Nihon Kohden ZM-941PA Medical Telemetry Transmitter User Manual 1

Nihon Kohden Corporation Medical Telemetry Transmitter Users Manual 1

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Contents

1. Users Manual 1
2. Users Manual 2

Users Manual 1

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Copyright NoticeThe entire contents of this manual are copyrighted by Nihon Kohden. All rights are reserved. No part of this document may be reproduced, stored, or transmitted in any form or by any means (electronic, mechanical, photocopied, recorded, or otherwise) without the prior written permission of Nihon Ko-hden.

Operator’s Manual ZM-940PA/941PA iContentsGENERAL HANDLING PRECAUTIONS ..........................................................................iWARRANTY POLICY ..................................................................................................... iiiEquipment Authorization Requirement ........................................................................... iiiEMC RELATED CAUTION ..............................................................................................ivConventions Used in this Manual and Instrument ......................................................... viiWarnings, Cautions and Notes .................................................................................. viiExplanations of the Symbols in this Manual and Instrument .................................... viiiIntroduction ............................................................................................................................1Panel Description ..................................................................................................................3Front Panel .......................................................................................................................3Rear Panel .......................................................................................................................4Top Panel .........................................................................................................................5Bottom Panel ...................................................................................................................5LCD ..................................................................................................................................7Notes on Parameter Settings.................................................................................................9Important Safety Information ...............................................................................................10General ..........................................................................................................................10Output Signal .................................................................................................................12Battery ...........................................................................................................................12Transmitter Channel Management .................................................................................13For Patients Using Implantable Pacemaker ...................................................................14NIBP Monitoring .............................................................................................................14ECG Monitoring .............................................................................................................15SpO2 Monitoring .............................................................................................................16Maintenance ..................................................................................................................19Preparation ..........................................................................................................................20Installing (Replacing) Batteries ......................................................................................20WARNING and CAUTION for Battery Handling ........................................................20Battery Lifetime .........................................................................................................21Installing (Replacing) Batteries..................................................................................21Situations Requiring Battery Replacement ...............................................................22Battery Condition Indication ......................................................................................23Turning the Transmitter On/Off .......................................................................................23Turning On the Power ................................................................................................23Turning Off the Power ................................................................................................23Check Items Before Use ............................................................................................23Check Items After Power On .....................................................................................24Check Items After Use ..............................................................................................24Changing the Transmitter Channel ......................................................................................25

ii Operator’s Manual ZM-940PA/941PAChanging Parameter Setup Settings ...................................................................................26Parameter Setup Setting List .........................................................................................26Displaying the PARAMETER SETUP Screen ................................................................27Changing Settings .........................................................................................................28SELECTABLE INTERVALS .......................................................................................28INITIAL INTERVAL ....................................................................................................28INITIAL CUFF PRESS ..............................................................................................28NIBP MODE AFTER STAT ........................................................................................29START/FINISH SOUND ............................................................................................29OLD NIBP DATA/AFTER ...........................................................................................29INHIBIT SpO2 DURING NIBP ....................................................................................302ND PARAMETER ....................................................................................................30LEADS OFF DISPLAY...............................................................................................31ECG ELECTRODE ....................................................................................................31Changing System Setup Settings ........................................................................................32System Setup Setting List ..............................................................................................32Displaying the SYSTEM SETUP Screen .......................................................................32Changing Settings .........................................................................................................33CHANNEL .................................................................................................................33PRESSURE UNIT .....................................................................................................33LANGUAGE ...............................................................................................................34BRIGHTNESS ...........................................................................................................34SYSTEM INITIALIZE .................................................................................................34Attaching NIBP Cuff, Electrodes and SpO2 Probe to the Patient .........................................35Attachment Examples ....................................................................................................35Attaching the NIBP Cuff .................................................................................................36Selecting the NIBP Cuff .............................................................................................36Connecting the NIBP Cuff to the Transmitter .............................................................39Attaching the NIBP Cuff to the Patient ......................................................................41Attaching Electrodes ......................................................................................................45Selecting Electrode Lead ..........................................................................................45Connecting the Electrode Lead to the Transmitter ....................................................46Selecting the Electrode Position ................................................................................46Attaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable Electrodes ...............................................................................................50Electrode Position for Respiration Monitoring ...........................................................51Attaching the SpO2 Probe ..............................................................................................53Selecting the SpO2 Probe ..........................................................................................53Connecting the SpO2 Probe to the Transmitter ..........................................................56Attaching the Probe to the Patient .............................................................................57Locking the Keys on the Transmitter ....................................................................................59Monitoring ............................................................................................................................60NIBP Monitoring .............................................................................................................60Selecting the Initial Cuff Inﬂation Pressure ................................................................60Selecting the Measurement Mode and Interval .........................................................60

Operator’s Manual ZM-940PA/941PA iiiMeasuring NIBP ........................................................................................................61Monitoring SpO2 during NIBP Measurement .............................................................64ECG and Respiration Monitoring ...................................................................................64Electrode Detachment ...............................................................................................66SpO2 Monitoring .............................................................................................................67SpO2 and PR Display Order ......................................................................................68Monitoring SpO2 during NIBP Measurement .............................................................69Display and Message List ....................................................................................................70Battery Indication ...........................................................................................................70ECG/Respiration ............................................................................................................70SpO2 .............................................................................................................................71NIBP ..............................................................................................................................72Troubleshooting ...................................................................................................................73Transmitter .....................................................................................................................73ECG/Respiration ............................................................................................................74SpO2 .............................................................................................................................74NIBP ..............................................................................................................................75Maintenance ........................................................................................................................771. External Check ......................................................................................................772. Transmitter Channel ...............................................................................................773. LCD Display ...........................................................................................................794. Key Operation ........................................................................................................805. NIBP Cuff for Attaching Transmitter to Patient Arm ...............................................81Maintenance Check Sheet .............................................................................................82Repair Parts Availability Policy ............................................................................................83Lifetime and Disposal ..........................................................................................................84Disposing of Used Batteries ..........................................................................................84Battery Lifetime .........................................................................................................84Disposal .....................................................................................................................84Disposing of Electrodes, SpO2 Probes and NIBP Cuffs .................................................84Cleaning, Disinfection and Sterilization ...............................................................................85Transmitter and Electrode Leads ...................................................................................85Cleaning ....................................................................................................................85Disinfection ................................................................................................................85SpO2 Probe ....................................................................................................................86YP-943P/944P NIBP Cuffs ............................................................................................86Cleaning ....................................................................................................................86Disinfection ................................................................................................................86Speciﬁcations ......................................................................................................................87ZM-940PA ......................................................................................................................87Measuring Parameters ..............................................................................................87Transmitting Data ......................................................................................................87Displayed Data ..........................................................................................................87ECG Measurement ....................................................................................................87Respiration Measurement .........................................................................................87

iv Operator’s Manual ZM-940PA/941PASpO2 Measurement ...................................................................................................87NIBP Measurement ...................................................................................................88Pulse Rate .................................................................................................................88Transmitter .................................................................................................................88Power Requirements .................................................................................................88Dimension and Weight ..............................................................................................89Environment ..............................................................................................................89Safety Standards .......................................................................................................89Electromagnetic Compatibility ...................................................................................90Electromagnetic Emissions .......................................................................................90Electromagnetic Immunity .........................................................................................91Recommended Separation Distances between Portable and Mobile RF Communications Equipment .....................................................................................93Recovery Time after Deﬁbrillation .............................................................................93System Composition for EMC Test ............................................................................93ZM-941PA ......................................................................................................................94Measuring Parameters ..............................................................................................94Transmitting Data ......................................................................................................94Displayed Data ..........................................................................................................94ECG Measurement ....................................................................................................94Respiration Measurement .........................................................................................94SpO2 Measurement ...................................................................................................94NIBP Measurement ...................................................................................................95Pulse Rate .................................................................................................................95Transmitter .................................................................................................................95Power Requirements .................................................................................................95Dimension and Weight ..............................................................................................96Environment ..............................................................................................................96Safety Standards .......................................................................................................96Electromagnetic Compatibility ...................................................................................97Electromagnetic Emissions .......................................................................................97Electromagnetic Immunity .........................................................................................98Recommended Separation Distances between Portable and Mobile RF Communications Equipment ...................................................................................100Recovery Time after Deﬁbrillation ...........................................................................100System Composition for EMC Test ..........................................................................100Standard Accessories........................................................................................................101Options ..............................................................................................................................102Transmitter ...............................................................................................................102ECG/RESP ..............................................................................................................102NIBP ........................................................................................................................103SpO2 .......................................................................................................................104Transmission Frequencies .................................................................................................105

Operator’s Manual ZM-940PA/941PA iGENERAL HANDLING PRECAUTIONSThis device is intended for use only by qualiﬁed medical personnel.Use only Nihon Kohden approved products with this device. Use of non-approved products or in a non-approved manner may affect the performance speciﬁcations of the device. This includes, but is not limited to, batteries, recording paper, pens, extension cables, electrode leads, input boxes and AC power.Please read these precautions thoroughly before attempting to operate the instrument.1. To safely and effectively use the instrument, its operation must be fully understood.2. When installing or storing the instrument, take the following precautions:(1) Avoid moisture or contact with water, extreme atmospheric pressure, excessive humidity and temperatures, poorly ventilated areas, and dust, saline or sulphuric air.(2) Placetheinstrumentonaneven,leveloor.Avoidvibrationandmechanicalshock,evenduring transport.(3) Avoidplacinginanareawherechemicalsarestoredorwherethereisdangerofgasleakage.(4) The power line source to be applied to the instrument must correspond in frequency and voltagetoproductspecications,andhavesufcientcurrentcapacity.(5) Choose a room where a proper grounding facility is available.3. Before Operation(1) Checkthattheinstrumentisinperfectoperatingorder.(2) Checkthattheinstrumentisgroundedproperly.(3) Checkthatallcordsareconnectedproperly.(4) Pay extra attention when the instrument is in combination with other instruments to avoid misdiagnosis or other problems.(5) Allcircuitryusedfordirectpatientconnectionmustbedoublychecked.(6) Checkthatbatterylevelisacceptableandbatteryconditionisgoodwhenusingbatteryoperated models.4. During Operation(1) Both the instrument and the patient must receive continual, careful attention.(2) Turn power off or remove electrodes and/or transducers when necessary to assure the patient’s safety.(3) Avoid direct contact between the instrument housing and the patient.5. To Shutdown After Use(1) Turn power off with all controls returned to their original positions.(2) Remove the cords gently; do not use force to remove them.(3) Clean the instrument together with all accessories for their next use.

ii Operator’s Manual ZM-940PA/941PA6. The instrument must receive expert, professional attention for maintenance and repairs. When the instrument is not functioning properly, it should be clearly marked to avoid operation while it is out of order.7. Theinstrumentmustnotbealteredormodiedinanyway.8. Maintenance and Inspection(1) The instrument and parts must undergo regular maintenance inspection at least every 6 months.(2) Ifstoredforextendedperiodswithoutbeingused,makesurepriortooperationthattheinstrument is in perfect operating condition.(3) Technical information such as parts list, descriptions, calibration instructions or other informationisavailableforqualiedusertechnicalpersonneluponrequestfromyourNihonKohden representative.9. When the instrument is used with an electrosurgical instrument, pay careful attention to the application and/or location of electrodes and/or transducers to avoid possible burn to the patient.10.Whentheinstrumentisusedwithadebrillator,makesurethattheinstrumentisprotectedagainstdebrillatordischarge.Ifnot,removepatientcablesand/ortransducersfrom the instrument to avoid possible damage.

Operator’s Manual ZM-940PA/941PA iiiWARRANTY POLICYNihon Kohden Corporation (NKC) shall warrant its products against all defects in materials and workmanshipforoneyearfromthedateofdelivery.However,consumablematerialssuchasrecordingpaper,ink,stylusandbatteryareexcludedfromthewarranty.NKC or its authorized agents will repair or replace any products which prove to be defective during the warranty period, provided these products are used as prescribed by the operating instructions given in the operator’s and service manuals.NootherpartyisauthorizedtomakeanywarrantyorassumeliabilityforNKC’sproducts.NKC will not recognize any other warranty, either implied or in writing. In addition, service, technicalmodicationoranyotherproductchangeperformedbysomeoneotherthanNKCoritsauthorized agents without prior consent of NKC may be cause for voiding this warranty.Defective products or parts must be returned to NKC or its authorized agents, along with an explanation of the failure. Shipping costs must be pre-paid.Thiswarrantydoesnotapplytoproductsthathavebeenmodied,disassembled,reinstalledorrepaired without Nihon Kohden approval or which have been subjected to neglect or accident, damageduetoaccident,re,lightning,vandalism,waterorothercasualty,improperinstallationorapplication,oronwhichtheoriginalidenticationmarkshavebeenremoved.In the USA and Canada other warranty policies may apply.CAUTIONUnited States law restricts this device to sale by or on the order of a physician.Equipment Authorization RequirementOperation of this equipment requires the prior coordination with a frequency coordinator designated by FCC for the Wireless Medical Telemetry Service.

iv Operator’s Manual ZM-940PA/941PAEMC RELATED CAUTIONThis equipment and/or system complies with IEC 60601-2 International Standard for electromagnetic compatibility for medical electrical equipment and/or system. However, an electromagnetic environment that exceeds the limits or levels stipulated in IEC 60601-1-2, can cause harmful interference to the equipment and/or system or cause the equipment and/or system to fail to perform its intended function or degrade its intended performance. Therefore, during the operation of the equipment and/or system, if there is any undesired deviation from its intended operational performance, you must avoid, identify and resolve the adverse electromagnetic effect before continuing to use the equipment and/or system.The following describes some common interference sources and remedial actions:1. Strong electromagnetic interference from a nearby emitter source such as an authorized radio station or cellular phone: Install the equipment and/or system at another location. Keep the emitter source such as cellular phone away from the equipment and/or system, or turn off the cellular phone.2. Radio-frequency interference from other equipment through the AC power supply of the equipment and/or system: Identify the cause of this interference and if possible remove this interference source. If this is not possible, use a different power supply.3. Effect of direct or indirect electrostatic discharge: Make sure all users and patients in contact with the equipment and/or system are free from direct or indirect electrostatic energy before using it. A humid room can help lessen this problem.4. Electromagnetic interference with any radio wave receiver such as radio or television: If the equipment and/or system interferes with any radio wave receiver, locate the equipment and/or system as far as possible from the radio wave receiver.5. Interference of lightning: When lightning occurs near the location where the equipment and/or system is installed, it may induce an excessive voltage in the equipment and/or system. In such a case, disconnect the AC power cord from the equipment and/or system and operate the equipment and/or system by battery power, or use an uninterruptible power supply.

Operator’s Manual ZM-940PA/941PA v6. Use with other equipment: When the equipment and/or system is adjacent to or stacked with other equipment, the equipment and/or system may affect the other equipment. Before use, check that the equipment and/or system operates normally with the other equipment. 7. Use of unspeciﬁed accessory, transducer and/or cable: When an unspeciﬁed accessory, transducer and/or cable is connected to this equipment and/or system, it may cause increased electromagnetic emission or decreased electromagnetic immunity. The speciﬁed conﬁguration of this equipment and/or system complies with the electromagnetic requirements with the speciﬁed conﬁguration. Only use this equipment and/or system with the speciﬁed conﬁguration.8. Use of unspeciﬁed conﬁguration: When the equipment and/or system is used with the unspeciﬁed system conﬁguration different than the conﬁguration of EMC testing, it may cause increased electromagnetic emission or decreased electromagnetic immunity. Only use this equipment and/or system with the speciﬁed conﬁguration.9. Measurement with excessive sensitivity: The equipment and/or system is designed to measure bioelectrical signals with a speciﬁed sensitivity. If the equipment and/or system is used with excessive sensitivity, artifact may appear by electromagnetic interference and this may cause mis-diagnosis. When unexpected artifact appears, inspect the surrounding electromagnetic conditions and remove this artifact source.If the above suggested remedial actions do not solve the problem, consult your Nihon Kohden representative for additional suggestions.

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Operator’s Manual ZM-940PA/941PA viiConventions Used in this Manual and InstrumentWarnings, Cautions and NotesWarnings,cautionsandnotesareusedinthismanualtoalertorsignalthereadertospecicinformation.WARNINGA warning alerts the user to the possible injury or death associated with the use or misuse of the instrument.CAUTIONA caution alerts the user to possible injury or problems with the instrument associated with its use or misuse such as instrument malfunction, instrument failure, damage to the instrument, or damage to other property.NOTEA note provides speciﬁc information, in the form of recommendations, prerequirements, alternative methods or supplemental information.

viii Operator’s Manual ZM-940PA/941PAExplanations of the Symbols in this Manual and InstrumentThe following symbols found in this manual/instrument bear the respective descriptions as given.On PanelSymbol Description Symbol DescriptionDebrillationprooftypeBFapplied part Serial numberDebrillationprooftypeCFapplied part Year of manufactureAttention, consult operator’s manual CSAmarkDirection for attaching battery coverRF transmitterNon-ionizing radiationDirect currentInside Battery CaseSymbol Description Symbol DescriptionBattery position Attention, consult operator’s manualOn LCDSymbol Description Symbol DescriptionFull battery Replace batteryNIBP cannot be measuredReplace battery Checkelectrode

Operator’s Manual ZM-940PA/941PA 1IntroductionThe ZM-940PA/ZM-941PA transmitter transmits ECG, respiration, SpO2, NIBP and pulse waveform from a patient to a Nihon Kohden monitor for continuous monitoring. The transmitter can change channels when connected to the QI-901PK channel writer. The front LCD displays SpO2%, NIBP, pulserate,pulsewaveformamplitude,electrodeconditionmark,batteryconditionandNIBPmeasuring mode and interval.The difference between the ZM-940PA and ZM-941PA is the transmission frequency range.ZM-940PA:608.0250MHz(channelnumber9002)to613.9750MHz(channelnumber9478)ZM-941PA:1395.0250MHz(channelnumberE002)to1399.9750MHz(channelnumberE398) 1427.0250MHz(channelnumberE502)to1431.9750MHz(channelnumberE898)Read the operator’s manual for the receiving monitor together with this manual before operation.WARNINGDo not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter.CAUTION• Do not use the same channel for different patients. If the same channel is used for two patients, the two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen.• Do not use transmitters of adjacent channels in a hospital. If a transmitter of an adjacent channel is used, radio waves from one transmitter affect the receiver of the adjacent channel’s transmitter and there may be interference.NOTE• To prevent interference between channels, assign a channel administrator in the hospital and only he or she should manage channel assignment.• Use Nihon Kohden parts and accessories to assure maximum performance from your instrument.• For stable signal reception, it is recommended to use a diversity antenna system on the receiving monitor. Otherwise, spike noise from transient fading of electric ﬁeld strength (for example, people moving) may interfere with the transmitter signal and may be mistaken as an arrhythmia on the receiving monitor.

2 Operator’s Manual ZM-940PA/941PA• NIBP cannot be measured on a neonate. (ECG, respiration and SpO2 can be monitored on a neonate.)• Do not diagnose a patient based on only part of the monitoring data on the transmitter or only on the data acquired by the transmitter. Overall judgement must be performed by a physician who understands the features, limitations and characteristics of the transmitter by reading this operator’s manual thoroughly and by reading the biomedical signals acquired by other instruments.• For details on the receiving monitor and upgrade information, contact your Nihon Kohden representative.

Operator’s Manual ZM-940PA/941PA 3Panel DescriptionFront PanelLCD:Displays measuring data, settings and other information.NIBP START/STOP key:Starts/stops NIBP measurement in selected mode.NIBP INTERVAL key:Selects NIBP measurement mode.Refer to the WARNING below. (This symbol is attached to the rear of the battery case cover.)Battery case:Contains three 1.5 V AA (R6) batteries.WARNINGClose the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when deﬁbrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data.

4 Operator’s Manual ZM-940PA/941PARear PanelLock plate:Fastens the transmitter to an NIBP cuff.Refer to the WARNING below.Refer to the symbol page.WARNINGThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.

Operator’s Manual ZM-940PA/941PA 5Top PanelNIBP socket:Connects the cuff hose.Refer to the WARNING on the next page.Refer to the symbol page.Refer to the WARNING on the next page.Refer to the symbol page.ECG/impedance RESP socket: Connects the electrode lead for measuring ECG and/or respiration by the impedance method.Bottom PanelRefer to the WARNING on the next page.Refer to the symbol page.SpO2 socket: Connects the SpO2 probe.Channel number label:Indicates the channel number of the transmitter. Attach the channel number label to the panel of the monitor.

6 Operator’s Manual ZM-940PA/941PAWARNINGBefore deﬁbrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury.WARNINGThe following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.• Assign a channel administrator in the hospital and only he or she should manage channel assignment.• The channel administrator must manage the channels in the facility so that there is no signal interference.• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.WARNINGWhen performing deﬁbrillation, discharge as far as possible from electrodes, patches and any gel, cream or medicine on the chest of the patient. If there is a possibility that the deﬁbrillator paddle could touch these materials, remove them from the patient. If the deﬁbrillator paddle directly contacts these materials, the discharged energy may cause skin burn to the patient.WARNINGWhen the transmitter is used with an electrosurgical unit (ESU), ﬁrmly attach the entire area of the ESU return plate. Otherwise, the current from the ESU ﬂows into the electrodes of the transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.CAUTIONDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.

Operator’s Manual ZM-940PA/941PA 7LCDLOCKKEYS1234567891011No. Name Description 1 NIBP SYS Displays NIBP systolic value. 2 NIBP DIA Displays NIBP diastolic value. 3 NIBP MAP Displays NIBP mean value.   “CUFF”isdisplayedwiththecuffinationpressureduring measurement. 4 Checkelectrodemark Appearswhenanelectrodeorelectrodeleadbecomesdetached during ECG measurement. 5 Batteryreplacementmark Appearswhenthebatteriesareweak.Fordetails,refertothe “Battery Condition Indication” section. 6 Message display area Displays messages.When ECG is monitored with 6 electrodes and an electrode or electrodeleadisdetached,“Checkelectrode”isindicatedasbelow, depending on the PARAMETER SETUP setting.Refer to the “Changing Parameter Setup Settings” and “ECG and Respiration Monitoring” sections.LEADS OFF DISPLAY set to CHAR ECG ELECTRODE set to AHALEADS OFF DISPLAY set to CHARECG ELECTRODE set to IECLEADS OFF DISPLAY set to IMAGE

8 Operator’s Manual ZM-940PA/941PALOCKKEYS1234567891011No. Name Description 7 NIBPmeasurementmode DisplaysNIBPmeasurementmode.Whensettoautomode,the measurement interval is displayed. 8 NIBP interval bar graph In auto NIBP measurement, the remaining time from the last measurement to the next measurement is displayed as a bar graph. 9 Pulselevelbargraph Displayspulselevelin7steps. 10 %SpO2 Displays SpO2 data. 11 PR Displays pulse rate when NIBP or SpO2 is measured. When the SpO2 probe is attached to the patient, the real time pulse rate is displayed. When the SpO2 probe is not attached to the patient, the pulse rate at the end of NIBP measurement is displayed.

Operator’s Manual ZM-940PA/941PA 9Notes on Parameter SettingsWhen monitoring NIBP and SpO2, the following setting must be set as indicated in the table to properly transmit the monitoring data to the receiving monitor. Otherwise, SpO2 cannot be monitored properly during NIBP measurement.Some receiving monitors require the software to be upgraded. For details, contact your Nihon Kohden representative.SpO2 probe attachment site INHIBIT SpO2 DURING NIBP settingProbe attached to the same limb as the cuff ONProbe attached to the limb without cuff* OFF* When the SpO2probeisattachedtothesamelimbastheNIBPcuffandthecuffisinated,the SpO2 value becomes unstable and SpO2 or PR alarm may occur.

10 Operator’s Manual ZM-940PA/941PAImportant Safety InformationGeneralWARNINGNever use the transmitter in the presence of any ﬂammable anesthetic gas or high concentration oxygen atmosphere. Failure to follow this warning may cause explosion or ﬁre.WARNINGNever use the transmitter in a hyperbaric oxygen chamber. Failure to follow this warning may cause explosion or ﬁre.WARNINGWhen performing MRI test, remove all electrodes from the patient which are connected to this transmitter. Failure to follow this warning may cause skin burn on the patient. For details, refer to the MRI manual.WARNINGWhen performing deﬁbrillation, discharge as far as possible from electrodes, patches and any gel, cream or medicine on the chest of the patient. If there is a possibility that the deﬁbrillator paddle could touch these materials, remove them from the patient. If the deﬁbrillator paddle directly contacts these materials, the discharged energy may cause skin burn to the patient.WARNINGBefore deﬁbrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury.WARNINGWhen the transmitter is used with an electrosurgical unit (ESU), ﬁrmly attach the entire area of the ESU return plate. Otherwise, the current from the ESU ﬂows into the electrodes of the transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.

Operator’s Manual ZM-940PA/941PA 11WARNINGClose the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when deﬁbrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data.WARNINGThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.WARNINGDo not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter.CAUTIONOnly use Nihon Kohden speciﬁed electrodes, electrode leads, SpO2 probes, and NIBP cuffs. Otherwise, the maximum performance from the transmitter cannot be guaranteed.CAUTIONDo not reuse disposable parts and accessories.CAUTIONDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.CAUTION• Do not use the same channel for different patients. If the same channel is used for two patients, the two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen.• Do not use transmitters of adjacent channels in a hospital. If a transmitter of an adjacent channel is used, radio waves from one transmitter affect the receiver of the adjacent channel’s transmitter and there may be interference.

12 Operator’s Manual ZM-940PA/941PACAUTIONTurn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.Output SignalWARNINGDo not use the output signal from the receiving monitor as the synchronization signal for other equipment such as IABP, MRI, echocardiography or deﬁbrillator. There may be time delay between the monitor and the other equipment caused by waveform transmission delay and spike noise may interfere on the output signal and be mistaken as a trigger.BatteryWARNING• Keep the batteries away from ﬁre. They may explode.• Keep the batteries away from patients.• Never short-circuit the + and – terminals on the battery. It may cause overheating and ﬁre.• Do not damage, disassemble, drop or give impact to the battery.WARNINGIf the battery is damaged and the substance inside the battery contacts the eyes or skin, wash immediately and thoroughly with water and see a physician. Never rub your eyes, because you may lose your eyesight.

Operator’s Manual ZM-940PA/941PA 13CAUTIONBattery replacement must be performed by the operator. When replacing batteries of the transmitter currently used for a patient, disconnect electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.CAUTIONThe battery charger must be used outside the patient environment.CAUTIONRefer to the battery and battery charger manuals for details on handling the batteries.Transmitter Channel ManagementWARNINGThe following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.• Assign a channel administrator in the hospital and only he or she should manage channel assignment.• The channel administrator must manage the channels in the facility so that there is no signal interference.• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.

14 Operator’s Manual ZM-940PA/941PAFor Patients Using Implantable PacemakerWARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac Monitoring and Diagnostic Equipment*The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor. If this occurs, disconnect the electrode leads from the patient or change the setting on the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker representative or Nihon Kohden representative.* Minuteventilationissensedinrate-adaptivepacemakersbyatechnologyknownasbioelectricimpedancemeasurement(BIM).Manymedicaldevicesinadditiontopacemakersusethistechnology. When one of these devices is used on a patient with an active, minute ventilation rate-adaptivepacemaker,thepacemakermayerroneouslyinterpretthemixtureofBIMsignalscreatedin the patient, resulting in an elevated pacing rate. For more information, see the FDA web site. http://www.fda.gov/cdrh/safety.htmlNIBP MonitoringWARNINGBe careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.WARNINGNIBP measurement may be incorrect in the following cases.• When using an electrosurgical unit• When there is body movement• When the pulse wave is small (insufﬁcient peripheral circulation)• Too many arrhythmias• When there is vibration• When there is a rapid blood pressure change• During CPRWARNINGWhen performing NIBP measurements in STAT mode or 5 minute intervals, periodically remove the cuff from the patient for ventilation. The skin temperature may increase at the cuff attachment site by 2 or 3°C (4 or 5°F). When measuring a patient with a fever or peripheral circulation insufﬁciency, it may cause a burn.

Operator’s Manual ZM-940PA/941PA 15CAUTIONDo not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause reﬂux of blood and stop injection.CAUTIONDo not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may increase.CAUTIONDo not attach the cuff to the site where there is injury or inﬂammation. If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff. Take extreme care on the patients with delicate skin.CAUTIONWhen using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inﬂate or deﬂate. If the cuff cannot deﬂate, it may cause congestion on the patient at the cuff attachment site.CAUTIONWhen performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.ECG MonitoringCAUTIONOnly use Nihon Kohden speciﬁed electrodes and electrode leads. When other type of electrodes or electrode leads are used, the “CHECK ELECTRODES” message may be displayed and monitoring may stop.CAUTIONWhen the “ELECTRODE OFF” or “CHECK ELECTRODE” message is displayed on the receiving monitor, ECG is not monitored properly and the ECG alarm does not function. Check the electrode, electrode leads, and if necessary, replace with new ones.

16 Operator’s Manual ZM-940PA/941PASpO2 MonitoringWARNINGSpO2 measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobin increases abnormally.• When dye is injected in the blood.• When using an electrosurgical unit.• During CPR.• When measuring at a site with venous pulse.• When there is body movement.• When the pulse wave is small (insufﬁcient peripheral circulation).WARNING• When using the TL-201T ﬁnger probe, do not fasten the probe and cable to the ﬁnger by wrapping with tape. This may cause burn, congestion or pressure necrosis from poor blood circulation.• When using probes other than the TL-201T ﬁnger probe, to avoid poor circulation, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation.WARNINGWhen not monitoring SpO2, disconnect the SpO2 cable from the transmitter. Otherwise, noise from the probe sensor may interfere and incorrect data is displayed on the screen.WARNINGCheck the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL-631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.• Patient with a fever• Patient with peripheral circulation insufﬁciency• Neonate or low birth weight infant with delicate skin• Patient who is receiving photodynamic therapy** Photodynamic therapy is a treatment to remove the affected tissue by using a photosensitizing agent and exposing the tissue to light. This treatment has a side effect of photosensitivityandthelightfromthengerprobe sensor may cause a burn. This probe uses two light wavelengths in the range from 650 to 950 nm. The maximum light intensity is less than 5.5 mW/sr.

Operator’s Manual ZM-940PA/941PA 17CAUTIONNIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO2 values.** Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood owdecreasesduringNIBPmeasurementand pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBITSpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2alarmoccurrence.However,whenmonitoring SpO2 on the same limb as the NIBP, be careful when reading SpO2 values.CAUTIONWhile a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO2 value might not be displayed.CAUTIONNormal external light does not affect monitoring but strong light such as a surgical light or sunlight may affect monitoring. If affected, cover the measuring site with a blanket.CAUTIONDo not use a probe which is deteriorated by aging. Accurate measurement cannot be performed.CAUTIONDo not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.CAUTIONThe disposable probe is not sterilized. Use the disposable probe only for a single patient. Never reuse the disposable probe for another patient because it causes cross infection.CAUTIONIf the attachment site is dirty with blood or bodily ﬂuids, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases, and measured value may be incorrect or measurement cannot be performed.CAUTIONIf the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe. Take extreme care for the patients with delicate skin.

18 Operator’s Manual ZM-940PA/941PACAUTIONDo not pull or bend the probe cable, and do not put caster feet on the probe cable. Do not immerse the probe cable in chemical solutions or water. Failure to follow these instructions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one.CAUTIONWhen the probe is attached on an appropriate site with sufﬁcient circulation and the error message conﬁrming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.CAUTIONWhen a message indicates a faulty probe, stop monitoring and replace the probe with a new one.CAUTIONWhen removing a probe that is taped to the skin, do not pull the probe cable because this can damage the cable.CAUTIONNeonatal skin is delicate. Remove the probe and tape carefully and slowly.CAUTIONWhen removing the probe from the attachment tape, do not pull the sensor cable because this can damage the cable.CAUTIONDo not immerse the disposable probe in detergents or water. If the probe adhesive surface gets wet, adhesiveness becomes weak and the probe cannot be attached to the skin.CAUTIONRefer to the probe instruction manual for details.

Operator’s Manual ZM-940PA/941PA 19MaintenanceCAUTIONBefore cleaning or disinfection, remove the batteries from the transmitter. Failure to follow this instruction may result in electrical shock or transmitter malfunction.CAUTIONThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning or disinfecting it and contact your Nihon Kohden representative. The transmitter needs to be checked for safety and function before use.CAUTIONThe transmitter cannot be sterilized. Sterilizing the transmitter may damage it.CAUTIONNever disassemble or repair the transmitter. Disassembly and repair must be performed by qualiﬁed service personnel.

20 Operator’s Manual ZM-940PA/941PAPreparationInstalling (Replacing) BatteriesWARNING and CAUTION for Battery HandlingWARNING• Keep the batteries away from ﬁre. They may explode.• Keep the batteries away from patients.• Never short-circuit the + and – terminals on the battery. It may cause overheating and ﬁre.• Do not damage, disassemble, drop or give impact to the battery.WARNINGIf the battery is damaged and the substance inside the battery contacts the eyes or skin, wash immediately and thoroughly with water and see a physician. Never rub your eyes, because you may lose your eyesight.CAUTIONRefer to the battery and battery charger manuals for details on handling the batteries.CAUTIONThe battery charger must be used outside the patient environment.CAUTIONDo not handle the batteries with wet hands.CAUTIONWhen the transmitter is not in use, remove batteries. When batteries are installed, battery power is consumed even if measurement is not performed. Especially, when NiMH batteries remain in the transmitter when the transmitter is not in use, the battery may become unusable from overdischarge and leak liquid which will damage the transmitter.

Operator’s Manual ZM-940PA/941PA 21Battery LifetimeUsethreeAA(R6)typealkalinedrycellbatteries.NiMHrechargeablebatteriescanalsobeused.ZM-940PAType Lifetime (Measuring parameters)ECG, SpO2, NIBP ECG, SpO2ECG onlyNiMHsecondary 2 days 2.5 days 3 daysAlkalineprimary 1 day 2.5 days 3 daysZM-941PAType Lifetime (Measuring parameters)ECG, SpO2, NIBP ECG, SpO2ECG onlyNiMHsecondary 1.5 days 2 days 2.5 daysAlkalineprimary 1 day 2 days 2.5 daysThe above data is when the following batteries and battery charger which are recommended by Nihon Kohden are used. The measurement is performed at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO2ismeasuredonanindexngerofamalepatientwithweight60kg.OperationtimedependsonthethicknessoftheSpO2 probe attachment site.NiMHsecondary: SANYOHR-3UF(W) Battery charger: SANYO NC-M55Alkalineprimary: NihonKohdenMedipower(equivalenttoPanasonicLR6(G))NOTE• When the “Low battery ” message is displayed on the receiving monitor, NIBP might not have been measured according to the NIBP interval setting. Therefore, the NIBP data displayed on the receiving monitor might not be updated. In this case, check the measurement time of the NIBP data displayed on the receiving monitor.• When using rechargeable NiMH batteries, shallow charging/discharging shortens battery capacity. For details, refer to the battery operator’s manual.Installing (Replacing) BatteriesCAUTIONBattery replacement must be performed by the operator. When replacing batteries of the transmitter currently used for a patient, disconnect electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.If electrode leads are attached to the patient and a person replacing batteries touches the patient duringbatteryreplacement,patientleakagecurrentovertheallowedamountmayow.

22 Operator’s Manual ZM-940PA/941PACAUTION• Replace all batteries at the same time.• Do not use different types of batteries together.NOTEInsert the batteries with the correct polarity (+ and –).Procedure1. Remove the battery case cover.2. Insert three new or fully charged batteries into the battery case observing the correct polarity.3. Close the cover.NOTERemove the batteries before disposing of the transmitter.Situations Requiring Battery ReplacementReplace the batteries when any of the following occurs.• The transmitter LCD displays the “ ” or “ ”mark.• The transmitter generates a constant alarm (continuous “peep” sound).• The transmitter LCD does not display anything when the power is turned on.• The monitor displays the battery replacement message on the screen.

Operator’s Manual ZM-940PA/941PA 23Battery Condition IndicationThe battery condition is indicated as follows.Indication Condition Receiving MonitorFully charged battery Batteries are full. There is no indication on the monitor.Batteries are low. Replace batteries. Message requiring battery replacement is displayed.Batteries are low. NIBP cannot be measured. Replace batteries.No indication Dead batteries No signal can be transmitted to the monitor.There is no indication on the monitor.Turning the Transmitter On/OffTurning On the PowerWhen the batteries are installed correctly, the power is turned on. A one second “peep” sounds and the startup screen appears. (There is no “peep” sound when there is no battery power.)NOTEReplace the batteries when the LCD displays the “ ” or “ ”mark.Turning Off the PowerTo turn off the power, remove batteries.Check Items Before UseBeforeturningonthetransmitterpower,checkthefollowingtoconrmthatthetransmittercanbeused in normal and safe condition.Appearance• Therearenodamagedordirtypartsontheoutsideofthetransmitter(LCD,keys,sockets,batterycasecover,batterycase,lockplate,etc.).Peep

24 Operator’s Manual ZM-940PA/941PA• The transmitter is completely dry.• The electrode lead, SpO2probeandNIBPcuffarenotbroken.• There are no damaged or dirty parts on the disposable SpO2 probe, disposable electrodes or disposable NIBP cuff.Batteries• The battery polarity is correct.• Thebatterycasespringisrmlyxedandthebatteryisnotloose.• Thebatterycasecoverisrmlyclosed.Channel Setting• The transmitter channel corresponds to those of the receiving monitor.• There is no transmitter in the surrounding area with the same channel.Check Items After Power OnAfterturningonthepower,checkthefollowing.Power On• The transmitter generates about a one second “peep” sound and the startup screen appears.• The transmitter does not generate a continuous “peep” sound.• The transmitter does not give excessive heat.• The transmitter LCD displays a “ ”mark.• The transmitter does not interfere with the operation of other medical instruments in use.Basic Operation• The “signal loss” message is not displayed on the receiving monitor when the transmitter is inside the receiving range of the monitor.• The battery replacement message is not displayed on the monitor.• Thekeysonthetransmitterfunctionproperly.• The LCD brightness is appropriate. To adjust brightness, refer to the “Changing System Setup Settings” section.Check Items After UseTousethetransmitterinsafeandoptimumconditionfornexttime,checkthefollowing.Before Turning Power Off• Temporarilychangedsettingsarechangedbacktotheprevioussettings.• There was no malfunction on the transmitter.Storage• ECG electrode leads, SpO2 probe and NIBP cuff are cleaned and disinfected.• When the transmitter gets wet, liquid is wiped off and the transmitter is thoroughly dried.• There are enough consumables, such as disposable electrodes.• The transmitter power is turned off by removing batteries from the transmitter.• Dead batteries are disposed of properly.

Operator’s Manual ZM-940PA/941PA 25Changing the Transmitter ChannelThe channel of the transmitter can be changed. The optional QI-901PK Channel Writer is required.WARNINGThe following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.• Assign a channel administrator in the hospital and only he or she should manage channel assignment.• The channel administrator must manage the channels in the facility so that there is no signal interference.• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.NOTEThe software version of the QI-901PK channel writer must be 02-01 or later to change the channel on the ZM-940PA/941PA transmitter.Tocheckthetransmitterchannel,referto“CHANNEL”inthe“ChangingSystemSetupSettings”section.

26 Operator’s Manual ZM-940PA/941PAChanging Parameter Setup SettingsThe initial settings on the PARAMETER SETUP screen must be changed before monitoring.Changing these settings during monitoring interrupts monitoring.Parameter Setup Setting ListThe factory default settings are underlined.Setting Item Description SettingsSELECTABLE INTERVALSSelect the NIBP measurement modes for the mode selection.STAT, 5, 10, 15, 30, 60, 120, 240INITIAL INTERVAL Select the initial NIBP measurement mode at power on.MAN., 5 min, 10 min, 15 min, 30 min, 60 min, 120 min, 240 minINITIAL CUFF PRESS SelecttheNIBPcuffinationpressure.120mmHg,150mmHg,180mmHg,210mmHg,240mmHgNIBP MODE AFTER STATSelect the NIBP measurement mode after completing STAT measurement.MAN., 5 min, 10 min, 15 min, 30 minSTART/FINISHSOUNDTurn ON or OFF the sound for NIBP measurementstart/nish. ON, OFF/ON, OFFOLD NIBP DATA AFTERSelect whether to hide or dim the NIBP data after measurement and how long to wait after measurement to dim or hide it.DATA: HIDE, DIMAFTER: 5 min, 10 min, 30 minINHIBITSpO2 DURING NIBPTurn SpO2 monitoring on or off during NIBP measurement. ON, OFF2ND PARAMETER Set SpO2 and PR display order. SpO2, PRLEADS OFF DISPLAYSelect the mode for displaying electrode off. This setting is only available when ECG is monitored with 6 electrodes.CHAR, IMAGEECG ELECTRODESelect the electrode lead type. This setting isonlyavailablewhenCHARisselectedfor LEADS OFF DISPLAY.IEC, AHA

Operator’s Manual ZM-940PA/941PA 27Displaying the PARAMETER SETUP Screen1. Remove one battery.2. WhilepressingtheNIBPSTART/STOPandNIBPINTERVALkeys,installthebattery. The SETUP screen appears.3. PresstheNIBPSTART/STOPkeytoenterthePARAMETERSETUPscreen. Whenthecursorismovedto“EXIT”bypressingtheNIBPINTERVALkeyandtheNIBPSTART/STOPkeyispressed,thestartupscreenappears,thenthemonitoringscreenappears.4. Toselectorchangeasetting,presstheNIBPSTART/STOPkey. Tomovethecursor,presstheNIBPINTERVALkey. Whenthecursorismovedto“RETURN”bypressingtheNIBPINTERVALkeyandtheNIBPSTART/STOPkeyispressed,theSETUPscreenappears.Selects or changes settingMoves cursorSelects or changes settingMoves cursor

28 Operator’s Manual ZM-940PA/941PAChanging SettingsSELECTABLE INTERVALSDuringmonitoring,whentheNIBPINTERVALkeyispressed,themeasurementmodechangesaccording to the modes selected in this item. MANUAL mode is already selected for the mode selection.1. PresstheNIBPINTERVALkeytomovethecursorto the desired mode.2. PresstheNIBPSTART/STOPkeytoselectorunselect the mode. Selectable modes are: STAT, 5, 10, 15, 30, 60, 120 and 240 min.INITIAL INTERVALSelect the initial NIBP measurement mode at power on.1 PresstheNIBPINTERVALkeytomovethecursorto “INITIAL INTERVAL”.2. PresstheNIBPSTART/STOPkeytoselectthemode. Selectable modes are the modes selected for “SELECTABLE INTERVALS” and “MAN.” (MANUAL).INITIAL CUFF PRESSSelecttheNIBPcuffinationpressure.1 PresstheNIBPINTERVALkeytomovethecursorto “INITIAL CUFF PRESS”.2. PresstheNIBPSTART/STOPkeytoselecttheinationpressurefrom120,150,180,210and240mmHg.

Operator’s Manual ZM-940PA/941PA 29NIBP MODE AFTER STATSelect the NIBP measurement mode after completing the STAT measurement.1. PresstheNIBPINTERVALkeytomovethecursorto “NIBP MODE AFTER STAT”.2. PresstheNIBPSTART/STOPkeytoselectthemode. The selected mode is automatically selected for “SELECTABLE INTERVALS” as well.START/FINISH SOUNDTurnonoroffthesoundforNIBPmeasurementstartandnish.1. PresstheNIBPINTERVALkeytomovethecursorto“START/FINISHSOUND”.2. PresstheNIBPSTART/STOPkeytoturnONorOFFOLD NIBP DATA/AFTERSelect whether to dim or hide the NIBP data after measurement and how long to wait after NIBP measurement to dim or hide it.1. PresstheNIBPINTERVALkeytomovethecursorto “OLD NIBP DATA/AFTER”.2. PresstheNIBPSTART/STOPkeytoselectthesetting.DATA: DIM NIBP data is dimmed after the “AFTER” interval. HIDE NIBPdataishiddenafterthe“AFTER”interval.“–––”isdisplayedonthescreen.AFTER: Select the interval after NIBP measurement to dim or hide.Dimmed HiddenStart sound End soundStart sound End sound

30 Operator’s Manual ZM-940PA/941PAINHIBIT SpO2 DURING NIBPSet whether or not to monitor SpO2 during NIBP measurement.When the SpO2 probe is attached to the same limb as the NIBP cuff and this setting is set to OFF, the pulse may become unstable and SpO2 or PR alarm may occur. It is recommended to set this setting to ON so that SpO2 is not measured during NIBP measurement.When the SpO2 probe is attached to the other limb from the NIBP cuff, this setting can be set to OFF.NOTEWhen this “INHIBIT SpO2 DURING NIBP” is set to OFF, refer to the “Monitoring SpO2 during NIBP Measurement” section.1. PresstheNIBPINTERVALkeytomovethecursorto“INHIBITSpO2 DURING NIBP”.2. PresstheNIBPSTART/STOPkeytoselect“ON”or“OFF”.ON: Stops SpO2 monitoring during NIBP measurement.OFF: SpO2 is monitored during NIBP measurement.2ND PARAMETERSet the display order of SpO2 and PR.When set to SpO2 When set to PR1. PresstheNIBPINTERVALkeytomovethecursorto “2ND PARAMETER”.2. PresstheNIBPSTART/STOPkeytoselect“SpO2” or “PR”.When set to SpO2When set to PR

Operator’s Manual ZM-940PA/941PA 31LEADS OFF DISPLAYSelect the mode for displaying electrode off. This setting is only available when ECG is monitored with 6 electrodes.1. PresstheNIBPINTERVALkeytomovethecursorto “LEADS OFF DISPLAY”.2. PresstheNIBPSTART/STOPkeytoselect“CHAR”or “IMAGE”.When set to CHAR When set to IMAGEECG ELECTRODESelecttheelectrodeleadtype.Thissettingisonlyavailablewhen“CHAR”isselectedforLEADSOFF DISPLAY.1. PresstheNIBPINTERVALkeytomovethecursorto “ECG ELECTRODE”.2. PresstheNIBPSTART/STOPkeytoselect“IEC”or“AHA”.AHA: RA,LA,LL,Va,VbIEC: R, L, F, Ca, Cb

32 Operator’s Manual ZM-940PA/941PAChanging System Setup SettingsNOTEChanging System Setup settings must be done only by a qualiﬁed personnel.System Setup Setting ListThe factory default settings are underlined.Setting Item Description SettingsCHANNEL Displays the transmitter channel. —PRESSURE UNIT Select the units for NIBP. mmHg,kPaLANGUAGE Select the language for screen display. JPN, ENGBRIGHTNESS Select the LCD brightness. 1, 2, 3, 4SYSTEM INITIALIZEInitializes all settings to the factory default settings. —Displaying the SYSTEM SETUP Screen1. Remove one battery.2 WhilepressingtheNIBPSTART/STOPandNIBPINTERVALkeys,installthebattery.TheSETUP screen appears.3. PresstheNIBPINTERVALkeytomovethecursorto“SYSTEMSETUP”.4. PresstheNIBPSTART/STOPkeytoentertheSYSTEM SETUP screen.When the cursor is moved to “EXIT” by pressing the NIBPINTERVALkeyandtheNIBPSTART/STOPkeyispressed,thestartupscreenappears,thenthemonitoring screen appears.

Operator’s Manual ZM-940PA/941PA 335. Toselectorchangeasetting,presstheNIBPSTART/STOPkey. Tomovethecursor,presstheNIBPINTERVALkey.Selects or changes settingMoves cursorWhenthecursorismovedto“RETURN”bypressingtheNIBPINTERVALkeyandtheNIBPSTART/STOPkeyispressed,theSETUPscreenappears.Changing SettingsCHANNELThe channel of this transmitter is displayed.Channel of this transmitterPRESSURE UNITSelect the unit for NIBP.1. PresstheNIBPINTERVALkeytomovethecursorto “PRESSURE UNIT”.2. PresstheNIBPSTART/STOPkeytoselect“mmHg”or“kPa”.

34 Operator’s Manual ZM-940PA/941PALANGUAGESelect the language for screen display.1. PresstheNIBPINTERVALkeytomovethecursorto “LANGUAGE”.2. PresstheNIBPSTART/STOPkeytoselectthelanguage.BRIGHTNESSSelect the LCD brightness.1. PresstheNIBPINTERVALkeytomovethecursorto“BRIGHTNESS”.2. PresstheNIBPSTART/STOPkeytoselecttheLCDbrightness from 1 to 4. 1 2 3 4Light..............................DarkSYSTEM INITIALIZEDo the following procedure to initialize the settings to the factory default settings.1. PresstheNIBPINTERVALkeytomovethecursorto“SYSTEMINITIALIZE”.2. PresstheNIBPSTART/STOPkey.The“EXECUTE”messageappears.3. PresstheNIBPSTART/STOPkeytoinitializethesettingstothefactorydefaultsettings.

Operator’s Manual ZM-940PA/941PA 35Attaching NIBP Cuff, Electrodes and SpO2 Probe to the PatientThe transmitter can be attached to an arm of the patient or placed on the bedside. The required length of the electrode leads and SpO2 probe cable depends on how the transmitter is to be attached to the patient.NOTEMonitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the blood ﬂow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be careful when reading SpO2 values.When monitoring SpO2 is important, attach the probe to the limb to which theNIBP cuff or catheter is not attached.Attachment ExamplesWhen transmitter is attached on an arm When transmitter is placed on a bedsideNOTEWhen placing the transmitter on a bedside, place it on a stable and ﬂat place. If the transmitter falls off, it may be damaged.

36 Operator’s Manual ZM-940PA/941PAAttaching the NIBP CuffSelecting the NIBP CuffSelect the NIBP cuff appropriate for the patient.NOTENIBP cannot be measured on neonates using this transmitter.Reusable CuffsWhen attaching the transmitter to the patient arm, a special NIBP cuff is required. An optional YN-990Pextensionhose(1.5m)isavailabletoextendthelengthbetweentheNIBPsocketonthetransmitter and NIBP cuff (e.g. when not attaching the transmitter to the patient arm and placing the transmitter on a bedside).Reusable cuff Model Width (cm) Air hose length (cm)For adult Standard YP-943P 13 15Large YP-944P 15 15WidthAir hoseWhen not attaching the transmitter to the patient arm, the following cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.Reusable cuff Model Width (cm) Air hose length (cm)For infant YP-960T 515For child Small YP-961T 7Standard YP-962T 10For adult Standard YP-963T 13Large YP-964T 15WidthAir hose

Operator’s Manual ZM-940PA/941PA 37Disposable CuffsCAUTIONDisposable cuffs are not sterilized. If necessary, sterilize the cuff using glutaraldehyde solution.When not attaching the transmitter to the patient arm, the following disposable cuffs can be used.To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.Reusable cuff Model Width (cm) Air hose length (cm)For infant YP-810P 6 17For child YP-811P 8 17For adultSmall YP-812P 10 17Standard YP-813P 14 20Medium large YP-814P 15 20Large YP-815P 17 20Extra large YP-816P 18 20WidthAir hoseExtension HoseCAUTIONWhen using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inﬂate or deﬂate. If the cuff cannot deﬂate, it may cause congestion on the patient at the cuff attachment site.YN-990P extension hose, 150 cm

38 Operator’s Manual ZM-940PA/941PAReference for selecting a cuffTheAHA(AmericanHeartAssociation)recommendsthatthecuffwidthbe40%ofthecircumference of the upper arm. Refer to the following graph and select the cuff which suits the patient’s arm.NOTE• If a range of arm circumference appropriate for the cuff is prescribed, use a cuff within that range.• To obtain accurate measured values, select a wide cuff which can be attached to the upper arm. Measuring with a very narrow cuff may result in measured values higher than the actual values.• The YP-943P NIBP cuff is for standard size adult. Do not use this cuff when it does not ﬁt the patient.1510510 20 30 40 500201510510 20 30 40 50 60060Cuff width (cm)Arm circumference (cm)Infants YP-960TChildren small YP-961TChildren standard YP-962TAdults standard YP-943P (cuff for transmitter) YP-963TAdults large YP-944P (cuff for transmitter) YP-964TCuff Width and Arm CircumferenceReusable CuffsCuff width (cm)Arm circumference (cm)Children standard YP-811PAdults large YP-815PDisposable CuffsInfants YP-810PAdults small YP-812PAdults standard YP-813PAdults medium large YP-814PAdults extra large YP-816P

Operator’s Manual ZM-940PA/941PA 39Connecting the NIBP Cuff to the TransmitterWhen Using YP-943P/944P NIBP CuffToattachtheYP-943P/944PNIBPcufftothetransmitter,thelockplateisrequired.YP-943P/944P NIBP cuffFront cover Air hoseD ringBeltBelt for the strapLock plate pocket Front cover openLock plateFor attaching the NIBP cuff to the transmitterNOTEDo not roll up or put weight on the cuff when the lock plate is attached to it. The lock plate may break if the cuff is rolled up or weight is put on it when the lock plate attached.Top tabBottom tabTop tabBottom tab

40 Operator’s Manual ZM-940PA/941PA1. Removethelockplatefromthetransmitter.2. InsertthelockplateintothelockplatepocketontheNIBPcuff.3. Attachthetransmittertothelockplate by inserting the tabs on the lockplateintotheslotsonthetransmitter.4. Cover the transmitter with the front cover of the NIBP cuff.5. Connect the air hose to the NIBP socketonthetransmitter.Turnthe cuff connector joint until it clicks.1212