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X Series™ Operator’s Guide
9650-001355-01 Rev. B
The issue date for the X Series Operator's Guide (REF 9650-001355-01 Rev. B) is February, 2012.
0197
ZOLL Medical Corporation
269 Mill Road Chelmsford, MA USA 01824-4105
ZOLL International Holding B.V.
Newtonweg 18 6662 PV ELST The Netherlands
If more than 3 years have elapsed since the issue date, contact ZOLL Medical Corporation to det ermine if additional product information updates are available.
Masimo, Rainbow, SET, SpCO, and SpMet are trademarks or registered trademarks of Masimo Corporation in the United States and/or other countries.
Propaq, Smartcuf and SureBP are trademarks or registered trademarks of Welch Allyn or its subsidiaries in the United States and/or other countries.
Oridion, Microstream, FilterLine, and CapnoLine are trademarks or registered trademarks of Oridion Systems, Ltd. in the United States and/or other countries.
IC Model: XSCP-1
Table of Content s
Ch a p t e r 1 General Information
Product Description ............................................................................................................1-1
X Series Optional Features .........................................................................................1-2
How to Use This Manual.....................................................................................................1-3
Operator’s Guide Updates..................................................................................................1-3
Unpacking...........................................................................................................................1-3
Symbols Used on the Equipment .......................................................................................1-4
Conventions........................................................................................................................1-7
X Series Indications for Use ...............................................................................................1-7
Manual Defibrillation ...................................................................................................1-8
Semiautomatic Operation (AED) ................................................................................1-8
ECG Monitoring ..........................................................................................................1-9
CPR Monitoring ..........................................................................................................1-9
External Transcutaneous Pacing ................................................................................1-9
Non-Invasive Blood Pressure Monitoring .................................................................1-10
Temperature Monitoring ...........................................................................................1-10
SpO2 Monitoring .......................................................................................................1-10
Respiration Monitoring ..............................................................................................1-10
CO2 Monitoring .........................................................................................................1-10
Invasive Pressure Monitoring ...................................................................................1-10
12-Lead Analysis ......................................................................................................1-11
X Series Product Functions..............................................................................................1-11
Defibrillator Function .................................................................................................1-11
Defibrillator Output Energy .......................................................................................1-11
External Pacemaker .................................................................................................1-11
ECG Monitoring ........................................................................................................1-12
Electrodes .................................................................................................................1-12
Batteries ....................................................................................................................1-12
Ready For Use (RFU) Indicator ................................................................................1-14
Safety Considerations.......................................................................................................1-15
9650-001355-01 Rev. B X Series Operator’s Guide i
TABLE OF CONTENTS
Warnings...........................................................................................................................1-15
General ..................................................................................................................... 1-15
ECG Monitoring ........................................................................................................1-16
Defibrillation .............................................................................................................. 1-17
Pacing ....................................................................................................................... 1-18
CPR ..........................................................................................................................1-19
Pulse Oximeter .........................................................................................................1-19
Noninvasive Blood Pressure .....................................................................................1-20
IBP ............................................................................................................................1-20
CO2 ..........................................................................................................................1-21
Respiration ................................................................................................................1-21
Ferromagnetic Equipment ........................................................................................1-21
Battery ......................................................................................................................1-21
Operator Safety ........................................................................................................1-22
Patient Safety ...........................................................................................................1-23
Cautions............................................................................................................................1-24
Restarting the Defibrillator................................................................................................1-25
FDA Tracking Requirements.............................................................................................1-25
Notification of Adverse Events ..................................................................................1-26
Software License..............................................................................................................1-26
Service..............................................................................................................................1-27
The ZOLL Serial Number..................................................................................................1-28
Ch a p t e r 2 Product Overview
Defibrillator Controls and Indicators....................................................................................2-1
The Front Panel ..........................................................................................................2-2
Display Screen ............................................................................................................2-4
Battery Status and Auxiliary Power Indicators ............................................................2-6
Patient Cables and Connectors ..................................................................................2-7
External Paddles .........................................................................................................2-9
Auxiliary Power Adapter ...........................................................................................2-11
Navigating the Display Screen..........................................................................................2-12
Quick Access Keys ...................................................................................................2-12
Navigation Keys .......................................................................................................2-15
Display Brightness ....................................................................................................2-15
Common Tasks.................................................................................................................2-15
Changing the Display Brightness ..............................................................................2-16
Replacing a Battery Pack on the X Series ................................................................2-16
Using Treatment Buttons ..........................................................................................2-17
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Ch a p t e r 3 Monitoring Overview
X Series Monitoring Functions............................................................................................3-1
ECG ............................................................................................................................3-2
Heart Rate ..................................................................................................................3-2
Respiration Rate .........................................................................................................3-2
Temperature ...............................................................................................................3-2
Invasive Pressures (IBP) ............................................................................................3-2
Non-Invasive Blood Pressure (NIBP) .........................................................................3-2
Capnography (CO2) ...................................................................................................3-3
Pulse Oximetry (SpO2) ...............................................................................................3-3
Monitoring Display Options.................................................................................................3-3
Configuring the Waveform Display.....................................................................................3-7
Chapter 4 Trends
Displaying the Trends Status Window................................................................................4-1
Displaying and Printing Trend Information..........................................................................4-2
Changing the Trends Status Window Display.....................................................................4-3
Chapter 5 Alarms
Visual Alarm Indicators.......................................................................................................5-1
Audible Alarm Indicators.....................................................................................................5-2
Alarm Indicator Self-Test.....................................................................................................5-2
Patient Alarm Display .........................................................................................................5-3
Life Threatening Rhythm Alarms........................................................................................5-4
Equipment Alert Display .....................................................................................................5-4
Responding to Active Alarms -- Silencing the Alarm..........................................................5-5
Re-enabling an Alarm .................................................................................................5-5
Suspending Alarms.............................................................................................................5-5
The Alarm Suspension Timer .....................................................................................5-6
Alarm Options.....................................................................................................................5-7
Selecting Default Alarm Limits ....................................................................................5-8
Setting Alarm Limits Relative to the Patient -- Stat Set Option ...................................5-8
Ch a p t e r 6 Monitoring ECG
ECG Monitoring Setup........................................................................................................6-2
Preparing the Patient for Electrode Application ..........................................................6-2
Applying Electrodes to the Patient ..............................................................................6-3
Connecting the ECG Cable To the X Series Unit .......................................................6-5
Selecting ECG Waveforms for Display .......................................................................6-6
Selecting the Waveform Trace Size ...........................................................................6-8
ECG Monitoring and Pacemakers......................................................................................6-9
ECG System Messages......................................................................................................6-9
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TABLE OF CONTENTS
Ch a p t e r 7 Monitoring Respiration (Resp) and Heart Rate (HR)
Respiration/Breath Rate Meter...........................................................................................7-2
Using Impedance Pneumography to Measure Respiration ........................................7-2
Configuring Respiration (RR/BR) Alarms and Settings ......................................................7-3
Enabling/Disabling RR/BR Alarms and Setting Alarm Limits ......................................7-3
Using the Resp Parameter Control Panel ...................................................................7-4
Heart Rate Meter........ .......... ........... .......... ........... ..............................................................7-5
Configuring Heart Rate (HR) Meter Alarms........................................................................7-5
Enabling/Disabling HR Alarms and Setting Alarm Limits ............................................7-6
Using the Heart Rate Parameter Control Panel ..........................................................7-7
Ch a p t e r 8 Monitoring Non-Invasive Blood Pressure (NIBP)
How does NIBP Work?.......................................................................................................8-2
The NIBP Numeric Display.................................................................................................8-3
NIBP Setup and Use...........................................................................................................8-3
Selecting the NIBP Cuff......................................................................................................8-4
Connecting the NIBP Cuff...................................................................................................8-5
Applying the Cuff to the Patient..........................................................................................8-7
Ensuring Correct Cuff Inflation Settings..............................................................................8-8
Configuring NIBP Alarms and Settings...............................................................................8-9
Enabling/Disabling NIBP Alarms and Setting Alarm Limits ........................................8-9
Using the NIBP Parameter Control Panel .................................................................8-11
NIBP System Messages...................................................................................................8-14
Ch a p t e r 9 Monitoring CO2
Overview.............................................................................................................................9-1
CO2 Monitoring Setup and Use..........................................................................................9-2
Selecting the CO2 Sampling Line ...............................................................................9-3
Connecting the CO2 Sampling Lines ..........................................................................9-4
Applying a FilterLine Set .............................................................................................9-5
Applying a Smart CapnoLine Nasal or Nasal/Oral Cannula .......................................9-6
Measuring CO2...................................................................................................................9-7
Setting CO2 and Respiration Rate Alarms.........................................................................9-8
Enabling/Disabling Alarms and Setting CO2 Alarm Limits .........................................9-8
Using the CO2 Parameter Control Panel ..................................................................9-10
System Messages ............................................................................................................9-11
Patents..............................................................................................................................9-12
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Chapter 10 Pulse CO-Oximetry (SpO2, SPCO, and SpMet)
Warnings -- SpO2, General...............................................................................................10-2
Warnings -- SpO SpO
Setup and Use ........................................................................................................10-4
2
Selecting the SpO Applying the SpO
Applying a Two-Piece Single-Use Sensor/Cable ......................................................10-5
Applying a Reusable SpO
Cleaning and Reuse of Sensors ...............................................................................10-8
Connecting the SpO Displaying SpO Enabling/Disabling SpO
Setting Upper and Lower SpO2 Alarm Limits ...........................................................10-9
Setting Upper and Lower SpCO and SpMet Alarm Limits ......................................10-10
Using the SpO
Selecting the SpCO and SpMet Monitoring ............................................................10-10
Specifying the SpO
Selecting the SpO2 Sensitivity ................................................................................10-11
Selecting the Heart Rate/ Pulse Rate (HR/PR) Tone .............................................10-11
SpO
System Messages................................................................................................. 10-11
2
Functional Testers and Patient Simulators .....................................................................10-12
, Oximeter Sensor.................................................................................10-3
2
Sensor...............................................................................................10-4
2
Sensor................................................................................................10-4
2
Sensor/Cable ................................................................10-7
2
Sensor............................................................................................10-8
2
, SpCO, and SpMet Measurements........................................................10-8
2
Alarms and Setting Alarm Limits..............................................10-9
2
Parameter Control Panel ......................................................................10-10
2
Averaging Time .....................................................................10-11
2
Chapter 11 Monitoring Invasive Pressures (IBP)
Invasive Pressure Transducers........................................................................................ 11-1
IBP Setup..........................................................................................................................11-2
Attaching the Invasive Pressure Transducer.................................................................... 11-2
Zeroing the Transducer.............................................................................................. .......11-3
Rezeroing a Transducer...................................................................................................11-4
Displaying IBP Measurements.......................................................................................... 11-5
Conditions Affecting IBP Measurements ..................................................................11-5
Enabling/Disabling IBP Alarms and Setting Alarm Limits.................................................11-6
Setting Upper and Lower Systolic (SYS) Alarm Limits .............................................11-6
Setting Upper and Lower Diastolic (DIA) Alarm Limits .............................................11-7
Setting Upper and Lower Mean Arterial Pressure (MEAN) Alarm Limits ..................11-7
Setting IBP Source Label ..........................................................................................11-8
IBP System Messages...................................................................................................... 11-9
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TABLE OF CONTENTS
Ch a p t e r 1 2 Monitoring Temperature
Temperature Monitoring Setup .........................................................................................12-1
Selecting and Applying Temperature Probes....................................................................12-1
Connecting the Temperature Probe..................................................................................12-2
Displaying Temperature....................................................................................................12-2
Enabling/Disabling Temperature Alarms and Setting Alarm Limits...................................12-3
Setting Upper and Lower Temperature Alarm Limits........................................................12-3
Setting Upper and Lower Temperature Alarm Limits.......................................................12-4
Selecting the Temperature Label......................................................................................12-4
Temperature System Messages .......................................................................................12-5
Chapter 13 Automated External Defibrillator (AED) Operation
AED Operation..................................................................................................................13-2
Determine Patient Condition Following Medical Protocols .......................................13-2
Begin CPR Following Medical Protocols ..................................................................13-2
Prepare Patient .........................................................................................................13-3
1 Turn on unit ............................................................................................................13-3
2 Analyze ..................................................................................................................13-5
3 Press SHOCK ........................................................................................................13-7
Operating Messages .................................................................................................13-8
Audio and Display Messages ...................................................................................13-8
Switching to Manual Mode Operation.............................................................................13-10
Chapter 14 12-Lead ECG Interpretive Analysis
Entering Patient Information.............................................................................................14-2
Entering the Patient Name and ID ............................................................................14-3
Entering Patient Age and Gender .............................................................................14-4
12-Lead ECG Monitoring Setup........................................................................................14-4
Preparing the Patient for Electrode Application ........................................................14-4
Applying Electrodes to the Patient ............................................................................14-5
Connecting the 12-Lead Cable .................................................................................14-7
Observing the 12-Lead Waveform Traces ................................................................14-8
12-Lead Interpretive Analysis ...................................................................................14-8
Fault Conditions Affecting 12-Lead Interpretive Analysis .......................................14-11
Printing 12-Lead Waveform Traces................................................................................14-12
12-Lead Print and Display Options.................................................................................14-13
Selecting 12-Lead Acquire ......................................................................................14-13
Specifying the Number of 12-Lead Print Copies .....................................................14-13
Specifying the 12-Lead Print Format ......................................................................14-13
Printing 10 Seconds of the Lead ll Waveform Trace ..............................................14-13
Specifying the 12-Lead Frequency Response ........................................................14-14
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Chapter 15 Manual Defibrillation
Emergency Defibrillation Procedure with Paddles............................................................15-1
Determine the Patient’s Condition Following Local Medical Protocols ..................... 15-2
Begin CPR Following Local Medical Protocols .........................................................15-2
Turn On Unit .............................................................................................................15-2
1 Select Energy Level ...............................................................................................15-2
2 Charge Defibrillator ................................................................................................15-3
3 Deliver Shock .........................................................................................................15-5
Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes......................15-6
Determine the Patient’s Condition Following Local Medical Protocols ..................... 15-6
Begin CPR Following Medical Protocols ..................................................................15-6
Prepare Patient .........................................................................................................15-6
Turn On Unit .............................................................................................................15-7
1 Select Energy Level ...............................................................................................15-7
2 Charge Defibrillator ................................................................................................15-8
3 Deliver Shock .........................................................................................................15-9
Internal Paddles................................................................................................................15-9
Verification Prior to Use ..........................................................................................15-10
Synchronized Cardioversion........................................................................................... 15-11
Synchronized Cardioversion Procedure.........................................................................15-12
Determine the Patient’s Condition and Provide Care Following Local Medical
Protocols ..............................................................................................................15-12
Prepare Patient .......................................................................................................15-12
Turn On Unit ...........................................................................................................15-12
Press the Sync Key ................................................................................................15-12
1 Select Energy Level .............................................................................................15-13
2 Charge Defibrillator ..............................................................................................15-13
3 Deliver Shock .......................................................................................................15-14
Chapter 16 Advisory Defibrillation
Advisory Defibrillation Procedure......................................................................................16-2
Determine the Patient’s Condition Following Local Medical Protocols ..................... 16-2
Begin CPR Following Local Medical Protocols .........................................................16-2
Prepare Patient .........................................................................................................16-2
1 Turn on unit ............................................................................................................16-3
2 Press ANALYZE Button .........................................................................................16-4
3 Press SHOCK button .............................................................................................16-5
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TABLE OF CONTENTS
Ch a p t e r 1 7 Advisory/CPR Protocol Defibrillation
Advisory/CPR Protocol Defibrillation Procedure...............................................................17-2
Determine the Patient’s Condition Following Local Medical Protocols ..................... 17-2
Begin CPR Following Local Medical Protocols .........................................................17-2
Prepare Patient .........................................................................................................17-2
1 Turn on unit ............................................................................................................17-3
2 Press ANALYZE Button .........................................................................................17-4
3 Press SHOCK button .............................................................................................17-5
Chapter 18 External Pacing
External Pacing.................................................................................................................18-2
Pacer Modes .............................................................................................................18-2
Pacing in Demand Mode ..................................................................................................18-2
Determine Patient Condition and Provide Care Following Local Medical Protocols. 18-2
Prepare the Patient ...................................................................................................18-2
1 Turn On Unit ..........................................................................................................18-2
2 Apply ECG Electrodes/Hands-Free Therapy Electrodes .......................................18-3
3 Press Pacer button ................................................................................................18-3
4 Set Mode ...............................................................................................................18-4
5 Set Pacer Rate ......................................................................................................18-4
6 Turn On Pacer .......................................................................................................18-4
7 Set Pacer Output ...................................................................................................18-4
8 Determine Capture ................................................................................................18-4
9 Determine Optimum Threshold ..............................................................................18-5
Pacing in Fixed Mode .......................................................................................................18-6
1 Turn On Unit ..........................................................................................................18-6
2 Apply ECG Electrodes/Hands-Free Therapy Electrodes .......................................18-6
3 Press Pacer button ................................................................................................18-7
4 Set Mode ...............................................................................................................18-7
5 Set Pacer Rate ......................................................................................................18-7
6 Turn On Pacer .......................................................................................................18-7
7 Set Pacer Output ...................................................................................................18-7
8 Determine Capture ................................................................................................18-8
9 Determine Optimum Threshold ..............................................................................18-8
Pediatric Pacing ........................................................................................................18-9
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Chapter 19 Real CPR Help
CPR Dashboard................................................................................................................19-2
Rate and Depth Measurements ................................................................................19-2
CPR Release Indicator .............................................................................................19-2
Chest Compression Indicator ...................................................................................19-2
CPR Metronome...............................................................................................................19-3
FULLY RELEASE Prompt.................................................................................................19-3
CPR Voice Prompts (Optional).........................................................................................19-3
CPR Idle Time Display......................................................................................................19-4
CPR Countdown Timer.....................................................................................................19-4
CPR Compression Bar Graph ..........................................................................................19-4
Chapter 20 See-Thru CPR (Optional)
Using See-Thru CPR........................................................................................................20-2
Examples .................................................................................................................. 20-2
Chapter 21 Patient Data
Storing Data......................................................................................................................21-1
Capturing a Data Snapshot...............................................................................................21-2
Reviewing and printing snapshots ............................................................................21-2
Treatment Summary Report.............................................................................................21-2
Printing Treatment Summary Report ........................................................................21-3
Transferring Data to a USB Device...................................................................................21-3
Clearing the Log .......................................................................................................21-4
Chapter 22 Wireless Communications
The Wireless Icon.............................................................................................................22-2
The Wireless Menu...........................................................................................................22-3
Selecting and Creating a Temporary Access Point Profile ....................................... 22-3
Setting up and Viewing Paired Devices ....................................................................22-7
Setting up Communications in the Supervisor Menu........................................................22-9
WiFi Access Point Profiles ......................................................................................22-10
Setting up Cellular Communications .......................................................................22-14
Configuring Report Transmissions .........................................................................22-17
Sending a 12-lead report................................................................................................22-18
Communications System Messages...............................................................................22-19
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TABLE OF CONTENTS
Chapter 23 Printing
Printing Patient Data.........................................................................................................23-1
Printer Setup .............................................................................................................23-2
Automatic Prints ........................................................................................................23-2
Printing Waveforms ..................................................................................................23-2
Printing Reports ...................................................................................... ........... .......23-3
Printing Trends ....................................................................................... ........... .......23-4
Chapter 24 Maintenance
Daily/Shift Check Procedure.............................................................................................24-2
Inspection .................................................................................................................24-2
Defibrillator/Pacing Test with Hands-Free Therapy Electrodes.........................................24-3
Defibrillator Testing with External Paddles........................................................................24-5
Recommended Minimum Preventive Maintenance Schedule..........................................24-7
Annually .................................................................................................................... 24-7
Guidelines for Maintaining Peak Battery Performance.....................................................24-7
Cleaning instructions ........................................................................................................24-8
Cleaning the X Series unit ........................................................................................24-8
Cleaning the NIBP Blood Pressure Cuff ...................................................................24-8
Cleaning SpO2 Sensors ...........................................................................................24-9
Cleaning Cables and Accessories ............................................................................24-9
Loading Recorder Paper ...........................................................................................24-9
Cleaning the Print Head ..........................................................................................24-10
Ap p e n d i x A Specifications
Defibrillator..........................................................................................................................A-2
Monitor/Display.................................................................................................................A-14
Impedance Pneumography...............................................................................................A-15
Alarms...............................................................................................................................A-16
Recorder...........................................................................................................................A-17
Battery .............................................................................................................................A-17
General.............................................................................................................................A-18
Pacer ................................................................................................................................A-19
CO2 ..................................................................................................................................A-19
Pulse Oximeter.................................................................................................................A-20
Non-Invasive Blood Pressure...........................................................................................A-22
Invasive Pressures ...........................................................................................................A-23
Temperature......................................................................................................................A-24
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Clinical Trial Results for the Biphasic Waveform ..............................................................A-25
Randomized Multicenter Clinical Trial for Defibrillation of Ventricular Fibrillation
(VF) and Ventricular Tachycardia (VT) ...................................................................A-25
Randomized Multi-Center Clinical trial for Cardioversion of
Atrial Fibrillation (AF) ..............................................................................................A-26
Synchronized Cardioversion of Atrial Fibrillation ......................................................A-28
Electromagnetic Compatibility Guidance and Manufacturer’s Declaration.......................A-29
ECG Analysis Algorithm Accuracy....................................................................................A-33
Clinical Performance Results ....................................................................................A-33
Wireless Output Guidance and Manufacturer’s Declaration.............................................A-34
RF Transmission Emitted (IEC 60601-1-2) ...............................................................A-34
FCC Notice ...............................................................................................................A-34
Canada, Industry Canada (IC) Notices .....................................................................A-34
Appendix B Accessories
9650-001355-01 Rev. B X Series Operator’s Guide xi
TABLE OF CONTENTS
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Product Description
The ZOLL® X Series™ unit is an easy-to-use portable defibrilla tor that combin es defibrillation and external pacing with the following monitoring capabilities: ECG, CO-Oximeter, Non­invasive Blood Pressure, IBP, CO2, Temperature, and Respiration. It has been designed for all resuscitation situations and its rugged , compact, lightweight design makes it ideal fo r transport situations. It is powered by auxiliary power and an easily replaced battery pack that is quickly recharged in the device when it is connected to auxiliary power. In addition, the unit’s battery may be recharged and tested using a ZOLL SurePower™ Battery Charger Station.
Note: The X Series has defibrillation and pacing functionality, but some of the monitoring
functions are optional features. See the complete list of options in Fig. 1-1. Optional features are specified as “optional” within this guid e.
The product is designed for use in both the hospital and the rugged EMS environment. The device is a versatile automated external defibrillator with manual capabilities and may be configured to operate in Manual, Advisory or Semiautomatic modes. It can be configured to start up in Semiautomatic (AED) mode or manual mode.
When operating in manual configuration, the device operates as a conventional defibrillator where the device’ s char ging and disc harging i s fully controlled by the operator. In Advisory and AED modes, some features of the device are automated and a sophisticated detection algorithm is used to identify ventricular fibrillation and determine the appropriateness of defibrillator shock delivery. Units may be configured to automatically charge, analyze, recharge, and prompt the operator to “PRESS SHOCK”, depending on local protocols. The unit is switched from AED mode to Manual mode for ACLS use by pressing the appropriate key on the front panel.
Chapter 1
General Information
9650-001355-01 Rev. B X Series Operator’s Guide 1-1
CHAPTER 1GENERAL INFORMATION
The X Series unit assists caregivers during cardiopulmonary resusc itatio n (CPR) by evaluat ing the rate and depth of chest compressions and providing feedback to the rescuer.
Real CPR Help® requires the use of ZOLL OneStep™ CPR electrodes, OneStep™ Complete electrodes, or CPR-D-padz adaptively filtered, using the See-Thru C PR
compressions. The unit has a large colorful LCD display of numerics and waveform data that provides easy
visibility from across the room and at any angle. ECG, plethysmograph, and respiration waveform traces can be displayed simultaneously, giving easy access to all patient monitoring data at once. The display screen is configurable, so you can choose the best visual layout to fit your monitoring needs. The X Series includes a transcutaneous pacemaker consisting of a pulse generator and ECG sensing circuitry. Pacing supports both demand and fixed noninvasive pacing for adult patients and adolescent, child, and infant pediatric patients.
The X Series has a patient data review and collection system that allow s you to view, sto re, and transfer patient data. The X Series unit contains a printer and USB port, which you can use to print the data and transfer it to a PC.
The X Series unit can send data through a wireless connection to remote locations. The X Series unit can send 12-lead report snapshots (including trend data) to a recipient via a ZOLL server. Ful l disclosure case s, which also contai n trend data, can be automatically retrieved from the X Series unit using ZOLL RescueNet or ePCR software.
®
. When using these pads, the displayed ECG waveforms can be
®
feature, to reduce the artifact caused by chest
X Series Optional Features
The following features are optional in the X Series unit.
Figure 1-1 X Series Optional Features
Optional Feature
12-Lead ECG with Interpretation SpO2 (Masimo®) with SpCO® and SpMet
NIBP (with Smartcuf® and SureBPTM) EtCO2 (Oridion
Temperature Invasive Pressures (3 Channels) Advanced CPR Help Pacing
®
Microstream®)
®
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How to Use This Manual
The X Series Operator's Guide provides information operators need for the safe and effective use and care of the X Series product. It is important that all persons using this device read and understand all the information contained within.
Please thoroughly read the safety considerations and warnings section. Procedures for daily checkout and unit care are located in the Chapter 24, "Maintenance".
Operator ’s Guide Updates
An issue or revision date for this manual is shown on the front cover. If more than three years have elapsed since this date, contact ZOLL Medical Corporation to determine if additional product information updates are available.
All users should carefully review each manual update to understand its significance and then file it in its appropriate section within this manual for subsequent ref erence.
Product documentation is available through the ZOLL website at www.zoll.com. From the Products menu, choose Product Manuals.
Unpacking
How to Use This Manual
Carefully inspect each container for damage. If the shipping container or cushion material is damaged, keep it until the contents have been checked for completeness and the instrument has been checked for mechanical and electrical integrity. If the contents are incomplete, if there is mechanical damage, or if the defibrillator does n ot pass its electrical self-t est, U.S.A. customers should call ZOLL Medical Corporation (1-800-348-9011). Customers outside of the U.S.A. should contact the nearest ZOLL authorized representative. If the shipping container is damaged, also notify the carrier.
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CHAPTER 1GENERAL INFORMATION
Symbols Used on the Equipment
Any or all of the following symbols may be used in this manual or on this equipment:
Symbol Description
Dangerous voltage.
Attention, consult accompanying documents.
Fragile, handle with care.
Keep dry.
This end up.
Temperature limitation.
Conformité Européenne Complies with medical device directive 93/42/EEC.
Type B patient connection.
Type BF patient connection.
Type CF patient connection.
Defibrillator-proof type BF patient connection.
Defibrillator-proof type CF patient connection.
Fusible link.
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Symbol Description
2%452.
,I)/.
RECYCLE
,I)/.
Equipotentiality.
Alternating current (ac).
Direct current (dc).
Auxiliary power adapter operation.
Caution, high voltage.
Earth (ground).
Symbols Used on the Equipment
Negative input terminal.
Positive input terminal.
Power On/Off
Protective earth (ground).
Contains lithium. Recycle or dispose of properly.
Keep away from open flame and high heat.
Do not open, disassemble, or intentionally damage.
Do not crush.
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CHAPTER 1GENERAL INFORMATION
Symbol Description
Do not discard in trash. Recycle or dispose of properly.
Return to a collection site intended for waste electrical and electronic equipment (WEEE). Do not dispose of in unsorted trash.
Date of manufacture.
Use by.
Latex-free.
Do not reuse.
Do not fold.
Not sterile.
Manufacturer.
Authorized representative in the European Community.
Serial Number.
Catalogue number.
Consult instructions for use.
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Symbol Description
Conventions
This guide uses the following conventions: Within text, the names and labels for physical buttons and softkeys appear in boldface type (for
example, “Press the Charge button or press the Pacer button”). This guide uses uppercase italics for audible prompts and for text messages displayed on the
screen (for example, LEAD FAULT).
Conventions
Prescription only.
Battery charging status.
War ning ! Warning statements a lert you t o co nditio ns o r ac tions th at c an result in personal injur y
or death.
Caution Caution statements alert you to conditions or actions that can result in damage to the unit.
X Series Indications for Use
The X Series is intended for use by trained medical personnel who are familiar with basic monitoring, vital sign assessment, emergency cardiac care, and the use of the X Series. The X Series is also intended for use by (or on the order of) physicians at the scene of an emergency or in a hospital emergency room, intensive care unit, cardiac care unit, or other similar areas of a hospital. The usage may be in an ambulance or at the scene of an emergency. It is also intended to be used during the transport of patients. The X Series will be used primarily on patients experiencing symptoms of cardiac arrest or in post trauma situation. It may also be used whenever it is required to monitor any of th ose functions that are included (as options) in the device. The X Series unit can be used on pediatric patients (as described in the following table) and on adult patients (21 years of age or older) with and without heart dysfunction.
Pediatric Patient Subpopulation Approximate Age Range
Newborn (neonate) Birth to 1 month of age. Infant 1 month to 2 years of age. Child 2 to 12 years of age. Adolescent 12 to 21 years of age.
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CHAPTER 1GENERAL INFORMATION
When the pediatric patient is less than 8 years of age or weighs less than 55 lbs. (25 kg.), use
®
ZOLL pedi-padz patient’s exact age or weight.
pediatric defibrillation electrodes. Do not delay therapy to deter m ine the
Manual Defibrillation
Use of the X Series in the manual mode for external and internal defibrillation is indicated on victims of cardiac arrest where there is apparent lack of circulation as indicated by:
• Unconsciousness.
• Absence of breathing.
• Absence of pulse.
This product should be used only by qualified medical personnel for converting ventricular fibrillation and rapid ventricular tachycardia to sinus rhythm or other cardiac rhythms capable of producing hemodynamically significant heart beats.
The unit can also be used for synchronized cardioversion of certain atrial or ventricular arrhythmias. Qualified medical personnel must decide when synchronized cardioversion is appropriate.
The patient population will range from newborn (neonate) to adul t.
Semiautomatic Operation (AED)
X Series products are designed for use by emergency care personnel who have completed training and certification requirements applicable to the use of a defibrillator where the device operator controls delivery of shocks to the patient.
They are specifically designed for use in early defibrillation programs where the delivery of a defibrillator shock during resuscitation involving CPR, transportation, and definitive care are incorporated into a medically-approved patient care protocol.
Use of the X Series in the Semiautomatic mode for defibrillation is indicated on victims of cardiac arrest where there is apparent lack of circulation as indicated by:
• Unconsciousness.
• Absence of breathing.
• Absence of pulse. Specifications for the ECG rhythm analysis functi on are provided in the section “ECG Analysis
Algorithm Accuracy” on page A-33. When the patient is less than 8 years of age or weighs less that 55 lbs. (25 Kg), you must use
ZOLL pediatric defibrillation electrodes. Do not delay therapy to determine patient’s exact age or weight.
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ECG Monitoring
The X Series is intended for use to monitor and/or record 3-, 5-, or 12-lead ECG waveform and heart rate, and to alarm when heart rate is above or below limits set by the operator. The patient population will range from newborn (neonate) to adult, with and without heart dysfunction.
CPR Monitoring
The CPR monitoring function provides visual and audio feedback designed to encourage rescuers to perform chest compressions at the AHA/ERC recommended rate of 100 compressions per minute. Voice and visual prompts encourage a minimum compression depth of at least 1.5 (3.8 cm) or 2.0 inches (5.0 cm), depending on the configuration, for adult patients. The CPR monitoring function is not intended for use on patients under 8 years of age.
External Transcutaneous Pacing
This product can be used for temporary external cardiac pacing in conscious or unconscious patients as an alternative to endocardial stimulation.
The purposes of pacing include:
X Series Indications for Use
• Resuscitation from standstill or bradycardia of any etiology:
Noninvasive pacing has been used for resuscitation from cardiac standstill, reflex vagal standstill, drug-induced standstill (due to procainamide, quinidine, digitalis, b-blockers, verapamil, etc.) and unexpected circulatory arrest (due to anesthesia, surgery, angiography, and other therapeutic or diagnostic procedures). It has also been used for temporary acceleration of bradycardia in Stokes-Adams disease and sick-sinus syndrome. It is safer, more reliable, and more rapidly applied in an emergency than endocardial or other temporary electrodes.
• As a standby when standstill or bradycardia might be expected:
Noninvasive pacing can be useful as a standby when cardiac arrest or symptomatic bradycardia might be expected due to acute myocardial infarction, drug toxicity, anesthesia, or surgery. It is also useful as a temporary treatment in patients awaiting pacemaker implants or the introduction of transvenous therapy. In standby pacing applications, noninvasive pacing might provide an alternative to transvenous therapy that avoids the risks of displacement, infection, hemorrhage, embolization, perforation, phlebitis, and mechanical or electrical stimulation of ventricular ta chycardia or fibrillation associ ated with endocardial pacing.
• Suppression of tachycardia.
Increased heart rates in response to external pacing often suppress ventricular ectopic activity and might prevent tachycardia.
• Pediatric pacing.
Pacing can be performed on pediatric patients weighing 33 lbs. (15 kg.) or less using ZOLL pediatric hands-free therapy electrode pads. Prolonged pacing (in excess of 30 minutes), particularly in neonates, could cause burns. Periodic inspection of underlying skin is recommended.
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CHAPTER 1GENERAL INFORMATION
Non-Invasive Blood Pressure Monitoring
The X Series is intended for use to make non-invasive measurements of arterial pressure and heart rate, and to alarm if either parameter is outside of the limits set by the user. Measurements are made using an inflatable cuff on the patient's arm or leg. The patient population will range from newborn (neonate) to adult.
Temperature Monitoring
The X Series is intended for use to make continuous temperature measurements of rectal, esophageal, or surface temperatures, and to alarm if the temperature is outside of the limits set by the user. The patient population will range from newborn (neonate) to adult.
SpO2 Monitoring
The X Series pulse CO-oximeter, with Masimo Rainbow® SET® technology and the Rainbow series of sensors, is intended for use for continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO2), pulse rate, carboxyhemoglobin saturation (SpCO), and/or methemoglobin saturation (SpMet). The pulse CO-oximeter and accessories are indicated for use on adult, pediatric, and neonatal patients during both no motion and motion conditions, and for patients who are well or poorly perfused, in hospitals, hospital-type facilities, or in mobile environments.
Respiration Monitoring
The X Series is intended for use to continuously monitor respiration ra te and to alarm if the rate falls outside of the range set by the operator. Because the measurement method actually measures respiratory effort, apnea episodes with continued respiratory effort (such as obstructive apnea) may not be detected. It is not intended to be used as an apnea monitor. The patient population will range from newborn (neonate) to adult.
CO2 Monitoring
The X Series is intended for use to make cont inuo us nonin vasive measurem ent an d moni tori ng of carbon dioxide concentration of the expired and inspired breath and breath rate. The patient population will range from newborn (neonate) to adult.
Invasive Pressure Monitoring
The X Series is intended for use to display and make continuous invasive pressure measurements from any compatible pressure transducer. The primary intended uses are arterial blood pressure, central venous pressure and intracranial pressure monitoring. Any contra­indications of the particular transducer selected by the user shall apply. The patient population will range from newborn (neonate) to adult.
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12-Lead Analysis
The 12-lead ECG Analysis is useful in the diagnosis and treatment of patients with acute myocardial infarction (AMI). 12-lead ECG Analysis is also useful in the interpretation and documentation of other transient cardiac arrhythmias that may occur. When used in the prehospital setting, the 12-lead analysis results can be of assistance in diagnosis and treatment decisions once the patient has arrived in the hospital emergency department.
X Series Product Functions
Defibrillator Function
The X Series contains a direct current (dc) defibrillator capabl e of delivering up to 200 jo ules. It may be used in synchronized mode to perform synchronized cardioversion using the patient’s R-wave as a timing reference. The unit uses paddles or disposable, pregelled electrodes for defibrillation.
Defibrillator Output Energy
X Series Product Functions
X Series defibrillators can deliver biphasic energy from 1 joule to 200 joules. The energy delivered through the chest wall, however, is determined by the patient’s transthoracic impedance. An adequate amount of e lectrolyte gel mu st be applied t o the paddles and a force of 10 to 12 kilograms (22 to 26.4 pounds) must be applied to each paddle in order to minimize this impedance. If hands-free therapy electrodes are used, make sure that they are properly applied. (Refer to the instructions on the electrode package).
External Pacemaker
X Series defibrillators include a transcutaneous pacemaker consisting of a pulse generator and ECG-sensing circuitry. Noninvasive transcutaneous pacing (NTP) is an established and proven technique. This therapy is easily and rapidly applied in both emergency and nonemergency situations when temporary cardiac stimulation is indicated.
The output current of the pacemaker is continuously variable from 10 to 140 mA (the output current is 0 mA when paused). The rate is continuously variable from 30 to 180 pulses per minute (ppm), by increments of 5 ppm (10 bpm when greater than 100 ppm).
The pacing output pulse is delivered to the heart via ZOLL hands-free defibrillation/pacing electrodes placed on the patient’s back and the precordium.
Proper operation of the device, together with correct electrode placeme nt, is critical to obtaining optimal results. Every operator must be thoroughly familiar with these operating instructions.
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CHAPTER 1GENERAL INFORMATION
ECG Monitoring
The patient’s ECG is monitored by connecting the patient to the unit via a 3-, 5-, or 12-lead patient cable or hands-free therapy electrodes. The ECG waveform is presented on the display along with the following information:
• averaged heart rate, derived by measuring R to R intervals
• lead selection - I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 (with ECG cable),
PADDLES, or PADS.
• ECG size - 0.125, 0.25, 0.50, 1.0, 2.0, 4.0 cm/mV, AUTO
• status messages
The ECG bandwidth is user selectable.
Electrodes
The X Series units will defibrillate, cardiovert, and monitor ECG using hands-free therapy electrodes. The X Series unit will pace using ZOLL hands-free therapy electrodes.
Energy Select, Charge and Shock controls are located on the paddles and front panel. When using hands-free therapy electrodes, you must use the controls on the front panel of the unit. To switch between paddles and hands-free therapy electrodes, remove the multifunction cable (MFC) from the apex paddle and connect the hands-free therapy electrodes to the cable.
Batteries
You should always check the expiration date on the electrode packaging. Do not use expired electrodes, which might result in false patient impedance readings and affect the level of delivered energy, or cause burns.
This symbol on the electrode package is accompanied by the expiration date. For stat-padz® II, this symbol does not appear; the expiration date appears on the
lower right corner of the label, below the lot number.
Note: ZOLL electrodes contain no hazardous materials and may be disposed of in general
trash unless contaminated with pathogens. Use appropriate precautions when disposing of contaminated electrodes.
X Series models use an easily replaced rechargeable li thium-ion battery pack (the Su r ePower II Battery Pack). A new, fully charged battery pack typically delivers more than 6 hours of ECG monitoring. Use of other functions (such as the defibrillator, printer, or pacemaker) reduc es this time.
When a LOW BATTERY icon appears on the display and the unit emits three beeps in conjunction with the displayed battery icon, the battery must be replaced and recharged.
You can charge the battery by either of the following methods:
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X Series Product Functions
• Internal charging — plug the X Series into an auxiliary power adapter to automatically
begin charging the installed battery pack. The front panel battery indicator operates as follows:
When the indicator is: It means:
Steady yellow Battery is charging. Steady green Battery is charged. Alternating yellow and
green
Not lit No battery in device.
Note: Upon power up, it takes approximately 45 seconds for the LEDs on the battery to
accurately display run time.
• External charging — use the ZOLL SurePower Battery Charger with the X Series battery
adapter to charge the battery pack and test the battery’s capacity. For details, refer to the SurePower II Battery Pack Guide.
The Recalibration LED icon ( ) lights for approximately 10 seconds (after you press and release the Display button) if the battery needs to be calibra ted. If the Recalibrat ion LED lights, the runtime indicator will not display run time for that battery. For best performance of the battery, you should recalibrate the battery as soon as possible.
The charge state cannot be determined or a battery charging fault has been detected.
To manually recalibrate the SurePower II Battery Pack, you can insert the battery into the SurePower Charger Station and perform a Manual Test (for more information, see the ZOLL SurePower Charger Station Operator’s Guide).
After you recalibrate the battery, the Recalibration LED will only flash when you press the Display button.
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CHAPTER 1GENERAL INFORMATION
Ready For Use (RFU) Indicator
The X Series has an RFU indicator on the front panel that indicates if the device is ready for use. The RFU indicator has three states which are described in the following table.
State Description Action
Ready for Use The device is ready for use. Patient
monitoring, defibrillation, and pacing parameters are functional and the battery is above the low battery capacity.
Note: If the device is plugged into the auxiliary power adapter, the Ready for Use indicator may display even if the battery is depleted. Check the status of the battery before removing the device from the auxiliary power adapter.
Flashing One or more of the following has
occurred:
• The battery is not properly installed.
• A low battery is installed.
• A battery fault has occurred.
• There is no battery installed
while connected to auxiliary power.
• One or more patient monitoring parameters have failed self-test (NIBP, SpO2, CO2, IBP, or Temp).
• The front panel button self-test failed.
• The speech database self-test failed.
None required.
Install a fully charged battery in the unit and check the RFU indicator again. If the RFU indicator continues to flash, remove the unit from service and contact the appropriate technical personnel or the ZOLL Technical Service Department.
Do Not Use One or more of the following has
occurred:
• The battery is not properly installed.
• No battery is installed and auxiliary power is not present.
• A very low battery (below software shutdown limit) was installed.
• ECG, defibrillator, or pacer self­tests have failed, or other critical self-tests have failed.
Install a fully charged battery in the unit and check the RFU indicator again. If the RFU indicator continues to display the Do Not Use symbol, remove the unit from service and contact the appropriate technical personnel or the ZOLL Technical Servic e Department.
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Safety Considerations
All operators should review these safety considerations before using the X Series unit. X Series units are high-energy defibrillators capable of delivering 200 joules. To completely
deactivate the unit, press the power switch to turn the unit off. To manually disarm a charged (or charging) defibrillator, do one of the following:
• Press the Disarm quick access key .
• Change the selected energy.
• Press the power switch to turn the unit off.
For safety, the X Series automatically disarms if left charged for more than 60 seconds if the shock button ( ) is not pressed.
Warnings
General
Federal (U.S.A.) law restricts this defibrillator to sale by or on the order of a physician.
Safety Considerations
Only appropriately trained, skilled personnel who are familiar with equipment operation should perform emergency defibrillation. The prescribing physician should determine what training, such as Advanced Cardiac Life Support (ACLS) or Basic Life Support (BLS) certification, is appropriate.
Only skilled personnel trained in Advanced C ardiac Life Support (ACLS) and who are familiar with equipment operation should perform synchronized cardioversion. The precise cardiac arrhythmia must be determined before attempting defi bril lat io n.
These operating instructions describe the functions and proper operation of the X Series products. They are not a substitute for a formal patient care training course. Operators should obtain formal training from an appropriate authority before using this defibrillator for patient care.
Proper operation of the unit and correct electrode placement is critical to obtaining optimal results. Operators must be thoroughly familiar with proper device operation.
The use of external pacing/defibrillation electrodes, accessories, or adapter devices from sources other than ZOLL is not recommended. ZOLL makes no representations or warranties regarding the performance or effectiveness of its products when used with pacing/defibrillation electrodes or adapter devices from other sources. Defibrillator failures attributable to the use of pacing/defibrillation electrodes or adapters not manufactured by ZOLL might void ZOLL’s warranty.
At receipt of shipment, check pacing/defibrillation electrodes to ensure compatibility. Allow ample slack in cables to make sure that cables do not tug at electrodes. Do not disassemble the unit. A shock hazard exists. Refer all problems to authorized service
personnel. Follow all recommended maintenance instructions. If a problem occurs, obtain service
immediately. Do not use the defibrillator until it has been inspected by appropriate personnel.
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CHAPTER 1GENERAL INFORMATION
The X Series unit might not perform to specifications when stored at the upper or lower extreme limits of storage temperature and then immediately put into use. The X Series unit should not be stored or used outside of the environmental limits p rovided in Appendix A of this manual.
A void using the X Series adjacent to, or stacked on, other equipment. If unavoidable, verify that the unit operates normally in this configuration before clinical use.
The X Series unit should be installed and put in to service a ccordi ng to the EM C informati on in Appendix A of this manual.
Do not use internal paddles while the X Series unit’s auxiliary power source is connected to an aircraft AC power operating at a frequency of 400 Hz.
The use of accessories, transducers, and cables other than those specified in this manual and related X Series option manual inserts may result in increased emissions or decreased immunity of the X Series.
Perform functional test of internal paddles prior to use. Do not use or place the unit in service if the Ready For Use indicator (at the upper right of the
front panel) displays a red circle with a line through it. Carefully route patient cabl es to avoid tri pping over the m, or inadverte ntly pulli ng the unit onto
the patient. Always inspect the unit for damage if it has been dropped. Only authorized personnel should use the Supervisor menus. If uncertain about the accuracy of any measurement, first check the patient’s vital signs by
alternate means, and then make sure the monitor is functioning correctly.
ECG Monitoring
Implanted pacemakers might cause the heart rate meter to count the pac emak er rate during incidents of cardiac arrest or other arrhythmias. Dedicated pacemaker detection circuitry may not detect all implanted pacemaker spikes. Check the patient's pulse; do not rely solely on heart rate meters. Patient history and physical examination are important factors in determining the presence of an implanted pacemaker. Pacemaker patients should be carefully observed. See “Pacemaker Pulse Rejection:” on page A-15 of this manual for disclosure of the pacemaker pulse rejection capability of this instrument.
Use only ECG electrodes that meet the AAMI standard for electrode performance (AAMI EC-12). Use of electrodes not meeting this AAMI standard could cause the ECG trace recovery after defibrillation to be significantly delayed.
Prior to attempting synchronized cardioversion, ensure the ECG signal quality is good and that sync markers are displayed above each QRS complex.
Do not place electrodes directly over an implanted pacemaker. The X Series unit detects ECG electrical signals only. It does not detect a pulse (effective
circulatory perfusion). Always verify pulse and heart rate by physical assessment of the patient. Never assume that the display of a nonzero heart rate means that the pat ient has a pulse.
Excessive artifact can result due to improper skin preparation of the electrode site s. Follow skin preparation instructions in Chapter 6: “Monitoring ECG.”
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Do not operate the X Series in conjunction with electroc autery or diathermy equipment. Such equipment, as well as equipment that emits strong radio frequency signals, can cau se electrical interference and distort the ECG signal displayed by the monitor, thereby preventing accurate rhythm analysis.
Shock Hazard: Use of accessories, other than those specified in the operating instructions, may adversely affect patient leakage currents.
Certain line-isolation monitors may cause interference on the ECG display and may inhibit heart rate alarms.
Monitoring ECG through the paddles may result in inaccurate heart rate display due to artifact.
Defibrillation
The ZOLL X Series can deliver 200 joules o f electrical energy. If this electrical energy is not discharged properly, as described in the this manual, the electrical energy could cause persona l injury or death to the operator or bystander.
To avoid possible damage to the X Series unit, turn off pacing before defibrillating the patient with a second defibrillator.
After a synchronized cardioversion, the SYNC mode may be cleared after each shock or disarm. The user may have to reselect (press) the SYNC button after each synchronized cardioversion shock performed on a patient. In Defib/Pacer Default settings in the Supervisor Setup menu, the X Series can be configured to remain in the SYNC mode after each synchronized cardioversion.
Warnings
Synchronized cardioversion can be performed in the paddle monitoring mode. However, it is possible that artifact can be produced by the moving paddles, which could cause the defibrillator to trigger on the artifact. It is recommended that monitoring in leads I, II or III be used during synchronized cardioversion. Paddle monitoring should not be used for elective cardioversions procedures.
To avoid stress to the defibrillator or the tester, never attempt to repeatedly charge and discharge the defibrillator in rapid succession. If a need for repetitive testing arises, allow a waiting period of at least 2 minutes after every third discharge.
In the SYNC mode, the defibrillator does not discharge without a command signal (R-w ave detection) from the ECG monitor indicate d by a SYNC marker on the trace and a flashing SYNC indicator.
If conductive gel forms a continuous path between the defibrillator electrodes, delivered energy may be dramatically reduced to zero. In this case, reposition the electrodes to eliminate the shunting path before attempting additional shocks.
Improper defibrillation technique can cause skin burns. To limit possible skin burns, use only ZOLL defibrillation gel on paddles, ensure the gel covers the entire paddle surface and press firmly against patient’s chest.
If a new energy level is selected after the CHARGE button is pushed and while the defibrillator is charging or charged, the defibrillator will disarm. The CHARGE button will need to be pressed again to charge to the new energy level.
Prior to defibrillation, disconnect from the patient any medical electronic device that is not labeled “defibrillation protected.”
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CHAPTER 1GENERAL INFORMATION
Before charging the defibrillator, verify that the energy selected on the display is the desired output.
Defibrillation takes priority over external pacing. Should the defibrillator be charged during the administration of external pacing, the pacer turns off and the defibrillator charges to the selected energy.
Pacing
Ventricular fibrillation does not respond to pacing and requires immediate defibrillation. Therefore, the patient’s dysrhythmia must be determined immediately, so that you can employ appropriate therapy . If t he patient is in ventricula r fibrillation and defibrilla tion is successful but cardiac standstill (asystole) ensues, you should use the pacemaker.
Ventricular or supraventricular tachycardias can be interrupted with pacing, but in an emergency or during circulatory collapse, synchronized cardioversion is faster and more certain.
Pulseless electrical activity (PEA) can occur following prolonged cardiac arrest or in other disease states with myocardial depression. Pacing might then produce ECG responses wi th out effective mechanical contractions, making other effective treatment necessary.
Pacing can evoke undesirable repetitive resp onses, tachycardia, or fibrillation in the presence of generalized hypoxia, myocardial ischemia, cardiac drug toxicity, electrolyte imbalance, or other cardiac diseases.
Pacing by any method tends to inhibit intrinsic rhythmicity. Abrupt cessation of pacing, particularly at rapid rates, can cause ventricular standstill and should be avoided.
Noninvasive temporary pacing can cause discomfort of varying intensity, which occasionally can be severe and preclude its continued use in conscious patients.
Similarly, unavoidable skeletal muscle contraction might be troublesome in very sick patients and might limit continuous use to a few hours. Erythema or hyperemia of the skin under the hands-free therapy electrodes often occurs; this effect is usually enhanced along the perimeter of the electrode. This reddening should lessen substantially withi n 72 hours.
There have been reports of burns under the anterior electrode when pacing adult patients with severely restricted blood flow to the skin. Prolonged pacing should be avoided in these cases and periodic inspection of the underlying skin is advised.
There are reports of transient inhibition of spontaneous respiration in unconscious patients with previously available units when the anterior electrode was placed too low on the abdomen.
The pacing rate determination can be adversely affecte d by arti fact. If the patient’s pulse and the heart rate display are sig nificantly different, external pacing pulses may not be delivered when required.
Artifact and ECG noise can make R-wave detection unreliable, affecting the HR meter and the demand mode pacing rate. Always observe the patient closely during pacing operations. Consider using asynchronous pacing mode if a reliable ECG trace is unob tai nab le .
Transcutaneous pacing should not be used to treat V FIB (ventricular fibrillation). In cases of V FIB, immediate defibrillation is advised.
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Warnings
Transcutaneous pacing may cause discomfort ranging from mild to severe, depending on the patient’s tolerance level, muscle contractions and electrode placement. In certain cases, discomfort may be decreased by slightly relocating the pacing pads.
It is important to monitor the patient closely to verify that both mechanical and electrical capture are occurring. Electrical capture can be verified by observing the presence of a large ectopic beat after the pacing pulse is delivered. The size and morphology of the beat are dependent on the patient. In some instances the be at may appe ar as a rel ati vel y normal looking QRS pulse. Mechanical capture can be verified by checking for signs of increased blood flow i.e., reddening of the skin, palpable pulses, increased blood pressure, etc. Continuously observe the patient during pacing administration , to insure capture retention. Do not leave the patient unattended when administering external pacing therapy.
Warning! This device can only be used for external pacing of patients and cannot be used for
internal pacing. Do not connect internal pacing lead wires to the X Series defibrillator.
CPR
The CPR monitoring function is not intended for use on patients under 8 years of age. Place the patient on a firm surface before performing CPR. The patient must be motionless during CPR for accurate CPR measurements.
Pulse Oximeter
Keep the ZOLL finger probe clean and dry. SpO2 measurements may be affected by certain patient conditions: severe right heart failure,
tricuspid regurgitation or obstructed venous return. SpO
2
vasoconstriction or hypovolemia or under conditions where there is no pulsating arterial vascular bed.
SpO
2
devices, IR lamps, bright lights, improperly applied sensors; the use of non-ZOLL sensors, or damaged sensors; in patients with smoke inhalation, or carbon monoxide poisoning, or with patient movement.
Tissue damage can result if sensors are applied incorrectly, or left in the same location for an extended period of time. Move sensor every 4 hours to reduce possibility of tissue damage.
Do not use any oximetry sensors during MRI scanning. MRI procedures can cause conducted current to flow through the sensors, causing patient burns.
measurements may be affected when using intravascular dyes, in extreme
measurements may be affected in the presence of strong EMI fields, electrosurgical
Do not apply SpO when the arterial circulation is cut off during NIBP measurements, and may affect SpO
sensor to the same limb that has an NIBP cuff. The SpO2 alarm may sound
2
2
measurements.
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CHAPTER 1GENERAL INFORMATION
In some instances, such as obstructed airway, the patient's breathing attempts may not produce any air exchange. These breathing attempts can still produce chest size changes, creating impedance changes, which can be detected by the respiration detector. It is best to use the pulse oximeter whenever monitoring respirations, to accurately depict the patient's respiratory condition.
Noninvasive Blood Pressure
Only a physician can interpret pressure measurements. Blood pressure measurement results may be affected by the position of the patient, his or her
physiological condition and other factors. Substitution of a component different from that supplied by ZOLL (e.g., cuff, hoses, etc.) may
result in measurement error. Use only ZOLL-approved cuffs and hoses. To avoid the risk of intravenous line misconnection and possible introduction of air into a patient’s blood, do not modify the NIBP system or hoses with Luer Lock adapters.
IBP
Do not use a blood pressure cuff on the limb being used for IV infusion or for SpO Accurate pressure readings may not be achieved on a person experiencing arrhythmias,
shaking, convulsions or seizures. Medication may also affect pressure readings. The correct size cuff is essential for accurate blood pressure readings.
Blood pressure hoses must be free of obstructions and crimps. If the patient’s cuff is not at heart level, an error in measurement may result. When monitoring blood pressure at frequent intervals, observe the cuffed extremity of the
patient for signs of impeded blood flow. Do not monitor one patient’s NIBP while monitoring another patient’s ECG. Blood pressure measurement may be inaccurate if tak en while acc elera ting or decelera ting in a
moving vehicle. If an NIBP measurement result is questionable or “motion” indication is displayed, repeat the
measurement. If the repeated measurement result is still questionable, use another blood pressure measurement method.
Do not use the NIBP on cardiopulmonary bypass patients.
To ensure compatibility and electrical safety, accessory pressure sensors should comply with ANSI/AAMI BP-22 and IEC 60601-2-34 for IBP or ANSI/AAMI NS28 for ICP.
monitoring.
2
Follow instructions supplied with any accessory pressure sensor regarding calibration and removal of trapped air.
Avoid touching metal parts of any transducer while it is in contact with the patient. Do not reuse any components that are labeled for single use only. Transducers should be rated to withstand an accidental drop of at least a meter onto a hard
surface. Transducers that are subject to immersion in liquids should be rated as watertight.
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CO
Warnings
2
During MRI scanning, the monitor must be placed outside the MRI suite. When the monitor is used outside the MRI suite, EtCO which permits placement of the monitor outside the MRI suite.
When using the monitor with anesthetics, nitrous ox ide or high concentrations of oxygen, connect the gas outlet to a scavenger system.
monitoring can be implemented using a long FilterLine®
2
Use only Oridion Microstream CO Microstream CO
lines. If using the CO
or when it becomes occluded. CO
readings and respiratory rate can be affected by sensor application errors, certain ambient
2
environmental conditions, and certain patient co nd itions.
sampling lines are labeled for single patient use onl y. Do no t reu s e sampl in g
2
Monitor for extended critical care, replace the airway adapter every 24 hours
2
Respiration
Do not operate the X Series with any other monitor with respiration measurements on the same patient. The two devices could affect the respiration accuracy.
The device should not be used as an apnea monitor.
Ferromagnetic Equipment
Biomedical equipment and accessories, such as ECG electrodes, cables, and oximeter probes contain ferromagnetic materials. Ferromagnetic equipment mu st no t be used in the presence of high magnetic fields created by magnetic resonance imaging (MRI) equipment.
sampling lines.
2
The large magnetic fields generated by an MRI device can attract ferromagnetic equipment with an extremely violent force, which could cause serious personal injury or death to persons between the equipment and the MRI device.
Battery
Although the device can operate with auxiliary power alone, ZOLL strongly recommends that you operate the unit with a battery installed at all times. Operating the unit with a battery provides a backup in case of ac power shortage, and results in faster charge time. The battery can be automatically recharged while it is installed in the unit. Keep a fully charged spare battery pack with the defibrillator at all times.
Test battery packs regularly. A battery that does not pass the ZOLL charger’s capacity test might cause the X Series unit to shut down unexpectedly.
If the Low Battery indication occurs at any time during operation, immediately replace the battery pack.
9650-001355-01 Rev. B X Series Operator’s Guide 1-21
CHAPTER 1GENERAL INFORMATION
If the LOW BATTERY icon appears, plug the X Series unit into a power source or install a fully charged battery pack. When the warning low battery shutdown prompt appears, immediately replace the battery pack with a fully charged pack or plug the X Series unit i nto a power source, as unit shut down due to a low battery condition is imminent.
If mistreated, a battery pack might explode. Do not disassemble a battery pack or dispose of it in fire.
Operator Safety
The X Series can deliver 200 joules of electrical energy. If this electrical energy is not discharged properly, as described in this manual, the electrical energy could cause personal injury or death to the operator or bystanders.
Do not use the X Series in the presence of oxygen-rich atmospheres, flammable anesthetics, or other flammable agents (such as gasoline). Usin g the unit in such envi ronments might cause an explosion.
Do not use the unit near or within standing water. Electrica l safety might be c ompromised when the defibrillator is wet.
Never discharge the unit with the defibrillation electrodes or paddles shorted together or in open air.
Do not discharge the defibrillator except as indicated in the instructions. Discharge the defibrillator only when defibrillation electrodes or paddles are properly applied to the patient.
To avoid risk of electrical shock, do not touch the gelled area of the hands-free therapy electrodes during pacing or defibrillation.
T o avoid risk of electrical shock, do not allow electrolyte gel to accumulate on hands or paddle handles.
To avoid risk of electrical shock, do not allow patient connectors to contact other conductive parts, including earth.
For defibrillation using paddles, use only high-conductivi ty electrolyte gel specified for such use by the manufacturer.
When using paddles for defibrillation, use your th umb s to operat e th e SHOCK buttons. Doing so avoids inadvertent shock to the operator.
The use of accessory equipment that does not comply with the equivalent safety requirements of the X Series defibrillator could reduce the level of safety of the combined system. When choosing accessory equipment, consider the following:
• Use of the accessory in the patient vicinity.
• Evidence that the safety certification of the accessory has been performed in accordance
with the appropriate IEC (EN) 60601-1 and/or IEC (EN) 60601-1-1 harmonized national standards.
Always check that the equipment functions properly and is in proper condition before use. Disconnect all electro-medical equipment that is not defibrillation-protected from the patient
prior to defibrillation. Before discharging the defibrillator, warn everyone to STAND CLEAR of the patient.
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Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result. To avoid hazardous pathways for the defibrillation current, do not allow exposed portions of the patient's body to touch any metal objects, such as a bed frame.
T o avoid risk of electric al shock, do not allow printer to come into contact with other condu cive parts, such as equipment connected to the USB port.
Patient Safety
Inappropriate defibrillation or cardioversion of a patient (for example, with no malignant arrhythmia) may precipitate ventricular fibrillation, asystole, o r other dangerous arrhythmias.
Defibrillation without proper application of electrodes or paddle electrolyte gel might be ineffective and cause burns, particularly when repeated shocks are necessary. Erythema or hyperemia of the skin under the paddles, or electrodes often occurs; this effect is usually enhanced along the perimeter of the paddles or electrodes. This reddening should diminish substantially within 72 hours.
This equipment should be connected to only one patient at a time. Neonatal and pediatric defibrillation energy level settings should be based on site-specific
clinical protocols.
Warnings
To ensure patient safety, do not place the monitor in any position that might cause it to fall on the patient.
To ensure patient safety, connect the X Series only to equipment with circuits that are electrically isolated.
Use only high-quality ECG electrodes. ECG electrodes are for rhythm acquisition only; you cannot use ECG electrodes for defibrillation or pacing.
Do not use therapy or ECG electrodes if the gel is dried, separated, torn or split from the foil; patient burns may result from using such electrodes. Poor adherence and/or air pockets under therapy electrodes can cause arcing and skin burns.
Check the expiration date on the electrode packaging. Do not use electrodes after their expiration date.
Excessive body hair or wet, diaphoretic skin can inhibit electrode coup lin g to th e skin. Clip excess hair and dry any moisture from the area where an electrode is to be attached.
Therapy electrodes should be replaced periodically during continuous pacing. Consult electrode directions for proper replacement instructions.
Prolonged pacing (more than 30 minutes), particularly in neonates or adu lt s with severely restricted blood flow, may cause burns. Periodically inspect the skin under the electrodes.
Carefully route the patient cables away from the patient’s neck to reduce the possibility of patient entanglement or strangulation.
T o avoid electrosurgery burns at monitoring sites, ensure proper connection of the electrosurgery return circuit so that a return path cannot be made through monit oring electrodes or probes.
9650-001355-01 Rev. B X Series Operator’s Guide 1-23
CHAPTER 1GENERAL INFORMATION
During electrosurgery, observe the following guidelines to minimize electrosurgery unit (ESU) interference and provide maximum operator and patient safety:
• Keep all patient monitoring cables away from earth ground, ESU knives, and ESU return
wires.
• Use electrosurgical grounding pads with the largest practical contact area.
Always ensure proper application of the electrosurgical return electrode to the patient. Check electrical leakage levels before use. Leakage current might be excessive if more than one
monitor or other piece of equipment is connected to the patient.
Cautions
If the unit is to be stored longer than 90 days, remove the battery pack. Do not sterilize the defibrillator, or its accessories unless the accessories are labelled as
sterilizable. Do not immerse any part of the defibrillator in water. Do not use the defibrillator if excessive condensation is visible on the device. Wipe only the
outside with a damp cloth. Do not use ketones (such as acetone or MEK) on the defibrillator. Avoid using abrasives (including paper towels) on the display window. To achieve the specified level of protection against spilled or splashed liquids, thoroughly dry
all exposed surfaces of this device prior to operation or connections to auxiliary power. If liquids enter the device connectors, remove all liquid from the connectors and al low the
device to dry thoroughly prior to use. Grounding reliability can be achieved only when the equipment is connected to a receptacle
marked “HOSPITAL ONLY,” “HOSPITAL GRADE,” or equivale nt. If the groundin g inte grity of the line cord or ac receptacle is questionable, operate the defibrillator using battery power only.
Do not connect to an electrical outlet controlled by a wall switch or dimmer. To protect the unit from damage during defibrillation, for accurate ECG information, and to
protect against noise and other interference, use only intern al current-limiting ECG cables specified or supplied by ZOLL.
For continued safety and EMI performance, use only the line cord supplied by ZOLL. Electrical installation of the room or the building in which the monitor is to be used must
comply with regulations specified by the country in which the equipment is to be used. Dispose of battery packs in accordance with national, regional and local regulations. Battery
packs should be shipped to a reclamation facility for recovery of metal and plastic compounds as the proper method of waste management.
Do not place the device where the controls can be changed by the patient.
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Restarting the Defibrillator
Certain events require the X Series products to be restarted after they shut off or become inoperative (for example, when the battery runs down and the unit shuts off).
In such a case, always try to restore defibrillator operation as follows:
1. Press the power switch on the top of the unit to turn it off.
2. If necessary , replace a depleted battery with a fully charge d pack, or connect the de fibrillator
to auxiliary power.
3. Press the power switch on the top of the unit to turn it back on.
This sequence is necessary to restart the defibrillator and can also be used to clear some fault messages when immediate use of the defibrillator is required.
If the X Series unit is powered off for less than 2 minutes, all patient monitoring parameter settings will be retained. If the unit has been powered off for at least two minutes, it will be considered a New Patient and all of the patient-specific parameters (alarm limits, defibrillator energy, etc.) will be reset to their default values.
FDA Tracking Requirements
Restarting the Defibrillator
U.S. Federal Law (21 CFR 821) requires the tracking of defibrillators. Under this law, owners of this defibrillator must notify ZOLL Medical Corporation if this product is
• received
• lost, stolen, or destroyed
• donated, resold, or otherwise distributed to a different organization
If any such event occurs, contact ZOLL Medical Corporation in writing with the following information:
1. Originator's organization – Company name, address, contact name, and contact phone number
2. Model number, and serial number of the defibrillator
3. Disposition of the defibrillator (for example, received, lost, stolen, destroyed, distrib uted to
another organization), new location and/or organization (if known and different from originator’s organization) – company name, address, contact name, and contact phone number
4. Date when the change took effect
Please address the information to:
ZOLL Medical Corporation Attn: Tracking Coordinator 269 Mill Road Chelmsford, MA 01824-4105
Fax: (978) 421-0025 Telephone: (978) 421-9655
9650-001355-01 Rev. B X Series Operator’s Guide 1-25
CHAPTER 1GENERAL INFORMATION
Notification of Adverse Events
As a health care provider, you may have responsibilities under the Safe Medical Devices Act (SMDA), for reporting to ZOLL Medical Corpora tion, and possibl y to the FDA, the occurrence of certain events.
These events, described in 21 CFR Part 803, include device-related death and serious injury or illness. In addition, as part of our Quality Assurance Program, ZOLL Medical Corporation requests to be notified of device failures or malfunctions. This information is required to ensure that ZOLL Medical Corporation provides only the highest quality products.
Software License
Note: Read this Operator’s Guide and License agreement carefully before operating any of
the X Series products.
Software incorporated into the system is protected by copyright laws and international copyright treaties as well as other intellectual property laws and treaties. This software is licensed, not sold. By taking delivery of and using this system, the Purchaser signifies agreement to and acceptance of the following terms and conditions:
1. Grant of License: In consideration of payment of the software license fee which is part of the price paid for this product ZOLL Medical Corporation grants the Purchaser a non­exclusive license, without right to sublicense, to use the system software in object-code form only.
2. Ownership of Software/Firmware: Title to, ownership of and all rights and interests in the
system software and all copies thereof remain at all times vested in the manufacturer, and Licensors to ZOLL Medical Corporation and they do not pass to purchaser.
3. Assignment: Purchaser agrees not to assign, sublicense or otherwise transfer or share its
rights under the license without the express written permission of ZOLL Medical Corporation.
4. Use Restrictions: As the Purchaser, you may physically transfer the products from one
location to another provided that the software/firmware is not copied. You may not disclose, publish, translate, release or distribute copies of the software/firmware to others. You may not modify, adapt, translate, reverse engineer, decompile, crosscompile, disassemble or create derivative works based on the software/firmware.
NO IMPLIED LICENSE
Possession or purchase of this device does not convey any express or implied license to use the device with replacement parts which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.
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Service
Service
The X Series only requires recalibration of the CO2 module. Service is required after 20,000 hours of use of the CO however, perform periodic tests of the defibrillator functionality to verify proper operation.
If a unit requires service, contact the ZOLL Technical Service Department.
For customers In the U.S.A. For customers outside the U.S.A.
Telephone:
Fax:
1-800-348-9011 1-978-421-9655
1-978-421-0010
When requesting service, please provide the following information to the service representative:
module. Appropriately trained and qualified person nel should,
2
Call the nearest authorized ZOLL Medical Corporation representative.
To locate an authorized service center, contact the International Sales Department at
ZOLL Medical Corporation 269 Mill Road Chelmsford, MA 01824-4105
Telephone: 1-978-421-9655
• Unit serial number
• Description of the problem
• Department using the equipment and name of the person to contact
• Purchase order to allow tracking of loan equipment
• Purchase order for a unit with an expired warranty
• Sample ECG or other stripcharts demonstrating the problem (if available and applicable),
less any confidential patient information.
Returning a unit for service
Before sending a unit to the ZOLL Technical Service Department for repair, obtain a service request (SR) number from the service representative.
Remove the battery pack from the unit. Pack the unit with its cables and battery in the original containers (if available) or equivalent packaging. Be sure the assigned service request number appears on each package.
For customers Return the unit to
In the U.S.A. ZOLL Medical Corporation
269 Mill Road Chelmsford, MA 01824-4105
Attention: Technical Service Department (SR number) Telephone: 1-800-348-901 1
9650-001355-01 Rev. B X Series Operator’s Guide 1-27
CHAPTER 1GENERAL INFORMATION
For customers Return the unit to
In Canada ZOLL Medical Canada Inc.
1750 Sismet Road, Unit #1 Mississauga, ON L4W 1R6
Attention: Technical Service Department (SR number) Telephone: 1-866-442-101 1
In other locations The nearest authorized ZOLL Medical Corporation representative.
To locate an authorized service center, contact the International Sales Department at
ZOLL Medical Corporation 269 Mill Road Chelmsford, MA 01824-4105
Telephone: 1-978-421-9655
The ZOLL Serial Number
Each ZOLL product displays a serial number that contains information about t hat product. From left to right, ZOLL serial numbers are structured as follows:
• A two-character product code
• A three-character date-of-manufacture code
• A product serial number of six or more alphanumeric characte rs
The first two characters of the date-of-manufacture code give the last two digi ts of the year (for example, “06” appears for products manufactured in 2006). The last character of the date-of­manufacture code gives the month in which the product was manufactured. The month appears in the form of a single alphanumeric character: “A” for January, “B” for February, “C” for March, and so on through “L” for December.
The product serial number is a unique set of alphanumeric c haracters that ZOLL assigns to each individual unit.
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Product Overview
SHOCK
123
®
PACER
5
2
9
1
6
4
5
7
8
3
5
Defibrillator Controls and Indicators
Chapter 2
9650-001355-01 Rev. B X Series Operator’s Guide 2–1
CHAPTER 2PRODUCT OVERVIEW
SHOCK
123
®
PACER
Seven quick
Display screen
RFU indicator
Auxiliary power LED
Battery charge LED
Silence/reset Display
Navigation keys Snapshot
NIBP
Shock
Charge
Pacer
Analyze
Energy Select
access keys
Power button
Visual Alarm Indicators
Table 2-1. X Series Unit Features
Item Description
1 Handle Integrated carrying handle. 2 Front panel Includes the display screen and primary controls. 3 Speaker Emits R-wave detection beeps and alarm tones. 4 Paper Compartment Holds the paper for the printer. 5 Patient connectors For details, refer to “Patient Cables and Connectors” on
6 USB device connector For connecting the X Series defibrillator to a USB device.
7 Battery compartment Holds a rechargeable lithium ion battery pack. 8 Auxiliary power connector For connecting the device to an auxiliary power adapter. 9 Dock connector For connecting the device to a docking station.
The Front Panel
The front panel of the X Series device includes the display screen, quick access keys, battery and auxiliary power indicators, Ready For Use (RFU) indicator, and the defibrillation front panel buttons: Pacer, Analyze, Energy Select, Charge, and Shock ( ). See Figure 2-1. Refer to Table 2-2 on page 2-3 for informati on about the controls and indicators.
page 2-7.
For details, refer to “Transferring Data to a USB Device” on page 21-3“.
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Figure 2-1. X Series Front Panel
Defibrillator Controls and Indicators
PACER
Table 2-2. X Series Controls and Indicators
Control or Indicator Description
Display screen Shows therapeutic settings, physiological waveforms and other
information for each monitored parameter, messages, time, and quick access key labels.
Quick access keys Seven buttons control different functions of the unit. Labels for the quick
access keys appear on the monitor display to the right of each key. Auxiliary power LED Illuminated when the unit is plugged in to an auxiliary power adapter. Battery charge LED Indicates battery status:
Steady yellow: Battery is charging.
Steady green: Battery is charged.
Alternating green and yellow: The charge state cannot be determined
or a battery charging fault has been
detected.
No light: Battery is not installed. Visual alarm
indicators
Pacer button Displays pacer settings window to start/stop pacing activity or change
Red, yellow, and green lights located on the top of the unit that flash on
and off when the unit is powered up and are used to indicate a patient
alert, equipment alert, and data transfer.
the rate, output, or mode settings.
ANALYZE button Displays in Manual mode only. Initiates ECG analysis to determine
whether or not a shockable rhythm is present.
ENERGY SELECT buttons
CHARGE Button Charges the defibrillator to the selected energy. In addition to the
Shock Button The front panel Shock button is only active when using hands-free
NIBP button Starts/stops an NIBP measurement.
Snapshot button Records 24 seconds of numeric and waveform data.
Two sets of up-down arrow buttons control the selection of defibrillator
energy; one set is located on the front panel and the other set is located
on the STERNUM paddle.
CHARGE button on the front panel, there is one located on the APEX
paddle handle.
therapy electrodes or internal defibrillation paddles without a discharge
button. The Shock button illuminates when the device is charged and
ready.
To discharge the defibrillator when using paddles (internal or external)
with discharge buttons, press and hold the SHOCK buttons on the
paddles.
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CHAPTER 2PRODUCT OVERVIEW
Table 2-2. X Series Controls and Indicators (continued)
Control or Indicator Description
Navigation keys
Display/Home button Cycles through three available display modes or functions as a Home
Silence/Reset button Silences the current alarm tone for 90 seconds or resets a silenced
The up (clockwise) arrow will cause the cursor to travel in an upward direction if the cursor is being used to navigate through a vertical list or in a clockwise direction if the cursor is being used to navigate around the full screen. Likewise, the down (counterclockwise) arrow will cause the cursor to travel in a downward direction if the cursor is being used to navigate through a vertical list or in a counterclockwise direction if the cursor is being used to navigate around the full screen. The up (clockwise) and down (counterclockwise) arrows may also be used to modify parameter settings.
The Select button acts based on what is highlighted.
button when in a menu.
alarm tone.
RFU indicator Shows the status of the unit, based on its most recent readiness check.
Ready
Power button Located on the top of the unit, this button turns the unit on and off.
Charge Indicator Light (not shown)
Display Screen
The front panel includes a color display which shows:
• Date and time
• Patient mode
• Battery status indicator
• Time elapsed (since unit was turned on)
• Quick access keys
• Waveform source
• Color-coded waveforms and ECG lead identifiers
• SpO
• Heart rate numeric data
• Respiration rate numeric data
• Temperature numeric data
• Non-invasive blood pressure numeric data
Do Not Use
numeric data
2
A red circle with a line through it indicate s that the unit’s readiness has been compromised and that it may not be ready for therapeutic use.
Located on the APEX paddle, this light turns on when the defibrillator is charged and ready.
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Defibrillator Controls and Indicators
Date and time Patient mode
Battery status Time elapsed
Quick access keys
Message
Waveform
SpO2 data
CO
2
data
Respiration rate
NIBP data
Heart rate
Current temp
06/06/2011 12:34:56
Adult
00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
79
(96)
NIBP mmHg
38
12
BR
CO2 mmHg
SpO2 %
97
T1 ºF
98.6
EtCO2 Low AlarmSpO2 Check Sensor
Some alarm limits disabled.
Status queue
• EtCO
• Invasive pressure numeric data
• The selected energy, charging status, and delivered energy for defibrillation and
numeric data
2
synchronized cardioversion
• The output current and stimulus rate for pacing
• Messages and prompts
Figure 2-2 shows the layout of parameter values, waveforms, system dat a, and quick access key labels.
12
CO
2
R
Figure 2-2. X Series Display Screen
Color coding
To differentiate information for various parameters, the unit displays each type of information in a specific user-configurable color.
9650-001355-01 Rev. B X Series Operator’s Guide 2–5
CHAPTER 2PRODUCT OVERVIEW
Low
1:00+
2:00+
3:00+
Battery Status and Auxiliary Power Indicators
The battery status indicator displays various battery icons to indicate the approximate remaining unit run time based on the charged state of the battery. Additionally, these icons provide indications of the status of the battery connection and communication with the unit. The auxiliary power indicator indicates that the unit is being powered by the auxiliary power adapter.
Note: Upon powering up the X Series unit, the battery capacity will be displayed within
approximately 15 seconds under normal conditions. Under some circumstances, such as activating the defibrillator immediately after the unit is turned on, the battery icon may display less than one hour battery capacity for up to two minutes after exiting the defibrillation mode.
Icon Status Indication/Action
Auxiliary power adapter is connected
No battery detected Either there is no battery in the unit
Low battery capacity Replace the battery soon.
The unit is being powered by the auxiliary power adapter.
while it is being powered by the auxiliary power adapter, or the device cannot detect that the battery is connected.
Communication failure The unit is unable to establish
communication with the battery and the battery capacity is unknown. Check the battery contacts.
Battery fault A battery fault has been detected.
Replace the battery.
Battery Level 1 The battery has less than one hour
of remaining battery capacity.
Battery Level 2 The battery has greater than one
hour of remaining battery capacity .
Battery Level 3 The battery has greater than two
hours of remaining battery capacity.
Battery Level 4 The battery has greater than three
hours of remaining battery capacity.
Battery Level 5 The battery is fully charged.
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Patient Cables and Connectors
ECG
SpO
2
NIBP
CO
2
CO
2
Exhaust
MFC
IBP
Temp
The left and right sides of the unit include sets of connectors for patient cables. Note: The SPO2, NIBP, CO2, Temperature, and IBP functions are optional. If your unit does
not include these options, it does not have the applicable connectors.
Defibrillator Controls and Indicators
Figure 2-3. Patient Cable Connectors on Left Side of Unit
Figure 2-4. Patient Cable Connectors on Right Side of Unit
9650-001355-01 Rev. B X Series Operator’s Guide 2–7
CHAPTER 2PRODUCT OVERVIEW
2. Connector is locked into place.
1. Insert MFC into unit.
Connector Description
ECG For connecting 3- or 5-lead ECG cable (12-lead monitoring is
SpO
2
NIBP For connecting NIBP hose. CO
2
Temp For connecting temperature probe(s). Multifunction Cable (MFC) For connecting paddles or ZOLL hands-free therapy and pacing
IBP For connecting IBP cable(s).
Multifunction Cable (MFC)
The unit ships with an MFC that is used to defibrillate the patient. Any other cables that ship with your unit depend on the options you have purchased.
optional).
For connecting Masimo SpO2/CO cable.
For connecting CO2 sampling line.
electrodes.
Figure 2-5. MFC
Inserting MFC into Unit
Plug the MFC connector into the therapy input connector on the right side of the unit. Push the connector in with the arrows aligned. The connector will click when it locks into place.
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Removing MFC from Unit
1. Twist MFC connector
2. Pull out connector.
to the left.
1. Align MFC as shown.
2. Insert MFC into APEX handle.
Twist the connector to the left to unlock it, and pull out the MFC connector.
External Paddles
Defibrillator Controls and Indicators
Paddles are defibrillation-proof Type BF equipment.
The external paddles on the X Series device are used for defibrillation and synchronized cardioversion.
Caution You cannot use paddles for external transcutaneous pacing.
Attach the MFC from the X Series unit to the connector at the base of the APEX paddle.
Figure 2-6. Attaching the MFC to the APEX Paddle
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CHAPTER 2PRODUCT OVERVIEW
MFC connected to APEX paddle
MFC Connected to APEX Paddle
SHOCK
Buttons
ENERGY SELECT
Buttons
CHARGE
Button
Charge Ready
Indicator
STERNUM Paddle
APEX Paddle
Connector and RELEASE button for MFC
RECORDER
Button
Figure 2-7. MFC Connected to APEX Paddle
If you need to detach the MFC from the APEX paddles, push the RELEASE button (see Figure 2-8) in the direction of the arrow and unplug the MFC.
Refer to Chapter 14, “Manual Defibrillation” before using paddles for defibrillation. The paddles include controls for selecting defibrillation energy, charging, and delivering a shock.
Figure 2-8. External Paddles
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Defibrillator Controls and Indicators
To expose the pediatric plate, press the PEDI button at the top of the paddle, then slide the Adult plate upward.
Before replacing the Adult plate, be sure to clean the pediatric plate and surrounding area thoroughly.
Slide the Adult plate onto the paddle until it locks into place.
PEDI button
Pediatric-size electrodes are built in to the paddle assembly beneath the standard electrode plates. The user must manually adjust energy settings to pediatric levels consistent with their institution’s protocols.
Figure 2-9. Pediatric Plate
Note: The X Series defibrillator also supports ZOLL autoclavable internal handles for use
during open chest defibrillation procedures.
Auxiliary Power Adapter
The auxiliary power adapter is used as backup power to operate the X Series unit. When it is connected to the unit, it powers the unit and char ge s the ba tte ry tha t is install ed insid e it. When the power cord is plugged in and the auxiliary power connector is inserted into the back of the X Series unit, the auxiliary power LED on the front panel illuminates and the auxiliary power icon displays at the top of the display screen.
Figure 2-10. Auxiliary Power Adapter
9650-001355-01 Rev. B X Series Operator’s Guide 2–11
CHAPTER 2PRODUCT OVERVIEW
I, II, III...
SYNC
IBP
First level keys
Second level keys
To connect the auxiliary power adapter, insert the auxiliary power connector into the black input connector on the back of the unit. To disconnect the auxiliary power adapter, grasp the connector collar, turn it to the left, and pull it out.
Figure 2-11. Connecting the Auxiliary Power Adapter
Navigating the Display Screen
You can access the X Series functions using the quick access keys that are located on the left side of the display screen, and the navigation keys that are located on the right side of the front panel.
Quick Access Keys
The seven quick access keys on the left side of the display screen are an easy way to access the functionality of the X Series. When you press the last key (left arrow), five more keys are displayed.
12
CO
R
2
LOG
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Navigating the Display Screen
I, II, III...
SYNC
IBP
Manual
Mode
Pause
Table 2-3. X Series Quick Access Keys
Quick access key Description
Lead Selects the ECG input source for the first waveform trace.
12 lead Displays the 12-lead monitoring screen.
12
CO
2
Turns CO2 on and off.
Treatment Displays the current clinical treatment options.
R
Sync Activates the synchronized cardioversion mode.
Print Starts or stops a continuous chart print.
More/Back Goes to the next or previous level of quick access keys.
Brightness Changes the brightness se tting -- toggles through high contrast
display (white background), color display (black background), and night vision goggle (NVG) friendly display.
IBP Displays IBP setup and zero buttons.
Alarms Displays the Limits option to allow the user to view/set all parameter
alarm limits and the alarm suspend button.
Log Opens the Log Control panel.
LOG
Setup Displays the Setup menu to allow the user to configure settings such
as ECG, display/volume, printer, trends, operational checklist, and supervisor.
Treatment Summary Displays treatment summary cases, which you can print.
Manual Mode Allows user to change from AED Mode to Manual Mode.
Pause
Allows user to Pause the rescue cycle
.
9650-001355-01 Rev. B X Series Operator’s Guide 2–13
CHAPTER 2PRODUCT OVERVIEW
Print
Trends
STOP
Row
Row
Exit
Stat
Set
Limits
Table 2-3. X Series Quick Access Keys
Quick access key Description
Print Trends Prints the trends that are displayed in the Trend Summary window.
Trend Settings Displays settings for trend display format, trend on interval, and trend
Transfer Log Transfers the current data in the log to a USB drive.
Clear Log Deletes the current data in the log.
Acquire Collects 10 seconds of 12-lead data for print.
12
Stop Acquisition Stops acquisition of 12-lead data.
Patient Information Allows you to enter information to accompany 12-lead data: patient
on alarm.
name, age, gender, and ID.
Row Up Allows you to move to the previous row when entering patient
information.
Row Down Allows you to move to the next row when entering patient information.
12-Lead Review Reviews all your 12-lead captured data.
12-Lead Review Next Goes to the next page of the 12-lead snapshot you are reviewing.
Transmit Transmits 12-lead data.
Exit 12-Lead Exits the 12-lead monitoring screen.
12
Stat Set Sets all alarm limits relative to the patient’s current vital signs.
Alarm Cancel Suspends the current alarm.
Limits Displays the current alarm settings.
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Table 2-3. X Series Quick Access Keys
Disarm
Disarm
Disarm
Quick access key Description
Disarm Safely discharges the defibrillator internally. No energy is delivered to
IBP Setup Brings up the IBP Control Panel for the corresponding channe l (P1,
IBP Zero Zeroes the IBP transducer for the corresponding channel (P1, P2, or
Navigation Keys
Use the navigation keys (up/clockwise arrow, down/ counterclockw ise arrow, and select butt on) to navigate through windows and make selections .
Using Up/Clockwise and Down/Counterclockwise Arrows
Common Tasks
the patient.
P2, or P3).
P3).
Use the up/clockwise down/counterclockwise arrows to do the following:
• Move clockwise and counterclockwise through the main display windows.
• Move up and down in a window.
• Change parameter settings.
Using the Select Button
Use the Select button to do the following:
• Display the settings window while a parameter is highlighted in the main window.
• Select options from a window.
Display Brightness
The monitor can display in two different brightness modes:
• high contrast with white background (for optimal display in bright sunlight)
• color with black background (numerics and waveforms are easy to read)
Common Tasks
The section contains procedures for the following tasks:
• “Changing the Display Brightness” on page 2-16.
• “Replacing a Battery Pack on the X Series” on page 2-16.
• “Using Treatment Buttons” on page 2-17
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CHAPTER 2PRODUCT OVERVIEW
Changing the Display Brightness
The following procedure shows how to select the different brightness options.
1. Press the power switch to turn the unit on.
2. Press the Brightness quick access key ( ) repeatedly to toggle through the brightness
options until you find your selection.
Note: Selecting a higher brightness setting (such as 70%) will deplete the battery pack at a
faster rate than when choosing a lower brightness setting (such as 30%). To select the brightness setting, go to the Setup>Display/Volume>Display Brightness menu to adjust the display percentage.
Replacing a Battery Pack on the X Series
This section describes how to replace a battery pack on the X Series.
Replacing a Battery Pack on the X Series
T o remove a battery pack, use your fingers to grasp and raise the latch and pull the battery pack out of the compartment.
Figure 2-12. Removing a Battery Pack
To install a battery pack:
1. Line up the battery so it will slide into the battery well.
2. Push the battery into place.
Figure 2-13. Installing a Battery Pack
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Using Treatment Buttons
Pressing the Treatment qu ick acc ess key ( ) causes the unit to display p reco nfigure d button s that contain clinical actions. These buttons allow you to add a treatment snapshot (which itemizes drugs or treatments administered to the patient) to a Treatment Summary Report.You can do this by selecting Print on Treatment Snapshot from Setup>Supervisor>Printer. The following is a list of preconfigured treatment buttons:
• O2
• ASA
• Nitro
• Morph
• IV
• B Block
• Lido
• MgSO4
• Valium
• Sedate
Customizing Tr eatment But tons
You can also customize up to 9 treatment b uttons by pressing the Setup qui ck access key ( ), and then selecting Supervisor>Log>T reat ment Options. Highli ght De fine C ustom Labels , and then can customize up to 9 buttons.
Common Tasks
R
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CHAPTER 2PRODUCT OVERVIEW
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Monitoring Overview
This chapter provides an overview of the X Series unit’s monitoring functions. It describes the types of vital sign monitoring that X Series provides, and the flexibility that the X Series unit gives you in displaying a patient’s vital signs information.
X Series Monitoring Functions
The X Series unit provides an array of standard, a nd optional, mo nitoring functio ns, and allows you to view the vital signs measurements that these functions provide in a variety of formats. The X Series unit also allows you to set alarm limits for each monitoring function. Should a patient’s vital signs measurements go outside of these limits, the X Se ri es issues an audible alarm tone and displays visual alarm indications to alert you.
If the X Series unit is powered off for less than 2 minutes, all patient monitoring parameter settings are retained. If the X Series unit is powered off for 2 minutes or longer, the unit operates as if there is a New Patient and all patient-specific parameters (alarm limits, defibrillator energy, etc.) are reset to their default values.
Chapter 3
The X Series unit can monitor the following patient vital signs:
• ECG
• Heart Rate
• Respiration Rate
• Temperature
• Invasive Pressures (IBP)
• Non-invasive Blood Pressure (NIBP)
• Capnography (CO
• Pulse Oximetry (SpO
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)
2
)
2
CHAPTER 3MONITORING OVERVIEW
ECG
An ECG waveform trace appears at the top of the display area. You can specify that the unit display the waveform trace of any available ECG source, such as and so on, in this area. You can configure the X Series unit to display up to four ECG waveform traces. In addition to being able to specify the ECG source for each waveform trace, you can adjust the display scale of those traces to make them easier to view.
Heart Rate
A Heart Rate meter gives the patient’s heart rate in Beats Per Minute (bpm). By default, the X Series unit derives the heart rate from the patient’s ECG, but can be configured to use other monitoring functions to derive the patient’s heart rate.
Respiration Rate
A Respiration Rate meter gives the patient’s respiration rate in Breaths Per Minute (br/min). The X Series unit can be configured to derive the respiration rate from the patient’s ECG or from the optional CO
2
Pads, ECG Leads l, ll, or lll,
monitoring function.
Temperature
The Temperature (Temp) meter can display temperature measurements from up to two temperature probes. The X Series unit provides two separate temperature monitoring channels and, if both are used, displays the monitored temperatures, in degrees F or C, one after the other, followed by the difference between those temperatures.
Invasive Pressures (IBP)
The X Series unit provides three separate channels for monitoring arterial, venous, or intracranial pressure using internal probes. The pressure measurements for each pressure channel appear in a labeled (
P1, P2, P3) numeric display.
Non-Invasive Blood Pressure (NIBP)
The X Series unit provides patented Smartcuf motion-tolerant technology for NIBP monitoring. NIBP monitoring measures the patient’s systolic, diastolic, and mean blood pressure through an inflatable blood pressure cuff that the X Series unit inflates/deflates. NIBP measurements can
be taken automatically or on-demand by p ressing the NIBP butto n ( ) on the front panel of the X Series unit. The blood pressure measurements appear in a labeled ( You can also specify that the X Series unit display non-invasive pressure waveforms in the waveform trace area.
NIBP) numeric display.
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Capnography (CO2)
CO2 monitoring measures the CO2 concentration in a patient’s exhaled breath (End Tidal Carbon Dioxide --EtCO CO
concentration in the gasses supplied to intubated patients (Fractional Inspired Carbon
2
Dioxide -- FiCO serves as an indicator for rebreathing in non-intubated pati ents. CO both intubated and non-intubated patients.
Monitoring Display Options
). CO2 monitoring can also measure a patient’s breath rate and the
2
). Since FiCO2 represents the amount of CO2 present during inhalation, it also
2
monitoring can be used for
2
The EtCO The EtCO
, breath rate, and FiCO2 measurements appear in a labeled (EtCO2) numeric display.
2
and FiCO2 measurements can appear as values given in millimeters of mercury
2
(mmHg). You can also specify that the X Series unit di splay a CO trace display area.
Pulse Oximetry (SpO2)
Pulse Oximetry monitoring measures the oxygen saturation (SpO2) of arterial blood at a peripheral site such as a finger or toe. If optional features SpCO and Sp Met are installe d, it also
monitors carboxyhemoglobin saturation (SpCO), and methemoglobin saturation (SpMet).
monitoring determines the ratio of oxygenated hemoglobin to total hemoglobin in arterial
SpO
2
blood and displays this ratio as percent SpO features SpCO and SpMet are installed, these values alternate and display as
under the SpO
display. You can also specify that the X Series unit display an SpO
2
plethysmograph in the waveform trace display area.
Monitoring Display Options
The X Series unit gives you great flexibility in how you display a patient’s vital signs information. By pressing the Display/Home button ( ) on the front panel, you can
successively display the patient’s vital signs information in these three windows:
capnogram in the waveform
2
in a labeled (SpO2) numeric display. If optional
2
SpCO and SpMet
2
• Waveform Display window, which initially displays an ECG waveform trace and numeric
displays for each monitoring function.
• Trends Status window, which displays a report listing vital signs measurements that the X
Series unit logs automatically, and the primary ECG waveform trace.
• Large Numerics Display window, on which large numeric displays of all vital signs
measurements appear.
The Waveform Display window appears when you power on the X Series unit. Initially, the Waveform Display window displays a single ECG waveform trace. All other monitored values appear in numeric display areas at the bottom of the screen:
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SYNC
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CO
2
R
You can display up to four waveform traces that you sp ecify on the Wave form Display window. You will determine how to add waveform traces to this window later in this chapter.
Press the Home/Display button when viewing the Waveform Display window, and the unit displays the Trends Status window. The Trends Status window reports the patient’s vital sign measurements, which the X Series logs automatically at a configurable interval (see the following chapter, Trends, for more detailed information about the Trends Status window). The primary ECG waveform trace appears above the Trends
report:
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I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
NIBP mmHg
121 79
(96)
EtCO2 mmHg
12
BR
38
SpO2 %
97
T1 ºF
NIBP Trends
Time HR/PR
bpm
NIBP
mmHg
SpO2
%
RR/BR
br/min
12:20:21 81
122/60 (85) 1597
12:15:21 73
124/63 (86) 1397
12:30:21 72
122/60 (85) 1297
12:25:21 80
122/60 (85) 1496
12
CO
2
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Monitoring Display Options
98.6
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I, II, III...
T1 ºF
98.6
P3
mmHg
12.4
P2
mmHg
P1
mmHg
121 79
(96)
25 9
(15)
HR bpm
80
NIBP mmHg
121
79
(96)
23:45
SDM
SYNC
EtCO2 mmHg
38
BR
12
SpO2 %
97
Press the Home/Display button when viewing the Trends Status window and the Large Numerics Display window appears. The patient’s vital signs measurements appear in large labeled numeric displays; no waveform trace appears on this screen:
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CO
2
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Press the Home/Display button to redisplay the Primary Display window. Note: When the X Series unit is displaying the Defibrillation or Pacing Control panels, the
unit will not allow the display the Large Numerics Display window.
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Configuring the Waveform Display
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I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
79
(96)
NIBP mmHg
38
12
BR
CO2 mmHg
SpO2 %
97
T1 ºF
98.6
Pads
III
aVL aVF
V
Insert
Source
II
aVR
I
Cascade
You can display up to four waveform traces on the Waveform Display window. The first waveform trace always uses an ECG lead as its source (such on). As you insert the remaining three traces, you can specify that the traces use an ECG lead as the waveform source, or that the trace derive its waveform from other available monitoring functions (such as
The X Series unit can also cascade a trace onto the adjoining trace area to double the duration of the trace display.
On the Waveform Display window, to insert a new trace (Insert) or cascade (Cascade) a displayed trace, highlight and select the trace label above the trace. In the following example, the unit is configured to cascade the ECG Lead l trace:
Resp, CO2, SpO2 or IBP channels P1, P2, or P3).
12
Configuring the Waveform Display
Pads or Leads l, ll, or lll, and so
CO
2
R
Note: The X Series unit automatically inserts a new waveform when you turn on a parameter
(CO2) or a new sensor signal is present (SPO2, IBP). The X Series unit automatically removes a waveform when you turn off a parameter or remove a sensor and the unit displays the resulting equipment alert.
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I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
79
(96)
NIBP mmHg
38
12
BR
CO2 mmHg
SpO2 %
97
T1 ºF
98.6
When the unit cascades the ECG Lead lI trace, the Waveform Display window appears as follows:
12
CO
2
R
The following screens demonstrate how t o insert two more waveform traces into th e window. A third trace is inserted for ECG lead that when the third trace is inserted, the numeric displays move to the right side of the window to allow more room for the waveform traces.
aVR, and fourth trace for EtCO2 (a capnogram). Notice
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Inserting a third waveform trace for ECG lead aVR:
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00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
79
(96)
NIBP mmHg
38
12
BR
CO2 mmHg
SpO2 %
97
T1 ºF
98.6
Pads
III
aVL aVF
V
Insert
Source
II
I
Cascade
aVR
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I, II, III...
SYNC
1 cm/mVaVR
1 cm/mV
II
HR bpm
80
NIBP mmHg
121 79
(96)
EtCO2 mmHg
12
BR
38
SpO2 %
97
T1 ºF
98.6
12
CO
2
R
Configuring the Waveform Display
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CO
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I, II, III...
1 cm/mV aVR
1 cm/mV
II
HR bpm
80
NIBP mmHg
121 79
(96)
EtCO2 mmHg
12
BR
38
SpO2 %
97
T1 ºF
98.6
Pads
I
II
III
aVR
aVL aVF
V
SpO2
Source
P1 P2 P3
Insert Cascade Remove
Resp CO2
SYNC
Adult
00:17:43
I, II, III...
0
30
60
CO2
0 to 60 mmHg
1 cm/mV
avR
SYNC
1 cm/mV
II
HR bpm
80
NIBP mmHg
121 79
(96)
EtCO2 mmHg
12
BR
38
SpO2 %
97
T1 ºF
Inserting a capnogram (CO2) into the fourth trace area:
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CO
2
R
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The X Series unit accumulates a patient’s trend information by logging all monitored vital sign measurements to memory at a user-configurable interval. It also logs all monitored vital sign measurements when the following occurs:
• An NIBP measurement is taken and the Trend on NIBP option is on
• You press the Snapshot button ( ) on the front panel
• A patient alarm occurs and the Trend on Alarm option is on
The X Series unit can store at least 24 hours of trend information when logged at a 1 minute trend interval. You can view, print, or save to external memory all logged trend information.
Displaying the T rends Status Window
The X Series unit displays the logged trend information in the Trends status window. Press the Display/Home button ( ) to display the Trends window, the primary ECG trace, and the
small numeric displays for each monitoring function:
Chapter 4
T rends
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CHAPTER 4TRENDS
Navigate Here to Scroll Through Trends
Adult
00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
(96)
NIBP mmHg
38
BR
CO2 mmHg
SpO2 %
97
T1 ºF
NIBP Trends
Time HR/PR
bpm
NIBP
mmHg
SpO2
%
RR/BR
br/min
12:20:21 81
122/60 (85) 1597
12:15:21 73
124/63 (86) 1397
Navigate Here to Scroll Through Trends
12:30:21 72
122/60 (85) 1297
12:25:21
Print
Trends
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CO
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98.6
Figure 4-1 Trends Status window
The Trends status wi ndow displays the lo gged trend information and the time at which the trend measurements were logged. While trend measurements are logged to memory at a user­configurable interval, the Trends status window can display the logged information at an interval that you specify, with the exception of NIBP measurements, which are logged and reported at the times they are taken. The Trends status window reports the trends information at 5-minute intervals.
Displaying and Printing Trend Information
To navigate in the Trends status window:
1. Use the navigation keys to highlight the
press Select.
2. Press the Up/Down buttons ( ) to scroll through the trend information.
3. T o print all trends for the current patient, highlight the NIBP Trends field, then press Select.
Press the Print Trend Summary button in the
4. T o select which trends to print for the current patient, press the Log quick access key ( ),
then press the Print Trends button ( ).
79
Navigate Here to Scroll Through Trends bar, then
12
Trend Settings menu.
LOG
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Changing the Trends Status Window Display
Changing the Trends Status Window Display
By default, the Trends status window displays all logged trend information. It displays the numeric information for all monitoring functions, which the unit logs at a user-configurable interval, and when you take NIBP measurements, when a patient alarm occurs, and when you
press .
To configure the display of the Trends status window, press ( ) and press the Trend Settings
LOG
quick access key ( ) to display the Trends Settings control panel. On the Trends Settings control panel, select
Trend Display Format to specify the following monitored vital signs that
appear in the Trends status window:
Trend Fo rmat Vital Signs Displayed
Resp HR, SpO2, RR, EtCO2, FiCO2 NIBP HR, SpO2, NIBP, RR IBP1 HR, SpO2, IBP1, RR IBP2 HR, SpO2, IBP2 RR IBP3 HR, SpO2, IBP3, RR Temp
HR, SpO2, T1, T2, T
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CHAPTER 4TRENDS
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The X Series unit supports the detection and indication of patient alarms and technical alerts. A patient alarm is any alarm condition that is caused by a monitored patient-related variable,
such as a measured vital sign that falls outside of a configured alarm limit. You can configure
patient alarm limits for each of the physiologic monitoring functions.
A technical alert is monitored equipment-related vari able that the X Series unit can detect, such as a disconnected sensor, internal diagnostics failures, and so on. Technical alerts are always enabled and are not user-configurable.
Patient alarms are always classified as high-priority alarms. Technical alerts are classified as medium or low priority alarms.
Alarm conditions from patient alarms and technical alerts are stored in the Event Log and retained with normal power down or total loss of power.
Visual Alarm Indicators
Chapter 5
Alarms
In addition to status messages that appear on the display, the X Series unit lights the red or yellow LED on the front panel to indicate the priority level of th e highest-p riority acti ve alarm. The X Series LEDs indicate the priority level of the highest-priority active alarm as shown in the following table.
Active Alarm Priority Visual Alarm Indicator
High Priority -- Patient Alarm Flashing Red LED Medium Priority -- Technical Alert Flashing Yellow LED Low Priority -- Technical Alert Continuous Yellow LED
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CHAPTER 5ALARMS
Audible Alarm Indicators
The X Series unit sounds an audible alarm to indicate the priority level of highest-priority active alarm. The X Series indicates the priority level of the highest-priority active alarm by
sounding the audible alarm tones described in the following table.
Active Alarm Priority Audible Alarm Indicator Alarm/Alert Volume
High Priority -­Patient Alarm
Medium Priority -­Technical Alert
Low Priority -­Technical Alert
Two sets of five short beep tones, repeated at 15-second intervals
One set of three longer beep tones, repeated at 30-second intervals
A single short beep tone, not repeated
Audible alarms can be silenced or suspended. More detailed information about how to silence and suspend audible alarms is included later in this chapter.
Alarm Indicator Self-Test
The X Series unit performs a self-test of the audio and visual alarm indicators upon power-up. To ensure that the alarms and alerts are functioning properly, verify that two alarm tones are heard and the green, yellow, and red LEDs are illuminated upon power up.
Volume is adjustable, up to a maximum sound pressure of at least 70 dBA (measured at 1m)
Volume is 3 to 12 dBA below high priority alarm
Volume is 3 to 6 dBA below the medium priority alert
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Patient Alarm Display
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I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
79
(96)
NIBP mmHg
38
12
BR
CO2 mmHgCO2 mmHg
BR
33
22
SpO2 %
97
T1 ºF
98.6
EtCO2 Low Alarm
When a patient’s vital signs measurements trigger an alarm, in addition to sounding the patient alarm, the X Series unit displays an alarm message, and changes the display characteristics of the monitoring function’s numeric display (the alarming parameter appears in red against a white background).
Patient Alarm Display
In the following example, the EtCO alarm limit (
EtCO2 Low Alarm):
12
CO
2
R
measurement (22 mmHg) has dropped below the lower
2
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00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
(96)
NIBP mmHg
38
BR
CO2 mmHg
SpO2 %
Check Sensor
T1 ºF
SpO2 Check Sensor
Life Threatening Rhythm Alarms
When LTA monitoring is enabled, the X Series will monitor for the following life threatening ECG rhythms: asystole, ventricular fibrillation, ventricular tachycardia, extreme bradycardia, and extreme tachycardia.
Depending upon configuration of the unit, it generates visible and audible alarms as needed. Note: LTA monitoring is not available in AED mode.
Equipment Alert Display
When a problem with the X Series unit or an attached sensor triggers an alert, in addition to sounding an equipment alert, the X Series unit displays an alert message (yellow background, black text).
Warning! Always respond immediately to a system alarm since the patient may not be monitored
during certain alert conditions.
In the following example, an equipment alert message indicates that the SpO2 sensor has become unattached (
SpO2 Check Sensor) from the unit:
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CO
2
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98.6
79
12
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Responding to Active Alarms -- Silencing the Alarm
Responding to Active Alarms -- Silencing the Alarm
When a patient alarm is triggered and the alarm tone sounds
1. Check the patient and provide appropriate care.
2. Press the Alarm Silence/Reset button ( )on the X Series unit’s front panel to silence the
alarm briefly (90 seconds).
3. After caring for the patient, check that the appropriate alarms are set (for more information
about setting and enabling alarms, see appropriate monitoring chapters later in this manual).
Note: Pressing suspends the alarm tone for all active alarms. If the patient’s vital signs
measurements trigger another, different alarm, the patient alarm tone will sound, even if the first alarm silence period hasn’t expired.
Re-enabling an Alarm
To re-enable an alarm before the alarm silence period has expired, press the Alarm Silence/ Reset button.
Warning! Do not silence the audible alarm if patient safety may be compromised.
Suspending Alarms
When caring for a patient, you may want to suspend potential or current patient alarms and equipment alerts for a period of time. To suspend patient alarms
1. Press the More quick access key ( )to access t he second set of quick access keys and press the Alarms quick access key.
2. Press the Alarms Suspend quick access key ( ).
No alarms will sound while alarms are suspended; however, if an alarm occurs during the suspension period, the X Series unit will display visual alarm indicators -- alarm messages in the message area (white text on a red background) and red/white numeric displays).
The duration of the alarm suspension can be configured to be for 2, 4, or 15 minutes, or for an indefinite period of time. The ability to suspend alarms can also be disabled.
Warning! When audible alarms are disabled, make sure that the patient is closely observed.
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Adult
00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
(96)
NIBP mmHg
38
BR
CO2 mmHgCO2 mmHg
BR
22
SpO2 %
97
T1 ºF
EtCO2 Low Alarm
1:30
Alarm Suspension Timer
The Alarm Suspension Timer
During an alarm suspension, the window displays an alarm suspension timer at the top of the display next to the message area:
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2
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12
33
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Alarm Options
Setup > Supervisor > Alarms
Default Neonate
General
Default Adult
Default Pediatric
The X Series unit provides alarm options that you can specify through the Supervisor parameter control panel (access to Supervisor is passcode-controlled).
Press the More quick access key ( ), press the Setup quick access key ( ), and select
Supervisor SAVE when you are finished. Once you have entered your supervisor passcode, you will be
able to access the configurable options in the Supervisor menu. Select Alarms to display the alarms parameter control panel:
Alarm Options
. Using the navigation keys, select the four digits in the Supervisor passcode. Press
Figure 5-1 Alarms Parameter Control Panel
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CHAPTER 5ALARMS
Stat
Set
Selecting Default Alarm Limits
The first three options -- Default Adult, Default Pediatric, Default Neonate -- allow you to set all alarm limits to the X Series unit’s factory-specified default values, by patient type.
Warning! • A potential hazard exists if different alarm limits are used for the same or similar
equipment in any single area.
• Confirm the alarm limits are appropriate for the patient each time there is a new patient case.
• Do not set alarm limits to such extreme values that render the alarm system useless.
Setting Alarm Limits Relative to the Patient -- Stat Set Option
The X Series unit also allows you to set all alarm limits relative to the patient’s current vital signs measurements by performing the following actions:
1. Press .
2. Press the Alarm quick access key ( ).
3. Press the Stat Set quick access key ( ). The X Series unit sets all parameters to a new value
based on the current values as follows:
Parameter
(units) HR/PR
(bpm)
IBP
(mmHg)
NIBP
(mmHg)
RR/BR
(/min)
Range Upper Limit Calculation Lower Limit Calculation
Numeric < 26 Limit is unchanged Limit = 25
26 Numeric 99 100 Numeric 250 Numeric > 250 Limit = 250 Limit is unchanged Numeric < 26 Limit = Numeric + 5 Limit = Numeric – 5
26 Numeric 99 Numeric > 99 Limit = Numeric + 20 Limit = Numeric – 20 Numeric < 26 Limit = Numeric + 5 Limit = Numeric – 5
26 Numeric 99 Numeric > 99 Limit = Numeric + 20 Limit = Numeric – 20 Numeric < 26 Limit = Numeric + 5 Limit = Numeric – 5
26 Numeric 99 Numeric > 99 Limit = Numeric + 20 Limit = Numeric – 20
Limit = Numeric x 1.2 Limit = Numeric x 0.8 Limit = Numeric + 20 Limit = Numeric – 20
Limit = Numeric x 1.2 Limit = Numeric x 0.8
Limit = Numeric x 1.2 Limit = Numeric x 0.8
Limit = Numeric x 1.2 Limit = Numeric x 0.8
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Alarm Options
SpO
2
(%)
SpCO
(%)
SpMet
(%)
EtCO2
(mmHg)
FiCO2
(mmHg)
Temp
(°C)
Temp
(°F)
Entire range Limit = 100 (Adult and
Pediatric) Limit = Numeric + 5 (Neo­nate)
Entire range Limit = Numeric + 2
Upper limit 40
Entire range Limit = Numeric + 2
Upper limit 15
Entire range Limit = Numeric + 10 Limit = Numeric - 5 mmHg
Entire range Limit = Numeric + 5 N/A
Entire range Limit = Numeric + 0.5 Limit = Numeric – 0.5
Entire range Limit = Numeric + 0.9 Limit = Numeric – 0.9
Limit = Numeric – 5
Limit = Numeric - 2 Lower limit 0
Limit = Numeric - 2 Lower limit 0
unless the numeric falls below the lower alarm limit range, in which case Stat Set sets the lower limit to 15 mmHg.
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CHAPTER 5ALARMS
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Chapter 6
Monitoring ECG
This chapter describes how to use the X Series unit to monitor ECG. X Series units can perform ECG monitoring through 3-, 5-, or 12-lead ECG patient cables,
Multi-Function Pads, or standard defibrillation paddles. The use of an ECG patient cable and electrodes is required, however, to monitor ECG during pacing.
You can use a 3-lead, 5-lead, or 12-Lead wire configuration for ECG monitoring (see Running H/F 1 for more information on 12-lead monitoring).
Warning! • Excessive body ha ir or wet, sweaty skin may interfere with electrode adhesion.
Remove the hair and/or moisture from the area where the electrode is to be attached.
• Use only electrodes that are well within the expi ration date ind icated on th e p ackage.
• Remove ECG electrodes from their sealed package immediately prior to use. Using previously opened or out-of- date electrodes may degrade the ECG signal quality.
• Monitoring electrodes may become polarized during defibrillator discharge, causing the ECG waveform to briefly go off screen. ZOLL Medical Corporation recommends the use of high quality silver/silver chloride (Ag/AgCl) electrodes to minimize this effect; the circuitry in the instrument returns the trace to the monitor display within a few seconds.
• To assure protection against the effects of defibrillator discharge, use only ZOLL-approved accessories.
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CHAPTER 6MONITORING ECG
• To avoid a shock hazard and interference from nearby electrical equipment, keep electrodes and patient cables away from grounded metal and other electrical equipment.
• To avoid electrosurgery burns at monitoring sites, ensure proper co nnection of the electrosurgery return circuit so that the return paths cannot be made through monitoring electrodes or probes.
• Check the operation and integrity of the X Series unit and ECG cable regularly by performing the Daily Operational Verification Test.
• Implanted pacemakers may cause the heart rate meter to count the pacemaker rate during incidents of cardiac arrest or other arrhythmias. Carefully observe pacemaker patients. Check the patient's pulse; do not rely solely on heart rate meters. Dedicated pacemaker detection circuitry may not detect all implanted pacemaker spikes. Patient history and physical exam are important in determining the presence of an implanted pacemaker.
ECG Monitoring Setup
The proper application and placement of electrodes is essential for high quality ECG monitoring. Good contact between the electrode and skin minimizes motion artifact and signal interference.
The following procedure describes how to monitor a patient’s ECG using 3- and 5-Lead ECG cables. For information on the application and use on MultiFunction Pads and External Paddles, which you can also use to monitor ECG, see Chapter 14, Manual Defibrillation.
To monitor a patient’s ECG using 3- and 5-Lead ECG cables, perform the following steps:
1. Prepare the patient's skin for electrode application:
2. Apply the electrode pads to the patient.
3. Connect each lead of the ECG cable to the appropriate electrode.
4. Insert the patient cable plug into the ECG input connector on the X Series unit.
5. Select the ECG waveforms to be displayed on the waveform trace display screen.
6. Observe the patient‘s electrocardiogram on the display , and adjust size of the ECG wave form
trace, as necessary.
Preparing the Patient for Electrode Application
The proper application of electrodes is essential for high quality ECG moni toring. Good cont act between the electrode and skin minimizes motion artifact and signal interference.
Before applying electrodes, prepare the patient’s skin, as necessary:
• Shave or clip excess hair at electrode site.
• Clean oily skin with an alcohol pad.
• Rub site briskly to dry.
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Applying Electrodes to the Patient
The following sections show where to place electrodes when using 3- and 5-Lead cables to perform ECG monitoring. For 3-Lead ECG cables, apply electrodes as in Figure 4-1, 3-Lead
Electrode Placement. For 5-Lead ECG cables, apply electrodes as in Figure 4-2, 5-Lead Electrode Placement.
Avoid placing electrodes over tendons and major muscle masses. Make sure that the ECG electrodes are placed to allow defibrillation, if necessary.
3-Lead Electrode Placement
Depending upon local usage, the ECG leads are marked either RA, LA, and LL (or R, L, and F). The following table shows the markings and color codes for the different lead sets.
AHA Color Coding IEC Color Coding Placement of Electrodes
RA/White Electrode R/Red Electrode Place near patient’s right mid-clavicular line,
LA/Black Electrode L/Yellow Electrode Place near patient’s left mid-clavicular line,
ECG Monitoring Setup
directly below clavicle.
directly below clavicle.
LL/Red Electrode F/Green Electrode Place between 6th and 7th intercostal
space on patient’s left mid-clavicular line.
Figure 6-1 3-Lead Electrode Placement
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CHAPTER 6MONITORING ECG
5-Lead Electrode Placement
Depending upon local usage, th e ECG leads are marked either RA , LA, LL , RL, and V or R, L, F, N and C. The following table shows the markings and color codes for the different lead sets.
AHA Color Coding IEC Color Coding Placement of Electrodes
RA/White Electrode R/Red Electrode Place near patient’s right mid-clavicular line,
LA/Black Electrode L/Yellow Electrode Place near patient’s left mid-clavicular line,
LL/Red Electrode F/Green Electrode Place between 6th and 7th intercostal
RL/Green* Electrode N/Black* Electrode Place between 6th and 7th intercostal
V/Brown* Electrode C/White* Electrode Single movable chest electrode. Place this
directly below clavicle.
directly below clavicle.
space on patient’s left mid-clavicular line.
space on patient’s right mid-clavicular line.
electrode in one of the positions, V1 - V6, as shown in the following figure.
V1 -- 4th intercostal space at right sternal margin.
V2 -- 4th intercostal space at left sternal margin.
V3 -- Midway between V2 and V4 leads. V4 -- 5th intercostal space at mid-clavicular
line. V5 -- Same transverse level as V4 at left
anterior-axillary line. V6 -- Same transverse level as V4 at left
mid-axillary line.
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ECG Monitoring Setup
Figure 6-2 5-Lead Electrode Placement
Connecting the ECG Cable To the X Series Unit
The X Series unit accepts Welch Allyn Propaq® ECG cables as well as ZOLL X Series ECG cables. Connect the ECG cable to the ECG connector on the left side of the X Series unit as follows:
Figure 6-3 Connecting ECG Cable to X Series Unit
9650-001355-01 Rev. B X Series Operator’s Guide 6-5
CHAPTER 6MONITORING ECG
06/06/2011
I, II, III...
SYNC
I, II, III...
Selecting ECG Waveforms for Display
You can fit up to four waveforms on the X Series display. The first waveform at the top of the display is always an ECG waveform. In the following example, Lead of the ECG waveform trace:
12
CO
2
R
II (RA-LL), is the source
The are two ways to specify which ECG lead is the source of the prima ry waveform trace. One way is to press the ECG lead selection quick access key to display the available ECG
waveform sources. The available waveform sources are determined by the type of ECG cable connected to the unit.
The other way to specify the source of the primary waveform trace is to navigate to and select the source label for the primary ECG waveform (Lead
l in the screen below). The X Series unit
then displays the available ECG waveform sources. The following example illustrates the waveform source list that the X Series unit displays when a 5- lead ECG cable is connected to it. The list of available ECG waveform sources i ncludes Leads can select Lead
lI (the default), or use the navigation keys to highlight and select another
I, II, III, aVR, aVL, aVF, and V. You
displayed ECG lead as the source for the waveform trace.
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Adult
00:17:43
I, II, III...
12
SYNC
1 cm/mV
I
HR bpm
80
121
79
(96)
NIBP mmHg
38
12
BR
CO2 mmHg
SpO2 %
97
T1 ºF
98.6
Pads
III
aVL aVF
V
Insert
Source
II
I
Cascade
aVR
CO
R
ECG Monitoring Setup
2
Select a current waveform source, and the unit displays the waveform immediately. If you select a waveform source that is not currently available, the unit displays the message, LEAD FAULT.
For more information on how to configure the display of waveforms on the X Series unit, see Chapter 3, Monitoring Overview.
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CHAPTER 6MONITORING ECG
Adult
00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
(96)
NIBP mmHg
38
BR
CO2 mmHg
SpO2 %
97
T1 ºF
0.125 cm/mV
1.0 cm/mV
4.0 cm/mV Auto
Lead II Size
0.50 cm/mV
2.0 cm/mV
0.25 cm/mV
Selecting the Waveform Trace Size
The X Series unit allows you to select the waveform trace size to adjust the size of displayed the ECG waveform.
To select the waveform size, use the navigation keys to highlight and select the trace size that appears to the right of the electrode label:
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12
CO
2
R
The default trace size is
0.125, 0.25, 0.50 cm/mV) trace size. You can also specify that the X Series unit select a best-fit
( trace size (
AUTO).
98.6
79
1cm/mV. You can select a larger (2.0, 4.0 cm/mV) or smaller
12
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ECG Monitoring and Pacemakers
When the unit performs ECG monitoring on a patient with an implantable pacemaker, the unit’s Pacer indicator feature can indicate the occurrence of pacemaker signals.
ECG Monitoring and Pacemakers
If the Pacer Indicator setting is
• detects the implantable pacemaker pulses
• blanks the pacemaker pulses from the waveform—preventing them from disturbing the
ECG waveform and allowing for an accurate QRS detection
• displays and prints vertical dashed lines to indicate the detected pacemaker signals
If the Pacer Indicator setting is
• detect the implantable pacemaker pulses
• blank the pacemaker pulses from the waveform
• display or print the vertical dashed line pacer markers
You can turn the Pacer Indicator There are situations where ECG artifact could simulate pacemaker signals which could cause
false pacemaker detection and blanking. These situations may cause inaccurate QRS detection and it may be desirable to turn the Pacer Indicator setting is
OFF, implantable pacemaker signals may cause inaccurate QRS detection and it may
be desirable to turn the Pacer Indicator on.
ECG System Messages
When monitoring ECG, the X Series unit may display the following messages:
System Message Cause
ON, the X Series performs the following actions:
OFF, the X Series does not perform the following actions:
ON/OFF from the Setup>ECG menu.
off. Inversely, when the Pacer Indicator
LEAD FAULT The current ECG source lead is defective (check
lead and replace, if necessary).
-- OR --
An unavailable waveform source has been specified for the trace display (check specified waveform source and correct, if necessary).
PADDLE FAULT or CABLE FAUL T Check the pad, paddle or cable and replace if
necessary.
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CHAPTER 6MONITORING ECG
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Chapter 7
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Adult
00:17:43
I, II, III...
SYNC
1 cm/mV
II
HR bpm
80
121
79
(96)
NIBP mmHg Resp br/min
16
SpO2 %
97
T1 ºF
98.6
Respiration Meter
Monitoring Respiration (Resp) and Heart Rate (HR)
This chapter describes how to use the X Series unit to monitor Respiration (Resp) and Heart
HR).
Rate ( The X Series unit displays Respiration (Resp) and Heart Rate (HR) mete rs. The Respiration and
Heart Rate meters display values that the X Series unit derives from measurements taken by other X Series monitoring functions.
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CO
2
9650-001355-01 Rev. B X Series Operator’s Guide 7-1
R
Heart Rate Meter
Chapter 7 Monitoring Respiration (Resp) and Heart Rate (HR)
Note: The respiration rate is disabled during defibrillation. During defibrillation, the
respiration rate will display ??? on the snapshot.
Respiration/Breath Rate Meter
If enabled, the X Series unit displays the patient’s respiration in the Respiration/Breath Rate Meter.
The respiration
monitoring function. If CO2 monitoring is not available, the unit derives the respiration
CO
2
rate through impedance pneumography, using a specifi ed ECG electrode co nfiguratio n. If ECG monitoring isn’t functioning, the Resp/BR meter will not display a respiration rate.
meter displays the respiration rate that it derives, by default, from the unit’s
Using Impedance Pneumography to Measure Respiration
Impedance pneumography detects respiration by applying a high-frequency, low-cu rrent AC signal to the patient and measuring the changes in impedance through ECG electrode Lead (RA-LA) or Lead increases; as the patient exhales, impedance decreases.
Warning! • Impedance pneumograp hy detects respiratory effort through changes in chest
volume. However, No Breath episodes with continued respiratory effort may go undetected. Always monitor and set alarms for SpO
pneumography to monitor respiratory function.
• With any monit or that de tects r espir atory effort thr ough impeda nce pneumography, artifact due to patient motion, apnea mattress shaking, or electrocautery use may cause apnea episodes to go undetected. Always monitor and set alarms for SpO
when using impedance pneumography to monitor respiratory functio n.
ll (RA-LL). As the patient inhales and chest volume expands, impedance
when using impedance
2
l
2
• When using impedance pneumography, don’t use the X Series unit with another respiration monitor on the same patient, because the respiration measurement signals may interfere with one another.
• Impedance pneumography is not recommended for use on paced patients, because pacemaker pulses may be falsely counted as breaths.
• Impedance pneumography is not recommended for use with high frequency ventilation.
• Since impedance pneumography uses the same leads as the ECG channel, the X Series unit determines which s i gn als are cardiovascular artifact and which signals are the result of respiratory effort. If the breath rate is within five percent of the heart rate, the monitor may ignore breaths and trigger a respiration alarm.
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Configuring Respiration (RR/BR) Alarms and Settings
Limits
Configuring Respiration (RR/BR) Alarms and Settings
The X Series unit allows you to enable and disable the Respiration (RR/BR) Rate alarm, to set alarm limits, and to specify the ECG monitoring source for the Respiration rate.
Enabling/Disabling RR/BR Alarms and Setting Alarm Limits
When enabled, the X Series unit sounds alarms whenever the patient’s respiration rate is above or below the specified respiration rate alarm limits.
To enable (or disable) Resp alarms and set Upper and Lower alarm limits, you can either do so through the Alarms quick access key ( ), or the Resp Parameter Control Panel. To configure
RR/BR alarms through the Alarms quick access key:
1. Press .
2. Press .
3. Press the Limits quick access key ( ). Use the navigation keys to highlight and select the
RR/BR Alarm menu selection.
4. On the RR/BR Alarm Setti ngs menu, use the navigation keys to select the fields that you want
to change:
• Upper Limit Enable
• Lower Limit Enable
• Upper Limit
• Lower Limit
5. When you are finished changing values on the alarm menu, navigate to the Backarrow key
to confirm your choices and exit the menu.
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Chapter 7 Monitoring Respiration (Resp) and Heart Rate (HR)
Resp
Lower Upper
RR/BR Alarm 10
30
No Breath Alarm 30 sec
Resp Monitoring On
Resp Lead
Lead II (RA-LL)
CO2/Resp Sweep Speed
12.5 mm/s
Respiration Rate Alarm Limits
Initially, the Resp Alarm Settings menu specifies that Resp alarms are enabled (ON) or disabled (OFF), and displays the default Upper and Lower respiration rate alarm limits. The upper and lower limits can be
ON or OFF (default is OFF).The following table lists the default
respiration rate alarm limits for adult, pediatric, and neonate patients, and gives the range in which you can set these limits:
Patient Type Respiration Rate Default Respiration Rate Range
Adult Lower: 3 br/min
Upper: 50 br/min
Pediatric Lower: 38 br/min
Upper: 50 br/min
Neonate Lower: 12 br/min
Upper: 80 br/min
Using the Resp Parameter Control Panel
To configure alarms through the Resp Parameter Control Panel, use the navigation keys to highlight and select the Respiration Rate meter and display the
Lower: 0 to 145 br/min Upper: 5 to 150 br/min
Lower: 0 to 145 br/min Upper: 5 to 150 br/min
Lower: 0 to 145 br/min Upper: 5 to 150 br/min
Resp Parameter Control Panel:
Figure 7-1 Respiration Parameter Control Panel
The Resp Parameter Control Panel allows you to set the following parameters:
• RR/BR Alarm -- enable/disable the Resp alarm and set high/low alarm limits.
• No Breath Alarm -- sets the duration of the No Breath alarm, or disables alarm by selecting
“Off”.
• Resp Monitoring -- enable/disable respiration monitori ng .
• Resp Lead -- selects the Resp lead, Lead I (RA-LA) or Lead II (RA-LL), from which the X
Series unit calculates the respiration rate. Resp Lead selection is independent of ECG Lead selection.
• CO2/Resp Sweep Speed -- sets the respiratory sweep speed on the display.
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Heart Rate Meter
Enabling/Disabling Resp Monitoring
Select the Resp Monitoring prompt to enable or disable Resp monitoring. When Resp Monitoring is set to On (the default), the X Series unit displays the Respiration Rate Meter. When set to off, X Series removes the Respiration Rate meter from the display.
Warning! When using impedance pneumography, the X Series unit automatically rejects
cardiovascular artifact (CVA). This function requires the accurate ECG R-wa ve detection. Therefore, always select the ECG lead with the most prominent QRS complex when using impedance pneumography to monitor respiration.
Heart Rate Meter
The Heart Rate meter displays the heart rate that it derives from the ECG monitoring function (by default) or from a monitoring function that you specify. If the ECG (or user-specified monitor function) measurements are not available, the Heart Rate meter derives the heart rate from the following monitoring functions, if they are available, in this order: User-selected default source, ECG, IBP channel 1, SpO
Rate meter is labeled other source is used.
HR (as in the following example) if the source is ECG, and PR if any
, IBP channel 2, IBP channel 3, and NIBP. The Heart
2
Configuring Heart Rate (HR) Meter Alarms
The X Series unit allows you to enable and disable the Heart Rate (HR) alarm, to set alar m limits, and to select a Heart Rate to ne.
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Chapter 7 Monitoring Respiration (Resp) and Heart Rate (HR)
Limits
Enabling/Disabling HR Alarms and Setting Alarm Limits
When enabled, the X Series unit sounds alarms whenever the patient’s heart rate is above or below the specified heart rate alarm limits.
To enable (or disable) HR alarms and set Upper and Lower alarm limits, you can either do so through the Alarms quick access key ( ) or the HR/PR Parameter Control Panel.
To configure HR alarms through the Alarms quick access key:
1. Press .
2. Press .
3. Press .
4. Use the navigation buttons to highlight and select HR/PR Alarm.
5. On the HR/PR Alarm Settings menu, use the navigation keys to select the fields that you want
to change:
• Upper Limit Enable
• Lower Limit Enable
• Upper Limit
• Lower Limit
When you are finished changi ng values on the alarm menu, navigate to the Backarrow key to confirm your choices and exit the menu.
Heart Rate (HR/PR) Alarm Limits
Initially, the HR/PR Alarm Settings menu specifies that alarms are enabled (ON) or disabled
OFF), and displays the default Upper and Lower heart rate alarm limits. The upper and lower
( limits can be
ON or OFF (default is OFF). The following table lists the default HR alarm limits
for adult, pediatric, and neonate patients, and gives the range in which you can set these limits:
Patient Type HR Default HR Rate Range
Adult Lower: 50 BPM
Upper: 120 BPM
Pediatric Lower: 50 BPM
Upper: 150 BPM
Neonate Lower: 100 BPM
Upper: 200 BPM
Lower: 20 to 298 BPM Upper: 22 to 300 BPM
Lower: 20 to 298 BPM Upper: 22 to 300 BPM
Lower: 20 to 298 BPM Upper: 22 to 300 BPM
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