Welch Allyn Medical Diagnostic Equipment 623NP, 622NP, 621NO, 621NP, 622NO User Manual

Operator’s Manual

NOTICE

The information in this document is subject to change without notice.

Welch Allyn makes no warranty of any kind on this material, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Welch Allyn shall not be liable for errors contained herein or for incidental or consequential damages concerning the furnishing, performance, or use of this material.

This document contains proprietary information that is protected by copyright. All rights are reserved. No part of this document may be photocopied, reproduced or translated to another language without prior written consent of Welch Allyn.

Before using this instrument, read this guide and become thoroughly familiar with the contents.

Welch Allyn only considers itself responsible for any effects on safety, reliability and performance of the equipment if: 1 assembly operations, extensions, re-adjustments, modifications or repairs are done by persons

authorized by Welch Allyn, and

2 the electrical installation of the relevant room complies with the IEC or national requirements, and 3 the instrument is used according to the instructions for use presented in this manual.

WARNING

Welch Allyn assumes no liability for failures resulting from RF interference between Welch Allyn medical electronics and any radio frequency device at levels exceeding those established by applicable standards.

The use of accessories other than those recommended by Welch Allyn may compromise product performance.

United States Federal law restricts this device to sale by or on the order of a licensed health care practitioner.

Welch Allyn

Nellcor Puritan Bennett™ is a registered trademark of Nellcor Puritan Bennett, Inc.

and Atlas™ are registered trademarks of Welch Allyn, Inc.

1 HOW THIS MANUAL WORKS......................................................................................................................1

1.1 A QUICK TOUR OF THE WELCH ALLYN ATLAS MONITOR...........................................................................2

2 MONITORING THE PATIENT...................................................................................................................... 4

2.1 MONITORING BLOOD PRESSURE .................................................................................................................6

2.1.1 MAP (Mean Arterial Pressure) .............................................................................................................8

2.1.2 Alternate BP Field Settings (only available if language setting configured to Chinese).....................10

2.2 MONITORING SPO2, PULSE RATE AND THE SPO2 WAVEFORM...................................................................12

2.3 MONITORING HEART RATE AND THE ECG WAVEFORM............................................................................ 15

2.4 MONITORING IMPEDANCE RESPIRATION (MODELS 622XX & 623XX) .......................................................19

2.5 MONITORING TEMPERATURE (MODELS 622XX & 623XX) ........................................................................21

2.6 MONITORING CO2, RESPIRATION RATE, AND THE ETCO

3 MANAGING THE ALARMS......................................................................................................................... 25

3.1 PATIENT ALARMS .....................................................................................................................................29

3.1.1 Factory Default Patient Alarm Settings...............................................................................................30

3.2 MEASUREMENT INVALID ALARMS ............................................................................................................31

3.3 INSTRUMENT PROBLEM ALARMS ..............................................................................................................32

3.4 BATTERY ALARMS (MODELS 622XX & 623XX)........................................................................................33

4 CAPTURING AND DISPLAYING TREND DATA.....................................................................................35

5 USING PRINT AND WAVEFORM FREEZE .............................................................................................37

5.1 THE PRINTER – LOADING PAPER AND TROUBLESHOOTING .......................................................................39

6 CONNECTING TO THE PATIENT ............................................................................................................. 41

6.1 CONNECTING THE NIBP CUFF .................................................................................................................. 43

6.2 CONNECTING THE SPO

FINGERCLIP SENSOR............................................................................................46

6.3 CONNECTING THE ECG ELECTRODES .......................................................................................................48

6.4 CONNECTING THE TEMPERATURE PROBE (MODELS 622XX & 623XX)......................................................52

6.5 CONNECTING THE END TIDAL CO

SAMPLE TUBE (MODEL 623XX) .........................................................53

7 USING THE MENUS......................................................................................................................................54

7.1 THE SET DATE AND TIME AND OTHER OPTIONS MENU ............................................................................54

7.2 THE ADVANCED CONFIGURATION MENU.................................................................................................. 56

7.2.1 Advanced Configuration Menu Settings..............................................................................................58

8 CLEANING AND MAINTAINING THE ATLAS MONITOR ..................................................................60

WAVEFORM (MODEL 623XX) .........................23

9 UNPACKING AND INSTALLING THE ATLAS MONITOR...................................................................62

10 APPENDIX A: TECHNICAL SPECIFICATIONS FOR THE ATLAS MONITOR ................................ 64

11 APPENDIX B: ELECTROMAGNETIC COMPATIBILITY (EMC) ........................................................ 72

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 ..............................................................................................................................................................92

iii

Safety Information

The Welch Allyn Atlas Monitor is intended for use in a hospital or clinical environment. It should not be used at home or in emergency transport vehicles. Monitor users should be skilled at the level of a technician, nurse, doctor or medical specialist.

The function of the Welch Allyn Atlas Monitor is to register ECG, CO Noninvasive Blood Pressure (Systolic, Diastolic, and Mean Arterial Pressure), Pulse Oximetry, Respiration Rate and Temperature for adult and pediatric patients (over the age of 3 years), in all hospital or clinic facilities.

To ensure patient electrical isolation, the Atlas Monitor should only be connected to other equipment that provides patient electrical isolation. When connecting the Welch Allyn Atlas Monitor to any instrument, verify proper operation before clinical use. Accessory equipment connected to the monitor’s serial data interface must be certified according to IEC Standard 950 for data-processing equipment or IEC Standard 60601-1 for electromedical equipment. All combinations of equipment must be in compliance with IEC Standard 60601-1-1 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 60601-1-1. If in doubt, consult the Welch Allyn Technical Service Department.

The Welch Allyn Atlas Monitor and its accessories should be tested by qualified service personnel at regular intervals to verify proper operation, according to the procedures of the user’s institution. A Service Manual is available from the manufacturer. Other important safety information is located throughout this manual where appropriate.

concentration, Heart Rate,

Warnings, Cautions, and Notes

All operating personnel should be familiarized with the general safety information in this summary. Specific warnings and cautions will also be found throughout the operator’s manual. Such specific warnings and cautions may not appear here in this summary.

This device has been tested and certified by the Canadian Standards Association International to comply with applicable U.S. and Canadian

medical safety standards.

Defibrillator-proof, Type CF Applied Part.

Attention! Consult the accompanying documentation.

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.

• If pulse oximetry measurements are suspect, verify the reading using another clinically accepted

measurement method.

• 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.

• Do not fit the Blood Pressure or ETCO

systems with Luer Lock adapters. There is a risk of a user

mis-connection with an IV line introducing air bubbles into a patient’s blood.

• WARNING: Use of accessories, transducers, and cables other than those specified may result in

degraded electromagnetic compatibility performance of this device.

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

• It is the operator’s responsibility to set alarm limits as appropriate for each individual patient.

• Any Atlas Monitor which has been dropped or damaged should be checked by qualified service

personnel to insure proper operation prior to use.

• There are no user serviceable parts inside the Atlas Monitor other than paper replacement and

battery replacement.

• Blood pressure measurements may not be accurate for patients experiencing moderate to severe

arrhythmias.

• This Atlas Monitor should not be used on patients who are linked to heart / lung machines.

• If the integrity of the external protective conductor in the installation or its arrangements is in doubt,

equipment shall be operated from its internal power source (models 622xx and 623xx).

sensor site periodically.

• 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.

• End tidal carbon dioxide (ETCO

ONLY when the second trace option is set to CO ETCO or ECG) the CO

and breath rate waveforms and data to another second trace selection (SpO2, Respiration

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

) and breath rate measurement and alarm capability are active

. Should the operator change from viewing the

even if the watertrap and cannula are still inserted into the Monitor.

• Impedance Respiration rate measurement and alarm capability are active ONLY when the second

trace option is set to Respiration. Should the operator change from viewing the Respiration waveforms and breath rate to another selection (SpO

, CO2 or ECG) the Respiration rate

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

• If you are using battery power, the AC indicator (AC~) on the front panel will NOT be lit. 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. See section 3.4 for battery alarm information.

• When using the motion tolerant pulse oximetry channel, a very sudden and substantial change in

pulse rate can result in erroneous pulse rate readings. Be sure to validate the patient data and patient condition before intervention or change in patient care.

• When using the 6200-12 ECG Wrist-Klip, although a normal Lead I QRS waveform is produced on

the monitor, this waveform should not be used for serious clinical interpretation because the electrodes are not properly triangulated around the patient’s heart.

• The 6200-12 ECG Wrist-Klip cannot be adjusted in size. Proper orientation of the clip with the

monitor depends on adjusting the position of the clip until a snug fit is found. The preferred position of the clip is the patient’s wrist but it can be moved up the patient’s arm toward the torso. You may find that the clip will not work with patients that have small wrists and arms. Caution must be exercised when placing the clip so that circulation is not impeded along the patient’s wrist and arm. If a snug fit cannot be found on the patient, other means of monitoring must be used.

Cautions

• When transporting or storing the Atlas monitor at temperatures between 40°C (104°F) and 50°C

F), the following procedure must be performed. The monitor must be returned to the normal

(122

operating temperature range of 10 patient monitoring is performed before two hours has elapsed, the displayed and printed ETCO2 values may be higher than the patient's actual values.

• 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.

C (50°F) - 40°C (104°F) for a period of at least two hours. If

vii

• 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

• If the Atlas monitor is stored or transported at temperatures outside of the published storage

temperature range of -20 accuracy standards.

• Sidestream waste material and the CO

• 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 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

Noninvasive Sphygmomanometers.

• The Atlas Monitor is designed with protective circuitry and current isolation that eliminates any risk

to the patient from possible software errors.

C (-4°F) - 50°C (122°F) the Atlas monitor will not perform to the published

watertrap should be treated as biohazard material.

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

viii

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.

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:

USA 1-800-535-6663 France (+33) 1-60-09-33-66 Australia (+61) 2-9638-3000 Latin America (+1) 305-669-9591 Germany (+49) 7477-927-173 Singapore (+65) 6291-0882

Europe (+353) 469-067-790 Canada 1-800-561-8797

Japan (+81) 3-5212-7391 UK 0-207-365-6780

South Africa (+27) 11-777-7509 China (+86) 21-6327-9631

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.

European contact for regulatory compliance: European Regulator Manager Welch Allyn LTD. Navan, Co. Meath Republic of Ireland Phone 353-46-67700 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.

xii

1 How This Manual Works

This manual is arranged so that everything about one topic is found in a single section. The statement immediately below the chapter title (like this one) appears in italics and presents the important points of the topic. Most topics include an illustration or a table. The chapters are numbered so that logically connected topics begin with the same number-- for example 2.1 and 2.2.

The Welch Allyn Atlas Monitor and this manual are designed for ease of use. Everything you need to know about a specific operation of the monitor is available in one place. This means you can see all the required information at a glance.

Redundancy - There is some redundancy in this manual; some step-by-step procedures are repeated in many places wherever they are pertinent. We did this so you would not have to search through other pages to find what you need to know “right now.”

For instance, setting an alarm limit is fully explained in the section on blood pressure, again in the section on SpO places.

Paragraphs - The statement in italics immediately below the chapter heading describes what the section is about. Sometimes just reading this and looking at the illustrations

, and in several other

will give you enough information.

Section Numbers - The double numbered pages indicate the relationship between the main subject and closely related topics.

The sections are organized so that what you want to know first is put first. Like most medical professionals who use the Atlas Monitor, you are probably very adept at taking blood pressure and connecting ECG leads to patients, so the section on how the Atlas Monitor is used for monitoring patients and what you need to know to operate the monitor comes first. We put the information on connecting blood pressure cuffs and ECG leads in a later section.

This manual is not meant for reading straight through, like a book, although you can read it that way. If you read it like this, the built-in redundancy may become a little tedious. When you read a paragraph or a step-by-step procedure with which you are already familiar, just skip it. It is there for the person who is doing the activity for the first time.

1.1 A Quick Tour of the Welch Allyn Atlas Monitor

When you turn on the power, the monitor starts with preset or default alarm levels. Waveforms are displayed on the screen. Readings are displayed on the screen and on LEDs. You can perform the most common operations — set and silence alarms, display trend data, print waveforms and trend data — from the front panel without using a menu. This section gives only a brief overview of the monitor; later sections present all the details.

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

621NO 621NP

Features

SpO2, SpO2 waveform Pulse Rate NIBP: Systolic, Diastolic, MAP ECG waveform, heart rate

Printer (optional) 622NO 622NP

All features of model 621xx,

plus:

Impedance Respiration

Patient Temperature

Battery Operation

PC Communication

Remote Nurse Call

Printer (optional) 623NP All features of model 622xx,

plus:

End Tidal CO

from ETCO

and Breath Rate

Printer (standard)

Power on - The Power On/Standby button is in the lower right corner. When you first turn on the monitor:

• all alarms are enabled, but no alarm will

sound until after a valid measurement value is received.

• all alarm limits are set at their default values.

• all the trend data (history) is cleared.

AC~ indicator, located below the screen,

A lit means the unit is being powered by the wall outlet, and that the battery is being charged (models 622xx and 623xx).

NOTE: Use the battery as a backup for low power conditions or short-term transports.

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. When alarms are silenced, they will not trigger a Print On Alarm. When the silence period is over, an alarm that is still active will trigger a Print On Alarm if the Print On Alarm configuration is set to Yes.

You can suspend an individual alarm by pressing

ALARMS Off button. There are four ALARMS

its

Off

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. When an alarm is suspended, it will not trigger a Print On Alarm. When the alarm is unsuspended, an alarm that is still active will trigger a Print On Alarm if the Print On Alarm configuration is set to Yes.

Note: Individual alarms can be suspended for only

3 minutes when the language setting is

configured to “Francais”. If the language is set

to any other language, pressing the individual

ALARMS Off buttons will suspend the alarm

until you remove the suspension.

Trend Data - Trend data is captured every time blood pressure is measured, whether this event is automatic or manual. Trend data is also automatically captured every 15 minutes if blood pressure intervals are longer, or blood pressure is not used. Push the data. Scroll through the trend data with either button. Push

Trend button to see the trend

Set

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

Note: If any measurements exceed the alarm

limits, they will be marked with asterisks on the printout. If trend data is displayed on the screen,

Print prints all the trend data. If the

Print On Alarm configuration is set to Yes, and a Patient Alarm or Measurement Invalid Alarm occurs, Atlas will print the current measurements and the currently configured waveforms automatically.

If your model of the Atlas Monitor does not have the optional printer, the

Freeze, and it freezes, or halts, the waveform

Print button is labeled

display for 10 seconds to permit studying of the waveform.

2 Monitoring the Patient

The patient’s vital measurements are displayed as numeric readings and as waveforms. You can set the measurement limit alarm levels, silence the alarms for a short period, and suspend individual alarms. You can print waveforms and current measurements, or print all the stored trend data.

The front panel has two sides:

The left side displays waveforms, numeric readings, and trend data on a CRT screen.

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

Each side responds to the adjacent

Select and Set

buttons used for setting alarm limits. Each side also has

ALARMS Off buttons, which are used to

suspend (turn off) individual alarms.

Note: Individual alarms can be suspended for only 3 minutes when the language setting is configured to “Francais”. If the language is set to any other language, pressing the individual

ALARMS Off

buttons will suspend the alarm until you remove the suspension. Note: The temperature measurement does not

have an alarm.

Setting alarm limits - Press the

Select button to

choose which alarm limit you want to set. Each time you press the 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. When alarms are silenced, they will not trigger a Print On Alarm. When the silence period is over, an alarm that is still active will trigger a Print On Alarm if the Print On Alarm configuration is set to Yes.

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 captured at the time that the

Print button is pressed. If the Print

On Alarm configuration is set to Yes and a Patient Alarm or Measurement Invalid Alarm occurs, Atlas will print the current measurements and the currently configured waveforms automatically.

Freeze – If your monitor does not have a printer,

the button is labeled

Freeze. Pressing Freeze

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

Trend

Lead Select Print

23%

ALARMS

Off

TEMP

Systolic

Diastolic

(mmHg)

BP ALARMS

Off

Alarm Suspend Buttons

Silence

PULSE

(bpm)

HR ALARMS

Off

SpO2%

/ RESP

ALARMS

Off

SpO

Power

TEMP

Systolic

Diastolic

(mmHg)

BP ALARMS

NIBP Sp0

CO2

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

Trend

mmHg

Trend Print

PULSE

(bpm)

SpO2%

Set

Top – Model 623xx showing waveform display and alarm controls

Bottom – Model 623xx showing trend display and associated

controls

2.1 Monitoring Blood Pressure

Blood pressure can be measured at timed intervals which you set, or you can start the blood pressure measuring cycle manually. Systolic and Diastolic readings are shown on the LEDs at the upper right of the monitor. You can set the high and low alarm limits for both the systolic and diastolic measurements.

Blood pressure cycles - You can measure NIBP at timed intervals or manually. To set a timed interval, press the

Auto button to cycle through

the available intervals: X, 1, 3, 5, 10, 15, 30, or 60 minutes. Wait until the number for the

selected interval stops flashing; the measurement will automatically begin 20 seconds later.

Note: The interval is timed from the start of one

BP cycle to the start of the next cycle.

Pressing the button one more time after the 60 is lit will return the

Auto timing to the Off mode

(indicated by an “X”). In this mode, automatic measurement at timed intervals will not occur. Initially, both blood pressure displays will be blank.

Stopping a blood pressure cycle - The

Start/Cancel

button does one of two things:

• If a blood pressure measurement is not in

progress, pressing

BP Start/Cancel will

start a blood pressure measurement cycle, 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.

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 has elapsed.

Alarms - When any of the blood pressure limits are exceeded, an audible alarm sounds and the affected measurement flashes. If the Print On

Alarm configuration is set to Yes, a blood pressure alarm will trigger an automatic print. You can silence the blood pressure 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. When alarms are silenced, they do not trigger a Print On Alarm.

To suspend the blood pressure alarms, press the

BP ALARMS Off button so the red LED in the

button lights. A suspended alarm will still flash if it goes outside the range of the limits, but it will not sound the audible alarm. When an alarm is suspended, it will not trigger a Print On Alarm.

Note: The blood pressure alarm can be

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

BP ALARMS Off button will

suspend the alarm until you remove the suspension.

Trend data – Trend data is captured at each blood pressure cycle, whether it is started 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.

PG 2-5

Off

CO2 / RESP

ALARMS

Off

Select

Set

Lead Select Print

Trend

Blood

Pressure

Connector

Atlas Monitor showing NIBP displays, controls and tubing

connector

Setting alarm limits - To set the Systolic and Diastolic alarm limits, use the buttons on the right side of the monitor to follow these steps:

• 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 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

Select and Set

HI or LO LED will

Select

Set

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).

Note: If the language setting is configured to Chinese and the alternate BP field to kPa, the blood pressure will be displayed in kPa on the screen, but the Systolic and Diastolic readings on the right side of the monitor will be displayed in mmHg. When setting the alarm limits, the and

LO alarm limits will be displayed in mmHg

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

2.1.1 MAP (Mean Arterial Pressure)

Mean Arterial Pressure is calculated from the systolic and diastolic measurements. MAP may be optionally displayed by selecting it on the Advanced Configuration menu. MAP is displayed in the upper left corner of the screen.

MAP - (Mean Arterial Pressure) display can be turned on and off by using the Advanced Configuration menu. When MAP is shown, you will see it in the upper left corner of the screen, above the ECG waveform.

To display (or turn off) MAP, enter the Advanced Configuration menu:

• Press the

• Use the left

Date/Time button. Trend button.

Select button to highlight

“MAP.”

• 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. If the Print On Alarm configuration is set to Yes, a MAP alarm will trigger an automatic print. You can silence the MAP 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. When alarms are silenced, they do not trigger a Print On Alarm.

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. When an alarm is

suspended, it will not trigger a Print On Alarm.

Note: The BP alarm can be suspended for only 3

minutes when the language setting is

configured to “Francais”. If the language is set

to any other language, pressing the

ALARMS Off

button will suspend the alarm

until you remove the suspension.

Note: MAP is calculated mathematically from the

Systolic and Diastolic pressures; it is not

measured directly.

Setting alarm limits – If MAP is displayed, you can set the alarm limits, using the

Select and Set

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

• Press the left Select button to cycle

through MAP

LO, Respiration HI and LO (models 622xx

or 623xx)

LO.

HI and LO, Heart Rate HI and

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

Map

MAP 96

Trend

Lead Select Print

Blood

Pressure

Connector

Select

HR ALARMS

2 / RESP

ALARMS

Off

BP ALARMS

Set

SetSelect

Blood

Pressure

Alarm Off

Off

Atlas Monitor waveform display showing location of MAP reading

Silence

2.1.2 Alternate BP Field Settings (only available if language setting

configured to Chinese)

Mean Arterial Pressure or blood pressure in kPa can be displayed by selecting it on the Advanced Configuration menu. MAP or kPa is displayed in the upper left corner of the screen and is included on the printout.

You can display MAP (Mean Arterial Pressure) or blood pressure in kPa (kiloPascals) in the upper left corner of the screen, above the ECG waveform. This alternate BP field display can be set by using the Advanced Configuration menu.

To set the alternate BP field display , enter the Advanced Configuration menu:

• Press the

• Use the left

Date/Time button. Trend button.

Select button to highlight

“Alternate BP Field:”.

• Press the left

Set to choose “MAP”, “kPa”,

or “Nothing.”

• Press the

Trend button again to exit

Advanced Configuration.

MAP - If MAP is displayed on the screen, it will also appear in the trend data and in the current readings of a waveform printout.

MAP Alarms - When either of the MAP limits are exceeded, an audible alarm sounds and the affected measurement flashes. If the Print On Alarm configuration is set to Yes, a MAP alarm will trigger an automatic print. You can silence the MAP alarm, and all alarms, by pressing the large blue

Silence button at the right side of the

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. When an alarm is suspended, it will not trigger a Print On Alarm.

Note: MAP is calculated mathematically from the

Systolic and Diastolic pressures; it is not measured directly.

Setting alarm limits – If MAP is displayed, you can set the alarm limits, using the

Select and Set

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

• Press the left Select button to cycle

through MAP

LO, Respiration HI and LO (models 622xx

or 623xx)

LO.

HI and LO, Heart Rate HI and

, 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 instrument is

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

kPa – If the blood pressure is displayed in kPa on the screen, the blood pressure readings will be in kPa in the trend data and in the current readings of the waveform printout.

Note: To set the blood pressure limits in kPa, you

will need to use the Select and Set buttons on the right side of the monitor. The alarm limits for systolic and diastolic will be displayed in mmHg on the right side of the monitor and in kPa on the screen.

HI and LO

2.2 Monitoring SpO2, Pulse Rate and the SpO2 Waveform

The oximetry and pulse rate measurements are generally taken with the reusable fingerclip sensor (provided), however a wide variety of SpO volume is displayed as a vertical bar graph, called the Plethysmograph, beside the SpO right side of the monitor. The SpO

pulse tone gives an audible indication of pulse rate and oxygen level.

Pulse - A fingerclip sensor provides the source of the light transmitted through the patient’s finger to determine the oximetry and pulse rate measurements. The green Pulse Rate numbers may sometimes differ slightly from the Heart Rate displayed over the ECG waveform, even though they both measure beats per minute (bpm). This is normal.

Oxygen level - The oxygen level is displayed in red numbers as a percentage. The Plethysmograph vertical bar graph next to the

percentage shows the strength of the

SpO

fingerclip sensor signal with each beat. If this signal is low, it could indicate that the fingerclip sensor is not placed properly, or that the patient has poor perfusion. Pigmented skin and nail polish can also lower the signal.

System Displays – The system will begin displaying the Plethysmograph signal almost immediately upon attachment of the fingerclip sensor to the patient. The SpO

level and Pulse

Rate will be displayed within about 5 seconds, after the system determines that the reading is stabilized.

Second waveform - The pulse oximetry waveform can be selected as a second trace. If this is chosen, the bottom line of the screen displays the SpO

waveform. Select the Second

trace source from the Advanced Configuration menu.

Pulse tone - A short SpO

tone sounds with

every pulse beat.

• 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)

sensors are available as accessory items. The oximetry pulse

% display on the

as the percentage of oxygen elevates.

The pulse tone volume can be controlled by a button on the lower right panel. The button is below the SpO icon and

display, labeled with a speaker

SpO

Note: The pulse tone volume can be turned

completely off with this button.

Note: If the SpO

SpO

pulse tone is in synchrony with the

is inactive, the timing of the

ECG heart rate as is normally the case, but the pitch of the tone is steady, unvarying, and different from the tone tracking oxygen content.

Alarms - When the oxygen percentage falls below the SpO

limit, an alarm sounds and the

affected measurement flashes. If the Print On Alarm configuration is set to Yes, an SpO will trigger an automatic print. You can silence the SpO large blue

alarm, and all alarms, by pressing the

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

alarm

Oximetry

Measurement

Pulse Rate

PULSE

(bpm)

Signal Strength

Silenc

12/

min

SpO2%

SpO2ALARMS

Off

Select

BP ALARMS

Off

Set

Trend

SpO

Connector

Lead Select Print

SpO

Alarms Off

SpO2

SpO

Pulse Tone Volume

Select

Set

Atlas Monitor showing SpO2 displays, controls, and sensor connector

Note: The SpO2 alarm can be suspended for only

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

ALARMS Off

button will suspend the alarm

until you remove the suspension.

Setting alarm limits - To set the SpO limits, use the

Select and Set buttons on the

alarm

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. If the Print On Alarm configuration is set to Yes, a Pulse rate alarm will trigger an automatic print. Use the large

Silence button to temporarily silence the

blue alarm, and use the

SpO2 ALARMS Off button to

suspend it. When alarms are silenced or suspended, they do not trigger a Print On Alarm.

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 Other Options menu, and press to save your settings. Press

Date/Time to display the

Print (or Freeze)

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. If the Print On Alarm configuration is set to Yes, this alarm will trigger an automatic print. You can silence the Heart Rate alarm, and all alarms, by pressing the

large 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. When alarms are silenced, they do not trigger a Print On Alarm.

To suspend the Heart Rate alarms, press the

ALARMS Off

Note: The Heart Rate alarm can be suspended

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

ALARMS Off

until you remove the suspension.

If ECG is inactive for any reason, the Heart Rate display will be dashes “---” and the Heart Rate alarm will respond to the pulse oximetry rate.

Setting alarm limits –To set the Heart Rate alarm limits, use the the left side of the monitor to follow these steps:

• Press the left Select button to cycle through

• Each push of Select moves you to the next

• Press the Set button up or down to raise or

Silence button at the right side of the

button so the red LED in the

button will suspend the alarm

Select and Set buttons on

HI and LO, Heart Rate HI and LO,

MAP Respiration 623xx)

LO.

HI and LO (models 622xx or

, then (model 623xx) CO

HI and

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

HI or LO will flash,

indicating which limit is being changed.

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

Heart Rate Selected Lead

Select

HR ALARMS

Off

/ RESP

ALARMS

Off

Trend

Lead Select

Lead Select Print

ECG

Connector

Atlas Monitor showing ECG waveform display, controls, and ECG

connector

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

Advanced Configuration

ECG setting

ECG gain automatic |

ECG lead set 3 wire | 5 wire

ECG speed 6.25 | 12.5 | 25 mm/s

ECG bandwidth Monitor | Extended

Second trace selection

Possible values

10 mm/mV

ECG | SpO2 | Respiration | CO

You can change the ECG settings in Advanced Configuration:

• Press the Date/Time button.

• Press

• Use either

• Use the

• Press

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

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

Trend.

Select button to highlight ECG

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

Set button to change any of these

values.

Trend to exit Advanced Configuration

Note: When using 3 wire leads, the ECG lead

set must be set correctly. Incorrect results

and noisy waveforms can be obtained if the system is configured for 5 wire leads when using 3 wire leads.

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

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

Note: Detection of ischemia is the interpretation

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

Note: It is normal for the ECG baseline to

wander slightly in Extended bandwidth.

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

+ 78 hidden pages

Welch Allyn Medical Diagnostic Equipment 623NP, 622NP, 621NO, 621NP, 622NO User Manual

Table Of Contents

Safety Information

Warnings, Cautions, and Notes

Warnings

Cautions

Notes

Product Warranty Information

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