://www.schiller.ch

SCHILLER entretient un réseau international composé de services clients, de services commerciaux et d’agences de conseil. Pour obtenir les coordonnées de votre représentant local, veuillez vous adresser à la filiale SCHILLER la plus proche de votre domicile. Vous trouverez une liste complète de tou(te)s les représentants et filiales sur notre

http://www.schiller.ch

ENGLISH

DEUTSCH

FRANÇAIS

ENGLISH

AT-1

Operating Instructions

English

i

Important Information	iv
Safety Information	vii
Short Form Instructions	1
Introduction	3
Modes of Operation	4
Automatic Mode	4
a. without external printer connected or printer switched off	4
b. with external printer connected and switched on	4
Modes of Operation	5
Manual Mode	5
Automatic Mode	6
a. without external printer connected or printer switched off	6
b. with external printer	7
Manual Mode	8
Location & Power	10
Switching On and Off	11
Keyboard	13
Settings	14
Default Settings	17
Language	18
Filters	19
Baseline Filter	19

ii

Mains Filter	20
Myogram Filter	21
Defining Lead Sequence & Printout	22
Acoustic QRS Indication	24
Time / Date	24
Automatic Mode (ECG) Settings, Internal Printer	26
Automatic Mode (ECG) Settings, External Printer	30
Automatic Mode (ECG) Settings	34
Service Printout	36
Installing Software Options	38
Patient Cable Connections	39
Settings in Automatic Mode	41
Patient Data Field	41
Measurements	42
Heart Rate (HR)	42
Intervals	42
Electrical Axes	43
Care & Maintenance	48
Replacing the Recording Paper	50
Thermal Paper Handling	52
Trouble Shooting	53
Technical Data	55

ENGLISH

iii

Important Information

Disposal Instructions

and Battery Care

Battery Care and Disposal Instructions

°DO NOT DISPOSE OF THE BATTERY BY FIRE OR INCINERATOR - DANGER OF EXPLOSION

°DO NOT ATTEMPT TO RECHARGE THE BATTERY - DANGER OF EXPLOSION

°DO NOT OPEN THE BATTERY CASING - DANGER OF ACID BURN

Only dispose of the battery in official recycling centres or municipally approved areas. Alternatively, used batteries can be returned to SCHILLER AG for disposal.

Unit Disposal Instructions

Units no longer required can be returned to SCHILLER AG for disposal. Alternatively dispose of the unit in municipally approved recycling centres.

This equipment has been tested and found to comply with the limits for a class A digital device, pursuant to both Part 15 of the FCC (Federal Communications Commission) Rules and the radio interference regulations of the Canadian Department of Communications. These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with this instruction manual, may cause harmful interference to radio communications. Operation of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense.

iv

Important Information

Power Supply

The mains connection is on the rear of the unit.

The power supply voltage is set by the factory for 100-115V (nom. 110V) or 220-240V (nom. 230V) working. The setting is indicated by the indented metal strip on the fuse panel. Contact your dealer if the voltage needs to be changed.

The mains indicator lamp on the keyboard is always lit when the unit is connected to the mains supply. The unit can either be operated from the mains supply or from the built-in rechargeable battery.

Changing a Mains Fuse

If it is necessary to change a fuse, always replace with the correct rating i.e. 2x200mAT for 230V, or 2x315mAT for 110V.

To change a fuse press the two retaining lugs on the side of the fuse panel (situated below the mains connector on the back panel). Remove the fuse panel and replace the fuse(s). Click back the fuse panel.

ENGLISH

v

Important Information

Terms of Warranty

The SCHILLER AT-1 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 unauthorized or unqualified persons attempt to make repairs.

In case of a defect, contact your dealer or 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 authorized by him, and

*the AT-1 and approved attached equipment are used

in accordance with the manufacturers 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.

About this Handbook

The philosophy of SCHILLER is one of continuous improvement. Our aim is to provide the user with the most up-to-date information and the latest technological developments.

Your suggestions and comments are welcome on all SCHILLER documentation. Please contact the SCHILLER Technical Documentation Department.

PHYSICIAN‘S RESPONSIBILITY

THE AT-1 ELECTROCARDIOGRAPH IS PROVIDED FOR THE EXCLUSIVE USE OF QUALIFIED PHYSICIANS OR PERSONNEL UNDER THEIR DIRECT SUPERVISION. THE NUMERICAL AND GRAPHICAL RESULTS FROM A RECORDING MUST BE EXAMINED WITH RESPECT TO THE PATIENTS OVERALL CLINICAL CONDITION. THE RECORDING PREPARATION QUALITY AND THE GENERAL RECORDED DATA QUALITY, WHICH COULD EFFECT THE REPORT DATA ACCURACY, MUST ALSO BE TAKEN INTO ACCOUNT.

IT IS THE PHYSICIANS RESPONSIBILITY TO MAKE THE DIAGNOSIS OR TO OBTAIN EXPERT OPINION ON THE RESULTS, AND TO INSTITUTE CORRECT TREATMENT IF INDICATED.

FEDERAL LAW IN THE USA RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN

NOTES

vi

Safety Information

DO NOT USE SOLVENT CLEANERS.

THIS UNIT COMPLIES WITH EMC REGULATIONS FOR MEDICAL PRODUCTS WHICH AFFORDS PROTECTION AGAINST EMISSIONS AND ELECTRICAL INTERFERENCE. HOWEVER SPECIAL CARE MUST BE EXERCISED WHEN THE UNIT IS USED WITH HIGH FREQUENCY EQUIPMENT.

BEFORE USING THE UNIT, ENSURE THAT AN INTRODUCTION REGARDING THE UNIT FUNCTIONS AND THE SAFETY PRECAUTIONS HAS BEEN PROVIDED BY A PRODUCT REPRESENTATIVE.

CAUTIONS

SWITCH THE UNIT OFF BEFORE CLEANING AND DISCONNECT FROM THE MAINS.

THE DEVICE MUST ONLY BE OPERATED USING BATTERY POWER IF THE EARTH CONNECTION IS SUSPECT OR IF THE MAINS LEAD IS DAMAGED OR SUSPECTED OF BEING DAMAGED.

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.

IT MUST BE ENSURED THAT NEITHER THE PATIENT NOR THE ELECTRODES (INCLUDING THE NEUTRAL ELECTRODE) COME INTO CONTACT WITH OTHER PERSONS OR CONDUCTING OBJECTS (EVEN IF THESE ARE EARTHED).

THERE IS NO DANGER WHEN USING THE ECG UNIT FOR A PACEMAKER PATIENT OR WITH SIMULTANEOUS USE OF OTHER ELECTRICAL STIMULATION EQUIPMENT. HOWEVER, THE STIMULATION UNITS SHOULD ONLY BE USED AT A SUFFICIENT DISTANCE FROM THE ELECTRODES. IN CASE OF DOUBT, THE PATIENT SHOULD BE DISCONNECTED FROM THE RECORDER.

IF SEVERAL UNITS ARE COUPLED THERE IS A DANGER OF SUMMATION OF LEAKAGE CURRENTS. WHEN OPERATING SEVERAL DEVICES FOR MEDICAL AND NON-MEDICAL APPLICATION DO NOT USE ANY EXTENSION CABLES OR DISTRIBUTION BOXES FOR THE CONNECTION.

EARTH MUST BE CONNECTED WHEN THE EXTERNAL PRINTER IS USED.

ENGLISH

vii

Safety Information

WARNINGS

TO PREVENT ELECTRIC SHOCK DO NOT DISASSEMBLE THE UNIT. NO SERVICEABLE PARTS INSIDE. REFER SERVICING TO QUALIFIED PERSONNEL ONLY.

DO NOT USE THIS UNIT IN AREAS WHERE THERE IS ANY DANGER OF EXPLOSION OR THE PRESENCE OF FLAMMABLE GASES SUCH AS ANAESTHETIC AGENTS.

THIS PRODUCT IS NOT DESIGNED FOR STERILE USE.

THIS PRODUCT IS NOT DESIGNED FOR OUTDOOR USE.

DO NOT, UNDER ANY CIRCUMSTANCES, IMMERSE THE UNIT OR CABLE ASSEMBLIES IN LIQUID.

DO NOT USE HIGH TEMPERATURE STERILISATION PROCESSES (SUCH AS AUTOCLAVING). DO NOT USE E-BEAM OR GAMMA RADIATION STERILISATION.

THIS UNIT IS CF CLASSIFIED ACCORDING TO IEC EN 60601-1. THIS MEANS THAT THE PATIENT CONNECTION IS FULLY ISOLATED AND DEFIBRILLATION PROTECTED. SCHILLER CAN ONLY GUARANTEE PROTECTION AGAINST DEFIBRILLATION VOLTAGE HOWEVER, WHEN THE ORIGINAL SCHILLER PATIENT CABLE IS USED.

DO NOT TOUCH THE CASING DURING DEFIBRILLATION.

IF THE PATIENT CABLE SHOULD BECOME DEFECTIVE AFTER DEFIBRILLATION, LEAD OFF WILL BE DISPLAYED AND AN ACOUSTIC ALARM GIVEN.

viii

AT-1

Short Form Instructions

Automatic ECG Recording with external printer connected and switched on:

Prepare skin, hook up patient.

Switch unit on, press ON

Press AUTO to record and print externally

with external printer NOT connected or switched off:

To record and print on internal printer: Prepare skin, hook up patient.

For AUTO Format 1 press

For Auto Format 2 press and then

Press COPY for additional copies.

Manual ECG Recording (internal printer only)

Prepare skin, hook up patient.

	Switch unit on, press ON	ENGLISH
	Press MAN START
	Change lead group with

Press STOP to stop the printout.

Electrode hook-up check

Press for print-out of electrode dc offsets.

Best results are obtained when the electrode voltage readings (right column) are between +50mV and -50mV.

Filter On/Off

Press to switch the (Myogram) filter On / Off.

System Configuration

Press to print system settings.

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AT-1 User Guide Art. No. 2.510171 g

Introduction

2

	Introduction		ENGLISH
	NOTE:	The only difference between AT-1 and AT-1 smartprint is that AT-1
		smartprint has a connector for an external ink-jet printer, which
		makes it possible to generate printouts in A4 size.

The ECG unit is a 3-channel ECG recorder with all (12) ECG signals simultaneously processed to provide instant ECG recordings. Three automatic recording modes - two for the internal printer and one for the external printer - can be individually preset to enable one button ECG recording of preferred print formats.

Individual lamps are provided to give power, paper error, filter, lead group and lead off indications. In addition, any detected disturbance (i.e. loose electrode or end of paper), gives an audible alarm and the corresponding indicator lamp flashes.

The ECG unit includes the following features:

•Low weight and compact dimensions

•Printout from integrated quality thermal printer - OR - from external A4 inkjet printer

•Built-in rechargeable battery for mains-independent use - 2 hours normal use on one battery charge

•Simple one key operation for main functions

•Automatic or manual recording modes

•Selectable printing formats - external and internal printer

•Choice of 10 languages (AT-1) and 9 languages (AT-1 smartprint) for printing.

•Interpretation program option (including measurements) for children and adults

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AT-1 User Guide Art. No. 2.510171 g

Modes of Operation

Automatic Mode

a.without external printer connected or printer switched off

Automatic Mode provides a printout giving 10 seconds of ECG recording of all 12 leads with a choice of 2 different formats (only for S version).

The following can be programmed freely for each of the 2 formats before recording:

•Lead Format

•Chart Speed

•With the optional interpretation program installed it is also possible to select the measurement table, average cycles with optional markings and interpretation statements for the printout.

For further information see paragraph `Automatic Mode (ECG) Settings` on page 26.

b. with external printer connected and switched on

Only one Automatic Mode format possible. Other details as above.

For further information see paragraph `Automatic Mode (ECG) Settings` on page 30.

4

	Modes of Operation	ENGLISH
	Manual Mode
	Manual Mode provides a real-time printout of 3 selected leads and is only possible on the
	internal thermal printer.
	The following can be freely selected before or during recording:

•Lead Group

•Chart Speed

•Sensitivity

•Myogram Filter

For further information see paragraph `Manual Mode` on page 8.

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AT-1 User Guide Art. No. 2.510171 g

Automatic Mode

a.without external printer connected or printer switched off

In automatic mode, a full 12-lead ECG is printed in one of two predefined formats with selectable sensitivity. These formats (see Settings) are selected by the user to suit his specific needs and requirements.

When the AUTO GAIN key is pressed before recording in automatic mode, the unit detects very large waveform amplitudes and sets the sensitivity for the extremity and/or precordial leads accordingly to reduce the overlapping of traces.

To start the automatic ECG recording in Format 1, press the AUTO START key:

To start the automatic recording in Format 2, press the ALT key followed by the AUTO START key:

+

Depending upon which option is included, the printout gives the following:

•ECG recording of all leads in either Standard or Cabrera format according to selection

•Sensitivity

•Heart Rate

6

Automatic Mode

	•	Speed	ENGLISH
	•	Filter Settings
	• Interpretation statements (with option C)
	• Average Cycles (with options M, C)
	• Intervals (with options M, C)
	• Axes (with options M, C)
	• Detailed Measurement Table (with options M, C)

To obtain an extra printout of the ECG recording in Format 1, simply press the COPY key: To obtain an extra printout of the second format, press the ALT key followed by the COPY key:

-

Note:

The Auto mode settings for the two formats are detailed in the paragraph entitled

'Automatic Mode (ECG) Settings` on page 26. b. with external printer

With the external printer connected and switched on, only one Auto Mode format (selectable) is available.

To start the automatic ECG recording in Automatic Mode, press the AUTO START key:

For further information see paragraph `Automatic Mode (ECG) Settings` on page 30.

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AT-1 User Guide Art. No. 2.510171 g

Manual Mode

Manual mode provides a real-time ECG printout of 3 selected leads with full control of parameter selection. This is only possible on the internal thermal printer.

To start the manual recording of a real-time ECG, press the MAN START Printout key

To stop the manual recording (printout) press the STOP key

The printout provides you with the following:

•Three (selected) leads with lead identification.

•On the lower edge, the chart speed and filter settings (if on).

•At the top, the heart rate as current average of 4 beats, trace sensitivity.

The following can be freely chosen during or before the recording:

Lead Group	by means of the LEAD FORWARD
	and LEAD BACKWARD key

8

	Manual Mode				ENGLISH
	The following lead groups are selectable:
	•	I, II, III	aVR, aVL, aVF
		(Cabrera: aVL, I, -aVR / II, aVF, III)
	•	V1, V2, V3	/	V4, V5, V6
	Chart Speed		Select speed 5, 25 or 50 mm/s by means of the SPEED keys:

Sensitivity	Select 5, 10 or 20 mm/mV by means of the SENSITIVITY keys:
Myogram Filter	Switch the filter ON or OFF with the FILTER key:
	25 Hz or 35 Hz is displayed on the bottom line of the printout when the filter is
	switched on.
Recentering	To re-centre the ECG traces, press the 1mV key

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AT-1 User Guide Art. No. 2.510171 g

Location & Power

Location

Do not keep or operate the apparatus in a wet, moist, or dusty environment. Also, avoid exposure to direct sunlight or heat from other sources. Do not allow the unit to come into contact with acidic vapours or liquids, as such contact may cause irreparable damage. The unit should not be placed near X-ray or diathermy units, large transformers or motors. The unit must be placed on a flat surface and must not be operated in areas where there is any danger of explosion.

Power Supply

The mains connection is on the rear of the unit. The mains indicator lamp on the keyboard is always lit when the unit is connected to the mains supply. The unit can either be operated from the mains supply or from the built-in rechargeable battery. The power source is indicated by the respective indicator lamp. When battery capacity is limited, the battery symbol flashes on and off.

To recharge the battery, connect the apparatus to the mains supply by means of the supplied power cable. A totally discharged battery needs less than 15 hours to be fully recharged (60% in less than 3 hours, 90% in less than 7 hours). A fully charged battery gives approximately 2 hours of normal use. The unit can remain connected to the mains supply without any danger of damage to either the battery or the unit.

10

	Switching On and Off	ENGLISH
	The AT-1 is switched on with the green ON key
	and off by means of the red OFF key

The unit is automatically switched off after 5 minutes (30 seconds if battery capacity is limited) if no key is pressed and the patient cable is not connected.

Potential Equalisation

If the AT-1 is used in conjunction with other patient connected equipment, we recommend that the potential equalisation stud on the rear of the unit is connected to the building common ground with the yellow/green ground cable (Part-no. 2.310005). When working from an emergency vehicle, the vehicle common ground can be used.

WARNING !

THE UNIT MUST BE GROUNDED WHEN THE EXTERNAL PRINTER IS CONNECTED.

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AT-1 User Guide Art. No. 2.510171 g

Keyboard

12

Keyboard

ENGLISH

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AT-1 User Guide Art. No. 2.510171 g

Settings

Each parameter is set by means of a code. This code comprises a combination of keys starting with the ALT key followed by two or three numbers. The setting is confirmed with the STOP key. As soon as the ALT key is pressed, the keyboard is dedicated to the programming function.

Note:	The Alternative (ALT) function is only active for 4 seconds. If a programming key is
	not pressed within 4 seconds, the unit reverts to standard mode. The ALT key must
	again be pressed to activate the programming mode.

The setting is remembered and the keyboard released for other functions when the STOP key is pressed. Once a setting has been confirmed, it is stored in the memory even when the unit is switched off.

Example

If you want to set the language on your ECG unit to English, the key sequence given in the table (see page 18), is

ALT - 0 - 2 - 2 - STOP.

On the following pages the programmable parameters and the programming sequences are described in detail.

14

Settings (cont.)	ENGLISH
ALT - 0 - 1 - any number
The defined formats and settings for your unit can be checked as follows:

A printout of the defined settings will be produced and gives the following information, depending on the installed software.

Unit designation	Software version, Software option installed (C = Interpretation)
	and interpretation version
Serial number	Serial number of the unit

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AT-1 User Guide Art. No. 2.510171 g

Settings (cont.)

Leads		Standard (S) or Cabrera (C)
ECG Format		Long (ooo), Short (o) or Suppressed (-)
M ECG		Average cycles as defined in auto ECG recording setup (e.g. 4 *
		3 (25 mm/s) + 2)
Measurements		Enabled (+) or Suppressed (-)
Marks		Enabled (+) or Suppressed (-)
Interpretation		Enabled (+) or Suppressed (-)
Selected Rhythm leads		Leads selected for R1 and R2
Automatic Centering		Enabled (+) or Suppressed (-)
Paper type		Z-folded
Printout	of signals	Sequential or Simultaneous
Baseline	Filter	0.05, 0.15 or 0.30 Hz
Mains Filter		50, 60 Hz or OFF (-)
Myogram Filter		25 or 35 Hz, ON (+) or OFF (-)
Interpretation settings:		N/A:+/-	‘normal/abnormal’ is written (+) or suppressed (-)
		U:+/-	‘unconfirmed report’ is written (+) or suppressed (-)
		A30:+/-	patient age is assumed to be < 30 (-) or >30 (+)
		S: +/-	low (-) or high (+) sensitivity

16