Welch Allyn Atlas Service manual

Patient Monitor
Service Manual
Operator’s Manual
NOTICE
The information in this document is subject to change without notice.
Welch Allyn makes no warranty of any kind on this material, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Welch Allyn shall not be liable for errors contained herein or for incidental or consequential damages concerning the furnishing, performance, or use of this material.
This document contains proprietary information that is protected by copyright. All rights are reserved. No part of this document may be photocopied, reproduced or translated to another language without prior written consent of Welch Allyn.
Before using this instrument, read this guide and become thoroughly familiar with the contents.
Welch Allyn only considers itself responsible for any effects on safety, reliability and performance of the equipment if: 1 assembly operations, extensions, re-adjustments, modifications or repairs are done by persons
authorized by Welch Allyn, and 2 the electrical installation of the relevant room complies with the IEC or national requirements, and 3 the instrument is used according to the instructions for use presented in this manual.
WARNING
Welch Allyn assumes no liability for failures resulting from RF interference between Welch Allyn medical electronics and any radio frequency device at levels exceeding those established by applicable standards.
The use of accessories other than those recommended by Welch Allyn may compromise product performance.
United States Federal law restricts this device to sale by or on the order of a licensed health care practitioner.

Table Of Contents

1 HOW THIS MANUAL WORKS......................................................................................................................1
1.1 A Q
UICK TOUR OF THE WELCH ALLYN ATLAS MONITOR
................................................................................2
2 MONITORING THE PATIENT ......................................................................................................................4
2.1 M
ONITORING BLOOD PRESSURE
......................................................................................................................6
2.1.1 MAP (Mean Arterial Pressure)..............................................................................................................9
2.2 M
2.3 M
2.4 M
2.5 M
1.6 M
ONITORING SP ONITORING HEART RATE AND THE ONITORING IMPEDANCE RESPIRATION (MODELS ONITORING TEMPERATURE (MODELS ONITORING
CO2, R
ULSE RATE AND THE SP
O2, P
ECG W
ESPIRATION RATE, AND THE
AVEFORM
O2 W
AVEFORM
622
XX
622
& 623XX) .............................................................................25
ETCO
.......................................................................14
................................................................................18
XX
& 623XX)............................................................23
WAVEFORM (MODEL
2
623XX) ..............................27
3 MANAGING THE ALARMS .........................................................................................................................29
3.1 P
ATIENT ALARMS
..........................................................................................................................................33
3.1.1 Factory Default Patient Alarm Settings...............................................................................................34
3.2 M
3.3 I
3.4 B
EASUREMENT INVALID ALARMS
NSTRUMENT PROBLEM ALARMS
ATTERY ALARMS (MODELS
622
.................................................................................................................35
...................................................................................................................36
XX
& 623XX).............................................................................................37
4 CAPTURING AND DISPLAYING TREND DATA.....................................................................................39
5 USING PRINT AND WAVEFORM FREEZE..............................................................................................41
5.1 T
HE PRINTER
OADING PAPER AND TROUBLESHOOTING
– L
............................................................................43
6 CONNECTING TO THE PATIENT .............................................................................................................45
6.1 C
6.2 C
6.3 C
6.4 C
1.5 C
ONNECTING THE ONNECTING THE SP ONNECTING THE ONNECTING THE TEMPERATURE PROBE (MODELS ONNECTING THE END TIDAL
NIBP C
ECG E
UFF
.......................................................................................................................47
FINGERCLIP SENSOR
O
2
LECTRODES
SAMPLE TUBE (MODEL
CO
2
.................................................................................................51
............................................................................................................53
XX
622
& 623XX)...........................................................57
623XX) ..............................................................58
7 USING THE MENUS ......................................................................................................................................59
HE SET DATE AND TIME AND
7.1 T
HE ADVANCED CONFIGURATION MENU
7.2 T
THER OPTIONS
O
ENU
M
.................................................................................59
.......................................................................................................61
7.2.1 Advanced Configuration Menu Settings ..............................................................................................63
8 CLEANING AND MAINTAINING THE ATLAS MONITOR...................................................................65
9 UNPACKING AND INSTALLING THE ATLAS MONITOR ...................................................................67
10 APPENDIX A: TECHNICAL SPECIFICATIONS FOR THE ATLAS MONITOR ................................69
11 APPENDIX B: ELECTROMAGNETIC COMPATIBILITY (EMC) ........................................................77
12 APPENDIX C: CALIBRATION AND MAINTENANCE ...........................................................................81
13 APPENDIX D: ACCESSORIES FOR THE WELCH ALLYN ATLAS MONITOR................................82
14 APPENDIX E: TROUBLESHOOTING........................................................................................................85
15 INDEX.............................................................................................................................................................100

Safety Information

The Welch Allyn Atlas Monitor is intended for use in a hospital or clinical environment. It should not be used at home or in emergency transport vehicles. Monitor users should be skilled at the level of a technician, nurse, doctor or medical specialist.
The function of the Welch Allyn Atlas Monitor is to register ECG, CO Noninvasive Blood Pressure (Systolic, Diastolic, and Mean Arterial Pressure), Pulse Oximetry, Respiration Rate and Temperature for adult and pediatric patients (over the age of 3 years), in all hospital or clinic facilities.
To ensure patient electrical isolation, the Atlas Monitor should only be connected to other equipment that provides patient electrical isolation. When connecting the Welch Allyn Atlas Monitor to any instrument, verify proper operation before clinical use. Accessory equipment connected to the monitor’s serial data interface must be certified according to IEC Standard 950 for data-processing equipment or IEC Standard 601-1 for electromedical equipment. All combinations of equipment must be in compliance with IEC Standard 601-2 systems requirements. Anyone who connects additional equipment to the signal input / output port is configuring a medical system and is therefore responsible that the system comply with the requirements of IEC Standard 601. If in doubt, consult the Welch Allyn Technical Service Department.
The Welch Allyn Atlas Monitor and its accessories should be tested by qualified service personnel at regular intervals to verify proper operation, according to the procedures of the users institution. A Service Manual is available from the manufacturer. Other important safety information is located throughout this manual where appropriate.
concentration, Heart Rate,
2

Warnings, Cautions, and Notes

All operating personnel should be familiarized with the general safety information in this summary. Specific warnings and cautions will also be found throughout the operators manual. Such specific warnings and cautions may not appear here in this summary.
Conforms to IEC 60601-1 UL 2601-1 CAN/CSA C22.2 No 601-1
C US Approved to Australia AS 3200.1, Appendix Z
Defibrillator-proof, Type CF Applied Part
Attention, consult accompanying document
Handle with care
Storage temperature. Refer to technical specification for more details.
Lead Acid Battery. For disposal see the Maintenance section of this manual.
Storage humidity. Refer to technical specification for more details.
Warning
Caution – Tells you about something that could damage the monitor.
Note – Tells you other important information.
– Tells you about something that could hurt the patient or hurt the operator.
Warnings
The Welch Allyn Atlas Monitor is designed for use by medical clinicians. Although this manual may
illustrate medical monitoring techniques, this system should only be used by a trained clinician who knows how to take and interpret a patient’s vital signs.
Do not operate this product in the presence of flammable anesthetics. Explosion may result.
WARNING – PACEMAKER PATIENTS. Rate meters may continue to count the pacemaker rate
during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms. Keep pacemaker patients under close surveillance. See this manual for disclosure of the pacemaker pulse rejection capability of this instrument.
This device must be used in conjunction with clinical signs and symptoms. This device is only
intended to be an adjunct in patient assessment. Certain arrhythmias or pacemaker signals could adversely affect heart rate indications or alarms.
During defibrillation, keep the discharge paddles away from ECG and other electrodes, as well as
other conductive components in contact with the patient. Avoid contact with any accessories connected to the Welch Allyn Atlas Monitor’s panel.
Prolonged use or the patient’s condition may require changing the SpO
Change sensor site and check skin integrity, circulatory status, and correct alignment at least every 4 hours.
When monitoring blood pressure over an extended period of time, or at frequent intervals, it is
recommended to check the cuff site and cuffed extremity regularly for possible ischemia, purpura and/or neuropathy.
Thoracic impedance respiration measurement may interfere with some pacemakers. Refer to the
pacemaker’s manual.
To ensure patient safety, the conductive parts of the ECG electrodes (including associated
connectors) and other patient-applied parts, should not contact other conductive parts, including earth ground, at any time.
The safety and effectiveness of this product in the detection of apnea, particularly for infants and
neonates, has not been established.
This equipment must not be connected to any other equipment that is not compliant with EN60601-1,
or a possibility exists that combined leakage currents could exceed safe limits.
WARNING: Use of accessories, transducers, and cables other than those specified may result in
degraded electromagnetic compatibility performance of this device.
Do not operate this product with MRI (Magnetic Resonance Imaging) equipment.
It is the operator’s responsibility to set alarm limits as appropriate for each individual patient.
Any Atlas Monitor which has been dropped or damaged should be checked by qualified service
personnel to insure proper operation prior to use.
There are no user serviceable parts inside the Atlas Monitor other than paper replacement and
battery replacement.
Blood pressure measurements may not be accurate for patients experiencing moderate to severe
arrhythmias.
This Atlas Monitor should not be used on patients who are linked to heart / lung machines.
If the integrity of the external protective conductor in the installation or its arrangements is in doubt,
equipment shall be operated from its internal power source (models 622xx and 623xx).
If an electrosurgical unit is used, place the ECG cable and wires as far as possible from the site of
the surgery and from the electrosurgical cables. This will minimize interference and the risk of burns to the patient. Ensure that the electrosurgical return cable (neutral) is well attached and making good contact with the patient.
sensor site periodically.
2
End tidal carbon dioxide (ETCO
ONLY when the second trace option is set to CO ETCO or ECG) the CO
and breath rate waveforms and data to another second trace selection (SpO2, Respiration
2
and breath rate monitoring and alarm capability will be disabled. This occurs
2
) and breath rate measurement and alarm capability are active
2
. Should the operator change from viewing the
2
even if the watertrap and cannula are still inserted into the Monitor.
Impedance Respiration rate measurement and alarm capability are active ONLY when the second
trace option is set to Respiration. Should the operator change from viewing the Respiration waveforms and breath rate to another selection (SpO
, CO2 or ECG) the Respiration rate
2
monitoring and alarm capability will be disabled. This occurs even if the ECG cable is still inserted into the Monitor.
Cautions
Place the Welch Allyn Atlas Monitor and accessories in locations where they cannot harm the patient
if they fall off a shelf or mount.
Never place fluids on top of this monitor. In case of fluid spilling on the monitor, disconnect power
cord, wipe clean immediately and have the monitor serviced to ensure that no hazard exists.
This Welch Allyn Atlas Monitor should not be stacked directly on top of other equipment, and other
equipment should not be stacked on top of this Welch Allyn Atlas Monitor. If stacking is necessary, observe the Welch Allyn Atlas Monitor to verify normal operation in the stacked configuration in which it will be used.
Unplug the external power cord from the monitor before cleaning or disinfecting the monitor.
Do not autoclave, subject to ethylene oxide sterilization, or immerse the Welch Allyn Atlas Monitor in
liquid. Sterilize accessories only according to the manufacturers instructions.
Make frequent electrical and visual checks on cables and electrode wires.
Ensure the AC rating for the device is correct for the AC voltage at your installation site before using
the monitor. The AC rating is shown on the back of the instrument. If the rating is not correct, do not use the monitor, and contact the Welch Allyn Technical Service Department for help.
Line isolation monitor transients may resemble actual cardiac waveforms and thus inhibit heart rate
alarms. Use care in placement of ECG electrodes and routing of cables to avoid interference and noise.
Electrode polarization: the type of electrode used can affect the recovery time from overload,
especially defibrillation. Electrodes of dissimilar metals should not be used.
If the accuracy of any measurement is in question, check the patients vital sign(s) by an alternate
method and then check the Atlas Monitor for proper functioning.
Extremity and cuff motion should be minimized during blood pressure determinations.
The pulse oximeter is calibrated to determine the percentage of arterial oxygen saturation of
functional hemoglobin. Significant levels of dysfunctional hemoglobins such as carboxyhemoglobin or methemoglobin may affect the accuracy of the measurement.
Grounding reliability can only be achieved when equipment is connected to an equivalent receptacle
marked Hospital Only” or “Hospital Grade”.
Notes
Sidestream waste material and the CO2 watertrap should be treated as biohazard material.
Blood pressure measurements determined with this device are equivalent to those obtained by a
trained observer using the cuff/stethoscope auscultation method, within the limits prescribed by the
vii
American National Standard, Electronic or automated sphygmomanometers (SP 10).
Blood Pressure measurements can be affected by the position of the patient, by the patient’s
physiological condition, and other factors.
The Blood Pressure system and Temperature system may not meet specifications if operated or stored
at conditions outside the stated ranges, or subjected to excessive shock or dropping.
The Blood Pressure system is compliant with requirements of EN 1060-3:1995 Specification for Non-
invasive sphygmomanometers.
The Atlas Monitor is designed with protective circuitry and current isolation that eliminates any risk
to the patient from possible software errors.
Product Warranty Information
Welch Allyn warrants the Welch Allyn Atlas Monitor, when new, to be free of defects in material and workmanship and to perform in accordance with manufacturers specifications for a period of two years from the date of purchase from Welch Allyn or its authorized distributors or agents. (Pulse oximetry sensors and temperature probes are warranteed for one year). Welch Allyn will either repair or replace any components found to be defective or at variance from the manufacturers specifications within this time at no cost to the customer. It shall be the purchasers responsibility to return the instrument to Welch Allyn or an authorized distributor, agent, or service representative. This warranty does not include breakage or failure due to tampering, misuse, neglect, accidents, modification or shipping. This warranty is also void if the instrument is not used in accordance with manufacturers recommendations or if repaired by other than Welch Allyn or an authorized agent. Purchase date determines warranty requirements. No other express warranty is given.
Return the Instrument Registration Card
Remember to submit the instrument registration card for warranty validation. Complete the information and mail the pre-addressed card to Welch Allyn. You may also register on-line at <http://www/welchallyn.com/medical/support/warranty
>.
Service Information: Service Policy
All service and repairs must be performed by authorized Welch Allyn personnel or agents, using approved Welch Allyn replacement parts and approved process materials. Failure to do so will invalidate the product warranty. Please refer to the product warranty for specific coverage.
Service Information: Technical Assistance
If you have an equipment problem that you cannot resolve, call the Welch Allyn Service Center nearest you for assistance. Technical service support is available to you by telephone on normal business days at the phone numbers listed below.
viii
If you are advised to return a product to Welch Allyn for service or repair, schedule the repair with the service center nearest you.
Before returning a product for repair you must obtain authorization from Welch Allyn. An RMA (Return Materials Authorization) number will be given to you by our service personnel. Be sure to note this number on the outside of your shipping box. Returns without an RMA number will not be accepted.
ix

Service Information

For Technical Support or to obtain return instructions, please contact your nearest Welch Allyn service center listed below:
Welch Allyn, Inc. 4341 State Street Road Skaneateles Falls, NY 13153-0220 Phone: 1-800-535-6663 Fax: 315-685-4653
Welch Allyn, Ltd. - Canada 160 Matheson Blvd. E., Unit #3 Mississauga, Canada L4Z 1V4 Phone: 905-890-0004 Fax: 905-890-0008
Welch Allyn, Ltd. - UK Aston Abbots, Buckinghamshire England HP22 4ND Phone: 011-44-1296-689905 Fax: 011-44-1296-682104
Welch Allyn, GmbH - Germany Zollerstrasse 2-4 D72417 Jungingen, Germany Phone: 011-49-7477-9271-73 Fax: 011-49-7477-9271-93
Welch Allyn, Ltd. - Singapore 6001 Beach Road #21-09 Golden Mile Tower Singapore 199589 Phone: 011-65-291-0882 Fax: 011-65-291-5780
Welch Allyn, Ltd. - Australia PO Box 864 Ground Floor, 18-20 Orion Road Lane Cove, NSW 2066, Australia Phone: 011-61-294-183-155 Fax: 011-61-294-183-650
CLINICAL SUPPORT
For clinical questions about Atlas Monitor call the Welch Allyn Clinical Support line at 800-769-4014 Extension 3225 or 315-685-4100 Extension 3225.
x
The CE Mark on this product indicates it has been tested to and conforms with the provisions noted with the 93/42/EEC Medical Device Directive.
European contact for regulatory compliance:
European Regulator Manager Welch Allyn LTD. Navan, Co, Meath Republic of Ireland Phone 353-46-79060 Fax: 353-46-27128
Service Information: Service Manual / Spare Parts
A service manual is available by request to qualified electronics personnel. The service manual is a comprehensive guide to troubleshooting, service and repair of the Welch Allyn Atlas Monitor.
A complete spare parts price list is available upon request. Spare parts may be ordered from your local Welch Allyn Service Center.
Service Information: Service Loaners
Service loaners are provided, on request, when repair service is provided by a Welch Allyn Service Center. Loaners for products repaired while under the original warranty, or while under extended warranty or service contract, are provided free of charge and are shipped within 48 hours of notification of need. Shipment charges to the user are paid by Welch Allyn.
For service repairs outside of warranty or contract, loaners will be available for a nominal charge and will be shipped subject to availability. Loaners will be shipped pre-paid.
xi

1 How This Manual Works

This manual is arranged so that everything about one topic is found in a single section. The statement immediately below the chapter title (like this one) appears in italics and presents the important points of the topic. Most topics include an illustration or a table. The chapters are numbered so that logically connected topics begin with the same number-- for example 2.1 and 2.2.
The Welch Allyn Atlas Monitor and this manual are designed for ease of use. Everything you need to know about a specific operation of the monitor is available in one place. This means you can see all the required information at a glance.
Redundancy - There is some redundancy in this manual; some step-by-step procedures are repeated in many places wherever they are pertinent. We did this so you would not have to search through other pages to find what you need to know right now.
For instance, setting an alarm limit is fully explained in the section on blood pressure, again in the section on SpO places.
Paragraphs - The statement in italics immediately below the chapter heading describes what the section is about. Sometimes just reading this and looking at the illustrations
, and in several other
2
will give you enough information.
Section Numbers - The double numbered pages indicate the relationship between the main subject and closely related topics.
The sections are organized so that what you want to know first is put first. Like most medical professionals who use the Atlas Monitor, you are probably very adept at taking blood pressure and connecting ECG leads to patients, so the section on how the Atlas Monitor is used for monitoring patients and what you need to know to operate the monitor comes first. We put the information on connecting blood pressure cuffs and ECG leads in a later section.
This manual is not meant for reading straight through, like a book, although you can read it that way. If you read it like this, the built-in redundancy may become a little tedious. When you read a paragraph or a step-by-step procedure with which you are already familiar, just skip it. It is there for the person who is doing the activity for the first time.
1.1 A Quick Tour of the Welch Allyn Atlas Monitor
When you turn on the power, the monitor starts with preset or default alarm levels. Waveforms are displayed on the screen. Readings are displayed on the screen and on LEDs. You can perform the most common operations set and silence alarms, display trend data, print waveforms and trend data from the front panel without using a menu. This section gives only a brief overview of the monitor; later sections present all the details.
AC~
Which model do you have? The Welch Allyn Atlas Monitor is a single, portable unit providing all the measurement capability normally needed to monitor patients under anesthesia, patients recovering from surgery, and patients who require bedside monitoring. The model number is encoded into the first three digits of the serial number on the back of the unit. There are three models:
Model
621SO 621SP
Features
SpO2, SpO2 waveform Pulse Rate NIBP: Systolic, Diastolic, MAP ECG waveform, heart rate
Printer (optional) 622SO 622SP 622NO 622NP
All features of model 621xx,
plus:
Impedance Respiration
Patient Temperature
Battery Operation
A lit means the unit is being powered by the wall outlet, and that the battery is being charged (models 622xx and 623xx).
Silencing Alarms - You can silence any alarm for 90 seconds by pressing the large blue button on the right-hand edge of the instrument. Silenced alarms continue to flash, as long as the measurement is outside the alarm limits.
You can suspend an individual alarm by pressing its buttons, each controlling a different group of measurements. The audible alarm is suspended as long as the red LED in the button is lit. When an alarm is suspended, the audible alarm will not sound, but readings will still flash when the measurement is outside the limits.
Note: Individual alarms can be suspended for only PC Communication Remote Nurse Call Printer (optional)
623SP 623NP
Power on - The the lower right corner. When you first turn on the monitor:
all alarms are enabled, but no alarm will sound until after a valid measurement value is received.
all alarm limits are set at their default values.
all the trend data (history) is cleared.
All features of model 622xx, plus: End Tidal CO from ETCO
and Breath Rate
2
2
Printer (standard)
Power On/Standby
button is in
Trend Data - Trend data is captured every time blood pressure is measured, whether this event is automatic or manual. Trend data is also automatically captured every 15 minutes if blood pressure intervals are longer, or blood pressure is not used. Push the data. Scroll through the trend data with either button. Push waveform display. The monitor will hold up to 144 lines of trend data, which is 36 hours if data is captured every 15 minutes.
indicator, located below the screen,
ALARM Off
button. There are four
Silence
ALARM Off
3 minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the individual
ALARMS Off buttons will suspend the alarm
until you remove the suspension.
Trend
button to see the trend
Set
Trend
again to return to the
Printing - A printer option is available with both models 621xx and 622xx, and is a standard model
Print
623xx feature. Push the
button to print what
is on the screen. If the waveforms are displayed
Print
on the screen, the
button prints 15 seconds of waveforms plus all the current measurements. The printout captures data from 9 seconds before
Print button was pressed until 6 seconds after.
the If trend data is displayed on the screen,
Print
prints all the trend data.
If your model of the Atlas Monitor does not have the optional printer, the
Freeze, and it freezes, or halts, the waveform
Print button is labeled
display for 10 seconds to permit studying of the waveform.

2 Monitoring the Patient

The patients vital measurements are displayed as numeric readings and as waveforms. You can set the measurement limit alarm levels, silence the alarms for a short period, and suspend individual alarms. You can print waveforms and current measurements, or print all the stored trend data.
The front panel has two sides:
The left side displays waveforms, numeric readings, and trend data on a CRT screen.
The right side has measurements displayed in green and red LEDs.
Each side responds to the adjacent
Select and Set
buttons used for setting alarm limits. Each side also has
ALARM Off buttons, which are used to
suspend (turn off) individual alarms.
Note: Individual alarms can be suspended for only
3 minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the individual
ALARMS Off buttons will suspend the alarm
until you remove the suspension.
Note: The temperature measurement does not
have an alarm.
Setting alarm limits - Press the
Select
button to choose which alarm limit you want to set. Each time you press the Select button, it cycles to the
HI
next alarm, shown by small
and LO indicators,
and the measurement display flashes the current
Set
alarm setting. The
button changes this alarm limit. Press the top or bottom of the button to change the limit up or down.
Note: the flashing alarm setting mode only lasts
10 seconds before reverting back to the normal measurement mode. If you take too long to set
Select
a limit, youll need to press the
button
and start over again.
Press the
Select button to go to the next
measurement alarm. Press it several times to cycle out of all the alarm settings and go back to the
normal measurement mode.
Silencing alarms - The
Silence button silences
all alarms for 60, 90 or 120 seconds. This silence period can be set to one of these three choices in Advanced Configuration. During the silence period, there will be no audible alarms, even for measurements that go outside the limit range for the first time. However, any measurement that is outside the limits you set will flash.
Trend data - Press the
Trend
button to see the trend data. The waveform display is replaced by the first screen of trend data, starting with the most recent measurements at the top. View the rest of the trend data by pressing the
Set button up
or down.
The trend memory can hold up to 144 lines of measurements, which is 36 hours of data if taken at 15 minute intervals.
Printing - The
Print
button prints what you see on the screen - the waveforms (including all current measurements) or the screen with trend data. When you push the button, waveforms are printed starting from 9 seconds before you pushed
Print
the
button until 6 seconds after you pushed the button for a total printout of 15 seconds. The other information on the printout is captured at the
Print
time that the
button is pressed.
Freeze
the button is labeled
– If your monitor does not have a printer,
Freeze. Pressing Freeze
stops the waveform display for 10 seconds, and then the readout resumes.
12
Trend
RR
Lead Select Print
70
23%
2
ALARMS
Off
TEMP
Systolic
HI
Diastolic
LO
(mmHg)
(mmHg)
BP ALARMS
F
C
HI
LO
HI
LO
Off
Alarm Suspend Buttons
Silence
PULSE
(bpm)
HR ALARMS
Off
SpO2%
2
/ RESP
CO
ALARMS
Off
SpO
AC
Power
TEMP
Systolic
Diastolic
LO
(mmHg)
(mmHg)
BP ALARMS
F
C
HI
LO
HI
LO
NIBP Sp02
CO2
mmHg
3:50 70 122/89(--) 92 38 14/min 98.6 3:40 69 120/84(--) 95 38 12/min 95.4 3:30 70 119/88(--) 92 33 10/min 98.6 3:20 70 120/82(--) 95 36 12/min 96.2 3:10 74 128/86(--) 97 40 16/min 98.7 3:00 72 122/85(--) 90 38 12/min 95.6 2:50 70 120/86(--) 98 33 14/min 98.6 2:40 66 118/80(--) 95 38 10/min 98.6 2:30 67 120/78(--) 96 37 12/min 97.5 2:20 70 120/80(--) 95 38 12/min 98.6 2:10 68 121/85(--) 94 35 10/min 97.6
Trend
RR
Print
Trend Print
PULSE
(bpm)
F
SpO2%
Set
Top – Model 623xx showing waveform display and alarm controls
Bottom – Model 623xx showing trend display and associated
controls
2.1 Monitoring Blood Pressure
Blood pressure can be measured at timed intervals which you set, or you can start the blood pressure measuring cycle manually. Systolic and Diastolic readings are shown on the LEDs at the upper right of the monitor. You can set the high and low alarm limits for both the systolic and diastolic measurements.
Blood pressure cycles - You can measure NIBP at timed intervals or manually. To set a timed interval, press the
Auto
button to cycle through the available intervals: X, 1, 3, 5, 10, 15, 30, or 60 minutes. Wait until the number for the selected interval stops flashing; the measurement will automatically begin 20 seconds later.
Note: The interval is timed from the start of one
BP cycle to the start of the next cycle.
Pressing the button one more time after the 60 is lit will return the
Auto timing to the Off mode
(indicated by an X). In this mode, automatic measurement at timed intervals will not occur. Initially, both blood pressure displays will be blank.
Stopping a blood pressure cycle - The
Start/Cancel
button does one of two things:
BP
If a blood pressure measurement is not in
progress, pressing
BP Start/Cancel will
start a blood pressure measurement cycle,
Auto
whether the
timer is set to a specific
interval or is off.
If a blood pressure measurement is in
progress, pressing
BP Start/Cancel
will deflate the cuff immediately and cancel the measurement. If the Auto
button is in one of the timed modes, the cuff will inflate again after the selected number of minutes.
Note: Canceling a blood pressure cycle does not
end automatic BP timing. If the Auto is set to any number, the next blood pressure cycle will start again after that number of minutes have elapsed.
Alarms - When any of the blood pressure limits are exceeded, an audible alarm sounds and the affected measurement flashes. You can silence this alarm, and all alarms, by pressing the large blue
Silence
button at the right side of the instrument. This will silence all alarms for 60, 90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outside the set limits will flash.
To suspend the blood pressure alarms, press the
BP ALARMS Off button so the red LED in the
button lights. A suspended alarm will still flash if it goes outside the range of the limits, but it will not sound the audible alarm.
Note: The blood pressure alarm can be
suspended for only 3 minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the
BP ALARMS Off
button will suspend the alarm until you remove the suspension.
Trend data – Trend data is captured at each blood pressure cycle, whether it is started
Auto
automatically or manually. If the
timing of NIBP is off (X), or greater than 15, then trend data is captured every 15 minutes.
Initial pressure – The initial cuff pressure can be set in the Advanced Configuration. The Atlas Monitor will pump up to the selected initial cuff pressure. If this pressure is too low to measure the systolic pulse, the system will repeatedly increase pressure by 40 mmHg and measure again.
PG 2-5
Off
CO2 / RESP
ALARMS
Off
Select
Set
Lead Select Print
Trend
Blood
Pressure
Connector
Atlas Monitor showing NIBP displays, controls and tubing
connector
Setting alarm limits - To set the Systolic and Diastolic alarm limits, use the buttons on the right side of the monitor to follow these steps:
Select
Press the LO, then Systolic HI and
SpO
2
Diastolic
Each push of
button to cycle through
HI
and LO.
Select
limit. Stop at the limit you want to set. The measurement and the flash, indicating which limit is being changed.
Press the
Set button up or down to raise or
lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).
Select
LO
and
, and
Set
moves you to the next
HI
or LO LED will
AC
Select
Set
Select
Press the
button again to go to the next limit, or press it several times until none of the measurements flash and no
LO
LEDs are lit. The instrument is now in its normal measurement mode. (If you do not press any button for 10 seconds, the instrument will automatically revert to its normal measurement mode).
Note: If the language setting is configured to Chinese and the alternate BP field to kPa, the blood pressure will be displayed in kPa on the screen, but the Systolic and Diastolic readings on the right side of the monitor will be displayed in mmHg. When setting the alarm limits, the
LO
and
alarm limits will be displayed in mmHg
HI
or
HI
7
on the right side of the monitor and in kPa on the screen.
8
2.1.1 MAP (Mean Arterial Pressure)
Mean Arterial Pressure is calculated from the systolic and diastolic measurements. MAP may be optionally displayed by selecting it on the Advanced Configuration menu. MAP is displayed in the upper left corner of the screen.
MAP - (Mean Arterial Pressure) display can be turned on and off by using the Advanced Configuration menu. When MAP is shown, you will see it in the upper left corner of the screen, above the ECG waveform.
To display (or turn off) MAP, enter the Advanced Configuration menu:
Press the
Press the
Use the left
Date/Time button. Trend button.
Select
button to highlight
MAP.
Set
Press the left
Press the
Trend
to choose Yes or No.”
button again to exit
Advanced Configuration.
If MAP is displayed on the screen, it will also appear in the trend data and in the current readings of a waveform printout.
Alarms - When either of the MAP limits are exceeded, an audible alarm sounds and the affected measurement flashes. You can silence this alarm, and all alarms, by pressing the large blue
Silence
button at the right side of the instru­ment. This will silence all alarms for 60, 90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outside the set limits will flash.
To suspend the MAP alarm, press the
ALARMS Off
button so the red LED in the button
BP
lights. A suspended alarm will still flash if it goes outside the range of the limits, but it will not sound the audible alarm.
Note: The BP alarm can be suspended for only 3
minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the
ALARMS Off
button will suspend the alarm
BP
until you remove the suspension.
Note: MAP is calculated mathematically from the
Systolic and Diastolic pressures; it is not measured directly.
Setting alarm limits If MAP is displayed, you can set the alarm limits, using the
Select
Set
and buttons on the left side of the monitor to follow these steps:
Press the left Select button to cycle through MAP
LO
, Respiration HI and
or 623xx)
LO
.
HI
, then (model 623xx) CO2 HI and
and
LO
, Heart Rate
LO
(models 622xx
HI
and
Each push of Select moves you to the next limit. Stop at the limit you want to set. The measurement and
HI or LO will flash,
indicating which limit is being changed.
Press the Set button up or down to raise or lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).
Press the Select button again to go to the next limit, or press it several times until
HI
none of the measurements flash and no
LO
indicators are lit. The instrument is
or now in its normal measurement mode. (If you do not press any button for 10 seconds, the instrument will automatically revert to its normal measurement mode).
9
Map
MAP 96
Trend
Lead Select Print
Blood
Pressure
Connector
70
AC
HR ALARMS
Select
CO
Off
2
/ RESP
ALARMS
Off
BP ALARMS
Set
SetSelect
Blood
Pressure
Alarm Off
Off
Atlas Monitor waveform display showing location of MAP reading
Silence
10
2.1.2 Alternate BP Field Settings
configured to Chinese)
(only available if language setting
Mean Arterial Pressure or blood pressure in kPa can be displayed by selecting it on the Advanced Configuration menu. MAP or kPa is displayed in the upper left corner of the screen and is included on the printout.
You can display MAP (Mean Arterial Pressure) or blood pressure in kPa (kiloPascals) in the upper left corner of the screen, above the ECG waveform. This alternate BP field display can be set by using the Advanced Configuration menu.
To set the alternate BP field display , enter the Advanced Configuration menu:
Press the
Press the
Use the left
Date/Time button. Trend button.
Select button to highlight
Alternate BP Field:”.
Press the left
Set to choose MAP, kPa,
or Nothing.”
Trend
Press the
button again to exit
Advanced Configuration.
MAP - If MAP is displayed on the screen, it will also appear in the trend data and in the current readings of a waveform printout.
MAP Alarms - When either of the MAP limits are exceeded, an audible alarm sounds and the affected measurement flashes. You can silence this alarm, and all alarms, by pressing the large
Silence
blue
button at the right side of the instru­ment. This will silence all alarms for 60, 90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outside the set limits will flash.
To suspend the MAP alarm, press the
ALARMS Off
button so the red LED in the button
BP
lights. A suspended alarm will still flash if it goes outside the range of the limits, but it will not sound the audible alarm.
Note: MAP is calculated mathematically from the
Systolic and Diastolic pressures; it is not measured directly.
Setting alarm limits If MAP is displayed, you can set the alarm limits, using the
Select
Set
and buttons on the left side of the monitor to follow these steps:
Press the left Select button to cycle through MAP
LO, Respiration HI and LO
or 623xx)
LO
.
HI and LO
, then (model 623xx) CO2 HI and
, Heart Rate
(models 622xx
HI and
Each push of Select moves you to the next limit. Stop at the limit you want to set. The
HI
measurement and
or LO will flash,
indicating which limit is being changed.
Press the Set button up or down to raise or lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).
Press the Select button again to go to the next limit, or press it several times until none of the measurements flash and no
LO
or
indicators are lit. The instrument is now in its normal measurement mode. (If you do not press any button for 10 seconds, the instrument will automatically revert to its normal measurement mode).
kPa – If the blood pressure is displayed in kPa on the screen, the blood pressure readings will be in kPa in the trend data and in the current readings of the waveform printout.
HI
11
Note: To set the blood pressure limits in kPa, you
will need to use the Select and Set buttons on the right side of the monitor. The alarm limits for systolic and diastolic will be displayed in mmHg on the right side of the monitor and in kPa on the screen.
HI and LO
12
13
2.2 Monitoring SpO2, Pulse Rate and the SpO2 Waveform
The oximetry and pulse rate measurements are generally taken with the reusable fingerclip sensor (provided), however a wide variety of SpO volume is displayed as a vertical bar graph, called the Plethysmograph, beside the SpO right side of the monitor. The SpO
pulse tone gives an audible indication of pulse rate and oxygen level.
2
Pulse - A fingerclip sensor provides the source of the light transmitted through the patients finger to determine the oximetry and pulse rate measurements. The green Pulse Rate numbers may sometimes differ slightly from the Heart Rate displayed over the ECG waveform, even though they both measure beats per minute (bpm). This is normal.
Oxygen level - The oxygen level is displayed in red numbers as a percentage. The Plethysmograph vertical bar graph next to the
percentage shows the strength of the
SpO
2
fingerclip sensor signal with each beat. If this signal is low, it could indicate that the fingerclip sensor is not placed properly, or that the patient has poor perfusion. Pigmented skin and nail polish can also lower the signal.
System Displays The system will begin displaying the Plethysmograph signal almost immediately upon attachment of the fingerclip sensor to the patient. The SpO
level and Pulse
2
Rate will be displayed within about 5 seconds, after the system determines that the reading is stabilized.
Second waveform - The pulse oximetry waveform can be selected as a second trace. If this is chosen, the bottom line of the screen displays the SpO
waveform. Select the Second
2
trace source from the Advanced Configuration menu.
Pulse tone - A short SpO
tone sounds with
2
every pulse beat.
sensors are available as accessory items. The oximetry pulse
2
% display on the
2
The pulse tone timing is based on the ECG heart rate. If ECG is not used, the pulse tone timing is based on the SpO
measurement.
2
The pulse tone pitch is determined by the oxygen level, increasing in frequency (pitch) as the percentage of oxygen elevates.
The pulse tone volume can be controlled by a button on the lower right panel. The button is below the SpO icon and
display, labeled with a speaker
2
SpO
.
2
Note: The pulse tone volume can be turned
completely off with this button.
Note: If the SpO
SpO
pulse tone is in synchrony with the
2
is inactive, the timing of the
2
ECG heart rate as is normally the case, but the pitch of the tone is steady, unvarying, and different from the tone tracking oxygen content.
Alarms - When the oxygen percentage falls below the SpO
limit, an alarm sounds and the
2
affected measurement flashes. You can silence this alarm, and all alarms, by pressing the large blue
Silence
button at the right side of the instrument. This will silence all alarms for 60, 90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outside the set limits will flash.
To suspend the SpO
ALARMS Off
button so the red LED in the
alarm, press the
2
SpO
button lights. A suspended alarm will still flash if it goes outside the range of the limits, but it will not sound the audible alarm.
2
14
e
Oximetry
Measurement
Pulse Rate
PULSE
(bpm)
Signal Strength
Silenc
12/
min
SpO2%
SpO2ALARMS
Off
LO
Select
BP ALARMS
Off
Set
Trend
CO
2
SpO
Connector
Lead Select Print
2
2
SpO
AC
SpO
Alarms Off
SpO
2
+
-
SpO
2
Pulse Tone Volume
2
Select
Set
Atlas Monitor showing SpO2 displays, controls, and sensor connector
Note: The SpO
3 minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the SpO
ALARMS Off
until you remove the suspension.
Setting alarm limits - To set the SpO limits, use the right side of the monitor to follow these steps:
Press the LO, then Systolic HI and
SpO
2
Diastolic
Each push of
limit. Stop at the limit you want to set. The measurement and the flash, indicating which limit is being
alarm can be suspended for only
2
button will suspend the alarm
alarm
2
and
Select
Select
HI
and LO.
Select
Set
buttons on the
button to cycle through
LO
, and
moves you to the next
HI or LO LED will
changed.
Set
Press the
button up or down to raise or
lower the alarm limit. (When you come to the
2
end of the range, the numbers will stop changing).
Select
Press the
button again to go to the next limit, or press it several times until none of the measurements flash and no LEDs are lit. The instrument is now in its normal measurement mode. (If you do not press any button for 10 seconds, the instrument will automatically revert to its normal measurement mode).
Pulse and Heart Rate alarms - There is one case where the Heart Rate alarm receives status information from the Oximeter pulse rate:
15
HI
or LO
If ECG is inactive and the Heart Rate is shown as dashes, the Heart Rate alarm is triggered by the Pulse rate instead of the ECG Heart Rate. If the Pulse rate falls outside the Heart Rate limits, the Pulse measurement flashes and the alarm sounds. Use the large blue
Silence button
to temporarily silence the alarm, and use the
SpO
ALARMS Off
2
button to suspend it.
Saving volume settings – You can save your
volume settings for alarms and for pulse tone after you change them, so that they become the initial settings every time the Atlas Monitor is powered on. After making the alarm and pulse volume changes, press Date/Time to display the Other Options menu, and press Print (or Freeze) to save your settings. Press Date/Time to return to the main screen. You may repeat this whenever you want to change your settings.
16
17
2.3 Monitoring Heart Rate and the ECG Waveform
The trace displays one of the ECG leads. This lead is indicated above the right end of the trace, near the
symbol and heart rate value. Choose the lead with the Lead Select button. Heart rate is displayed at
the right.
ECG displays – The ECG waveform is always displayed on the upper half of the screen. The ECG waveform cascades (continues) from the upper half of the screen to also appear at the bottom portion when other waveforms are not selected in Advanced Configuration. The Heart Rate is displayed above the right end of the top waveform, near the symbol. The symbol for the selected ECG lead is shown to the right of the Heart Rate.
There is always a scale reference bar shown to the left of the upper ECG waveform. This scale bar has a height that represents a 1 mV signal. The apparent height of the scale bar will vary depending upon the ECG gain setting being used, but will always correspond to a 1mV signal.
Selecting leads - Press Lead Select to change the lead display. The ECG function can use either 3 wire leads - I, II, III , or 5 wire leads ­I, II, III, aVR, aVL, aVF, and V. 3 wire or 5 wire lead setting is selected in the Advanced Configuration menu.
Note: When using 3 wire leads, the ECG lead
set must be set correctly. Incorrect results
and noisy waveforms can be obtained if the system is configured for 5 wire leads when using 3 wire leads.
Alarms - When either of the Heart Rate limits are exceeded, an audible alarm sounds and the affected measurement flashes. You can silence this alarm, and all alarms, by pressing the large blue
Silence button at the right side of the
instrument. This will silence all alarms for 60,
90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outside the set limits will flash.
To suspend the Heart Rate alarms, press the
ALARMS Off
button so the red LED in the
HR
button lights. A suspended alarm will still flash if it goes outside the range of the limits, but it will not sound the audible alarm.
Note: The Heart Rate alarm can be suspended
for only 3 minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the
ALARMS Off
button will suspend the alarm
HR
until you remove the suspension.
If ECG is inactive for any reason, the Heart Rate display will be dashes “---” and the Heart Rate alarm will respond to the pulse oximetry rate.
Setting alarm limitsTo set the Heart Rate alarm limits, use the
Select
and
Set buttons on
the left side of the monitor to follow these steps:
Press the left Select button to cycle through
HI
MAP Respiration 623xx)
LO
.
LO
and
, then (model 623xx) CO2 HI and
, Heart Rate
HI
and
LO
HI
and LO,
(models 622xx or
Each push of Select moves you to the next limit. Stop at the limit you want to set. The measurement and
HI
or LO will flash,
indicating which limit is being changed.
Press the Set button up or down to raise or lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).
Press the Select button again to go to the next limit, or press it several times until
18
none of the measurements flash and no HI or
LO indicators are lit. The instrument is now
in its normal measurement mode. (If you do not press any button for 10 seconds, the instrument will automatically revert to its normal measurement mode).
2-19
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