Non-Invasive Blood
Pressure (NIBP)
August 2009 |
9650-0914-01 Rev. A |
R SERIES — NON-INVASIVE BLOOD PRESSURE (NIBP) OPTION INSERT
The issue date or revision level for this operation guide is shown on the front cover.
ZOLL, R Series and “Advancing Resuscitation. Today.” are registered trademarks of ZOLL Medical Corporation.
SunTech Advantage is a registered trademark of SunTech Medical Group.
All other trademarks and registered trademarks are property of their respective owners. Copyright 2009 by ZOLL Medical Corporation. All rights reserved.
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9650-0914-01 Rev. A |
Non-Invasive Blood Pressure (NIBP)
Product Description
The Non-Invasive Blood Pressure (NIBP) option on the R Series® unit gives you the ability to take a single blood pressure measurement, STAT measurements (automatically repeated measurements over a 5 minute period), or automatic measurements at repeating pre-selected intervals. The blood pressure information (including the patient’s systolic, diastolic and mean blood pressure values) is shown on the R Series monitor in the NIBP display area, on the left side of the screen.
For R Series BLS/Plus models, the NIBP option can only be used while the unit is in Manual mode.
How To Use This Manual
This insert describes how to set up and use the R Series NIBP option. Important safety information relating to the general use of the R Series NIBP option appears in “Safety Considerations” on page 2.
Before attempting to use the NIBP option, you must read and understand all the information contained in the R Series Operator’s Guide, which provides information that operators need for the safe and effective use and care of the R Series unit.
Thoroughly read the Safety Considerations and Warnings sections in both the R Series Operator’s Guide and the relevant inserts before operating your R Series product.
SunTech CE Contact
Direct all cuff, hose, and NIBP questions with regards to the Declaration of Conformity with European Union Directives to the authorized representative for SunTech:
SunTech Medical Instruments Ltd. Oakfield Industrial Estate Stantom Harcourt Road Eynsham, Witney
OX8 ITS UK
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R SERIES — NON-INVASIVE BLOOD PRESSURE (NIBP) OPTION INSERT
Safety Considerations
General NIBP Safety
•Read the R Series Operator’s Guide and this manual insert before use.
•Ensure that the R Series NIBP option is operated by qualified personnel only.
•Consult a physician for the proper interpretation of pressure measurements.
•Do not use on patients known to be susceptible to bruising.
•Use caution when using on elderly hypertensive patients, as such patients may be more susceptible to bruising.
•Route patient hoses carefully to avoid patient entanglement, strangulation or compression of hose.
•Do not select a cuff inflation pressure that exceeds the patient’s expected systolic pressure by more than 30-40 mmHg (4.0-5.3 kPa). The factory-installed default adult cuff inflation pressure is 160 mmHg (21.3 kPa) for adult patients, 120 mmHg (16.0 kPa) for pediatric patients, and 90 mmHg (12.0 kPa) for neonatal patients.
•Keep patient, hose and cuff as still as possible during measurement. Patient movement or vibrations from outside sources, particularly moving vehicles, can degrade measurement accuracy.
•Check patient regularly for signs of skin irritation or impaired circulation in the monitored limb.
•Do not use the NIBP option on a patient when the R Series unit is connected to an ECG simulator.
•If an alarm occurs while the audible alarm indicators are disabled, alarms do not sound; rather only the visual alarm indicators are displayed.
•If the accuracy of measurements is suspect, first check the patient's vital signs by alternate means. Then check the cuff, hose and R Series NIBP option for proper functioning.
•The cuff, hose, and fitting are defibrillation-protected. Using the NIBP option introduces no risk for shock due to defibrillation. The cuff and hose are non-conductive. Using the NIBP option introduces no risk for burns due to electrosurgery.
Cuff and Hose Safety
•Only use cuffs, hoses, and connectors supplied or specified by ZOLL.
•Ensure that the hose is not kinked or obstructed before taking measurement.
•Do not use damaged cuffs, hoses, or connectors.
•Ensure proper cuff selection and placement to avoid inaccurate measurements or patient injury.
•Position the cuff so it is level with the heart during measurement.
•Do not attach the cuff to a limb being used for IV infusion or SpO2 monitoring. Cuff inflation might block the infusion, causing harm to the patient or inaccurate SpO2 measurements.
•Do not repeat NIBP measurements (particularly STAT measurements) at intervals less than 3-5 minutes over an extended period of time. Rapidly repeating measurement can impair circulation in the monitored limb.
•Do not sterilize or immerse the cuffs or hoses.
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9650-0914-01 Rev. A |
NIBP Indications for Use
NIBP Indications for Use
The ZOLL R Series NIBP option is indicated for the non-invasive measurement of arterial blood pressure for resting patients in critical care and in-hospital transport.
The R Series NIBP option is designed to measure blood pressure for adult patients (21 years of age and older) and for pediatric patients, as described in the following table:
Pediatric Subpopulation |
Approximate Age Range |
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Newborn (neonate) |
Birth to 1 month of age |
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Infant |
1 month to 2 years of age |
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Child |
2 to 12 years of age |
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Adolescent |
12-21 years of age |
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What Can I Do With the NIBP Option?
With the NIBP option you can do the following in MONITOR, PACER, or DEFIB (ON for BLS/Plus units, then select Manual) mode:
•Take a single blood pressure measurement.
•Take a STAT measurement (as many measurements – up to 10 – as possible within 5 minutes).
•Take repeated measurements at user-programmable intervals.
•Immediately abort any measurement in progress by pressing one button.
•Set the cuff inflation pressure to adjust automatically based on the previously measured systolic value.
•Display systolic, diastolic and mean blood pressure on the screen.
•Configure alarms to go off when the unit detects blood pressure values above or below user-programmable limits.
•Display a history of NIBP measurements taken in the last 4 hours.
How Do I Use the NIBP Option?
To take safe and accurate blood pressure measurements using the R Series NIBP option, you must perform the following steps, each of which corresponds to a subsequent section in this document. Read each section carefully before you use the R Series NIBP option.
1.Select the proper size cuff.
2.Connect the hose to the R Series unit and to the cuff.
3.Apply the cuff to the patient.
4.Display the NIBP menu.
5.Select the correct patient type (if the current setting is not appropriate).
6.Set the cuff inflation pressure (if the current setting is not appropriate).
7.Configure alarms (if the current settings are not appropriate).
8.Take blood pressure measurement(s).
9.Read the display.
9650-0914-01 Rev. A |
R Series Non-Invasive Blood Pressure (NIBP) |
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R SERIES — NON-INVASIVE BLOOD PRESSURE (NIBP) OPTION INSERT
WARNING! Do not use the NIBP option without proper training. Setting initial inflation pressure too high can result in serious injury to the patient. Patient movement, very low pulse volume, or vibration from outside sources can influence the accuracy of blood pressure measurements.
How Does the NIBP Option Work?
The patient blood pressure cuff and hose connect to the R Series unit through the NIBP connector on the rear panel of the unit. The NIBP button ( 
) on the front panel of the
R Series allows you to initiate and terminate non-invasive blood pressure measurements, whose values display in the NIBP area of the monitor. You can also initiate and terminate Auto or STAT mode measurements using the softkeys on the NIBP menu.
The ZOLL R Series NlBP Option non-invasively measures arterial blood pressure and pulse rate in resting adult, neonate and pediatric patients. By incorporating the SunTech Medical Advantage OEM BP A+ R-wave Motion Tolerance Module into the R Series Defibrillator/Monitor/Pacemaker devices, the option facilitates the ability to monitor and assess the physiological characteristics of the indicated patient populations.
The NIBP module measures the oscillometric pulses transmitted through the blood pressure cuff and hose, and calculates the blood pressure measurements accordingly. The pressure measurement cycle takes approximately 30 seconds and proceeds as follows:
1.The cuff inflates to a preconfigured pressure (configured default value for adult patients is 160 mmHg), above the patient’s systolic blood pressure, to occlude blood flow through the arteries in the monitored limb.
2.The cuff deflates incrementally, allowing blood to flow through the cuff and into the monitored limb.
3.As blood flows past the partially deflated cuff, it produces pressure oscillations that are transmitted to the R Series unit through the hose.
4.The R Series unit measures the oscillometric pulses and uses them to calculate the corresponding systolic, diastolic, and mean blood pressure, as well as the patient’s pulse rate.
5.The NIBP option automatically adjusts the blood pressure measurement procedure in response to certain error conditions such as:
Condition |
Adjustment/Response |
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The unit cannot detect |
The unit automatically |
systolic pressure |
increases the cuff inflation |
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pressure and completes |
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the blood pressure |
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measurement |
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The unit cannot detect |
The unit aborts the blood |
systolic, diastolic or |
pressure measurement |
mean pressure after |
and deflates the cuff |
3 minutes |
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The unit detects a |
The unit displays a |
fault |
corresponding error |
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message on the monitor |
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and aborts the |
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measurement |
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How Do I Read the Display?
How Do I Read the Display?
After each measurement, the NIBP display area displays measured systolic, diastolic, and mean blood pressure values.
To facilitate quick reaction in emergency situations, you can control certain NIBP features by pressing the NIBP button ( 
) at the lower left-hand corner of the unit. To access other NIBP features, you must press a softkey with the appropriate softkey label.
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3 SHOCK |
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72 |
LEAD |
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2 |
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CPR |
ECG |
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ANALYZE |
CHARGE |
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SpO2% |
IDLE |
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0:00 |
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x1 |
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SIZE |
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99 |
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Depth |
PADS |
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Rate |
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ALARM |
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ENERGY |
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NIBP |
NIBP mmHg |
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SUSPEND |
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SELECT |
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--- |
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1 |
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Display |
--- |
ECG |
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Area |
--- |
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MONITOR |
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DEFIB |
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CO2 mmHg |
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--- |
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OFF |
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RR --- |
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PACER |
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MONITOR |
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11:24 |
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Options |
Param |
Code |
Report |
Alarms |
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Softkey Labels |
Marker |
Data |
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OUTPUT |
4:1 |
RATE |
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mA |
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ppm |
NIBP Button
Softkey Label
Softkeys
Note: Depending on the options included in your R Series unit, your display may differ slightly from the illustrations in this insert.
The NIBP display area on the left side of the monitor screen consists of:
•Symbols that represent the status of blood pressure measurements.
•Numbers that represent the measurement values (refer to the following figure).
Systolic BP
Diastolic BP
NIBPmmHg |
Patient Type |
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(blank if Adult) |
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120 |
P |
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* |
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80 |
* = artifact |
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100
Mean BP |
Alarm |
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When taking a reading, the screen will display only the current cuff pressure.
9650-0914-01 Rev. A |
R Series Non-Invasive Blood Pressure (NIBP) |
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R SERIES — NON-INVASIVE BLOOD PRESSURE (NIBP) OPTION INSERT
The symbols below show the current status or action being taken.
Display Symbols |
Status |
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NIBP |
Idle, or taking a single |
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measurement |
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STAT |
Taking a STAT measurement |
alternating with |
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NIBP |
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AUTO |
Taking an Auto measurement |
alternating with |
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NIBP |
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Alarms enabled |
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Alarms disabled |
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P |
Pediatric Patient Type |
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N |
Neonatal Patient Type |
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* |
Artifact indicator |
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The artifact indicator is shown when the R Series unit detects artifact in the signal. Under such circumstances, the displayed pressure values may be inaccurate. Perform additional blood pressure measurements before taking clinical action. If you repeatedly obtain artifact, use alternate techniques to obtain blood pressure prior to taking clinical action.
Note that the R Series default unit of measure is millimeters of mercury (mmHg), but you can configure the R Series to display kilopascals (kPa). Refer to the R Series Configuration Guide for information on configuring alternate units of measure.
Preparing to Take Measurements
The following sections describe how to prepare to take measurements.
Selecting the Proper Size Cuff
The NIBP option comes with a cuff that inflates to cut off the patient’s blood flow and then deflates slowly to allow the blood flow to resume gradually. To take accurate measurements, you must use the proper sized cuff. Bladder length should be at least 80 percent of the limb circumference, while the cuff width should be equal to 40 percent of the limb circumference.
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9650-0914-01 Rev. A |
Preparing to Take Measurements
Select the appropriate size cuff for the patient from the following table:
Limb Circumference |
Cuff |
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38 to 50 cm |
Thigh |
(14.96 to 19.69 in.) |
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31 to 40 cm |
Large Adult |
(12.20 to 15.75 in.) |
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23 to 33 cm |
Adult |
(9.06 to 12.99 in.) |
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17 to 25 cm |
Small Adult |
(6.69 to 9.84 in.) |
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12 to 19 cm |
Child |
(4.72 to 7.48 in.) |
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8.0 cm to 15.0 cm |
Neonate #5 |
(3.1 to 5.9 in.) |
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7.0 to 13.0 cm |
Neonate #4 |
(2.8 to 5.1 in.) |
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6.0 to 11.0 cm |
Neonate #3 |
(2.4 to 4.3 in.) |
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4.0 to 8.0 cm |
Neonate #2 |
(1.6 to 3.1 in.) |
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3.0 to 6.0 cm |
Neonate #1 |
(1.2 to 2.4 in.) |
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Caution You must use the 3 m hose when making neonatal NIBP measurements with the R Series. The 3 m hose (ZOLL Part No. 8000-0662) is standard on R Series units. Do not use the 1.5 m hose when making neonatal NIBP measurements; the cuff may not inflate, causing the unit to abort the NIBP measurement.
You can order additional cuffs and hoses from ZOLL Medical Corporation. See “NIBP Accessories” on page 22.
Connecting the Hose
The NIBP option comes with a hose that has a plastic connector on one end and a metal connector on the other end; you must attach the hose to both the R Series unit rear panel using the metal connector and the cuff’s hose using the plastic connector. The cuff has its own short length of hose with a connector on the end. This connector fits into the end of the hose that is not connected to the R Series unit.
To connect the hose:
9650-0914-01 Rev. A |
R Series Non-Invasive Blood Pressure (NIBP) |
7 |
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