Welch Allyn Atlas 6200 User manual

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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)............................................................................................................. 8

2.2 M

2.3 M

2.4 M

2.5 M

2.6 M

ONITORING SPO

ONITORING HEART RATE AND THE ECG WAVEFORM................................................................................ 13

ONITORING IMPEDANCE RESPIRATION (MODELS 622XX & 623XX) ........................................................... 16

ONITORING TEMPERATURE (MODELS 622XX & 623XX).............................................................................18

ONITORING CO

, PULSE RATE AND THE SPO2 WAVEFORM.......................................................................10

, RESPIRATION RATE, AND THE ETCO

WAVEFORM (MODEL 623XX) .............................20

3 MANAGING THE ALARMS........................................................................................................................ 22

3.1 P

ATIENT ALARMS.......................................................................................................................................... 26

3.1.1 Factory Default Patient Alarm Settings.............................................................................................. 27

3.2 M

3.3 I

3.4 B

EASUREMENT INVALID ALARMS ................................................................................................................28

NSTRUMENT PROBLEM ALARMS................................................................................................................... 29

ATTERY ALARMS (MODELS 622XX & 623XX)............................................................................................ 30

4 CAPTURING AND DISPLAYING TREND DATA.................................................................................... 32

5 USING PRINT AND WAVEFORM FREEZE............................................................................................. 34

5.1 T

HE PRINTER – LOADING PAPER AND TROUBLESHOOTING ...........................................................................36

6 CONNECTING TO THE PATIENT............................................................................................................. 38

6.1 C

6.2 C

6.3 C

6.4 C

6.5 C

ONNECTING THE NIBP CUFF....................................................................................................................... 40

ONNECTING THE SPO2 FINGERCLIP SENSOR ................................................................................................ 43

ONNECTING THE ECG ELECTRODES ...........................................................................................................45

ONNECTING THE TEMPERATURE PROBE (MODELS 622XX & 623XX).......................................................... 49

ONNECTING THE END TIDAL CO2 SAMPLE TUBE (MODEL 623XX).............................................................. 50

7 USING THE MENUS...................................................................................................................................... 51

7.1 T

HE SET DATE AND TIME AND OTHER OPTIONS MENU................................................................................. 51

7.2 T

HE ADVANCED CONFIGURATION MENU...................................................................................................... 53

7.2.1 Advanced Configuration Menu Settings.............................................................................................. 55

8 CLEANING AND MAINTAINING THE ATLAS MONITOR.................................................................. 57

9 UNPACKING AND INSTALLING THE ATLAS MONITOR ..................................................................59

10 APPENDIX A: TECHNICAL SPECIFICATIONS FOR THE ATLAS MONITOR................................ 61

11 APPENDIX B: ELECTROMAGNETIC COMPATIBILITY (EMC)........................................................ 69

12 APPENDIX C: CALIBRATION AND MAINTENANCE........................................................................... 73

13 APPENDIX D: ACCESSORIES FOR THE WELCH ALLYN ATLAS MONITOR ............................... 74

14 APPENDIX E: TROUBLESHOOTING ....................................................................................................... 77

15 INDEX.............................................................................................................................................................. 91

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

concentration, Heart Rate,

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.

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 – Tells you about something that could hurt the patient or hurt the operator.

Caution – Tells you about something that could damage the monitor.

Note – Tells you other important information.

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 compatibil ity perfo rmance of thi s devic e.

• Do not operate this product with MRI (Magnetic Resonance Imaging) equipment.

• It is the operator’s responsibili ty to set alarm lim its as approp ria te for each ind iv idua l patien t.

• 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 protectiv e conduc tor in the ins tal lat ion 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 (ETCO2) and breath rate measurement and alarm capability are active

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

. 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 regulato ry com pliance : 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

, and in several other

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 illustrat ions

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 your 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~ indicator, located below the screen,

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 Features

621SO 621SP

622SO 622SP 622NO 622NP

623SP 623NP

Power on - The Power On/Standby button is in the lower right corner. When you firs t 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 defaul t va lu es.

• all the trend data (history) is cleared.

SpO2, SpO2 waveform Pulse Rate NIBP: Systolic, Diastolic, MAP ECG waveform, heart rate Printer (optional) All features of model 621xx, plus: Impedance Respiration Patient Temperature Battery Operation PC Communication Remote Nurse Call Printer (optional) All features of model 622xx, plus: End Tidal CO from ETCO

and Breath Rate

Printer (standard)

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

Silence

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

ALARM Off button. There are four ALARM Off

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.

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

Trend button to see the tre nd

Set

button. Push Trend again to return to the waveform display. The monitor will hold up to 144 lines of trend data, which is 36 hours if data is captured every 15 minutes.

Printing - A printer option is available with both models 621xx and 622xx, and is a standard model 623xx feature. Push the

Print button to print what

is on the screen. If the waveforms are displayed on the screen, the

Print 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.

Each side responds to the adjacent Select and Set

The right side has measurements displayed in green and red LEDs.

buttons used for setting alarm limits. Each side also has

ALARM Off buttons, which are used to

suspend (turn off) individual alarms.

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 next alarm, shown by small

Select button, it cycles to the

HI and LO indicators,

and the measurement display flashes the current alarm setting. The

Set 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 a limit, you’ll need to press the

Select button

and start over again.

Press the Select button to go to the next measurement alarm. Press it several times to cycle out of all the alarm settings and go back to the normal measurement mode.

Silencing alarms - The Silence button silences all alarms for 60, 90 or 120 seconds. This silence

period can be set to one of these three choices in Advanced Configuration. During the silence period, there will be no audible alarms, even for measurements that go outside the limit range for the first time. However, any measurement that is outside the limits you set will flash.

Trend data - Press the Trend button to see the trend data. The waveform display is replaced by the first screen of trend data, starting with the most recent measurements at the top. View the rest of the trend data by pressing the

Set button up

or down.

The trend memory can hold up to 144 lines of measurements, which is 36 hours of data if taken at 15 minute intervals.

Printing - The Print button prints what you see on the screen - the waveforms (including all current measurements) or the screen with trend data. When you push the button, waveforms are printed starting from 9 seconds before you pushed

Print button until 6 seconds after you pushed

the the button for a total printout of 15 seconds. The other information on the printout is cap ture d at the time that the

Freeze

the button is labeled

Print button is pressed.

– If your monitor does not have a printer,

Freeze. Pressing Freeze

stops the waveform display for 10 seconds, and then the readout resumes.

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 la ter .

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 BP

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, whether the

Auto 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.

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

Silence button at the right side of the

blue 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 ALARM S Of f 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.

Trend data – Trend data is captured at each

blood pressure cycle, whether it is started automatically or manually. If the

Auto 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.

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.

Atlas Monitor showing NIBP displays, controls and tubing

connector

Setting alarm limits - To set the Systolic and Diastolic alarm limits, use the

Select and Set

buttons on the right side of the monitor to follow these steps:

• Press the

SpO Diastolic

• Each push of

Select button to cycle through

LO, then Systolic HI and LO, and

HI and LO.

Select moves you to the next

limit. Stop at the limit you want to set. The measurement and the

HI or LO LED will

flash, indicating which limit is being changed.

• Press the Set button up or down to raise or

lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).

• Press the

Select button again to go to the

next limit, or press it several times until none of the measurements flash and no

LO LEDs are lit. The instrument is now in

HI or

its normal measurement mode. (If you do not press any button for 10 seconds, the instrument will automatically revert to its normal measurement mode).

2.1.1 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.”

• Press the left

• Press the

Set to choose “Yes” or “No.”

Trend 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

Silence button at the right side of the instru-

blue ment. This will silence all alarms for 60, 90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outs ide the set limits will flash.

measured directly.

Setting alarm limits – If MAP is displayed, you can set the alarm limits, using 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 HI and LO, Heart Rate HI and

LO, Respiration HI and LO (models 622xx

or 623xx)

LO.

, then (model 623xx) CO

HI and

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

HI or LO will flash,

indicating which limit is being changed.

• Press the Set button up or down to raise or lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).

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

or LO indicators are lit. The instrum ent 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).

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

Atlas Monitor waveform display showing location of MAP reading

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.

sensors are available as accessory items. The oximetry pulse

% display on the

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 th at the rea ding 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.

• 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

pulse tone is in synchrony with the

SpO

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

Silence button at the right side of the

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.

Atlas Monitor showing SpO2 displays, controls, and sensor connector

Setting alarm limits - To set the SpO2 alarm

limits, use the

Select and Set buttons on the

right side of the monitor to follow these steps:

• Press the

SpO Diastolic

• Each push of

Select button to cycle through

LO, then Systolic HI and LO, and

HI and LO.

Select moves you to the next

limit. Stop at the limit you want to set. The measurement and the

HI or LO LED 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

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: 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

SpO2 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

Silence button at the right side of the

blue 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 HR

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.

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 step s:

• Press the left Select button to cycle through

MAP HI and LO, Heart Rate HI and LO, Respiration 623xx)

LO.

HI and LO (models 622xx or

, then (model 623xx) CO

HI and

• Each push of Select moves you to the next

limit. Stop at the limit you want to set. The measurement and

HI or LO will flash,

indicating which limit is being changed.

• Press the Set button up or down to raise or

lower the alarm limit. (When you come to the end of the range, the numbers will stop changing).

• Press the Select button again to go to the

next limit, or press it several times until none of the measurements flash and no

LO indicators are lit. The instrument is now

HI or

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).

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:

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.

Advanced Configuration

ECG setting Possible values

ECG gain automatic |

10 mm/mV

ECG lead set 3 wire | 5 wire ECG speed 6.25 | 12.5 | 25 mm/s ECG bandwidth Monitor | Extended Second trace

selection

You can change the ECG settings in Advanced Configuration:

• Press the

• Press

Date/Time button.

Trend.

• Use either Select button to highlight ECG

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

• Use the

Set button to change any of these

values.

• Press

Trend to exit Advanced Configuration

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 | SpO2 | Respiration | CO

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.

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

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 cascad ing 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.

movement, making it less accurate than ETCO

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

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 button at the right side of the instru-

blue ment. This will silence all alarms for 60, 90, or 120 seconds, depending on the setting selected in Advanced Configuration. However, any measurement still outs ide the set limits will flash.

To suspend the respiration rate alarms, press the

CO2/RE S P ALARM S Of f (RES P 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.

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

Configuration:

• Press the

• Press

Date/Time button.

Trend.

• Use either Select button to highlight Second

trace selection.

• Use either

from the choices ECG, SpO

• Press

Set button to choose Respiration

, Respiration,

(model 623xx).

Trend to exit Advanced Configuration.

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.

Impedance Respiration is sensitiv e to patient

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 step s:

• Press the left Select button to cycle through MAP HI and LO, Heart Rate HI and LO, Respiration only) CO

HI and LO, then (model 623xx

HI and LO.

• 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,

the end of the range, the numbers will stop changing).

• Press the Select button again to go to the

next limit, or press it several times until none of the measurements flash and no

LO indicators are lit. The instrument is now

HI or

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

2.5 Monitoring Temperature (Models 622xx & 623xx)

The Temperature, measured on the skin surface with a skin sensor, is displayed in °F or °C, as chosen 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

Date/Time button.

Trend.

• Use either Select button to highlight

Temperature units.

• Use either

• Press

Set button to choose °

Trend to exit Advanced Configuration.

°F or °°°°C.

°°

Note: The temperature display is blank at power-

on until a temperature probe has been detected.

Atlas Monitor showing Temperature display and connector

2.6 Monitoring CO2, Respiration Rate, and the ETCO2 Waveform

(Model 623xx)

The lower trace displays the ETCO2 waveform, although you can display Impedance Respiration, ECG, or SpO Respiration Rate appears on the left. You can set alarm limits for both of these measurements.

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

What is displayed – In the Atlas Monitor model 623xx, one of the lower trace alternatives to the cascading ECG includes the CO

waveform. The

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 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.

measured by detecting absorption in this band. The IR absorption in the CO

wavelength band

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 the effect that water vapor has on the IR absorption characteristics of CO During normal sidestream operation, CO

molecules.

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.

To suspend both the CO

alarms, press the

CO2/RES P ALAR MS Of f

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.

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 CO

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

gas has a unique absorption

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

molecules present in

molecule’s

gas concentration is

Atlas Monitor model 623xx showing ETCO2 waveform display,

controls, and watertrap connector

Setting alarm limits –To set the CO2 and Respiration 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 HI and LO, Heart Rate HI and LO, Respiration

HI and LO, then CO

HI and LO.

• 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

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).

HI or

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 turn off (suspend) the audible signal for any patient alarm or measurement invalid alarm. 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 Alar m 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.

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.

Suspending Alarms

“Off” button

label

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

Note: To remove suspension, press the ALARMS

Off

button again. Remember, suspended

alarms remain suspended until you press the

ALARMS Off button again. They do not time

out automatically. Alarms are not suspended at power up, but an alarm will not sound until valid measurements have begun.

Suspends

measurements

ETCO2 and Respiration Rate

MAP

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, 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:

Alarm Conditions

Alarm type Normal operation Silenced Suspended

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.

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

Numbers flash No audible alarm

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

Affected measurement blank No audible alarm No message on screen

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

HI 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 again to move to another

press 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 button

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.

The ALARMS Off buttons to suspend alarms are shown in the table:

Suspending Alarms

“Off” button

label

Suspends

measurements

HR ALARMS Heart Rate CO2/RESP ALARMS (RESP

ETCO2 and Respiration

Rate ALARMS) SpO2 ALARMS Oximetry and Pulse Rate BP ALARMS Systolic, Diastolic and

MAP

Press the appropriate ALARMS Off button to

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. To remove suspension, press the ALARMS Off button again and the light will turn off.

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.

3.1.1 Factory Default Patient Alarm Settings

Measurement Low alarm default High alarm default

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 SpO

Respiration Rate 7 breaths/minute 30 breaths/minute CO

85% -

25 mmHg 60 mmHg

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.

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

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

sample line is kinked.

• one of the ECG leads has fallen off the

patient.

• the ETCO

watertrap is full and must be

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.

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

ALARMS Off button. This will erase the

message from the screen and prevent further audible alarms and messages for this condition. The dashes “---” will be solid, not blinking.

The ALARMS Off buttons are:

HR ALARM S Of f for heart rate.

•

SpO2 ALAR MS Off for oximetry levels and

•

pulse rate.

BP ALARM S Of f for blood pressure.

•

RES P ALARM S Of f for respiration rate

•

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

CO2/RE S P ALARM S Of f, and it suspends

alarms for respiration rate and CO

Note: The

Temperature measurement never

levels.

produces an audible alarm. If the temperature probe disconnects from the patient, the display is replaced by solid dashes “---”.

Silencing alarms – You can silence the audible alarm with the

Silence button for a short period.

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

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 contac t the Welch Allyn Technical Service Department).

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 appropr ia te

ALARMS Off button to prevent this alarm from

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

Silence

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.

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 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

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.

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.

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 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 shut ting off if there is any trend data that has not been printed yet.

Note: Atlas Monitor model 621xx does not have

a battery option

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.

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

Viewing trend data - To see trend data, press

Trend button below the screen. The latest

the measurements are shown at the top of the screen. Scroll through the trend data with either

Set

button. Return to the waveform screen by pressing

Trend again. The system will

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

Auto button

located below the blood pressure indicators. Pressing the

Auto button cycles to the next

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

Auto

setting is greater than 15 minutes, Trend data will be captured every 15 minutes.

A blood pressure cycle is manually started by pressing the

BP Start/Cancel button. All trend

data is captured when this happens. Also, a blood pressure cycle that has been canceled by pressing the

BP Start/Cancel button is shown

by dashes in the trend screen.

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 off.

Invalid or missing trend data – Invalid data or measurements that are not activ e are disp lay ed by dashes in place of the data, on both the Trend screen and the printout.

Trend Data Capacity

Auto setting

(minutes)

1 2.4 3 7.2 512

10 24

15, 30, 60, X 36

Trend capacity

(hours)

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

Trend to display the data, then press Print. All

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

Atlas Monitor showing Trend display with associated controls

5 Using Print and Waveform Freeze

Pressing the Print button prints the waveforms (and current measurements) if the waveforms are displayed. If a screen of trend data is displayed, all the trend data is printed. Atlas Monitors without printers have a

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

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

Freeze.

Printing waveforms - To print the waveforms and the current measurements, press

Print while

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

Print button is pressed.

Printing trend data – To print trend data, press

Trend to view the data on the screen, then press Print. If trend data is displayed and you want to

print the waveforms, press the waveforms, then press

Trend to go back to

Print.

waveform starts again, automatically.

• Any patient alarm or instrument problem

alarm that affects the frozen display will end the freeze period.

Note: No data is lost during the freeze period.

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

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

waveforms. The bandwidth choices in Advanced Configuration are:

• 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: 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 has a

Freeze button. Pressing this button halts the

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.

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.

• Ten seconds after you press

Freeze, the

Note: It is normal for the ECG baseline to wander

slightly in Extended bandwidth.

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.

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.

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

Atlas Monitor showing paper being loaded

6 Connecting to the Patient

The main patient connections are for NIBP, SpO2, and ECG. Atlas Monitor models 622xx and 623xx 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.

. 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

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.

readings will

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.

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

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 CIRCUMFERENCECUFF

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 prefe rre d blood pressur e 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

Correct placement of NIBP pressure cuff

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

Auto 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 se lec t 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.

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-m easure the oscillations.

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: 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

6.2 Connecting the SpO2 Fingerclip Sensor

The SpO2 fingerclip sensor provides the means to take the oximetry and pulse readings. Clip the fingerclip 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, foreh ead, 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

connector.

Warning: 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

Note: Avoid excessive ambient light, which can

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

Note: Prolonged use of the pulse oximetry probe

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.

measurement will cause

results and false alarms.

Nellcor or Nonin compatible SpO

systems.

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

display). These include:

• Excessive ambient light, particul ar ly

fluorescent light.

• Excessive patient movement.

• Excessive duration on one finger.

• Cold hands/digits.

• Electrosurgical int erfer enc e.

• Arterial catheters, blood pressu re and fus ion

lines.

• Moisture in the sensor.

• Improperly attached sensor.

• Incorrect sensor for the patient.

• Poor patient perfusion.

• Venous pulsations.

• Anemia or low hemoglobin concentrations.

• Cardiovascular dyes, such as methylene blue.

• Fingernail polish.

• Strongly pigmented skin.

Note: Atlas Monitors are available with either

Correct p lacement of re usable Nellc or 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 config ured 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.

• For 3 wire,

II, III

• For 5 wire,

II, III, aVR, aVL, aVF, V

Lead Select will cycle through I,

3 Wire Lead Colors & Symbols

Lead AHA IEC

Right arm White Left arm Black

Left leg Red

RA LA

Red Yellow

Green

5 Wire Lead Colors & Symbols

Lead AHA IEC

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

RA LA LL RL V

Red Yellow Green Black White

R L

R L F N C

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

to match the leads you

are using. To change the lead set, press the

Date/Time button, then press Trend. The screen

will display the Advanced Configuration menu. Scroll down to the ECG lead set selection using

Select button. Press the Set button to

either choose 3 wire or 5 wire. After you make the choice, press the

Trend button again to exit the

Advanced Configuration menu.

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

Select

button and watch the lead selection

Lead

indicator in the upper right corner of the screen.

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.

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.

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 measurem ent.

You can change the Temperature units in Advanced Configuration:

• Press the

• Press

• Use either Select button to select

Temperature units.

• Use either and °°°°C.

• Press

Date/Time button.

Trend.

Set button to change between °

Trend to exit Advanced Configuration.

°F

°°

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)

ETCO2 is measured with a sample tube using a nasal cannula adapted for sidestream CO2 measurement. Attach the cannula to the patient’s nose. Connect the sample tube to the watertrap and plug the watertrap into the monitor. The watertrap must be replaced after every six hours of use. An alarm sounds if the watertrap becomes full.

End Tidal CO2 is collected through a sample tube with a cannula adapted for nasal use, and a watertrap. These items are supplied with the monitor. CO

connectors are available from

medical supply vendors for direct connection to ET tubes and LMAs.

Connecting the CO2 airway -

• Place the cannula below the patient’s nose so that the tubes enter the nostrils.

• Direct the tubing along both cheeks and over the patient’s ears.

• Bring the tubing together beneath the patient’s chin and slide the plastic ring up to the chin for a snug and comfortable fit.

• Join the CO

watertrap to the sample line.

• Plug the watertrap into the front panel of the

monitor at the connector for CO

analysis. Be

sure to push it in until it is firmly seated.

Note: When ETCO2 is displayed, the breath rate is

on the left and the CO right above the CO

Watertrap – The watertrap should be replaced

concentration is on the

waveform.

after every 6 hours of use. If the watertrap is full, an alarm will sound and a message reading “Replace CO screen. The message “CO

watertrap” will appear on the

watertrap occluded”

may also appear. If this happens, change the watertrap.

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 Date/Time button on the bottom right of the monitor will access a menu from which you can manage several settings. The Time and Date can be set using the Options menu provides a list of buttons that have special functions.

Select and Set buttons. The Other

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

Date/Time button (labeled with a

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

• Use either

Select button to sequentially

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

• Use either

Set button to scroll through the

values for each setting.

• Stop pressing the

Set button when the correct

value is shown.

• Use either

Select button sequentially to

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

• Press the

Date/Time button again to return to

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.

Other Options menu - the buttons:

• Trend

• Lead Select

• Print (or Freeze)

• CO

/RE S P ALARM S Of f (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 button accesses the Service

The 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.

Print button (or Freeze in those monitors

The 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 button initiates the

The process of CO

Reset.

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

Date/Time button again.

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 button, then the Trend button.

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

Date/Time button. This will access

the Set Date and Time and Other Options menu.

• Press the

Trend button to enter the

Advanced Configuration menu.

• Press either

Select button to highlight the

parameter you want to change.

• Press either

Set button to choose the value

you want for the parameter.

• Press either

Select to move on to the next

parameter, or

• Press

Trend to exit the menu and return to

the waveform display.

Advanced Configuration Details

- The table

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.

Advanced Configuration Menu Settings

Advanced Configuration Item Possible settings Factory

default

Language English, French, Spanish, German,

English

Portuguese, Italian, Chinese, Japanese

Silence duration 60, 90, or 120 seconds 90 seconds

ECG gain automatic, or 10mm/mV automatic

ECG lead set 3 wire or 5 wire 3 wire

ECG speed 6.25, 12.5, or 25 mm/s 25 mm/s

ECG bandwidth Monitor or Extended Monitor

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

MAP Yes or No No Second trace selection (621xx) ECG or SpO

ECG Second trace selection (622xx) ECG, SpO2 or Respiration ECG Second trace selection (623xx) ECG, SpO2, Respiration or CO

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

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

Respiration speed (622xx and 623xx)

CO2 units (623xx) mmHg, %, or kPa 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.

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).

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 tem pera ture probes and probe covers should be handled as biohazard material after use and must be sterilized.

ETCO

watertrap – The watertrap for ETCO

should be replaced after every six (6) hours of use. 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

pressing the

CO2/RESP ALARMS Off

selection by

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 CO2 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.

• The system will then report Reset

Complete.

• Remove the watertrap/Scrubber from the

watertrap socket.

• Detach the Scrubber from the watertrap

Reset.

and reattach the tubing.

• Replace the watertrap in the watertrap

socket.

• Press

Trend to return to the normal

screen.

Scrubber - The CO2 Scrubber has an

indefinite lifespan when used at the normal rate of one CO

reset every month and one CO

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

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

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 assu re tha t the measurements are accurate and that the unit is working properly at all times. The re are diffe ren t service requirements at 6, 12, and 24 month periods, as documented in the Technical Servic e 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

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: Do not use a standard hospital

mobile IV stand. The pole may tip over.

Warning: Keep the monitor away from liquids

that might spill on it.

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.

Reset - On model 623xx, you may see a

message indicating that a CO 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

pressing the

CO2/RESP ALARMS Off

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 CO2 watertrap socket.

reset is

selection by

Reset.

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.

• Press

Trend to return to the normal

screen.

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)

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 Temperatu re

10° to 40° C Operating Humidity 15 to 90% non-condensing Operating Altitude -170 to 1700 meters Equipment Type Class 1 (model 621xx)

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

Type CF

Continuous operation Moisture Resistance IPX2 (IEC EN529)

, model 623xx only)

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 SpO

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 Diastolic Range 30 to 160 mmHg 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 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 Tim e 3 m inutes (ty pic al : <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 Alarm Ranges Heart Rate Low Limits: 21 to 245 beats/minute

Pulse Tone Constant frequency, ECG used alone;

Input Impedance >2.5 Megohms at 10Hz

±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

Heart Rate High Limits: 25 to 249 beats/minute

Synchronized to SpO

pulse tone, ECG and SpO

used together, frequency varies with perfusion

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

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)

±5%

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

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) Print timing Waveforms: 9 seconds prior to PRINT button

press, 6 seconds after button press

Numeric data captured at time of button press

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

Measurement Technique Trans-thora cic im pedanc e 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

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 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

O2 concentration >50%, no N2O:

Actual CO

= (displayed measurement) x 1.03

than 50%

O concentration >50%:

No automatic compensation provided, user must apply equations provided.

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 suitab le for use in the spec if ied el ect rom agnetic 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 Atla s Moni tor is sui tab le for use in

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

Complies This Welch Allyn Atla s Moni tor is sui tab le 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 3

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

3 Mains power quality is that of a typical commercial

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.

and/or hospital environment.

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

3 Power frequency magnetic fields are at levels

characteristic of a typical loc at ion in a typica l 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.

250 mW 2

DISTANCE

(meters)

4 7

7 d = ------------------ √‾P B) 3

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

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)

Description

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)

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 v ers ion) 6200-42P Operator Manual (Portuguese versio n) 6200-42C Operator Manu al (Chinese versi on) 6200-42J Opera tor Manu al (Japane se vers ion ) 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: Troubl eshooting 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.

intercostal space.

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.

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 tim ed cycle. Pre ss BP

Start/Cancel

to manually start a measurement; Auto timing will resume.

;

E.1.2 CO

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

not displayed.

RECOMMENDED ACTIONS:

Watertrap not fully inserted. CO

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 ora lly . 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 Appendix A: Technical Specifications for the Atlas Monitor. Poor placement of nasal cannula in patient’s nose. Patient breathing ora lly . Patient breathing very shallowly.

CO2 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. CO

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 hea rt ra te.

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 sou rce s:

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

E.1.6 Power

PROBLEM: AC~ indicator not lit. RECOMMENDED ACTIONS:

• Atlas Monitor is specified to operate on any voltage from 100 to 240, and on 50 or 60 Hz – verify that

the service provided meets these requirements; Check proper connection of AC cord in Atlas Monitor appliance socket. Check proper connection of AC cord in wall outlet. Check proper power cord for local outlet standards. Check for tripped fuse or circuit breaker in AC service. If no problems are found, have the unit repaired.

PROBLEM:

Battery life is too short.

RECOMMENDED ACTIONS:

• Model 622xx is specified for 1 hour of battery life when operating ECG, SpO

blood pressure, with one blood pressure measurement every 5 minutes, and one printout every 30

minutes;

• Model 623xx is specified for 45 minutes of battery life when operating ECG, SpO

, and blood pressure with one blood pressure measurement every 5 minutes, and one printout

every 30 minutes;

• Battery charge time is specified as 24 hours to full charge, 5 hours to 80% charge;

• Battery charging occurs whenever unit is plugged in to AC power, whether it is operating or not;

Leave the Atlas Monitor plugged into AC power overnight and whenever the unit is not in use. Reduce the frequency of blood pressure measurements or printouts if practical. Charge Atlas for 24 hours and time battery life in use as specified above; if less than the specified battery life is provided, unit must be repaired.

, Temperature, and

, Temperature,

E.1.7 Printer

PROBLEM:

Printer does not print

RECOMMENDED ACTIONS:

If paper is not feeding out of printer:

Check that paper is installed with end of paper extending beyond door slot. Check that printer door is closed. Check for paper scraps jamming in roller and gears in printer door. Have unit repaired.

If paper is feeding out of printer, but it is blank:

Check that thermal side of paper faces the front of the Atlas Monitor. Replace paper with a new roll (preferably with a known good partial roll).

Check that the printer door is fully closed and latched. Have unit repaired.

PROBLEM:

Printing too light / too dark.

RECOMMENDED ACTIONS:

Replace paper with a new roll. Have unit repaired.

PROBLEM:

Printing blurred.

RECOMMENDED ACTIONS:

Check that printer door is properly closed. Replace paper with a new roll. Have unit repaired.

E.1.8 Sounds

PROBLEM:

Pulse or alarm sounds are too loud or too quiet when unit is turned on.

RECOMMENDED ACTIONS:

Sound levels can be changed and then set as default values – see section: Managing the Alarms

PROBLEM:

No pulse tone.

RECOMMENDED ACTIONS:

Check default volume setting for pulse tone – see section: Managing the Alarms. Press SpO

If SpO

volume up button several times.

is not active and ECG is active:

• Pulse tone will not sound until a stable Heart Rate is measured and displayed by ECG – this

can take up to 20 seconds;

If Heart Rate is displayed, have unit repaired.

If SpO

is active and ECG is active:

• Pulse tone will not sound until a stable heart rate is measured and displayed by ECG – this

can take up to 20 seconds;

If Heart Rate is displayed, have unit repaired.

If SpO

is active and ECG is not active:

If Pulse measurement is displayed, have unit repaired.

E.1.9 SpO

PROBLEM:

No SpO

reading or plethysmograph display.

RECOMMENDED ACTIONS:

Check whether the correct brand (Nellcor or Nonin) sensor is installed in the Atlas Monitor. The Atlas Monitor is equipped with one or the other, and the two brands of sensors are not interchangeable. Refer to your Atlas Monitor model number to determine which SpO Check connection of SpO Check connection of SpO

cable to monitor.

sensor to extension cable.

system you have.

Check patient: see section Connecting the SpO2 Fingerclip Sensor

E.1.10 Temperature

PROBLEM:

Temperature display is blank

RECOMMENDED ACTIONS:

No temperature probe has been detected: check connection at Atlas Monitor front panel.

PROBLEM:

Temperature display is inaccurate

RECOMMENDED ACTIONS:

Skin probe:

Verify proper placement on patient. Eliminate drafts or other airflow near probe – cover with tape.

Oral, rectal, skin probe:

Replace probe. Have unit repaired.

E.2 Atlas Monitor Error Messages

MESSAGE:

Altitude too high - CO2 unavailable Altitude too low - CO

MEANING:

The ambient barometric pressure is too high or low for Atlas Monitor ETCO

RECOMMENDED ACTIONS:

If you are not above 1700 meters, or below 170 meters below sea level, this indicates a failure or calibration error in the Atlas Monitor barometric sensing system. The unit must be repaired.

MESSAGE:

unavailable

functions.

Battery depleted - shutdown imminent

MEANING:

The battery (models 622xx and 623xx) is drained. The system will shut down within one minute.

RECOMMENDED ACTIONS:

If you have AC power available, plug in the Atlas Monitor. The battery will recharge automatically, whether the Atlas Monitor is turned on or off. The battery will return to 80% charge within 5 hours, and full charge within 24 hours. You will see the When operating on battery power, you can extend the battery life by reducing the number of Blood Pressure measurements and printouts.

MESSAGE:

AC~ symbol lit above the ECG cable connection.

Battery is missing

MEANING:

The Atlas Monitor cannot detect the battery (models 622xx and 623xx). It has been removed, or there has been a failure of the battery or its connections.

RECOMMENDED ACTIONS:

The battery is not user serviceable. The unit must be repaired. You can still operate the Atlas Monitor on AC power if available.

MESSAGE:

Blood pressure failure, service required

MEANING:

Atlas Monitor has detected a malfunction of the Blood Pressure system.

RECOMMENDED ACTIONS:

A mechanical or electrical fault has been detected in the Blood Pressure system. Remove the Atlas Monitor from service. The unit must be repaired.

MESSAGE:

Check blood pressure cuff

MEANING:

The Atlas Monitor has detected a problem in making a Blood Pressure measurement. No internal problem is detected. Either the Atlas Monitor could not detect a pulse, could not bring the cuff to the required pressure, or detected an overpressure condition. There may also be a problem that prevented the Atlas Monitor from completing a measurement within 3 minutes of the start of the measurement.

RECOMMENDED ACTIONS:

Check the tubing for kinks, crimps, or constrictions. Check the tubing for leaks at the Atlas Monitor connection, and at the cuff connection. Check the cuff for leaks. 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 two fingers between the deflated cuff and the patient’s limb. 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 – must be motionless. Excess movement, shivering, seizure could interfere with the measurement. Check the patient – unusual physiology, obesity, or poor circulation could be preventing Atlas Monitor from detecting the pulse.

MESSAGE:

Clock battery is dead - service required

MEANING:

There is a lithium battery inside the Atlas Monitor model 621xx that runs the time-of-day clock. It has lost power and the Atlas Monitor is no longer able to maintain its time settings. In models 622xx and 623xx, the rechargeable battery runs the clock, and it is depleted.

RECOMMENDED ACTIONS:

The model 621xx lithium battery is not user serviceable, and the unit must be repaired. The models 622xx and 623xx batteries can be recharged by plugging the system into AC power for 5 to 24 hours.

MESSAGE:

Clock not set

MEANING:

The time-of-day clock and calendar has not been set.

RECOMMENDED ACTIONS:

Press the

Date/Time button to access the Set Date and Time menu. Use the Select and Set buttons to set

the correct date and time.

MESSAGE:

CO2 cannula or hose occluded

MEANING:

The CO

RECOMMENDED ACTIONS:

Check the tubing for kinks, bends, or blockage. Check the patient’s nasal cannula for blockage. Replace the watertrap.

system has detected a flow restriction in its intake.

MESSAGE:

CO2 failure, service required

MEANING:

The Atlas Monitor has detected a malfunction of the CO

system.

RECOMMENDED ACTIONS:

A mechanical or electrical fault has been detected in the CO service. The unit must be repaired.

MESSAGE:

CO2 Reset Failed

MEANING:

When performing a CO use as a baseline reference. This reset operation has failed.

RECOMMENDED ACTIONS:

Reset operation, the Atlas Monitor samples CO2-free air through the Scrubber, to

system. Remove the Atlas Monitor from

Turn the Atlas Monitor off and back on, and retry the CO2 Reset operation. Repeat several times if necessary. If repeated attempts fail, then the unit must be repaired.

MESSAGE:

CO2 reset recommended

MEANING:

The Atlas Monitor has determined that the baseline (no CO CO

Reset procedure. The Atlas Monitor will recommend a CO2 Reset operation about once per month.

) setting should be verified by performing a

RECOMMENDED ACTIONS:

At a convenient time, perform a CO 623xx. The CO

system is safe to use in the interim before you perform the reset.

Reset procedure using the CO2 Scrubber included with your model

MESSAGE:

CO2 watertrap not detected

MEANING:

The Atlas Monitor has CO now no longer detect the watertrap. This message will not occur unless the Atlas Monitor has been successfully monitoring CO

RECOMMENDED ACTIONS:

Check to see that the watertrap is firmly inserted in its socket. You will hear the CO watertrap is properly inserted. If the CO

pump does not start when the watertrap is inserted, there is a failure in the circuitry that detects

the watertrap. The unit must be repaired.

selected as the Second trace selection, has been monitoring CO2, and can

and has subsequently lost contact with the watertrap.

pump start when the

MESSAGE:

Configuration lost - Factory default settings are active

MEANING:

A problem has occurred with the internal memory of the Atlas Monitor. The Patient Alarm settings that were saved have been lost, and the Patient Alarms are set back to the factory default settings. Advanced Configuration settings and volume settings may also have been reset to factory defaults.

RECOMMENDED ACTIONS:

Change the alarm limit settings and volume settings back to your preferences. Check the Advanced Configuration menu settings and change them to your preferences. Save your settings. Return to the waveform screen, and turn off the power. Turn the power back on. Your settings should remain, and you should not see the error message again. It is now safe to return the Atlas Monitor to use.

If you see the error message again when you turn on the power, it indicates an internal problem with the Atlas Monitor. The unit must be removed from service and repaired.

MESSAGE:

ECG failure, service required

MEANING:

The Atlas Monitor has detected a malfunction of the ECG system.

RECOMMENDED ACTIONS:

An electrical fault has been detected in the ECG system. Remove the Atlas Monitor from service. The unit must be repaired.

MESSAGE:

ECG lead fault

MEANING:

Atlas Monitor has detected a problem with the ECG leads. A signal cannot be properly detected. Note that Atlas Monitor only reports lead faults on the lead that is currently selected by the Lead Select button (and indicated in the upper right corner of the screen).

RECOMMENDED ACTIONS:

Check the ECG cable connection on the front of the Atlas Monitor. Check the connections of the individual ECG leads where they attach to the ECG trunk cable. Verify that the correct leads are plugged into the correct sockets. Make sure that you are not confusing AHA and IEC lead color schemes. Check the attachment of the leads to the snap electrodes. Check the attachment of the electrodes to the patient. Check for good contact. Shave hair or clean skin if necessary. Check the proper placement of the electrodes on the patient.

MESSAGE:

Low battery power - shutdown in less than 10 minutes Low battery power - shutdown in less than 5 minutes

MEANING:

The battery is running down. You have the indicated amount of time before the system shuts down. You will hear a chime once per minute (once per two minutes until 5 minutes remain) to remind you that you are low on power.

RECOMMENDED ACTIONS:

If you have AC power available, plug in the Atlas Monitor. The battery will recharge automatically, whether the Atlas Monitor is turned on or off. The battery will return to 80% charge within 5 hours, and full charge within 24 hours. You will see the AC~ symbol lit above the ECG cable connection. When operating on battery power, you can extend the battery life by reducing the number of Blood Pressure measurements and printouts.

MESSAGE:

Memory failure, service required

MEANING:

A problem has occurred with the internal memory of the Atlas Monitor.

RECOMMENDED ACTIONS:

Remove the Atlas Monitor from service. The unit must be repaired.

MESSAGE:

Power interrupted - settings lost

MEANING:

The Atlas Monitor model 621xx was unplugged from AC power without being turned off using the

Power On/Standby button first; or there was a power failure. The changes in settings that you made such

as alarm limits and Advanced Configuration settings may not have been saved. This error should not occur on models 622xx or 623xx due to the built-in battery.

RECOMMENDED ACTIONS:

Review and correct the settings that you want to change. If you want the Alarm settings and volume settings to become permanent changes, perform a Save Alarm Settings procedure – see section: Managing the Alarms. The technical alarm sounds when the system is first powered back on after the power interruption, and the alarm will be silenced by pressing any button on the Atlas Monitor.

MESSAGE:

Room too cold - CO2 unavailable Room too warm - CO

MEANING:

The ambient temperature is too high or low for Atlas Monitor ETCO

RECOMMENDED ACTIONS:

If you are not above 40º C, or below 10º C, this indicates a failure or calibration error in the Atlas Monitor temperature sensing system. The unit must be repaired.

MESSAGE:

unavailable

functions.

SpO2 cable not detected

MEANING:

Atlas Monitor has lost communication with the SpO

RECOMMENDED ACTIONS:

Check the connection where the SpO Check the connection between the SpO Check the connection between the SpO Replace the SpO

sensor and cable.

cable attaches to the Atlas Monitor.

extension cord and the SpO2 sensor, if used.

sensor and the SpO2 cable.

If none of these solves the problem, the unit must be repaired.

cable and sensor.

MESSAGE:

SpO2 cuff not detected

MEANING:

Atlas Monitor has lost the pulse signal from the SpO sensor and cable are attached, but does not detect a patient’s pulse.

RECOMMENDED ACTIONS:

Check attachment of sensor to patient. Block ambient light infiltration into sensor – cover with gauze or other opaque material. Check for health and condition of sensor attachment point. Move sensor to a new attachment point. Check patient for physiological problems – anoxia, anemia, defective hemoglobin, poor peripheral circulation, restricted blood flow to limb. Check fingernail for polish or other coverage that may block sensors ability to acquire measurement. Check that blood pressure cuff is not on the same limb as the SpO Replace SpO

sensor and cable.

sensor. The Atlas Monitor can still detect that the

sensor.

Welch Allyn Atlas 6200 User manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Table Of Contents

Safety Information

Warnings, Cautions, and Notes

Service Information