Welch Allyn Atlas Service manual

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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.

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

& 623XX) .............................................................................25

ETCO

.......................................................................14

................................................................................18

& 623XX)............................................................23

WAVEFORM (MODEL

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

& 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

LECTRODES

SAMPLE TUBE (MODEL

.................................................................................................51

............................................................................................................53

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

ENU

.................................................................................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

iii

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 user’s institution. A Service Manual is available from the manufacturer. Other important safety information is located throughout this manual where appropriate.

concentration, Heart Rate,

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 operator’s 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.

• 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

and breath rate monitoring and alarm capability will be disabled. This occurs

) and breath rate measurement and alarm capability are active

. Should the operator change from viewing the

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

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 manufacturer’s 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 patient’s 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 manufacturer’s 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 manufacturer’s specifications within this time at no cost to the customer. It shall be the purchaser’s 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 manufacturer’s 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.

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.

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.

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

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

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

623xx feature. Push the

button to print what

is on the screen. If the waveforms are displayed

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,

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 patient’s 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

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, you’ll 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

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

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

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.

Trend

Lead Select Print

23%

ALARMS

Off

TEMP

Systolic

Diastolic

(mmHg)

BP ALARMS

Off

Alarm Suspend Buttons

Silence

PULSE

(bpm)

HR ALARMS

Off

SpO2%

/ RESP

ALARMS

Off

SpO

Power

TEMP

Systolic

Diastolic

(mmHg)

BP ALARMS

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

Trend Print

PULSE

(bpm)

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:

• 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

Diastolic

• Each push of

button to cycle through

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

and

, and

Set

moves you to the next

or LO LED will

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

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

and

alarm limits will be displayed in mmHg

on the right side of the monitor and in kPa on the screen.

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

• 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

To suspend the MAP alarm, press the

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 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

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

, Respiration HI and

or 623xx)

, then (model 623xx) CO2 HI and

and

, Heart Rate

(models 622xx

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

none of the measurements flash and no

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).

Map

MAP 96

Trend

Lead Select Print

Blood

Pressure

Connector

HR ALARMS

Select

Off

/ RESP

ALARMS

Off

BP ALARMS

Set

SetSelect

Blood

Pressure

Alarm Off

Off

Atlas Monitor waveform display showing location of MAP reading

Silence

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

• 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

To suspend the MAP alarm, press the

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: 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)

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

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

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.

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

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.

Pulse - A fingerclip sensor provides the source of the light transmitted through the patient’s 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

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

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

trace source from the Advanced Configuration menu.

Pulse tone - A short SpO

tone sounds with

every pulse beat.

sensors are available as accessory items. The oximetry pulse

% display on the

• 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.

• 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

SpO

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

is inactive, the timing of the

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

affected measurement flashes. You can silence this alarm, and all alarms, by pressing the large blue

Silence

To suspend the SpO

ALARMS Off

button so the red LED in the

alarm, press the

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.

Oximetry

Measurement

Pulse Rate

PULSE

(bpm)

Signal Strength

Silenc

12/

min

SpO2%

SpO2ALARMS

Off

Select

BP ALARMS

Off

Set

Trend

SpO

Connector

Lead Select Print

SpO

Alarms Off

SpO

Pulse Tone Volume

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

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

button will suspend the alarm

alarm

and

Select

and LO.

Select

Set

buttons on the

button to cycle through

, 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

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:

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

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.

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

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

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 limits –To 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

MAP Respiration 623xx)

and

, then (model 623xx) CO2 HI and

, Heart Rate

and

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

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 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

Heart Rate Selected Lead

Select

HR ALARMS

Off

CO2 / RESP

ALARMS

Off

Trend

Lead Select

Lead Select Print

ECG

Connector

Atlas Monitor showing ECG waveform display, controls, and ECG

connector

ECG settings in Advanced Configuration The five settings in the Advanced Configuration menu associated with the ECG are listed in this table:

Advanced Configuration

ECG setting

ECG gain automatic |

ECG lead set 3 wire | 5 wire

ECG speed 6.25 | 12.5 | 25 mm/s

ECG bandwidth Monitor | Extended

Second trace selection

Possible values

10 mm/mV

ECG | SpO2 | Respiration | CO

You can change the ECG settings in Advanced Configuration:

• Press the Date/Time

• Press

• Use either

• Use the

• Press

ECG gain - The height of the vertical ruler that appears to the left of the ECG waveform indicates a 1 mV amplitude and is 10 mm high if 10 mm/mV gain is chosen. When automatic gain is selected the ruler height will vary, but it will always indicate a 1 mV signal size. The ruler size is automatically increased or decreased to scale to a particular set of waves, but the vertical line still indicates the same amplitude of 1 mV.

ECG lead set - The Atlas Monitor allows for both 3 wire and 5 wire ECG lead sets.

Trend.

gain, ECG lead set , ECG speed, ECG bandwidth, or Second trace selection.

values.

Trend to exit Advanced Configuration

Select

Set button to change any of these

button.

button to highlight ECG

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.

ECG speed - The amount of ECG waveform shown on the CRT is determined by the trace speed. A slower trace speed means more seconds of waveform are shown on the CRT.

ECG bandwidth - The ECG waveform can be displayed and printed in either Monitor or Extended bandwidth. Monitor mode allows for a clearer picture of the waveform by filtering out noise. Extended mode, usually used with cardiac paced patients, shows the finer nuances of ECG waveform, facilitating the detection of conditions such as ischemia.

Note: Detection of ischemia is the interpretation

of the clinician only, the Atlas Monitor does not provide automated ischemia detection.

Note: It is normal for the ECG baseline to

wander slightly in Extended bandwidth.

Pacemaker signals – The Atlas Monitor displays pacemaker signals exactly as they are captured. There is no option to display symbolic pace indications. Use Extended bandwidth for enhanced display of pacemaker signals.

2.4 Monitoring Impedance Respiration (Models 622xx & 623xx)

The lower trace can display the Impedance Respiration waveform if this is chosen in Advanced Configuration. In this case, the Respiration Rate is displayed above the right side of the waveform. The Impedance Respiration waveform is always derived from Lead I (RA-LA).

What is it? - Respiration Rate is measured with the ECG leads. As the chest expands and contracts during the respiration cycle, the resistance, or impedance, between the RA-LA electrodes (

) changes. The result of these changes indicates

Lead

the respiration rate.

For best performance in monitoring impedance respiration rate, change the LA and RA electrode placement to the mid-axillary line on each side of the chest as shown in the section on connecting the ECG.

Where is it? - In Atlas Monitor model 622xx, the lower trace normally shows cascading ECG. In Atlas Monitor model 623xx, the lower trace normally displays the ETCO

waveform.

However, the lower trace can instead show Impedance Respiration, if it is chosen in Advanced Configuration.

How to display it – You can change the Second trace selection settings in Advanced

Configuration:

• Press the

• Press

Trend.

• Use either

Date/Time

Select

button.

button to highlight Second

trace selection.

Set

• Use either from the choices ECG, SpO

(model 623xx).

• Press

Trend

button to choose Respiration

, Respiration,

to exit Advanced Configuration.

Impedance Respiration is sensitive to patient movement, making it less accurate than ETCO

for measuring the breath rate. For this reason, model 623xx users often prefer to view the

ETCO2 waveform and let the monitor measure breath rate from this source.

Alarms - When either of the respiration 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

Silence

blue

To suspend the respiration rate alarms, press the

CO2/RESP ALARMS Off (RESP 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 respiration 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

CO2/RESP

until you remove the suspension.

Warning: 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 monitoring and alarm capability will be disabled. This occurs even if the ECG cable is still inserted into the Monitor.

Respiration

Rate

ECG

Connector

PULSE

(bpm)

SpO2%

RESP

ALARMS

Off

SpO2ALARMS

Select

Set

Off

Set

Suspend

Respiration

Alarms

Select

SpO

TEMP

Systolic

Diastolic

BP Start/Can

Atlas Monitor showing Impedance Respiration waveform display,

controls, and ECG connector

Setting alarm limits –To set the Respiration 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

MAP Respiration only) CO

and

, Heart Rate

and LO, then (model 623xx

HI and

and LO,

• Each push of Select moves you to the next limit. Stop at the limit you want to set. The

measurement and

or LO will flash,

• Press the Select button again to go to the next limit, or press it several times until none of the measurements flash and no

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).

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).

2.5 Monitoring Temperature (Models 622xx & 623xx)

The Temperature, measured on the skin surface with a skin sensor, is displayed in Advanced Configuration. There are no audible alarms for Temperature. An invalid temperature reading is indicated by dashes “---” in the numeric display.

Temperature can be measured with a skin sensor.

No alarms – There are no temperature alarm limits and no audible alarms for temperature. If there is no temperature probe connected when the monitor is first turned on, the TEMP display will be blank.

If the probe becomes disconnected from the patient or the monitor, the TEMP display will show steady dashes “---”, but there will be no alarm.

Changing the scale – The temperature display can be in °F or °C, as selected in Advanced Configuration.

You can change the Temperature units setting in Advanced Configuration:

• Press the

• Press

Trend.

• Use either

Date/Time

Select

button.

button to highlight

Temperature units.

• Use either

• Press

Set

button to choose °°°°F or °°°°C.

Trend

to exit Advanced Configuration.

Note: The temperature display is blank at power-

on until a temperature probe has been detected.

F or °C, as chosen in

Temperature

Units

TEMP

Temperature

Connector

Atlas Monitor showing Temperature display and connector

2.6 Monitoring CO2, Respiration Rate, and the ETCO2 Waveform

(Model 623xx)

The lower trace displays the ETCO or SpO

in its place if desired. The CO2 measurement is shown above the right end of the trace, and

Respiration Rate appears on the left. You can set alarm limits for both of these measurements.

What is displayed – In the Atlas Monitor model 623xx, one of the lower trace alternatives to the cascading ECG includes the CO Respiration Rate is displayed above the left end of this trace. Carbon Dioxide concentration displayed above the right end of the trace. CO can be displayed in units of %, mmHg, or kPa. There are high and low alarm levels for Respiration Rate and for CO

concentration.

Note: the watertrap must be installed for the CO

displays to be active. If the watertrap is not installed, the Atlas Monitor will display cascading ECG.

Warning: End tidal carbon dioxide (ETCO

and breath rate measurement and alarm capability are active ONLY when the second trace option is set to CO

. Should the

operator change from viewing the ETCO and breath rate waveforms and data to another second trace selection (SpO Respiration or ECG) the CO rate monitoring and alarm capability will be disabled. This occurs even if the watertrap and cannula are still inserted into the Monitor.

How it works - The CO

sensor is based on a

single beam, single frequency Infra-Red (IR) source and a dual thermopile detector. CO measurement is based on the IR absorption characteristics of CO

molecules. The CO2

sensor uses non-dispersive IR spectroscopy to measure the number of CO the sample gas. CO

gas has a unique absorption

molecules present in

band which is related to a CO composition and mass. CO

gas concentration is

waveform, although you can display Impedance Respiration, ECG,

measured by detecting absorption in this band.

waveform. The

The IR absorption in the CO may be affected by a number of factors that skew the CO

measurement. The Atlas Monitor

automatically compensates for some of these factors. Water vapor compensation accounts for

wavelength band

the effect that water vapor has on the IR absorption characteristics of CO

During normal sidestream operation, CO measurements are adjusted mathematically to compensate for this effect.

Alarms - When any of the CO

or Respiration

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.

and breath

To suspend both the CO alarms, press the

CO2/RESP ALARMS Off

and Respiration Rate

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 CO

and Respiration Rate 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

CO2/RESP ALARMS Off

will suspend the alarm indefinitely.

molecule’s

molecules.

button

PG 2-17

Respiration

Rate

Waveform

CO2 Watertrap

Connector

23%

CO2 Measurement

CO2 / RESP

ALARMS

Off

Select Set

Suspend CO2 and RR Alarms

Set

Atlas Monitor model 623xx showing ETCO2 waveform display,

controls, and watertrap connector

Setting alarm limits –To set the CO Respiration Rate alarm limits, use the and

Set

buttons on the left side of the monitor to

and

Select

follow these steps:

• Press the left Select button to cycle through

MAP Respiration

and

, Heart Rate

and LO, then CO2 HI and

and LO,

• Each push of Select moves you to the next limit. Stop at the limit you want to set. The

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

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).

3 Managing the Alarms

Four types of events can cause an alarm: 1) the patient’s measurement is outside the limits you set; 2) the measurement is invalid; 3) the instrument is malfunctioning; 4) the battery is low. You can silence alarms for a period (60, 90, or 120 seconds) by pressing the Silence button, or you can suspend the audible signal for any patient alarm or measurement invalid alarm for 3 minutes under the “Francais” language setting or indefinitely with other language setting configurations. You can also adjust the alarm volume.

With this monitor, it is easy to set alarm levels, to silence alarms for a short period, and to suspend a selected measurement from triggering the audible alarm.

Alarm types – Three types of events cause an audible alarm:

• A Patient Alarm is triggered by a vital measurement registering outside the limits you set. That measurement display will flash and, if the measurement is not suspended or silenced, an audible alarm will sound.

• A Measurement Invalid Alarm means the instrument is working properly, but something is wrong with one of the measurements. This could be caused by one of the leads coming off the patient, or by the cable connection to the instrument coming out. This alarm can also mean that the actual patient vital sign is outside of the range of measurement of the Atlas Monitor. These events cause an audible alarm, a message on the screen, and the affected display turns to dashes “---” which flash.

• An Instrument Problem Alarm means the instrument has found an internal problem. These alarms are very rare. They produce an audible alarm, a message on the screen, and the affected measurement display will be blank.

• A Battery Low Alarm means that the battery (models 622xx and 623xx) is running low and has 10 or fewer minutes of life remaining.

To help you determine what an alarm means, there are four principal alarm sounds. The four alarm types and their visual indications are shown in the table.

Alarm volume – The Alarm Volume is controlled by a button labeled with a bell icon. Eight volume settings are provided.

Note: The alarm volume cannot be turned

completely off with this button.

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.

Nurse Call – All alarms activate the Nurse Call relay through a rear panel connector of models 622xx and 623xx. This relay can be connected to the hospital system to alert the central nurse station. The Nurse Call relay will be activated for any condition that causes an audible alarm at the unit. This means suspended alarms will not alert the nurse station, nor will alarms that occur during a silence period, until the period is over. See the Technical Service Manual for details on the Nurse Call relay.

Warning: it is the user’s responsibility to

implement the interface between the Nurse Call system and the Welch Allyn Atlas Monitor. It is also the user’s responsibility to adequately test the interface between the Monitor and the Nurse Call system to ensure that the desired functionality is operational.

Silencing alarms – You can turn off the audible alarm sound for a brief period by pressing the

Silence button. The LED will light and no audible

alarms will be heard for 60, 90, or 120 seconds, depending on the alarm silence duration.

To set the alarm silence duration, enter Advanced Configuration by pressing pressing

Trend. Use either Select button to

highlight Silence duration. Press the

Date/Time, then

Set

button

to choose 60, 90 or 120 seconds. Exit by pressing

Trend button again.

the

Pressing the

Silence button silences all alarms,

including new alarm events that may occur after you press the button. However, even with no sound, those measurements that are outside their limits will still be noticeable, by the flashing numbers or dashes, or blank displays.

At the end of the silence period, when the LED on

Silence button turns off, any measurement

the still outside its limits will cause another audible alarm.

If you press the Silence button during the silence period, while the bell icon is still lit, the silence period ends, and any alarm condition, new or old, will sound the audible alarm.

Suspending alarms – Suspending an alarm means preventing a patient measurement from triggering an alarm. Suspended alarms are “off” in the sense that they will not sound the alarm for a period of time, but they are “on” in the sense that the patient’s vital signs are still measured and displayed. Suspended measurements flash if they are outside the limits, but they do not cause an alarm sound.

To suspend a measurement alarm, press the appropriate ALARMS Off button and the red LED in the center of the button will light. There are 4 ALARMS Off buttons, and they suspend the groups of measurements in the following table:

Suspending Alarms

“Off” button

label

HR ALARMS Heart Rate CO2/RESP ALARMS SpO2 ALARMS Oximetry and Pulse Rate BP ALARMS Systolic, Diastolic and

Removing suspension of alarms – When the “Francais” language option is selected in the Advanced Configuration Menu, the alarms can only be suspended for 3 minutes. To remove suspension before the 3 minutes have elapsed, press the

When the Atlas Monitor is set to all other languages including Canadian French, alarms will remain suspended until they are turned back on or the monitor is turned off. To remove suspension, press the suspended alarms do not time out automatically. Alarms are not suspended at power up, but an alarm will not sound until valid measurements have begun.

ALARMS Off

measurements

ETCO2 and Respiration Rate

MAP

button again.

button again. Remember,

Suspends

Alarm Conditions

Alarm type

Patient Alarm; a vital sign measurement is outside limits

Sensor disconnected from patient

Measurement outside the range of the instrument

Temperature probe disconnected*

Instrument problem Affected

Battery low Tone once every 2

Battery very low Tone once every

*The temperature display remains blank until a probe is detected for the first time after turning on the monitor.

Normal operation

Numbers flash Audible alarm – medium pitched tone once per second Flashing “---” Audible alarm – high pitched tone twice per second Message on screen Flashing “---” Audible alarm – high pitched tone twice per second Message on screen Solid “---” No audible alarm Message on screen

measurement is blank Audible alarm – very high pitched tone, very rapid rate Message on screen

minutes Message on screen

minute Message on screen

Numbers flash No audible alarm

Flashing “---” No audible alarm Message on screen

Solid “---” No audible alarm Message on screen Affected measurement blank No audible alarm Message on screen

No audible tone Message on screen

Silenced

Suspended

Numbers flash No audible alarm

Solid “---” No audible alarm No message on screen

Affected measurement blank No audible alarm No message on screen

PG 3-6

Flashing Heart

Rate Limit

SpO

and Set

TEMP

Systolic

Diastoli

Select

BP Start/Can

PULSE

(bpm)

HR ALARMS

Trend

Lead Select Print

170

Select

Off

SpO

/ RESP

ALARMS

Off

SpO2ALARMS

Off

Set

Alarm Select

Flashing Systolic

Pressure Limit

PULSE

(bpm)

HR ALARMS

Off

SpO

/ RESP

ALARMS

Select

Off

SpO2ALARMS

Off

Set

TEMP

Systolic

Diastolic

Select

(mmHg)

BP ALARMS

Off

Set

Off 1 3 5

10 15 30 60

AutoBP Start/Cancel

SpO

Alarm Select

and Set

Atlas Monitor showing alarm setting displays and controls

3.1 Patient Alarms

Patient alarms sound when one of the patient’s vital measurements is registering outside the limits you have set. You can set high and low alarm limits for most of the measurements. Setting and checking the alarm limits can be easily done from the front panel. The alarm settings can be saved as defaults by accessing a menu.

A Patient Alarm is a signal that some vital measurement is outside the limits that were set by you. Patient alarm limits assume preset values when the monitor is first turned on and it is easy to change the limits at the front panel.

Setting alarm limits – The front panel of the monitor has 2 sets of Select and Set buttons. One set is on the right side of the monitor, and one set is on the left side. To set a patient alarm limit, use one of the Select buttons and follow these steps:

• Press the

Select button on the side of the

monitor closest to the measurement you want to change several times until the limit you want to change flashes. Successively pressing this button cycles through the settings for each different measurement.

These numbers and the

or LO indicator will slowly flash. The flashing numbers show the current alarm limit.

• While the alarm limit you want to change is flashing, press the top or bottom half of the

Set

button. This changes the alarm limit.

Note: The alarm limits do not wrap around at the

upper and lower end of their legal values. Instead, the number stops changing when you reach the upper or lower measurement limit of the instrument.

• When you are satisfied with this alarm limit,

Select

press

again to move to another

patient alarm.

• To exit alarm limit setting and return to normal mode, press alarm limits or

Select until there are no

HI or LO indicators flashing.

Note: If the buttons are not pressed for 10

seconds, the unit will automatically revert to its normal mode.

Silencing patient alarms – The

Silence

turns off all audible alarms - patient alarms and other types - for a short period. Any vital measurement that is outside its limits will flash, showing which measurement is out of range. Any other measurements that go outside their limits during the current silence period will also flash, but will not trigger the audible alarm during the silence period.

Suspending patient alarms – You can suspend patient alarms individually, which means that the specific measurement will not sound the audible alarm when it goes outside the limits. However, this value will still flash whenever it is outside the limits, giving you a visual indication of an alarm condition.

ALARMS Off

The

buttons to suspend alarms are

shown in the table:

Suspending Alarms

“Off” button label

HR ALARMS Heart Rate CO2/RESP ALARMS (RESP ALARMS) SpO2 ALARMS Oximetry and Pulse Rate BP ALARMS Systolic, Diastolic and

Press the appropriate ALARMS Off button to

Suspends measurements

ETCO2 and Respiration Rate

MAP

button

suspend the audible alarm for a selected measurement. The LED in the button will light, indicating that the alarm is off. If this measurement goes outside the set limits, the displayed value will flash. When you remove the suspension, the light will turn off.

Remove suspension under the Francais language setting – When the “Francais”

language option is selected in the Advanced Configuration Menu, the alarms can only be suspended for 3 minutes. At the end of that time the suspension will be removed. You can remove the suspension before the 3 minutes have elapsed by pressing the button again.

Remove suspension under other language settings – When the Atlas Monitor is set to all

ALARMS Off

other languages including Canadian French, alarms will remain suspended until they are turned back on or the monitor is turned off. To remove suspension, press the button again. Remember, suspended alarms do not time out automatically. Alarms are not suspended at power up, but an alarm will not sound until valid measurements have begun.

Saving alarm settings – You can save your alarm settings after you change them, so that they become the initial settings every time the Atlas Monitor is powered on. After making the alarm limit 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.

ALARMS Off

3.1.1 Factory Default Patient Alarm Settings

Measurement

Heart Rate 45 beats/minute 140 beats/minute Blood Pressure – Systolic 70 mmHg 200 mmHg Blood Pressure – Diastolic 50 mmHg 155 mmHg Blood Pressure – MAP 60 mmHg 180 mmHg SpO2 85% Respiration Rate 7 breaths/minute 30 breaths/minute CO2 25 mmHg 60 mmHg

Low alarm default

High alarm default

3.2 Measurement Invalid Alarms

Invalid measurements could be caused by problems such as an ECG lead detaching from the patient or by a kinked ETCO other alarms. You can quiet these with the Silence button, and you can suspend the alarm with the appropriate vital sign has exceeded the measurement capability of the Atlas Monitor.

The Measurement Invalid Alarm is indicated by distinctly different alarm tones and by a message on the screen. A variety of conditions might cause this type of alarm, such as:

• the ETCO

• one of the ECG leads has fallen off the

patient.

• the ETCO replaced.

• one of the sensor cables is unplugged from the monitor.

• the blood pressure cuff is detached, has a leak, or is kinked.

• the patient’s vital sign measurement is outside the range supported by the instrument.

Any of these Measurement Invalid conditions will cause three things to happen:

• The audible alarm will sound, if the event occurs outside a silence period.

• The affected measurement will show flashing dashes “---”.

• A message appears on the screen.

Silencing alarms – You can silence the audible

alarm with the This will not erase the message from the screen. During this period, you should try to correct the problem by reconnecting the cable or patient lead, or changing the watertrap, if appropriate. At the end of the silence period, if the condition still exists, the audible alarm will announce the problem again.

Suspending alarms – If the problem cannot be corrected, or if you want to ignore this

sample line. Such conditions sound an alarm with a tone and pattern distinct from the

ALARMS Off

button. A Measurement Invalid alarm could also indicate that the patient’s

measurement, you can suspend a measurement invalid alarm by pressing the corresponding

ALARMS Off

button. This will erase the

message from the screen and, depending on the

sample line is kinked.

language setting, prevent further audible alarms and messages for this condition. The dashes “--- ” will be solid, not blinking.

watertrap is full and must be

The ALARMS Off buttons are:

HR ALARMS Off

•

SpO2 ALARMS Off

•

for heart rate.

for oximetry levels and

pulse rate.

BP ALARMS Off for blood pressure.

•

RESP ALARMS Off for respiration rate

•

(model 622xx). In model 623xx, this is

CO2/RESP ALARMS Off, and it suspends

alarms for respiration rate and CO

Note: Individual alarms can be suspended for

only 3 minutes when the language setting is configured to “Francais”. If the language setting is set to any other language, pressing

ALARMS Off

the

button will suspend the corresponding alarm until you remove the suspension.

Note: The

Temperature

measurement never

produces an audible alarm. If the temperature

Silence

button for a short period.

probe disconnects from the patient, the display is replaced by solid dashes “---”.

levels.

3.3 Instrument Problem Alarms

Instrument Problem Alarms, although they rarely occur, are of three types: 1) the Atlas Monitor detected an internal fault during power-on self test; 2) the Atlas Monitor detected an internal fault during use; 3) the Atlas Monitor reports that it lost power while in use the last time it was operating.

You will rarely see an Instrument Problem Alarm. These alarms indicate the failure of some internal circuitry. The Atlas Monitor performs a SelfCheck when it is turned on. If it finds something that does not respond correctly to the tests, an Instrument Problem Alarm will be reported. Problems detected at power-on will produce an error message telling you what is wrong, but will not sound an alarm. Also, the affected measurement indicator will be blank. Problems detected during use will produce an error message and sound the Instrument Problem Alarm.

When a problem is detected by the Self-Check, the rest of the instrument may not be affected, so in most cases, you can use the monitor for the other measurements. (Be sure to contact the Welch Allyn Technical Service Department).

back on.

A message will appear reporting that the power was interrupted and settings were lost. The Atlas Monitor may not remember changes that you made to alarm limits and Advanced Configuration menu entries during the last session. You should review your settings to ensure that you have the proper values set.

The alarm and error message will clear when you press any button on the Atlas Monitor.

The power failure alarm should not occur on Atlas Monitor models 622xx and 623xx because the built-in battery will keep the system running during a power failure or power cord being pulled out.

Silencing alarms – The audible alarm for instrument problems has a distinctly different sound from Patient Alarms and from Measurement Invalid Alarms. Press the button to silence this alarm for a short period. This will not erase the message. Press the appropriate

ALARMS Off

sounding the audible alarm again and to remove the error message.

Note: If the Atlas Monitor is set the “Francais”

language in the Advanced Configuration Menu, the suspend the alarm for 3 minutes.

Power failure – If the AC power to the Atlas Monitor model 621xx is interrupted when the monitor is in use, either because of a power failure or because the AC cord was pulled out without turning off the Atlas Monitor first, an alarm will occur when the system is plugged in and turned

button to prevent this alarm from

ALARMS Off

buttons will only

Silence

3.4 Battery Alarms (Models 622xx & 623xx)

Battery Alarms indicate that there are 10 or fewer minutes of battery life remaining. When one minute of battery life remains, a final alarm tone indicates that the Atlas Monitor is about to shut down, and a Trend report is automatically printed.

Battery problems – When the Atlas Monitor is running on battery power, it will warn you when there is less than 10, less than 5, and less than 1 minute of life remaining in the battery.

If you are using battery power, the AC indicator (

AC ~

) on the front panel will not be lit. The monitor will run on battery power for about one hour, depending on what patient measurements are being taken. More power is required by NIBP than by some of the other measurements because the air pump is used. This means that if you are not taking blood pressure readings, the battery power will last longer. Printing also uses more power.

Low battery power – When only 10 minutes of battery power is left, a chime sounds and a message appears on the screen. The chime will sound a reminder every two minutes.

Very low battery power - When the battery has only 5 minutes of power left, a message appears and a chime sounds every minute.

Battery Depleted - When the battery power is nearly depleted, the Instrument Problem Alarm sounds, a message is displayed, and the monitor will automatically shut off within one minute.

If the Atlas Monitor is equipped with a printer, it will print out a Trend report before shutting off if there is any trend data that has not been printed yet.

Note: If the battery is depleted, it may turn itself

off immediately without warning. This will occur if the battery is defective or damaged or if the battery was depleted when you

turned it on. In this case, plug the Atlas Monitor into AC power and allow the battery to charge for a few minutes before using the instrument on AC.

Note: Atlas Monitor model 621xx does not have

a battery option

Note: Repeated total depletion of the battery will

reduce the life of the battery.

Recharging the battery – The battery is permanently installed. The battery is recharged whenever the instrument is operating on AC power.

Note: It takes about five hours to recharge a

battery that is completely depleted to the 80% level. It can take up to 24 hours to charge a depleted battery to full capacity.

Message Location

Atlas Monitor showing location of system message

4 Capturing and Displaying Trend Data

Trend data is captured at every Blood Pressure cycle, whether it is automatically timed or manually initiated. If automatic BP timing is turned off, trend data will be captured every 15 minutes. Display the data by pressing The Atlas Monitor can capture and hold up to 144 lines of trend data. This is 36 hours of data at 15 minute intervals. If the intervals are shorter, naturally the total time covered in the trend data is shorter. A table on this page shows these times.

Viewing trend data - To see trend data, press the

Trend

button below the screen. The latest measurements are shown at the top of the screen. Scroll through the trend data with either button. Return to the waveform screen by pressing

Trend

automatically return to the waveform screen after 3 minutes of displaying the Trend screen.

All trend data is captured at every blood pressure cycle whether automatically timed or manually initiated. Automatic blood pressure cycles occur at 1, 3, 5, 10, 15, 30 or 60 minute intervals, as determined by the located below the blood pressure indicators. Pressing the interval. One of these intervals is labeled “X” for manual timing mode. When this is lit, blood pressure is not taken automatically, and trend data is captured every 15 minutes without any action from you. If the blood pressure setting is greater than 15 minutes, Trend data will be captured every 15 minutes.

A blood pressure cycle is manually started by pressing the data is captured when this happens. Also, a blood pressure cycle that has been canceled by pressing the by dashes in the trend screen.

Trend data: Printing, Erasing - The only way to preserve the trend data is to print it. Press

Trend

to display the data, then press the trend data will be printed; you do not need to scroll to the other screens of data to print them.

Trend data is always erased when the instrument

Trend. Then press Print to print it. Trend data is erased when the instrument is shut off.

is shut off.

Note: If the monitor was not turned off between

patients, the printed trend data will include that recorded from previous patients. Trend data is only erased when the unit is turned

again. The system will

Set

off.

Invalid or missing trend data – Invalid data or measurements that are not active are displayed by dashes in place of the data, on both the Trend

Auto button

Auto

button cycles to the next

screen and the printout.

Trend Data Capacity

Auto setting

(minutes)

Trend capacity

(hours)

1 2.4

Auto

3 7.2 5 12

10 24

15, 30, 60, X 36

BP Start/Cancel

button. All trend

button is shown

. All

3:50 70 122/89(--) 92 38 14 98.6 3:40 69 120/84(--) 95 38 12 95.4 3:30 70 119/88(--) 92 33 10 98.6 3:20 70 120/82(--) 95 36 12 96.2 3:10 74 128/86(--) 97 40 16 98.7 3:00 72 122/85(--) 90 38 12 95.6 2:50 70 120/86(--) 98 33 14 98.6 2:40 66 118/80(--) 95 38 10 98.6 2:30 67 120/78(--) 96 37 12 97.5 2:20 70 120/80(--) 95 38 12 98.6 2:10 68 121/85(--) 94 35 10 97.6

BP Sp0

CO2

mmHg

Select

SpO

Set

Trend

Print Scroll using Set

Atlas Monitor showing Trend display with associated controls

5 Using Print and Waveform Freeze

Pressing the displayed. If a screen of trend data is displayed, all the trend data is printed. Atlas Monitors without printers have a

Print or Freeze - Except for model 623xx, the printer is optional. Your Welch Allyn Atlas Monitor has a printer if there is a button labeled

Print beneath the screen. If there is no printer, this

button is labeled

Printing waveforms - To print the waveforms and the current measurements, press the screen shows the waveforms. When you print waveforms, the waveforms are printed starting from 9 seconds before you pressed the button until 6 seconds after you pressed it. The numeric data is captured and printed at the moment that the

Printing trend data – To print trend data, press

Trend

to view the data on the screen, then press

. If trend data is displayed and you want to print the waveforms, press the waveforms, then press

Note: If the monitor was not turned off between

patients, the printed trend data will include that recorded from previous patients. Trend data is only erased when the unit is turned off.

Freeze - If your monitor does not have a printer, it

Freeze

has a waveforms. You can then examine something on the screen before it is overwritten. The heart rate and alarm status are not updated during a freeze.

Print button prints the waveforms (and current measurements) if the waveforms are

Freeze button that halts the waveform display for 10 seconds for examination.

Three events can end the freeze period and return the waveforms to the normal, updating mode:

• Pressing

Freeze a second time ends the

freeze period.

Freeze

• Ten seconds after you press

Freeze

waveform starts again, automatically.

• Any patient alarm or instrument problem alarm that affects the frozen display will

while

end the freeze period.

Note: No data is lost during the freeze period.

Data is still added to the trend list during this time.

Print button is pressed.

ECG waveforms – Changing the ECG bandwidth affects both the displayed and printed

waveforms. The bandwidth choices in Advanced Configuration are:

Trend

to go back to

•

Monitor — a narrow bandwidth which produces a cleaner waveform printout.

•

Extended — a wider bandwidth which allows better viewing of the ST segment and enhanced detail of the pacemaker signals in a paced patient.

Note: It is normal for the ECG baseline to wander

slightly in Extended bandwidth.

button. Pressing this button halts the

, the

ECG Lead

ECG Scale

ECG Bandwidth

Print Speed

Respiration

Scale

Respiration Rate

5mm/mV

.05 - 40Hz

25mm/s

3 Dec 1998 23:40:01

Tren d

PULSE

(bpm)

SpO2%

PrintLead Select

mmHgCO

BP / ( )

23%

120

2 Waveform

75.1 FRR SpO

Atlas Monitor showing waveform display and printed waveform

record

5.1 The Printer – Loading Paper and Troubleshooting

The printer has an easy loading feature that doesn’t require threading the paper strip. The lid is popped open, the thermal paper roll placed into the well with the correct surface towards the front, and the lid is shut.

The printer - If your Atlas Monitor has this feature, the printer is located on the top center of the monitor, covered by a lid. The lid can be popped open by pushing the button located on the right side of the lid.

Printer paper – The printer is designed for thermal paper only. The suggested size for the paper roll is 2.25 inches (58 mm) in width and 100 feet long. Black ink is recommended.

Loading printer paper – A convenient feature developed for the Atlas Monitor printer is that no threading is involved to load the printer paper. To load paper:

• Open the printer door by pressing on the button and lifting the lid.

• Place the roll into the printer well with the thermal, coated side facing out, towards you.

• Pull enough of the paper out so that the strip will appear beyond the lid.

• Shut the lid to hold down the strip of paper.

Note: The coated side for thermal paper is

markable by a fingernail scratch, the noncoated side is not.

Note: Some manufacturers of paper may produce

paper rolls with the thermal side facing the inside of the roll. The Atlas Monitor printer will work with the paper rolled either way, as long as the thermal side faces towards the front of the monitor.

If it won’t print – The printer will not print if there is no printer paper or if the printer door is

open. Check to see that the thermal coated side of the paper is loaded against the print head (towards the front).

The end of the paper must extend out of the slot between the printer door and top of the monitor.

Make sure that the printer door is completely latched closed.

Atlas Monitor showing paper being loaded

6 Connecting to the Patient

The main patient connections are for NIBP, SpO additionally provide temperature measurement, and the model 623xx adds ETCO the measurement capabilities of the monitor, you will not have alarms for the measurements you do not use. You may connect the sensors to the patient before or after you turn the unit on.

, and ECG. Atlas Monitor models 622xx and 623xx

. If you do not use all

The Welch Allyn Atlas Monitor can only do its job when it is properly connected to a patient through the various sensors. You may turn on the monitor before you connect any leads to the patient. No alarm will sound until a valid measurement is made.

Patient connections - The first step is usually to connect the sensor cables and tubes to the monitor, and then to the patient. For convenience, all sensors connect to the front of the machine. Also, all of the sensors have different types of connectors, so there should be no confusion when connecting cables and tubes.

Caution: It is possible to incorrectly connect

the blood pressure tubing to the CO watertrap. Note that this is not a patient safety issue, only that ETCO not be captured and a CO

readings will

alarm will sound.

It is recommended that the blood pressure tubing be left connected to the monitor, and the cuff removed when necessary using the quick-release connector.

Unused features - You don’t have to use all the measurement capabilities on the monitor. For instance, if you want ECG only, just connect

these leads. Other features that are not connected will not produce alarms.

Warning: Impedance Respiration rate

, CO2 or

ECG) the Respiration rate monitoring and alarm capability will be disabled. This occurs even if the ECG cable is still inserted into the Monitor.

Warning: End tidal carbon dioxide (ETCO

)

and breath rate measurement and alarm capability are active ONLY when the second trace option is set to CO operator change from viewing the ETCO

. Should the

and breath rate waveforms and data to another second trace selection (SpO Respiration or ECG) the CO

and breath rate monitoring and alarm capability will be disabled. This occurs even if the watertrap and cannula are still inserted into the Monitor.

CO2

SpO2

ECG Temp

Atlas Monitor showing hookup of patient sensors

6.1 Connecting the NIBP Cuff

Select the proper cuff size (Small, Adult, Large Adult, or Extra Large Adult). Place cuff on patient, correctly oriented. Connect the tubing to the cuff and to the monitor. Blood pressure measurements can be taken automatically or manually.

BP cuff sizes - For accurate blood pressure measurements, it is important to select the proper cuff size. The Atlas Monitor comes with a Large Adult cuff. This is the correct cuff for most adults. (Other sizes are available from Welch Allyn: Small, Standard Adult and Extra Large Adult).

Warning

: The Welch Allyn Atlas Monitor is not designed for use on children younger than 3 years old.

A good way to assure proper cuff size is to wrap the cuff around the patient’s upper arm and inspect it. Welch Allyn cuffs are marked with a distinct white edge and two divisions that indicate “range.” When the cuff fits properly, the white edge marked “Index” will meet the cuff at some point within the “Range” as shown in the illustration.

You can also determine cuff size by measuring the patient’s arm circumference midway between the elbow and shoulder, and then use the chart below to select the correct cuff.

ARM CIRCUMFERENCE CUFF

SIZE

Small 4.7 – 8.3 12.0 – 21.0 Adult 7.1 – 12.6 18.0 – 32.0 Large Adult 8.3 – 15.4 21.0 – 39.0 Extra Large Adult

Cuff placement – The preferred blood pressure measurement site for adults and children is the upper arm. The arm must be relaxed and motionless during the reading. For accurate blood

INCHES CENTIMETERS

11.8 – 18.5 30.0 – 48.-0

pressure measurements, the upper arm should be placed at the same elevation as the heart, with the lower arm passively supported.

• Squeeze any air from the cuff.

• Wrap the cuff snugly around the limb with

room between cuff and arm for only one or two fingers. If it is too loose, the cuff cannot inflate properly, and it may result in an inaccurate reading.

• There is a mark on the cuff indicating the proper placement, to align the cuff over the patient’s brachial artery.

• Connect the hose to the cuff and to the front panel connector. The front panel connector is a simple, push-on friction fit. The tubing-tocuff connection is a twist-on connection. Be sure the hose is not kinked or pinched.

Warning: Do not apply the cuff to any extremity

being used for other diagnostic monitoring or therapeutic intervention, which may include intravenous infusions, intra-arterial lines, A-V shunts, PIC lines, and central venous lines.

Warning: Do not place the cuff on any area

where circulation might be compromised. In a situation involving repeated blood pressure measurements, monitor the circulation of the limb to ensure that blood flow is not compromised.

Warning: Do not place the cuff on an arm that is

also being used for SpO pressure cuff inflation during SpO measurement will cause inaccurate SpO results and false alarms.

monitoring. Blood

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RANGE

ARTERY

31.5 cm MAX SIZE

ADULT

INDEX

Correct placement of NIBP pressure cuff

Blood pressure measurements – Blood pressure cycling can be scheduled automatically or started manually, as determined by the choice

Auto

selected by the the monitor, the

button. When you turn on

Auto

setting defaults to “X”,

but it remembers the previous setting. Press the

Auto

button once to return to the previous setting, or press it repeatedly to select a new interval. Or choose “X” for manual operation. Wait 10 seconds for the selected Auto value to stop flashing. If any value other than “X” is selected, the first automatic measurement will begin 20 seconds after the Auto LED stops flashing.

If you press

BP Start/Cancel

between automatically timed measurements, the cuff will begin to inflate immediately and the monitor will record a new set of measurements. The manual measurement will not interfere with the automatic timing unless the next automatic measurement is scheduled to occur within 30 seconds of the end of the manual measurement.

Pressing

BP Start/Cancel during a blood

pressure measurement will cause the cuff to deflate immediately, and the reading is canceled. The trend data for that reading will show as dashes “---” on the screen and in the printout.

Both Systolic and Diastolic blood pressures are displayed on the front panel. During measurement, the Systolic display shows the cuff pressure as it pumps up and steps down. Mean Arterial Pressure (MAP) is displayed on the screen (upper left) only if it is enabled in the Advanced Configuration menu.

Note: If the language setting is configured to

Chinese, you can configure the Alternate BP field to display MAP or blood pressure in kPa on the screen (upper left).

Note: MAP is calculated using the formula: one

third of the Systolic reading plus two thirds of the Diastolic reading.

Principles of Operation – The Atlas Monitor

uses an ‘oscillometric’ method to measure the patient’s blood pressure. This technique is characterized by inflating the blood pressure cuff until the arterial blood flow is occluded, and then slowly releasing the cuff pressure and monitoring the oscillations in the cuff air pressure due to arterial blood flow pulses. While the cuff is deflating, the amplitude of the oscillations are recorded versus cuff pressure. The systolic measurement is found by noting the cuff pressure when the pre-maximum oscillations are at a fixed percentage of the maximum oscillations. Similarly, the diastolic pressure is found by noting the cuff pressure when the post-maximum oscillations are at a fixed percentage of the maximum oscillations.

If the initial cuff pressure is insufficient to occlude the arterial blood flow, the instrument will re-inflate the cuff by approximately 40 mmHg. During deflation, the instrument may also re-inflate in order to re-measure the oscillations.

6.2 Connecting the SpO2 Fingerclip Sensor

The SpO sensor to the patient, making sure it is in the correct orientation. Connect the sensor to the monitor. The sensors come in sizes for adult and child. A range of sensors are available to attach to the patient’s finger, toe, nose, forehead, or ear.

Fingerclip sensors – Pulse and oximetry are measured from a fingerclip sensor. There are several sizes of fingerclip sensors, and they come in both reusable and disposable styles. Sensors come in sizes for adults and children. There are also sensors available that use the toes, forehead, ear or nose as the measurement sites.

Connecting – Clip the sensor to the patient’s finger. Make sure the cable to the sensor is attached properly to the SpO

Warning

Note: Avoid excessive ambient light, which can

Note: Prolonged use of the pulse oximetry probe

fingerclip sensor provides the means to take the oximetry and pulse readings. Clip the fingerclip

Note: Atlas Monitors are available with either

Nellcor or Nonin compatible SpO The sensors are not interchangeable between these two types of systems. If you fail to see any SpO

or Plethysmograph readings, check

to see that you have not inserted the wrong brand of sensor into the Atlas Monitor.

Performance factors –Many factors may degrade the performance of the pulse oximeter, as

connector.

indicated by a lowered rise of the Plethysmograph display (next to SpO

display). These include:

• Excessive ambient light, particularly

: Do not place the fingerclip sensor on an arm that is also being used for blood pressure monitoring. Blood pressure cuff inflation during SpO inaccurate SpO

measurement will cause

results and false alarms.

fluorescent light.

• Excessive patient movement.

• Excessive duration on one finger.

• Cold hands/digits.

• Electrosurgical interference.

• Arterial catheters, blood pressure and fusion

lines.

• Moisture in the sensor. affect sensor performance, by keeping the fingerclip sensor and sensor site covered with an opaque material.

• Improperly attached sensor.

• Incorrect sensor for the patient.

• Poor patient perfusion.

• Venous pulsations.

• Anemia or low hemoglobin concentrations.

may require you to change the location of the probe. Move it to another finger every few hours. Monitor skin condition and circulation in the finger.

• Cardiovascular dyes, such as methylene blue.

• Fingernail polish.

• Strongly pigmented skin.

systems.

Correct placement of reusable Nellcor SpO2 fingerclip sensor

6.3 Connecting the ECG Electrodes

Prepare the patient’s skin, attach the leads to the electrodes, place the electrodes in the three (or five) correct locations, and plug the ECG cable into the monitor. The heart rate alarm usually operates in conjunction with the ECG measurement.

Connecting - Connect the ECG leads to the patient:

• Thoroughly clean the patient’s skin at each place where an electrode will be attached. Shave if necessary. Attach lead wires to the electrodes before applying them to the patient.

• Apply the electrodes to the patient as shown in the diagrams for 3 wire and 5 wire locations.

• Attach the ECG cable to the front panel connector.

• Support the ECG cable so it does not stress the electrode wires, the ECG cable connectors, or electrodes. Ensure that conductive parts of the electrodes and their connectors do not contact any other conductive parts, including earth. Verify that the monitor is configured for the

•

number of leads you are using.

•

You should now see an ECG waveform scrolling across the upper part of the monitor screen. If you do not, check the wires, electrodes and cable.

3 wire or 5 wire - Either 3 wire or 5 wire ECG leads can be used with the Atlas Monitor. You must select either the 3 wire or 5 wire setting in Advanced Configuration are using. To change the lead set, press the

Date/Time

will display the Advanced Configuration menu. Scroll down to the ECG lead set selection using either choose 3 wire or 5 wire. After you make the choice, press the Trend Advanced Configuration menu.

You can quickly determine whether the monitor is set for 3 wire or 5 wire ECG: press the

Select

indicator in the upper right corner of the screen.

button, then press

Select

button. Press the

button and watch the lead selection

to match the leads you

button again to exit the

Trend

Set

button to

. The screen

Lead

• For 3 wire,

II, III

• For 5 wire,

II, III, aVR, aVL, aVF, V

3 Wire Lead Colors & Symbols

Lead

Right arm White Left arm Black

Left leg Red

5 Wire Lead Colors & Symbols

Lead

Right arm White Left arm Black Left leg Red Right leg Green Chest Brown V White

Interference factors - If an electrosurgical unit is going to be 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. Also ensure that the electrosurgical return cable (neutral) is well attached and making good contact with the patient.

Impedance Respiration – In some patients, impedance respiration detection may be inadequate using the standard ECG electrode placement. In these cases, change the LA and RA electrode placement to the mid-axillary line on each side of the chest as shown in the illustration.

Lead Select

Lead Select will cycle through I,

will cycle through

AHA

RA LA

Red Yellow

Green

AHA

RA LA LL RL

Red Yellow Green Black

IEC

R L

R L F N C

ECG

LLLL

ECG

One of six V Lead electrode placement sites for the fifth lead.

Correct placement of 3 wire and 5 wire ECG electrodes

V-Lead Placement – The brown V-lead connector can be placed at one of six standard locations:

• V1 –Right Sternal border, fourth intercostal

space.

• V2 – Left sternal border, fourth intercostal

space.

• V3 –Between V2 and V4, midpoint between

the two, in a line that joins all three.

• V4 – Mid-clavicular line, fifth intercostal

space.

• V5 – Anterior axillary line, fifth intercostal

space.

• V6 – Mid-axillary line fifth intercostal

space.

Note: If you wish to see a cascading ECG

waveform from the upper line to the lower line on the display, you must set the Second trace source to ECG in the Advanced Configuration menu.

ECG

LLLL

Alternate ECG electrode placement for Impedance Respiration

6.4 Connecting the Temperature Probe (Models 622xx & 623xx)

The Temperature measurement comes from a skin probe.

Atlas Monitor models 622xx and 623xx can measure skin temperature with the supplied surface probe. Follow the package instructions for probe placement.

Fahrenheit or Celsius - Temperature is displayed in °F or °C. The current setting is indicated next to the temperature measurement.

You can change the Temperature units in Advanced Configuration:

• Press the

• Press

Trend.

• Use either

Temperature units.

• Use either and °°°°C.

• Press

Trend

Date/Time

button.

Select

button to select

Set

button to change between °°°°F

to exit Advanced Configuration.

No alarm - The temperature display is an indicator only; there is no alarm for temperature. If the monitor is unable to read a temperature properly, dashes will appear in place of the temperature measurement.

Note: The temperature display is blank at power-

up and will remain blank until a temperature probe is detected.

6.5 Connecting the End Tidal CO2 Sample Tube (Model 623xx)

ETCO Attach the cannula to the patient’s nose. Connect the sample tube to the watertrap and plug the watertrap into the monitor. – The watertrap should be replaced in accordance with the institution’s infection control policies for disposables. An alarm sounds if the watertrap becomes full.

End Tidal CO with a cannula adapted for nasal use, and a watertrap. These items are supplied with the monitor. CO medical supply vendors for direct connection to ET tubes and LMAs.

Connecting the CO

• Place the cannula below the patient’s nose so

• Direct the tubing along both cheeks and over

• Bring the tubing together beneath the patient’s

• Join the CO

• Plug the watertrap into the front panel of the

is measured with a sample tube using a nasal cannula adapted for sidestream CO2 measurement.

is collected through a sample tube

connectors are available from

Note: When ETCO

on the left and the CO right above the CO

is displayed, the breath rate is

concentration is on the

waveform.

Watertrap – The watertrap should be replaced in accordance with the institution’s infection control policies for disposables. If the watertrap is full, an

airway -

that the tubes enter the nostrils.

alarm will sound and a message reading “Replace

watertrap” will appear on the screen. The

message “CO

watertrap occluded” may also

appear. If this happens, change the watertrap.

the patient’s ears.

The watertrap should be handled as a biohazard after use.

chin and slide the plastic ring up to the chin for a snug and comfortable fit.

watertrap to the sample line.

monitor at the connector for CO

analysis. Be

sure to push it in until it is firmly seated.

Correct placement of CO2 nasal cannula

7 Using The Menus

Two menus are provided for configuring the Atlas Monitor. The items on these menus are choices that you might make to configure the Atlas Monitor to your needs when you first place it into service. You may change the date/time setting for Daylight Savings/Standard time, or when traveling across time zones. You might change the Advanced Configuration settings when monitoring different patient health issues, or for different display preferences.

7.1 The Set Date and Time and Other Options Menu

Pressing the manage several settings. The Time and Date can be set using the Options menu provides a list of buttons that have special functions.

Setting Date and Time - You will need to set the Date and Time when:

• First unpacking and installing the monitor.

• Adjusting to different time zones.

• Starting or ending Daylight Savings Time.

To set the Date and Time:

• Press the

clock icon) to get to the Set Date and Time menu.

• Use either Select

highlight the day, month, year, hours, minutes and seconds.

• Use either

values for each setting.

• Stop pressing the

value is shown.

• Use either

highlight the next item you want to set, and repeat.

• Press the

the waveform screen when the date and time are correct.

The monitor now has the correct Time and Date, and the monitor’s internal battery will retain these settings, even after turning off the power and unplugging the monitor.

Date/Time

Date/Time button (labeled with a

button on the bottom right of the monitor will access a menu from which you can

button to sequentially

Set

button to scroll through the

Set

button when the correct

Select button sequentially to

Date/Time

button again to return to

Select and Set buttons. The Other

Other Options menu - the buttons:

• Trend

• Lead Select

• Print (or Freeze)

CO2/RESP ALARMS Off

•

(model 623xx only) which have been described earlier, serve a second function, which is listed on this menu.

The

Trend button accesses the Advanced

Configuration menu, which allows other settings to be changed.

Lead Select

The

button accesses the Service Mode screen, which allows a qualified technician to service various aspects of the monitor.

Note: Service Mode is never used by the clinician

and is not to be used in any patient-oriented operation of the monitor.

The

button (or

Freeze

in those monitors without a printer) saves the current alarm settings as set by the user. These saved alarm settings are used instead of the factory defaults when the instrument is turned on.

CO2/RESP ALARMS Off

The process of CO

Reset.

button initiates the

Exiting the Set Date and Time Menu - To exit the menu, press the

Date/Time button again.

Set Date and Time

15 Jan 1999 19:18:50

Adjust using the Select and Set buttons

Press button to exit

Other Options

Press button

Trend

Adjust using the Select and Set buttons

Trend

Lead Select

/Resp Alarms

Lead Select Print

Alarm silence duration

ECG lead set

ECG sweep speed

ECG bandwidth

Initial cuff pressure

Monitor MAP

Second trace selection

Temperature units

Respiration sweep speed

Press the Trend button to exit

Advanced Configuration

Service Mode

automatic

Reset

Language

ECG gain

CO2 units

For

English 60 seconds automatic 5 wire 25mm/s Monitor 160 mm/hg Yes

12.5 mm/s mmHg

Select

PULSE

Off

Set

PULSE

Off

Set

Trend

Lead Select Print

Atlas Monitor model 623xx showing the Advanced Configuration

and the Set Date and Time menus

7.2 The Advanced Configuration Menu

The Advanced Configuration menu provides options to configure monitoring settings for your specific needs. Access Advanced Configuration by pressing the Date/Time

What’s it for? - This menu allows the user to choose other options available with the monitor. You may never need to change Advanced Configuration settings. Most of the settings are satisfactory for normal use as shipped from the factory. Some users may make a few adjustments when they first set up the monitor, then may discover no further need to make changes.

Advanced Configuration menu - To get to the Advanced Configuration menu:

• Press the the Set Date and Time and Other Options menu.

• Press the Advanced Configuration menu.

• Press either

Date/Time button. This will access

Trend

button to enter the

Select

button to highlight the

parameter you want to change.

• Press either you want for the parameter.

• Press either parameter, or

• Press the waveform display.

Advanced Configuration Details

lists all of the Advanced Configuration menu items and the possible settings. Some of these options may not appear on the monitor you are using, depending on the model.

button, then the

Set button to choose the value

Select

Trend to exit the menu and return to

Trend

button.

to move on to the next

The table

Advanced Configuration Menu Settings

Advanced Configuration Item

Possible settings

Factory

default

Language

Silence duration

ECG gain

ECG lead set

ECG speed

ECG bandwidth

Initial pressure

MAP or Alternate BP field (when language setting is configured to Chinese only) Second trace selection (621xx) ECG or SpO2 ECG Second trace selection (622xx) ECG, SpO2 or Respiration ECG Second trace selection (623xx) ECG, SpO2, Respiration or CO2 CO2

Temperature units (622xx and 623xx) ºF or ºC

Respiration speed (622xx and 623xx)

units (623xx)

English, French, Canadian French, Spanish, German, Portuguese, Italian, Chinese, Japanese

60, 90, or 120 seconds

automatic, or 10mm/mV

3 wire or 5 wire

6.25, 12.5, or 25 mm/s

Monitor or Extended

120, 140, 160, 180, 200, 240, 280 mmHg 160 mmHg

Yes or No

MAP, kPa, or nothing

12.5, 6.25, 3.125 mm/s 6.25 mm/s

mmHg, %, or kPa

English

90 seconds

automatic

3 wire

25 mm/s

Monitor

ºF

mmHg

7.2.1 Advanced Configuration Menu Settings

The Advanced Configuration menu offers settings to customize the Atlas Monitor to suit your needs. Not all options are available on all models.

Language - Factory default will be set for the dominant language used in your country. Of course, if you are more familiar with another language, the monitor provides a choice of eight.

Silence duration - The large

Silence button on

the right edge of the monitor allows you to turn off all of the alarms simultaneously – for a short duration lasting either 60, 90, or 120 seconds.

ECG gain - When 10 mm/mV gain is chosen, the height of the vertical ruler that appears to the left of the ECG waveform is 10 mm high and indicates a 1 mV amplitude. When automatic gain is selected the ruler height will vary, but it will always indicate a 1 mV signal size. The ruler size is automatically increased or decreased to scale to a particular set of waves, but the vertical line still indicates the same amplitude of 1 mV.

ECG lead set - The Atlas Monitor allows for both 3 wire and 5 wire ECG lead sets.

ECG speed - The amount of ECG waveform shown on the CRT is determined by the trace speed. A slower trace speed means more seconds of waveform are shown on the CRT.

ECG bandwidth - The ECG waveform can be displayed and printed in either Monitor or Extended bandwidth. Monitor mode allows for a clearer picture of the waveform by filtering out noise. Extended mode, usually used with cardiac paced patients, shows the finer nuances of ECG waveform facilitating the detection of conditions such as ischemia.

Initial pressure – Specifies the initial blood pressure cuff pump-up pressure. If this pressure is not enough to complete a blood pressure measurement, the cuff will re-inflate with a higher target pressure and re-attempt the measurement.

MAP - The Mean Arterial Pressure can be displayed on the screen, above the ECG waveform. This measurement is calculated from the Systolic and Diastolic readings. The choices are Yes (MAP is displayed) or No (MAP is not displayed).

Alternate BP field (when language setting is configured to Chinese only) – You can display

MAP or blood pressure in kPa on the screen (upper left) above the ECG waveform. The choices are MAP, kPa, or nothing. If you choose “nothing” then, neither MAP nor kPa will be displayed on the screen.

Second trace selection – All models offer a choice of displaying a second line of ECG waveform or displaying the SpO

waveform.

Model 622xx adds the option of displaying Impedance Respiration as the second trace. Model 623xx adds the option of displaying CO concentration as the second trace.

Temperature units - In models 622xx and 623xx, temperature can be displayed as either Celsius °

°C, or Fahrenheit °°°°F.

°°

Respiration speed – Models 622xx and 623xx allow the Impedance Respiration or CO

waveforms to be displayed at three different speeds.

units – The concentration of Carbon Dioxide

can be expressed in millimeters of mercury (mmHg), percent (%), or kiloPascals (kPa). The values displayed for percentage and kiloPascals are calculated from the mmHg partial pressure based upon current barometric conditions.

8 Cleaning and Maintaining the Atlas Monitor

No harsh chemicals should be used for cleaning the monitor. A mild detergent solution works well. Care should be taken to keep liquids away from the monitor and its connecting parts. Servicing should be performed by a qualified technician at 6, 12, and 24-month intervals.

Cleaning – The Welch Allyn Atlas Monitor may be wiped clean with a slightly damp cloth and a mild detergent solution. Never immerse the monitor in any type of liquid. As necessary, the monitor may be cleaned with an appropriately diluted, non-staining disinfectant solution.

Warning: Take care that no water or other

liquids enters any of the connectors. If this should occur, dry them with warm air. Then check all the monitoring functions to be sure everything works properly.

Blood pressure cuff – The blood pressure cuff should be cleaned by sponging with a damp cloth.

Connections – Cables and hoses can be wiped with a damp cloth and mild detergent. Do not immerse the hoses or the cables.

Fingerclip sensor – The reusable SpO

fingerclip sensor may be cleaned with isopropyl alcohol and may be sterilized with ethylene oxide (EtO), cold cycle. Do not immerse the sensor.

Temperature sensors – The temperature probes and probe covers should be handled as biohazard material after use and must be sterilized.

ETCO

watertrap The watertrap should be

replaced in accordance with the institution’s infection control policies for disposables. If the

watertrap is full, an alarm will sound and a message reading “Replace CO

watertrap” will

appear on the screen. The message “CO watertrap occluded” may also appear. If this happens, change the watertrap The watertrap should be handled as a biohazard after use.

Reset - The monitor keeps track of when

the CO

subsystem was last reset. If the monitor

has been unused for a long time, is just being set up, or if it has been more than one month since its last reset, you may see a message on the screen indicating that a CO

Reset is

recommended.

To perform a CO

• Press the

Reset:

Date/Time button on the lower

right of the monitor.

• The Set Date and Time and Other Options menu will be displayed.

• Select the Reset CO

CO2/RESP ALARMS Off

the

selection by pressing

button.

• This will access a screen titled CO

• Follow the instructions on the screen.

• You will be told to remove the CO

watertrap

• You will be told to install the CO Scrubber into the CO

watertrap socket.

The Scrubber looks similar to a watertrap, but is filled with white granules. It is included with model 623xx. The Scrubber must be attached to the watertrap. Remove the tubing from the watertrap and attach the Scrubber to the watertrap. Insert the watertrap/Scrubber combination into the watertrap socket.

• There may be a message indicating a 5 minute Warming Up period.

• The system will report that it is Sampling.

Reset.

• The system will then report Reset Complete.

• Remove the watertrap/Scrubber from the watertrap socket.

• Detach the Scrubber from the watertrap and reattach the tubing.

• Replace the watertrap in the watertrap socket.

• Press

Trend to return to the normal

screen.

Scrubber - The CO

Scrubber has an

indefinite lifespan when used at the normal rate of one CO

reset every month and one CO2

calibration every 6 months. The Scrubber can be disposed of as normal non-hazardous waste.

Servicing schedule – Servicing of the monitor should be done at 6 month intervals by a qualified service technician. It is important to maintain this schedule to assure that the measurements are accurate and that the unit is working properly at all times. There are different service requirements at 6, 12, and 24 month periods, as documented in the Technical Service Manual.

Battery Replacement (Models 622xx and 623xx) - If the monitor will not run for at least

an hour on battery after being plugged in to AC for at least 24 hours, the battery may need to be replaced. It is covered by warranty for the first two years of ownership. If you are beyond the warranty period, you can replace the battery by the following method:

• Turn off the monitor and disconnect all patient sensors

• Remove the AC power cord from the rear of the monitor

• Using a TORX-10 screwdriver, remove the two screws retaining the battery cover

• Tip the monitor and slide the battery out being careful not to stress the wires

• Press the locking clip release lever on the

plug that attaches the battery wires to the Atlas and pull gently to remove the plug from the Atlas

• Connect the replacement battery to the connector in the Atlas. The plug can only attach one way. The locking clip must seat on the Atlas connector

• Slide the battery into the unit, routing the wires around the edges of the battery and being careful not to pinch the wires

• Replace the battery door and secure the two screws

• Plug the Atlas back into AC power for at least 24 hours to fully charge the battery

• You may return the Atlas to service (on AC power) immediately

The battery is a non-spillable lead-acid battery. In the USA, call 1-800-SAV-LEAD for instructions on how to recycle. For International users, contact your local authorities on recycling.

9 Unpacking and Installing the Atlas Monitor

When you first unpack the monitor, you should check it for shipping damage. Then verify that you have all the accessories, documentation, and supplies.

Unpacking – As you carefully unpack the monitor, inspect it for damage from shipping. If you find any damage, notify the shipper immediately. Save the packing material. It will be useful if you have to return the monitor for any reason. Next, remove the inner packing material. Remove the plastic film that covers the front panel.

Check the accessories - check all the accessories against this list:

All models:

• 1 large adult blood pressure cuff.

• 1 SpO

fingerclip sensor with cable (Nonin

or Nellcor).

• 1 power cord.

• 1 blood pressure hose.

• 1 ECG 3 wire lead set.

• 1 set of disposable ECG electrodes.

• (optional) 1 roll of printer paper.

• User manual.

Model 622xx: all the above plus:

• Temperature skin probe.

Model 623xx: all the above plus:

• 1 End Tidal CO

• 1 CO

watertrap.

scrubber.

nasal cannula.

• 1 roll of printer paper.

Installing – The monitor can be installed and used on a table top, shelf or other platform. This surface should be level and stable. The Atlas Monitor can optionally be mounted on a rigid Welch Allyn custom mobile stand or wall mount.

Warning

Warning: Keep the monitor away from liquids

Turn the Power On – When the monitor is turned on, all alarms are enabled at the default limits, and there is no trend data. If plugged into AC power, an indicator AC~ shows the unit is using AC power. The unit goes through an initial self-check. When this is complete, the instrument is ready to use.

message indicating that a CO recommended.

To perform a CO

: Do not use a standard hospital

mobile IV stand. The pole may tip over.

that might spill on it.

Reset - On model 623xx, you may see a

reset is

Reset:

• Press the

Date/Time

button on the lower

right of the monitor.

• The Set Date and Time and Other Options menu will be displayed.

• Select the Reset CO pressing the

CO2/RESP ALARMS Off

selection by

button.

• This will access a screen titled CO

Reset.

• Follow the instructions on the screen.

• You will be told to remove the CO

watertrap

• You will be told to install the CO Scrubber into the CO

watertrap socket.

the watertrap. Insert the watertrap/Scrubber combination into the watertrap socket.

• There may be a message indicating a 5 minute Warming Up period.

• The system will report that it is Sampling.

• The system will then report Reset Complete.

• Remove the watertrap/Scrubber from the watertrap socket.

• Detach the Scrubber from the watertrap and reattach the tubing.

• Replace the watertrap in the watertrap socket.

Trend

• Press screen.

to return to the normal

10 Appendix A: Technical Specifications for the Atlas Monitor

A.1 General Specifications:

Size 33 x 24 x 23 cm (13 x 9.5 x 8.75 inches) Weight 4.3 kg (9.5 lb.) (model 621xx)

6 kg (13.2 lb.) (models 622xx & 623xx) Display Type Cathode Ray Tube / LED Display Size 275 x 125 mm (10.8 x 4.9 inches) Screen Displays (numeric) Heart Rate (ECG)

MAP (mean arterial pressure)

BP in kPa (option for Chinese language setting

only)

Respiration Rate (impedance respiration, models

622xx and 623xx)

Respiration Rate (ETCO

concentration (model 623xx only)

Screen Displays (waveform) ECG – one line, or cascading to two lines, with 1

mV scale bar on first line

SpO

Impedance Respiration (models 622xx and 623xx)

ETCO

(model 623xx)

Numeric Displays 3-digit green LED: Pulse

3 digit red LED: Systolic

3 digit red LED: Diastolic

2-digit red LED: SpO

4-digit green LED: Temperature (models 622xx

and 623xx) Trend Data Date/Time, Heart Rate, Systolic, Diastolic, MAP,

SpO

Respiration Rate, Temperature (models 622xx and

623xx)

concentration (model 623xx)

Trend Sampling Sample at every BP cycle, or every 15 minutes Trend Capacity 144 samples, maximum time span 36 hours Power Voltage 100 to 240 VAC Power Frequency 50 - 60 Hz Power Current 1 A Storage Temperature

-20° to 50° C Storage Humidity 15 to 95% non-condensing Storage Altitude -170 to 1700 meters Operating Temperature

10° to 40° C Operating Humidity 15 to 90% non-condensing Operating Altitude -170 to 1700 meters

, model 623xx only)

Equipment Type Class 1 (model 621xx)

Class 1, Internally powered (model 622xx, 623xx)

Type CF

Continuous operation Moisture Resistance IPX2 (IEC EN529) Flammable Gases Equipment not suitable for use in the presence of a

Flammable Anesthetic Mixture.

A.2 SpO2 - Nonin (all models) or Nellcor (optional Models 622xx & 623xx)

SpO2 Range 40 to 100% Measurement Method Functional saturation SpO2 Accuracy

Pulse Range 21 to 249 beats/minute Pulse Accuracy ±3 beats/minute or 3%, whichever is greater Plethysmograph 10 segments, vertical bar graph; proportional to

Alarms Low SpO2

Alarm range SpO2: 60 to 99%

Audible signals (pulse tone) Frequency tracks SpO2 level

Audible volume (pulse tone) 8 levels including OFF Update frequency – Nonin Three times per second Update frequency – Nellcor Every heart beat Sensor measurement wavelengths – Nellcor Red: 660 nm, nominal; Infrared: 920 nm, nominal

70 to 100%, ±2 digits (specified at 28° to 42° C

sensor temperature)

pulse volume

High and Low Pulse Rate (if ECG not active)

Pulse Rate alarms use ECG Heart Rate settings

when ECG not used

Used alone, pulse tone tracks SpO

Used with ECG, pulse tone tracks ECG Heart Rate

pulse

A.3 NIBP

Systolic Range 60 to 250 mmHg (8 to 33 kPa) Diastolic Range 30 to 160 mmHg (4 to 21 kPa) Mean Arterial Pressure (MAP) Range 40 to 190 mmHg Blood Pressure Accuracy Per AAMI SP10-1992 Clause 4.4.2

Efficacy study results using Auscultatory Method

as Reference Standard are available upon request. Heart Rate Range for Specified Accuracy 40 to 200 beats/minute

Display Numeric displays for Systolic, Diastolic and MAP

Cuff pressure displayed during measurement cycle

Data available in Trend display and printed report Method Oscillometric Control Manual and automatic control Automatic Intervals 1, 3, 5, 10, 15, 30, and 60 minutes Alarms High and Low Systolic

High and Low Diastolic

High and Low MAP (in mmHg) Alarm Ranges Systolic Low Limits: 60 – 245 mmHg

Systolic High Limits: 65 – 250 mmHg

Diastolic Low Limits: 30 – 150 mmHg

Diastolic High Limits: 35 – 155 mmHg

MAP Low Limits: 45 – 185 mmHg

MAP High Limits 50 – 190 mmHg Initial Cuff Pressure 120, 140, 160, 180, 200, 240, 280 mmHg - user

selectable Repeated Cuff Pressure Previous Systolic pressure + 40 mmHg Maximum Inflation Time 3 minutes (typical: <40 seconds) Inflation Over-Pressure Dump <300 mmHg Inflation Over-Pressure Dump Backup <330 mmHg

A.4 ECG

Heart Rate Range 21 to 249 beats/minute Heart Rate Accuracy Bandwidth, Normal Mode 0.5 to 40 Hz Bandwidth, Extended Mode 0.05 to 100 Hz Leads 3 wire or 5 wire, available in AHA or IEC colors Connector AAMI 6 pin Electrodes Disposable snap electrodes Display Sweep Speeds 6.25, 12.5, 25 mm/second Gain 10 mm/mV, and automatic gain with visual scale

Scale Reference Bar A fixed 1 mV reference bar is displayed with the

Lead Display Single, user selectable: I, II, III; or I, II, III, aVR,

Heart Rate Display Numeric Waveform Display One or two rows (cascading) of ECG waveform

Leads Off Condition Detected and displayed (selected lead only) Alarms High and Low Heart Rate

±3 beats/minute or ±3% whichever is greater

indicator

top ECG waveform for scaling of the waveform.

This is provided in place of a standardizing voltage.

aVL, aVF, V

display

Alarm Ranges Heart Rate Low Limits: 21 to 245 beats/minute

Heart Rate High Limits: 25 to 249 beats/minute Pulse Tone Constant frequency, ECG used alone;

Synchronized to SpO

used together, frequency varies with perfusion Input Impedance >2.5 Megohms at 10Hz Input Protection Defibrillator and Electrosurgery protected Defibrillator Recovery per EC13:1992 Clause

3.1.2.1a) Impedance Respiration/Leads Off Detection Current per EC13:1992 Clause 3.1.2.1b) Tall T Wave Rejection per EC13:1992 Clause

3.1.2.1c) Heart Rate Averaging Method per EC13:1992 Clause 3.1.2.1d)

Response to Change in Heart Rate per EC13:1992 Clause 3.1.2.1f) Time to Alarm for Tachycardia per EC13:1992 Clause 3.1.2.1g)

Pacemaker Display per EC13:1992 Clause 3.2.9.12 Pacemaker signals displayed as captured. Pacemaker Rejection per EC13:1992 Clause 3.1.4.1 Rejects all specified pacemaker signals, including

Pacemaker Rejection per EC13:1992 Clause 3.1.4.2 Rejects all specified pacemaker signals, including

<8 seconds

50nA max for RA ,LA, LL, V; 200nA max for RL

Rejects Tall T waves through 1.4 mV

Number of consecutively detected beats:

>12: Heart rate = 60/(average of last 12 detected

consecutive R-R intervals)

<12: Heart rate = 60/(average of the detected

consecutive R-R intervals)

Increasing from 80 to 120 beats/minute: 3 sec

Decreasing from 80 to 40 beats/minute: 9 sec

Waveform 4(a)

Amplitude: Average time to alarm:

0.5 mV 6.21 seconds

1.0 mV 50.2 seconds

2.0 mV 10.96 seconds

Waveform 4(b)

Amplitude: Average time to alarm:

1.0 mV 50.3 seconds

2.0 mV 12.06 seconds

4.0 mV 6.40 seconds

double paces, without over/undershoot.

Exception: Ineffectively paced QRS pattern may

cause a QRS to be rejected and not counted as a

pulse when the pace occurs very close to the R

wave.

double paces, with over/undershoot with the

exception of ±2 mV amplitude, 0.1 ms duration, 0.5

mV overshoot, time constant=100

pulse tone, ECG and SpO2

A.5 Printer (standard Model 623xx, optional Models 621xx & 622xx)

Printing method Direct thermal Printer type Thermal array Resolution Vertical: 8 dots/mm (203 dots/inch)

horizontal: 12 dots/mm (305 dots/inch) Printing speed 25 mm/second Chart position accuracy (dot to dot) Effective print width 54 mm ± 0.2 mm Paper capacity 100 foot roll of 58 mm paper, non printed grid Paper loading non-threading, drop-in from top of unit Time scale 25 mm/second Printout data Waveform: 15 second record of ECG; lead

Print timing Waveforms: 9 seconds prior to PRINT button

±5%

selected, gain setting, time scale

Waveform: 15 second record of selected second

waveform

Numeric: Systolic, Diastolic, MAP, ETCO

Respiration Rate, Temperature, Time and Date (as

configured)

press, 6 seconds after button press

Numeric data captured at time of button press

A.6 Impedance Respiration (Models 622xx & 623xx)

Measurement Technique Trans-thoracic impedance Leads RA to LA (Lead I) Current 50 nA max Range 5 to 100 breaths/minute Accuracy Alarms High and Low Respiration Rate Alarm Ranges Respiration Low limits: 5 to 99 breaths/minute

Waveform Display One line Respiration waveform Respiration Rate Display Numeric Display Sweep Speeds 3.125, 6.25, 12.5 mm/second

±3 breaths/minute

Respiration High limits: 6 to 100 breaths/minute

A.7 Temperature (Models 622xx & 623xx)

Range 17° to 50°C (62.6° to 122° F) Accuracy ±0.2°F, ±0.1°C plus probe tolerance. Resolution ±0.1°F or ±0.1°C Compatibility YSI 400 series probes Alarms None provided

Temperature Display Numeric Units Fahrenheit or Centigrade

A.8 Backup Battery (Models 622xx & 623xx)

Type Sealed Lead Acid (leak proof) Duration BP reading every 5 minutes; 15 second strip printed

every 5 minutes:

1 hour (model 622xx)

45 minutes (model 623xx) Charging Automatic when AC power connected Charge time 80% capacity: 5 hours

100% capacity: 24 hours Alarms Low battery

Very low battery

Nearly depleted battery Low Battery Alarm 10 minutes remaining; chime every 2 minutes and

CRT message Very Low Battery Alarm 5 minutes remaining; chime every minute and CRT

message Nearly depleted Battery Alarm 1 minute remaining; trend data printed; continuous

alarm and CRT message; system shut down, BP

pressure released

A.9 I/O Communications (Models 622xx & 623xx)

Connector RJ45 socket on rear of case Nurse Call Signal Normally open relay contacts from pins #1 and #8

of RJ45 connector. Contacts closed when any alarm

is audible. Contacts rated for 1 A, 24 VAC. Serial Interface Bi-directional RS232; 9600 baud, 8 bit, 1 stop bit,

no parity, no flow control Protocols Pangea SIO command interface

Welch Allyn serial communications protocol

A.10 End Tidal CO2 (Model 623xx)

Measurement Method Sidestream Measurement Range 0 to 98 mmHg

Percentage and kPa conversions are based on

current barometric pressure.

Measurement Accuracy Ambient temperature 15ºC to 45ºC:

0 to 40 mmHg: ±3 mmHg;

41 to76mmHg: ±8% of reading;

77 to 99 mmHg: ±10% of reading.

Ambient temperature 5ºC to 15ºC and 45ºC to

55ºC:

0 to 40 mmHg: ±4 mmHg;

41 to76mmHg: ±10% of reading;

77 to 99 mmHg: ±12% of reading.

Accuracy unspecified for breath rates >30

breaths/minute. Standard Conditions Automatic compensation to comply with BTPS.

BTPS CO

= (internal measurement) x 1.03

Breath Rate Range 5 to 100 breaths/minute Breath Rate Accuracy

±1 breath/minute or ±5%, whichever is greater Display Units mmHg, %, kPa; user selectable Resolution 1 mmHg Alarms High and Low CO2 measurement

High and Low Respiration Rate Alarm Ranges Low CO2 Limits: 0 to 97 mmHg

High CO

Limits: 1 to 98 mmHg

Low Respiration Limits: 5 to 99 breaths/minute

High Respiration Limits: 6 to 100 breaths/minute Display Sweep Speed 3.125, 6.25, 12.5 mm/second Start-up Time <10 seconds to acquire waveform; <5 minutes to

full operating specifications Display Waveform, Respiration Rate and CO2 measurement

displayed on CRT and printer Interfering Gas Compensation: Nitrous Oxide or Oxygen Concentration Greater than 50% No automatic compensation provided, user must apply equations provided.

O2 concentration >50%, no N2O:

Actual CO

= (displayed measurement) x 1.03

O concentration >50%:

Actual CO

= (displayed measurement) x 0.952

Stability Unaffected by humidity or temperature within

specified operating range; unaffected by moisture

in sampled air Rise Time 0.58 second rise time; 0.59 second fall time Delay Time 5.4 seconds Total System Response Time 5.99 seconds Sound Pressure Without tubing: 50.2 dB

With tubing: 48 dB Diversion Flow Nominal 175 ml/minute Adverse Effects of Testing per ISO 9918:1992

System remains within specification Clauses 50, 60, 61, 62; EN864:1997 Clauses 50, 101, 102, 103

Adverse Effects of Electrocautery, Electrosurgery, Defibrillation, X-ray, IR, Conducted Transients, Magnetic Fields, RFI

Clinical Utility within 8 seconds of electrosurgery

and defibrillation;

Meets EN60601-1-2 for EMC and emissions;

Not suitable for use in MRI

11 Appendix B: ElectroMagnetic Compatibility (EMC)

Electromagnetic Emissions

IEC 601-1-2

This Welch Allyn Atlas Monitor is suitable for use in the specified electromagnetic environment. The purchaser or user of the Welch Allyn Atlas Monitor should assure that it is used in an electromagnetic environment as described below:

Emissions Test Compliance Electromagnetic Environment

Radiated and conducted RF emissions

CISPR 11

Harmonic emissions IEC 1000-3-2

Voltage fluctuations/ flicker emissions IEC 1000-3-3

Class A This Welch Allyn Atlas Monitor is suitable for use in

domestic establishments and in establishments directly connected to the low voltage power supply network which supplies buildings used for domestic purposes.

Group 1 This Welch Allyn Atlas Monitor uses RF energy only for its

internal function. Therefore, the RF emission is very low and not likely to cause any interference in nearby electronic equipment.

Complies This Welch Allyn Atlas Monitor is suitable for use in

establishments directly connected to a public low voltage power supply network.

Complies

This Welch Allyn Atlas Monitor is suitable for use in establishments directly connector to a public low voltage power supply network.

Electromagnetic Immunity

IEC 601-1-2

Immunity

Test

IEC 601-1-2

Test level

Compliance

level

Electromagnetic Environment

Electrostatic discharge (ESD) IEC 1000-4-2 Radiated RF IEC 1000-4-3

Conducted RF IEC 1000-4-6

Electrical fast transient/burst IEC 1000-4-4

Surge IEC 1000-4-5

Voltage dips, short interruptions and voltage variations on power supply input lines IEC 1000-4-11

6 kV contact 8 kV air

Non-life-supporting equipment

3 V/m 80 MHz to 2 GHz

All equipment

3 V 150 kHz to 80 MHz

2 kV for power supply lines

1 kV for input/output lines >3m 1 kV differential mode 2 kV common mode 0 % Un for 0.5 cycle 40 % Un for 5 cycles 70 % Un for 25 cycles 0% Un for 5 sec

Floors are wood, concrete, or ceramic tile, or floors are covered with synthetic material and the relative humidity is at least 50 percent

Field strengths from fixed RF transmitters are less than 3 V/m, as determined by an electromagnetic site survey*. Portable and mobile RF communications equipment are used no closer to any part of the Welch Allyn Atlas Monitor, including cables, than the DISTANCE listed in the Recommended Separation Distances Table. For portable RF sources not listed, the DISTANCE can be estimated using Equations A or B, according to the frequency of the transmitter. Interference may occur in the vicinity of equipment marked with the following symbol:

Mains power quality is that of a typical commercial and/or hospital environment.

Mains power quality is that of a typical commercial and/or hospital environment. If the user of the Welch Allyn Atlas Monitor requires CLINICAL UTILITY during power mains interruptions, it is recommended that the Welch Allyn Atlas Monitor be powered from an uninterruptible power supply.

Power frequency (50/60 Hz) magnetic field IEC 1000-4-8 *Field strengths from fixed transmitters, such as cellular phone and land mobile base stations, amateur radio, AM and FM radio broadcast, and TV broadcast cannot be estimated accurately. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be performed. If the measured field strength exceeds the RF compliance level above, observe the Welch Allyn Atlas Monitor to verify normal operation in each use location. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the Welch Allyn Atlas Monitor, shielding the room in which the Welch Allyn Atlas Monitor is used, and/or adding filters to signal and/or power lines.

Note: These are guidelines. Actual conditions may vary.

10 A/m

Power frequency magnetic fields are at levels characteristic of a typical location in a typical commercial and/or hospital environment.

Recommended Separation Distances

IEC 601-1-2

RF Source Typical Rated

Power (watts)

Microcellular phone, CT1, CT2, CT3 10 mW 3 DECT cellular phone, wireless information technology equipment (modems, LANs) Cellular phone, hand-held (USA) 600 mW 2 Cellular phone, hand-held (e.g. GSM and NMT, Europe; DECS 1800) 2

Walkie-talkie (rescue, police, fire, maintenance) 5 3 Cellular phone, bag 16 10 Mobile radio (rescue, police, fire) 100 24 For transmitters using frequencies below 800 MHz, the DISTANCE can be estimated using Equation A:

3.5 d = ---------------- √‾P A) 3

For transmitters using frequencies between 800 MHz and 2 GHz, the DISTANCE can be estimated using Equation B.

7 d = ------------------ √‾P B) 3

Where P is the power rating of the transmitter in watts (W) according to the transmitter manufacturer.

250 mW 2

DISTANCE

(meters)

4 7

12 Appendix C: Calibration and Maintenance

The Atlas Monitor must be serviced by authorized Welch Allyn personnel or agents at 6 month intervals. Maintenance requirements are specified for 6 month, 12 month and 24 month service intervals. The monthly CO

Reset operation can be performed by the user.

Service Interval Maintenance Requirements

Every month CO2 Reset Every 6 months CO2 Calibration

Button test LED test Printer test

Every 12 months All 6 month maintenance requirements

BP Calibration ECG Calibration Battery test

Every 24 months All 6 month maintenance requirements

All 12 month maintenance requirements ECG signal gain & noise test Temperature measurement check with calibrated probe

measurement check and functional tests

SpO

13 Appendix D: Accessories for the Welch Allyn Atlas Monitor

Part number

Blood Pressure Accessories

5200-01 Adult Cuff Assembly (cuff, latex-free bladder and connectors) 5200-02 Large Adult Cuff Assembly (cuff, latex-free bladder and connectors) 5200-03 Small Cuff Assembly (cuff, latex-free bladder and connectors) 5200-10 Extra-large Cuff Assembly (cuff, latex-free bladder and connectors) 5200-04 Adult Bladder (latex-free, includes connector) 5200-05 Large Adult Bladder (latex-free, includes connector) 5200-06 Small Bladder (latex-free, includes connector) 5200-11 Extra-large Adult Bladder (latex-free, includes connector) 5082-59 Adult Cuff 5082-61 Large Adult Cuff 5082-63 Small Cuff 5082-64 Extra-large Adult Cuff 5200-07 Coiled Pressure Hose (8 feet, latex-free) 5200-12 Straight Pressure Hose (8 feet, latex-free) 5200-08 Calibration "T" Connector

Nonin Pulse Oximetry Accessories

5200-40 Finger Clip Sensor (Adult) with 9 foot cable 5200-56 Finger Clip Sensor (Pediatric) with 9 foot cable 5200-41 Ear Clip Sensor 5200-42 Flex Sensor 5200-44 Reflectance Sensor 5200-45 Reflectance Sensor Holder (box of 10) 5200-46 Adult Finger Flexiform Sensors (single use, box of 10) 5200-47 Pediatric Finger Flexiform Sensors (single use, box of 10) 5200-50 Sensor Attachment Tape 5200-51 Hydrogel Tape Strips 5200-52 Extension Cable (3 feet) 5200-54 Finger Clip Sensor with 3 foot cable 5200-55 Extension Cable (9 feet)

Nellcor Puritan Bennett Pulse Oximetry Accessories

DS-100A DURASENSOR Adult Oxygen Transducer EC-8 Extension Cable (8 feet) D-YS DURA-Y Oxygen Transducer (1 sensor, 40 wraps) D-YSE Ear Clip (use with Dura-Y sensor) D-YSPD PediCheck Pediatric Spot Check (use with Dura-Y sensor) D-25 OXISENSOR II Adult (single use, case of 24) D-25L OXISENSOR II Adult, long cable (single use, case of 24) D-20 OXISENSOR II Pediatric (single use, case of 24)

Description

I-20 OXISENSOR II Infant (single use, case of 24) R-15 OXISENSOR Adult Nasal (case of 24) OXICLIQ A Adult Oxygen Transducer, use with OC-3 cable OXICLIQ P Pediatric Oxygen Transducer, use with OC-3 cable OC-3 OxiCliq Sensor Cable OXI - A/N OXIBAND Adult/Neonatal Transducer (1 sensor, 50 wraps) OXI - P/I OXIBAND Pediatric/Infant Transducer (1 sensor, 50 wraps) RS-10 Reflectance Oxygen Transducer (6 sensors, 6 headbands) SRC-2 Portable Oximetry Tester

Power Cord Accessories

5200-110 Line Cord (US / Canada / Japan version) 5200-111 Line Cord (European version) 5200-112 Line Cord (United Kingdom version) 5200-113 Line Cord (Australian version) 5200-114 Line Cord (Swiss version) 5200-115 Line Cord (South American version)

Mounting Accessories

6200-30 Mobile Stand 6200-31 Wall Mount

Miscellaneous Accessory Items

6200-40 Printer Paper – Case (25 rolls) 6200-41 Replacement battery 6200-42E Operator Manual (English version) 6200-42F Operator Manual (French version) 6200-42G Operator Manual (German version) 6200-42S Operator Manual (Spanish version) 6200-42I Operator Manual (Italian version) 6200-42P Operator Manual (Portuguese version) 6200-42C Operator Manual (Chinese version) 6200-42J Operator Manual (Japanese version) 6200-44 Inservice Training Videotape (English, NTSC version) 6200-43E Technical Service Manual (English) 6200-45 Monitor Carrying Case

Thermometry Accessories

6200-15 Temperature Probe-Surface

ECG Accessories

6200-01 ECG Patient Cable (3 lead AHA) 6200-02 ECG Patient Cable (5 lead AHA) 6200-03 ECG Patient Cable (3 lead IEC) 6200-04 ECG Patient Cable (5 lead IEC) 6200-05 ECG Leads, 3 Lead (AHA) 6200-06 ECG Leads, 5 Lead (AHA)

6200-07 ECG Leads, 3 Lead (IEC) 6200-08 ECG Leads, 5 Lead (IEC) 6200-09 Disposable Electrodes (package of 3) 6200-10 Disposable Electrodes (package of 5) 6200-11 Disposable Electrodes (package of 30)

ETCO2 Accessories

6200-20 ETCO2 Water Trap (package of 5) 6200-21 ETCO2 Scrubber 6200-22 ETCO2 Adult Nasal Sample Line 6200-23 ETCO2 Adult Nasal Sample Line (package of 10)

14 Appendix E: Troubleshooting

E.1 Diagnosing Atlas Monitor Problems

E.1.1 Blood Pressure

PROBLEM:

Blood pressure readings are inaccurate.

RECOMMENDED ACTIONS:

Squeeze all air out of cuff and repeat measurement. Check the cuff for correct size for the patient – check that the index mark falls within the range markings. Check the cuff for proper fit – there should be room to insert no more than two fingers between the deflated cuff and the patient’s limb. A cuff applied too loosely may result in artificially high readings. Check the cuff for proper alignment – there is a mark indicating where the cuff should align over the patient’s brachial artery. Check the patient:

The blood pressure should be taken on a bare arm. Place patient with midpoint of upper arm at heart level. This is approximately at the mid-axillary line at the 4 Have patient lie down. Patient must be motionless. Excess movement, shivering, seizure could interfere with the measurement. If the patient is sitting, the back and legs should be supported. The lower arm should be passively supported. i.e. sitting in patient’s lap. Unusual physiology, obesity, or poor circulation could be preventing Atlas Monitor from detecting the pulse. Cardiac arrhythmia could interfere with the measurement.

Have the unit recalibrated.

PROBLEM:

Blood pressure cannot complete reading in 3 minutes.

RECOMMENDED ACTIONS:

• Safety mechanisms automatically abort blood pressure measurements when a reading has not been

obtained within 3 minutes; Check for leaks in tubing and cuff, and at connections. Check the cuff for correct size for the patient – check that the index mark falls within the range markings. Check the cuff for proper alignment – there is a mark indicating where the cuff should align over the patient’s artery. Check the patient:

Must be motionless. Excess movement, shivering, seizure could interfere with the measurement. Unusual physiology, obesity, or poor circulation could be preventing Atlas Monitor from detecting the pulse.

Cardiac arrhythmia could interfere with the measurement. Set Initial pressure higher if many repressurization steps are necessary due to high patient blood pressure.

intercostal space.

PROBLEM:

Blood pressure automatic timing stops.

RECOMMENDED ACTIONS:

Safety mechanisms automatically stop the timed blood pressure measurements when the Atlas

•

Monitor repeatedly fails to make a measurement within 3 minutes

Determine the reason that the measurements are failing and restart the timed cycle. Press

Start/Cancel

to manually start a measurement; Auto timing will resume.

;

E.1.2 CO2

PROBLEM:

Pump does not start.

RECOMMENDED ACTIONS:

Watertrap not fully inserted.

not selected as Second trace selection in Advanced Configuration menu.

PROBLEM:

Display does not start - waveform, Respiration Rate, CO

RECOMMENDED ACTIONS:

Watertrap not fully inserted.

not selected as Second trace selection in Advanced Configuration menu.

PROBLEM:

Long delay in starting/stabilizing waveform display or numeric displays.

RECOMMENDED ACTIONS:

• CO

function is specified to begin display within 10 seconds, but not to reach full specification for up

to 5 minutes. Restriction in sampling tubing. Poor placement of nasal cannula in patient’s nose. Patient breathing orally. Patient breathing very shallowly.

PROBLEM:

readings inaccurate.

RECOMMENDED ACTIONS:

Pressure or suction being applied to sampling tubing – check for flow interference from ventilation, oxygen, anesthetic supplies. High concentration of oxygen or nitrous oxide requires compensation calculation – see section

End Tidal CO2 (Model 623xx).

A.10 Poor placement of nasal cannula in patient’s nose.

not displayed.

Patient breathing orally. Patient breathing very shallowly.

exhaust port on rear of unit blocked or obstructed.

Have the unit recalibrated.

PROBLEM:

pump sounds change – speeding up, slowing down.

RECOMMENDED ACTIONS:

Flow restrictions or leaks in tubing.

exhaust port on rear of unit blocked or obstructed.

E.1.3 Displays

PROBLEM:

CRT display is misaligned, twisted, or tilted.

RECOMMENDED ACTIONS:

Have CRT mounting adjusted by Service.

PROBLEM:

Extraneous marks on CRT display – extra lines, overlapping numbers.

RECOMMENDED ACTIONS:

Turn the power off and back on; this will clear the display.

PROBLEM:

An LED segment/display is not functioning.

RECOMMENDED ACTIONS:

Have unit repaired.

E.1.4 ECG

PROBLEM: ECG waveform baseline is drifting on screen. RECOMMENDED ACTIONS:

Change ECG Bandwidth from Extended to Monitor in Advanced Configuration menu. Check connections: ECG trunk cable at Atlas Monitor socket. ECG leads at trunk cable. ECG leads at electrodes. Check for proper placement of electrodes on patient. Check for good contact of electrodes to patient – shave, clean if necessary. Minimize patient motion.

PROBLEM: Heart Rate is not being displayed by ECG. RECOMMENDED ACTIONS:

If ECG waveform is displayed: Wait 20 seconds for heart rate to be determined and displayed.

Select different leads for display (wait 20 seconds after selecting). Some leads may sense QRS complexes that have too low of an amplitude for the Heart Rate detection circuit. Evaluate ECG waveform – excess noise, low QRS amplitude, arrhythmia could interfere with determining stable heart rate.

If ECG waveform is not displayed: Check connections: ECG trunk cable at Atlas Monitor socket. ECG leads at trunk cable. ECG leads at electrodes.

Check for proper placement of electrodes on patient. Check for good contact of electrodes to patient – shave, clean if necessary.

PROBLEM:

ECG waveform is noisy or erratic.

RECOMMENDED ACTIONS:

Change ECG Bandwidth from Extended to Monitor in Advanced Configuration menu. Change ECG Gain to Automatic in Advanced Configuration menu. If using a 3 wire lead set, ensure that ECG lead set is set to 3 wire in Advanced Configuration menu. Check connections: ECG trunk cable at Atlas Monitor socket. ECG leads at trunk cable. ECG leads at electrodes.

Check for proper placement of electrodes on patient.

Check for good contact of electrodes to patient – shave, clean if necessary. Eliminate patient movement. Move ECG cables away from other equipment and possible interference sources. Evaluate interference sources:

Models 622xx, 623xx – unplug AC and run on battery power to determine whether interference is

from power line.

Move RFI sources and radio transmitters away from Atlas – see Appendix B: ElectroMagnetic

Compatibility (EMC) for recommended separation distances. Turn off fluorescent lights.

PROBLEM:

ECG Leads Off fault not reported.

RECOMMENDED ACTIONS:

ECG Leads Off is only detected and reported on the Lead that is currently being monitored.

PROBLEM:

ECG waveform, heart rate corrupted by Electrosurgery or Electrocautery.

RECOMMENDED ACTIONS:

• Monitor is specified to return to Clinical Utility within 8 seconds of discontinuance of electrosurgery;

Heart Rate display may require up to 20 seconds to stabilize. Verify that electrosurgery neutral (return) line is making good contact with patient. Route ECG cables as far as possible from electrosurgery site and neutral line.

PROBLEM:

ECG Heart Rate significantly differs from SpO

pulse rate.

RECOMMENDED ACTIONS:

ECG heart rate may be inaccurate due to arrhythmia, cabling problems. SpO2 pulse rate may be inaccurate due to poor perfusion, poor blood flow to limb, light interfering with sensor, patient movement. Manually measure pulse by

arterial palpation to determine which instrument is reading incorrectly and

troubleshoot that instrument further.

PROBLEM:

Pacemaker signals not visible on ECG trace.

RECOMMENDED ACTIONS:

• Pacemaker signals are displayed as captured; the Atlas Monitor does not have an option to present

symbolic indication of pacemaker signals; Change ECG Bandwidth to Extended in Advanced Configuration menu. Change ECG Gain to Automatic in Advanced Configuration menu.

PROBLEM:

Heart Rate inaccurate on pacemaker patient.

RECOMMENDED ACTIONS:

Certain unusual artifacts of pacemaker signals may be counted as pulse signals. Connect SpO

sensor and

monitor displayed Pulse rate as an adjunct measurement. In patients with pacemakers that are not successfully capturing the pulse, certain timing interactions between pace signal and pulse can cause an occasional additional pulse beat to be counted.

E.1.5 Impedance Respiration

PROBLEM: Cannot detect impedance respiration. RECOMMENDED ACTIONS:

Move leads to mid-axillary positions as shown in Connecting the ECG Electrodes. Check connections: ECG trunk cable at Atlas Monitor socket. ECG leads at trunk cable. ECG leads at electrodes.

Welch Allyn Atlas Service manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Table Of Contents

Safety Information

Warnings, Cautions, and Notes

Service Information

1 How This Manual Works

2 Monitoring the Patient

4 Capturing and Displaying Trend Data

5 Using Print and Waveform Freeze

6 Connecting to the Patient

8 Cleaning and Maintaining the Atlas Monitor

9 Unpacking and Installing the Atlas Monitor