Philips Medical Systems North America SRRBV1 Short Range Radio Module User Manual m81029001b

Philips Medical Systems North America Co. Short Range Radio Module m81029001b

User Manual X2

Patient MonitoringINSTRUCTIONS FOR USEIntelliVue X2Multi-Measurement ModuleRelease G.0 with Software Revision G.0x.xx
SPrinted in Germany 09/08*M3002-9001B*Part Number M3002-9001B4512 610 28261
M3002-9001B i1Table Of Contents1Installation 1Installation Checklist 1Unpacking and Checking the Shipment 2Mounting the Monitor 3Mounting the External Power Supply (M8023A) 3Connecting the Monitor to AC Mains 3Checking Out the Monitor 5Operating the Monitor 6Setting the Date and Time 7Checking Country-Specific Default Settings 7Handing Over the Monitor 82Basic Operation 9Introducing the IntelliVue X2 9Controls, Indicators and Connectors 11Extending Measurements 14Operating and Navigating 17Operating Modes 23Understanding Screens 24Using the XDS Remote Display 25Using the Visitor Screen 25Understanding Profiles 26Understanding Settings 28Changing Measurement Settings 28Switching a Measurement On and Off 28Adjusting a Measurement Wave 28Using Labels 29Changing Monitor Settings 31Checking Your Monitor Revision 32Getting Started 32Disconnecting from AC Mains Power 34Monitoring After a Power Failure 34Networked Monitoring 34Using the X2 with a Host Monitor (Companion Mode Indicated) 35Pairing When Connected to a Host Monitor (Companion Mode Indicated) 35Pairing Without a Direct Connection 35Unpairing the Host Monitor and the Paired Device 36Capturing Alarm Reports and Printing 363What’s New? 37What’s New in Release G.0? 37What’s New in Release F.0? 38
ii4Alarms 41Visual Alarm Indicators 42Audible Alarm Indicators 43Acknowledging Alarms 44Pausing or Switching Off Alarms 45Alarm Limits 47Reviewing Alarms 51Latching Alarms 52Testing Alarms 53Alarm Behavior at On/Off 53Alarm Recordings 535Patient Alarms and INOPs 55Patient Alarm Messages 55Technical Alarm Messages (INOPs) 616Managing Patients 85Admitting a Patient 85Quick Admitting a Patient 87Editing Patient Information 87Discharging a Patient 87Transferring Patients 887ECG, Arrhythmia, ST and QT Monitoring 93Skin Preparation for Electrode Placement 93Connecting ECG Cables 93Selecting the Primary and Secondary ECG Leads 94Checking Paced Status 94Understanding the ECG Display 95Monitoring Paced Patients 96Changing the Size of the ECG Wave 97Changing the Volume of the QRS Tone 98Changing the ECG Filter Settings 98Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 99Choosing EASI or Standard Lead Placement 99About ECG Leads 99ECG Lead Fallback 100ECG Lead Placements 100Capture 12-Lead 104EASI ECG Lead Placement 105ECG and Arrhythmia Alarm Overview 106Using ECG Alarms 107ECG Safety Information 108About Arrhythmia Monitoring 109Switching Arrhythmia Analysis On and Off 110Choosing an ECG Lead for Arrhythmia Monitoring 110
iiiUnderstanding the Arrhythmia Display 111Arrhythmia Relearning 114Arrhythmia Alarms 115About ST Monitoring 121Switching ST On and Off 121Understanding the ST Display and Windows 122Updating ST Baseline Snippets 123About the ST Measurement Points 124ST Alarms 126Viewing ST Maps 126About QT/QTc Interval Monitoring 131QT Alarms 134Switching QT Monitoring On and Off 1358Monitoring Pulse Rate 137Entering the Setup Pulse Menu 137System Pulse Source 137Switching Pulse On and Off 138Using Pulse Alarms 1389Monitoring Respiration Rate (Resp) 141Lead Placement for Monitoring Resp 141Understanding the Resp Display 142Changing Resp Detection Modes 142Changing the Size of the Respiration Wave 143Changing the Speed of the Respiration Wave 144Using Resp Alarms 144Changing the Apnea Alarm Delay 144Resp Safety Information 14410 Monitoring SpO2147SpO2 Sensors 147Applying the Sensor 147Connecting SpO2 Cables 148Measuring SpO2148SpO2 Signal Quality Indicator (Fast SpO2 only) 149Assessing a Suspicious SpO2 Reading 149Changing the Averaging Time 150Setting the Measurement Mode 150Understanding SpO2 Alarms 150Pleth Wave 151Perfusion Numeric 152Perfusion Change Indicator 152Setting SpO2/Pleth as Pulse Source 152Setting Up Tone Modulation 152Setting the QRS Volume 153
iv11 Monitoring NBP 155Introducing the Oscillometric NBP Measurement 155Preparing to Measure NBP 156Starting and Stopping Measurements 158Enabling Automatic Mode and Setting Repetition Time 158Enabling Sequence Mode and Setting Up The Sequence 158Choosing the NBP Alarm Source 158Switching Pulse from NBP On/Off 159Assisting Venous Puncture 159Calibrating NBP 16012 Monitoring Temperature 161Making a Temp Measurement 161Calculating Temp Difference 16213 Monitoring Invasive Pressure 163Setting up the Pressure Measurement 163Zeroing the Pressure Transducer 165Adjusting the Calibration Factor 166Displaying a Mean Pressure Value Only 166Changing the Pressure Wave Scale 166Optimizing the Waveform 167Non-Physiological Artifact Suppression 167Choosing the Pressure Alarm Source 167Calibrating Reusable Transducer CPJ840J6 169Calculating Cerebral Perfusion 17014 Monitoring Carbon Dioxide 171Measuring CO2 using the CO2 Option or M3014A 172Measuring Mainstream CO2 using M3016A 175Measuring Microstream CO2 using M3015A 177Setting up all CO2 Measurements 17815 Assigning Two Devices to One Patient 181How Can You Combine Devices? 181Functions Available When the Telemetry Data Window is Displayed 185Functions Available For Devices Connected Via SRR 186General Telemetry-related Functions 187Use Models With Telemetry 18816 Enhancing Telemetry Monitoring with the Monitor 18917 Tre n d s 191Viewing Trends 191Setting Up Trends 193Documenting Trends 196
vTrends Databases 196Screen Trends 19718 Recording 203Starting and Stopping Recordings 203Overview of Recording Types 204Creating and Changing Recordings Templates 204Recorder Status Messages 20519 Printing Patient Reports 207Starting Report Printouts 207Stopping Reports Printouts 208Setting Up Reports 208Setting Up Individual Print Jobs 210Checking Printer Settings 210Printing a Test Report 210Switching Printers On Or Off for Reports 210Dashed Lines on Reports 211Unavailable Printer: Re-routing Reports 211Checking Report Status and Printing Manually 211Printer Status Messages 212Sample Report Printouts 21320 Care and Cleaning 217General Points 217Cleaning the Monitor 218Disinfecting the Monitor 218Sterilizing the Monitor 218Cleaning, Sterilizing and Disinfecting Monitoring Accessories 219Cleaning Batteries and the Battery Compartment 21921 Using Batteries 221Battery Power Indicators 222Checking Battery Charge 224Replacing a Battery 225Optimizing Battery Performance 225Battery Safety Information 22722 Maintenance and Troubleshooting 229Inspecting the Equipment and Accessories 229Inspecting the Cables and Cords 229Maintenance Task and Test Schedule 230Troubleshooting 231Disposing of the Monitor 231Disposing of Empty Calibration Gas Cylinders 231
vi23 Accessories 233ECG/Resp Accessories 233NBP Accessories 237Invasive Pressure Accessories 238SpO2 Accessories 239Temperature Accessories 243Mainstream CO2 Accessories 243Sidestream CO2 Accessories 244Mainstream CO2 Accessories (for M3016A) 244Microstream CO2 Accessories 244Battery Accessories 24524 Specifications 247Intended Use 247Manufacturer’s Information 247Symbols 248Installation Safety Information 249Altitude Setting 250Monitor Safety Specifications 250EMC And Radio Regulatory Compliance 250Out-Of-Hospital Transport - Standards Compliance 251Monitor Performance Specifications 254M4607A Battery Specifications 257Measurement Specifications 258Safety and Performance Tests 27025 Default Settings Appendix 275Country-Specific Default Settings 275Alarm and Measurement Default Settings 281Alarm Default Settings 281ECG, Arrhythmia, ST and QT Default Settings 282Pulse Default Settings 285Respiration Default Settings 285SpO2 Default Settings 286NBP Default Settings 287Temperature Default Settings 287Invasive Pressure Default Settings 287Cardiac Output Default Settings 290CO2 Default Settings 290
111InstallationInstallation should be carried out by qualified service personnel, either by the hospital’s biomedical department, or by Philips Support.If you have purchased a “customer-installable bundle”, it is assumed that your own hospital personnel will install and, if necessary, configure the monitor. You can contact Philips Support for assistance if required; any assistance will be associated with additional costs. For mechanical and electrical installation, you need technically qualified personnel with a knowledge of english. Additionally, for monitor configuration, you need clinically qualified personnel with a knowledge of the use environment. For further information on Installation, refer to the Service Guide.WARNING • Monitor configuration settings must be specified by authorized hospital personnel.• For installation of the device as part of a system, always refer to the Service Guide.• As the first step in preparing the monitor for use, follow the installation instructions given in this chapter.Installation ChecklistUse this checklist to document your installation.Step Task Check Box when Task Done1 Perform initial inspection of delivery, unpack and check the shipment (see “Unpacking and Checking the Shipment” on page 2).❏2 Mount the monitor as appropriate for your installation (see “Mounting the Monitor” on page 3).❏3 Insert the battery into the battery compartment (the battery must always be in the battery compartment during use). Connect the monitor to AC mains via the external power supply using the supplied power cord (see “Connecting the Monitor to AC Mains” on page 3).❏4 Perform Visual, Power On and Functional test blocks (see “Checking Out the Monitor” on page 5).❏5 Perform Safety Tests, if required by local laws and regulations (see “Checking Out the Monitor” on page 5).❏
1 Installation Unpacking and Checking the Shipment2Unpacking and Checking the ShipmentThe monitor and any supporting options ordered are supplied packed in protective shipping cartons.Initial InspectionBefore unpacking, check the packaging and ensure that there are no signs of mishandling or damage.Open the package carefully and remove the monitor and accessories.Check that the contents are complete and that the correct options and accessories have been delivered.Claims for DamageIf the shipping cartons are damaged, contact the carrier.If any of the equipment is damaged, contact both the carrier and your local Philips service organization for repair or replacement arrangements.RepackingRetain the original packing carton and material, in case you need to return equipment to Philips for service. If you no longer have the original packing materials, Philips can advise you on alternatives.6 Check/set the time and date (see “Setting the Date and Time” on page 7). ❏7 Check that the country-specific default settings are appropriate (see “Checking Country-Specific Default Settings” on page 7)❏8 Perform System Test as necessary (see the Service Guide)❏Step Task Check Box when Task DoneSystem Components, Accessories and Supplies CommentsMonitor with options as ordered 1ECG accessories optionalNBP accessories optionalSpO2 accessories optionalPressure accessories optionalTemperature accessories optionalCO2 Accessories optionalExternal Power Supply including AC power cord and MSL cable optionalRechargeable battery 1Instructions for Use 1Quick Guide 1Documentation CD-ROM (includes Service Guide and Instructions for Use)1
Mounting the Monitor 1 Installation3Mounting the MonitorThe monitor can be rested on a flat, level surface, hung on the bed rail, mounted on a wall or on a rollstand, or on the left side of the Flexible Module Rack (FMS). See the Service Guide for details.Mounting the External Power Supply (M8023A)The external power supply (M8023A) can be rested on its rubber feet on a flat, level surface, or mounted as described in the Service Guide.The following pictures show examples of correct ( ) and incorrect ( ) ways to mount the power supply.Connecting the Monitor to AC MainsThe monitor is an electrical Class II device in which the protection against electric shock does not rely on basic insulation and a protective earth conductor but on double and/or reinforced insulation.
1 Installation Connecting the Monitor to AC Mains4Host Monitor as Power SourceWhen connected to a host monitor, via the Measurement Link (MSL) cable or when directly attached to the host, the X2 obtains its power from the host, including that needed for battery charging. Note that the X2 will operate and charge its battery even when attached to a host monitor running on battery power.External Power Supply M8023A (Option)The optional wide-range external power supply (M8023A) allows you to operate the monitor from an AC (alternating current) power source of 100 V to 240 V (± 10%) and 50/60 Hz (± 5%). The external power supply also charges the monitor’s battery. X2 attached to MP70MSL Cable connects to host monitor or power supply (M8023A)1342
Checking Out the Monitor 1 Installation5WARNING • Always use the supplied power cord with the earthed mains plug to connect the external power supply (M8023A) to an earthed AC mains socket. Never adapt the mains plug from the power supply to fit an unearthed AC mains socket.• Do not use AC mains extension cords or multiple portable socket-outlets. If a multiple portable socket-outlet without an approved isolation transformer is used, the interruption of its protective earthing may result in enclosure leakage currents equal to the sum of the individual earth leakage currents, so exceeding allowable limits.• Do not connect any devices that are not supported as part of a system.• Any non-medical device placed and operated in the patient’s vicinity must be powered via an approved isolation transformer that ensures mechanical fixing of the power cords and covering of any unused power outlets.Checking Out the MonitorThe following table defines which tests and inspections need to be performed, and when they are required.For test and inspection information regarding repairs, upgrades and all other service events, refer to the Service Guide.1 AC power cord. Connect to AC mains socket.2 Connect LAN cable here. For connection to a PC or Information Center.3 Measurement Link (MSL) cable. Supplies AC input power to the monitor for AC operation and for battery charging. When there is a LAN connection to a PC or Information Center, the MSL cable also carries this data to and from the monitor.4 Power-on LED. The green light is on when the external power supply is connected to AC mains.Te st Test or Inspection to be PerformedVisual Inspect the monitor, measurement accessories and cables for any damage. Are they free of damage?Power On Power on the monitor. Does it start up successfully without errors? Do all alarm lamps light up during power up? After start up, the monitor sounds a tone, and you can see the monitoring main screen (normally with measurement wave channels and numeric positions). Functionality Test After power up, touch the battery status indicator in the bottom right of the screen. The battery status window should open. Press the blue Main Screen key to close the window and return to the main screen. Safety Tests (1) to (4) Perform safety tests (1) to (4), as described in the Service Guide, for standalone devices if required by local laws and regulations, and each time you combine equipment to form a system, or exchange system components. Details of the safety tests and procedures are described in the Service Guide. These safety tests are derived from international standards but may not always be sufficient to meet local requirements.System Perform the system test according to IEC 60601-1-1, if applicable, after combining equipment to form a system (see the Service Guide).
1 Installation Operating the Monitor6Operating the MonitorTo complete installation you will need to operate the monitor to check basic functionality. Here is a quick introduction to the monitor. 1Switch on the monitor. After start-up the monitor display will become active. You operate the monitor using the touch screen.2Touch something on the screen (numerics, waves, other screen items) to enter the corresponding menu. Touching the NBP numeric, for example, brings you to the Setup NBP menu.3Touch again to select an item on the menu and work through the menu activities.4To access SmartKeys, press the SmartKeys key. Main Setup is one of the SmartKeys.5If you cannot find a menu by touching the screen you can always use the Main Setup SmartKey which will get you to all menus on the monitor.6Press the Main Screen key to close all open menus/windows and return to the main screen. Press again to enter the Change Screen window, where you can choose from a number of pre-configured screens.
Setting the Date and Time 1 Installation7Setting the Date and TimeTo set the date and time:1Press the SmartKeys key to enter the SmartKeys window.2Select the Main Setup SmartKey to enter the Main Setup menu.3Select the Date, Time screen element from the monitor’s info line to enter the Date, Time menu.4Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list.5Select Store Date, Time to change the date and time.If your monitor is connected to an Information Center, the date and time are automatically taken from this.If the X2 is connected to a host monitor, the date and time are automatically synchronized with the host monitor. When connected to a host monitor, you cannot set the date and time on the X2.Once it is set, the internal clock retains the setting even when you switch off the monitor.Checking Country-Specific Default SettingsSome settings are made in the factory to match the typical requirements in a specific country. Line frequency, units for weight and height, and ECG cable colors (AAMI or IEC) have been set to appropriate values. If you suspect that these settings may not match your institution’s requirements, check the settings and change them if necessary as described in the Configuration Guide.WARNING Before starting monitoring, check that the current configuration meets your requirements, especially patient category, alarm limits and paced setting. If you need to enter configuration mode:1In the Main Setup menu, select Operating Modes.2Select Config and enter the passcode.The passcode for configuration mode is given in the monitor’s service documentation. The monitor displays Config at the right hand side of the status line and in the center of the Screen while you are in configuration mode. Before you leave configuration mode, always be sure to store any changes you made. You must store changes made to each Settings Block and to each Profile, individually. As it may be difficult to remember whether the settings you changed belong to a Monitor Settings block or a Measurement Settings block, we recommend that you store each block before you leave configuration mode.To leave configuration mode:♦In the Main Setup menu, select Operating Modes and then select Monitoring.
1 Installation Handing Over the Monitor8Handing Over the MonitorIf you are handing over the monitor to the end-users directly after configuration, make sure that it is in Monitoring mode.Users must be adequately trained to use the monitor before monitoring a patient. To achieve this, they should have access to, and read, the following documentation delivered with the monitor:• Instructions for Use (this book) - for full operating instructions• Quick Guide - for quick reminders during use
922Basic OperationThese Instructions for Use are for clinical professionals using the IntelliVue X2 (M3002A) Multi-Measurement Module.This basic operation section gives you an overview of the device and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment.Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients. Read and keep the Instructions for Use that come with any accessories, as these contain important information about care and cleaning that is not repeated here.This guide describes all features and options. Your monitor may not have all of them; they are not all available in all geographies. Your monitor is highly configurable. What you see on the screen, how the menus appear and so forth, depends on the way it has been tailored for your hospital and may not be exactly as shown here.In this guide:•A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient.•A caution alerts you to where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.•Monitor refers to the entire patient monitor. Display refers to the physical display unit. Display Screen and Screen refer to everything you see on monitor’s display, such as measurements, alarms, patient data and so forth.Introducing the IntelliVue X2The Philips IntelliVue X2 Multi-Measurement Module is a versatile patient monitoring device with a color touchscreen display. It can simultaneously monitor 3-, 5-, 6- or 10-lead ECG (including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure and temperature, or CO2.The X2 can be used in two ways:• As a Multi-Measurement Module (MMS) for the Philips IntelliVue family of patient monitors.• As a stand-alone patient monitor.
2 Basic Operation Introducing the IntelliVue X210In this book, the X2 is generally referred to as “the monitor”, except in situations describing its use with a host monitor, where it is referred to as “the X2” to distinguish it from the host monitor.The monitor can be used with adult, pediatric and neonatal patients in a hospital environment and during patient transport both inside and outside hospitals.The monitor stores data in trend databases. You can see tabular trends (vital signs) and document them on a central printer. You can view measurement trend graphs, including horizon trends, to help you identify changes in the patient’s physiological condition.The X2 can run on one of three power sources: a rechargeable battery, a host monitor when connected to the X2, or the optional external power supply (M8023A). For battery charging, care and status information, refer to the chapter “Using Batteries” on page 221.X2 as Multi-Measurement ModuleYou can connect the X2 to an IntelliVue patient monitor, where it acts as a Multi-Measurement Module (MMS), providing measurements, trends and patient information to the MP20/30, MP40/50 and MP60/70/80/90. You can connect the X2 to a host monitor via the MSL cable, or attach it directly to the host.When connected to a host monitor, the X2 takes power from the host, including that required for battery charging. The host controls the connected X2, including all alarm functionality. No alarms are available on the X2, and the alarm lamps are controlled by the host. You can recognize when an X2 is connected to a host monitor by the following indication on the X2 screen (white text on a blue background):X2 as Stand-alone MonitorYou can use the X2 as a stand-alone, highly portable monitor. In stand-alone mode, you can run the monitor from the rechargeable battery, or from mains power using the optional external power supply.Through networking it provides information integration, documentation and information access.Continuous MonitoringCombining its role as MMS with that of stand-alone monitor, the X2 is particularly suited to transport situations. When the X2 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor running on battery power, eliminating the need for a separate transport monitor. When the X2 is connected to a new host monitor, it resumes its role as MMS, uploading trend data, patient demographic information and measurement settings, and allowing fully continuous monitoring.Companion Mode No Alarm Display
Controls, Indicators and Connectors 2 Basic Operation11Controls, Indicators and ConnectorsX2 Overview1On/Standby Switch2Power and battery indicators (see “X2 Controls and Indicators” on page 12)33.5-inch TFT LCD touchscreen QVGA display4Alarm lamps (see “X2 Controls and Indicators” on page 12)5Battery eject button6Keys (see “X2 Controls and Indicators” on page 12)7Measurement connectors (see “X2 Patient Connectors, Right Side” on page 13)8Battery12435612346857
2 Basic Operation Controls, Indicators and Connectors12X2 Controls and Indicators1On/Standby switch. Disabled when X2 is connected to a host monitor2On/Standby LED. Green when monitor is on. Red indicates an error.3Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected.4External power LED. Green when monitor is powered from an external power source.5Alarms off indicator. When alarms are suspended, the lamp is red, and the ALARMS OFF message appears on the screen.6Active INOP alarm lamp in light blue. Stays lit until active INOP is acknowledged.7Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is acknowledged.8Silence key9Alarms key: turns alarms On/Off, or pauses them10 SmartKeys key: brings up SmartKeys on the screen11 Main Screen key: closes all open menus/windows and returns to the main screen, or selects current screen.2346751111098
Controls, Indicators and Connectors 2 Basic Operation13X2 Patient Connectors, Right Side1Pressure (option)2Temperature (option)3Noninvasive blood pressure4SpO25ECG sync pulse output(See page 255 for specifications)6ECG/Respiration7CO2 (option)1243654321123456Symbols (International) Text (English versions only)7X2 Left Side1Loudspeaker2MSL Connector. Connects to a host monitor or the external power supply via the MSL cable for power, battery charging, and communication with a network.21
2 Basic Operation Extending Measurements14Extending MeasurementsYour monitor is compatible with Philips measurement extensions for use with other IntelliVue patient monitoring devices. These allow you to add specific measurements to those already integrated into your monitor. These measurement extensions are referred to as MMS extensions.The MMS extensions connect to the monitor and use the monitor’s settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the monitor.WARNING • Measurements from a MMS extension are only available when the extension is connected to the X2, and the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A). Measurements from a MMS extension connected to the X2 are not available when the X2 is running on battery power.• Any measurements on a MMS extension that conflict with those in the monitor cannot be used. For example, only one CO2 measurement is supported.To separate an extension from the monitor, press the release lever and push the extension forward.MMS Extension M3014A attached to the X2
Extending Measurements 2 Basic Operation15M3014A, M3015A and M3016A Measurement ExtensionsWhen attached to an X2 connected to external power (either via the external power supply or a host monitor), the optional M3014A Capnography extension adds mainstream capnography, and optionally one pressure plus either a pressure or a temperature to the monitor. When the X2 is connected to a host monitor, Cardiac Output (C.O.) measurements can be performed and can be used to calibrate Continuous Cardiac Output (CCO). These stored C.O. results and the calibrated CCO measurement are still available in the X2 when it is disconnected from the host monitor.The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the monitor. The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the monitor. Only one CO2 measurement at a time is supported.1Pressure connectors (red) 5Inlet2Temperature connector (brown) 6Microstream connector CO23Mainstream/sidestream connector CO2 (optional)7Gas sample outlet4Cardiac Output connector M3014A Capnography M3015A Microstream12613275412M3016A Mainstream3
2 Basic Operation Extending Measurements16M3012A Hemodynamic MMS ExtensionWhen attached to an X2 connected to external power (either via the external power supply or a host monitor), the optional M3012A Hemodynamic extension adds temperature, pressure, and an additional pressure or a temperature to the monitor. When the X2 is connected to a host monitor, or is using a PC as a remote display, Cardiac Output (C.O.) measurements can be performed and can be used to calibrate Continuous Cardiac Output (CCO). These stored C.O. results and the calibrated CCO measurement are still available in the X2 when it is disconnected from the host monitor.Temperature connectors (brown)Cardiac Output (orange; optional)Pressure connectors (red)MSL Connector to X2
Operating and Navigating 2 Basic Operation17Operating and NavigatingThe principle method of operating your monitor is via the touchscreen. Almost every element on the screen is interactive. Screen elements include measurement numerics, information fields, alarms fields, waveforms and menus.There are also four keys to the right of the screen (see also “X2 Controls and Indicators” on page 12). These let you: Key with symbol (international)Text repl aces symbol (English versions only)• Silence alarms: the Silence key acknowledges all active alarms by switching off audible alarm indicators and lamps.• Switch alarms on or off, or pause alarms. • Call up SmartKeys on the screen (see below).• Close all open menus/windows and return to the main screen.• If you are already in the main screen (no additional menus/windows are open), then pressing this key opens the Change Screen window, where you can choose from a number of pre-configured screens.• To temporarily disable the touchscreen operation, press and hold this key for 2 seconds. Press the key again to re-enable the touchscreen operation.
2 Basic Operation Operating and Navigating18A typical main screen looks like this:X2 Screen ElementsItem Description Comments1 Place for Alarm Volume Off indicator is displayed when the alarm volume is set to zero (0). Not displayed when the X2 is connected to a host monitor (Companion Mode is indicated).2 Alarm message / patient name field Patient name can be covered by alarm messages or alarms On/Off/Paused message.If red and yellow alarms are active at the same time, they rotate in the alarm field.3 Patient category and bed label / INOP message fieldPatient category and bed label can be covered by INOP messages. If there are multiple red/yellow/cyan INOPs active at the same time, they rotate in the INOP field.4 Network connection indicator Documented in Information Center Instructions for Use.All Sett. reset Profile AdultABPABPSys.M1mVHR SpO2TempALARMS OFFSinus Rhythm2568911Bed9 Adult34711110Bed4HR ST-IST-V6SpO2Adult SpO2 LOWAPNEAHR ST-IST-V6SpO2SAdultALL ECG ALARMS OFF APNEAHR ST-IST-V6SpO2
Operating and Navigating 2 Basic Operation19Using the TouchscreenTouch a screen element to get to the actions linked to that element. For example, touch a measurement numeric and the setup menu for that measurement opens. Touch a wave to enter the setup menu for that wave.Measurement Setup MenusEach measurement has a setup menu where you can perform operations or change settings. Typically, the setup menu window covers the whole screen, with the exception of the INOP and alarm message fields, which are always displayed at the top. The following picture is for illustration purposes, and may not exactly represent what you see on the screen. We are using non invasive blood pressure as an example, but all measurement setup windows are similar and share the same basic layout and components.Touch the measurement numeric on the screen to enter the setup menu.5 Measurement label Touch the measurement to enter the measurement setup menu.6 Paced status Displayed below the HR label.7 Measurement numeric/values Touch the numeric to enter the measurement setup menu.8Measurement wave Touch the wave to enter the measurement setup menu.9 Status line Shows information and messages prompting you for action.10 Measurement Selection key Opens the Measurement Selection window which shows all measurements and where they are physically located. From here you can also enter the measurement setups.11 Battery status indicator Gives information about remaining battery charge, estimated operating time, maintenance requirements and malfunctions. See the chapter “Using Batteries” on page 221.X2 Screen ElementsItem Description CommentsHR SpO2Pulse 60 Auto 15 minBed4 Doe, JohnAdult No Central Monit. NBPs HIGH**Alarms : OnSys.Al. from : SysMode : AutoRepeat: 15 minStart/StopStop AllNBP STATNBP meas. + autom. cycle startedNBP 23451Main screen Measurement setup menuPulse 60 Auto 08:28Setup NBP
2 Basic Operation Operating and Navigating20Main Setup MenuThere is usually more than one way to enter a setup menu for a measurement, to change a setting or to execute a task. Some routes are more direct than others. You can use whichever method you find most convenient. Which routes are available to you, however, can vary depending on your monitor’s configuration.For this reason, this book generally describes entry to a measurement’s setup menu via the Main Setup menu, as this route is always available and is not subject to configuration dependencies. You can get to all setup windows from the Main Setup menu. You enter the Main Setup menu by pressing the SmartKeys key, then selecting the Main Setup SmartKey.SmartKeysA SmartKey is a configurable graphical key on the screen allowing fast access to frequently used functions. Press the SmartKeys hard key to call up a set of SmartKeys on the screen. Although the selection of SmartKeys available on your monitor depends on the monitor configuration and on the options purchased, the SmartKeys window generally looks like this:Key to measurement setup menu:Item Description Comment1 INOP and alarm message field. These are always displayed at the top of the screen.2 Wave/numerics window. The main measurement numeric and wave (if applicable) are shown in this window so that you do not lose sight of the current measurement while making changes in the menu.3 Status/prompt message. Status/prompt messages related to the measurement menu are displayed below the wave/numerics. General status/prompt messages on the main screen are covered by the measurement setup menu.4 Next page arrows. The menu may have more than one page, as shown here. Move to another page by touching these arrows.5 Measurement menu buttons. Each button has two lines of text. To perform an operation on a measurement, press one of the buttons. Some buttons lead directly to a task. For example, pressing the Start/Stop button for noninvasive blood pressure starts a measurement. Other buttons open a pop-up window, which can have more than one page, from which you make a selection. Again, using noninvasive blood pressure as an example, pressing the Repeat Time button for setting the repetition time opens a pop-up window from which you pick a time, scrolling if necessary.Main Setup menuFrom here you can get to all setup menus
Operating and Navigating 2 Basic Operation21Main Setup is one of the SmartKeys.enter Main Setup menu - you can get to all setup windows using this keyenter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained.enter profile menu, orrevert to default profilechange Screen, orrevert to default screenprevious Screen quick admit a patiententer patient identification menu to admit/discharge/transfer end case to discharge a patientlock touchscreen operation set alarm limitschange alarm volume change screen brightness (not for independent displays)change QRS volume change amplitude (size) of ECG wavereview beat labels (annotate arrhythmia wave) re-learn arrhythmia- start/stop manual NBP measurement- start auto series- stop current automatic measurement within seriesstart NBP STAT measurementstop automatic or STAT NBP measurement and measurement seriesstart NBP measurement and measurement seriesTouch to view more SmartKeysNo Central Monit. NBPs HIGH**Start/StopMeasmt. Select.Admit/DischrgeAlarm LimitsVitals Trend ProfilesAlarm VolumeQRS VolumeMonitor StandbySmartKeys
2 Basic Operation Operating and Navigating22Pop-Up KeysPop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the confirm pop-up key appears only when you need to confirm a change.Using the On-Screen KeyboardUse this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift key to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard.start veni puncture (inflate cuff to subdiastolic pressure)stop current NBP measurementset the NBP repeat time access patient reportsswitch CO2 pump off zero invasive pressure transducernew lead setup set standard or EASI lead placementreview vital signs trend review graph trendunpair equipment and continue central monitoring with the monitorunpair equipment and continue central monitoring with the telemetry devicestart 12-Lead Capture (only available if Information Center is connected) access ST Map applicationselect measurement deviceAdultBed10 Not Admitted@!#$%^*()QWETR&JGHFDSAPOIUY?ZXVC><MNBKLAlt <> ClrShift Back EnterLast Name
Operating Modes 2 Basic Operation23Operating ModesWhen you switch the monitor on, it starts up in monitoring mode. To change to a different mode:1Select the Main Setup menu. 2Select Operating Modes and choose the mode you require. Your monitor has four operating modes. Some are passcode protected. •Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them. These are for your information and can be changed only in Configuration Mode.•Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend information is deleted from the monitor’s memory.•Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks. These tasks are described in the Configuration Guide. During installation the monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on, the number of waves you see and so forth.•Service Mode: Passcode protected, this is for trained service personnel.When the monitor is in Demonstration Mode, Configuration Mode, or Service Mode, this is indicated by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand corner. Select this field to change to a different mode.When an X2 is connected to a host monitor (Companion Mode is indicated):• The X2 will adopt the operating mode of the host monitor:• You cannot change the operating mode at the X2.Standby ModeStandby mode can be used when you want to temporarily interrupt monitoring. To enter Standby mode,1Press the SmartKeys key .2Either select the Monitor Standby SmartKeyOr select the Main Setup SmartKey, then select Monitor Standby.The Standby screen looks like this:Config
2 Basic Operation Understanding Screens24The monitor enters Standby mode automatically after the End Case function is used to discharge a patient. Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed.If a patient location is entered at the Information Center, this will also be displayed on the Standby screen (availability depends on Information Center revision, applies to stand-alone monitor only).To resume monitoring,♦Select anything on the screen or press any key.When the X2 is on (not in Standby) and is connected to a host monitor in Standby mode, the host monitor will turn on.When the X2 and the host monitor are both in Standby:• Operating the X2 will make the host monitor turn on.• The X2 will switch off when disconnected from the host monitor.• If the host monitor loses AC mains power, the X2 will switch off.Understanding ScreensYour monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios. A Screen defines the overall selection, size and position of waves and numerics on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.Switching to a Different ScreenTo switch to a different Screen:1After closing any open menus or windows, press the Main Screen key to access the Change Screens menu.2Choose the new Screen from the Change Screens menu.STANDBYPress any key or select any field on the screen to resume monitoring
Using the XDS Remote Display 2 Basic Operation25Changing a Screen’s ContentIf you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, or trends. Be aware that these changes cannot be stored permanently in Monitoring Mode.To change the selection of elements on a Screen, 1Select the element you want to change. For example, touch the wave to enter the wave setup menu, or touch the numeric to enter the numeric setup menu.2From the menu that appears, select Change Wave or Change Numeric, and then select the wave or numeric you want.In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk. Up to three modified Screens can be accessed via the Change Screen menu. To recall Screens, select the name of the Screen in the Change Screen menuAfter a patient discharge, the monitor’s default Screen is shown. Modified Screens are still available in the Change Screen menu. If the monitor is switched off and then on again, modified Screens are erased from the monitor’s memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained (unless Automat. Default is set to Yes in Configuration Mode). Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software.For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. Using the Visitor ScreenIf a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and Information Center. You can change the name of the visitor Screen in Configuration Mode.To activate this Screen,1 Wave B1 Big WaveVital Signs B2 Waves A2 Waves BChange Screen
2 Basic Operation Understanding Profiles261Press the Main Screen key to open the Change Screen menu.2Select the name of the visitor Screen configured for your monitor from the list of available Screens.To select a Screen with waves and numerics again,♦Touch the gray rectangle in the center of the screen showing the visitor Screen’s name, or press the Main Screen key, to open the Change Screen menu and then select a Screen from the list.Understanding ProfilesProfiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings.The settings that are defined by Profiles are grouped into three categories. Each category offers a choice of ‘settings blocks’ customized for specific monitoring situations. These categories are: Display (screens)– Each profile can have a choice of many different predefined screens. When you change the profile, the screen selection configured for the new profile becomes active.• Measurement Settings– Each profile can have a choice of different predefined measurement settings. These relate directly to individual measurements, for example, measurement on/off, measurement color, alarms limits, NBP alarm source, NBP repeat time, temperature unit (oF or oC) pressure unit (mmHg or kPa).• Monitor Settings– Each profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.PAP ZERO+CHECK CAL Doe, JohnProfile : Profile AdultPatient Category : AdultPaced : NoDisplay : Vital SignsProfilesMeasmnt.Settings : Measmt. AdultMeasmnt. AdultMeasmnt. PediPlease ConfirmTo activate the highlighted settings block select ConfirmPAP ZERO+CHECK CAL Doe, JohnConfirm CancelProfilePatientProfiles Menu, showing current settings Available choices in measurement menu. Confirm your choice when prompted.Please Confirm
Understanding Profiles 2 Basic Operation27You can change from one complete profile to another or swap individual settings blocks (display screen/monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode.Depending on your monitor configuration, when you switch on or discharge a patient the monitor either continues with the previous profile, or resets to the default profile configured for that monitor.WARNING If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be setup to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles.When you leave Demonstration Mode, the monitor uses the default profile.Swapping a Complete Profile 1Press the SmartKeys key and–Either select Main Setup and then Profiles in the Setup menu.–Or select the Profiles SmartKey . 2In the Profiles menu, select Profile.3Chose a profile from the pop-up list.4Confirm your selection.Swapping a Settings Block1Select the Main Setup SmartKey and then Profiles in the Main Setup menu, or select the Profiles SmartKey. 2In the Profiles menu, select Display or Measmnt. Settings or Monitor Settings to call up a list of the settings blocks in each category.3Choose a settings block from the pop-up list.4Confirm your selection.Default ProfileYour monitor has a default profile that it uses when you leave Demonstration, or Service modes, or when you discharge a patient. This profile is indicated by a diamond . Locked ProfilesSome profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol.
2 Basic Operation Understanding Settings28Understanding SettingsEach aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including,Screen Settings, to define the selection and appearance of elements on each individual ScreenMeasurement settings, to define settings unique to each measurement, for example, high and low alarm limitsMonitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness.You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitor’s Configuration Mode. All settings are reset to the stored defaults: • when you discharge a patient • when you load a Profile• when the monitor is switched off for more than one minute (if Automat. Default is set to Yes).Changing Measurement SettingsEach measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:• via the measurement numeric - select the measurement numeric to enter its setup menu. For example, to enter the Setup ECG menu, select the HR (heart rate) numeric.•via the Main Setup SmartKey - if you want to setup a measurement when the measurement is switched off, use the Main Setup SmartKey and select Measurements. Then select the measurement name from the popup list. With this permanent key you can access any setup menu in the monitor.• via the Measurement Selection key.Switching a Measurement On and OffWhen a measurement is off, its waves and numerics are removed from the monitor’s screen. The monitor stops data acquisition and alarming for this measurement. 1Enter the measurement’s setup menu and select the measurement.2Select the measurement name to toggle between on and off. The screen display indicates the active setting.Adjusting a Measurement WaveTo quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement Wave menu, which has only wave-related measurement settings.
Using Labels 2 Basic Operation29Changing Wave SpeedsLowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.The monitor distinguishes two groups of wave speed settings, •RespiratorySpeed, for CO2 waves.•Global Speed, for all waves not included in the other group.Changing the Wave Group SpeedThe wave speed group setting defines the speed of all the waves in the group. To change the wave speed of a wave speed group,1Select Main Setup -> User Interface2Select Global Speed or RespiratorySpeed, as required3Select a value from the list of available speeds.Changing Wave Speed for a ChannelTo change the wave speed of an individual wave channel, 1Enter the Wave menu for a measurement by selecting its wave.2Select Change Speed.3To set the speed to the wave group speed, select RespiratorySpeed or Global Speed. To set an individual channel speed, select a numeric value from the list of available speeds. This overrides the wave group speed setting and sets the speed for the individual wave channel on the monitor Screen. The wave channel speed is independent of the wave (label) depicted in the channel, if you change the wave, the new wave will retain the set channel speed.Using LabelsYou can measure up to three invasive pressures and temperatures simultaneously. The monitor uses labels to distinguish between them. The default settings defined in the profile (such as measurement color, wave scale, and alarm settings) are stored within each label. When you assign a label to a measurement, the monitor automatically applies these default settings to the measurement. The labels assigned are used throughout the monitor, in reports, recordings, and in trends.Changing Measurement Labels (e.g. Pressure)To change a measurement label of a measurement with multiple labels (invasive pressure or temperature),1Enter the Wave menu of the measurement. 2Select Label.3Choose a label from the list.The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you select. You can change scale settings in Monitoring Mode, but color can only be changed in the monitor’s Configuration Mode.
2 Basic Operation Using Labels30Any labels already being used in the monitor are shown “grayed-out” in the list and cannot be selected. Resolving Label ConflictsEach label must be unique, that is, it can only be assigned once. If you have a MMS Extension equipped with a pressure measurement connected to the monitor, there is a potential conflict with, for example, the ABP label. If you manually enter measurement values these may also conflict with existing labels on the monitor.Depending on your configuration, the monitor will either • display the Measurement Selection window automatically for you to resolve the conflict• take no action, you must enter the Measurement Selection window and resolve the conflictAll the currently available measurements are depicted in the Measurement Selection window. Any measurement labels causing a label conflict are shown in red. If a measurement is connected but currently unavailable, for example, because it was deactivated due to a label conflict, that measurement is shown “grayed-out”. If a MMS Extension is not available, for example if monitor is running on battery power and not an external power source, the MMS Extension is not displayed.On an X2 display, a MMS Extension is only shown in the Measurement Selection window when the X2 is connected to a host monitor or the external power supply (M8023A), and not when running on battery power.WARNING When an X2 with an active measurement, say SpO2, is connected to a host monitor with the same measurement already active, the SpO2 measurement on the X2 is deactivated and the SpO2 DEACTIVATED INOP is displayed. The measurement can only be reactivated if the X2 is disconnected from the host monitor. The label conflict can be resolved on the host monitor like any other label conflict. measurement selection keyPAP ZERO+CHECK CALABPTcoreNBPSpO2ECGRespTempPAPCO2Measurement Selection*** APNEADe-ActivateSetup SpO2MoreChange LabelCPPTempUnavailable measurements are grayed-out
Changing Monitor Settings 2 Basic Operation31When the X2 is connected to a host monitor, the Measurement Selection window can be opened, but only the measurement Setup key is functional. Derived measurements are not active and cannot be activated, but become active again when the X2 is disconnected from the host monitor. Resolve any label conflicts at the host monitor. To resolve a label conflict when the X2 is not connected to a host monitor:1Press the SmartKeys key and–Either select Main Setup and then Meas. Selection–Or select the Meas. Select. SmartKeyto display the Measurement Selection window.2Select the label to be corrected.3Use the measurement selection keys to resolve the conflict. Select either:–Change Label: to assign a different label to the conflicting label.–De-activate: to disable the conflicting measurement. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged.–Setup <Measurement label>: to enter the Setup menu for the measurement and change the conflicting device’s label to a different label.4Select the De-activate pop-up key to disable the conflicting measurement.Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used. If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. Changing Monitor SettingsTo change monitor settings such as brightness, or QRS tone volume:1Press the SmartKeys key .2Either Enter the Main Setup menu by selecting the SmartKey . Select the setting you want to change, or select User Interface to enter a submenu where you can change user interface settings.Or Select the appropriate SmartKey for the setting you want to change.Adjusting the Screen Brightness1Select the Brightness SmartKey.
2 Basic Operation Checking Your Monitor Revision322Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most monitoring locations and optimizes power usage for battery powered monitors.Your monitor may be configured with a lower brightness for Standby mode and also for transport to conserve battery power. These settings can only be changed in the monitor’s Configuration Mode. Setting the Date and TimeIf your monitor is connected to an Information Center, the date and time are automatically taken from this.If the X2 is connected to a host monitor, the date and time are automatically synchronized with the host monitor. When connected to a host monitor, you cannot set the date and time on the X2.Once it is set, the internal clock retains the setting even when you switch off the monitor.1In the Main Setup menu, select Date, Time.2Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list.3Select Store Date, Time to change the date and time.Checking Your Monitor Revision1Select Main Setup -> Revision to open the Monitor Revision menu. 2Select the correct device from the device pop-up keys.3From the Monitor Revision menu, select the monitor component for which you need revision information.Getting StartedOnce you understand the basic operation principles, you can get ready for monitoring.Inspecting the MonitorWARNING If the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel. 1Before you start to make measurements, carry out the following checks on the monitor. – Check for any mechanical damage.– Check all the external cables, plug-ins and accessories.2Always ensure that the battery is loaded in the battery compartment when monitoring a patient, even when the monitor is running on external power.3If you are using battery power, ensure that the battery has sufficient power for monitoring. Before using a battery for the first time, you must charge it, following the instructions given in the section on Charging Batteries.
Getting Started 2 Basic Operation334Measurements from measurement extensions attached to the monitor are only available when the monitor is operating from external power (when connected to a host monitor or to the external power supply). The measurement extensions are not active when the monitor is operating from battery power.5Check all the functions of the instrument that you need to monitor the patient, and ensure that the instrument is in good working order.Switching OnPress the on/off switch on the monitor for one second. The monitor performs a self test and is then ready to use. If you see a message such as CO2SENSOR WARMUP wait until it disappears before starting to monitor that measurement.When the X2 is connected to a host monitor (Companion Mode is indicated), note that the On/Off switch is disabled.Power On/Power Off BehaviorThe general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows:• A monitor that was switched on prior to a temporary power loss switches on again when power is restored.• A monitor that was switched off prior to a temporary power loss remains off when power is restored.• When AC mains power is lost, a battery powered monitor continues to run without interruption on battery power.• The X2 switches on automatically when connected to a running host monitor.• When the X2 is disconnected from a running host monitor, it continues to run without interruption on battery power.Setting up the Measurements1Decide which measurements you want to make. 2Connect the required patient cables and sensors. The connectors are color-coded to the patient cables and sensors for easy identification.WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Starting Monitoring After you switch on the monitor,1Admit your patient to the monitor.2Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and so forth are appropriate for your patient. Change them if necessary. 3Refer to the appropriate measurement section for details of how to perform the measurements you require.
2 Basic Operation Disconnecting from AC Mains Power34Disconnecting from AC Mains PowerTo disconnect the X2 from AC mains power, disconnect the MSL cable, or detach the X2 from the host monitor (if directly connected) or unplug the power cord for the optional external power supply (M8023A) from the mains socket.Monitoring After a Power FailureIf external power is disconnected or there is a power failure, the monitor continues to run on its rechargeable battery.If the monitor is without any power (no external power or the battery is empty) for less than one minute, monitoring will resume with all active settings unchanged. If the monitor is without power for more than one minute, the behavior depends on your configuration. If Automat. Default is set to Yes, the default profile will be loaded when power is restored. If Automat. Default is set to No, all active settings are retained, if power is restored within 48 hours. The Automat. Default setting is made in Configuration Mode.Networked MonitoringYou can connect your monitor to an Information Center on a network, using one of the optional interfaces:• Standard wired LAN• Wireless LAN• IntelliVue Instrument Telemetry System (IIT)WARNING Do not connect patient monitors to the standard hospital network. Additionally, when the X2 is equipped with an IIT interface and declared at the Information Center as a telemetry device, it allows data continuity when paired to a host monitor. After disconnection from the host monitor, it continues to monitor the patient during transport (or roaming within the specified area of coverage) and provides continuous data to the same sector on the Information Center. (See the Instructions for Use for your host monitor for viewing telemetry data on the host.)If your monitor is connected to a network, a network symbol is displayed in the upper left corner next to the bed label. To see details about the monitoring equipment and technical information about the network, select the Main Setup SmartKey to enter the Setup menu, then select Bed Information.Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks.
Using the X2 with a Host Monitor (Companion Mode Indicated) 2 Basic Operation35Using the X2 with a Host Monitor (Companion Mode Indicated)Host monitors that can support the X2 as a multi-measurement module require software revision F.00.00 or higher. When you connect an X2 to a host monitor, an integrated system is formed for monitoring a single patient. The following general observations and considerations apply to such a system:• The host monitor is the “master” of the system, and you have full control over all the system’s operation only via the host monitor.• Functions you can operate on an X2 are restricted to measurements originating in that device. If you try to operate controls that are disabled, you are prompted by the message Not available in Companion Mode.• Depending on how it is configured, your host monitor can determine whether the user interface of a connected X2 is completely disabled or not, and what is displayed (a standard main screen, or a blank screen similar to the Standby screen indicating Companion Mode).This is controlled by two monitor settings that are applied to the X2 on connection. You can change the settings in Configuration Mode.• General settings from the host monitor are applied to the X2 on connection. When disconnected from the host, the X2 applies its own general settings.• No audible alarms are available on an X2 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps which are controlled by the host monitor. Alarms become active again as soon as the X2 is disconnected from the host monitor.• The host monitor is the master of all ADT information. ADT operations on the X2 are disabled, and any pending actions on the X2 (for example, admit or end case) are cancelled.• The date and time of the X2 is synchronized with that of the host monitor.Pairing When Connected to a Host Monitor (Companion Mode Indicated)An X2 with an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a “telemetry device” at the Information Center.Pairing Without a Direct ConnectionWhen the X2 is declared as a telemetry device and has a connection to the Information Center, it can also be paired to a host monitor even without a direct connection:1Select Main Setup then Measurements2Select TelemetryThe Setup Telemetry menu will appear with only one entry Paired Equipment.3Enter here the equipment label of the telemetry device to be paired.
2 Basic Operation Unpairing the Host Monitor and the Paired Device36Unpairing the Host Monitor and the Paired DeviceIf the patient will no longer be monitored with the paired X2, or only with the paired X2 and no longer with the host monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the host monitor or from the paired X2. At the host monitor:♦Select the Main Setup -> Measurements - > Telemetry or the Unpair to Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the host monitor♦Select the Main Setup -> Measurements - > Telemetry or Unpair to Tele SmartKey to end pairing and have the Information Center receive the measurement data from the paired X2You can also use the Unpair function at the Information Center or directly on the paired X2.Capturing Alarm Reports and PrintingYou can print out standard reports, alarm reports and trends with the IntelliVue PC Printing Solution. This is a software package which allows you to print to a standard, off-the-shelf printer or to an electronic file such as PDF. You can download the IntelliVue PC Printing Solution free-of-charge from the Internet and install it on an existing PC. Capturing Alarm ReportsThe monitor can be set up to automatically capture alarm reports, triggered by selected alarms. The necessary settings must be made in Configuration mode. When one of the selected alarms occurs, the monitor automatically captures the alarm and creates a report which is stored in the database. As soon as the monitor is connected to a PC or network with the IntelliVue PC Printing Solution software, it will automatically print the reports, or send them to a patient-specific folder as an electronic file.
3733What’s New?This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital.What’s New in Release G.0?Short Range Radio Interface for X2A short range radio interface is now available for the X2 monitor. This allows a telemetry transceiver with a short range radio adapter to be assigned to the monitor, resulting in a direct connection. The measurement data from the telemetry transceiver appear directly on the monitor screen with a minimal delay and are combined with the monitor data in one sector at the Information Center. IntelliVue XDS SolutionUsing the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software.New Fields in the Admission FormA Middle Name field is now available in the admission form - whether it appears is configurable. Two additional ID fields, Lifetime Id and Encounter Id, can also be configured to appear and their names can be customized to fit hospital requirements. SpO2 Enhancements•Additional SpO2 Labels - SpO2pr and SpO2po labels have been added.•New manual measurement mode when telemetry devices are connected via a short range radio link.• Signal Quality Indicator displayed with the SpO2 numerics. ECG Enhancements•New */**Afib yellow alarm when an atrial fibrillation waveform is detected.•QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points.
3What’s New? What’s New in Release F.0?38What’s New in Release F.0?QT/QTc Interval Monitoring QT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a 'QTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and 'QTc enabling alarm notification. Manual Data EntryMeasurement values (for example lab data or manually measured temperatures) can be entered manually into the monitor and stored in the database. They can then be used for trends, reports and also be displayed as a numeric on screen, if required. Horizon Trend Enhancements The trend indicator arrow indicates how the patient trend has developed in a set time period. This period is now configurable and can be set to 10 minutes, 5 minutes or 2 minutes. The horizon (or baseline) can now be set to a range or to a specific value. Connecting an MP5 to a Monitor (Companion Mode is indicated)The MP5 monitor can be connected to one of the MP20 to MP90 monitors (then called the host monitor) and used like an MMS. This provides monitoring continuity in transport situations allowing measurement data and patient demographics from the MP5 to be transferred to another monitor. When the MP5 is connected to a host monitor, no alarms will be announced on the MP5. NBP - Programmable Measurement SequenceUp to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously you can have regular measurements continue after the sequence has run. New Printing Options For ReportsReports can now also be printed via an external PC-based print server or to an internal print database, when no printer is available (for example, during transport). As soon as a printer becomes available, the reports stored in the database will print automatically.Manual Pairing At MonitorPreviously, devices could only be manually paired at the Information Center. You can now pair devices at the monitor as long as the monitor is already connected to the Information Center. Moving Windows And MenusWindows and menus can now be moved on the monitor screen. Using touch or a mouse you can select the title of a window and then “drag” it across the screen. Some positions on the screen are not allowed, such as ones overlapping the alarm field or the monitor info line. Invasive Pressure ChangesWave cursor - A cursor is now available on the realtime pressure wave to allow you to define a position and store the corresponding value. Reduced alarm limit steps in lower ranges - The alarm limits setting in 2 mmHg steps is now possible in ranges up to 50 mmHg (previously up to 30 mmHg).
What’s New in Release F.0? 3What’s New?39New Patient CheckThe monitor can be configured to ask you in certain situations: after a specified power-off period, after a specified standby period and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings. New Smart KeysA SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used. Better Visibility Of GridlinesThe brightness of the gridlines on the realtime waves has been increased for better visibility.
3What’s New? What’s New in Release F.0?40
4144AlarmsThe alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements.The monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy). INOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, LEADS OFF), the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded. INOPs without this audible indicator indicate that there may a problem with the reliability of the data, but that monitoring is not interrupted. Most INOPs are light blue, however there are a small number of INOPS which are always yellow or red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be configured as red or yellow INOPs to provide a severity indication:• ECG LEADS OFF•ECG/ARRH ALARM OFF (yellow only, no red INOP)• CUFF OVERPRESS• CUFF NOT DEFLATED• OCCLUSION• TELE DISCONNECT.• Replace TeleBattAll monitors in a unit should have the same severity configured for these INOPs.Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the trigger delay time for the individual measurement. See the specifications section for details.If more than one alarm is active, the alarm messages are shown in the alarm status area in succession. An arrow symbol next to the alarm message informs you that more than one message is active. n** HR HIGH
4Alarms Visual Alarm Indicators42The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged.Visual Alarm IndicatorsWARNING • No alarms are available on the X2 when connected to a host monitor. Alarms become active again as soon as the X2 is disconnected from the host monitor.• Alarm fields and other visual alarm indicators are disabled on the X2 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps, which are controlled by the host monitor. No Alarm Display is shown in the field for red/yellow alarms, and Companion Mode is shown in the INOP field. Alarm message: An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. There is a field for INOPs (light blue, red or yellow) and a field for patient alarms, which is shared for red and yellow alarms. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow ( ) at the side. If both red and yellow alarm conditions are active simultaneously, they alternate every two seconds in the patient alarms field. The background color of the alarm message matches the alarm priority: red for red alarms, yellow for yellow alarms, light blue for standard INOPs, red for red INOPs and yellow for yellow INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms, ** for yellow alarms, * for short yellow alarms. Standard INOPs do not have a symbol, red and yellow INOPs have exclamation marks beside the alarm message: !!! for red INOPs and !! for yellow INOPs. Depending on how your monitor is configured, it may display alarm limit violation messages• in text form, for example “**SpO2 LOW” or• in numeric form, for example “**SpO2 94<96”, where the first number shows the maximum deviation from the alarm limit, and the second number shows the currently set limit. Flashing numeric: The numeric of the measurement in alarm flashes.Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if Show AlarmLimits is enabled and there is sufficient room on the screen.Alarm lamp: A lamp on the monitor’s front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds. The color is yellow or red corresponding to the highest priority patient alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow or red INOPs as follows:Companion Mode No Alarm Display
Audible Alarm Indicators 4Alarms43If only patient alarms are present, and no INOPs, the patient alarms will use both left and right sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and right sections to flash but light blue INOPs will always light continuously in the left section only.Audible Alarm Indicators The audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to non-latching).WARNING • Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.• No alarms are available on the X2 when connected to a host monitor. (Companion Mode is indicated). Alarms become active again as soon as the X2 is disconnected from the host monitor.• When connected to a host monitor (Companion Mode is indicated), no alarm tones are available on the X2.Alarm Tone Configuration The audible alarm indicators of your monitor are configurable. In the monitor’s Configuration Mode, you can:• increase the alarm volume of unacknowledged alarms at regular intervals• change the interval between alarm sounds (ISO/IEC Standard alarms only)• change the base volume of the red and yellow alarm tones and the INOP tones• change the alarm sound to suit the different alarm standards valid in different countries.Traditional Audible Alarms (HP/Agilent/Philips/Carenet)• Red alarms and red INOPs: A high pitched sound is repeated once a second. • Two-star yellow alarms and yellow INOPs: A lower pitched sound is repeated every two seconds.• One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration.• Standard INOPs: an INOP tone is repeated every two seconds.INOP Lamp ColorModulation (how long the lamp is on or off while flashing)On OffYellow 1.0 seconds 1.0 secondsRed 0.25 seconds 0.25 seconds
4Alarms Acknowledging Alarms44ISO/IEC Standard Audible Alarms• Red alarms and red INOPs: A high pitched tone is repeated five times, followed by a configurable pause. • Two-star yellow alarms and yellow INOPs: A lower pitched tone is repeated three times, followed by a configurable pause. • One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration. • Standard INOPs: a lower pitched tone is repeated twice, followed by a pause. Changing the Alarm Tone Volume ♦If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, or change the setting, select the Alarm Volume SmartKey. The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale. Any settings that are inactive (“grayed out”) have been disabled in the monitor’s Configuration Mode.When the alarm volume is set to zero (off), the alarm volume symbol reflects this. If you switch the alarm volume off, you will not get any audible indication of alarm conditions.There is no alarm volume indication on the X2 display when the X2 is connected to a host monitor (Companion Mode is indicated).Minimum Volume for No Central Monitoring INOPIf your monitor is connected to an Information Center, and the connection is interrupted, the INOP message No Central Monit. will appear within 30 seconds, accompanied by an INOP tone. To help ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the monitor alarm volume is set to zero.Minimum Volume for Severe Yellow or Red INOPsSevere yellow or red INOPs require action to ensure the well-being of the patient. Therefore the minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.The severe INOPs for which this applies are:Cuff Not Deflated (configurable to yellow or red)NBP Cuff Overpress (configurable to yellow or red)Insert Battery (yellow)Acknowledging Alarms Alarm Volume
Pausing or Switching Off Alarms 4Alarms45To acknowledge all active alarms and INOPs, press the Silence key. This switches off the audible alarm indicators and alarm lamps. A check mark beside the alarm message indicates that the alarm has been acknowledged. If the monitor is configured to re-alarm, a dashed check mark will be shown.If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message stays on the screen with a check mark symbol beside it, except for NBP alarms. When an NBP alarm is acknowledged the alarm message disappears.If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also stops alarm indication.Acknowledging Disconnect INOPsAcknowledging an INOP that results from a disconnected transducer switches off the associated measurement. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the Information Center switches off the audible INOP indicator but does not switch off the measurement. Alarm Reminder (ReAlarm)If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). Alarm reminder is not available for standard, light blue INOPs but for yellow and red INOPs. In Configuration Mode, you can set the interval between silencing the alarm and sounding the reminder tone to one, two, or three minutes. The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the Information Center Instructions for Use for further information. Pausing or Switching Off AlarmsIf you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely. To view the alarm pause setting chosen for your unit, 1Select Main Setup -> Alarms -> Alarm Settings2Check the Alarms Off setting. This setting can only be changed in Configuration Mode. To avoid the possibility that alarms could be switched off by accident, it is recommended not to configure the alarm pause setting to infinite when the X2 is not connected to a host monitor, unless you are sure that clinical personnel are available to supervise the patient. APNEA
4Alarms Pausing or Switching Off Alarms46To Pause All Alarms♦Press the Alarms key.♦If your monitor is configured to infinite pause time, the lamp next to the alarms off symbol is red, and pressing this key switches alarms off.Depending on the configuration, you may need to select Confirm to complete the change.To Switch All Alarms OffYou can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause. ♦Press the Alarms key.Pausing alarms infinitely is the same as switching them off. To Switch Individual Measurement Alarms On or Off1Select the measurement numeric to enter its setup menu.2Select Alarms to toggle between On and Off.The alarms off symbol is shown beside the measurement numeric. While Alarms are Paused or Off• The red Alarms Paused lamp on the monitor front panel is lit. •In the alarm field, the monitor displays the message ALARMS PAUSED or ALARMS OFF, together with the alarms paused symbol and the remaining pause time in minutes and seconds, or alarms off symbol.• No alarms are sounded and no alarm messages are shown. • INOP messages are shown but no INOP tones are sounded. The only exceptions are the INOPs CUFF NOT DEFLATED, CUFF OVERPRESS and INOPs relating to empty, missing and malfunctioning batteries. These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or off. You need to remove the INOP condition first before you can switch the alarm tones off again.AlarmsOffALARMS PAUSED 1:28ALARMS OFF
Alarm Limits 4Alarms47If a NO SENSOR or NO TRANSDUCER INOP is present and alarms are paused or switched off, the measurement in question is switched off. The alarms off symbol is not displayed when the X2 is connected to a host monitor. Restarting Paused Alarms ♦To manually switch on alarm indication again after a pause, press the Alarms key again. Alarm indication starts again automatically after the pause period expires. If the monitor is configured to stay paused infinitely, you must select ALARMS OFF again to restart alarm indication.Resetting Arrhythmia Alarm Timeouts♦To reset the arrhythmia alarm timeout period, press the Alarms key and then press it again. Extending the Alarm Pause Time If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patient’s condition closely. To extend the alarm pause time to five or 10 minutes, 1Select one of the alarm fields. This calls up the Review Alarms window.2Select either the pop-up key Pause Al. 5 min or the pop-up key Pause Al. 10 min. Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes.Alarm LimitsThe alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO2), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off. In these cases, the alarms off symbol is not displayed.WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different patients. Always check that the alarm settings are appropriate for your patient before you start monitoring.Viewing Individual Alarm LimitsYou can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen. If your monitor is not configured to show the alarm limits next to the numeric, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits. 8512050HRAlarm limits
4Alarms Alarm Limits48Viewing All Alarm Limits The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea alarm delay time is set, this is also shown. The ALARMS OFF symbol is shown beside the measurement label of any measurement whose alarm switched off. To open the Alarm Limits window, either select one of the alarm fields then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured.♦Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Selecting Hide ST Limits hides the list again.You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:–All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all measurements. These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window.Changing Alarm LimitsTo change individual measurement alarm limits using the measurement’s Setup Menu, 1In the measurement’s setup menu, select the alarm limit you want to change. This calls up a list of available values for the alarm limit.2Select a value from the list to adjust the alarm limit.For example, to change the alarm limits for SpO2:1Graphic view of current yellow and red alarm limits and currently monitored measurement valueOff indicates the measurement is switched off2Measurement labels, with alarms off symbol where appropriate3Set narrow or wide alarm AutoLimits for all measurementsSpO2NBPsABPsOff'QTcAll Lim. NarrowAll Lim. WideAlarm Limits123
Alarm Limits 4Alarms49Alternatively, you can use the keys in the measurement Change Limits window, which you access by selecting the measurement label in the Alarm Limits window. • Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-up list that opens.• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.1Parameter label2High red alarm (view only)3High yellow alarm fieldSelect to open a pop-up list of high alarm limits4Alarms On/Off key - select to toggle between alarms on or off5Preview Alarm AutoLimits for a measurement before applying6Select to apply wide AutoLimits7Select to apply narrow AutoLimits8Low yellow alarm fieldSelect to open a pop-up list of low alarm limits9Low red alarm (view only)10 Graphic view of alarm limits with currently measured value45823910Alarms On/OffABPs167
4Alarms Alarm Limits50To change alarm limits,1Enter the Alarm Limits window.2To set the high alarm limit, select the high yellow alarm field to open a pop-up list of high alarm limits. Select a limit from the list. Repeat to set the low yellow alarm field.If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically set the red alarm to the yellow alarm limit. When an ST measurement is in the Change Limits window there are also two pop-up keys available labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST Leads.About Automatic Alarm Limits (AutoLimits)The monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function. This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds. The wide and narrow limits have a fixed relationship to the measured value within the non-pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinician’s judgement about the specific patient.Limits Narrow sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patient’s vital signs.Limits Wide sets limits further away from the currently measured values for situations where small changes are not so critical. ♦Use the keys in the Change Limits window to apply AutoLimits for individual measurements. These keys are not available if AutoLimits have been disabled for the measurement in the monitor’s Configuration Mode. 1 Wide alarm limits2 Narrow alarm limits3Alarm Limits4 Measurement value122143
Reviewing Alarms 4Alarms51AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitor’s Configuration mode. Use the Change Limits window to check AutoLimits before you apply them to ensure that they are appropriate for your individual patient and their clinical condition. Once applied, AutoLimits are shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not appropriate for your patient, you must set alarm limits manually. The limits remain unchanged until you set them again or change them manually. Documenting Alarm LimitsTo print a list of all current alarm limit settings on an available printer:1Select the Main Setup SmartKey.2Select Reports from the Main Setup menu.3Select Alarm Limits.Reviewing AlarmsYou can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen.To review the history of alarms and INOPs, select the alarms or INOPs field to open the Review Alarms window.All alarms and INOPs are erased from the Review Alarms window when you discharge a patient, or if you change to Demonstration Mode.Review Alarms WindowThe Review Alarms window contains a list of the most recent alarms and INOPs with date and time information.If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit. The Review Alarms window also shows when the monitor was switched on (after being switched off for longer than 1 minute) and any changes made to the Alarms On/Off, Standby, Silence or ECG source.Review Alarms23 Apr 14:08:30 ***Apnea23 Apr 14:08:30 Alarms Silenced23 Apr 14:08:19 **AwRR LOW (14<15)23 Apr 14:42:55 **SpO2 NON-PULSAT.Alarm LimitsPauseAl. 5 MInPauseAl. 10 MIn
4Alarms Latching Alarms52No entries are made in the Review Alarms window of the X2 while it is connected to a host monitor, except the time when the X2 was connected to the host (Companion Entered), and when it was disconnected (Companion Left). Alarms can be reviewed on the host monitor.When you select an item from the list, you can get additional information about that item. If you select a high or low limit alarm in the list, the Graphical Trends window will open to provide further data. If you select an alert other than a high or low alarm, a help text window opens with more information. Some items in the list are simply log items not related to a patient alert as such (for example, Alarms On or Alarms Off). You cannot see any further information if you select one of these items. When you close these windows you will return to the Review Alarms window.The information in the Review Alarms window is deleted when a patient is discharged, and when you leave Demonstration Mode. The Review Alarms window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive.Latching AlarmsThe alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed or announced by the monitor after the alarm condition ends. The indication lasts until you acknowledge the alarm. Viewing the Alarm Latching SettingsTo see the alarm latching setting for your monitor 1In the monitor’s Main Setup menu, select Alarms.2Select Alarm Settings, and see the Visual Latching and Audible Latching settings.This setting can only be changed in Configuration Mode. You should be aware of the settings chosen for your unit. There are three possible choices each for visual and audible latching, Red, Red and Yellow, and Off. These choices can be combined to give the following settings:R = red alarms, Y = yellow alarmsAlarm Limits Pause Al. 5 Min.Pause Al. 10 Min.Visual Latching R&Y R&Y R&Y RROffAudible latching R&Y ROffROffOff
Testing Alarms 4Alarms53Alarm Latching BehaviorAll INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 116 for information on one-star yellow alarms latching behavior. Te s t i n g A l a r m sWhen you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.Alarm Behavior at On/OffWhen you switch alarms on, the settings defined in the currently active Profile are used. If the monitor is switched off for longer than one minute and then switched on again, or after a loss of power lasting longer than one minute, or when a patient is discharged, the monitor can be configured to restore either the alarm settings from the monitor's configured default Profile, or the most recently used alarm settings. After any of these situations, you should check that the alarm settings are appropriate for your patient, and if necessary, select the correct Profile and patient category. If power is lost for less than one minute, the alarm settings prior to the power loss are restored.Alarm RecordingsYou can set up your monitor so that it automatically triggers alarm recordings at the Information Center, or if configured, to a printer as a realtime report.1Press the Main Setup SmartKey.2Select Alarms from the Main Setup menu.3Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.4Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list.Red and Yellow Measurement AlarmsNon-latching alarmsVisual and audible latchingVisual latching, audible non-latchingAlarm has not been acknowledged.Alarm condition still present.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm condition no longer present.All audible and visual alarm indicators automatically stop.Alarm tone on.Alarm lamp on. Alarm message. Flashing numerics. Alarm message. Flashing numerics.Audible alarm indicators automatically stop. Alarm has been acknowledged.Alarm condition still present.Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured). Alarm condition no longer present.Audible and visual alarm indicators automatically stop.
4Alarms Alarm Recordings545For the desired measurement(s), choose the alarm condition to trigger an alarm recording:Red Only: an alarm recording will automatically be triggered when the measurement enters a red alarm condition.Red&Yell: both yellow and red alarms will trigger an alarm recording.Off: disables automatic alarm recording.Refer to the chapter “Recording” for details of how to set up a recording.
5555Patient Alarms and INOPsThis chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 61. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. Patient Alarm MessagesThe measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent alarms are explained in the individual chapters. Some alarms may be shown at the Information Center in shortened form, when transferred through IntelliVue Instrument Telemetry. These shortened alarm texts are included in the list and identified with the note “at Information Center”.Note that yellow arrhythmia alarms may be shown with one or with two stars, depending on your monitor configuration and the Information Center revision you are using.Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices. Alarm Message From Condition Indication*/**AFIB ECG/ArrhythmiaAtrial fibrillation waveform detected yellow alarm lamp, short yellow audible alarm.***APNEA or***APNEA mm:ss sec or***APNEA >10minCO2, Resp, SpirometryRespiration has stopped for longer than the preset apnea time. “mm:ss” denotes the Apnea duration in minutes and seconds. numeric flashes, red alarm lamp, alarm tone. ***ASYSTOLE ECG No QRS detected for a period greater than the asystole threshold (in the absence of Vfib or chaotic ECG).numeric flashes, red alarm lamp, alarm tone.**awRR HIGH CO2, Resp, AGMThe airway respiration rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.**awRR LOW CO2, Resp, AGMThe airway respiration rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.**BIS HIGH BIS The Bispectral Index value has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.
5 Patient Alarms and INOPs Patient Alarm Messages56**BIS LOW BIS The Bispectral Index value has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.***BRADY/P xxx<yyyor ***BRADY xxx<yyyPress, SpO2The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit.numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.**CCO/CCI HIGH CCO Continuous Cardiac Output or CC Index is above the high alarm limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone.**CCO/CCI LOW CCO Continuous Cardiac Output or CC Index is below the low alarm limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone.**CPP HIGH CPP The CPP value has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone**CPP LOW CPP The CPP value has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.***DESAT or ***DESAT xxx<yyySpO2The SpO2 value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. numeric flashes, red alarm lamp, alarm tone.**etCO2 HIGH CO2, Resp, AGMThe end tidal CO2 high alarm limit has been exceeded. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.**etCO2 LOW CO2, Resp, AGMThe end tidal CO2 value has fallen below the low alarm limit. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.**etO2 HIGH O2, AGM The end tidal O2 high alarm limit has been exceeded.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.**etO2 LOW O2, AGM The end tidal O2 value has fallen below the low alarm limit. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone.*/**/*** EVENT:<GRP> Event surveillanceAn event has occurred and the event notification is configured to alarm. <GRP> is the event groupevent group name flashes, yellow or red alarm lamp and alarm tone*/**/*** EVENTat Information centerEvent surveillanceAn event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group.(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone***EXTREME BRADY ECG The bradycardia limit has been exceeded.numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.***EXTREME TACHY ECG The tachycardia limit has been exceeded.numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone.Alarm Message From Condition Indication
Patient Alarm Messages 5 Patient Alarms and INOPs57**HR HIGH ECG The heart rate high alarm limit has been exceeded.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On.**HR LOW ECG The heart rate has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On.*/**IRREGULAR HR ECG/Arrhythmia Consistently irregular heart rhythm. numeric flashes, yellow alarm lamp, short yellow audible alarm.*/**MISSED BEAT ECG/ArrhythmiaNo beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only).numeric flashes, yellow alarm lamp, short yellow audible alarm.*/**MULTIFORM PVCs ECG/ArrhythmiaTwo differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats.numeric flashes, yellow alarm lamp, short yellow audible alarm.**NBP HIGH NBP The measured NBP value is above the high alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.**NBP LOW NBP The measured NBP value is below the low alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.*/**NON-SUSTAIN VT ECG/ArrhythmiaA run of Vs having a ventricular HR>V-Tach HR limit, but lasting for less than the V-Tach Run limit has been detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.*/**PACER NOT CAPT ECG/Arrhythmia(paced patients only)A missed beat with a pace pulse was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm. */**PACER NT PACING ECG/Arrhythmia (paced patients only)A missed beat without a pace pulse was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.*/**PAIR PVCs ECG/Arrhythmia A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.*/**PAUSE ECG/ArrhythmiaNo beat detected for a period greater than the pause threshold. numeric flashes, yellow alarm lamp, short yellow audible alarm.Alarm Message From Condition Indication
5 Patient Alarms and INOPs Patient Alarm Messages58***<Pressure> DISCONNECT PRESS The pressure is non-pulsatile and the mean pressure is continuously less than 10mmHg (1.3kPa). This alarm occurs only with arterial pressures (P, ABP, ART, Ao, BAP, FAP, PAP, UAP, P1, P2, P3, P4).numeric flashes, red alarm lamp, alarm tone.***<Pressure> HIGH PRESS The measured pressure value is above the extreme high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes, high limit is highlighted, red alarm lamp, alarm tone.**<Pressure> HIGH PRESS The measured pressure value is above the high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone.***<Pressure> LOW PRESS The measured pressure value is below the extreme low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and low limit is highlighted, red alarm lamp, alarm tone.**<Pressure> LOW PRESS The measured pressure value is below the low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.**Pulse HIGH PRESSSpO2The pulse rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.**Pulse LOW PRESSSpO2The pulse rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.*/**PVCs/min HIGH ECG/ArrhythmiaMore premature ventricular contractions have been detected in a minute than the limit.numeric flashes, yellow alarm lamp, short yellow audible alarm.**QTc HIGH ECG/QT QTc value has exceeded the QTc high limit for more than 5 minutesnumeric flashes, yellow alarm lamp, alarm tone.**'QTc HIGH ECG/QT 'QTc value has exceeded the 'QTc high limit for more than 5 minutesnumeric flashes, yellow alarm lamp, alarm tone.*/**R-ON-T PVCs ECG/ArrhythmiaFor HR <100, a PVC with R-R interval < 1/3 the average interval followed by a compensatory pause of 1.25 x average R-R interval or two such Vs without compensatory pause occurring within 5 minutes of each other. (When HR >100, 1/3 R-R interval is too short for detection.).numeric flashes, yellow alarm lamp, short yellow audible alarm.**RR HIGH RESP The respiration rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.Alarm Message From Condition Indication
Patient Alarm Messages 5 Patient Alarms and INOPs59**RR LOW RESP The respiration rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.*/**RUN PVCs HIGH ECG/ArrhythmiaA run of PVCs greater than 2 was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.**<SO2 label> HIGH SvO2/SO2The the measured intravascular oxygen saturation has exceeded the high limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone.**<SO2 label> LOW SvO2/SO2The measured intravascular oxygen saturation has fallen below the low limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone.**<SpO2 label> HIGH SpO2The arterial oxygen saturation has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.**<SpO2 label> LOW SpO2The arterial oxygen saturation has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.**ST<n> HIGH ECG/ST The ST elevation in lead <n> is higher than the limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone. **ST<n> LOW ECG/ST The ST depression in lead <n> is lower than the limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone. **ST MULTI <n>,<n> ECG/ST The ST depression or elevation is outside of the limit in two or more leads <n> and <n>numeric flashes, yellow alarm lamp, alarm tone**ST MULTIat Information CenterECG/ST The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor for more details about which leads are affected.(on monitor) numeric flashes, yellow alarm lamp, alarm tone*/**SVT ECG/ArrhythmiaA run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit.numeric flashes, yellow alarm lamp, alarm tone.***TACHY/P xxx>yyy or ***TACHY xxx>yyyPress, SpO2The heart rate from the Pulse signal has exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit.numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone.**Tblood HIGH C.O. The blood temperature value has exceeded the high alarm limit.numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone.**Tblood LOW C.O. The blood temperature value has fallen below the low alarm limit.numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone.**tcpO2 HIGH/**tcpCO2 HIGHtcGas The tcpO2 or tcpCO2 value has exceeded the high alarm limit.numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone.**tcpO2 LOW/ **tcpCO2 LOWtcGas The tcpO2 or tcpCO2 value has fallen below the low alarm limit.numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone.Alarm Message From Condition Indication
5 Patient Alarms and INOPs Patient Alarm Messages60*/**/***TELE ALARM Telemetry This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window.yellow or red alarm lamp and alarm tone**<Temperature label> HIGHTEMP The temperature has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. **<Temperature label> LOWTEMP The temperature has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.*/**VENT BIGEMINY ECG/ArrhythmiaA dominant rhythm of N, V, N, V (N = supraventricular beat, V = ventricular beat) was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.***VENT FIB/TACH ECG A fibrillatory waveform for 4 consecutive seconds was detected.numeric flashes, red alarm lamp, alarm tone.*/**VENT RHYTHM ECG/ArrhythmiaA dominant rhythm of adjacent Vs > vent rhythm limit and ventricular HR < VTach HR limit was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.*/**VENT TRIGEMINY ECG/ArrhythmiaA dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V = ventricular beat) was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm.***VTACH ECG, ArrhythmiaVentricular tachycardia has been detected (Consecutive PVCs exceed V-Tach Run limit and HR exceeds V-Tach HR limit).numeric flashes, red alarm lamp, alarm tone.**/***VueLink ALARMat Information CenterVueLink A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information.(on monitor) yellow or red alarm lamp, alarm toneAlarm Message From Condition Indication
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs61Technical Alarm Messages (INOPs)If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ?appears next to the numeric. INOP Message, Indication Source What to doABP INOPS PRESS See <Pressure label> INOPS (under Pressure).ALL ECG ALARMS OFF ECG/ArrhythmiaAll ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch ECG alarms on or select ECG as the alarms source.Ao INOPS PRESS See <Pressure label> INOPS (under Pressure).ART INOPS PRESS See <Pressure label> INOPS (under Pressure).AWF CHANGE SCALE Spirometry Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave.AWP CHANGE SCALE Spirometry Airway pressure signal exceeds range of selected scale. Adjust scale to display complete waveAWV CHANGE SCALE Spirometry Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave.Bad ServerlinkINOP toneMonitor 1) An MMS with an incompatible software revision is connected to the monitor. This combination does not allow monitoring, OR 2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact your service personnel.BAP INOPS PRESS See <Pressure label> INOPS (under Pressure).BATT EMPTYINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.Battery The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery immediately. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it. BATT INCOMPATINOP toneBattery The battery cannot be used with this monitor. Replace with the correct battery (M4607A). BATT LOWINOP toneBattery The estimated battery-powered operating time remaining is less than 20 minutes. BATT MALFUNCTIONINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.Battery The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Place the battery in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.BATTERIES EMPTY or BATT 1/BATT 2 EMPTYINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.Batteries The estimated remaining battery-powered operating time of the indicated battery or batteries is less than 10 minutes. Replace the batteries immediately. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it. BATTERIES INCOMP or BATT 1/BATT 2 INCOMPATINOP toneBatteries The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)62BATTERIES LOW or BATT 1/BATT 2 LOWINOP toneBatteries The estimated battery-powered operating time remaining is less than 20 minutes. BATTERIES MALFUNC. or BATT 1/BATT 2/ BATTERY MALFUNCT.INOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.Batteries The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.BATTERY LOW T Telemetry The battery in the Telemetry device is low and must be replaced soon.BATT 1/BATT 2 MISSINGINOP tone.During this INOP, alarms cannot be paused or switched off.Batteries The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately. BIS CABLE INCOMPATINOP tone.BIS The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philips-supported sensor cable.BIS CABLE USAGEINOP tone.BIS The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.BIS DSC DISCONNINOP toneBIS DSC is not properly connected OR either DSC or BIS engine may be faulty.Make sure that the DSC is properly connected to the BIS Engine. If INOP persists, replace DSC with a known good one of the same type. If INOP persists replace BIS engine.Silencing this INOP switches the measurement off.BIS DSC INCOMPTINOP toneBIS DSC is not supported by the BIS engine or new DSC connected to an old BIS engine. A software upgrade may be required. Contact your service personnel. BIS DSC MALFUNC BIS Electrocautery used during self-test OR malfunction in the DSC hardware.Make sure not to use electrocautery during the self-test procedure. Disconnect and reconnect the DSC to the BIS engine. If the INOP persists, replace the DSC or contact your service personnel. BIS DSC UPDATEINOP toneBIS DSC update currently being carried out. This INOP will disappear when the DSC update is finished. Do not disconnect the DSC during the update. No action is needed.BIS ELECTR. DISCINOP tone.BIS One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections.BIS ENGINE DISCONNINOP toneBIS BIS engine not connected OR Module Cable defective.Make sure that the Module Cable is properly connected. If INOP persists, replace the Module Cable. Silencing this INOP switches the measurement off. BIS ENGINE INCOMPTINOP toneBIS BIS engine software is not supported. A software upgrade may be required. Contact your service personnel. MP20/30 - BIS engine not supported. INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs63BIS ENGINE MALFUNCINOP toneBIS Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine. BIS EQUIP MALFINOP toneBIS There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists, contact your service personnel. BIS HIGH IMPEDANCEINOP tone may soundBIS Impedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question using correct skin preparation.If INOP persists, contact your service personnel. BIS IMPEDANCE CHCKINOP tone may soundBIS The Cyclic Impedance check is running. It will stop automatically if all impedances are within the valid range. If any electrodes do not pass the impedance test, check the sensor montage and press the electrode pads firmly. To manually stop the Cyclic Impedance Check, select Cyclic Check off in the Setup BIS menu.BIS ISOELECTRC EEG BIS No discernible EEG activity is detected for longer than one minute.Check the patient. Check that the electrodes are properly connected.BIS LEAD OFFINOP tone may soundBIS One or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question, using correct skin preparation.BIS OVERCURRENTINOP toneBIS Unplug and replug the BIS module or, f or the MP20/MP30, disconnect and reconnect the BISx from the Interface board. If the INOP persists, contact your service personnel.BIS SENSOR DISCONNINOP toneBIS The sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty. Check all the connections. Disconnect and reconnect the sensor, PIC, DSC, BISx. If the INOP persists, replace the sensor.If the INOP persists, replace PIC. If INOP persists, contact your service personnel. Silencing this INOP switches the measurement off. BIS SENSOR INCOMPTINOP toneBIS Unsupported sensor connected or sensor type unknown or not supported by your software revision. Replace the sensor, using only Philips supported sensors.BIS SENSOR MALFUNCINOP toneBIS Malfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR patient interface cable (PIC) or DSC or BISx may be faulty. Replace the sensor. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure that the both sides of the PIC connector (between PIC and sensor) are dry. If you are not sure that the connector is dry, replace the PIC until it has dried. If this INOP persists, contact your service personnel. INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)64BIS SENSOR USAGEINOP toneBIS Excessive sensor usage. Replace sensor. A Cyclic Impedance Check will start automatically.BIS SQI < 15% (INOP tone)OR BIS SQI < 50% (no INOP tone)BIS If the signal quality is below 50%, BIS numerics cannot be reliably derived. If the signal quality is below 15%, no BIS numerics can be derived. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices. Make sure the sensor is properly attached to the patient. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure the patient is completely relaxed (even small motions of the facial muscles affect the signal quality). BIS UNPLUGGEDINOP toneBIS Plug in the BIS module. Silencing this INOP switches off the measurement.BISx DISCONNECTEDINOP toneBIS The BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches the measurement off.BISx INCOMPATIBLEINOP toneBIS The BISx software is not compatible with the BIS module or with the MP20/MP30 monitor software. A software upgrade may be required. Contact your service personnel.BISx MALFUNCTIONINOP toneBIS The BISx is faulty. Disconnect and reconnect it to the module or BIS interface board. If the INOP persists, replace the BISx.MP20/MP30 - Malfunction on interface board. If the INOP persists, contact your service personnel.CANNOT ANALYZE ECG ECG/ArrhythmiaThe arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off. CANNOT ANALYZE QT QT The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase. CANNOT ANALYZE ST ST The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points. If the patient has a ventricular pacemaker, ST analysis is not possible.CCI NO BSACCI numeric unavailableINOP toneC.O. CCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight and height to provide the BSA for CCI calculation. CCO BAD PRESS SIGNnumeric is replaced by -?-INOP toneC.O. The arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs65CCO NO <Pressure label>numeric is replaced by -?-INOP tone may soundC.O. CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, B A P, FA P, o r U A P.CCO NO CALIBRATIONnumeric is replaced by -?-C.O. The CCO measurement is currently not calibrated.CCO NO PRESSat Information CenterC.O. CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, B A P, FA P, o r U A P.CCO NOT SUPPORTEDnumeric is replaced by -?-INOP toneC.O. A catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right Heart C.O. catheter, or the measurement mode has been changed manually. Silencing this INOP switches the measurement off.CCO/CCI OVERRANGEnumeric is replaced by -?-INOP toneC.O. The measured CCO or CCI value is not within the specified range for CCO/CCI measurement.CCO <Pressure label> INVALIDnumeric is replaced by -?-INOP tone may soundC.O. The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid. CCO PRESS INVALIDat Information CenterC.O. The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid. CCO PRESS OVERRANGnumeric is replaced by -?-INOP tone C.O. The mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0 mmHg or above 300 mmHg.CCO PULSE OVERRANGnumeric is replaced by -?-INOP toneC.O. The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm.CCO/Tbl NO TRANSD Numeric is replaced by -?-INOP toneC.O. No transducer attached to the module or catheter disconnected.CCO RECALIBRATEnumeric is replaced by -?-C.O. The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed. The pressure measurement must be zeroed before a CCO calibration. CENTRAL:TELE ONLYINOP toneMonitor System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station.Charge BATT1/BATT2 nowINOP toneBatteries Battery must be charged. Connect the monitor to mains power or exchange the battery.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)66CHARGER MALFUNCINOP tone, battery LED may flashBatteries There is a problem with the battery charger in the monitor. Connect the monitor to mains power and contact your service personnel. Check Alarm LampsINOP tone.Monitor Perform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps.CHECK BATT TEMPINOP tone Battery The temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat.Check DrugSettingsINOP tone Monitor There was a problem loading the drug settings. Check that the settings are complete and correct. Check ECG SettingsINOP toneTelemetry Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate.!!CHECK ECG SOURCEINOP toneMonitor The telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and the monitor if they are no longer used for the same patient.Check Flex TextsINOP tone Monitor Check the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel. CheckInternVoltageat Information CenterMonitor Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP will appear on the monitor as Check Monitor Func.Check KeyboardINOP toneMonitor Perform a visual and functional check of the keyboard. Contact your service personnel.Check Main Board 2INOP tone.Monitor There is a problem with the second main board in the monitor. Contact your service personnel.Check Monitor FuncINOP tone.Monitor Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP may appear on the Information Center as CheckInternVoltage.Check Monitor TempINOP toneMonitor The temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed. If the situation continues, contact your service personnel. Check Mouse DeviceINOP tone.Monitor Perform a visual and functional check of the mouse input device. Contact your service personnel.Check MSL VoltageINOP toneMonitor/Multi-Measuremt ModuleThere is a problem with the voltage of the Measurement Link (MSL). Contact your service personnel.Check Network ConfINOP toneMonitor The monitor is receiving network topology information from more than one source, e.g. the Database Server and an Application Server. Contact your service personnel.Check Nurse RelayINOP toneMonitor There is a problem with the connection to the nurse relay. Contact your service personnel.!!Check PairingINOP toneMonitor There is a problem with device pairing. Check that the monitor and telemetry device are correctly paired. INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs67Check Screen ResINOP tone Monitor The Screen you have selected uses a resolution which is not supported by the display. The monitor will show a generic Screen instead until you select a different Screen. Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.Check SettingsINOP toneMonitor If this INOP appears, check the monitor and patient settings before you resume monitoring. If the settings are unexpected, there may be a problem with the monitor software. Contact your service personnel.Check SpeedPointINOP tone.Monitor Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel.Check Touch InputINOP toneMonitor Perform a visual and functional check of the touch input device. Contact your service personnel.Check WavesINOP tone Monitor The options purchased with this monitor may not support the number of waves required to show the selected Screen, so some waves or high resolution trends are missing from the Screen. Select a different Screen with fewer waves.Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.CHK ECG Sync CableINOP toneMonitor The ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected.Chk IndepDsp Cable Monitor The monitor cannot communicate with the D80 Intelligent Display. Check the MSL coupling cable. The end with the grey connector must be connected to the Intelligent Display.CHK MSL ConnectionINOP toneMonitor Check that the MSL connector or cable are properly connected. Check the cable and connector for damage.Chk SpO2T SettingsINOP toneTelemetry Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate.C LEAD OFFHR Numeric is replaced by -?- for 10 seconds. INOP tone. ECG The C electrode (AAMI: V electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. CO2 AUTO ZERONumeric is replaced by a -?-if the Autozero lasts >15 sec, INOP tone sounds.CO2The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO2 values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring. CO2 CAL MODECO2 numeric displays current CO2 value for accuracy checkCO2Currently no calibration is running. Accuracy can be checked by placing the transducer on the two cells of the calstick and starting calibration. To start monitoring, leave Cal. Mode.CO2 CAL RUNNINGNumeric is replaced by a -?-CO2Wait until calibration is finished.CO2 CHANGE SCALE CO2The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave. CO2 CHK ADAPTERNumeric is replaced by a -?- INOP tone.CO2Check that the sensor is connected to the airway adapter, clean the airway adapter, if necessary. Perform a zero calibration. If the INOP persists, contact your service personnel.CO2 CHECK CALNumeric is replaced by a -?- INOP tone.CO2The CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)68CO2 DEACTIVATEDINOP tone.CO2The CO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.C.O. DEACTIVATEDINOP tone.C.O. The Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.C.O. EQUIP MALFNumeric is replaced by a -?- INOP tone.C.O. There is a problem with the C.O. hardware. Contact your service personnel.CO2 EQUIP MALFNumeric is replaced by -?- INOP tone.CO2The Measurement Extension is faulty. Unplug and replug the Multi-Measurement Module with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel.CO2 FAILED CALNumeric is replaced by -?-INOP tone.CO2Make sure that the Cal cell was changed between CAL1 and CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel.CO2 NO SENSORNumeric is replaced by -?-INOP tone.CO2There is no CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off.CO2 NO TRANSDUCNumeric is replaced by -?-INOP tone.CO2There is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 measurement will be switched off.CO2 NO TUBINGNumeric is replaced by -?-INOP tone. CO2Either the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories).If you silence this INOP, the measurement will be switched off.(!!/!!!)CO2 OCCLUSIONNumeric is replaced by a -?-INOP tone.CO2The sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line.CO2 OVERRANGENumeric is replaced by -?-INOP tone.CO2The CO2 value is higher than the measurement range. If you suspect a false high value, contact your service personnel. CO2 PUMP OFFNumeric is replaced by a -?-.CO2The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the Setup CO2 menu.CO2 PURGINGNumeric is replaced by a -?-INOP tone.CO2The Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is removed, the INOP will disappear. If not, the INOP CO2 OCCLUSION is displayed.CO2 SENS. WARMUPNumeric is displayed with a -?-Microstream CO2: INOP tone. Mainstream CO2: no INOP toneCO2Wait until the sensor reaches operating temperature and the INOP disappears.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs69C.O. UNPLUGGEDnumeric is replaced by -?-INOP tone.C.O. Plug in the C.O. module. Silencing this INOP switches off the measurement.CO2 UPDATE FWNumeric is replaced by a -?-INOP tone.CO2The software in the Measurement Extension does not match the software in the MMS. Contact your service personnel.CO2 WAIT CAL2Numeric is replaced by a -?- CO2Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle. CO2 ZERO FAILEDNumeric is replaced by a -?- INOP tone.CO2An error occurred during the last zero calibration. Check the airway adapter and clean, if necessary. Perform another zero calibration. If the INOP persists, contact your service personnel.CO2 ZERO REQU’DNumeric is replaced by a -?- INOP toneCO2Perform zero calibration for the CO2 sensor. If the INOP persists, contact your service personnel.CO2 ZERO RUNNING CO2Wait until zero calibration is finished.CPP CHK SOURCESNumeric is replaced by a -?- CPP Not all measurements or values required to perform the calculation are available. Check the measurement sources.CPP CHK UNITSNumeric is replaced by a -?- CPP The monitor has detected a conflict in the units used for this calculation. Check the unit settings.!!/!!!CUFF NOT DEFLATNumeric is displayed with a -?-Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off. NBP Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try repeating the measurement. You can silence the INOP, but the INOP message remains visible until the next NBP measurement is started or the Stop All SmartKey is selected.[Adult or pediatric patients: The NBP cuff pressure has exceeded 15mmHg (2kPa) for more than 3 minutes. Neonatal patients: The NBP cuff pressure has exceeded 5mmHg (0.7kPa) for more than 90 seconds.]!!/!!!CUFF OVERPRESSNumeric displayed with -?- ; Severe yellow/red INOP tone.During this INOP, alarms cannot be paused or switched off.NBP The NBP cuff pressure exceeds the overpressure safety limits. Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try restarting the measurement. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.CVP INOPS PRESS See <Pressure label> INOPS (under Pressure).DEVICE CHECK SETUPINOP tone.IntelliBridge Device identification completed, but communication could not be established due to timeout.IntelliBridge INOP abbreviations may differ slightly depending on the device category.DEVICE CHECK CONF.INOP tone.IntelliBridge Device identification completed, but communication could not be established due to error. IntelliBridge INOP abbreviations may differ slightly depending on the device category.DEVICE DEMO DATAINOP toneIntelliBridge The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)70DEVICE REAL DATAINOP toneIntelliBridge The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. <Device> UNPLUGGEDINOP tone.IntelliBridge The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement.IntelliBridge INOP abbreviations may differ slightly depending on the device category.DEVICE UNSUPPORTEDINOP tone.IntelliBridge Device identification completed, but no appropriate device driver installed.IntelliBridge INOP abbreviations may differ slightly depending on the device category.<EC10/EC40> EQUIP MALFINOP tone.IntelliBridge Malfunction in the IntelliBridge module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.ECG/ARRH ALARM OFF!!ECG/AR ALARM OFFECG All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch ECG alarms on or select ECG as the alarm source. ECG EQUIP MALFNumeric is displayed with a -?- INOP tone. ECG Contact your service personnel.The ECG hardware is faulty.ECG EQUIP MALF TNumeric is displayed with a -?- INOP tone. Monitor Contact your service personnel.The ECG in the Telemetry device is faulty.(!!/!!!)<ECG LEAD> LEAD OFFNumeric is displayed with a -?-INOP tone. ECG Not all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by <ECG lead> [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected. ECG EL. NOISY <ECG LEAD> ECG The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy. Check the ECG connections and make sure that the electrode indicated is attached.(!!/!!!)ECG LEADS OFF ECG Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced.ECG NOISY SIGNALINOP tone. ECG The ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient.The ECG signal may be saturated or overloaded.EcgOut EQUIP MALFINOP toneECG Check that the ECG out cable is securely connected. Contact your service personnel.EEG EQUIP MALFINOP toneEEG The EEG hardware is faulty. Contact your service personnel.EEG IMPEDANCE HIGH or EEG1 and/or EEG2 IMPED. HIGH EEG The signal electrode in one or both channels exceeds the user-selected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines. If the INOP persists, contact your service personnel. EEG<X> LEAD OFF <n>[X = channel, n = electrode]EEG Reconnect specified electrode.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs71EEG<X> LEAD OFF[X = channel]at Information CenterEEG One or more electrodes are not connected. Check in the EEG Impedance/Montage window on the monitor which electrode(s) are affected and reconnect the electrodes.EEG<X> LEADS OFF[X = channel]EEG Two or more electrodes are not connected. Check in the EEG Impedance/Montage window which electrodes are affected and reconnect the electrodes.EEG LINE NOISEEEG 1 or 2 LINE NOISEEEG Excessive line noise has been detected in either channel EEG1 or EEG2, or in both EEG channels. Keep all cables together and away from metallic bodies, other cables & radiated fields.EEG MUSCLE NOISEEEG 1 or 2 MUSCLE NOISEEEG Too much power above 30 Hz has been detected in channel EEG1 or EEG2, or both. Check the Electrode-to-Skin Impedance and reposition the electrode away from possible muscle activity, if necessary.EEG NO TRANSDUCERINOP toneEEG The trunk cable is disconnected from the EEG plug-in module. Reconnect the trunk cable. Silencing this INOP switches the measurement off. EEG UNPLUGGEDINOP toneEEG Plug in module. Silencing this INOP switches off the measurement.EEG OVERRANGE, or EEG<X> OVERRANGEEEG Input signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electro-surgery. X denotes the EEG channel.FAP INOPS PRESS See <Pressure label> INOPS (under Pressure).FMS UNPLUGGED INOP tone.FMS Make sure that the Flexible Module Rack is connected to the monitor. All FMS measurements are off while the FMS is unplugged.FMS UNSUPPORTEDINOP tone.FMS The Flexible Module Rack is not supported by your monitor. Contact your service personnel.IC1/IC2 INOPS PRESS See <Pressure label> INOPS (under Pressure).ICP INOPs PRESS See <Pressure label> INOPS (under Pressure).Indep.Dsp Malfunc. Display A problem has occurred with the second main display. Contact your service personnel.Indep.Dsp NotSupp. Display The monitor does not support a second main display. The monitor software is incompatible. Contact your service personnel.!!INSERT BATTERYSevere yellow INOP tone.During this INOP, alarms cannot be paused or switched off.Battery X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on AC mains while the battery compartment is open (not sealed with a battery). Load a battery immediately.Intell.Dsp Malf.INOP toneDisplay There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your service personnel.Intell.Dsp Missing Display The monitor has lost contact with the connected Intelligent Display. Contact your service personnel.Intell.Dsp Unsupp. Display The monitor does not support the connected Intelligent Display. The monitor software is incompatible.Internal.Comm.MalfINOP toneMonitor There is a problem with I2C Bus communication in the monitor. Contact your service personnel.INVALID LEADSET TelemetryINOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)72LA LEAD OFFNumeric is replaced by -?- for 10 seconds; INOP tone.ECG The LA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. LAP INOPs PRESS See <Pressure label> INOPS (under Pressure).LEADSET UNPLUGGED Telemetry The leadset has been unplugged from the telemetry device.LL LEAD OFFNumeric is replaced by -?- for 10 seconds; INOP tone.ECG The LL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. MCC ReversedINOP toneMonitor The MSL coupling cable is reversed. Connect the end with the grey connector to the Intelligent Display.MCC UnsupportedINOP toneMonitor An MSL coupling cable has been connected to a device which does not support MSL coupling.Meas. DEACTIVATED An X2 or MP5 has been connected to a host monitor (companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor.MEASSRV UNSUPPORTDINOP toneMMS The Multi-Measurement module is not supported by the monitor. Contact your service personnel.MMS Ext. EQUIP MALFINOP toneMMS ExtensionLoss of communication between the Multi-Measurement Module and the MMS extension. Contact your service personnel.MMS Ext. UNPLUGGEDINOP toneMMS ExtensionThe MMS extension has been disconnected from the Multi-Measurement Module.MMS Ext. UnpoweredINOP toneMMS ExtensionThe MMS extension cannot operate while the Multi-Measurement Module is running on battery power.MMSExt.UnsupportedINOP toneMMS ExtensionThe MMS extensions not supported by your monitor. Contact your service personnel.MMS UNPLUGGED INOP tone.MMS Make sure that the Multi-Measurement Module is connected to the monitor. All MMS measurements are off while the MMS is unplugged.MMS UNSUPPORTED INOP tone.MMS The Multi-measurement Module is not supported by your monitor. Contact your service personnel.!!/!!!MORE BED ALARMSAt Information CenterMonitor The monitor is associated with a telemetry device and is sending data to the Information Center via the telemetry device. There are currently more alarms at the bedside than can be transmitted to the Information Center.MSL Power High Monitor The power consumption of the devices connected to the Measurement Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel.MSL Power OffINOP tone.Monitor The power consumption of the devices connected to the Measurement Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel.MSL Power OverloadINOP tone.Monitor The power consumption of the devices connected to the Measurement Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off. Contact your service personnel.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs73NBP DeactivatedINOP tone.NBP The NBP measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. NBP EQUIP MALFNumeric is replaced by -?- INOP tone.NBP Remove the cuff from the patient. The NBP hardware is faulty. Contact your service personnel. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.NBP INTERRUPTEDNumeric is replaced by -?- INOP tone.NBP Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement. If the INOP occurs repeatedly, contact your service personnel.You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.This INOP arises when the measurement needed longer than the maximum time for inflation, deflation or the total measurement.NBP MEASURE FAILEDNumeric may be displayed with a -?- INOP tone.NBP Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement.You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue measuring. No Central Monit.INOP toneMonitor There is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. Contact your service personnel. !!/!!! NO DEVICE DATANO DEVICE DATAIntelliBridge Communication with connected device has been lost. NO ECG AT CENTRAL Monitor The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device. NO ECG SOURCE Telemetry A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. NO PPV FROM MeasSrvat Information CenterMMS or FMSThe measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.NO PPV FROM <Device> MMS or FMSThe measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.OUT OF AREA Telemetry The telemetry device has left the access point coverage area. P/P1/P2/P3/P4 INOPS PRESS See <Pressure label> INOPS (under Pressure).PAP INOPS PRESS See <Pressure label> INOPS (under Pressure).PPV BAD <Pressure Label> SIGNALPPV The arterial pressure source selected for PPV is not providing a pulsatile signal.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)74PPV BAD SIGNALat Information CenterPPV The arterial pressure source selected for PPV is not providing a pulsatile signal.PPV CHK SOURCES PPV The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off.<Pressure label> ARTIFACTNumeric questionablePRESS A non-physiological event is detected (for example, a flush or blood sample). A resulting high limit alarm will be suppressed.<Pressure label> DEACTIVATEDINOP tonePRESS A Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either reconnect a Pressure transducer or reactivate the measurement label in the Measurement Selection window. <Pressure label> EQUIP MALFNumeric is replaced by -?- INOP tone.PRESS Contact your service personnel.The pressure hardware is faulty.<Pressure label> NO TRANSDUCERNumeric is replaced by -?- INOP tone.PRESS Make sure that the pressure transducer is connected to the measurement device or module.If you silence this INOP, the measurement will be switched off.<Pressure label> NOISY SIGNALPulse numeric is replaced by -?- INOP tone.PRESS This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse detector finds a pulse rate above 350bpm. This is usually caused by movement artifact or electrical interference.<Pressure label> NON-PULSATILEPulse numeric is replaced by -?- INOP tone.PRESS This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate being measured is less than 25 beats per minute or the amplitude is less than three mmHg.Check the catheter and connections to the patient.<Pressure label> OVERRANGENumeric is replaced by -?- INOP tone.PRESS Make sure that the measurement has been properly prepared and zeroed, and that the transducer is level with the heart. If this INOP persists, try another transducer.Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the transducer.<Pressure label> REDUCE SIZEPRESS Increase the scale for the pressure wave. <Pressure label> UNPLUGGEDINOP tone.PRESS A Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.<Pressure label> ZERO+CHECK CALNumeric is replaced by -?- PRESS Perform a zero and check the calibration of the transducer. INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs75<pTemp label> CHECK PROBENumeric is replaced by -?- INOP tone.Predictive TempCheck that the probe holder is correctly installed and that a compatible probe is in use. If the INOP does not clear, remove the probe from the holder then replace it. If the INOP still does not clear, disconnect and reconnect the probe.<pTemp label> DEACTIVATEDINOP tone.Predictive TempThe Predictive temperature has been deactivated.<pTemp label> EQUIP MALFNumeric is replaced by -?- INOP tone.Predictive TempThe Predictive Temperature hardware is defective. Contact your service personnel. <pTemp label> INCOMPAT. Predictive TempThe Predictive Temperature version is not supported by the monitor.<pTemp label> MEAS FAILEDNumeric is replaced by -?- INOP tone.Predictive TempThe ambient temperature is outside the specified range (10 to 40°C /50 to 104°F). Bring the temperature into range to continue monitoring. If the INOP does not clear, disconnect and reconnect the probe.<pTemp label> NO PROBENumeric is replaced by -?- INOP tone.Predictive TempConnect a probe to the Predictive temperature unit.<pTemp label> OVERRANGENumeric is replaced by -?- INOP tone.Predictive TempThe temperature at the measurement site is out of range. Check that the probe is correctly located. If the INOP does not clear, disconnect and reconnect the probe.<pTemp label> PROBE MALFNumeric is replaced by -?- INOP tone.Predictive TempThe connected probe may be defective. Disconnect and reconnect the probe. If the INOP does not clear, try another probe.pTaxil INOPS Predictive TempSee <pTemp label> INOPSpToral INOPS Predictive TempSee <pTemp label> INOPSpTrect INOPS Predictive TempSee <pTemp label> INOPS(!!)PW:Action Required Protocol WatchThe protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response.PW:Check Settings Protocol WatchContact your service personnel. Settings could not be loaded or interpreted correctlyPW in conflict Protocol WatchThere is a patient information mismatch which has not yet been resolved (>15 minutes). RA LEAD OFFNumeric is replaced by -?- INOP tone.ECG The RA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. RAP INOPS PRESS See <Pressure label> INOPS (under Pressure).Rem.Alarmdev.MalfINOP toneMonitor There is a problem with the connection to the remote alert device. Contact your service personnel to check the remote alert device and its connections.Rem. Display Malf. Remote displayThere is a problem with an input device at the remote display. Perform a visual and functional check of all input devices. Contact your service personnel.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)76!!/!!! REPLACE BATTERY TSevere yellow/red INOP tone.During this INOP, alarms cannot be paused or switched off.Telemetry The battery in the telemetry device is almost empty and must be replaced.RESP EQUIP MALFNumeric is replaced by -?- INOP tone.RESP Contact your service personnel. The RESP hardware is faulty. RESP ERRATICNumeric is replaced by -?- RESP The monitor has detected too many artifacts in the measured Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out. RESP LEADS OFFNumeric is replaced by -?- INOP tone.RESP Not all the required leads for Resp monitoring are attached. Make sure that the RA and LL leads are attached. RL LEAD OFFNumeric is replaced by -?- for 10 seconds; INOP tone.ECG The RL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. Settings Malfunc.INOP tone.Monitor The monitor cannot use the predefined settings for monitoring. Contact your service personnel. <SO2 Label> CAL FAILEDNumeric is replaced by -?- INOP tone.SO2The calibration failed. Check the catheter-to-Optical-Module connection. Manually restart the calibration. Try another catheter and Optical Module. If the catheter is already inserted, perform an in-vivo calibration.<SO2 Label> CAL MODENumeric is replaced by -?- INOP tone.SO2Pre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The catheter is now ready for insertion. <SO2 Label>CAL REQUIREDNumeric is replaced by -?- INOP tone.SO2There is no valid calibration data in the Optical Module. Perform either a pre-insertion or an in-vivo calibration.<SO2 Label> CANNOT MEASNumeric is replaced by -?- INOP tone.SO2The signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter.<SO2 Label>CONFIG ERRORNumeric is replaced by -?- INOP tone.SO2The Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode. <SO2 Label> CONN OPTMODNumeric is replaced by -?- INOP tone.SO2The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds.<SO2 Label> EQUIP MALFNumeric displays -?-.INOP toneSO2The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel.SO2 INCOMPATIBLEINOP toneSO2The SO2 Module or Optical Module is not supported. Contact your service personnel. <SO2 Label> IN-VIVO CAL SO2The in-vivo calibration is not yet complete. Lab values must be stored to the Optical Module to complete the calibration. Either continue with the next steps of the current calibration or recall the previous calibration.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs77<SO2 Label>LIGHT INTENSNumeric is replaced by -?- INOP tone.SO2The intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the catheter (and perform a Light Intensity Calibration). <SO2 Label> LOW LIGHTNumeric is replaced by -?- INOP tone.SO2The optical signal levels are too low. Check that the catheter is either in the optical reference or inserted into the patient. Check the catheter-to-Optical Module connection. If INOP persists, try another catheter and Optical Module.<SO2 Label> NO OPTMODNumeric is replaced by -?- INOP tone.SO2Connect the Optical Module. If the INOP persists, try another Optical Module. Silencing this INOP switches the measurement off.<SO2 Label> OPTMOD MALF SO2The Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this capability is needed, use another Optical Module. <SO2 Label> PRE-INS CALNumeric displays -?- INOP toneSO2The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete. <SO2 Label> UNPLUGGEDNumeric displays -?-.INOP toneSO2Measurement switched on and SO2/SvO2 module unplugged from the rack.SO2 UPGRADEINOP toneSO2The SO2 module is currently in upgrade mode.Monitoring is not possible in this mode. <SO2 Label> WARMUPNumeric is displayed with ?SO2The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished.SOME ECG ALRMS OFF Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile.Speaker Malfunct.INOP toneMonitor Contact your service personnel to check the speaker and the connection to the speaker.SPIRO MALFUNCTION Spirometry Module failure detected. Contact your service personnel.SPIRO INCOMPATIBLE Spirometry Module revision not compatible with the host monitor software revision. Contact your service personnel.SPIRO UPGRADE Spirometry The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring.SPIRO CANNOT MEAS Spirometry Measurement is at its limit, e.g. ambient pressure out of range.SPIRO PURGE FAILED Spirometry The purge operation could not be completed successfully. Check for kinked sensor tubings, hard occlusions and make sure that the pump is running and all valves are switching.SPIRO UNKN. SENSOR Spirometry An unknown sensor ID code was detected. Use only the sensors listed in the Accessories chapter.SPIRO ALARMS SUPPR Spirometry Alarming is suppressed for the spirometry module.SPIRO PURGING Spirometry A purge operation is in progress - no data update on the screen. Wait until purge is complete.SPIRO NO SENSOR Spirometry No sensor detected. Make sure the correct sensor is attached to the breathing circuit.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)78SPIRO NO BREATH Spirometry No breath was detected for more than 25 seconds. Breath derived numerics are not available.SPIRO GAS COMPENS? Spirometry Gas compensation is set to “gas analyzer” but not all gases necessary for compensation are measured by a gas monitor. Some of the fall-back values provided by the user are used. Measurement accuracy might be reduced.SPIRO PATIENT CAT. Spirometry Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the Spirometry chapter.'SpO2 CHK SOURCESNumeric is replaced by -?- SpO2 Difference Not all measurements or values required to perform the calculation are available. Check measurement sources.'SpO2 CHK UNITSNumeric is replaced by -?- SpO2 Difference The monitor has detected a conflict in the units used for this calculation. Check the unit settings.<SpO2 label> DEACTIVATEDINOP toneSpO2The SpO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. <SpO2 label> EQUIP MALFNumeric is replaced by -?- INOP tone.SpO2The MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel. <SpO2 label> ERRATICNumeric is replaced by -?- INOP tone.SpO2Check the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. <SpO2 label> EXTD. UPDATELabel is displayed with a -?- (questionable numeric)SpO2The update period of displayed values is extended due to an NBP measurement on the same limb or an excessively noisy signal.<SpO2 label> INTERFERNCE Numeric is replaced by -?- INOP tone.SpO2There is too much interference, caused by a high level of ambient light and/or electrical interference. Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is not damaged or positioned too close to power cables.<SpO2 label> LOW PERFLabel is displayed with a -?- (questionable numeric)SpO2Accuracy may be compromised due to very low perfusion. Stimulate circulation at sensor site. If INOP persists, change the measurement site.<SpO2 label> NOISY SIGN.Numeric is replaced by -?- INOP tone.SpO2Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce patient movement or to relieve the cable strain on the sensor.<SpO2 label> NON-PULSAT.Numeric is replaced by -?- INOP tone.SpO2Check the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is finished. <SpO2 label> NO SENSORNumeric is replaced by -?- INOP tone.SpO2Make sure the SpO2 sensor is connected. If the INOP persists, try another adapter cable and sensor. If you silence this INOP, the measurement will be switched off.<SpO2 LABEL> POOR SIGNAL Label is displayed with a -?-(questionable numeric)SpO2The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs79<SpO2 LABEL> PULSE? Numeric is replaced by -?-INOP toneSpO2The detectable pulsations of the SpO2 signal are outside the specified pulse rate range.<SpO2 LABEL> SEARCHINGNumeric unavailableSpO2SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. <SpO2 label> SENSOR MALF Numeric is replaced by -?- INOP tone.SpO2The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.<SpO2 LABEL> SENSOR OFF Numeric is replaced by -?-INOP toneSpO2The SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer.<SpO2 LABEL> UNKN.SENSORNumeric is replaced by a -?- SpO2The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified sensors and cables.<SpO2 LABEL> UNPLUGGEDNumeric is replaced by -?-INOP toneSpO2An SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.<SpO2 LABEL> UPGRADELabel is displayed with a -?-, numeric is unavailableSpO2The SpO2 measurement is currently in UPGRADE mode. Monitoring is not possible in this mode.Sp - vO2 CHK SOURCESNumeric is replaced by -?- Sp - vO2Not all measurements or values required to perform the calculation are available. Check measurement sources.Sp - vO2 CHK UNITSNumeric is replaced by -?- Sp - vO2The monitor has detected a conflict in the units used for this calculation. Check the unit settings.SRR INTERFERENCEINOP toneMonitor The short range radio connection has interference from another device. Try using another channel.SRR INVALID CHANINOP toneMonitor The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration.SRR MALFUNCTION Malfunction in the short range radio device. If the INOP persists contact your service personnel. SVR/SVRI CHK SOURCESNumeric is replaced by -?- SVR/SVRI Not all measurements or values required to perform the calculation are available. Check measurement sources.SVR/SVRI CHK UNITSNumeric is replaced by -?- SVR/SVRI The monitor has detected a conflict in the units used for this calculation. Check the unit settings.SVR/SVRI SET CVP USEDNumeric is replaced by -?- SVR/SVRI A CVP value is required for this calculation, but is not currently being measured. The monitor is using the CVP value preset in the Setup SVR menu.T/T1/T2/T3/T4 INOPs TEMP See <Temp label> INOPs (under Temp)TAAP DISABLEDINOP toneMonitor The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor.Tamb INOPs TEMP See <Temp label> INOPs (under Temp)Tart INOPs TEMP See <Temp label> INOPs (under Temp)INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)80Tblood NO TRANSDUC Numeric is replaced by -?-INOP toneC.O. No transducer attached to the module or catheter disconnected.Tblood OVERRANGE Numeric is replaced by -?-C.O. Tblood out of range 17°C - 43°C.Tcereb INOPS TEMP See <Temp label> INOPs (under Temp)Tcore INOPs TEMP See <Temp label> INOPs (under Temp).tcpO2 (or tcpCO2 or tcGas) CAL FAILEDNumeric is replaced by -?- INOP tone.tcGas A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration has failed more than once, remembrane the transducer and restart the calibration. If this INOP persists, contact your service personnel.tcpO2 (or tcpCO2 or tcGas) CAL REQUIRD Numeric is replaced by -?- INOP tone.tcGas Calibration is required before applying the transducer to the patient. Insert a membraned transducer into the calibration chamber on the module, connect the calibration unit to the calibration chamber, open the gas valve and start the calibration. If this INOP occurs during a calibration, there may be a module or transducer malfunction: contact your service personnel.tcpO2 (or tcpCO2 or tcGas) CAL RUNNING Numeric displays first -?- , then numeric is displayed with a ?tcGas Wait until the tcpO2/tcpCO2 calibration is finished. tcpO2 (or tcpCO2 or tcGas) CHECK TIME tcGas Site Timer due to time out in 15 minutes or less.tcpO2 (or tcpCO2 or tcGas) CHANGE SITEIf Heat Switch Off is configured to Yes, numeric is replaced by -?- INOP tone. tcGas Site Timer has timed out. Change the application site to avoid skin burns. To reset the Site Timer, either calibrate and change the measurement site, or change the measurement site and reset the Site Timer manually by selecting the appropriate site time from the Setup TCGas menu.tcpO2 (or tcpCO2 or tcGas) EQUIP MALF Numeric is replaced by -?- INOP tone.tcGas There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel.tcpO2 (or tcpCO2 or tcGas) NO TRANSDUC Numeric is replaced by -?- INOP tone.tcGas No transducer is connected to the tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement. tcpO2 (or tcpCO2 or tcGas) STABILIZING Numeric is displayed with a ?tcGas The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes.tcpO2 (or tcpCO2 or tcGas) UNPLUGGED Numeric is replaced by -?- INOP tone.tcGas The measurement is switched on but the module is unplugged. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.TELE CONFIG UNSUPPINOP toneMonitor Telemetry device not supported (companion mode)INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs81!!/!!!TELE DISCONNECTINOP toneTelemetry Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup.For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.) If this INOP persists, ask your service personnel to survey the interference sources.TELE EQUIP MALFINOP toneMonitor The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device. TELE INCOMPATIBLE Monitor SRR-enabled telemetry device is not supported by this central software revision. Please check configuration.!!/!!! TELE INOPSevere yellow/red INOP tone.Telemetry Check for further details at the Information Center or in the Telemetry Data window on the monitor.Tele Sync Unsupp.INOP toneTelemetry The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above. TELE UNSUPPORTEDINOP toneMonitor This telemetry device is not supported for direct connection to the monitor.<'Temp> CHK SOURCESNumeric is replaced by -?- TEMP Difference Not all measurements or values required to perform the calculation are available. Check measurement sources.<'Temp> CHK UNITSNumeric is replaced by -?- TEMP Difference The monitor has detected a conflict in the units used for this calculation. Check the unit settings.<Temp label> DEACTIVATEDINOP toneTEMP A Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either reconnect a Temp transducer or reactivate the measurement label in the Measurement Selection window. <Temp label> EQUIP MALFNumeric is replaced by -?- INOP tone.TEMP Contact your service personnel.The temperature hardware is faulty.<Temp label> NO TRANSDUCERNumeric is replaced by -?- INOP tone.TEMP Make sure the TEMP probe is connected to the MMS or module.If you silence this INOP, the measurement will be switched off.<Temp label> UNPLUGGEDINOP toneTEMP A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)82<Temp label> OVERRANGENumeric is replaced by -?- INOP tone.TEMP Try changing the application site of the transducer.[The temperature is less than -1qC, or greater than 45qC.]Tesoph INOPS TEMP See <Temp label> INOPs (under Temp).TEXT UPLOAD FAILEDINOP toneIntelliBridge Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary. TimeExpired:<timer label>INOP toneMonitor The time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP. Tnaso INOPS TEMP See <Temp label> INOPs (under Temp).Trect INOPS TEMP See <Temp label> INOPs (under Temp).Tskin INOPS TEMP See <Temp label> INOPs (under Temp).Ttymp INOPS TEMP See <Temp label> INOPs (under Temp)Tven INOPS TEMP See <Temp label> INOPs (under Temp).Tvesic INOPS TEMP See <Temp label> INOPs (under Temp)UAP INOPS PRESS See <Pressure label> INOPS (under Pressure).Unsupported LANINOP toneMonitor There is a problem with the communication to the network and central monitoring is currently not possible. Check the connection. If the INOP persists, switch off the monitor and contact your service personnel.User I/F Malfunct.INOP tone.Monitor Perform a visual and functional check of all the monitor input devices. Contact your service personnel.UVP INOPS PRESS See <Pressure label> INOPS (under Pressure).V LEAD OFFNumeric is replaced by -?- for 10 seconds; INOP tone.ECG The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. <VueLink option> CHK CABLEINOP tone.VueLink No cable or the wrong cable connected to the VueLink module, or incorrect device selected. Silencing this INOP switches the measurement off. VueLink INOP abbreviations may differ slightly depending on the device category.<VueLink option> CHK CONF.INOP tone.VueLink The wrong external device has been selected on the VueLink module, or the external device has not been correctly setup, or the wrong cable has been used to connect the device to the VueLink module.VueLink INOP abbreviations may differ slightly depending on the device category.INOP Message, Indication Source What to do
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs83<VueLink option> CHECK SETUP INOP tone.VueLink No information was received from the external device. The device may be switched off or disconnected.VueLink INOP abbreviations may differ slightly depending on the device category.VueLnk EQUIP MALF INOP tone.VueLink Malfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.VueLink INOP abbreviations may differ slightly depending on the device category.VueLnk NO CONFIG INOP tone.VueLink The VueLink module has not been configured during installation. The installation process should be completed by either your biomedical engineering department or the Philips service engineer.VueLink INOP abbreviations may differ slightly depending on the device category.VueLnk UNPLUGGEDINOP tone.VueLink The VueLink module has been unplugged from the rack, or the whole rack has been disconnected. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.VueLink INOP abbreviations may differ slightly depending on the device category.INOP Message, Indication Source What to do
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs)84
8566Managing PatientsUse the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer (ADT) patients. All patient demographic and ADT information is shared between the patient monitor and the Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center.Note that when the X2 is connected to a host monitor, its ability to admit or discharge a patient is disabled, and the host monitor controls patient demographic and ADT information.Admitting a PatientThe monitor displays physiological data and stores it in the trends as soon as a patient is connected. This lets you monitor a patient who is not yet admitted. It is however important to admit patients properly so that you can identify your patient on recordings, reports, and networked devices. During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.NOTE It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center. To admit a patient,1Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window.
6 Managing Patients Admitting a Patient862Clear any previous patient data by selecting the Dischrge Patient or End Case pop-up key and then Confirm. If you do not discharge the previous patient, you will not be able to distinguish data from the previous and current patients, for example, in the trend database.3Select Admit Patient.4Enter the patient information: select each field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information. –Last Name: Enter the patient’s last name (family name), for example Smith.–First Name: Enter the patient’s first name, for example Joseph.–Middle Name (if configured to appear): Enter the patient’s middle name.–Lifetime Id, Encounter Id: Whether these fields appear and how they are labelled can be configured for your hospital. One or both fields may be displayed and the labels may read: MRN, Case Id, Visit Id, etc. Enter the appropriate data for the fields displayed.–Patient Cat: Choose the patient category, either Adult, Pediatric, or Neonatal.–Paced: Choose Yes or No (You must use “Yes” if your patient has a pacemaker).–Height: Enter the patient’s height.–Weight: Enter the patient’s weight.–BSA: The monitor calculates the body surface area automatically.–Date Of Birth: Enter the patient’s date of birth. Enter this in the form dd/mm/yyyy.–Age: The monitor calculates the patient age automatically.–Gender: Choose Male or Female.–Notes: Enter any extra information about the patient or treatment.5Select Confirm. The patient status changes to admitted.Patient Category and Paced StatusThe patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is set to No, pace pulses are filtered and therefore do not show in the ECG wave.AdultSBed10 Doe, JohnPatient DemographicsLast Name : DoeFirst Name : JohnMRN : 12345678Patient Cat.Tr a n s f e r: AdultDischrge PatientEndCaseAdmit Patient
Quick Admitting a Patient 6 Managing Patients87WARNING Patient Category and Paced status will always contain a value, regardless of whether the patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the default settings from the current profile, which might not be correct for your patient.Patient category Changing the patient category may change the arrhythmia and NBP alarm limits. Always check alarm limits to make sure that they are appropriate for your patient.Paced status For paced patients, you must set Paced to Yes. If it is incorrectly set to No, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole.Admitting a Centrally-Monitored PatientYou can admit a patient at either the bedside or the Information Center. When you admit a patient, the patient’s name appears on the bedside monitor and the Information Center.If you do not fill in all patient information required by the Information Center, the Information Center may reject the admission. Complete all the required fields and try again to admit the patient.Quick Admitting a PatientUse Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later.1Select the Quick Admit SmartKey.2Enter the required data (ID fields or Last Name depending on configuration) with the keyboard.3Select Enter.4In the confirmation window, select Confirm to discharge the previous patient (if confirmation is configured). 5Check that patient category and paced status are correct for the new patient.If the monitor is connected to an Information Center and only the ID field is entered, the patient name is set to - - - at the Information Center. Complete the rest of the demographic details as soon as possible to fully identify the patient on the network, on the monitor and on printed reports. To complete the details, select Admit Patient again and complete all required fields. Editing Patient InformationTo edit the patient information after a patient has been admitted, select the patient name field on the Main Screen to open the Patient Demographics window, and make the required changes.Discharging a PatientWARNING Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient.A discharge:
6 Managing Patients Transferring Patients88– clears the information in the Patient Demographics window – erases all patient data (including trend data) from the monitor and Information Center. This ensures that data from a previous patient are not mixed with data from the new patient. – resets patient category and paced settings to the settings defined in the default Profile– resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile– discharges the patient from the Information Center. When a patient is discharged from the monitor or from an Information Center, all patient data is deleted. Make sure that you have printed out any required reports before discharging. Check that a functioning central printer is available before you use End Case.To discharge a patient, 1Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window and associated pop-up keys.2Select the pop-up key for either:–End Case - to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an End Case SmartKey is configured for your monitor, you can also select this instead and then confirm. To see which end case reports are set up for your monitor, select Main Setup -> Reports -> Auto Reports. For each auto report, if End Case Report is set to On, this report will be printed when you select End Case. See the section on AutoReports for information on setting up end case reports. –Dischrge Patient - to discharge the patient without printing any reports. New Patient CheckThe monitor can be configured to ask you in certain situations:• after a specified power-off period• after a specified standby period• when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified periodwhether a new patient is now being monitored. The pop-up window is entitled Is this a new Patient?. The monitor offers a Yes key to discharge the previous patient and begin monitoring a new patient and a No key to continue monitoring with the current patient data and settings. The time periods for the three conditions can be configured independently. Transferring PatientsTo save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, patient demographic information is shared between patient monitors and Information Centers.
Transferring Patients 6 Managing Patients89Transferring a Centrally-Monitored PatientWARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A).Scenario: A centrally-monitored patient is moved to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information, using the X2 as both MMS and transport monitor.1Before you disconnect the X2 from the host monitor, select the patient name field or select the Admit/Dischrge SmartKey on the host monitor to open the Patient Demographics window, then select the Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive (“grayed-out”). This step preserves the patient’s demographic data during the transfer. 2Remove the X2 and any connected extensions from the host monitor.3Move the patient using the X2 as the transport monitor.4At the new location, connect the X2 to the new host monitor. If the host monitor detects a patient mismatch, a window will open showing your patient’s data and asking Complete transfer of this patient?.5Select Yes to complete the transfer.This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2 to the receiving host monitor. 6Verify that the settings for patient category and paced mode are correct.Transferring a Centrally-Monitored Patient using IITWARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).Scenario: A centrally-monitored patient is moved with an X2 to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. The X2 has an IntelliVue Instrument Telemetry interface (IIT), is connected to a host monitor, and is declared as a telemetry device at the Information Center.NOTE The Transfer key is not available while the X2 is connected to a host monitor (Companion Mode is indicated).1Remove the X2 and any connected extensions from the host monitor.2Move the patient using the X2 as the transport monitor.3At the new location, just before connecting the X2 to the new host monitor:– open the Patient Demographics window.– select the Transfer pop-up key.–wait until the transfer has completed.
6 Managing Patients Transferring Patients904Connect the X2 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patient’s data and asking Complete transfer of this patient?.5Select Yes to complete the transfer.This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2 to the receiving monitor.Verify that the settings for patient category and paced mode are correct.Transferring a Centrally-Monitored Patient with the MonitorScenario: A centrally-monitored patient is moved with the monitor to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information.1Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window, then select the Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive (“grayed-out”). This step preserves the patient’s demographic data during the transfer. 2At the new location, connect the monitor to the network (only needed for wired networks). If the monitor detects a patient mismatch, a window will open showing your patient’s data and asking Complete transfer of this patient?.3Select Yes to complete the transfer.4Verify that the settings for patient category and paced mode are correct. If you accidentally transfer a patient, use Re-Admit to restore this patient’s data to the Information Center. If you are not connected to the network, select Clear Transfer to leave transfer mode. The patient data remains in the monitor.Data Exchange Between Information CentersYou can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors. Resolving Patient Information MismatchWhen you connect together devices which store patient demographic data, for example:• an MMS and a monitor, • an X2 or MP5 and a host monitor, • a monitor and an Information Center, the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical.WARNING 1When a monitor is connected to an Information Center by the wireless IntelliVue Instrument Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary.
Transferring Patients 6 Managing Patients912It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Category, may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in the case of asystole. It is important that the Patient Category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set.In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a “telemetry device” at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center.Manually Resolving Patient MismatchThe source of the patient mismatch is indicated by question marks (???) and displayed in the status line at the bottom of the screen (Patient ???,Patient Category ??? or Paced ???).The Select Patient window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, but the indicators remain until you do.For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patient’s data and ask Complete transfer of this patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window.After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the monitor. Always check the Patient Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.WARNING After resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient.
6 Managing Patients Transferring Patients92Patient Mismatch - If One Set of Patient Data is Correct♦If there is a mismatch between an Information Center and a monitor, choose the data set you want to continue using for this patient by selecting one of the sectors in the Select Patient window.After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.Patient Mismatch - If Neither Patient Data Set is CorrectA patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. ♦Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient. Patient Mismatch - If Both Patient Data Sets Are CorrectA patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor.♦Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor.Select PatientDOE, JOHN F1234HG9556, 2008/00123Adult Non-PacedMILLER, Adult PacedSame PatientNew Patient
9377ECG, Arrhythmia, ST and QTMonitoringThe electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see page 109), ST monitoring (see page 121) and QT monitoring (see page 131).Skin Preparation for Electrode PlacementGood electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity.1Select sites with intact skin, without impairment of any kind.2Clip or shave hair from sites as necessary.3Wash sites thoroughly with soap and water, leaving no soap residue. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.4Dry skin thoroughly.5Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site.Connecting ECG Cables1Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.2Place the electrodes on the patient according to the lead placement you have chosen.
7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads943Attach the electrode cable to the patient cable.4Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display. CAUTION To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips. Selecting the Primary and Secondary ECG LeadsThe monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis. To select a lead as primary or secondary lead:♦In the Setup ECG menu, select Primary or Secondary, then select the appropriate lead. You can assign any available lead whether it is currently displayed or not.Checking Paced StatusIt is important to set the paced status correctly when you start monitoring ECG. ♦To change the paced status in the Setup ECG menu, select Paced to toggle between Yes or No.1 - ECG Connector1You should choose a lead as primary or secondary lead that has the following characteristics: • the QRS complex should be either completely above or below the baseline and it should not be biphasic• the QRS complex should be tall and narrow• the P-waves and T-waves should be less than 0.2 mV
Understanding the ECG Display 7 ECG, Arrhythmia, ST and QT Monitoring95WARNING Pace pulse rejection must be switched on for paced patients by setting “Paced” to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient.Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation.Understanding the ECG DisplayYour display may be configured to look slightly different.ECG HR numeric: This is the heart rate derived from the monitored ECG. Pace pulse markers: These are shown if the Paced status has been set to Yes, the pacer spikes are not configured to have a fixed size, and the patient has a paced signal.Pacer Spikes: The pacer spikes are shown in white, unless the ECG wave is white, then they will be green. If the pacer spikes have been configured to have a fixed size, they will be displayed in the background as a dotted line.1 Lead label of the displayed wave2 1 mV calibration bar3Pacer spikes4 Pace pulse markers5 Current heart rate6 Current heart rate alarm limits7 EASI lead placement label8 ECG Filter labelEASIMHR bpm4816573Paced Rhythm2
7 ECG, Arrhythmia, ST and QT Monitoring Monitoring Paced Patients96Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave. The synchronization marks will be shown in yellow, unless the ECG wave is yellow, then they will be green. ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the left side.Monitoring Paced PatientsAn ECG optimized for monitoring a paced patient should look like this:You should choose a lead as primary or secondary lead that has these characteristics:• the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses. • the QRS complex should be tall and narrow• the P-waves and the T-waves should be less than 0.2 mV.For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They are then shown in the background as a dotted lines. The length of the dotted line is fixed to the wave channel height and is independent of the actual pacer amplitude. 1 Pacer spikes configured to have a fixed size11Normal Beats2 Pace Pulses/Beats21
Changing the Size of the ECG Wave 7 ECG, Arrhythmia, ST and QT Monitoring97Setting the Paced Status (Pace Pulse Rejection)Avoiding Pace Pulse Repolarization TailsSome unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as QRSs in the event of cardiac arrest or other arrhythmias. If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.Changing the Size of the ECG WaveIf any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the ECG waves on the screen.Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor.Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose AutoSize, or an individual size using the Size Up / Size Down keys, the calibration bar may be a different size for each wave. To Change the Size of an Individual ECG Wave1Select the wave segment you want to change. This calls up the lead menu for this segment.♦In the Setup ECG menu, select Paced to toggle between Yes and No. You can also change the paced status in the Patient Demographics window. When Paced is set to Yes: – Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes. – pace pulse marks are shown on the ECG wave as a small dash (only when the pacer spikes are not configured to have a fixed size)– the paced symbol is displayed under the HR label.When Paced is set to No, pacer spikes are not shown in the ECG wave. Be aware that switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected.PacedNon-Paced1 Repolarization tail (note width)1
7 ECG, Arrhythmia, ST and QT Monitoring Changing the Volume of the QRS Tone982In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.Selecting AutoSize lets the monitor choose the optimal adjustment factor for all displayed ECG waves.To Change the Size of all the ECG Waves To change the size of all the ECG waves on the screen by a fixed adjustment factor, 1In the Setup ECG menu, select Adjust Size. 2Select the required adjustment factor from the line of pop-up keys. –Size x0.5 to halve the wave size –Size x1 to display the wave without zoom–Size x2 to double the wave size –Size x4 to multiply the wave size by fourChanging the Volume of the QRS ToneThe QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off). ♦To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop-up list.There will be no QRS tone when the X2 is connected to a host monitor. Changing the ECG Filter SettingsThe ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement. ♦To change the filter setting, in the Setup ECG menu, select Filter and then select the appropriate setting. –Monitor: Use under normal measurement conditions.–Ext. Monitor: Use for pediatric and neonatal patients when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting. –Filter: The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electro-surgical units. Under normal measurement conditions, selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor. If AutoFilter is set to On in Configuration Mode, the filter setting will automatically be set to Filter if electromagnetic interference is detected.
Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 7 ECG, Arrhythmia, ST and QTMonitoring99–Diag: Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible.The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the Adult, Pedi and Neo patient category. The term “diagnostic” relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/AAMI standard EC11-1991. When you are using a telemetry transmitter connected via short range radio to the monitor, the upper bandwidth for all filter settings is limited to 40 Hz. Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)The two chest leads for the 6-lead placement can be positioned at any two of the V1 to V6 positions. Select the positions you have used in the Setup ECG menu, so that the chest leads will be correctly labeled.1In the Setup ECG menu, select Va Lead.2Select the position used from the list.3Select Vb Lead and select the position used from the listChoosing EASI or Standard Lead PlacementYou must enable either standard lead placement or EASI lead placement. ♦In the Setup ECG menu, select Placement and then Standard or EASI.EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any printouts.See the section on EASI ECG Lead Placement for electrode placement diagrams.About ECG LeadsTo make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called “leads”. To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor.When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis. Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location.
7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback100ECG Leads MonitoredChanging Lead Sets To change the ECG lead set, •When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement.•When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in the Setup ECG menu and the INOP message will disappear. ECG Lead FallbackIf fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback. When the Leads Off condition is corrected, the leads are automatically switched back. This setting can only be changed in Configuration Mode.ECG Lead PlacementsThe labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.If you are using these leads are available: Resp is measured between electrodes:a 3-electrode set I, II, III RA and LLa 5-electrode set I, II, III, aVR, aVL, aVF, V and MCL RA and LLa 6-electrode set I, II, III, aVR, aVL, aVF, Va, Vb RA and LLa 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LLan EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Electrode labels Electrode colorsAAMI EASI IEC AAMI IECRA I RWhite RedLA S LBlack YellowLL A FRed GreenRL N N Green BlackV E CBrown WhiteV1 C1 Brown/Red White/RedV2 C2 Brown/Yellow White/Yellow
ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring101Standard 3-Lead PlacementStandard 5-Lead PlacementV3 C3 Brown/Green White/GreenV4 C4 Brown/Blue White/BrownV5 C5 Brown/Orange White/BlackV6 C6 Brown/Violet White/Violet Electrode labels Electrode colorsAAMI EASI IEC AAMI IEC1 RA placement: directly below the clavicle and near the right shoulder2 LA placement: directly below the clavicle and near the left shoulder3 LL placement: on the left lower abdomen123RA placement: directly below the clavicle and near the right shoulderLA placement: directly below the clavicle and near the left shoulderRL placement: on the right lower abdomenLL placement: on the left lower abdomenV placement: on the chest, the position depends on your required lead selection2 4 1V 3 IIIIIIaVRaVLaVF5
7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Placements1026-Lead PlacementFor a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and Vb, can be positioned at any two of the V1 to V6 positions shown in the chest electrode diagram below. The Va and Vb lead positions chosen must be selected in the ECG Setup Menu to ensure correct labeling. Chest Electrode PlacementFor accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space. 1Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space. 2Palpate and count down the chest until you locate the fourth intercostal space.V1 placement: on the fourth intercostal space at the right sternal borderV2 placement: on the fourth intercostal space at the left sternal borderV3 placement: midway between the V2 and V4 electrode positionsV4 placement: on the fifth intercostal space at the left midclavicular lineV5 placement: on the left anterior axillary line, horizontal with the V4 electrode positionV6 placement: on the left midaxillary line, horizontal with the V4 electrode positionV3R to V6R placement: on the right side of the chest in positions corresponding to those on the leftVE placement: over the xiphoid processV7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal spaceV7R placement: on posterior chest at the right posterior axillary line in the fifth intercostal spaceVEV1 V2V3V4 V5V6V7V3RV4R234Angle of Lewis
ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring10310-Lead PlacementWhen monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement.Conventional 12-Lead ECG1 - V1 - V62 - LA3 - LL4 - RL5 - RAIn conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.Limb electrodes:– Place arm electrodes on the inside of each arm, between the wrist and the elbow.– Place leg electrodes inside of each calf, between the knee and the ankle.Chest electrodes:V1 - on the 4th intercostal space at the right sternal borderV2 - on the 4th intercostal space at the left sternal borderV3 - midway between the V2 and V4 electrode positionsV4 - on the 5th intercostal space at the left midclavicular lineV5 - on the left anterior axillary line, horizontal with the V4 electrode positionV6 - on the left midaxillary line, horizontal with the V4 electrode position52143
7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead104Modified 12-Lead ECGChoosing Standard or Modified Electrode PlacementIf your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch ModLdPlcmt to On in the monitor. To do this,♦in the Setup ECG menu, select ModLdPlcmt to toggle between On and Off.–When ModLdPlcmt is set to On, 12 Lead ECG Reports will be labelled 12 Lead ECG Report (Mason-Likar), and captured 12-lead ECGs will be labelled Mason-Likar to the right of the bandwidth annotation at the Information Center.–When ModLdPlcmt is set to Off, 12 Lead ECG Reports will be labelled 12 Lead ECG Report, and captured 12-lead ECGs will not be annotated at the Information Center.WARNING Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and ST slope. Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label. Capture 12-LeadIf the monitor is connected to an Information Center via a wired network, the Capture 12-Lead SmartKey may be configured. Selecting this exports 12-Lead ECG information to the Information Center for analysis. For details see the Instructions for Use supplied with the Information Center. 1 - LA2 - V1 - V63 - LL4 - RL5 - RA6 - Angle of LewisIf your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen.The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.1 35462
EASI ECG Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring105EASI ECG Lead PlacementUsing a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia. WARNING EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations. Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I and A electrodes. Place the electrodes as accurately as possible to obtain the best quality EASI measurements.When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts.When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any printouts.EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP condition (for example, LEAD OFF), a flat line is displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn.EASI Electrode Placement1E (V) on the lower sternum at the level of the fifth intercostal space2A (LL) on the left midaxillary line at the same level as the E electrode3S (LA) on the upper sternum4I (RA) on the right midaxillary line at the same level as the E electrode5Nreference electrode - can be anywhere, usually below the sixth rib on the right hip12345
7 ECG, Arrhythmia, ST and QT Monitoring ECG and Arrhythmia Alarm Overview106ECG and Arrhythmia Alarm Overview The ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.• Cardiotach alarms are available when HR is on and the active alarm source is ECG, but arrhythmia is switched off• Basic arrhythmia alarms are available when Arrhythmia is switched on• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced Arrhythmia option has been enabled for your monitorCardiotach Alarms Additional Alarms with Basic Arrhythmia OptionAdditional Alarms with Enhanced Arrhythmia Option ***Asystole***Ventricular Fibrillation/Tachycardia***Extreme Bradycardia***Extreme Tachycardia**High heart rate**Low heart rate***Ventricular Tachycardia**Pacer Not Capture**Pacer Not Pacing**PVCs/min HIGH(PVC > limit/min)**Afib**Supraventricular Tach**Missed Beat**Pause**Irregular HR**Ventricular Rhythm**Run PVCs High**Pair PVCs**R-on-T PVCs**Ventricular bigeminy**Ventricular trigeminy**Non-sustain VT**Multiform PVCs
Using ECG Alarms 7 ECG, Arrhythmia, ST and QT Monitoring107Using ECG AlarmsECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to ECG are described here. Extreme Alarm LimitsThe extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value (the ' value) to the high and low alarm limits. You need to know which value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.♦To see the extreme rate alarms set for your monitor, in the Setup ECG menu, see the menu items 'ExtrTachy and 'ExtrBrady.ECG Alarms Off DisabledBe aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitor’s Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and enable Alarms Off. HR Alarms When Arrhythmia Analysis is Switched OffWhen arrhythmia analysis is switched off, only these HR-related alarms will be detected:• the asystole alarm• the ventricular fibrillation/tachycardia alarm• the extreme tachycardia and extreme bradycardia alarms• the high heart rate and low heart rate alarms.Enhanced Asystole DetectionIn order to improve alarming on asystole under certain conditions, you can set Asystole Detect. in Configuration Mode to Enhanced. In enhanced mode an asystole alarm will be suppressed for up to five seconds if a valid beat-to-beat Pulse is detected from a Pressure. ExtremeBrady Limit LowLimitHighLimitExtremeTachy Limit' Extreme Brady ' Extreme Tachy
7 ECG, Arrhythmia, ST and QT Monitoring ECG Safety Information108ECG Safety InformationCAUTION Interference from instruments near the patient and ESU interference can cause problems with the ECG wave. See the monitor specifications for more information.WARNING Defibrillation and Electrosurgery: Do not touch the patient, or table, or instruments, during defibrillation.After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions. ECG cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again. According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal.General: When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth.During surgery: Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves (greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest.Patients exhibiting intrinsic rhythm: When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest.The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patient’s heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined.Filtered ECG signal from external instruments: Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance.
About Arrhythmia Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring109External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This may result in the arrhythmia algorithm’s failure to detect pacemaker noncapture or asystole.Fusion beat pacemakers: Pacemakers that create fusion beats (pace pulse on top of the QRS complex) cannot be detected by the monitor’s QRS detector.Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this. About Arrhythmia MonitoringArrhythmia analysis provides information on your patient’s condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously • optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.• detects beats, for example, QRS complexes, identifying them for further analysis.• measures signal features such as R-wave height, width, and timing.• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.• examines the ECG signal for ventricular fibrillation, asystole, and noise. Arrhythmia OptionsYour monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labelling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different options are listed in the section “ECG and Arrhythmia Alarm Overview” on page 106, the rhythm and ectopic messages detected are listed in “Arrhythmia Status Messages” on page 113. Where Can I Find More Information? See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed information on the arrhythmia algorithm and its clinical application.
7 ECG, Arrhythmia, ST and QT Monitoring Switching Arrhythmia Analysis On and Off110Switching Arrhythmia Analysis On and Off1In the Setup Arrhy menu, select Arrhythmia to toggle between On and Off.2Select the Confirm pop-up key which appears at the bottom of the screen.Be aware that when arrhythmia analysis is switched off,–the message Arrhythmia Off appears beside the ECG wave, if configured to do so– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate and low heart rate alarms)– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.Choosing an ECG Lead for Arrhythmia MonitoringIt is important to select a suitable lead for arrhythmia monitoring. Guidelines for non-paced patients are: – QRS complex should be tall and narrow (recommended amplitude > 0.5 mV) – R-Wave should be above or below the baseline (but not bi-phasic) – T-wave should be smaller than 1/3 R-wave height – the P-wave should be smaller than 1/5 R-wave height.For paced patients, in addition to the above, the pace pulse should be:– not wider than the normal QRS– the QRS complexes should be at least twice the height of pace pulses– large enough to be detected, with no re-polarization.To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole. Aberrantly-Conducted BeatsAs P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.Atrial Fibrillation AlarmThe monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability.In order to generate an Afib alarm the following criteria must be detected for 1 minute:• normal beat RR intervals must be irregular
Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring111• PR interval deviation must be large• P-wave region must not match wellAtrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats.Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm.An Afib alarm can be falsely detected in the presence of:• sinus arrhythmia,• muscle noise, or• electrode motion artifact. If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations. See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis.Intermittent Bundle Branch BlockBundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.Understanding the Arrhythmia DisplayYour monitor screen may look slightly different from the illustration. PP PDelayed1mVIIM45713Pair PVCs6Paced Rhythm75HR2PVC21 Beat label2 Pace pulse marks3 Rhythm status message
7 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display112Viewing Arrhythmia Waves ♦To review arrhythmia beat labels, in the Setup Arrhy menu, select Annotate Arrhy.The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey background. Beat labels will be annotated above the ECG wave and Delayed will be written beside it.♦To return to the normal ECG primary lead display, select Annotate Arrhy again.Arrhythmia Beat LabelsArrhythmia beat labels tell you how the monitor is classifying beats. N = NormalV = Ventricular EctopicS = Supra-ventricular PrematureP = Paced' = Pacer spike“ = Biventricular Pacer SpikeL = Learning patient's ECGA = Artifact (noisy episode)? = Insufficient information to classify beatsI = Inoperative condition (e.g., LEADS OFF)M = Pause or missed beat4PVC Numeric5HR Numeric6 Ectopic status message7 Delayed arrhythmia wave
Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring113Arrhythmia Status MessagesThe monitor displays two types of status messages: • Rhythm Status Messages -- to indicate the patient’s rhythm.• Ectopic Status Messages -- to indicate the presence of ectopic beats.These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages. The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats.If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level.Rhythm Status MessagesThe label B or E indicates basic (B) or enhanced (E) arrhythmia capability.Rhythm Status Message Description B or EASYSTOLE No QRS for 4 consecutive seconds in absence of vent fib or chaotic signalB, EVENT FIB/TACH A fibrillatory wave for 4 consecutive seconds B, EV-TACH A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate LimitB, ESUSTAINED V-TACH Ventricular tachycardia rhythm for more than 15 seconds EVENT RHYTHM A dominant rhythm of adjacent PVCs and a HR dthe V-Tach HR Limit EVENT BIGEMINY A dominant rhythm of N, V, N, V EVENT TRIGEMINY A dominant rhythm of N, N, V, N, N, V EPACED RHYTHM A dominant rhythm of paced beats B, EIRREGULAR HR Consistently irregular rhythm ESINUS BRADY SINUS RHYTHM SINUS TACHYA dominant rhythm of SV beats preceded by P-waves B, ESV BRADYSV RHYTHMSV TACHYA dominant rhythm of SV beats not preceded by P-waves B, EUNKNOWN ECG RHYTHM Rhythm cannot be determined B, ELEARNING ECG Algorithm is learning the ECG beat morphology B, ELEARNING RHYTHM Algorithm is learning the rhythm of the classified beats B, ECANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be analyzedB, E
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Relearning114Ectopic Status MessagesThe label B or E indicates basic (B) or enhanced (E) arrhythmia capability.Arrhythmia RelearningDuring a learning phase:• Alarm timeout periods are cleared• Stored arrhythmia templates are cleared•Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.Initiating Arrhythmia Relearning Manually1To initiate relearning manually, in the Setup Arrhy menu, select Relearn Arrhy.– While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the rhythm status message Learning ECG. – Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm status message changes to Learning Rhythm.2After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly. 3If beats are still not classified correctly, check that the ECG is optimized for arrhythmia monitoring. You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves. Ectopic Status Message Explanation B or E (No message displayed) No ectopic activity within the last minuteRUN PVCs More than 2 consecutive PVCs within the last minute EPAIR PVCs Pair PVCs within the last minute EPACER NOT CAPT Pause with pace pulse (paced patient only) within the last minute B, EPACER NT PACING Pause without pace pulse (paced patient only) within the last minute B, EPAUSE No beat detected for 1.75 x average R-R interval for HR <120, or No beat for 1 second with HR >120 (non-paced patient only), or No beat detected for more than the set pause threshold.ER-ON-T PVCs R-ON-T detected within the last minute EMULTIFORM PVCs Multiform PVCs detected within the last minute EFREQUENT SVPBs SVPB count within last minute is greater than 5 ESVPBs 1-5 SVPBs in the last minute with a sinus rhythm and no Vs ESV BEATS SV count within last minute and rhythm status is PACED B, EPACED BEATS Paced beat count within last minute and rhythm status is NOT PACEDB, E
Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring115Automatic Arrhythmia Relearn Arrhythmia relearning is initiated automatically whenever:• ECG monitoring is switched on• The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs•A Leads Off INOP condition (that has been active for > 60 seconds) ends.If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no Learning ECG rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active.Arrhythmia Relearn and Lead FallbackLead fallback triggers an automatic arrhythmia relearn.WARNING If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-Fib. For this reason you should: • take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free• be aware that arrhythmia relearning can happen automatically• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads• always ensure that the arrhythmia algorithm is labeling beats correctly.Arrhythmia Alarms Arrhythmia alarms can be switched on and off and the alarm settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here. The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter. The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms116Yellow Arrhythmia AlarmsYellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. Depending on your monitor and Information Center configuration, they may be shown with one or two stars. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply. WARNING When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms behave as usual.Arrhythmia Alarms and Latching When using arrhythmia analysis, Visual Latching and Audible Latching should be on for red alarms, or at least Visual Latching should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in Configuration Mode.Switching Individual Arrhythmia Alarms On and OffSome arrhythmia alarms can be individually switched on or off. They are: Pacer not capture, Pacer not pace, Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, Irregular HR, Missed Beat, PVCs/min and Afib.♦To switch individual alarms on or off, in the Setup Arrhythmia menu, select the alarm from the list to toggle between On and Off. The monitor displays the INOP message SOME ECG ALRMS OFF, if configured, when more alarms are switched off than configured in your active profile.Switching All Yellow Arrhythmia Alarms On or OffAll yellow arrhythmia alarms can be switched on and off together. To do this,♦In the Setup Arrhythmia menu, select All Yellow Off or All Yellow On.Adjusting the Arrhythmia Alarm LimitsSome arrhythmia alarms have limits which can be individually adjusted. They are:Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold.1To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted.2Select the appropriate setting from the pop-up list.
Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring117Arrhythmia Alarm Timeout PeriodsNormally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include: • if a more serious alarm condition is active in the same chain• if a timeout period is in effect for a particular alarm • if a timeout period is in effect for a higher alarm in that chain.See “Arrhythmia Alarm Chaining” on page 118 for more details on alarm chains. What is a Timeout Period?Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm. Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see “Arrhythmia Alarm Chaining” on page 118). This setting can only be changed in Configuration Mode.♦To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd.Resetting the Timeout Period♦To reset the timeout period, press the Alarms key and then reselect it.How are Yellow Arrhythmia Alarms Indicated?When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators. Yellow arrhythmia alarms are always set to latch visually for three minutes except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:Alarm Condition Example Audible IndicatorsShort yellow alarm tone sounds ...Visual IndicatorsAlarm message displayed ...Single alarm instance Non-sustained V-tachwhen alarm condition is initially detectedfor 3 minutes (latching time)Continuous alarm condition PVCs/min HIGHwhen alarm condition is initially detected and - as an alarm reminder - every time the configured time out period has expireduntil the alarm condition stops, plus a maximum of three minutes latching timeSame intermittent alarm conditionPair of PVCs each time the alarm condition is detected, provided that the configured timeout period has expired
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms118If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will get an alarm reminder every time the configured timeout period has expired.If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared. Silencing an alarm does not reset its time out period, so you will not get a realarm for the same condition or lower on the chain until the timeout expires.Arrhythmia Alarm ChainingWhen arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm “chains”: PVC Alarms; Beat Detection Alarms, and Rate Alarms. Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are occurring.See “ECG and Arrhythmia Alarm Overview” on page 106 for information on which alarms are included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 117 for an explanation of how alarm timeouts work.
Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring119– If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain.– Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated. Understanding PVC-Related AlarmsPVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). Example: This diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to eight, and the V-Tach HR Limit is set to 100. Red Arrhythmia AlarmsAsystoleVent Fib/TachV-TachExtreme Tachy/Extreme BradyYellow Arrhythmia AlarmsPVC Alarms Chain Beat Detection Alarms Chain Rate Alarms ChainPacer Not Captured/Pacer Not Pacing/Missed BeatHR High/ HR Low*PVCs > xx/minNon-sustain VT/ Vent RhythmRun PVCs R-on-T PVCsPause SVTMultiform PVCsVent BigeminyVent Trigeminy Irregular HR (occurs only if no other arrhythmia alarms are present)First level timeout period (TimeOut 1st)Second level timeout period (TimeOut 2nd)Pair PVCs lower priority higher priorityAFib*If HR High/Low alarms are configured as standard yellow alarms, they are independent of the arrhythmia alarms and are not in the Rate alarms chain.
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms120You will see that • if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated.Ventricular Heart RateNumber of Consecutive PVCs (PVC Run)**Pair PVCsPVC = 2** Non-Sustain VTPVC Run < 8HR > 100***V-TachPVC Run t8HR > 100** Run PVCsPVC Run > 2butd12HR d 100** Vent RhythmPVC Run > 12 HR d 100V-Tach Heart Rate LimitV-Tach Run LimitVentricular Rhythm Run Limit1 2 3 4 5 6 7 8 9 10 11 12 14 15 100
About ST Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring121About ST MonitoringThe monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor. All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the monitor for ST Segment analysis. ST analysis is always performed using a dedicated filter which ensures diagnostic quality. If you are monitoring ECG using an ECG filter mode other than Diagnostic, the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave. For diagnostic evaluation of the ST segment, always switch to Diagnostic filter mode or use the ST snippet.WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example: • if you are unable to get a lead that is not noisy• if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline• if the patient is continuously ventricularly paced• if the patient has left bundle branch block.You should consider switching ST monitoring off if these conditions are present. This monitor provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for ST monitoring in neonatal and pediatric modes is ST Analysis: Off. Switching ST On and Off♦To switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis to toggle between On and Off.Selecting Leads for ST AnalysisYou select which leads to use for ST analysis in the Setup ST Analysis menu.To see the current list of leads selected for ST analysis:1Enter the Setup ST Analysis menu.2Select Setup ST Leads. This opens the Setup ST Leads pop-up window. Leads chosen for ST monitoring are listed here. There are two pop-up keys at the bottom of the screen:If all leads are already selected, the Add pop-up key is disabled.To choose a lead for ST monitoring:1Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up window.Add Delete
7 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display and Windows1222Choose a lead from the list for ST monitoring. This closes the Choices window and adds the selected lead to the list of chosen leads.To disable ST monitoring for a lead:1Choose a lead from the list in the Setup ST Leads window.2Select the Delete key. This removes this lead from the list.NOTE The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen.To change the order in which ST leads are displayed,1In the Setup ST Leads menu, choose a lead from the list.2Select the Sort Up or Sort Down key to move the lead up or down in the list.Understanding the ST Display and WindowsYour monitor screen may be configured to look slightly different from the illustrations.ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet. A positive ST value indicates ST segment elevation; a negative value indicates depression.ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the Setup ST Analysis -> Setup ST Leads list. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric.ST Index The ST index numeric (STindx) is the sum of the absolute values for the ST leads V2, V5, aVF. Because it is based on absolute values, it is always a positive number. If you haven’t selected one of the leads V2, V5, and aVF for ST analysis, the STindx numeric will display a question mark “?”.♦To switch the ST index numeric on or off for display, in the Setup ST Analysis menu, select ST-Index to toggle between On and Off.1ST numerics2 Current HR alarm limits3 Current heart rateST-II 1.2ST-V 2.5ST-aVR -3.031 2
Updating ST Baseline Snippets 7 ECG, Arrhythmia, ST and QT Monitoring123ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient.The information is updated once per minute. You can see ST snippets in the Adjust ST Points window or the ST Baseline window. ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid. The current ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between these two numerics. A “?” in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored. ♦To v iew the ST Baseline window, select the ST numerics, then ST Baseline.Updating ST Baseline SnippetsST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear. The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines,1Select the ST numerics then ST Baseline to open the ST Baseline window. 2In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines.1 ST label and numeric2 Baseline ST numeric and difference since baseline was stored3 1mV calibration bar4Current snippet5ST baseline6 Timestamp of most recently stored baseline snippet1ST Baseline from 04 Apr 07 9:386 ST Baseline3452ST-II-0.30.8?-1.11mv 1sec
7 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points124About the ST Measurement PointsThe ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly. CAUTION The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus the placement of the ST point. Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set. Always ensure that ST measurement points are appropriate for your patient.Adjusting ST Measurement PointsDepending on your monitor’s configuration, the ST point can be positioned either • relative to the J-point. In the Adjust ST Points window, the pop-up keys ISO Point, J Point and ST Point are visible and can be adjusted. or• directly by selecting a numeric value for the ST point. In the Adjust ST Points window, you can adjust the ISO and ST point. The ST Uses setting can only be changed in Configuration Mode. To adjust the ST measurement points, 1In the Setup ST Analysis menu, select Adjust ST Points to open the Adjust ST Points window. Alternatively, you can use the Adjust ST Points pop-up key in the ST Baseline window.2Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads. J point, for example, 48 msecR-wave peak at 0 msecIsoelectric point set to -80 msecDifference = ST valueST measurement point, for example, J + 60 msecTPQS
About the ST Measurement Points 7 ECG, Arrhythmia, ST and QT Monitoring1253Select the ST point you need to adjust by touching the appropriate point on the screen. The current choice is highlighted (ISO point -80 in the screen example).The ISO-point cursor positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds. Position the ISO-point in the middle of the flattest part of the baseline (between the P and Q waves or in front of the P wave). The J-point cursor positions the J-point relative to the R-wave peak. It helps you to correctly position the ST-point. Position the J-point at the end of the QRS complex and the beginning of the ST segment. The J-point cursor is not available if your monitor is configured to let you set the ST point directly. To position the ST-point relative to the J-point:select either J+60 or J+80. Select J Point and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment. To position the ST-point directly: select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the ST segment.4Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all ST values.The most recent ST Points adjustment time is displayed in the Adjust ST Points window. This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor. 1mV calibration barHighlighted ST pointST label and the ST numeric that would apply using the current pointsCursors for adjusting ST pointsAdjust ST PointsST-I0.1Update Apply Changes1mv 1secST Points adjusted at 04 Apr 07 11:38ISO
7 ECG, Arrhythmia, ST and QT Monitoring ST Alarms1265To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key.ST Alarms ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads. If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits. Single- or Multi-lead ST AlarmingBe aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead will be announced. To choose individual or multi-lead ST alarming,♦In the Setup ST Analysis menu, select ST Alarm Mode and select either Single ST or Multi ST.Changing ST Alarm LimitsThe monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.1In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST.2Select the alarm to be adjusted.3Select the appropriate setting. Viewing ST MapsThe monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the ECG parameter. Current ViewIn current view, the monitor displays an ST map that corresponds to the current ST values. Three or more leads per plane are necessary to display a map. The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads.
Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring127If an ST lead is switched off, its axis is not shown in the map.If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is unplugged), the area formed by the remaining ST leads is left open.If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.ST label and polarity of corresponding leadST mapTrend ViewPrintSizeUpSize DownShow Baseline Scroll to view more pop-up keysST Map (Current)Select Interval ST-II HIGHAdultSBed10Limb Leads Chest LeadsShow ValuesST-IST-IIST-aVRST-aVLST-aVFLimb Leads
7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps128Additionally, when both ST maps are displayed, you can view the currently available ST values in the ST Map window (Current or Trend) at any time. To do this, select the Show Values pop-up key. The ST values are shown in place of the second ST map, and the pop-up key text changes to Hide Values. Select the Hide Values pop-up key and the display shows both ST maps again.Trend ViewIn trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old. The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values on the diagrams show the current ST values.If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off 20 seconds ago. The current ST values and the first trended value reflect this change in the lead setup. All other maps are displayed the way in which they were recorded.ST-IST-IIST-VIST-V2ST-V3ST-V4ST-V5ST-V6ST-aVFSizeUpSize DownShow BaselineST Map (Current) ST-II HIGHAdultSBed10Limb LeadsST values are shown where the STmap for the chest leads is normally displayed.Select the Show Values pop-up key to see the current ST values. Select Hide Values and the display shows both ST maps again.Hide ValuesScroll to view more pop-up keysCurrent ViewSelect IntervalPrintSizeUpSize DownShow BaselineShow ValuesST Map (Trend) ST-II HIGHAdultSBed10Limb Leads Chest Leads5 min trending interval
Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring129Viewing an ST MapTo display an ST map,♦In the Setup ST Analysis menu, select ST Map.Working in the ST Map Task WindowYou may need to activate the ST map task window to see all the data, and to access the pop-up keys. Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here.Switching Between ST Map ViewsTo switch between views,♦Select Current View or Trend View to toggle between views.If your trend view is empty, you need to adjust the priority of this measurement in the trending priority list. See “Trend Priority” on page 195.Displaying an ST Reference BaselineYou can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request.♦Select Show Baseline/Hide Baseline to toggle between baseline display on and off.Updating an ST Map Reference BaselineTo update the baseline,♦In the Setup ST Analysis menu, select ST Baseline -> Update baseline.Changing the Scale of the ST MapTo change scale,♦Select Size Up or Size Down to alter the size at which monitor displays the map.In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed.
7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps130Changing the Trending IntervalTo determine how frequently the monitor displays a trended sample,1In Trend view, select Select Interval.2Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.Printing an ST Map ReportTo print the most recently viewed (current or trend) window, 1Select Main Setup - > Reports.2Select ST Map.3Press Print.
About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring131About QT/QTc Interval MonitoringThe QT interval is defined as the time between the beginning of the Q-wave and the end of the T-wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome. The QT interval has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in Configuration Mode. For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned on. QT Measurement AlgorithmThe QT values are updated every five minutes except in the initial phase (first five minutes) where they are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing. Normal beats followed by a premature QRS will be excluded from the measurements to prevent the premature beat from obscuring the end of the T-wave. If the algorithm cannot form a representative waveform, for example because the morphology of the beats is too varied, a CANNOT ANALYZE QT INOP will be generated after 10 minutes. This is also the case if normal beats have been falsely labelled so that the algorithm does not have enough valid beats to make QT measurements. No QT value is calculated if the QT-HR is >150 bpm (Adult) or >180 bpm (Pedi/Neo).Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor. Where Can I Find More Information? See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance.TQSPRQT interval
7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval Monitoring132Indications For Use Of QT Interval MonitoringOf special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category. Limitations For Use Of QT Interval MonitoringSome conditions may make it difficult to achieve reliable QT monitoring, for example: • the T-wave is very flat• T-waves are not well defined due to atrial flutter or atrial fibrillation• the end of the T-wave is difficult to define because of the presence of U-waves• a high heart rate causes the P-wave to encroach on the end of the previous T-wave• noise or high QRS morphology variationFor these cases you should select a lead with a good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave. Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm. If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured. When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable QTc calculation it is important to avoid a region where the heart rate is changing. WARNING QT/QTc measurements should always be verified by a qualified clinician.Selecting The QT LeadsFor QT Monitoring you can select one of the following three modes:• All Leads mode - all available leads (I, II, III, V, MCL, V1 - V6) are used to produce a global QT measurement. For EASI lead placement, directly acquired AI, AS and ES leads are used. • Primary-Lead mode - the primary lead will be used for QT measurement. If the original primary lead becomes unavailable or is changed, QT measurement will continue with the new primary lead.• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable. To select the mode, 1Select the QT numeric to enter the Setup QT Analysis window.2Select QT Lead and select All, Primary Lead or one of the available single leads.When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads.
About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring133Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT ViewIn the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads. Changing The View To A Single Wave SetTo view one set of waves in a larger scale, you can cycle through the different views, 1Select Current view to see the set of current waves.2Select Baseline view to see the set of baseline waves. 3Select Split view to return to the combined view with current and baseline waves. Setting The QT BaselineIn order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the effect of medication on the QT interval you can set the current value as the baseline before you begin medication. This baseline will then be used to calculate the 'QTc value. To set the baseline, ♦Select Set Baseline and set the value.
7 ECG, Arrhythmia, ST and QT Monitoring QT Alarms134If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the 'QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a 'QTc alarm from being generated. Discharging a patient clears the baseline. Printing The QT WavesTo start a printout,♦Select Print QT.Recording The QT WavesTo start a recording,♦Select Record QT.QT AlarmsThere are two QT alarms, QTc high limit alarm and 'QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The 'QTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes. The CANNOT ANALYZE QT INOP and the ?_will be displayed when no QT measurement could be calculated for 10 minutes. Up to this time the previous valid value will be displayed. The following additional messages on the cause of the invalid measurements may also be displayed. Additional Message Cause of Invalid QT MeasurementQT Startup QT monitoring was just turned on or has been resetAsystole or Leads Off 1Not all specified leads needed to perform QT analysis are available, or2Asystole condition is detectedInsufficient Valid LeadsNot enough valid QRS complexes to generate a QT measurementInvalid rhythm for QTc Not enough valid RR intervals to generate QT-HR, the averaged HR used for QTc calculationHigh QT-HR QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics)Small R Wave R-wave of the signal is too smallSmall T Wave T-wave of the signal is too smallEnd of T Not detected End of the T-Wave cannot be accurately detectedQT Out Of Range QT measurement is outside the specified range of valid QT values (200-800 msec)QTc Out Of Range QTc measurement is outside the specified range of valid QTc values (200-800 msec)QTc Erratic QTc measurements are not stable
Switching QT Monitoring On and Off 7 ECG, Arrhythmia, ST and QT Monitoring135Switching Individual QTc Alarms On and OffEach QTc alarm can be switched off individually. ♦To switch an alarm on or off, in the Setup QT Analysis menu, select QTc Alarm or 'QTc Alarm to toggle between On and Off. Changing QTc Alarm LimitsSet the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits.1In the Setup QT Analysis menu, select High Limit.2Select the appropriate setting. 3Select 'High Limit.4Select the appropriate setting.Switching QT Monitoring On and Off♦To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analys. to switch between On and Off.
7 ECG, Arrhythmia, ST and QT Monitoring Switching QT Monitoring On and Off136
13788Monitoring Pulse RateThe pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the Setup Pulse menu to check whether it is switched on.Entering the Setup Pulse MenuIf a pulse numeric is displayed on the screen, select it to enter the Setup Pulse (Pulse Source) menu. If no pulse numeric is visible, in the Setup SpO2 menu or a Setup arterial pressure menu, select Pulse (Pulse Source).System Pulse Source The currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:• is monitored as system pulse and generates alarms when you select pulse as the active alarm source• is sent via the network to the Information Center, if available• is trended in the HighRes Trends and stored in the monitor’s databases.To define which pulse rate is used as system pulse, 1In the Setup Pulse menu, select System Pulse.2Select one of the SpO2 or arterial pressure labels from the pop-up list, or select Auto. If you select Auto, the monitor automatically chooses a pulse rate to be used as system pulse. It looks through the list from top to bottom and activates the first pulse rate that is switched on and available. If your selected pulse source measurement becomes unavailable or is switched off, the monitor will use the next measurement from the list as system pulse until the selected pulse source measurement becomes available again.
8 Monitoring Pulse Rate Switching Pulse On and Off138Switching Pulse On and OffTo switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off, 1Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO2 menu.2In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and Off.Using Pulse AlarmsYou can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the Setup Pulse menu or the Setup ECG menu by selecting AlarmSrc (xxx) where xxx is the current alarm source. Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms.Pulse alarms are only generated when the active alarm source is set to Pulse, a pulse source is set as system pulse and pulse alarms are switched on. Selecting the Active Alarm Source: ECG or Pulse?In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the monitor uses either ECG or Pulse as its active alarm source. To change the alarm source, select AlarmSrc in the ECG/Pulse Alarms menu, then select •ECG: if you want the HR to be the alarm source for HR/Pulse.•Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off. •Auto: If the AlarmSrc is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and at least one ECG lead can be measured without an INOP condition.The monitor will automatically switch to Pulse as the alarm source if:– a valid ECG lead can no longer be measuredand – a Pulse source is switched on and available,The monitor then uses the pulse rate from the measurement currently active as system pulse. While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source.Note: If ECG is switched off, the monitor will always change to Pulse as alarm source, if a Pulse is available. One exception to this rule can arise when you have a telemetry device paired with your monitor. The monitor ECG is then deactivated but the monitor may be configured to allow only ECG as the active alarm source. In this case the monitor will not switch to Pulse as alarm source and Pulse will not be available as a selection in the ECG/Pulse Alarms menu.
Using Pulse Alarms 8 Monitoring Pulse Rate139WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section “ECG and Arrhythmia Alarm Overview” on page 106, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow (medium severity) INOP after a fixed number of hours.High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active. Alarm Source Selection DisabledIf Alarm Source Selection is disabled, you cannot change the alarm source. If you try to change the source, the monitor displays the message To activate enter Config and enable Alarm Source Selection. This setting can only be changed in Configuration Mode.Changing HR/Pulse Alarm Limits As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the Setup Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO2 is 30 bpm; for HR 15 bpm, and for Pressure 25 bpm. Extreme Alarm LimitsThe extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm limits. You need to know what value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.♦To see the values added to the high and low limit alarms to create the extreme rate alarms for your monitor, in the Setup ECG menu, see the menu items Extr.Tachy and Extr.Brady.QRS ToneThe active alarm source is also used as a source for the QRS tone. You can change the tone volume in the Setup SpO2 and Setup ECG menus and the QRS tone modulation in the Setup SpO2 menu. WARNING The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis.If arrhythmia detection is needed, do not rely on the audible QRS tone.There will be no QRS tone when the X2 is connected to a host monitor.
8 Monitoring Pulse Rate Using Pulse Alarms140
14199Monitoring Respiration Rate(Resp)For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patient’s chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).Lead Placement for Monitoring RespCorrect patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG.The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI™ placement - to measure Resp, as long as you use ICU ECG cables. The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI™ ECG electrode placement, Resp is measured between the I and A electrodes. Optimizing Lead Placement for RespIf you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients. Repositioning ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation.Cardiac OverlayCardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is particularly important for neonates.
9 Monitoring Respiration Rate (Resp) Understanding the Resp Display142Lateral Chest ExpansionAbdominal BreathingSome patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave.Understanding the Resp DisplayThe Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration.Changing Resp Detection ModesThe Resp detection level can be set either automatically or manually. ♦To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings. Auto Detection ModeIn Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode, • the detection level (a dotted line) is not displayed on the waveform,Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient’s maximum point of breathing movement to optimize the respiratory wave. Resp1 Ohm22RRManually-set Resp detection level1 Ohm calibration bar Resp numeric and label
Changing the Size of the Respiration Wave 9 Monitoring Respiration Rate (Resp)143• the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.Use Auto Detection Mode for situations where: • the respiration rate is not close to the heart rate• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).Manual Detection ModeIn Manual Detection Mode you must set the Resp detection level. ♦In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached.Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.Use Manual Detection Mode for situations where:• the respiration rate and the heart rate are close.• patients have Intermittent Mandatory Ventilation.• respiration is weak. Try repositioning the electrodes to improve the signal.Resp Detection Modes and Cardiac OverlayIn Auto Detection Mode: If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration.In Manual Detection Mode: Cardiac overlay can in certain situations trigger the respiration counter. This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you may need to optimize the electrode placement as described in the section ”Lateral Chest Expansion”.Changing the Size of the Respiration WaveWARNING When monitoring in Manual Detection Mode, make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave.♦In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to decrease it.
9 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave144Changing the Speed of the Respiration WaveResp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.♦Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).Using Resp AlarmsResp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter. Changing the Apnea Alarm DelayThe apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm. 1In the Setup Resp menu, select Apnea Time.2Select the appropriate setting.Resp Safety Information WARNING Respiration detection level If you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of apnea.Apnea The respiration measurement does not recognize obstructive and mixed apneas — it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath. The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. Interference If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit.Resp Accessories To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electro-surgery is being performed.
Resp Safety Information 9 Monitoring Respiration Rate (Resp)145Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.
9 Monitoring Respiration Rate (Resp) Resp Safety Information146
1471010Monitoring SpO2Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact suppression technology (FAST). It provides four measurements:• Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).• Pleth waveform - visual indication of patient’s pulse.• Pulse rate (derived from pleth wave) - detected pulsations per minute.• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation.The monitors are also compatible with SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information. SpO2 SensorsDepending on the purchased SpO2 option, different sensors and adapter cables can be used. The sensors for the different options are color-coded to match the connectors. See the section on Accessories for a compatibility table. Familiarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site.CAUTION Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors on patients who have allergic reactions to the adhesive. Applying the Sensor1Follow the SpO2 sensor’s instructions for use, adhering to all warnings and cautions.2Remove colored nail polish from the application site.3Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor,
10 Monitoring SpO2Connecting SpO2 Cables148select a finger or toe with a diameter of between 7 and 8 mm (0.27” and 0.31”). When applying a M1193A neonatal sensor do not overtighten the strap.4Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient’s tissue. WARNING Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site at least every four hours.Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.Ambient Temperature: At elevated ambient temperatures be careful with measurement sites that are not well perfused, because this can cause severe burns after prolonged application. All listed sensors operate without risk of exceeding 41°C on the skin if the initial skin temperature does not exceed 35°C. Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line.Connecting SpO2 Cables♦Connect the sensor cable to the color-coded socket on the X2. You can connect some Philips sensors directly to the measurement device. For other sensors, use the corresponding adapter cable.CAUTION Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “long” cable version).Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.Measuring SpO21Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 2During measurement, ensure that the application site:– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.– has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.
SpO2 Signal Quality Indicator (Fast SpO2 only) 10 Monitoring SpO2149WARNING Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours.CAUTION • Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.• Interference can be caused by:– High levels of ambient light or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.)– Electromagnetic interference.– Excessive patient movement and vibration.SpO2 Signal Quality Indicator (Fast SpO2 only)The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the current values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled.Assessing a Suspicious SpO2 ReadingTraditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse. When pulse rate is very low, or strong arrhythmia is present, the SpO2/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value.If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality.NOTE With pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or electromagnetic interference can give unexpected intermittent readings when the sensor is not attached to a patient. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling. SpO2
10 Monitoring SpO2Changing the Averaging Time150Changing the Averaging TimeDepending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high.1In the SpO2 Setup, select Average.2Select the required averaging time from the list. Setting the Measurement ModeWhen a telemetry device supplies SpO2T to the monitor via short range radio transmission, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save the telemetry device’s battery power. To set the measurement mode, 1In the SpO2 Setup, select Mode.2Select Continuous or Manual mode.Making a Manual MeasurementWhen the measurement mode is set to manual, ♦In the SpO2 Setup, select Measure SpO2.When manual measurements are made, there will be no continuous SpO2 monitoring or alarming. The manual measurement value reflects a momentary status. The numerics from SpO2T measurements made in manual mode, for example SpO2T, PerfT, PulseT, will remain for a time on the main screen. They are annotated with the time that the measurement was made to distinguish them from continuously measured values. Understanding SpO2 AlarmsThis refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit.Perf T
Pleth Wave 10 Monitoring SpO2151CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 INOP can occur. If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating critical patient status, such as sudden pulse loss or hypoxia.Alarm DelaysThere is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components:• The time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and the configured averaging time. The longer the averaging time configured, the longer the time needed until the numerical values reflect the physiological event.• The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the combination of the configured alarm delay time plus the general system delay time (see “Monitor Performance Specifications” on page 254).Adjusting the Alarm LimitsIn the Setup SpO2 menu:• Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-up list that opens.• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off. Adjusting the Desat Limit AlarmThe Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation. 1In the Setup SpO2 menu, select DesatLimit.2Adjust the limit.Pleth WaveThe Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.
10 Monitoring SpO2Perfusion Numeric152 Perfusion NumericThe perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow.As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable. Below 0.3 is marginal; reposition the sensor or find a better site.Perfusion Change IndicatorThe perfusion change indicator is a graphic symbol which shows the change in the perfusion value, relative to a reference value which you can set. To set the current perfusion value as the reference value:♦In the Setup SpO2 menu, select Set Perf Ref..When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric.Setting SpO2/Pleth as Pulse Source1In the Setup SpO2 menu, select Pulse (SpO2) to enter the Setup Pulse menu.2In the Setup Pulse menu, select SystPulse and select SpO2 from the pop-up list.Setting Up Tone ModulationIf tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source. ♦In the Setup SpO2 menu, select Tone Mod. to toggle between Yes (for on) and No (for off).minimum size for reliable SpO2 valuePerfusion changeindicator
Setting the QRS Volume 10 Monitoring SpO2153Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated.Setting the QRS Volume♦In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume.When the X2 is connected to a host monitor there will be no QRS tone.
10 Monitoring SpO2Setting the QRS Volume154
1551111Monitoring NBPThis monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure.In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.A physician must determine the clinical significance of the NBP information.Introducing the Oscillometric NBP MeasurementOscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish.Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques.WARNING Patient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients.Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.Skin Damage: Do not measure NBP on patients with sickle-cell disease or any condition where skin damage has occurred or is expected.Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff.
11 Monitoring NBP Preparing to Measure NBP156CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.Measurement LimitationsMeasurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine.The measurement may be inaccurate or impossible:• if a regular arterial pressure pulse is hard to detect• with cardiac arrhythmias• with excessive and continuous patient movement such as shivering or convulsions• with rapid blood pressure changes• with severe shock or hypothermia that reduces blood flow to the peripheries• with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery• on an edematous extremity.Measurement MethodsThere are three methods of measuring NBP:•Manual - measurement on demand.•Auto - continually repeated measurements (between one and 120 minute adjustable interval).•Sequence - up to four measurement cycles which will run consecutively, with number of measurements and interval between them configurable for each cycle. •STAT - rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients.Reference MethodThe NBP measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-arterial). For further information, see the Application Note on NBP supplied on the monitor documentation CD-ROM. In Adult and Pediatric mode to check the current setting, select Main Setup -> Measurements -> NBP, and check whether the Reference setting is set to Auscult. or Invasive. This setting can only be changed in Configuration Mode. In Neonatal mode, to comply with safety standards, invasive is always used as the reference method. This setting cannot be changed and is not visible in any operating mode.Preparing to Measure NBP1Connect the cuff to the air tubing.
Preparing to Measure NBP 11 Monitoring NBP1572Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing.3Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted. A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb.4Apply the cuff to a limb at the same level as the patient’s heart. If it is not, you must use the measurement correction formula to correct the measurement. The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements.Correcting the Measurement if Limb is not at Heart LevelTo correct the measurement if the limb is not at heart level, to the displayed valueUnderstanding the NBP NumericsDepending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values.Alarm Sources if you have parallel alarm sources, the sources are displayed instead of the alarm limits. NBP Timestamp depending on the configured NBP Time setting, the time shown beside the NBP numeric can be: –Meas Time: the time of the most recent NBP measurement, or–Next Meas: the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here.add 0.75mmHg (0.10kPa) for each centimeter higher ordeduct 0.75mmHg (0.10kPa) for each centimeter lower oradd 1.9mmHg (0.25kPa) for each inch higher. deduct 1.9mmHg (0.25kPa) for each inch lower.AutoSys.Measurement Mode Timestamp/TimerMean pressureDiastolicAlarm limitsAlarm sourceSystolic
11 Monitoring NBP Starting and Stopping Measurements158During measurements the cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement.Starting and Stopping MeasurementsCAUTION Use clinical judgement to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff.Enabling Automatic Mode and Setting Repetition Time1In the Setup NBP menu, select Mode and select Auto from the pop-up menu.2For an automatic measurement, select Repeat and set the time interval between two measurements.Enabling Sequence Mode and Setting Up The Sequence1In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.2Select Setup Sequence to open the Setup Sequence window.Up to four measurement cycles can be setup which will run consecutively. For each cycle you can set the number of measurements and the interval between them. If you want to run less than four cycles in a sequence, you can set the number of measurements for one or more cycles to Off. 3Select each sequence in turn and select the number of measurements and the time interval between the measurements. 4To have measurements continue after the sequence, set the number of measurements for your last cycle to Continuous and this cycle will run indefinitely.CAUTION Be aware that, if none of the cycles are set to Continuous, NBP monitoring will end after the last measurement of the cycle.When the NBP measurement mode is set to Sequence, the repetition time for Auto mode cannot be changed. Choosing the NBP Alarm SourceYou can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic. In the Setup NBP menu, select Al. from and choose from:
Switching Pulse from NBP On/Off 11 Monitoring NBP159If mean is not selected as alarm source (Sys, Dia, or Sys&Dia selected), but the monitor can only derive a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits. When no value can be derived an NBP MEASURE FAILED INOP will be displayed.Switching Pulse from NBP On/OffIn the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse value is displayed together with the time the measurement was made. After one hour the value becomes invalid. There are no alarms associated with pulse from NBP. To switch the display of the pulse value on or off:♦In the NBP Setup menu select Pulse (NBP).Assisting Venous PunctureYou can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.1In the NBP Setup menu select VeniPuncture.2Puncture vein and draw blood sample.3Reselect VeniPuncture to deflate the cuff. During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode.Menu option Pressure value monitoredSys. systolic Dia. diastolic Mean mean Sys&Dia systolic and diastolic in parallelDia&Mean diastolic and mean in parallelSys&Mean systolic and mean in parallelSys&Dia&Mean all three pressures in parallelPulse from NBPNBP AutoSys.Pulse
11 Monitoring NBP Calibrating NBP160Calibrating NBPNBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at least once every two years by a qualified service professional. See the Service Guide for details.(60)Cuff pressureVenous puncture measurement modeVPNBP 01:45Time left in venous puncture mode
1611212Monitoring TemperatureWARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A).You can measure temperature using the built-in temperature measurement (optional), or one of the MMS extensions.Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.Making a Temp Measurement1Select the correct type and size of probe for your patient.2If you are using a disposable probe, connect the probe to the temperature cable.3Plug the probe or temperature cable into the temperature connector socket.4Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.5Select an appropriate temperature label.6Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement.Temp connector socket
12 Monitoring Temperature Calculating Temp Difference162WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.Selecting a Temperature for MonitoringTell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that label’s stored color and alarm settings.1In the Setup <Temp> menu, select Label.2Select the appropriate label from the list.Extended Temperature Label Set The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode. Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information. Calculating Temp DifferenceThe monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled 'Temp. 1In the Main Setup menu, select Measurements.2In the Setup 'Temp menu, select First Temp.3Label the measurement source as appropriate.4Select Second Temp.5Label the measurement source as appropriate.The 'Temp value is not available when the X2 is connected to a host monitor. Temp non-specific temperature label. Trect rectal temperatureTart arterial temperature Tskin skin temperatureTcore core temperature Tven venous temperatureTesoph esophageal temperature Tnaso nasopharyngeal temperatureT1, T2, T3, T4 Non-specific temperature labelsTamb ambient temperatureTcereb cerebral temperatureTtymp tympanic temperatureTvesic vesical temperature
1631313Monitoring Invasive PressureWARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A).CAUTION Do not use the X2 in combination with monitors using an M1006A pressure module and the HP1290A pressure transducer. This may cause interference on the respiration or invasive pressure signals. You can measure pressure using the monitor’s built-in pressure measurement (optional), or one of the MMS extensions.Setting up the Pressure Measurement1Plug in the pressure cable.2Prepare the flush solution.3Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles. WARNING If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading.Pressure connector
13 Monitoring Invasive Pressure Setting up the Pressure Measurement1644Connect the pressure line to the patient catheter.5If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.6Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line. WARNING If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient’s ear. Incorrect leveling may give incorrect values.Selecting a Pressure for MonitoringTell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that label’s stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values. 1In the Setup <Press> menu, select Label.2Select the appropriate label from the list.Extended Pressure Label SetThe following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode. Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information. Label Description Label DescriptionABP Arterial blood pressure PNon-specific pressure labelART Arterial blood pressure (alternative) PAP Pulmonary artery pressureAo Aortic pressure RAP Right atrial pressureCVP Central venous pressure UAP Umbilical arterial pressureICP Intracranial pressure UVP Umbilical venous pressureLAP Left atrial pressureLabel DescriptionBAP Brachial arterial pressureFAP Femoral arterial pressureIC1, IC2 Alternative intracranial pressures P1, P2, P3, P4 Alternative non-specific pressure labels
Zeroing the Pressure Transducer 13 Monitoring Invasive Pressure165Zeroing the Pressure TransducerTo avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy (at least once per day). You must perform a zero: • when you use a new transducer or tubing• every time you reconnect the transducer cable to the monitor• if you think the monitor’s pressure readings are not correct. Zeroing ICP (or IC1/IC2)Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values are automatically stored and you will not be prompted to repeat the zero procedure. If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the monitor while zeroing. Reconnecting the transducer recalls the stored values.WARNING If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero. Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturer’s instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient.Determining a Pressure’s Most Recent ZeroThe monitor displays the most recent zero on the status line. If this has “timed-out” after you have performed a zero, redisplay the information in the status line by entering the pressure’s setup menu.Zeroing a Pressure MeasurementWARNING Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing.1Turn off the stopcock to the patient.2Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer.3In the setup menu for the pressure, select Zero <Press>. 4When you see the message <Press> zero done at <date and time> on the status line, (for example, ABP zero done at 13 Mar 02 23.35) close the stopcock to atmospheric pressure, and open the stopcock to the patient.CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure.
13 Monitoring Invasive Pressure Adjusting the Calibration Factor166Troubleshooting the ZeroThe status line lists the probable cause of an unsuccessful zero: Adjusting the Calibration FactorEach time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same. 1In the Setup <Press> menu, select Cal. Factor. If the value here does not match that on the transducer, select the corresponding value from the list now in accordance with your hospital’s procedure.2To confirm you want to use the new calibration factor, select the Confirm popup.Displaying a Mean Pressure Value OnlyUse this when you want to see only the mean pressure.♦In the pressure’s setup menu, select Mean only. Toggle between On to display mean pressure value only, and Off to display all pressure values (systolic, diastolic and mean).Changing the Pressure Wave Scale 1Select the label of the pressure wave whose scale you want to set to enter the Setup menu.2In the Setup <Press> menu, (for example ABP) select Scale.3Select a value from the pop-up list: – a positive value sets the top gridline. The bottom gridline is set at zero.– a negative value sets the bottom gridline. The middle gridline is set at zero.Message Corrective Actioncan’t zero; equipment malf.The hardware is faulty. Contact your service personnel. can’t zero; excessive offsetMake sure the transducer is vented to air and try again. If this fails, the hardware may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel.can’t zero - unstable signalcan’t zero - no transducerMake sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer.can’t zero; pulsat. pressureMake sure that the transducer is vented to air, not to the patient, and try again.unable to zero - timed outTry pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel.switch <Press> on firstPressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressure’s label.
Optimizing the Waveform 13 Monitoring Invasive Pressure167Optimizing the Waveform♦In the Setup <Press> menu, select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave.Non-Physiological Artifact SuppressionSome clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample. Your monitor may be configured to suppress these non-physiological artifacts for a specified duration (Artifact Suppression is configured to 30, 60, or 90 seconds). During artifact suppression, the monitor shows the INOP message <Pressure label> ARTIFACT, and a question mark is shown beside the pressure numerics. Pressure alarms and the Pulse NON-PULSATILE INOP are suppressed during the configured period. The CPP high alarm is not suppressed.Choosing the Pressure Alarm SourceWARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic. ♦In the Setup <Press> menu, select Al. from and choose the source.♦Select and set the High Limit and Low Limit for the pressure(s) you have selected.Extreme Alarm LimitsThe extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the ' value) to the high and low alarm limits. This value can be set for each pressure label individually. Menu option Pressure value monitoredSys. systolic Dia. diastolic Mean mean Sys & Dia systolic and diastolic in parallelDia & Mean diastolic and mean in parallelSys & Mean systolic and mean in parallelSys&Dia&Mean all three pressures in parallel
13 Monitoring Invasive Pressure Choosing the Pressure Alarm Source168You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.♦To see the extreme pressure alarms set for your monitor, in the Setup <Press> menu, see the menu items 'Extr. High and 'Extr. Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message.LowLimitHighLimitExtremeLow LimitExtremeHigh Limit' Extreme Low ' Extreme High
Calibrating Reusable Transducer CPJ840J6 13 Monitoring Invasive Pressure169Calibrating Reusable Transducer CPJ840J6Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:• standard sphygmomanometer.• sterile 10cc syringe with heparinised solution.• 3-way stopcock.• approximately 25cm of tubing.Making the Pressure CalibrationWARNING Never perform the invasive pressure calibration while a patient is being monitored.1Zero the transducer.2Connect the syringe and manometer.a. Attach the tubing to the manometer.b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient.c. Attach the syringe to one port and the manometer tubing to the other port.d. Open the port to the manometer.3Move the syringe barrel in and raise the mercury to 200mmHg (30kPa). 200mmHg is the recommended calibration pressure.4In the Setup Pressure menu, select Cal. Press. M1006A12PINPRESSPRESSTZEROtubing to manometerSyringe with heparinised solutionOffPatient connection stopperedPressure connector on monitor
13 Monitoring Invasive Pressure Calculating Cerebral Perfusion1705Select the calibration pressure from the list, for example 200 mmHg.6Select Confirm to recalculate the calibration factor using the applied pressure. 7When the monitor displays <Press> calibration done at <date and time>, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones.8Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure’s setup menu.9Reconnect the patient and start measuring again.Troubleshooting the Pressure CalibrationThe status line lists the probable cause of an unsuccessful calibration.Calculating Cerebral PerfusionThe monitor can calculate the difference between mean arterial pressure and the intracranial pressure. The difference is labeled CPP.1In the Main Setup menu, select Measurements.2In the Setup CPP menu, select ABP, ART, Ao, BAP or FAP as the arterial pressure source.The CPP value will not be available when the X2 is connected to a host monitor.Message Corrective Actioncan’t calibr.; equipmt malf.Contact your service department. The pressure hardware is faulty.can’t calibrate;out of rangeMake sure that you have selected the value for Cal. Press that you are applying to the transducer, and repeat the calibration.can’t calibr.; no transd.Make sure that the transducer is connected and try again.can’t cal.; unstable signalMake sure there are no disturbances to the transducer, and repeat the calibration.can’t calibr.;do zero firstNo valid zero. Zero the transducer.
1711414Monitoring Carbon DioxideWARNING • Measurements from an MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).•Only one CO2 measurement at a time is supported.Use the CO2 measurement to monitor the patient’s respiratory status and to control patient ventilation.There are two methods for measuring carbon dioxide in the patient’s airway:• Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patient’s breathing system. This method is available using the monitor’s built-in CO2 measurement (optional), the M3014A Capnography Extension or the M3016A Mainstream Extension.• Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient’s airway and analyzes it with a remote CO2 sensor. You can measure sidestream CO2 using the monitor’s built-in CO2 measurement (optional) or using the M3014A Capnography Extension, or the M3015A Microstream CO2 Extension.In both cases, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2. When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2.The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure.The measurement provides:•a CO2 waveform.• an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase.• an inspired minimum CO2 (imCO2): the smallest value measured during inspiration.• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform.
14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A172Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off).WARNING Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols.Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel.Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only.Measuring CO2 using the CO2 Option or M3014AThe monitor (with the CO2 option) or the M3014A Capnography Extension measures partial pressure of carbon dioxide in a patient’s expired gas using the mainstream method or the sidestream method. The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 measurement can be used, with appropriate accessories, with intubated and nonintubated adult, pediatric, infant and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patient’s breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.WARNING Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference.Preparing to Measure Mainstream CO2You must perform a zero as described in this procedure each time you use a new airway adapter.1Attach the sensor connector to the CO2 connector on the monitor (when the optional CO2 measurement is integrated) or on the extension.2Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition.
Measuring CO2 using the CO2 Option or M3014A 14 Monitoring Carbon Dioxide1733Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly.4To zero t he sensor :– expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient’s breath and your own.– in the setup menu for the CO2, select Start Zero Cal. – When you see the message Zero done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring.5Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section.WARNING To prevent stress on the endotrachial tube, support the sensor and airway adapter.Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable.Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the CO2 waveform changes unexpectedly without a change in patient status. To avoid infection, use only sterilized, disinfected or disposable airway adapters. Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population.Preparing to Measure Sidestream CO2 1Plug the sensor cable into the monitor’s CO2 input connector. Allow the sensor two minutes warm up time2Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly.3To zero t he sensor :– expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient’s breath and your own.– In the setup menu for the CO2, select Start Zero Cal.
14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A174– When you see the message Zero done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring.4For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section. For intubated patients with an integrated airway adapter in the breathing circuit.: Connect the male luer connector on the straight sample line to the female port on the airway adapter.For non-intubated patients: Place the nasal cannula onto the patient.For patients prone to mouth breathing use an oral-nasal cannula. For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow. WARNING Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor.CAUTION Always disconnect the cannula, airway adapter or sample line from the sensor when not in use. Using the Sidestream Sensor HolderThe holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.1Push the sensor into the holder until it clicks into position.2Clamp the holder onto an IV pole, a shelf or another appropriate location.To remove the sensor from the holder, release the clip and pull the sensor out of the holder. clip
Measuring Mainstream CO2 using M3016A 14 Monitoring Carbon Dioxide175Removing Exhaust Gases from the SystemWARNING Anesthetics: When using the sidestream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics.Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.Measuring Mainstream CO2 using M3016AThe M3016A Mainstream CO2 Extension measures partial pressure of carbon dioxide in a patient’s expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO2 measurement with ventilated adults, pediatric and neonatal patients.WARNING Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation during use. This may cause incorrect readings.Preparing to Measure Mainstream CO21Attach the transducer connector to the CO2 connector on the M3016A extension.2Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition.3Perform an accuracy check and then, if necessary, calibrate the transducer.Checking Transducer AccuracyWARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings.1In Setup CO2 menu, select Cal. Mode to switch on calibration mode.2Look at the calibration value displayed in the Setup CO2 menu next to Start CAL1. Is it the same as the value on the calstick? If not, calibrate the transducer now.3Place the transducer on the low cell of the calstick (labelled 0.0 mmHg or “ZERO”). The reading on the screen should be zero within ±1 mmHg within one minute.4Place the transducer on the high cell of the calstick. The reading on the screen should be within ±1 mmHg of the value on the calstick within one minute.5If both readings are in range, you can leave calibration mode and begin monitoring. If either of the readings is out of range, calibrate the transducer.Calibrating the Transducer1Check that the windows on the calstick are clean and clear.2Place the transducer on one of the calstick cells and select Start CAL1.
14 Monitoring Carbon Dioxide Measuring Mainstream CO2 using M3016A1763Enter the calibration value printed on the calstick then press Confirm to start calibration.4When the message CO2 CAL1 done;Start CAL2 cal appears, put the transducer on the other cell and select Start CAL2 then press Confirm.5When you see the message CO2 cal done;leave Cal. Mode, calibration is complete.6Select Cal. Mode to switch calibration mode off. You cannot monitor in calibration mode.Attaching and Removing the CO2 Transducer1Open the latch and place the transducer onto the airway adapter. Place the airway adapter in the patient’s breathing circuit between the endotracheal tube and the Y-piece. You may see the CO2 SENSOR WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement.2To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.WARNING To prevent stress on the endotrachial tube, support the transducer and airway adapter.To avoid infection, use only sterilized airway adapters. Airway AdapterCO2 Tra n s d ucer
Measuring Microstream CO2 using M3015A 14 Monitoring Carbon Dioxide177Measuring Microstream CO2 using M3015AThe M3015A Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patient’s expired gas using Microstream technology.The measurement is equipped with an automatic barometric pressure compensation.Preparing to Measure Microstream CO2 Use appropriate accessories for:• the patient type (adult, pediatric or neonatal),• the ventilation situation (including humidification)• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU). All accessories are for single patient use only. Using Microstream AccessoriesThe Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory.For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set.For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine (which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine).Using the FilterLine and Airway Adapter1Attach the female Luer connector to the CO2 inlet connector on the extension by pushing the socket cover down and screwing the connector into place.2Check that the FilterLine is not kinked.3Change the FilterLine if a CO2OCCLUSION INOP appears on the monitor or if the readings become extremely erratic. inlet connector coveroutlet connector
14 Monitoring Carbon Dioxide Setting up all CO2 Measurements178Disconnect the FilterLine during suctioning and nebulizing therapies.Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories.CO2 values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blockedRemoving Exhaust Gases from the SystemWARNING Anesthetics: When using the Microstream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ventilator, to avoid exposing medical staff to anesthetics.Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector.Suppressing Zero CalibrationTo prevent an automatic zero calibration from being started in the next five minutes, ♦in the Setup CO2 menu, select No Zero For 5Min, or select the Suppress CO2Zero SmartKey, if configured.Selecting No Zero For 5Min or selecting the Suppress CO2Zero SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.Setting up all CO2 MeasurementsThese tasks are common to all CO2 measurements except where otherwise noted.Adjusting the CO2 Wave Scale1In the CO2 Wave menu or the Setup CO2 menu, select Scale.2Choose a suitable scale range from the pop-up list.Setting up CO2 CorrectionsTemperature, water vapor in the patient’s breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections.CorrectionAltitude (M3014A only)Altitude is set during installation. The monitor automatically applies an appropriate correction.
Setting up all CO2 Measurements 14 Monitoring Carbon Dioxide179Suppressing Sampling (not Mainstream CO2)To temporarily stop sampling, ♦in the Setup CO2 menu, select Pump 15Min Off or use the CO2 Pump Off SmartKey if available. Selecting Pump 15Min Off again before fifteen minutes have passed resets the timer to fifteen minutes. To re-start the pump,♦in the Setup CO2 menu, select Pump On.Changing CO2 AlarmsThis refers to CO2 specific alarms. See the Alarms section for general alarm information.You change CO2 alarm settings in the Setup CO2 menu.To switch etCO2 alarms on and off:♦Select etCO2 Alarms and toggle between On and Off.To change the etCO2 alarm limits:• Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-up list that opens.• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.O2 (M3014A only)In the Setup CO2 menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list. Humidity At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO2 menu, and scroll down to look at Hum. Corr or HumidityCorr.N2O(M3016A mainstream and M3015A microstream only)In the Setup CO2 menu, select N2O Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on.If the N2O correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below).Gas(M3014A only)In the Setup CO2 menu, select Gas Corr. and select Helium, N2O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection.If the Gas correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with N2O Corr. (see above).Agent (M3014A only)In the Setup CO2 menu, select Agt. Corr. and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration. Correction
14 Monitoring Carbon Dioxide Setting up all CO2 Measurements180To change the imCO2 high limit:♦Select imCO2 High and choose the high alarm limit from the pop-up list that opens.Changing the Apnea Alarm DelayThis determines the time limit after which the monitor alarms if the patient stops breathing.1In the Setup CO2 menu, select awRR.2In Setup awRR menu, select Apnea.3Choose the apnea alarm delay time.WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.Deriving Alarms From awRR1In the Setup CO2 menu, select awRR.2In the Setup awRR menu, select Alarms.3Choose On to derive alarms from the airway respiration signal or Off to disable them.Changing awRR Alarm Limits1In the Setup CO2 menu, select awRR.2Select High Limit to set the upper alarm limit.Select Low Limit to set the lower alarm limit.3Select the appropriate setting.
1811515Assigning Two Devices to OnePatientIt is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called “pairing” and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be:• any Philips telemetry device (only for indirect connections, see below).• a TRx+/TRx+ Intellivue Telemetry system transceiver.• an X2 Multi-measurement module with a telemetry interface, declared as a telemetry device and with a telemetry equipment label.How Can You Combine Devices?•With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor. •With a direct connection to the monitor, via a short range radio link - the data arrive with a minimal delay on the monitor screen.Indirect Connection - Manual PairingThe telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use.To pair the monitor with a telemetry device at the monitor:1Select Main Setup then Measurements 2Select Telemetry The Setup Telemetry menu will appear with only one entry Paired Equipment.3Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor.
15 Assigning Two Devices to One Patient How Can You Combine Devices?182Telemetry Data WindowThe measurements from the telemetry device are shown in the telemetry data window on the monitor when there is no direct connection via short range radio link. WARNING All data presented in the telemetry data window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG Sync Pulse output.Direct Connection - Automatic PairingThe following direct connections are possible:• a TRx+4841A Intellivue Telemetry system transceiver connected via short range radio (SRR) link to an X2 with SRR capability.• an X2, declared as a telemetry device, and connected with an MSL cable to a monitor (MP20-90).If a telemetry device is assigned to a monitor via a direct short range radio link, the monitor and the telemetry device are automatically paired at the Information Center (if configured).The measured data from the telemetry device — ECG and, if available, SpO2T— will appear on the monitor screen and will be sent through the monitor to the Information Center. The ECG waves and numerics appear in place of the monitor’s own ECG, and SpO2T is displayed as an additional measurement. When ECG is measured with the telemetry device there will be no Respiration measurement derived.WARNING • When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel.• When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected.Telemetry data windowNBPSys.Auto 10 min etCO2imCO2* TELE ALARMTELE INOPDelayed** HR 140>120SOME ECG ALRMS OFFHR %SpO2T
How Can You Combine Devices? 15 Assigning Two Devices to One Patient183• Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. See the "Enhancing Telemetry Monitoring with the Monitor" chapter.Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor Monitors which have this capability have a short range radio symbol on the model label. A telemetry device with a short range radio adapter can be assigned to a monitor directly. To assign a telemetry device to a monitor:1Press the Check button on the telemetry device. The measurement selection key on the monitor will change to show the “assign telemetry” icon2Select the assign telemetry icon.3In the Assign Telemetry Device menu, select the correct equipment label for the telemetry device.4Check that the assignment is successful and that transmission has begun:•A Tele Device assigned message appears on the monitor• a tone sounds at the telemetry device and the Laeds Off indicators light• the ECG wave appears on the monitorTo confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label.If a monitor is already paired to another device, you cannot assign a telemetry device to that monitor. If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Telemetry Data Window as described above.If a monitor is manually paired with a telemetry device with a short range radio adapter, the short range radio assignment will be automatically made.If a telemetry device disappears from the list in the Assign Telemetry Device menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the “assign telemetry” icon will appear crossed out . If the devices are unpaired, the short range radio connection will be ended.WARNING Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section 36.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a TELE DISCONNECT INOP.
15 Assigning Two Devices to One Patient How Can You Combine Devices?184Correct channel configuration is important, refer to the Configuration Guide for details.If a TELE DISCONNECT INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission.SpO2T Manual ModeWhen a telemetry device with a short range radio connection supplies SpO2T to the monitor, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save battery power. To ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor. Unassigning a Telemetry Transceiver with SRR Adapter at the MonitorIf a monitor and a telemetry device are paired, the assignment and the short range radio connection will be ended when the devices are unpaired (see “Unpairing the Monitor and Telemetry Device” on page 184). If the monitor does not have a connection to an Information Center, you must manually end the assignment and the short range radio connection. 1Select the Measurement Selection key.2In the Measurement Selection window, select the Tele pop-up key.3In the Tele device window select Unassign Tele.Pairing an X2 With a Telemetry Interface to a Host Monitor An X2 using an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a “telemetry device” at the Information Center. When the X2 is disconnected from the host monitor it will remain paired and the measurement data will appear at the host monitor in the Telemetry Data window. After the X2 is disconnected from the monitor it may take over 15 seconds until its data is displayed at the Information Center.NOTE Pairing of a host monitor and a telemetry device, with all the related functionality, is only possible when the host monitor is using a wired LAN connection or a wireless LAN interface (but not using the IntelliVue Instrument Telemetry interface). The X2 can also be paired to a host monitor without a direct connection, as described in “Indirect Connection - Manual Pairing” on page 181.Refer also to “Use Models With Telemetry” on page 188 for further related use modes.Unpairing the Monitor and Telemetry DeviceIf the patient will no longer be monitored with the telemetry device, or only with the telemetry device and no longer with the monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device:♦select the Unpair To Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the monitor
Functions Available When the Telemetry Data Window is Displayed 15 Assigning Two Devices to One Patient185♦select the Unpair To Tele SmartKey to end pairing and have the Information Center receive the measurement data from the telemetry deviceor ♦use the Unpair function at the Information Center.NOTE The Unpair SmartKeys and pop-up keys appear only on the monitor which is directly involved in pairing.Functions Available When the Telemetry Data Window is DisplayedControlling the Telemetry Device from the BedsideYou can change settings for a paired telemetry device at the monitor:1Select the telemetry data screen element 2Select the Setup Tele pop-up key The Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here. Viewing and Silencing Telemetry Alarms at the BedsideWhen a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic Tele Alarm message will appear in the alarm status area with standard alarm tones. The Tele Alarm message will have the color and * or !coding corresponding to the severity of the alarm. The specific alarm message (for example *HR Low) will appear in the Telemetry Data Window. If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:1Select the telemetry screen element. 2Select the Silence Bed pop-up key.Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms.WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured.Suspending Telemetry AlarmsWhen you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected.
15 Assigning Two Devices to One Patient Functions Available For Devices Connected Via SRR186Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device. Using StandbyWhen you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring. Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device. Functions Available For Devices Connected Via SRRThe Telemetry Device window can be opened from the Measurement Selection window, by selecting the Tele pop-up key, or via Main Setup -> Telemetry Device.The window shows the equipment label of the assigned telemetry device and, for monitors with SRR capability, a battery status symbol and a symbol indicating the signal quality of the SRR link . If the monitor has a connection to an Information Center, the pop-up keys Unpair to Mon. and Unpair to Tele let you end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device.If the monitor does not have a connection to an Information Center, or there is a pairing mismatch, the Unassign Tele pop-up key lets you end the telemetry device assignment and close the SRR link.Temporarily Stopping the Short Range Radio ConnectionTo temporarily disable the SRR connection for this device, for example, in case of interference:♦Select the Stop SRR pop-up key.This closes the SRR link and the telemetry device switches over to standard telemetry transmission. The battery status symbol will no longer be shown and the SRR quality indicator symbol will be crossed out.To return to SRR use:♦Select the Start SRR pop-up key and press the Check button on the telemetry transceiver.Telemetry DeviceTele 1
General Telemetry-related Functions 15 Assigning Two Devices to One Patient187Setting Up MeasurementsThe Setup ECG and Setup SpO2T pop-up keys give you access to the measurement setup menus. The Measmt. Select. pop-up key takes you directly to the Measurement Selection window where all connected measurement devices are shown.General Telemetry-related FunctionsThe following functions are valid for directly and indirectly connected telemetry devices.ECG Source Tracking at the Information CenterThe Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated — the ECG Setup menu will no longer be accessible.When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitor’s own measurements, the SpO2T measurement (if present) will no longer be displayed.In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa. In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. Synchronized SettingsIf ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:Heart Rate HR/Pulse Alarm On/Off, Heart Rate High/Low Limit, ECG Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead PlacementArrhythmia Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/OffST ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm LimitQT QT analysis On/Off, QT Lead, QTc High Alarm On/Off, 'QTc Alarm On/Off, QTc High Limit, 'QTc High Limit, QTc Formula2, QT BaselineSpO2TSpO2 Alarms on/off, SpO2 Alarm limitsNBP Alarm Suppression On/Off, Pulse(SpO2) On/Off
15 Assigning Two Devices to One Patient Use Models With Telemetry188WARNING • Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate.• Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient.Use Models With TelemetryThe standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the Information Center in the same patient sector as the monitor data. The following variations are possible:1X2 monitor is paired with a telemetry transceiver - direct connection– telemetry data appear on the monitor– the X2 cannot be connected to a host monitor (Companion Mode)2X2 is declared as a telemetry device and paired with one of the larger monitors (MP20-90)– X2 measurement data appear on the monitor it is paired with– a telemetry transceiver cannot be used with the X23A telemetry transceiver with a short range radio adapter is assigned to an X2 which is connected (Companion Mode) to a larger host monitor (MP20 - MP90) - direct connection.– telemetry data appear on the host monitor– telemetry transceiver is paired with the host monitor but is assigned to the X2–the X2 must have no equipment labelThe different variations require different configuration settings; refer to the Configuration Guide for details.NOTE If a telemetry transceiver is directly connected to an X2 or MP5 that is connected (via Companion Mode) to a host monitor with revision F software, a TELE CONFIG UNSUPP INOP will appear as this combination is not supported.1.Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is notone of V1 through V6.2.These setting will only be synchronized when the Information Center supports QT Analysis for Telemetry.
1891616Enhancing TelemetryMonitoring with the MonitorYou can use a monitor without a network connection to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio. Monitor and Telemetry Transceiver RequirementsThe monitor and the telemetry transceiver need a direct connection via a short range radio link. Not all revisions of the telemetry transceiver can be used directly with the monitor, if you connect a device that cannot be used you will see a TELE UNSUPPORTED INOP. Due to data availability restrictions, it is not recommended to use a monitor connected to a host monitor (Companion Mode) to collect data in this way. If such a monitor is used a CENTRAL: TELE ONLY INOP will be displayed.Data Sent to the Information CenterThe data sent to the Information Center includes numerics from NBP, SpO2, Pulse from SpO2 and predictive temperature. INOPs from these measurements, battery INOPs and a general INOP generated by alarms from any other measurement (MORE BED ALARMS) will also be transmitted.NOTE The monitor must be configured appropriately to support direct connection to a telemetry transceiver; refer to the Configuration Guide for details.Changing Assignment to a New Telemetry Transceiver1Assign the telemetry transceiver to the monitor; see “Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor” on page 183. 2Make the required measurements; the data will be automatically sent to the Information Center via the telemetry transceiver. It is not necessary to unassign the telemetry transceiver. This will happen automatically when the next telemetry transceiver is assigned. The patient is also discharged (if configured), ensuring that the measurement data is erased before data from the next patient appears. Always assign the telemetry transceiver before you start making measurements.
16 Enhancing Telemetry Monitoring with the Monitor190
1911717TrendsTrends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient’s condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-measured parameters, such as Cardiac Output.Viewing TrendsTrend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen. ♦To view trends embedded as a screen element, enter the Change Screen window, then select a Screen designed to show an embedded trend window.♦To open the tabular trends window, select Main Setup > Trends > Vitals Trend, or select the Vitals Trend SmartKey. ♦To open the graphic trends window over the current Screen, select Main Setup > Trends > Graph Trend, or select the Graph Trend SmartKey.The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the latest available measurement value. The preview column is updated every five minutes or whenever an NBP or other aperiodic measurement is completed. A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement. Your monitor screen may look slightly different to the examples shown in this chapter.Trends Pop-Up KeysWhen you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks.Vitals TrendGraph Trend
17 Trends Viewing Trends192Viewing Graphic Trends A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column. In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.To use the trend cursor to navigate in time through the trends database,1Select the graphical trend or the arrow pop-up keys to activate the cursor.2Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, orPop-Up Keys Selecting this pop-up key lets you....Select Groupsee a pop-up list of trend groups and select a group for viewing. Select Intervalsee a pop-up list of available data resolution settings and select the level of detail shown in the trend view.Print print a graphic trends report of the data in the current window. The report will use the current trend interval settings.move the cursor one step to the left or right to navigate through the trends database timeline. move the cursor one page to the left or right to navigate through the trends database timeline.scroll up and down the screen to see measurement trends that do not fit in the current view.Vital Signsopen the current trend view in tabular form. The displayed time period and resolution stay the same.Graph Trendopen the current trend view in graphic form. The displayed time period and resolution stay the same.Graphical Trends: StandardHRSpO2RR4 AprSelect Interval Scroll to view more pop-up keysSelect GroupVital SignsPrint
Setting Up Trends 17 Trends1933Place the cursor at a specific time by touching the graph.Viewing Vital Signs TrendsThe currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets.If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow. Setting Up TrendsTrends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under Main Setup -> Trends. Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu.Making Segment SettingsThe Graphical Trends window is divided into measurement segments, each of which has its own settings.To enter the segment menu,♦select the left hand column of the segment, where the measurement label is displayed.Expanded ViewTo expand the segment to fill the Graphical Trends window, ♦in the Segment menu, select Expand to have that segment enlarged to fill the window.Vital Signs: StandardHRSpO2etCO2Aperiodic values are shown with a timestampimCO2RRawRRSelect GroupGraph TrendPrintSelect Interval Scroll to view more pop-up keys
17 Trends Setting Up Trends194In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement,♦in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement.To return the segment to its original size,♦in the Segment menu, select Expand again.Trend Scales for Segment MeasurementsTo change the trend scales for a measurement in the current segment:1In the segment menu, select the measurement label2Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale.Optimum ScaleTo have the monitor automatically select an optimum scale for viewing, based on current values,♦in the Segment menu, select Optimum Scale.This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in Parameter Scales. To switch off automatic optimum scaling,♦in the Segment menu, select Optimum Scale again.Trend GroupTo add or remove measurements for this trend group or change the order of the existing measurements:1In the Segment menu, select Change Group2Use the Add, Change, Sort Up and Sort Down popup keys to change or re-order the group as required.No. of SegmentsIn an embedded graphical trend window, you can select the number of segments to be displayed in the Segment menu:♦In the Segment menu, select No. of SegmentsTrend GroupsThe measurements grouped in trend groups define the trends displayed together in the Vital Signs or Graphics Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group All contains all available measurements, you cannot change the order or selection of this group. To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or:
Setting Up Trends 17 Trends1951Select Main Setup -> Trends -> Trend Groups2Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended. To temporarily change the order in which the measurements are displayed in a group, 1Select Main Setup -> Trends -> Trend Groups2Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort Down pop-up keys. Trend Interval The trend interval defines the resolution of trend data shown on the Screen. To set the trend resolution, in the Vital Signs or Graphical Trends window, ♦Select the Select Interval pop-up key and then select the required interval from the list. Trend PriorityThe monitor stores trend information for all monitored measurements, if configured to do so. If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements. To see the measurement priority list for trending, 1In the Main Setup menu, select Trends.2Select Trend Priority. To add measurements to the priority list, 1Select the pop-up key Add and choose from the pop-up list of available measurements. 2Use the Sort Up and Sort Down pop-up keys to change the priority order. Trend Parameter ScalesParameter scales define how the trend waveform will appear on the screen and in trend reports. Separate scales can be set for adult, pediatric, and neonatal patient trends. To change the trend parameter scales settings, either use the Scale setting in the Segment menu or: 1In the Main Setup menu, select Trends.2Select Parameter Scales. 3Select the measurement or parameter you want to change from the list. 4Select the pop-up key Change to call up the Scale menu. 5In the Scale menu, select the parameter label you want to define settings for. Select Adult, Pedi, and Neo and use the pop-up keypad to enter new upper and lower scale definitions.Graphical Trend PresentationGraphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, 1Select Main Setup -> Trends
17 Trends Documenting Trends1962Select Global Style and choose•Line to display the trends as a continuous line•Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color. This sample ABP trend shows the continuously-measured values for the systolic, diastolic and mean pressures displayed in band form. Documenting Trends To print a Vital Signs or Graphical Trends report, ♦in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor’s configuration. Trends reports can be printed on central or local printers. Trends DatabasesThe trend databases store information for up to 16 measurements for up to 48 hours.The values in the trends database are stored as measured by the monitor, they are not averaged values. The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown.Example database configuration In this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution. “4 hours @ 12 second resolution” means that the monitor stores trend data every 12 seconds, for the most recent four hours. ABP24050
Screen Trends 17 Trends197Aperiodic Trends DatabaseAperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time. Trending Multiple-Value MeasurementsSome measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements.Screen TrendsTrends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, histogram or horizon format.If you do not see screen trends on the monitor Screen, select a different Screen, one that is configured to show screen trends. Screen trends are only available on specially designed Screens.Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended. - 48 hours- 24 hours- 4 hours nowtime4 hours @12 second resolution24 hours @ 1 minute resolution48 hours @ 5 minute resolution
17 Trends Screen Trends198NBPsNBPM1mVHR PerfTempALARMS OFFArrhythmia OffSBed9 AdultSpO2Auto 15 min-60min -30minSys.ABP24050NBP graphical screen trendExample of other graphical screen trends: ABPMeasurement waveMeasurement numerics65NBPs-60min -30min65NBPNBPSys.M1mVHR SpO2TempALARMS OFFArrhythmia OffMeasurement waveSBed9 AdultPulseAuto 15 minMeasurement numericsTabular screen trend
Screen Trends 17 Trends199Setting the Screen Trend TimeTo set the ScreenTrend Time for all graphical, histogram and horizon screen trends (“global” trend time), 1Select a screen trend then select Setup Trend, or select Main Setup -> Trends.2Select ScreenTrend Time and select the required time: 30 minutes, one, two, four, eight, or twelve hours.This is now the Global screen trend time and defines the period of trend information shown for all screen trends. To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends,1Select a screen trend2Select Change TrendTime3Select the required trend time.Selecting Global leaves the trend time set to the global screen trend time. Changing the Selection of Screen Trends Displayed1Select the screen trend.2Select Change Trend and select the required trend from the list of available trends.Select Blank to remove the selected trend from the Screen. If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend. To display two or more screen trends overlapping, 1Select the screen trend to open the screen trend menu, 2Select Change Trend -> Add Trend and select a screen trend from the pop-up list. Activating the Cursor for Screen TrendsTo activate the cursor for Screen Trends:1Select the screen trend.2Select Activate CursorYou can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor. To de-activate the cursor,♦Press the Main Screen key.Changing the Screen Trend View ♦To switch between tabular, graphic, histogram and horizon views, select the screen trend then select Change View and select the required view. Tabular ViewAperiodic measurements such as NBP, can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label.
17 Trends Screen Trends200Horizon ViewThe horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient’s condition since the baseline was set. The horizon view is made up of: • a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient’s condition. The horizon can be set to represent your patient’s current condition, or a target condition and can be a single value or a range. • a graphical trend, displaying patient data for the set TrendTime (1).• a trend indicator arrow, indicating how the patient trend has developed in the set time period (10 minutes, 5 minutes or 2 minutes) (2).• a deviation bar, showing how the currently measured value deviates from the set horizon (3). The height of the deviation bar is an indication of the extent of the change in your patient’s condition relative to the (horizon) baseline. Your monitor may not be configured to show all elements of the screen trend horizon view.Setting the HorizonThe horizon is the reference value to which deviations in the measurements are compared.1To set the horizon, select the horizon trend2Select–Set High Horizon to select the upper horizon value. If the high and low horizon values are the same, the horizon is a baseline - if the values are different the horizon is a range.–Set Low Horizon to select the lower horizon value.–Auto Horizon to set the horizon for the selected horizon trend to the currently-measured value–Auto All to reset the horizon for all horizon screen trends to the currently-measured values–Set Horizon to set the horizon to a specific value from a pop-up list.Setting the Horizon Trend ScaleThe horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.To set the horizon trend scale delta,1Select the horizon trend.NBPSys.123
Screen Trends 17 Trends2012Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits. Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient’s condition having changed.If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits. Setting the Time Period for the Trend Indicator ArrowThe time period for which the trend indicator arrow can be set in the Trends window. 1Select Main Setup > Trends2Select HorizonArrowTime.3Select 10, 5 or 2 minutes.
17 Trends Screen Trends202
2031818 RecordingCentralRecordingFor central recording from the bedside, your monitor must be connected via a network to an Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A 4-Channel Recorder. See the documentation supplied with the Information Center for information on the 4-Channel Recorder.When an X2 is connected to a host monitor (Companion Mode is indicated):• No central recording is available on the X2. Central recordings are made via the host monitor.• Local recordings may be available. See the Instructions for Use for your host monitor for details.Starting and Stopping RecordingsThe recordings pop-up keys let you start and stop recordings. Select the Main Setup SmartKey then select Recordings to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.Recording Without a TemplateTo record without a preconfigured template, selecting the waves you require,1Select the Main Setup SmartKey then select Recordings.2Select the pop-up key Select Waves,3Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key.4Select one of the recording speed pop-up keys to set the required recording speed. 5Select the Start pop-up key to start the recording.Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping. DelayedRecordng RT A RecordngRT B RecordngSelect WavesSetup RecordngStop all Recordng
18 Recording Overview of Recording Types204Overview of Recording TypesCreating and Changing Recordings TemplatesTo save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the Setup Recording menu. You can create templates for one delayed recording, one alarm recording and two realtime recordings (Realtime A and Realtime B).Changing recordings templates changes the settings that will be used each time a recording of this name is triggered.1Select the Main Setup SmartKey to call up the Main Setup menu.2Select Recordings.3Select the Setup Recording pop-up key to enter the Setup Recordings menu.4Select the name of the template you want to create or change. Each recording name is linked to a recording type: delayed, alarm, and realtime. Recording names can be changed in the monitor’s Configuration Mode.5Design the template by selecting each menu item and entering the information for the template. •Recorder: choose which recorder the recording will print to (Central 2-Ch. or Central 4-Ch. recorder, or a printer (for realtime reports in alarm recording only)). •Channels 1 - 4: choose which waveform to record in each channel.In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:–Alarm Par will always record the measurement in alarm in the chosen recorder channel–Primary Lead will always record the current primary lead in the chosen recorder channelDelayed Alarm Realtime (RT)Type of recording manual automatic, triggered by defined alarm conditions manualRecording Destination central central printer centralInformation recordedfrom the start trigger minus the delay timefrom the start trigger minus the delay timeN/A from the start triggerNumber of waves up to 2 up to 2 N/A up to 2Speed 50, 25, 6.25 mm/sec 25 mm/sec N/A 50, 25, 6.25 mm/secRuntime N/A N/A N/A continuouslyStops automatically automatically N/A manuallyDelay Time 10, 15 seconds 10, 15 seconds N/A noneOverlap OffOn (up to 2 waves)OffOn (up to 2 waves)N/A OffOn (up to 2 waves)N/A = not applicable
Recorder Status Messages 18 Recording205–Secondary Lead will always record the current secondary lead in the chosen recorder channel•Overlap: define whether the recorded waveforms will be printed overlapping or beside each other.•Speed: choose the recording print speed.•Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the “Delay Time” and can be set as specified in the table on page 204. This setting can only be changed in Configuration Mode.•Runtime: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely.•Central Config - if available in the General menu, select this setting to use the recording settings made for the centrally-connected recorder.Maintaining Recording StripsRecording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation. Recorder Status MessagesCAUTION If no central recorder is available, alarm recordings may be lost. The message No alarm recording available will be displayed. This message is not shown if Printer is configured as the alarm recording destination.Recorder Status Messages Explanation<Recording name> running The named recording is currently running. No alarm recording available No recorder available. Alarm recordings will be lost. Try configuring Printer as the alarm recording destination.Central Recorder out of paperThe named recorder is out of paper.Central Recorder door open The door of the specified recorder is open.
18 Recording Recorder Status Messages206
2071919Printing Patient ReportsStarting Report PrintoutsMost patient reports can be printed by selecting Main Setup - > Reports (or the Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up. Data from the time of the print request is printed, even if the print job is delayed in the printer queue.Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up 1Select Main Setup - > Reports 2Select Auto Print Dbs. –Always will print all reports when a matching printer is available. –Host only will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in grey on the Reports Job List) must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 211.–Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 211.Depending on availability, reports can be printed on printers connected to the Information Center, an external PC-based print server or into the print database. Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available. Print jobs in the print database are not deleted after a patient discharge. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient. When the X2 is connected to a host monitor, reports requested or stored on the X2 can be printed via the host monitor. Reports requested on the X2 when connected to a host monitor will not show any patient alarms or INOPs. In order to see alarms, reports should be requested on the host monitor.
19 Printing Patient Reports Stopping Reports Printouts208Stopping Reports Printouts♦To stop Reports printing, in the Reports menu, select –Delete Report to stop the current print job –Delete All Repts to cancel all queued report printouts–Scheduled Rep. to toggle to Off and switch off scheduled reports.Setting Up ReportsECG report layout and Auto Reports settings must be defined in Configuration Mode. The content you define in the individual Setup Reports menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report will be printed at this speed, irrespective of format.Setting Up ECG ReportsThe settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG Reports, 1Select Main Setup -> Reports -> ECG Reports. Note the report layout configured for your monitor, either Internat. or Cabrera. This setting is inactive (“grayed-out”) in Monitoring Mode and can only be changed in Configuration Mode. 2Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the ECG report printouts. 3Select Speed and select the report print speed.Report types Report contents How to start printing reportsVital Signs Report depends on selected trend group, data resolution, and period.In the Vital Signs window, select PrintGraphic Trends Report In the Graphic Trends window, select PrintECG Reports Depends on format selected Select the ECG Report SmartKeys, if configuredST Map Report ST data in a transversal and/or horizontal multiaxis diagram, In the ST Map window, select Print.Alarm Limits Report Graphic and numeric report of all current alarm limitsIn the Alarm Limits window, select Print LimitsRealtime Reports Patient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT wavesSelect the Realtime Reports SmartKey, if configuredBattery Report Battery serial number, information on the currently-measured and potential charge status of the batteryIn the Battery Status window, select Print Status.Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available.In the Main Setup select Reports then Central Report A, B or C.
Setting Up Reports 19 Printing Patient Reports2094Select Annotation and toggle to On if the printed ECG wave should be annotated with beat labels or not. See the chapter on ECG for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.Setting Up Vital Signs and Graphic Trend Reports The settings you choose in the Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed.To set up Vital Signs and Graphic Trend reports,1Select Main Setup -> Reports -> Vital Signs Rep. or Graph Trend Rep. 2Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor’s trend configuration.3Select Period and select the period of time for which trend data should be printed on the report. If Automatic Period is configured to On, all trend data for the current patient will be printed, irrespective which trend period is selected.4Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report, Setting Up Auto Reports Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports: Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report. To set up Auto Reports, 1Select Main Setup -> Reports -> Auto Reports and select the Auto Report you want to set up (A, B, C, or D).2Select Report and assign a report type to the Auto Report. 3Select End Case Report and toggle to On if you want the selected report to print automatically when you select End Case to discharge a patient.Toggle End Case Report to Off if the report is a Scheduled Report only.4Select Scheduled Rep. and toggle to On if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day. For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on. – To set the time of day at which you want the report to print every day: select Start Hour and Start Minute and select the required time from the pop-up list – To set the time interval in minutes between two scheduled reports: select Rep. Freq.(Hr) and Rep. Freq.(Min) and select the time interval from the pop-up list.If you are setting up an end case report, these settings will be inactive (“grayed-out”).Toggle Scheduled Rep. to Off if the report is an End Case Report only.5Repeat the procedure for all Auto Reports you want to set up. All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger.Be aware that the monitor’s memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost.
19 Printing Patient Reports Setting Up Individual Print Jobs210Setting Up Individual Print JobsTo adjust the appearance of individual print jobs, in the Reports menu, 1Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu.2Select Report and then select the report you want to set up. 3Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected. Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:VisibleWaves: all waves currently visible, in the order they appear on the screen.All Waves: all measured waves,RT Waves: all currently measured realtime waves, according to the monitor’s priority list.Vital Signs: trend information in tabular form.Graph Trend: trend information in graphic form.ECG3X4, ECG6X2, ECG12X1, ECG4X2, ECG8X1, ECG12X1(2P): ECG reports.Alarm Limits: a list of all currently set alarm limits.4Select Report Size to set the paper size to be used for the report: Unspecified to use the default size for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or Ledger. The list of available sizes depends on the report type selected.5Select Orientation to set the orientation of the report printout: Unspecified to use the default size for the template chosen, Landscape or Portrait.6Select Target Device and choose which printer the print job will be sent to: Unspec. to use the default printer, or choose from the list of printer names defined at the Information Center or in the monitor’s Configuration Mode (for example, Remote 1 or Database). Some settings may be inactive (“grayed-out”) in this menu for reports that can only be started in a special window.Checking Printer Settings The printer settings for your monitor are defined in Configuration Mode. The printer settings Paper Size, Resolution, Color Support, and Duplex Option for the active printer are visible but inactive (“grayed-out”) in the Setup Printers menu. When Print Database is selected as active printer only the Paper Size setting will be shown. ♦To enter the Setup Printers menu, in the Reports menu, select Setup Printers.Printing a Test ReportA test report can be printed in Configuration mode, refer to the Service Guide for details.Switching Printers On Or Off for ReportsYou can enable or disable printer status to switch individual printers on or off for report printouts.
Dashed Lines on Reports 19 Printing Patient Reports2111In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.2Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Enabled/Disabled setting will automatically be set to Disabled and “grayed out”.Dashed Lines on ReportsIf a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing. For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place. Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports. To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.Unavailable Printer: Re-routing ReportsIf you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitor’s memory.If the target device of this print job was set to Unspecified, the monitor will periodically try to resend the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and that has paper of the correct size. To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-route a print job,♦Enable the new target printer by selecting it in the Setup Printers menu and toggling to Enabled. As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.If the target device of the print job was set to a specific printer, re-routing is not possible. Checking Report Status and Printing ManuallyA list of all print requests which are waiting, printing or stored can be viewed in the Reports Job List. To view the list, ♦in the Reports menu, select Reports Job List.The following information is displayed for each print request:• Report title
19 Printing Patient Reports Printer Status Messages212• Patient name (except for system reports such as the battery status report)• Request date and time• Report paper format• Job status: Preparing, Printing, Waiting, In Database, In Companion, Retry, Cancelling, ErrorIndividual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Reps key. CAUTION The reports job list includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality. Printing ManuallyThose jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host only or Never, some or all reports will not be printed automatically and will be shown in grey. Any jobs shown in grey must be printed manually; to do this, 1In the Reports Job List, select the required report2Select Print Report.Selecting Print All Reps. will send all reports to the printer. Printer Status MessagesPrinter Status Message Possible causes and suggested actionPrint job queued <Printer name>The report has been placed in the queue for the named printer. Print job can’t queue;queue fullThe printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again, OR A report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request.Cancelling all print jobsStop All Reports has been selected in the Report menu, ORThe Operating Mode has been changed from Monitoring Mode to Demonstration or Service Mode.Cancelling the active print jobThe current report is being cancelled as the result of a user request.Deleted N print jobs;dischargeWhen a patient is discharged, all queued reports are cancelled except those stored in the print database. “N” is the number of reports cancelled.Deleted N print jobs; hotstartThe monitor has restarted and all report requests have been cancelled except those stored in the print database. “N” is the number of reports cancelled. Print failed;No report configurdA report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report.
Sample Report Printouts 19 Printing Patient Reports213Sample Report PrintoutsEach report header contains the patient’s bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end.The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the Addressograph and it can only be changed in the monitor’s Configuration Mode.Printing on <Printer name>A report is in progress, or the monitor is waiting for the central printer to accept the print job. NoPrinter <Printer name>;job suspThe chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available.Print Database full->job suspnd.The requested report does not fit into the print database. You can select another printer to print the report (see “Unavailable Printer: Re-routing Reports” on page 211). Alternatively you can delete another report from the Reports Job List (using the Stop report key) to create space for your report. Job <Printer name> fail; A report cannot be started on the requested printer. One of three reasons will also be shown in the status message: • data requisition error (data error) - an internal error has caused data required for the report to be unavailable, try starting the report again.• printer unavailable (no printer)- make sure the printer is plugged in, switched on, and has paper loaded. • data unavailable (no data) - the connected X2 or MP5 has been removed before the data for the report was transferred.Print job on <Printer name> doneThe report has been printed. Printer Status Message Possible causes and suggested action
19 Printing Patient Reports Sample Report Printouts214Alarm Limits ReportRealtime ReportNBed6 Doe, John 123456789-P1Alarm Limits 19 Apr 07 15:59:37HRST-IST-IIST-IIIST-aVRST-aVLST-aVFST-V1ST-V2ST-V3ST-V4ST-V5ST-V6SpO2NBPsABPsRRApnea Time 20 secMeasurement labels, with alarms off symbol where alarms are switched offGraphic view of current alarm limits in relation to currently monitored measurement valueNBed6 Doe, John 123456789-P1Realtime Report 19 Apr 07 15:59:54Patient Cat.: AdultPaced: NoGender: MaleDate of Birth: 19 Nov 1963Age: 43 yearsHeight: 69 inPatient Cat.: AdultPaced: NoST-aVR 0.0 mmST-aVL 0.0 mmST-aVF 0.0 mmST-V1 0.0 mmST-V2 0.0 mmST-V3 0.0 mmST-V4 -0.1 mmST-V5 0.0 mmHR 60 bpmPVC 0 /mST-I 0.0 mmST-II 0.0 mmST-III 0.0 mmST-V6 0.0 mmSpO2 -?- %Pulse -?- bpmPerf -?-NBPPulseABP 119/81 (93) mmHgST-V5 0.0 mm**ABPs HIGHSpO2 NON-PULSAT.Bandwidth 0.5-40 Hz Non-Paced 10mm/mV 25mm/secPatient demographic information, time stampActive Alarms and INOPs, followed by vital signsMeasurement waves section
Sample Report Printouts 19 Printing Patient Reports215ECG ReportsBelow the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patient’s paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.Other ReportsSee the sections on Trends for other example reports.ECG Report type Available Formats Available Paper Sizes12-Lead ECG 3X4 landscape A4, letter, A3, ledger6X2 landscape A4, letter, A3, ledger12X1 portrait A4 and letter only12X1 landscape A4, letter, A3, ledger12X1 (2P) landscape A4, letter (2 pages)Multi-lead ECG 2X4 landscape A4, letter, A3, ledger8X1 portrait A4 and letter only8X1 landscape A4, letter, A3, ledgerPatient informationNumeric blockWave area
19 Printing Patient Reports Sample Report Printouts216
2172020Care and CleaningUse only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods.Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to “Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-Safety Workers” issued by the U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country.General PointsKeep your monitor, cables and accessories free of dust and dirt. After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first. Observe the following general precautions:• Always dilute according to the manufacturer’s instructions or use lowest possible concentration.• Do not allow liquid to enter the case.• Do not immerse any part of the equipment or any accessories in liquid.• Do not pour liquid onto the system.• Never use abrasive material (such as steel wool or silver polish).• Never use bleach.WARNING If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.
20 Care and Cleaning Cleaning the Monitor218Cleaning the MonitorClean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene. Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement connectors. Wipe around, not over, connector sockets.CAUTION To clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by pressing and holding the Main Screen key for two seconds. Press the Main Screen key again to re-enable touch operation. Recommended cleaning agents are:Disinfecting the MonitorCAUTION Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.Hospital policy: Disinfect the product as determined by your hospital’s policy, to avoid long term damage to the product. Clean equipment before disinfecting. Recommended types of disinfecting agents are:Sterilizing the MonitorSterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies.Tensides (dishwasher detergents) Edisonite Schnellreiniger£, Alconox£Ammonias Dilution of Ammonia <3%, Window cleanerAlcohol Ethanol 70%, Isopropanol 70%, Window cleanerBase Approved AgentsAlcohol Ethanol up to 70%1- and 2- Propanol up to 70%Aldehyde Glutaraldehyde up to 3.6%
Cleaning, Sterilizing and Disinfecting Monitoring Accessories 20 Care and Cleaning219Cleaning, Sterilizing and Disinfecting Monitoring AccessoriesTo clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory. Cleaning Batteries and the Battery CompartmentWipe with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap. Do not use strong solvents. Do not soak the battery.
20 Care and Cleaning Cleaning Batteries and the Battery Compartment220
2212121Using BatteriesWhen monitoring a patient, one Philips M4607A rechargeable Lithium Ion battery must always be inserted into the battery compartment on the right side of the X2. This applies even when you are running the X2 external power, either via the external power supply or when connected to a host monitor. The battery has the effect of sealing the battery compartment, thereby preventing the ingress of fluids or foreign bodies. A severe yellow INOP (!!INSERT BATTERY) will be issued if the monitor is connected to AC mains without a battery fully inserted in the battery compartment. This INOP will persist until a battery is loaded.To use the X2 with battery power, disconnect it from the host monitor or the external power supply (M8023A).You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. When an X2 is connected to a host monitor, no battery data from the X2 is visible on the host. Battery INOPs, however, are displayed.The battery recharges automatically when the X2 is connected to a host monitor (running either on AC mains or battery power) or the optional external power supply (M8023A).Battery compartment
21 Using Batteries Battery Power Indicators222Battery Power IndicatorsThe battery LED and battery status information on the Main Screen, in combination with INOP messages and prompts, help you keep track of the battery power status. The indicators always show the remaining capacity in relation to the battery’s actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window. Battery LEDThe battery LED on the front panel of the monitor is indicated by a battery symbol.The battery LED is yellow during charging and switches off when the battery is charged.Battery Status on the Main ScreenBattery status information can be configured to display permanently on all Screens. It shows the status of the battery, with the battery power remaining and, when the battery is not charging, an estimate of the monitoring time this represents. Battery power gauge: This shows the remaining battery power. It is divided into sections, each representing 20% of the total power. If three sections are filled, as in this example, this indicates that 60% battery power remains. If no battery is detected, a blank battery gauge marked with a flashing red X is displayed. If no data is available from the battery, a question mark is shown in the gauge.Battery LED Colors If the X2 is connected to a host monitor or external power supply (M8023A)If the X2 is running on battery power, this meansYellow battery chargingRed, flashing less than 10 minutes power remainingRed, flashes intermittently battery or charger malfunction battery or charger malfunctionBattery LED
Battery Power Indicators 21 Using Batteries223Battery status/malfunction indicator: Normal battery function is indicated by the battery power gauge, together with the remaining operating time, on the Main Screen. You are informed of problems or changes in the status of the battery by the battery status/malfunction indicator. This consists of a blank battery gauge containing a symbol. If the symbol is red, this indicates a critical situation. You can check the specific cause of the problem by looking at the symbol(s) displayed in the Battery Status window (see page 223).Monitoring Time Available: While the X2 is running on battery power, a time is displayed below the battery power gauge. No time is displayed when the X2 is running on external power via a host monitor or the external power supply (M8023A). This is the estimated monitoring time available with the current battery power. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery. Battery Status Window♦To access the Battery Status window and its associated pop-up keys, select the battery status information on the Screen, or select Main Setup -> Battery. Capacity, remaining tells you how much power is left in the battery.Capacity, fullCharge tells you how much power the battery can hold when fully charged. Battery status indicator Battery malfunction indicatorAlternates with the battery gauge on the Main Screen.Check in the Battery Status window to see which status symbol is displayed to identify the cause.The red ! flashes. Critical battery situation or malfunction. Check in the Battery Status window to see which malfunction indicator is displayed, or refer to the INOP, to identify the cause.Indicator for missing battery (flashing red X). An INOP is issued when the battery compartment is empty, and the X2 is connected to external power (a host monitor or the optional external power supply). This !!INSERT BATTERY INOP is suppressed for 15 seconds while the monitor is connected to AC mains power, allowing you sufficient time to load a new battery. After silencing, the INOP reappears every 10 seconds until a battery is loaded.!!XBattery StatusTimeToEmpty:CapacityremainingfullCharge[mAh][mAh]2:33 hrs
21 Using Batteries Checking Battery Charge224TimeToEmpty tells you approximately how long you can continue to use the monitor with this battery. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery.TimeToFull is shown in place of TimeToEmpty if the monitor is connected to mains power via a host monitor or the M8023A external power supply, and tells you how much time is left until the battery is charged to 90%. You can use the M8043A Smart Battery Charger to charge the batteries externally.Battery status/malfunction symbols: If a problem is detected with the battery, an INOP may be issued, and the following symbols are displayed in the Battery Status window, where they may be accompanied by a battery status message providing more details. Messages appear in the line where TimeToFull/TimetoEmpty is shown. Symbols indicating critical situations are colored red.Printing Battery ReportsTo print the information in the Battery Status window on a connected printer,1Select the battery status information on the Screen to open the Battery Status window 2Select the Print Status pop-up key. Checking Battery Charge♦To check the charge status of a battery in a monitor, see the battery power gauge on the Screen or select Main Setup -> Battery to enter the Battery Status window.♦To check the charge status of a battery that is not connected to a monitor or battery charger, press the black dot marked “PUSH” on the labeled side of the battery. The remaining charge is indicated by four LEDs on the electronic fuel gauge directly above the dot. Each LED represents 25% of charge. If all LEDs are lit, the battery is fully charged, if only one LED is lit, 25% or less charge is left.Battery status symbols Battery malfunction symbolsbattery is empty (red) incompatible battery battery not charging as the temperature is above or below the specified range(red) battery malfunction battery requires maintenance (red) battery has no power leftcharging stopped to protect the battery (red) battery temperature too high
Replacing a Battery 21 Using Batteries225Replacing a BatteryTo replace the battery,1Press the battery eject button. This releases the battery.The INOP !!INSERT BATTERY is suppressed for 15 seconds, allowing you sufficient time to load a new battery.2Remove the battery from the compartment.3Slide the new battery into position with the contacts facing downwards. It should ‘click’ into position when it is fully inserted.Optimizing Battery PerformanceThe performance of rechargeable batteries may deteriorate over time. Battery maintenance as recommended here can help to slow down this process.Display Brightness Setting ♦In the Main Setup menu, select User Interface -> Brightness - > Optimum. This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings. Satisfy yourself that this level of brightness is suitable for your monitoring location. Battery eject buttonClick!
21 Using Batteries Optimizing Battery Performance226Note that your monitor may be configured to dim or brighten the display brightness automatically when you disconnect from power, to suit the most common transport scenario (“TransportBrightn” setting). Charging a BatteryA battery can be charged in a monitor during monitoring. You can also use the M8043A Smart Battery Charger to charge batteries.1Insert the battery into an X2 connected to a host monitor or the external power supply (M8023A) that is connected to mains power.2Charge the battery until it is full, the battery LED goes out, and the battery power gauge is filled.In certain situations, internal temperature conditions may mean that the battery will not charge. This is sometimes necessary to protect the battery from damage, and does not indicate a malfunction. In this case you must use the M8043A Smart Battery Charger to charge the battery.Conditioning a BatteryYou must condition a battery when its “battery requires maintenance” symbol shows on the Screen. Do not interrupt the charge or discharge cycle during conditioning. CAUTION Do not use a monitor being used to monitor patients to condition batteries. The monitor switches off automatically when there is no battery power left.You can also use the M8043A Smart Battery Charger for external battery conditioning (requires adapter, order number 4512 610 17451). For details please see the Instructions for Use for the Smart Battery Charger. Do not use any other battery chargers or conditioners.To condition a battery using a monitor, 1Insert the battery into an X2 connected to a host monitor or the external power supply (M8023A) that is connected to mains power.2Charge the battery until it is completely full. Open the Battery Status window and check that the Batt Fully Charged message is displayed. 3Disconnect the X2 from the external power supply (M8023A) or host monitor, and let it run until there is no battery power left and the X2 switches itself off.4Reconnect the monitor to mains power or a host monitor and charge the battery until it is full for use or charge to 50% for storage.Storing a BatteryA battery should not remain inside the monitor if it is not used for a longer period of time. Batteries should be charged to a maximum of 50% for storage. NOTE The battery will discharge over time if it is stored inside the X2 when not connected to a powered (either running or in Standby) host monitor or the external power supply (M8023A). The reported values for “remaining capacity” and “runtime” will become less accurate when the battery is stored in this way for a longer period of time (that is, several weeks).
Battery Safety Information 21 Using Batteries227Battery Safety InformationWARNING Use only Philips batteries part number M4607A. Use of a different battery may present a risk of fire or explosion.Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury.Dispose of used batteries promptly and in an environmentally-responsible manner. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements.CAUTION Do not disassemble, heat above 100°C (212°F) or incinerate the batteries, to avoid the risk of fire and burns. Keep batteries out of the reach of children and in their original package until you are ready to use them.If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Refer to qualified service personnel.
21 Using Batteries Battery Safety Information228
2292222Maintenance andTroubleshootingWARNING Schedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.Inspecting the Equipment and AccessoriesYou should perform a visual inspection before every use, and in accordance with your hospital’s policy. With the monitor switched off:1Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse.2Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use.3Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier.Inspecting the Cables and Cords1Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.2Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.3Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.
22 Maintenance and Troubleshooting Maintenance Task and Test Schedule230Maintenance Task and Test ScheduleThe following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation CD. Ensure that these tasks are carried out as indicated by the monitor’s maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.Maintenance and Test Schedule FrequencyMonitor TestsSafety checks. Selected tests on the basis of IEC 60601-1At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped.Monitor MaintenanceCheck ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation)At least once every two years, or as needed. Measurement TestsPerformance assurance for all measurements not listed below.At least once every two years, or if you suspect the measurement values are incorrect.Measurement MaintenanceNBP calibration At least once every two years, or as specified by local laws.Microstream CO2 calibration and performance testAt least once a year or after 4000 operating hours.Mainstream and sidestream CO2 calibration check At least once a year, or if you suspect the measurement values are incorrect.Battery MaintenanceBattery See the section on Maintaining Batteries
Troubleshooting 22 Maintenance and Troubleshooting231TroubleshootingIf you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly.If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log,1In the Main Setup menu, select Revision.2View the status log by selecting Status Log from the Monitor Revision window.Disposing of the MonitorWARNING To avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your country’s laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste.You can disassemble the monitor as described in the Service Guide.You will find detailed disposal information on the following web page: http://www.medical.philips.com/main/company/sustainability/recycling/patient_monitoring/The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium).Do not dispose of waste electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered.Disposing of Empty Calibration Gas Cylinders1Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.2When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.3Write “Empty” on the cylinder and dispose of it appropriately for scrap metal.WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.
22 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders232
2332323AccessoriesYou can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details.WARNING Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard.Philips’ approval: Use only Philips-approved accessories. Using non-Philips-approved accessories may compromise device functionality and system performance and cause a potential hazard.Packaging: Do not use a sterilized accessory if its packaging is damaged.ECG/Resp AccessoriesThis symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.The following cables may not all be available in all countries. Please check availability with your local Philips supplier.Recommended CablesTrunk Cables3-Electrode Cable Set5-Electrode Cable Set6-Electrode Cable Set10-Electrode Cable set(5+5)10-Electrode Cable set(6+4)Part No. M1669A M1668A M1667A M1663A M1665ALength 2.7m 2.7m 2.7m 2.0m 2.7m
23 Accessories ECG/Resp Accessories2343-Electrode Cable Sets 5-Electrode Cable Sets6-Electrode Cable Sets10-Electrode (5+5)Cable Sets10-Electrode (6+4)Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m M1675A M1678AICU Grabber shielded 1.0m M1671A M1672AICU snap shielded 1.0m M1673A M1674AICU Clip non-shielded 0.45m M1622A --ICU Clip non-shielded 0.7m M1624A M1626ADescription Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m/1.6m M1973A M1974AICU Grabber shielded 1.0m/1.6m M1968A M1971AICU Snap shielded 1.0m/1.6m M1644A M1645AICU Miniclip non-shielded 0.7m/1.3m M1647A M1648ADescription Length AAMI Part No. IEC Part No. OR Grabber 1.0m/1.6m M1684A M1685AICU Grabber 1.0m/1.6m M1680A M1681A ICU Snap 1.0m/1.6m M1682A M1683A Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded 1.0m M1976A M1978AICU Snap, chest, shielded 1.0m M1602A M1604AOR Grabber, chest, shielded 1.0m M1979A M1984AFor Limb Leads see 5-electrode cable setsDescription Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded 1.0m M1532A M1533AICU Snap, chest, shielded 1.0m M1537A M1538AOR Grabber, chest, shielded 1.0m M1557A M1558AFor Limb Leads see 6-electrode cable sets
ECG/Resp Accessories 23 Accessories235One-piece CablesRadio-translucent CablesPack of five single wires, radio-translucent, 0.9m, M1649ASet Combiners and OrganizersSupported CablesTrunk CablesDescription Length AAMI Part No. IEC Part No. 3-lead Grabber, ICU 1.0m 989803143181 9898031431715-lead Grabber, ICU 1.0m 989803143201 989803143191Set combiners and organizers Part No. Set combiner 3-electrode M1501A5-electrode M1502ASet organizer for shielded leadsets - grabber and snap3-electrode M1503A4-electrode M1664A5-electrode M1504A6-electrode M1679ASet organizer for non-shielded lead sets - miniclip3-electrode M1636A5-electrode M1638ABedsheet clip M1509AReplacement red cover for trunk cable (for 5-electrode cable sets)989808148861Length 3-Electrode Cable Set 5-Electrode Cable SetAAMI Part No. IECPart No. AAMI Part No. IECPart No. 0.9m M1540C M1550C M1560C M1570C2.7m M1500A M1510A M1520A M1530A
23 Accessories ECG/Resp Accessories2363-Electrode Cable Sets 5-Electrode Cable Sets3-Electrode One Piece Cables5-Electrode One Piece CablesSet Combiners and Organizers Description Length AAMI Part No. IEC Part No. OR 1.0m M1601A M1611AICU Grabber shielded 1.0m M1603A M1613AICU snap shielded 1.0m M1605A M1615AICU Clip non-shielded 0.45m M1608A M1618AICU Clip non-shielded 0.7m M1609A M1619ADescription Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m/1.6m M1621A M1631AICU Grabber shielded 1.0m/1.6m M1623A M1633AICU Snap shielded 1.0m/1.6m M1625A M1635AICU Clip non-shielded 0.7m/1.3m M1629A M1639A AAMI 3-Electrode One Piece CablesLength AAMIPart No. IEC 3-electrode One Piece CablesIECPart No. OR Grabber 1.9m M1970A OR Grabber M1980AICU Snap 1.9m M1972A ICU Grabber M1981A AAMI 5-electrode One Piece CablesLength AAMIPart No. IEC 5-electrode One Piece CablesIECPart No. OR Grabber 2.5m M1975A OR Grabber M1985AICU Snap 2.5m M1977A ICU Grabber M1986ASet combiners and organizers Part No. Set combiner 3-electrode M1501A 5-electrode M1502ASet organizer Shielded 3-electrode M1503AShielded 5-electrode M1504ABedsheet clip M1509A
NBP Accessories 23 Accessories237NBP Accessories These cuffs and tubings are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery.Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable CuffsReusable Cuff KitsAdult/Pediatric Antimicrobial Coated Reusable cuffsPatient Category Limb CircumferenceBladder WidthDisposable cuffPart No. Reusable cuffPart No. Tu b i n gAdult (Thigh) 42 to 54 cm 20 cm M1879A M1576A M1598B (1.5m) or M1599B (3m)Large Adult 34 to 43 cm 16 cm M1878A M1575AAdult 27 to 35 cm 13 cm M1877A M1574ASmall Adult 20.5 to 28 cm 10.5 cm M1876A M1573APediatric 14 to 21.5 cm 8 cm M1875A M1572AInfant 10 to 15 cm 5.5 cm M1874A M1571ACuff Kits Part No. Infant, pediatric, small adult, adult M1577ASmall adult, adult, large adult, thigh M1578AInfant, pediatric, small adult, adult, large adult, thigh M1579APatient Category (color) Limb Circumference (cm)Bladder Width Part No. Tu b i n gAdult Thigh (grey) 45 - 56.5 21.0 cm M4559A M1598B (1.5m) or M1599B (3m)Large Adult X-Long (burgundy) 35.5 - 46.0 17.0 cm M4558ALarge Adult (burgundy) 35.5 - 46.0 17.0 cm M4557AAdult X-Long (navy blue) 27.5 - 36.5 13.5 cm M4556AAdult (navy blue) 27.5 - 36.5 13.5 cm M4555ASmall Adult (royal blue) 20.5 - 28.5 10.6 cm M4554APediatric (green) 13.8 - 21.5 8.0 cm M4553AInfant (orange) 9 - 14.8 5.4 cm M4552A
23 Accessories Invasive Pressure Accessories238Adult/Pediatric Soft Single Patient Single-Hose Disposable CuffsNeonatal/Infant Cuffs (Disposable, non-sterile)Invasive Pressure AccessoriesThese transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.Patient Category Limb Circumference (cm)Bladder WidthPart No. Tu b i n gAdult (Thigh) 45 - 56.5 cm 20.4 cm M4579A M1598B (1.5m) or M1599B (3m)Large Adult X-Long 35.5 - 46 cm 16.4 cm M4578ALarge Adult 35.5 - 46 cm 16.4 cm M4577AAdult X-Long 27.5 - 36.5 13.1 cm M4576AAdult 27.5 - 36.5 cm 13.1 cm M4575ASmall Adult 20.5 - 28.5 cm 10.4 cm M4574APediatric 15.0 - 21.5 cm 8.0 cm M4573AInfant 9 - 15 cm 5.6 cm M4572A Cuffs Limb Circumference (cm)Bladder Width Part No. Tu b i n gSize 1 3.1 to 5.7 cm 2.2 cm M1866A M1596B (1.5m) or M1597B (3m)Size 2 4.3 to 8.0 cm 2.8 cm M1868ASize 3 5.8 to 10.9 cm 3.9 cm M1870ASize 4 7.1 to 13.1 cm 4.7 cm M1872ATransducer, accessories, sensor kits Part NoReusable pressure transducer 5 PV/.V/mmHg sensitivity CPJ840J6Sterile disposable pressure domes for CPJ840J6 (pack of 50) CPJ84022Transducer holder for CPJ840J6 (pack of 4) CPJ84046IV pole mount for CPJ840J6 CPJ84447Single channel disposable sensor kit (20) - (EU/EFTA only) M1567ADual channel disposable sensor kit (20) (EU/EFTA only) M1568ATransducer holder for M1567/8A (EU/EFTA only) M2271AIV pole mount for M1567/8A (EU/EFTA only) M2272CAdapter cable for disposable sensor kit 3,0m for M1567/8A M1634AMonitoring Line Set CPJ84026
SpO2 Accessories 23 Accessories239SpO2 AccessoriesThis section lists accessories for use with Philips SpO2 technology. For accessory lists for other SpO2 technologies, refer to the instructions for use provided with these devices. Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare.Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with:• Masimo adapter cables, • Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “Long” version).All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result.Product NumberDescription CommentsPhilips reusable sensors. M1191A/B Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb.No adapter cable required. M1191AL/BLM1191A/B with longer cable (3 m)M1192A Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb.M1193A Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot.M1194A Ear sensor (1.5m cable) for patients more than 40 kg.M1195A Infant sensor (1.5m cable) for patients between 4kg and 15 kg. Any finger except thumb.M1196A Adult clip sensor (3m cable) for patients over 40 kg. Any finger except thumb.No adapter cable required.
23 Accessories SpO2 Accessories240M1191T Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb.Requires M1943 (1 m) or M1943AL (3 m) adapter cableM1192T Small adult, pediatric sensor (0.45m cable) for patients between 15 kg and 50 kg. Any finger except thumb.M1193T Neonatal sensor (0.9m cable) for patients between 1kg and 4 kg. Hand or foot.M1196T Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb.M1191ANL Special Edition (SE) Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb.No adapter cable required. M1192AN Special Edition (SE)Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb.M1193AN Special Edition (SE)Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot.M1194AN Special Edition (SE)Ear sensor (1.5m cable) for patients more than 40 kg.No adapter cable required. M1195AN Special Edition (SE)Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb.Philips disposable sensors. Not available in the USA and Canada. M1904B Identical to OxiMax MAX-A Use adapter cable M1943A or M1943AL.M1903B Identical to OxiMax MAX-PM1902B Identical to OxiMax MAX-IM1901B Identical to OxiMax MAX-NPhilips disposable sensors. Available worldwide. M1131A Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg)Use adapter cable M1943A or M1943AL.Product NumberDescription Comments
SpO2 Accessories 23 Accessories241M1132A Infant finger or toe sensor, 0.9m cable (patient size 3 - 10 kg)Use adapter cable M1943A or M1943AL.M1133A Adult/Infant/Neonatal, 0.9m cableFoot or hand for neonates < 3 kgBig toe or thumb for patients between 10kg and 20kgAny finger except thumb for patients > 40kgUse adapter cable M1943A or M1943AL.NELLCOR disposable sensors (must be ordered from Nellcor)OxiMax MAX-AAdult finger sensor (patient size >30 kg)Use adapter cable M1943A or M1943AL.OxiMaxMAX-ALOxiMax MAX-A with long cableOxiMax MAX-PPediatric foot/hand sensor (patient size 10-50 kg)OxiMax MAX-IInfant foot/hand sensor (patient size 3-20 kg)OxiMax MAX-NAdult finger or neonatal foot/hand sensor (patient size >40 kg or <3 kg)Oxisensor II D-25Adult sensor (patient size >30kg) Use adapter cable M1943A or M1943AL Oxisensor II D-20Pediatric sensor (patient size 10-50 kg)Oxisensor II I-20Infant sensor (patient size 3-20 kg)Oxisensor II N-25Neonatal sensor (patient size <3 kg or >40 kg)OxiCliq A See OxiMax MAX-A Use adapter cable M1943A or M1943AL together with OC-3 adapter cable. OxiCliq P See OxiMax MAX-POxiCliq I See OxiMax MAX-IOxiCliq N See OxiMax MAX-NExtension / Adapter Cables for Philips and Nellcor SensorsM1941A Extension cable (2 m) For use with Philips reusable sensors and adapter cables. M1943A Adapter cable (1.1 m cable) Adapter cable for Philips/Nellcor disposable sensors.M1943AL Adapter cable (3 m cable)Product NumberDescription Comments
23 Accessories SpO2 Accessories242OC-3 Adapter Cable for OxiCliq sensors Available from Nellcor only.Product Number Description Philips Part NumberMASIMO LNOP reusable sensors. LNOP DC-I Adult Finger Sensor (> 30 kg) 989803140321LNOP DC-IP Pediatric Finger Sensor (10 - 50 kg) 989803140331LNOP YI Multi-site Sensor (> 1 kg) n/aLNOP TC-I Ear Sensor (> 30 kg) 989803140341MASIMO LNCS reusable sensors. LNCS DC-I Adult reusable Sensor (> 30 kg) 989803148281LNCS DC-IP Pediatric reusable Sensor (10 - 50 kg) 989803148291LNCS TC-I Reusable ear Sensor (> 30 kg) 989803148301MASIMO LNOP disposable adhesive sensors. LNOP Adt Adult Sensor (> 30 kg) 989803140231LNOP Adtx Adult Sensor (> 30 kg) n/aLNOP Pdt Pediatric Sensor (10 - 50 kg) 989803140261LNOP Pdtx Pediatric Sensor (10 - 50 kg) n/aLNOP Inf-L Infant Toe Sensor (3 - 20 kg) 989803140311LNOP Neo-L Neonatal Sensor (<3kg)or Adult adhesive Sensor (> 40 kg)989803140291LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin Sensors (<1kg)989803140301MASIMO LNCS disposable adhesive sensors. LNCS Adtx Adult Finger Sensor (> 30 kg) 989803148231LNCS Pdtx Pediatric Finger Sensor (10 - 50 kg) 989803148241LNCS Inf-L Infant Toe Sensor (3 - 20 kg) 989803148251LNCS Neo-L Neonatal Foot Sensor (< 3 kg)or Adult Finger Sensor (> 40 kg)989803148271LNCS NeoPt-L Neonatal pre-term sensitive skin Sensor (< 1 kg)989803148261Adapter Cable for MASIMO sensors.LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors451261000761LNC MP10 LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors989803148221Product NumberDescription Comments
Temperature Accessories 23 Accessories243The Philips M3002A option A01 uses Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo.Temperature AccessoriesMainstream CO2 AccessoriesTemperature Probes Part No. Minimum measurement time for accurate readingsReusableGeneral purpose probe 21075A 90 secSmall flexible vinyl probe (Infant/Pediatric) 21076A 60 secAttachable surface probe 21078A 60 secDisposableGeneral purpose probe M1837A 90 secSkin probe 21091A 60 secEsophageal/Stethoscope Probe (12 French) 21093A 180 secEsophageal/Stethoscope Probe (French 18) 21094A 210 secEsophageal/Stethoscope Probe (French 24) 21095A 310 secFoley Catheter Probe (12 French) M2255A 180 secFoley Catheter Probe (16 French) 21096A 180 secFoley Catheter Probe (18 French) 21097A 180 secAdapter cable 1.5m 21082BAdapter cable 3.0m 21082ADescription Part No. CO2 Sensor M2501AAdult/Pediatric Airway Adapter (reusable) M2513AInfant Airway Adapter (reusable) M2516AAdult Airway Adapter (single-patient use) M2533AInfant Airway Adapter (single-patient use) M2536A
23 Accessories Sidestream CO2 Accessories244Sidestream CO2 AccessoriesMainstream CO2 Accessories (for M3016A)Microstream CO2 Accessories• “FilterLine Set” is a combination of a FilterLine with an Airway Adapter. • “H” in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.• “Smart CapnoLine” is a combined oral-nasal FilterLine. Description Part No. CO2 Sensor M2741ANasal and Oral-Nasal CannulasCO2 Nasal Cannula, Adult M2744ACO2 Nasal Cannula, Pediatric M2745ACO2 Nasal Cannula, Infant M2746ACO2 / O2 Nasal Cannula, Adult M2750ACO2 / O2 Nasal Cannula, Pediatric M2751ACO2 / O2 Nasal Cannula, Infant 989803144471CO2 Oral-Nasal Cannula, Adult M2756ACO2 Oral-Nasal Cannula, Pediatric M2757ACO2 / O2 Oral-Nasal Cannula, Adult M2760ACO2 / O2 Oral-Nasal Cannula, Pediatric M2761AAirway AdaptersAirway Adapter Set, ET > 4.0 mm M2768AAirway Adapter Set, ET =< 4.0 mm 989803144531Airway Adapter Set H, ET > 4.0 mm M2772AAirway Adapter Set H, ET =< 4.0 mm M2773AStraight Sample LinesStraight Sample Line M2776AStraight Sample Line H M2777ADescription Part No. CO2 Sensor M1460AStandard Airway Adapter (reusable) M1465ASmall Airway Adapter (reusable) 14363A
Battery Accessories 23 Accessories245• “Smart CapnoLine O2” is a combined oral-nasal-O2-CO2 FilterLine.• “NIV Line” is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).•“Single purpose” means CO2 measurement only, “dual purpose” means CO2 measurement and O2 delivery.• The accessories are supplied in packs of 25.Battery AccessoriesMicrostream accessory selection flowchart Is the patient intubated? Yes NoDoes the patient need oxygen?Yes NoShort-term(up to 6 hours)Long-term(up to 72 hours)Short term(up to 8 hours)Long term(up to 24 hours)Long-term(up to 24 hours)Short term(up to 8 hours)Short term(up to 8 hours)Oral/Nasal Nasal Nasal Oral/Nasal NasalKey ApplicationsCritical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, EDCritical Care, Sleep Lab, Long-term Pain ManagementCritical Care, Sleep LabProcedural Sedation, Critical Care, EMS, EDEMS, EDPhilips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate)FilterLine Set:A/P: M1920AFilterLine Set Long:A/P:989803160241*FilterLine:M1925A*FilterLine H Set:A/P: M1921AI/N: M1923AFilterLine H Set LongA/P:989803160251*I/N:989803160261*VitaLine H Set:A/P:989803159571*I/N: 989803159581*FilterLine H:M1926A*Smart CapnoLine O2:A: M2522AP: M2520ASmart CapnoLine O2 LongA:989803160281*P:989803160271*CapnoLine HO2:A: M4680AP: M4681ACapnoLine H:A: M4689AP: M4690AI/N: M4691ASmart CapnoLine:A: M2526AP: M2524ASmart CapnoLine Plus LongA:989803160301*NIV Line:A: 4686AP: M4687A*Not available in all geographies.Description Part No. Battery Charger and Conditioner (requires size adapter 4512 610 17451 to charge M4607A battery)M8043ASize adapter for M4607A battery 4512 610 17451
23 Accessories Battery Accessories246
2472424SpecificationsIntended UseThe monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in a hospital environment and during patient transport inside and outside of the hospital environment. The monitor is intended for use by health care professionals.The monitor is only for use on one patient at a time. It is not intended for home use. Not a therapeutic device.Rx only: U.S. Federal Law restricts this device to sale by or on the order of a physician.ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11). NOTE1 Hospital EnvironmentThe monitor is suitable for use in all medically used rooms which fulfil the requirements regarding electrical installation according to IEC60364-7-710 “Requirements for special installations or locations - Medical locations”, or corresponding local regulations.NOTE2 EMC EnvironmentAll measurements (except the sidestream CO2 measurement with M2741A sensor) and system interfaces (except short range radio and wireless LAN) are, in addition, suitable for use in establishments directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes (see table in “Electromagnetic Emissions” on page 270).The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.WARNING The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers.Manufacturer’s InformationYou can write to Philips at this address
24 Specifications Symbols248Philips Medizin Systeme Boeblingen GmbHHewlett-Packard-Str. 271034 BoeblingenGermanyVisit our website at: www.philips.com.© Copyright 2002 - 2008. Koninklijke Philips Electronics N.V. All Rights Reserved.Trademark AcknowledgementThe following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor®, Durasensor®, Dura-Y®, Oxiband®, Oxicliq®, OxiMax®. MAX-FAST® is a trademark of Mallinckrodt Inc.Masimo, Masimo SET, and LNOP are federally registered trademarks of the Masimo Corporation.Other product and company names mentioned in this book may be trademarks of their respective owners.SymbolsThese symbols can appear on the monitor and its associated equipment.‘These symbols can appear on the monitor and its associated equipment (depending on options).SymbolsRefer to accompanying documentsOn/Off/Standby Main ScreenDC power source Battery symbol Battery EjectSmartKeysECG Sync Pulse Output indicatorConnection direction indicatorPressure connector Temperature connector Connector has special protection against electric shocks and is defibrillator proofNBP connector SpO2 connector Uses FAST SpO2 algorithm
Installation Safety Information 24 Specifications249Installation Safety InformationWARNING If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1, IEC60601-1-1, UL60601-1. Consult your service personnel.ConnectorsThe actual placement of boards and configuration of connections for your monitor depends on how your hardware has been configured. See the symbols table on page 248 to see which symbols are used to mark the connections.WARNING • Connect only medical devices to the ECG output connector socket.Masimo SET technology Nellcor OxiMax compatible LAN connection indicator for connection to a wired networkSilence Alarms Alarms Alarms OffECG connector Error LED Identifies year and month of manufactureIntelliVue Instrument Telemetry wireless network Always use separate collection for waste electrical and electronic equipment (WEEE)Monitor supports 12-lead ECGBuilt-in short range radio interface Built-in wireless networkSymbols2002-06Earthing The monitor must be earthed during operation. The earthing is for functional purposes and does not provide protection against electric shock. The protection against electric shock in this device is provided by double and/or reinforced insulation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter.Combining equipment Combinations of medical equipment with non-medical equipment must comply with IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment.Network Cables All network cables must be unshielded.
24 Specifications Altitude Setting250• Connecting the ECG sync out to external equipment should only be done by a qualified user. Do not touch the patient when you have contact to the ECG output connector socket.• Always connect the ECG sync cable first to the external device and then to the monitor. Wherever possible, pre-install the cable before the patient is brought into the vicinity of the equipment.Altitude SettingAltitude affects CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety SpecificationsThe monitor complies with the Medical Device Directive 93/42/EEC.In addition, the product complies with:IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 60601-1:2003; CAN/CSA C22.2#601.1-M90; JIS T 0601-1:1999; IEC 60601-1-1:2001; EN 60601-1-1:2001; IEC 60601-1-2:2001; EN 60601-1-2:2001.Classification (according to IEC 60601-1): Class II, Type CF, Continuous Operation.The possibility of hazards arising from software errors was minimized in compliance with ISO 14971:2000, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999.EMC And Radio Regulatory ComplianceThis ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-001 du Canada.The X2 including IntelliVue Instrument Telemetry WMTS (US only) complies with part 15 of the FCC Rules. Operation is subject to the condition that this device does not cause harmful interference. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.The X2 including IntelliVue Instrument Telemetry ISM (2.4 GHz) - FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.0366
Out-Of-Hospital Transport - Standards Compliance 24 Specifications251The X2 including the Wireless IntelliVue Adapter - CC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.The maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210.The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210.The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems.CAUTION High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices.The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.The radio component contained in this device is compliant to Council Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive)In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1; ARIB STD-T66.The X2 including the short range radio interface - FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 1 radio equipment. In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66.Out-Of-Hospital Transport - Standards ComplianceThe X2 Multi-Measurement Module/patient monitor with measurements and interfaces other than those listed below cannot be used for patient transport outside of the hospital environment.The X2 Multi-Measurement Module/patient monitor, with the following measurements and interfaces: –ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A)
24 Specifications Out-Of-Hospital Transport - Standards Compliance252– LAN, Batterycan be used in a transport environment such as a road ambulance, airplane or helicopter. For this purpose the monitor fulfils the following additional mechanical, EMC and environmental requirements:•Shock Tests according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-27 (peak acceleration up to 100 g).•Random Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-64 (RMS acceleration 5 g).•Sinusoidal Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-6 (acceleration up to amplitude 2 g).•Bump Test according to IEC/EN60068-2-29 (peak acceleration 15 g, 1000 bumps).•Free Fall Test according to EN1789 (covers also IEC TR 60721-4-7 and Class 7M3). Test procedure according to EN 60068-2-32 (height 0.75 m).• Specification for degrees of protection provided by enclosures according to IEC/EN 60529: IP 32 •EN 1789 +A1:2003 Medical vehicles and their equipment - Road ambulances (chapter 6 - Medical Devices).•Radiated susceptibility 20 V/m according to EN ISO 9919 (SpO2) and EN ISO 21647 (CO2).•Altitude Range from -500 to 3000 m operating and -500 to 4600 m storage and transportation.•Extended radiated susceptibility testsThe X2 Multi-Measurement Module/patient monitor with its out-of-hospital parameter set provides a general immunity level of 20 V/m with only few restrictions. Details are as listed below:– GSM 900: Immunity at 900 MHz (uplink mobile phone), 20 V/m (ECG:10V/m), duty cycle 1:8– GSM 1800: Immunity at 1800 MHz (uplink mobile phone), 20 V/m, duty cycle 1:8.– DECT: Immunity at 1800 MHz (digital cordless phone), 20 V/m, duty cycle 1:24– AM: 1 kHz Immunity from 80 MHz to 1.0 GHz (any radio communication unit, broadcasting and TV transmitter), 20 V/m, modulation factor 80%. (ECG: 20 V/m except 600-950 MHz where it is 10 V/m and Temperature which holds 3 V/m over the full range).CAUTION Temperature measurement accuracy may be compromised in the presence of strong electromagnetic fields (>3 V/m) in certain small frequency bands.•Magnetic Field emission according to MIL STD 461E, Chapter RE101: Radiated emissions, magnetic field, 30 Hz to 100 kHz. Limit class: Army.•Magnetic Field susceptibility: Radiated susceptibility, magnetic field, 50, 60 and 400 Hz, 18 μT(15 A/m)•Operating ambient temperature testing over the range from 0 to 40°C (32 to 100°F).•Operating ambient humidity testing up to 95% RH at 40°C (100°F), non condensing.NOTE Additional requirements can be necessary for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU.
Out-Of-Hospital Transport - Standards Compliance 24 Specifications253Physical SpecificationsEnvironmental SpecificationsThe monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges. The monitor is protected against ingress of objects and fluids according to IEC 60529 IP32 (applies to all options intended for out-of-hospital use). However, do not expose the monitor directly to heavy rain.When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.Specification CommentsMaximum Weight1.25 kg(2.8 lb)including battery, without optionsSize (W x H x D)188 x 99 x 86 mm7.4 x 3.9 x 3.4 inwithout handle and optionsM8023A External Power Supply Weight and DimensionsMaximum Weight700 g ±10%(1.5 lb ±10%)Size (W x H x D)207 x 70 x 113 mm8.1 x 2.8 x 4.4 inItem Condition RangeTemperature Range Operating 0 to 40°C (32 to 104°F)Storage including transportation-20 to 60°C (-4 to 140°F)Temperature Range with the Wireless IntelliVue Adapter or IntelliVue Instrument Telemetry Wireless Network or when charging the batteryOperating 0 to 35°C (32 to 95°F)Humidity Range Operating 15% to 95% Relative Humidity (RH)Storage including transportation5% to 95% Relative Humidity (RH)
24 Specifications Monitor Performance Specifications254Monitor Performance SpecificationsAltitude Range Operating -500 m to 3000 m (10000 ft)Storage including transportation-500 m to 4600 m1 (15000 ft)Ingress Protection Monitor IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°)External Power Supply (M8023A)IP31(protected against the ingress of solid foreign objects 2.5 mm in diameter or larger, and the ingress of water when the water is dripping vertically) when rested on its rubber feet on a flat, level surface.IP32 when mounted as shown in the section ““Mounting the External Power Supply (M8023A)” on page 3 of the Installation chapter and as described in the Service Guide.1.Sufficient for flight altitudes up to 12,000 m with pressurized cabins.Item Condition RangeX2 (M3002A) Performance SpecificationsPower Specifications Power consumption <12 W average<30 W while battery is chargingOperating Voltage 36 to 60 V DC floatingBattery Specifications Operating Time(with new, fully charged battery at 25°C)Basic monitoring configuration: 2.5 hours(Brightness set to Optimum, ECG/Resp, SpO2 measurements in use, NBP measurement every 15 minutes)Charge Time When X2 is off: 2 hoursWhen X2 is in use, and connected to MP20/30/40/50/60/70/80/90 without extensions: 12 hours approx.When X2 is in use, and connected to the external power supply (M8023A), without extensions: 12 hours approx.Indicators Alarms Off red (crossed-out alarm symbol) LEDAlarms red/yellow/light blue (cyan) LEDOn/Standby / Error green / red LEDAC Power green LEDBattery yellow (charging)/red blinking (empty) LEDExternal Power green LEDSounds Audible feedback for user inputPrompt toneQRS tone, or SpO2 modulation tone3 different alarm soundsTrends Resolution 12 or 16 numerics @ 12 sec, 1 minute, 5 minute resolution.Information Multiple choices of number of numerics, resolution and duration depending on trend option and application area.For example:For neonatal, you can choose between 12 and 16 numerics.
Monitor Performance Specifications 24 Specifications255Alarm signal System delay less than 3 secondsPause duration 1,2,3 minutes or infinite, depending on configurationExtended alarm pause 5 or 10 minutesReview Alarms Information all alarms / inops, main alarms on/off, alarm silence and time of occurrenceCapacity 300 itemsReal Time Clock Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59Accuracy <4 seconds per day (typically)Hold Time infinite if powered by host monitor or external power supply; otherwise at least 48 hoursBuffered Memory Hold Time if powered by host monitor or external power supply: infinitewithout power: at least 48 hours (typical: >72 hours)Contents Active settings, trends, patient data, realtime reports, review alarmsM8023A External Power Supply Performance SpecificationsPower Specifications Power consumption <12 W average<30 W peakLine Voltage 100 to 240 V ~Current 1.3 to 0.7 AFrequency 50/60 Hz ~Indicators AC Power green LEDX2 (M3002A) Interface Specifications Measurement Link (MSL)Connectors Female ODU (Proprietary)Power 30 V to 60 V inputPower Sync. RS-422 compliant input 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliantLocal signals Provided for connecting MMS extensionsECG Sync Pulse Output(See “Connectors” on page 249 for safety-related information)Cable detection YesMarker In NoWave Output NoConnector Binder Series 709/719Output levels Output low <0.8 V @ I = -4 mAOutput high >2.4 V @ I = 4 mAIsolation NonePulse Width 100 +/- 10 ms (high)Delay from R-wave peak to start of pulse20 ms maximum per AAMI EC13Minimum required R-wave amplitude0.5 VX2 (M3002A) Performance Specifications
24 Specifications Monitor Performance Specifications256Wireless NetworkDevice Interface (integrated, for compatible network options see below)Signals RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND12.5 V ±20 %, 3.5 W continuousFrequency Band USA: 2.400 – 2.483GHz, 5.15 ~ 5.35Ghz, 5.725 ~ 5.825Ghz Europe: 2.400 – 2.483GHz, 5.15~ 5.35Ghz, 5.47 ~ 5.725Ghz Japan: 2.400 – 2.483GHz, 4.90 – 5.091GHz, 5.15 – 5.25GHz China: 2.400 – 2.483GHz, 5.725 ~5.85Ghz Modulation Technique 802.11b/g DSSS (DBPSK, DQPSK, CCK) OFDM (BPSK,QPSK, 16-QAM, 64-QAM) 802.11a OFDM (BPSK,QPSK, 16-QAM, 64-QAM) Short Range Radio InterfaceType Internal SRR interfaceTechn o logy IEEE 802.15.4Frequency Band 2.4 GHz ISM (2.400 - 2.483 GHz)Modulation Technique DSSS (O -QPSK)Effective radiated powermax. 0 dBm (1 mW)M8023A External Power Supply Interface Specifications Measurement Link (MSL)Connectors Male ODU (Proprietary)Power 48 V outputPower Sync. RS-422 compliant output 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliant output 78.125 kHz (typical)Local signals Not connectedDisplay Specifications Integrated QVGA DisplaySweep Speeds 6.25, 12.5, 25 and 50 mm/s; Resolution 320 x 240Refresh frequency 60 HzUseful screen 72 x 54 mm (2.8 x 2.1 in)Pixel size 0.22 x 0.22 mmX2 (M3002A) Interface Specifications
M4607A Battery Specifications 24 Specifications257M4607A Battery SpecificationsOne battery is required for battery operation of the monitor.Compatible DevicesIntelliVue Instrument Telemetry Wireless Network (USA only)Internal WMTS Adapter Technology compatible with Philips Cellular Telemetry System (CTS), cellular infrastructure Frequency Band WMTS, 1395-1400 MHz and 1427-1432 MHzIntelliVue Instrument Telemetry Wireless Network (except USA)Internal ISM Adapter Technology compatible with Philips Cellular Telemetry System (CTS), cellular infrastructure Frequency Band 2.4 GHz ISMIntelliVue 802.11 Bedside Adapter (Wireless Network Adapter)Internal Wireless Adapter Technology IEEE 802.11a/b/gFrequency Band 2.4 GHz and 5 GHz ISM BandM4607A Battery SpecificationsPhysical SpecificationsW x D x H 66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in)Weight 160 g ±5%Performance SpecificationsNominal Voltage 10.8 VoltRated Capacity at discharge C/5 1000 mAh (typical)Environmental SpecificationsTemperature Range Discharge 0 to 60qC (32 to 122qF)Charge 0 to 60qC (32 to 122qF)Storage and Transportation: -20 to 65qC (-4 to 140qF)Humidity Range Operating: 15% to 95% Relative Humidity (RH)Storage and Transportation: 5% to 95% Relative Humidity (RH)Battery Type Lithium Ion Mangan, 10.8 V, 1000 mAh, Safety complies with UL 2054Electromagnetic Compatibility (EMC) complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2Communication Standard complies with the SMBus specification v1.1
24 Specifications Measurement Specifications258Measurement SpecificationsSee the Appendix on Default Settings for a list of the settings the monitor is initially shipped with. ECG/Arrhythmia/ST/QTComplies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-27:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/EC13:1991/2002.ECG/Arrhythmia/ST Performance SpecificationsCardiotach Range Adult/pedi: 15 to 300 bpmNeo range: 15 to 350 bpmAccuracy ±1% of rangeResolution 1bpmSensitivity t200 μVpeakPVC Rate Range 0 to 300 bpmResolution 1bpmST Numeric Range -20 to +20 mmAccuracy ±0.5 mm or 15%, whichever is greaterResolution 0.1 mmQT Numeric Range 200 to 800 msAccuracy ±30 msResolution 8msQTc Numeric Range 200 to 800 msResolution 1ms'QTc Numeric Range -600 to +600 msResolution 1msQT-HR Numeric Range - adult 15 to 300 bpmRange - pediatric and neonatal15 to 350 bpmSinus and SV Rhythm RangesBrady Adult: 15 to 59 bpmPedi: 15 to 79 bpmNeo: 15 to 89 bpmNormal Adult: 60 to 100 bpmPedi: 80 to 160 bpmNeo: 90 to 180 bpmTachy Adult: >100 bpmPedi: >160 bpmNeo: >180 bpmBandwidth Diagnostic Mode Adult/neo/pedi: 0.05 to 150 HzExtended Monitoring ModeNeo/pedi: 0.5 to 150 HzMonitoring Mode Adult: 0.5 to 40 HzNeo/pedi: 0.5 to 55 HzFilter Mode Adult/neo/pedi: 0.5 to 20 Hz
Measurement Specifications 24 Specifications259Bandwidthwhen the ECG is transmitted from a telemetry device via short range radioDiagnostic Mode Adult/neo/pedi: 0.05 to 40 HzExtended Monitoring ModeNeo/pedi: 0.5 to 40 HzMonitoring Mode Adult: 0.5 to 40 HzNeo/pedi: 0.5 to 40 HzFilter Mode Adult/neo/pedi: 0.5 to 20 HzDifferential Input Impedance >2 M: RA-LL leads (Resp)>5 M: at all other leads (at 10 Hz including patient cable)Common Mode Rejection Ratio Diagnostic mode: >86 dB (with a 51 k:/47 nF imbalance).Filter mode: >106 dB (with a 51 k:/47 nF imbalance).Electrode Offset Potential Tolerance ±500 mVAuxiliary Current(Leads off Detection)Active electrode: <100 nAReference electrode: <900 nAInput Signal Range ±5 mVECG/Arrhythmia/ST/QT Alarm Specifications Range AdjustmentHR 15 to 300 bpmmaximum delay: 10 seconds according to AAMI EC 13-1992 standardAdult:1 bpm steps (15 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (15 to 50 bpm)5 bpm steps (50 to 300 bpm)Extreme Tachy Difference to high limit 0 to 50 bpm 5 bpm stepsClamping at 150 to 300 bpm 5 bpm stepsExtreme Brady Difference to low limit 0 to 50 bpm 5 bpm stepsClamping at 15 to 100 bpm 5 bpm stepsRun PVCs 2 PVCs Not adjustable by userPVCs Rate 1 to 99 PVCs/minute 1PVCVent Tach HR 20 to 300 bpm 5bpmVent Tach Run 3 to 99 PVCs/minute 1PVCVent Rhythm Run 3 to 99 PVCs/minute 1PVCSVT HR 120 to 300 bpm 5bpmSVT Run 3 to 99 SV beats 1SV beatST High -19.8 to +20 mm 0.2 mmST Low -20 to +19.8 mm 0.2 mmQTc High 200 ms to 800 ms 10 ms steps'QTc High 30 ms to 200 ms 10 ms stepsECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13Respiration Excitation Waveform Sinusoidal signal, 260 PA, 40.5 kHzNoise Suppression RL drive gain 44 dB max., max. voltage 1.8 VrmsECG/Arrhythmia/ST Performance Specifications
24 Specifications Measurement Specifications260RespirationTime to Alarm for TachycardiaVent Tachycardia1mVpp,206 bpmGain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 secondsGain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 secondsGain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 secondsVent Tachycardia2mVpp,195 bpmGain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 secondsGain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 secondsGain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 secondsTall T-Wave Rejection Capability Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitudeHeart Rate Averaging Method Three different methods are used:Normally, heart rate is computed by averaging the 12 most recent RR intervals.For runs of PVCs, up to 8 RR intervals are averaged to compute the HR.If each of 3 consecutive RR intervals is greater than 1200 ms (that is, rate less than 50 bpm), then the 4 most recent RR intervals are averaged to compute the HR.Response Time of Heart Rate Meter to Change in Heart RateHR change from 80 to 120 bpm:Range: [6.4 to 7.2 seconds] Average: 6.8 secondsHR change from 80 to 40 bpm:Range: [5.6 to 6.4 sec] Average: 6.0 secondsHeart Rate Meter Accuracy and Response to Irregular RhythmVentricular bigeminy: 80 bpmSlow alternating ventricular bigeminy: 60 bpmRapid alternating ventricular bigeminy: 120 bpmBidirectional systoles: 90 bpmAccuracy of Input Signal Reproduction Methods A and D were used to establish overall system error and frequency response.Pacemaker Pulse Rejection Performance Rejection of pacemaker pulses with amplitudes from ±2 mV to ±700 mV and widths from 0.1 ms to 2.0 ms (Method A)ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13Respiration Performance SpecificationsRespiration Rate Range Adult/pedi: 0 to 120 rpmNeo: 0 to 170 rpmAccuracy at 0 to 120 rpm ±1 rpmat 120 to 170 rpm ±2 rpmResolution 1rpmBandwidth 0.3 to 2.5 Hz (–6 dB)Noise Less than 25 m:(rms) referred to the input
Measurement Specifications 24 Specifications261Respiration Alarm Specifications Range Adjustment DelayHigh Adult/pedi: 10 to 100 rpmNeo: 30 to 150 rpmunder 20 rpm: 1 rpm stepsover 20 rpm: 5 rpm stepsmax. 14 secondsLow Adult/pedi: 0 to 95 rpmNeo: 0 to 145 rpmunder 20 rpm: 1 rpm stepsover 20 rpm: 5 rpm stepsfor limits from 0 to 20 rpm: max. 4 secondsfor limits above 20 rpm: max. 14 secondsApnea Alarm 10 to 40 seconds 5 second steps
24 Specifications Measurement Specifications262SpO2Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001).Measurement Validation: The SpO2 accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements. Display Update Period: Typical: 2 seconds, Maximum: 30 seconds. Maximum with NBP INOP suppression on60 seconds. SpO2 Performance SpecificationsSpO2The specified accuracy is the root-mean-square (RMS) difference between the measured values and the reference valuesRange 0 to 100%Accuracy Philips Reusable Sensors:M1191A, M1191AL, M1191ANL, M1191B, M1191BL, M1192A, M1192AN = 2% (70% to 100%)M1193A, M1193AN, M1194A, M1194AN, M1195A, M1195AN, M1196A = 3% (70% to 100%)M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%)M1193T (Neonate) = 4% (70% to 100%)Philips Disposable Sensors with M1943A(L):M1132A, M1133A (adult/infant) = 2%M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate) = 3% (70% to 100%)NellcorPB® Sensors with M1943A(L):MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-25, OxiCliq A, P, I, N = 3% (70% to 100%)Masimo Reusable Sensors® with LNOP MP12 or LNC MP10:LNOP DC-I, LNOP DC-IP, LNOP YI, LNCS DC-1, LNCS DC-IP: 2% (70% to 100%)LNOP TC-I, LNCS TC-I: 3.5% (70% to 100%)Masimo Disposable Sensors® with LNOP MP12 or LNC MP10:LNOP Adt, LNOP Adtx, LNOP Pdt, LNOP Pdtx, LNOP Inf-L, LNCS Adtx, LNCS Pdtx, LNCS Inf-L: 2% (70% to 100%)LNOP Neo-L, LNOP NeoPt-L, LNCS Neo-L, LNCS NeoPt-L: 3% (70% to 100%)Resolution 1%Pulse Range 30 to 300 bpmAccuracy ±2% or 1 bpm, whichever is greaterResolution 1bpmSensors Wavelength range: 500 to 1000 nmEmitted Light Energy: d15 mWInformation about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)Pulse Oximeter Calibration Range 70% to 100%
Measurement Specifications 24 Specifications263NBPComplies with IEC 60601-2-30:1999/EN60601-2-30:2000.SpO2 Alarm Specifications Range Adjustment DelaySpO2Adult: 50 to 100%Pedi/Neo: 30 to 100%1% steps (0, 1, 2, 3,... 30) +4 secondsDesat Adult: 50 to Low alarm limitPedi/Neo: 30 to Low alarm limit1% stepsPulse 30 to 300 bpm Adult:1 bpm steps (30 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (30 to 50 bpm)5 bpm steps (50 to 300 bpm)max. 14 secondsTachycardia Difference to high limit 0 to 50 bpm 5 bpm steps max. 14 secondsClamping at 150 to 300 bpm 5 bpm stepsBradycardia Difference to low limit 0 to 50 bpm 5 bpm steps max. 14 secondsClamping at 30 to 100 bpm 5 bpm stepsNBP Performance SpecificationsMeasurement Ranges Systolic Adult: 30 to 270 mmHg (4 to 36 kPa) Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa)Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa) Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa)Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa) Pedi: 20 to 160 mmHg (2.5 to 21 kPa) Neo: 20 to 120 mmHg (2.5 to 16 kPa)Pulse Rate Adult: 40 to 300Pedi: 40 to 300Neo: 40 to 300Accuracy Max. Std. Deviation: 8 mmHg (1.1 kPa)Max. Mean Error: ±5 mmHg (±0.7 kPa)Pulse Rate Measurement Accuracy 40 to 100 bpm: ±5bpm101 to 200 bpm: ±5% of reading201 to 300 bpm: ±10% of reading(average over NBP measurement cycle)Pulse Rate Range 40 to 300 bpmMeasurement Time Typical at HR >60 bpmAuto/manual/sequence: 30 seconds (adult)25 seconds (neonatal)Stat: 20 secondsMaximum time: 180 seconds (adult/pediatric)90 seconds (neonates)
24 Specifications Measurement Specifications264Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure. In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 - 1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.Cuff Inflation Time Typical for normal adult cuff: Less than 10 secondsTypical for neonatal cuff: Less than 2 secondsInitial Cuff Inflation Pressure Adult: 165 ±15 mmHgPedi: 130 ±15 mmHgNeo: 100 ±15 mmHgAuto Mode Repetition Times 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutesSTAT Mode Cycle Time 5minutesVenipuncture Mode InflationInflation Pressure Adult 20 to 120 mmHg (3 to 16 kPa)Pediatric 20 to 80 mmHg (3 to 11 kPa)Neonatal 20 to 50 mmHg (3 to 7 kPa)Automatic deflation afterAdult/pediatric 170 secondsNeonatal 85 secondsNBP Alarm Specifications Range AdjustmentSystolic Adult: 30 to 270 mmHg (4 to 36 kPa) 10 to 30 mmHg: 2 mmHg (0.5 kPa)>30 mmHg: 5 mmHg (1 kPa)Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa)Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa)Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa) Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa)Pedi: 20 to 160 mmHg (2.5 to 21 kPa)Neo: 20 to 120 mmHg (2.5 to 16 kPa)NBP Overpressure SettingsAdult >300 mmHg (40 kPa) >2 sec not user adjustablePedi >300 mmHg (40 kPa) >2 sec Neo >150 mmHg (20 kPa) >2 sec NBP Performance Specifications
Measurement Specifications 24 Specifications265Invasive Pressure and PulseComplies with IEC 60601-2-34:2000/EN60601-2-34:2000.Invasive Pressure Performance SpecificationsMeasurement Range –40 to 360 mmHgPulse Rate Range 25 to 350 bpmAccuracy ±1% Full RangeResolution 1bpmInput Sensitivity Sensitivity:5 μV/V/mmHg (37.5 μV/V/kPa)Adjustment range:±10%Tr a n s d u c e r Load Impedance:200 to 2000 : (resistive)Output Impedance:d3000 : (resistive)Frequency Response dc to 12.5 Hz or 40 HzZero Adjustment Range: ±200 mmHg (±26 kPa)Accuracy ±1 mmHg (±0.1 kPa)Drift Less than 0.1 mmHg/°C (0.013 kPa/°C)Gain Accuracy Accuracy ±1%Drift Less than 0.05%/°CNon linearityand HysteresisError of d0.4% FS (@CAL 200 mmHg)Overall Accuracy (including transducer)±4% of reading or ±4 mmHg (±0.5 kPa), whichever is greaterVolume displacement of CPJ840J6 0.1 mm3 /100 mmHgInvasive Pressure Alarm Specifications Range Adjustment DelayPressure –40 to 360 mmHg (–5.0 to 48 kPa)-40 to 50 mmHg2 mmHg (0.5 kPa)>50 mmHg5 mmHg (1 kPa)max. 12 secondsExtreme High Difference to high limit 0 to 25 mmHg5 mmHg steps (0.5 kPa)Clamping at -40 to 360 mmHg5 mmHg steps (1.0 kPa)Extreme Low Difference to low limit 0 to 25 mmHg5 mmHg steps (0.5 kPa)Clamping at -40 to 360 mmHg5 mmHg steps (1.0 kPa)Pulse 25 to 300 bpm Adult:1 bpm steps (25 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (25 to 50 bpm)5 bpm steps (50 to 300 bpm)
24 Specifications Measurement Specifications266Te m p Complies with EN 12470-4:2000. Specified without transducer.CO2The CO2 measurement in the monitor, M3014A and M3015A complies with EN ISO 21647:2004 + Cor.1:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001).Tachycardia Difference to high limit 0 to 50 bpm5 bpm steps max. 14 secondsClamping at 150 to 300 bpm5 bpm stepsBradycardia Difference to low limit 0 to 50 bpm5 bpm steps max. 14 secondsClamping at 25 to 100 bpm 5 bpm stepsInvasive Pressure Alarm Specifications Range Adjustment DelayTemp Performance SpecificationsTe m p Range –1 to 45qC (30 to 113qF)Resolution 0.1qC (0.2qF)Accuracy ±0.1qC (±0.2qF)Average Time Constant Less than 10 secondsTemp Alarm Specifications Range AdjustmentTemp H igh / L ow A lar ms –1 to 45qC (30 to 113qF) -1 to 35qC (30 to 95qF), 0.5qC (1.0qF) steps35 to 45qC (95 to 113qF), 0.1qC (0.2qF) stepsM3015A Microstream CO2 Performance Specifications CO2Range 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lowerAccuracy Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greaterAfter 5 minutes warmup:0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of readingThese specifications are valid for 21% O2 and N2 balance, up to 35qC ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode. Outside of these conditions the accuracy reaches at a minimum ±4 mmHg or ±12% of the reading, whichever is greater.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability Included in Accuracy specificationsawRR Range 0 to 150 rpmAccuracy 0 to 40 rpm: ±1 rpm41 to 70 rpm: ±2 rpm71 to 100 rpm: ±3 rpm>100 rpm: ±5% of readingWarm-up Time 5 minutes for full accuracy specification
Measurement Specifications 24 Specifications267Rise Time 190 ms for neonatal mode (measured with FilterLine H for neonatal)240 ms for adult mode (measured with FilterLine H for adult)Sample Flow Rate 50 + 15/-7.5 ml/minuteGas Sampling Delay Time Maximum: 3 seconds (2m sample lines)6 seconds (4m sample lines)Sound Pressure Acoustic noise: <45 dBATotal System Response Time The total system response time is the sum of the delay time and the rise time. M3014A Mainstream CO2 Performance Specifications CO2Range 0 to 150 mmHg (0 to 20.0 kPa)Accuracy after 2 minutes warmup:For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)For values from 41 to 70 mmHg: ±5% of readingFor values from 71 to 100 mmHg: ±8% of readingThe specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, Pabs = 760 mmHg, flow rate = 2 l/min.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability:Short term driftLong term drift±0.8 mmHg over four hoursAccuracy specification will be maintained over a 120 hour periodawRR Range 2 to 150 rpmAccuracy ±1 rpmWarm-up Time 2 minutes with CO2 transducer attached for full accuracy specificationResponse Time Less than 60 ms (with adult or infant reusable or disposable adapter)M3014A Sidestream CO2 Performance Specifications CO2Range 0 to 150 mmHg (0 to 20.0 kPa)Accuracy after 2 minutes warmup:For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)For values from 41 to 70 mmHg: ±5% of readingFor values from 71 to 100 mmHg: ±8% of readingFor values from 101 to 150 mmHg: ±10% of readingAt respiration rates above 80 rpm, all ranges are ±12% of actual. The specifications are valid for gas mixtures of CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability:Short term driftLong term drift±0.8 mmHg over four hoursAccuracy specification will be maintained over a 120 hour periodawRR Range 2 to 150 rpmAccuracy ±1 rpmM3015A Microstream CO2 Performance Specifications
24 Specifications Measurement Specifications268M3002A/M3014A Mainstream and Sidestream CO2 Humidity Correction FactorEither BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is: Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35°C and 100% RH.Mainstream CO2 Humidity Correction FactorEither BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2 readings. The formula for the correction calculation is: Where p = partial pressure, Pabs = absolute pressure, and PH2O = 47 mmHg @37qC and 100% RH.Warm-up Time 2 minutes with CO2 sensor attached for full accuracy specificationSample Flow Rate 50 ±10 ml/minuteTotal System Response Time 3secondsOperating Temperature 0 to 40°C (32 to 100°F)M3016A Mainstream CO2 Performance Specifications CO2Range –4 to 150 mmHg (-0.5 to 20.0 kPa)Accuracy after 20 minutes warmup and calibration:For values between 0 and 40 mmHg: ±2.2 mmHg (±0.29 kPa)For values between 40 and 76 mmHg: ±5.5% of readingThe specifications are valid for 45% O2 and N2 or N2O balance. Outside these conditions the accuracy reaches at a minimum the requirements of EN864/ISO9918.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability ±1.0 mmHg over a 7 day periodawRR Range 0 to 150 rpmAccuracy ±2 rpmWarm-up Time 20 minutes with CO2 transducer attached for full accuracy specificationResponse Time Less than 125 ms (for step from 10% to 90%)M3014A Sidestream CO2 Performance Specifications PATPD PBTPS=PabsPabs PH2O–-----------------------------PATPD PBTPS=PabsPabs PH2O–-----------------------------
Measurement Specifications 24 Specifications269Interfering Gas and Vapor Effects On CO2 Measurement ValuesThe specified deviations for M3002A/M3014A are valid when the appropriate corrections are switched on and set correctly.CO2 Alarm Specifications Range Adjustment DelayetCO2 High 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) M8102A/M3014A/M3016A: less than 14 secondsM3015A: less than18 seconds.etCO2 Low 10 to 90 mHg (1 to 12 kPa)imCO2 High 2 to 20 mmHg (0.3 to 3.0 kPa)steps of 1 mmHg (0.1 kPa)M8102A/M3014A/M3016A: less than 14 secondsM3015A: less than18 seconds.awRR High Adult/pedi: 10 to 100 rpmNeo: 30 to 150 rpmunder 20 rpm: 1 rpm stepsover 20 rpm:5 rpm stepsM8102A/M3014A/M3016A: less than 14 secondsM3015A: less than18 seconds.awRR Low Adult/pedi: 0 to 95 rpmNeo: 0 to 145 rpmM3015A: settings <20 rpm: less than 8 seconds>20 rpm: less than 18 secondsM8102A/M3014A/M3016Asettings <20 rpm: less than 4 seconds>20 rpm: less than 14 secondsApnea delay 10 to 40 seconds 5 second steps set apnea delay time +4 seconds (M8102A/M3014A/M3016A) or 8 seconds (M3015A) Gas or VaporGas Level (% volume fraction)M3002A/M3014A M3015AAdditional deviation due to gas interference, measured at 0 - 40 mmHg CO2Nitrous Oxide 60 ±1 mmHg ±5 %Halothane 4 ±2 mmHg ±5 %Enflurane 5 ±2 mmHg ±5 %Isoflurane 5 ±2 mmHg ±5 %Sevoflurane 5 ±2 mmHg ±5 %Xenon 80 -5 mmHg ±5 %Helium 50 ±1 mmHg ±5 %Metered dose inhaler propellants- not specified for useDesflurane 15 +5 mmHg ±5 %Ethanol 0.1 ±1 mmHg ±5 %Isopropanol 0.1 ±1 mmHg ±5 %Acetone 0.1 ±1 mmHg ±5 %Methane 1.0 ±1 mmHg ±5 %
24 Specifications Safety and Performance Tests270Safety and Performance TestsYou must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications are described in the Installation and Service guide.Electromagnetic Compatibility (EMC) SpecificationsTake special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radio frequency (RF) communications equipment can affect medical electrical equipment.Accessories Compliant with EMC StandardsAll accessories listed in the accessories section comply, in combination with the monitor, with the requirements of IEC 60601-1-2:2001 + A1:2004.WARNING Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment.Electromagnetic EmissionsThe monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environmentAvoiding Electromagnetic Interference (Resp)The respiration (Resp) measurement is a very sensitive measurement that measures a very small signal. Technological limitations do not allow higher immunity levels than 1 V/m for radiated RF electromagnetic fields and 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of this measurement. Emissions test Compliance Avoiding Electromagnetic InterferenceRadio Frequency (RF) emissions Group 1 The monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipmentRF emissions CISPR 11for the MP2 or X2 with all accessories except the M2741A Sidestream CO2 sensorClass B The monitor is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes.RF emissions CISPR 11for the MP2 or X2 whenever used with the M2741A Sidestream CO2 sensorClass A The monitor is suitable for use in all establishments other than those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.
Safety and Performance Tests 24 Specifications271WARNING The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients.Electromagnetic ImmunityThe monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below.In this table, UT is the a.c. mains voltage prior to application of the test level.Recommended Separation DistanceWARNING The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that other equipment complies with CISPR emission requirements.In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m). The values given in brackets are for respiration. Immunity testIEC 60601-1-2 test level Compliance levelElectromagnetic environment guidanceElectrostatic discharge (ESD) IEC 61000-4-2±6 kV contact±8 kV air±6 kV contact±8 kV airFloors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.Electrical fast transient/burstIEC 61000-4-4±2 kV for power supply lines±1 kV for input/output lines±2 kV for power supply lines±1 kV for input/output linesMains power quality should be that of a typical commercial and/or hospital environmentSurge IEC 61000-4-5±1 kV differential mode±2 kV common mode±1 kV differential mode±2 kV common modeMains power quality should be that of a typical commercial and/or hospital environmentVoltage dips, short interruptions and voltage variations on power supply input linesIEC 61000-4-11<5% UT(>95% dip in UT) for 0.5 cycles40% UT(60% dip in UT) for 5 cycles70% UT(30% dip in UT) for 25 cycles<5% UT(>95% dip in UT) for 5 sec<5% UT(>95% dip in UT) for 0.5 cycles40% UT(60% dip in UT) for 5 cycles70% UT(30% dip in UT) for 25 cycles<5% UT(>95% dip in UT) for 5 secMains power quality should be that of a typical commercial and/or hospital environment. If the user of the monitor requires continued operation during power mains interruptions, it is recommended that the monitor is equipped with an internal battery or is powered from an uninterruptible power supply.Power frequency (50/60 Hz) magnetic fieldIEC 61000-4-83 A/m 3 A/m Power frequency magnetic fields should be a t levels characteristic of a typical location in a typical commercial and/or hospital environment
24 Specifications Safety and Performance Tests272Portable and mobile RF communications equipment should be used no closer to any part of the monitor, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter.Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range.Interference may occur in the vicinity of equipment marked with this symbol:Field strengths from fixed transmitters, such as base stations for radio (cellular, cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the monitor is used exceeds the applicable RF compliance level above, the monitor should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the monitor. These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.Immunity testIEC 60601-1-2 test level Compliance level Electromagnetic environment guidanceConducted RF IEC 61000-4-63VRMS150 kHz to 80 MHz3VRMS(1 VRMS for respiration)Recommended separation distance::for respiration::Radiated RFIEC 61000-4-33V/m80 MHz to 2.5 GHz3V/m(1 V/m for respiration)For short range radio, see note1.1.If ECG/SpO2 signals are acquired from a telemetry device via short range radio the compliance level is 3V/m except inthe range 2.0 to 2.3 GHz where it is 1 V/m.Recommended separation distance:80 MHz to 800 MHz 80 MHz to 800 MHz for respiration:800 MHz to 2,5 GHz800 MHz to 2,5 GHz for respiration2.0 to 2,3 GHz for short range radiod1,2P=d3,5P=d1,2P=d3,5P=d2,3P=d7,0P=d7,0P=
Safety and Performance Tests 24 Specifications273Recommended separation distances from portable and mobile RF communication equipmentThe monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment.In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m). The values given in brackets are for those measurements which do not use the general formula. Electrosurgery Interference/Defibrillation/Electrostatic DischargeThe equipment returns to the previous operating mode within 10 seconds without loss of any stored data. Measurement accuracy may be temporarily decreased while performing electro-surgery or defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magnetic fields (MRI).Fast Transients/BurstsThe equipment will return to the previous operating mode within 10 seconds without loss of any stored data. If any user interaction is required, the monitor indicates with a technical alarm (INOP).Restart timeAfter power interruption, an ECG wave will be shown on the display after 30 seconds maximum.Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHzEquationfor respiration: for respiration: for respiration:for short range radio in the range 2.0 to 2.3 GHz:Rated max. output power of transmitter (W) Separation distance (m) Separation distance (m) Separation distance (m)0.01 0.1 (0.4) 0.1 (0.4) 0.2 (0.7)0.1 0.4 (1.1) 0.4 (1.1) 0.7 (2.2)1 1.3 (3.5) 1.3 (3.5) 2.3 (7.0)10 3.8 (11.1) 3.8 (11.1) 7.3 (22.1)100 12.0 (35.0) 12.0 (35.0) 23.0 (70.0)d1,2P=d3,5p=d1,2P=d3,5P=d2,3P=d7,0P=d7,0P=
24 Specifications Safety and Performance Tests274
2752525Default Settings AppendixThis appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor’s default settings can be permanently changed in Configuration Mode. Note: If your monitor has been ordered preconfigured to your requirements, the settings at delivery will be different from those listed here. Country-Specific Default SettingsCertain default settings are specific to a particular country. These are listed here for all countries alphabetically.Country-Description Line Frequency UnitsWeightUnitsHeightECG Cable Color50/60 [Hz] kg, lb in, cm IEC, AAMIAfghanistan 50 kg cm AAMIÅland Islands 50 kg cm IECAlbania 50 kg cm IECAlgeria 50 kg cm IECAmerican Samoa 60 lb in AAMIAndorra 60 lb in AAMIAngola 50 kg cm IECAnguilla 60 lb in AAMIAntarctica 60 lb in AAMIAntigua and Barbuda 50 kg cm AAMIArgentina 50 kg cm AAMIArmenia 50 kg cm IECAruba 60 kg cm AAMIAustralia 50 kg cm AAMIAustria 50 kg cm IECAzerbaijan 50 kg cm IECBahamas, The 60 kg cm AAMIBahrain 50 kg cm AAMIBangladesh 60 lb in AAMIBarbados 50 kg cm AAMIBelarus 50 kg cm IECBelgium 50 kg cm IEC
25 Default Settings Appendix Country-Specific Default Settings276Belize 60 lb in AAMIBenin 60 lb in AAMIBermuda 60 kg cm AAMIBhutan 60 lb in AAMIBolivia 50 kg cm AAMIBosnia and Herzegovina 50 kg cm IECBotswana 50 kg cm IECBouvet Island 60 lb in AAMIBrazil 60 kg cm AAMIBritish Indian Ocean Territory 60 lb in AAMIBrunei Darussalam 50 kg cm AAMIBrunei 50 kg cm IECBulgaria 50 kg cm IECBurkina Faso 50 kg cm IECBurundi 50 kg cm IECCambodia 50 kg cm IECCameroon 50 kg cm IECCanada 60 kg cm AAMICape Verde 60 lb in AAMICayman Islands 60 kg cm AAMICentral African Republic 50 kg cm IECChad 60 lb in AAMIChile 50 kg cm AAMIChina 50 kg cm IECChristmas Islands 60 lb in AAMICocos Keeling Islands 60 lb in AAMIColombia 60 kg cm AAMIComoros 60 lb in AAMICongo 50 kg cm IECCongo, Democratic Republic of the 50 kg cm IECCook Islands 60 lb in AAMICosta Rica 60 kg cm AAMICôte d'Ivoire 50 kg cm IECCroatia 50 kg cm IECCuba 60 kg cm IECCyprus 50 kg cm IECCzech Republic 50 kg cm IECDenmark 60 lb in AAMIDjibouti 50 kg cm IECDominica 50 kg cm AAMIDominican Republic 60 kg cm AAMIEcuador 60 kg cm AAMIEgypt 50 kg cm IECEl Salvador 60 kg cm AAMIEquatorial Guinea 50 kg cm IECEritrea 50 kg cm IECEstonia 50 kg cm IECEthiopia 50 kg cm IECFalkland Islands, Malvinas 60 lb in AAMIFaroe Islands 60 lb in AAMIFiji 60 lb in AAMI
Country-Specific Default Settings 25 Default Settings Appendix277Finland 50 kg cm IECFrance 50 kg cm IECFrench Guiana 50 kg cm IECFrench Polynesia 60 lb in AAMIFrench Southern Territories 60 lb in AAMIGabon 50 kg cm IECGambia, The 50 kg cm IECGeorgia 60 lb in AAMIGermany 50 kg cm IECGhana 50 kg cm IECGibraltar 60 lb in AAMIGreece 50 kg cm IECGreenland 60 lb in AAMIGrenada 50 kg cm AAMIGuadeloupe 50 kg cm IECGuam 60 lb in AAMIGuatemala 60 kg cm AAMIGuernsey 50 kg cm IECGuinea 60 lb in AAMIGuinea-Bissau 60 lb in AAMIGuyana 60 kg cm AAMIHaiti 60 kg cm AAMIHeard Island and McDonald Islands 60 lb in AAMIHoly See, Vatican City State 60 lb in AAMIHonduras 60 kg cm AAMIHong Kong 50 kg cm IECHungary 50 kg cm IECIceland 50 kg cm IECIndia 50 kg cm IECIndonesia 50 kg cm IECIran, Islamic Republic of 50 kg cm AAMIIraq 50 kg cm AAMIIreland 50 kg cm IECIsle of Man 50 kg cm IECIsrael 50 kg cm IECItaly 50 kg cm IECJamaica 50 kg cm AAMIJapan 60 kg cm IECJersey 50 kg cm IECJordan 50 kg cm AAMIKazakhstan 50 kg cm IECKenya 50 kg cm IECKiribati 60 lb in AAMIKorea, Democratic People’s Republic of 60 lb in AAMIKorea, Republic of 60 kg cm AAMIKuweit 50 kg cm AAMIKyrgyzstan 60 lb in AAMILao People’s Democratic Republics 50 kg cm IECLatvia 50 kg cm IECLebanon 50 kg cm AAMILesotho 50 kg cm IEC
25 Default Settings Appendix Country-Specific Default Settings278Liberia 50 kg cm IECLibyan Arab. Jamahiriya 60 lb in AAMILiechtenstein 60 lb in AAMILithuania 50 kg cm IECLuxembourg 50 kg cm IECMacao 60 lb in AAMIMacedonia, The former Yugoslavian Republic of50 kg cm IECMadagascar 50 kg cm IECMalawi 50 kg cm IECMalaysia 50 kg cm IECMaldives 60 lb in AAMIMali 50 kg cm IECMalta 50 kg cm IECMarshall Islands 60 lb in AAMIMartinique 60 kg cm IECMauritania 50 kg cm IECMauritius 60 lb in AAMIMayotte 60 lb in AAMIMexico 60 kg cm AAMIMicronesia, Federal States of 60 lb in AAMIMoldova, Republic of 60 lb in AAMIMonaco 60 lb in AAMIMongolia 60 lb in AAMIMontenegro 50 kg cm IECMontserrat 50 kg cm AAMIMorocco 50 kg cm IECMozambique 50 kg cm IECMyanmar 60 lb in AAMINamibia 50 kg cm IECNauru 60 lb in AAMINepal 60 lb in AAMINetherlands 50 kg cm IECNetherlands Antilles 50 kg cm AAMINew Caledonia 60 lb in AAMINew Zealand 50 kg cm AAMINicaragua 60 kg in AAMINiger 50 kg cm IECNigeria 50 kg cm IECNiue 60 lb in AAMINorfolk Islands 60 lb in AAMINorthern Mariana Islands 60 lb in AAMINorway 50 kg cm IECOman 50 kg cm AAMIPakistan 50 kg cm IECPalau 60 lb in AAMIPalestinian Territory 50 kg cm AAMIPanama 60 lb in AAMIPapua New Guinea 60 lb in AAMIParaguay 50 kg cm AAMIPeru 60 kg cm AAMI
Country-Specific Default Settings 25 Default Settings Appendix279Philippines 60 kg cm AAMIPitcairn 60 lb in AAMIPoland 50 kg cm IECPortugal 50 kg cm IECPuerto Rico 60 lb in AAMIQatar 50 kg cm AAMIReunion 60 lb in AAMIRomania 50 kg cm IECRussian Federation 50 kg cm IECRwanda 50 kg cm IECSaint Helena 60 lb in AAMISaint Kitts and Nevis 60 kg cm AAMISaint Lucia 50 kg cm AAMISaint Pierre and Miquelon 60 lb in AAMISaint Vincent and the Grenadines 50 kg cm AAMISamoa 60 lb in AAMISan Marino 60 lb in AAMISao Tome and Principe 60 lb in AAMISaudi Arabia 50 kg cm AAMISenegal 50 kg cm IECSerbia 50 kg cm IECSerbia & Montenegro 50 kg cm IECSeychelles 60 lb in AAMISierra Leone 50 kg cm IECSingapore 50 kg cm IECSlovakia 50 kg cm IECSlovenia 50 kg cm IECSolomon Islands 60 lb in AAMISomalia 50 kg cm IECSouth Africa 60 lb in AAMISouth Georgia and the South Sandwich Islands60 lb in AAMISpain 50 kg cm IECSri Lanka 60 lb in AAMISudan 50 kg cm IECSuriname 60 kg cm AAMISvalbard and Jan Mayen 60 lb in AAMISwaziland 60 lb in AAMISweden 50 kg cm IECSwitzerland 50 kg cm IECSyrian Arab Rep 50 kg cm AAMITaiwan, Province of China 60 kg cm AAMITajikistan 60 lb in AAMITanzania, United Republic of 60 lb in AAMIThailand 50 kg cm AAMITimor-Leste 60 lb in AAMITogo 60 lb in AAMITokelau 60 lb in AAMITonga 60 lb in AAMITrinidad and Tobago 60 lb in AAMITu n i s i a 5 0 k g c m I E C
25 Default Settings Appendix Country-Specific Default Settings280Turkey 50 kg cm IECTurkmenistan 60 lb in AAMITurks and Caicos Islands 60 kg cm AAMITuvalu 60 lb in AAMIUganda 60 lb in AAMIUkraine 60 lb in AAMIUK 50 kg cm IECUnited Arab Emirates 50 kg cm AAMIUnited Kingdom 50 kg cm IECUnited States 60 lb in AAMIUnited States Minor Outlying Islands 60 lb in AAMIUruguay 50 kg cm AAMIUzbekistan 60 lb in AAMIVanuatu 60 lb in AAMIVenezuela 60 lb in AAMIViet Nam 50 kg cm IECVirgin Islands (British) 50 kg cm AAMIVirgin Islands (US) 60 lb in AAMIWallis and Futuna Islands 60 lb in AAMIWestern Sahara 50 kg cm IECYemen 50 kg cm AAMIZambia 60 lb in AAMIZimbabwe 60 lb in AAMI
Alarm and Measurement Default Settings 25 Default Settings Appendix281Alarm and Measurement Default SettingsSettings are only entered once per table row if they are the same for all patient categories1.Alarm Default Settings1.A profile “Outdoor” exists for use in typical outdoor conditions (bright sunlight, higher ambient noise). See the ConfigurationGuide for details.Alarm Settings Factory DefaultAlarm Volume 5Alarms Off 2 min.Pause Al. 5min EnabledPause Al. 10min EnabledAuto Alarms Off OffAlarm Off Reminder OffVisual Latching Red & Yell Audible Latching Red & Yell Alarm Reminder OnReminder Time 3 minAlarm Sounds Traditional Red Alarm Interval 10 secYel. Al. Interval 20 secAlarm Low 4Red Alarm Volume AlarmVol +2Yell. Alarm Volume AlarmVol +0Inop Volume AlarmVol +0Auto Increase Vol. 2 StepsIncrease Vol Delay 20 secKeep Blinking NoRelay 1 Sensitiv. R & Y & IRelay 2 Sensitiv. Red & YellRelay 3 Sensitiv. RedInop Relay Latency 5 secYel. Relay Latency 2 secAlarm Text StandardNo Centr Mon Min Vol 4
25 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings282ECG, Arrhythmia, ST and QT Default SettingsECG SettingsFactory DefaultsAdult Pedi NeoHigh Limit 120 bpm 160 bpm 200 bpmLow Limit 50 bpm 75 bpm 100 bpmAlarms OnAlarm Source AutoECG OnQRS Volume 1Primary Lead IISecondary Lead VAnalysis Mode Multi-leadLead Placement StandardMod. Lead Placment OffFilter MonitorSpeed 25 mm/sAuto Filter OffDefault ECG Size x1Color GreenAsystole Thresh 4.0 sec 3.0 sec'ExtrTachy 20 bpmTachy Clamp 200 bpm 220 bpm 240 bpm'ExtrBrady 20 bpmBrady Clamp 40 bpm 50 bpmALL ECG IN. OnFallback OnAlarms Off EnabledAlarm Source Sel. EnabledVa Lead V2Vb Lead V5SyncPulse sensit MediumSyncPulse Marker OnFallback ECGTele EnabledArrhythmia SettingsFactory DefaultsAdult Pedi NeoArrhythmia On OffPause Threshold 2.0 sec 1.5 secVTach HR 100 120 150VTach Run 5
ECG, Arrhythmia, ST and QT Default Settings 25 Default Settings Appendix283Vent Rhythm 14SVT HR 180 200 210SVT Run 5PVCs/min 10 5 5Non-Sustain OnVent Rhythm OnRun PVCs OnPair PVCs OnR-On-T PVCs OnV.Big e miny OnV.Trige m i n y OnPVCs/min OnMultif. PVCs OnPacer N. Cap OnPacer N. Pac OnPause OnMissed Beat OnSVT OnAfib OnIrregularHR OnHR Alarms Short YellTimeOut 1st 3 minTimeOut 2nd 10 minArrhy Off Message YesSOME ECG IN OnArrhythmia SettingsFactory DefaultsAdult Pedi Neo
25 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings284Lead-independent ST SettingsFactory DefaultsAdult Pedi NeoST Alarm Mode Single STAlarms OnST Analysis On OffST-Index OnISO Point -80 msJ Point 48 msST Point J+60Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL SettingsFactory DefaultsFactory Adult Factory Pedi Factory NeoST(Label) On OffFor Alarm Mode = Single-STST(Label) High +2.0 mmST(Label) Low -2.0 mmFor Alarm Mode = Multi-STST(Label) High +1.0 mmST(Label) Low -1.0 mmQT SettingsFactory DefaultsFactory Adult Factory Pedi Factory NeoQT Lead AllQTc High Limit 500 ms 480 ms 460 ms'QTc Limit 60 msQTc High Alarm On/Off On'QTc High Alarm On/Off OnQT Analysis OffQTc Formula Bazett
Pulse Default Settings 25 Default Settings Appendix285Pulse Default SettingsPulse alarms use the settings of the currently selected Pulse alarm source.Respiration Default SettingsPulse SettingsFactory DefaultsAdult Pedi NeoAlarms Source AutoPulse (Label) OnSystem Pulse SpO2Alarms Off EnabledAlarm Source Sel. EnabledPulse Alarm SettingsFactory DefaultsAdult Pedi NeoPulse (SpO2) OnPulse Alarms OffHigh Limit 120 bpm 160 bpm 200 bpmLow Limit 50 bpm 75 bpm 100 bpm' Extr Brady 20 bpmBrady Clamp 40 bpm 40 bpm 50 bpm' Extr Tachy 20 bpmTachy Clamp 200 bpm 220 bpm 240 bpmRespiration SettingsFactory Defaults Adult Pedi NeoHigh Limit 30 rpm 100 rpmLow Limit 8 rpm 30 rpmApnea Time 20 secAlarms OnResp On Auto/Manual Auto (Trigger Mode)Resp Speed 6.25 mm/sColor Yellow
25 Default Settings Appendix SpO2 Default Settings286SpO2 Default SettingsSpO2 SettingsFactory DefaultsAdult Pedi NeoAlarms OnQRS Volume 1Tone Modulation YesTone Mod. Type EnhancedSpeed 25 mm/sPerfusion OnAverage 10 secNBP Alarm Suppr. OnExtd. Auto OnOff DisabledColor light blue (cyan)SpO2 Alarm Default SettingsSetting Adult Pediatric NeonatalDesat Limit 80 80 80Low Limit 90 90 85High Limit 100 100 95Desat delay 20 sec 20 sec 20 secHigh Alarm delay 10 sec 10 sec 10 secLow Alarm delay 10 sec 10 sec 10 secParameter Alarms On/Off on on onLabel SpO2SpO2SpO2Pulse SettingsPulse (SpO2) On/Off on on onPulse Alarms On/Off on on onPulse High Limit 120 bpm 160 bpm 200 bpmPulse Low Limit 50 bpm 75 bpm 100 bpm'Extr Brady 20 bpm 20 bpm 20 bpmBrady Clamp 40 bpm 40 bpm 50 bpm' ExtrTachy 20 bpm 20 bpm 20 bpmTachy Clamp 200 bpm 220 bpm 240 bpm
NBP Default Settings 25 Default Settings Appendix287NBP Default SettingsTemperature Default SettingsInvasive Pressure Default SettingsNBP SettingsFactory DefaultsAdult Pedi NeoMode Auto ManualAlarms from Sys.High Alarm Limit 160/90 (110) 120/70 (90) 90/60 (70)Low Alarm Limit 90/50 (60) 70/40 (50) 40/20 (24)Alarms OnNBP OnRepetition Time 10 min Pulse (NBP) OnUnit mmHgDone Tone OffStart Time SynchronizedVP Pressure 60 mmHg 40 mmHg 30 mmHgReference Auscultatory InvasiveColor RedTemp SettingsFactory DefaultsAdult Pedi NeoLow Limit 36High Limit 39Alarms OnUnit qCRange 35...43Color GreenABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP SettingsFactory DefaultsAdult Pedi NeoAlarms from Sys.High Limit 160/90 (110) 120/70 (90) 90/60 (70)Low Limit 90/50 (70) 70/40 (50) 55/20 (36)Alarms OnExtreme Alarms Disabled
25 Default Settings Appendix Invasive Pressure Default Settings288'Extreme High 15 10 5'Extreme Low 15 10 5High Clamp 190/100 (125) 140/80 (100) 105/75 (75)Low Clamp 80/45 (65) 60/35 (45) 45/15 (30)Scale 150 100 100Speed 25 mm/sMean Only NoFilter 12 HzMercury Cal. YesArtifact Suppr. 60 secUnit mmHgColor RedC V P, R A P, L A P, U V P S e t t i n g sFactory DefaultsAdult Pedi NeoAlarms from MeanHigh Limit 14/6 (10) 10/2 (4) 10/2 (4)Low Limit 6/-4 (0) 2/-4 (0) 2/-4 (0)Alarms OnExtreme Alarms Enabled'Extreme High 5 5 5'Extreme Low 5 5 5High Clamp 20/10 (15) 15/5 (10) 15/5 (10)Low Clamp 0/-5 (-5) 0/-5 (-5) 0/-5 (-5)Scale 30Speed 25 mm/sMean Only YesFilter 12 HzMercury Cal. YesArtifact Suppr. 60 secUnit mmHgColor light blue (cyan)Average in Mon. NoSignal Quality OnABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP SettingsFactory DefaultsAdult Pedi Neo
Invasive Pressure Default Settings 25 Default Settings Appendix289PAP Settings Factory Defaults Adult Pedi NeoAlarms from Dia.High Limit 34/16 (20) 60/4 (26) 60/4 (26)Low Limit 10/0 (0) 24/-4 (12) 24/-4 (12)Alarms OnExtreme Alarms Enabled Enabled Enabled'Extreme High 5 5 5'Extreme Low 5 5 5High Clamp 45/20 (25) 65/5 (35) 65/5 (35)Low Clamp 5/-5 (-5) 15/-5 (5) 15/-5 (5)Scale 30Speed 25 mm/sMean Only NoFilter 12 HzMercury Cal. YesArtifact Suppr. 60 secUnit mmHgColor YellowICP, IC1, IC2 Settings Factory Defaults Adult Pedi NeoAlarms from MeanHigh Limit 14/6 (10) 10/2 (4) 10/2 (4)Low Limit 6/-4 (0) 2/-4 (0) 2/-4 (0)Alarms OnExtreme Alarms Enabled Enabled Enabled'Extreme High 10 10 10'Extreme Low 10 10 10Low Clamp 20/10 (-5) 15/5 (-5) 15/5 (-5)High Clamp 0/-5 (0) 0/-5 (0) 0/-5 (0)Scale 30Speed 25 mm/sMean Only YesFilter 12 HzMercury Cal. YesArtifact Suppr. 60 secUnit mmHgColor Magenta
25 Default Settings Appendix Cardiac Output Default Settings290Cardiac Output Default SettingsCO2 Default SettingsC.O. SettingsFactory DefaultsAdult Pedi NeoAuto-Calibration OnTblood High Limit 39.0 ºCTblood Low Limit 36.0 ºCTblood Alarm On/Off OnTemperature Unit qCColor GreenCCO/CCI Settings Factory Adult Factory Pedi Factory NeoSettings common to CCO and CCIAlarms from CCOCCO from ABPColor GreenCCOAlarms OnCCO High Limit 8.5 l/min 3.7 l/min 1.3 l/minCCO Low Limit 4.0 l/min 2.6 l/min 0.3 l/minCCIAlarms OnCCI High Limit 4.3 l/min/m23.7 l/min/m25.2 l/min/m2CCI Low Limit 2.0 l/min/m22.6 l/min/m21.2 l/min/m2CO2 SettingsFactory Defaults Adult Pedi NeoetCO2 low 30etCO2 high 50imCO2 high 4CO2 Alarms onUnit mmHgScale 40 mmHgImCO2onN2O Corr (only M3015A/M3016A) OffOxygen Corr (only M3014A) 16%Gas Corr (only M3014A) OffHumidity Corr BTPS
CO2 Default Settings 25 Default Settings Appendix291Max Hold OffAwRR OnAwRR Alarms OnAwRR high limit 30 100AwRR low limit 8 30Apnea time 20 secsColor YellowCO2 SettingsFactory Defaults Adult Pedi Neo
25 Default Settings Appendix CO2 Default Settings292
i1Index#10-lead placement (ECG) 10312-lead placement (ECG) 1033-lead placement (ECG) 1015-lead placement (ECG) 101AAAMI ECG lead labels 100abdominal breathingand Resp electrode placement 142aberrantly conducted beats 110accessories10-electrode cable sets 2343-electrode cable sets 234, 2365-electrode cable sets 234, 2365-electrode one piece cables 2366-electrode cable sets 234CO2 177CO2 (mainstream) 243, 244CO2 (microstream) 244ECG 233NBPadult cuffs 238comfort cuffs 237disposable cuffs 237multi-patient comfort cuff kits 237neonatal/infant cuffs (disposable) 238reusable cuffs 237single-hose disposable cuffs 238Nellcor 239pressure 238Pulsion 238resp 233set combiners and organizers 235, 236SpO2 239Nellcor adhesive sensors (disposable) 239Philips sensors (disposable) 239Philips sensors (reusable) 239temperature 243trunk cables 233, 235active alarms 41address, Philips 247addressograph (printer configuration setting) 213adjusting ST measurement points 124adjusting wave scale (pressure) 166adjusting wave size (CO2) 178admitediting information 87quick admit 87admitting a patient 85airway adapterCO2, microstream accessory 177alarm latching 52, 53, 116alarm limitschanging 48checking 47manually adjusting 48narrow 50report 214ST 126switching auto limits on/off 51using automatic limits 50wide 50window 48alarm recordingchoosing recorded measurements 204alarm source selection, disabled 139alarmsacknowledging 44active 41active SpO2 source 152alphabetical listing 55apnea delay 180apnea delay time (Resp) 144arrhythmia 41audible indicators 43awrr limits 180chaining 118CO2 specific 179CO2, apnea delay 180CO2, awRR 180companion mode 42desat, SpO2 151effect on pressure alarms during zero 165extending pause time 47high priority 41INOP 41ISO/IEC standard 44key 17limit, SpO2 263message field 18NBP source 158off indicator 18patient messages 55pausing 45physiological 55pleth as source 152recordings 53red 41reminder 45restarting 47reviewing window 51selftest 53silencing 44SpO2 high and low limits 151SpO2 specific 150ST 126suspended symbol 46switching on and off 46temperature 161testing 53tone configuration 43traditional 43visual indicators 42volume, changing 44yellow 41alarms key 17alphabetical listing of alarms 55analog outputECG 249apnea alarm delayCO2 180apnea alarm delay time (RESP) 144apnea alarmsand Resp detection modes 144arrhythmiaaberrantly conducted beats 110analysis, how it works 109atrial fibrillation and flutter 110beat labels 112initiating learning 114, 115intermittent bundle branch block 111learning during ventricular rhythm 115levels of analysis 106, 109monitoring non-paced patients 110monitoring paced patients 110options 109relearning 114relearning and lead fallback 115status messages 113switching on/off 110understanding the display 111arrhythmia alarms 41, 115adjusting alarm limits 116
iiall yellow on/off 116chaining 118latching 116multiple 118pvc-related alarms 119sinus and SV rhythm ranges 260, 263switching on/off 116timeout periods 117arrhythmia monitoringand defibrillation 108arrhythmia options 106arrhythmia relearningwith EASI INOP 105arterial pressure source 170arterial pulsation 147artifact suppression (pressure) 167atrial fibrillation and flutter 110audlatching (arrhythmia alarms) 116auto alarm limitsswitching on/off 51using 50auto detection mode (Resp) 142autofilter 98automatic arrhythmia relearn 115automatic default setting 28automatic NBPrepeat time 158autosizeECG wave 98awRR alarmlimits 180awRR alarmsCO2 180BbaselineST map, updating 129ST, updating 123basic arrhythmia option 106, 109battery 221and display brightness 225battery reports 224battery status window 223charge status 224compartment 221conditioning 226conserving power 225indicators 222LED 222malfunction indicator 223malfunction symbols 222monitoring time 223power gauge 222recharging 221replacing 225safety information 227severe INOP 221status indicator 19, 223symbol 248time to empty 224time to full 224battery eject symbol 248battery performanceoptimizing 225battery status indicator 19beat labelsarrhythmia 112bed information 34blood pressure. See also NBP (non-invasive) or PRESS (invasive)Brightness SmartKey 31brightness, adjusting 32Ccalculating cerebral perfusion 170calculating temperature difference 162calibratingCO2 transducer 175calibrationinterval, NBP 230NBP 160pressure 169pressure transducer 169capnographymainstream 15Microstream 15carbon dioxide, see CO2 171cardiac output 16cardiac overlayand Resp detection modes 143when measuring Resp 141cardiotach alarms 106cautions 9central recorderchoosing 204cerebral perfusion 170chaining 118change screen menu 25change screen window 17, 25Changing 25changing ECG lead sets 100changing Resp detection mode 142changing Resp wave size 143changing Resp wave speed 144changing screen content 25channelsrecorder 204checking battery charge 224checking paced status 94checklistdelivery 2installation 1cleaninginfection control 217method 218monitoring accessories 219recommended substances 218CO2airway adapter 177alarms, apnea delay 180alarms, awRR 180alarms, specific 179awRR alarm limits 180checking transducer accuracy 175correction, humidity 179correction, N2O 179corrections 178FilterLine 177measuring mainstream 172, 175measuring microstream 177method, mainstream 171method, microstream 171method, sidestream 171microstream accessories 177microstream extension 177removing exhaust gases 175, 178transducer, calibrating 175transducer, using 176troubleshooting 178wave scale, adjusting 178CO2 (mainstream).accessories 243, 244CO2 (microstream).accessories 244companion mode 23, 35pairing 184conditioning batteries 226configuration mode 23entering 7conflictlabel 29, 30connecting power 4connecting temperature probe 161connection direction symbol 248connectors 249temp 161continuous cardiac output 16conventional 12-lead ECG 103correcting the NBP measurement 157CPAP (RESP) 143cuffpressure, NBP 158selection, NBP 157
iiicurrent viewST map 126Ddamagemechanical 32damage claims 2date, setting 7, 32DC power symbol 248default profile 27default settings 275checking country-specific 7defibrillationand arrhythmia monitoring 108and ECG monitoring 108synchronization marks 95defibrillator proof symbol 248defibrillator synchmaintenance interval 230delay timerecording 205demonstration mode 23desat alarm, SpO2 151detection modes (Resp) 142diagnostic (ECG filter setting) 99discharging a patient 87disconnect INOPssilencing 45disinfectinginfection control 217recommended substances 218displayarrhythmia 111ECG 95NBP 157Resp 142ST 122display brightness 225display settings 26disposalgas cylinder 231parts and accessories 231dual Temp measurement 162dyshemoglobinsintravascular (SpO2) 149Eearly systolic blood pressure, NBP 158EASIactivating 99ECG monitoring 105lead placement 105EASI ECG lead labels 100ECG 93accessories 233alarms off (Config Mode) 107changing lead sets 100choosing electrode sites 99conventional 12-lead 103external pacing electrodes 109filter settings 98fusion beat pacemakers 109intrinsic rhythm 108modified 12-lead 103New Lead Setup 100pacemaker failure 108rate adaptive pacemakers 109unfiltered 99wave size 97ECG analog output 249ECG cablefor operating room 108ECG cables, connecting 94ECG connector 94ECG display 95ECG electrode colors 100ECG electrode placementduring electro-surgery 108ECG gainin reports 208ECG lead labels 100ECG lead placementchoosing EASI/Standard 99ECG leads monitored 100ECG report 215lead layout 208ECG safety information 108ECG source tracking 187ECG waveautosize 98calibration bar 98ectopic status messages (arrhythmia monitoring) 114electrical output symbol 248electrode placement (ECG) 93conventional 12-lead 103modified 12-lead 103electrode placement (Resp) 141with abdominal breathing 142with lateral chest expansion 142electro-surgeryand ECG 108EMC interferenceResp 144EMI filter for ECG 98end casedischarging a patient 87report, printing 87end case reportssetup 209enhanced arrhythmia option 106, 109exclamation mark symbol 248exhaust gases, removing 175, 178extension cable for SpO2 148external pacing electrodesand ECG monitoring 109extreme bradycardia alarm 107, 139extreme pressure alarms 168extreme rate alarms 107, 139extreme tachycardia alarm 107, 139Ffallback (ECG) 100FASTFourier artefact suppression technology 147filter (ECG filter setting) 98filter (ECG) 98FilterLineCO2, microstream accessory 177flushing invasive pressure accessories 163functional arterial oxygen saturation 147fusion beat pacemakersand ECG monitoring 109Ggas cylinderempty, disposing of 231getting started 32global trend time 199graphic trends 192graphic trends report 196Hhemodynamic measurement extension 16hemodynamic MMS extension 16horizon trendtrend time 199host monitor 35HR = RR (Resp) 142HR alarmswhen arrhythmia off 107HR alarms off (Config Mode) 107HR and pulse alarm source selection 139HR from (heart rate source) 138humidity correctionCO2 179IIEC ECG lead labels 100
ivIf 187IIT 34, 89IMV (Resp) 143indicatorsbattery malfunction 223battery status 19, 223infection controlcleaning 217disinfecting 217sterilizing 217Information Centercentral recording 203transferring patients 89, 90transferring patients using IIT 89INOPsindicators 41message field 18silencing 45installationchecklist 1connectors 249personnel 1Instructions for Useintended audience 9IntelliVue Instrument Telemetry System (IIT) 34intermittent bundle branch block 111intermittent mandatory ventilation (Resp) 143interruption symbol 249intravascular dyshemoglobins (SpO2) 149intrinsic rhythm 108ISO point (ST) 124JJ point (ST) 124Kkeyboard, on screen 22keysalarms 17main screen 17pop-up 22silence 17SmartKeys 17Llabel conflict resolution 29, 30label conflicts,resolving 30labels 29changing 29LAN connection 5latchingalarms 52alarms, behavior 53latching arrhythmia alarms 116lateral chest expansion (neonates)monitoring Resp 142lead fallbackand arrhythmia relearning 115lead fallback (ECG) 100lead labels (ECG) 100lead placementactivating EASI/Standard 99for Resp measurement 141leads monitored (ECG) 100Leads Off INOP (ECG) 100levels of arrhythmia analysis 109Mmain screen key 17main setup 20mains powerconnecting to 3mainstreamcapnography 15mainstream CO2measuring 172, 175maintenancecables 229cords 229measurements, schedule 230microstream CO2, calibration 230schedule 229visual inspection 229malfunction symbolsbattery 222manual detection mode (Resp) 143and apnea alarms 144manufacture date symbol 249manufacturer’s information 247mapST 126Mason-Likar lead system 103max hold setting (CO2) 172measurementadjusting a wave 28preparation 32setting up 28wave speed, changing 29measurement extensionM3012A 16M3015A 15M3016A 15measurement label 19measurement labels 29changing 29measurement points, ST 124measurement serverECG connector 94measurement settings 26measurement setup menu 19measurementssetting up 33switching on and off 28mechanical damage 32menumain setup 20measurement setup 19merging patient data 92messagesalarm 18INOP 18status and prompt 19methemoglobin (SpO2) 149Microstream capnography 15microstream CO2 177accessories 177maintenance, calibration 230measuring 177mismatchpatient data, resolving 91modified 12-lead ECG 103modifyingscreens 24monitorinspecting before use 32quick operating giude 6starting monitoring 33switching on 33monitor (ECG filter setting) 98monitor defaults 275monitor revisionhow to find 32monitor settings 26changing 31monitoringpreparation 32starting 32monitoring mode 23mountingpower supply 3mounting information 3MSL cable 5multi-lead ST alarming 126NN2O correctionCO2 179narrow alarm limits 50NBPadult cuffs 238
valarm source 158ANSI/AAMI SP10-1992 155automatic mode, enabling 158calibrating 160calibration interval 230comfort cuff kits 237comfort cuffs 237cuff pressure 158cuff, applying 157cuff, selecting 157cuff, tightness 157disposable cuffs 237how the measurement works 155measurement correction 157measurement limitations 156measurement methods, auto 156measurement methods, manual 156measurement methods, sequence 156measurement methods, stat 156neonatal cuffs (disposable) 238numerics 157oscillometric method 155pediatric cuffs 238preparing to measure 156repeat time 157repeat time for automatic 158repetition time, setting 158reusable cuffs 237single-hose disposable cuffs 238site inspection 157time of last measurement 157units 157venous puncture 159neonatesResp electrode placement 142network connection indicator 18networked monitoring 34new features 37non-invasive blood pressure. See NBPnon-paced patientsarrhythmia monitoring 110numericsexplanation of NBP display 157Oon-screen keyboard 22operating modes 23configuration 23demonstration 23monitoring 23passcode protection 23service 23operating room ECG cable 108orange ECG cable 108organizers 235, 236oscillometric NBP measurement method 155overlapin recordings 205overlapping screen trends 199Ppace pulse rejection (ECG)about 95switching on/off 97paced patientsarrhythmia monitoring 110repolarization tails 97safety information 108setting status 108paced status 19checking 94pacemaker failure 108pairingcompanion mode 184connected to host 35no direct connection 35with wireless device 35paper sizefor reports 210parameter scalestrends 195passcode protection 23patientadmit 85category, NBP 155discharge 87end case 87patient alarm messages 55patient category field 18patient demographics window 85patient mismatch 91patient name field 18patient reportscontents 213patient trendsviewing 191paused alarms 45extending time 47restarting 47performance specificationspressure 258, 265performance test 270perfusion indicator 147, 148, 152Philips contact information 247physiological alarms 41pleth alarm source 152pleth wave 151pleth waveform 147Pop 22pop-up keys 22powerconnecting 4connection 3disconnecting frommains powerdisconnecting from 34from host monitor 4power supllyexternal 4power supplymounting 3power-on LED 5preparing skinfor ECG 93pressurealarms during zero 165arterial source 170calibration pressure 169cerebral perfusion, calculating 170performance specifications 258, 265wave scale 166wave size 166zeroing the transducer 165pressure accessories 238pressure artifact suppression 167pressure of NBP cuff 158pressure transducercalibration 169zeroing 165primary lead (ECG)selecting 94print jobsuspended 211printerdisabling 210settings 210status messages 212unavailable 211printingST map reports 130status log 231trends reports 196priority list for trends 195probesdisposable temperature 161profiles 26default profile 27patient category 27swapping a complete profile 27swapping setting block 27prompts 19pulsealarms 138system pulse source 137
vipulse numerics for SpO2 148PVC-related alarms 119QQRS tone 139changing volume 31QRS tone pitch, SpO2 152QRS volume, changing 98QT alarms 134QT baseline 133QT measurement algorithm 131QT monitoringlimitations 132QT/QTc monitoring 131quick admit 87Rradiated field immunityResp 144rate adaptive pacemakersand ECG monitoring 109realtime report 214realtime reportscontent 210recorder status messages 205recordingcentral 203changing recording type 204channels 204choosing central recorder 204choosing recording speed 205creating templates 204preventing fading ink 205runtime 205setting the runtime 205setup menu 204starting and stopping 203wave overlap 205recording alarms 53recording delay time 205recycling 231rejecting pace pulses 95relearning arrhythmia 114reminder, alarm 45replacing batteries 225repolarization tails 97reportsalarm limits 214battery reports 224choosing paper size 210contents 213ECG 215end case 209patient trends 196realtime report 214re-routing 211scheduled 209setting up 208ST map 130stopping printouts 208re-routing reports 211resolutiontrends 195resolving patient mismatch 91resp accessories 233Resp alarmsapnea alarm delay time 144Resp detection leveland apnea detection 144Resp detection modesand cardiac overlay 143changing 142Resp display 142Resp monitoringand cardiac overlay 141Resp safety information 144Resp wavechanging size 143changing speed 144restarting paused alarms 47retrolental fibroplasia (SpO2) 151reviewing alarms window 51rhythm status messages (arrhythmia monitoring) 113runtimesetting recording runtime 205Ssafetymaintenance interval 230monitor 250safety informationbatteries 227ECG 108Resp 144safety test 270safety testsperformance tests 5power on test 5system 5visual inspection 5same patient data merge 92scaleECG wave 97Resp wave 143scalesfor trends waveforms 195scheduled reports 209screenadjusting brightness 31screen trendtrend time 199screen trends 197screenschanging content 25switching 24understanding 24visitor screen 25secondary lead (ECG)selecting 94selecting the primary lead (ECG) 94selecting the secondary lead (ECG) 94selftestalarms 53sensordisposable SpO2 147sequence mode 158service mode 23set combiners 235, 236setting uptrends 193setting up reports 208setting up the sepuence 158settings 28about 28default 275measurement settings 28monitor settings 28screen settings 28synchronized telemetry and monitor 187settings blocks 26Setup Recording menu 204short yellow alarms on/off 116signal quality of SpO2 149silence key 17sinus and SV rhythm ranges 260, 263skin preparationECG 93SmartKeys 20key 17SmartKeys key 17SmartKeys symbol 248source trackingECG 187specifications 247arrhythmia 258speedrecording 205wave speed, changing 29SpO2accessories 239
viiactive alarm source 152alarms specific to 150arterial pulsation 147assessing suspicious reading 149connecting the cables 148disposable sensors 147extension cable 148FAST technology 147Nellcor adhesive sensors (disposable) 239perfusion indicator 147, 148, 152Philips sensors (disposable) 239Philips sensors (reusable) 239pleth as alarm source 152pleth wave 151pleth waveform 147pulse numerics 148QRS tone 152signal quality 149site inspection 149site selection 147tone modulation 152SpO2 desat alarm 151SpO2 limit alarms 151STadjusting alarm limits 126alarms 106, 126baseline, updating 123ensuring diagnostic quality 121filtering 121measurement points, adjustingadjusting 124multi-lead alarms 126numerics in ECG wave 96snippets 123ST display 122ST mapbaseline, updating 129current view 126report, printingprintingST map report 130scale, changingscaleST map 129task window 129trend view 128trending interval, changing 130trending priority 129ST maps 126ST point 124standard 10-lead placement 103standard 3-lead placement 101standard 5-lead placement (ECG) 101standby mode 23Standby screen 23standby symbol 248starting monitoring 33status line 19status logprinting 231status messagesprinter 212recorder 205status messages (arrhythmia) 113ectopic 114rhythm 113sterilizinginfection control 217stopping reports printouts 208surgical ECG cable 108suspended alarm 46suspicious SpO2 reading 149switching onmonitor 33switching screens 24symbols 248battery 222synchronization marks (defibrillator) 95system pulse 137systolic blood pressure, NBP, early 158Ttabular trends 193Tamb 162task window for ST map 129Tcereb 162telemetry alarms 185suspending at bedside 185telemetry devicecontrolling from bedside 185silencing alarms at bedside 185unpairing 36, 184temperature 161accessories 243alarm settings 161connecting probe to monitor 161difference, calculating 162dual Temp measurement 162extended label set 162first 162label 162making a measurement 161probe, disposable 161probe, selecting 161second 162temperature probeconnecting 161templatescreating for recordings 204test blocks, how to perform 5testing alarms 53time, setting 7, 32tone configuration, alarm 43tone mod (SpO2) 152tone modulation 152touchscreendisable/re-enable 17using 19transducerCO2, accuracy 175CO2, calibrating 175pressure, zeroing 165transferring centrally-monitored patients 89, 90using IIT 89transport brightness setting 225trend time 199global 199trend viewST map 128trending intervalST map 130trendsresolution 195screen trends 197setting parameter scales 195setup 193viewing 191trends pop-up keys 191trends priority list 195ST map 129troubleshootingCO2 178trunk cablesaccessories 233, 235Ttymp 162Tvesic 162UUnderstanding 26unfiltered ECG signal 99unpacking 2unpairing 36, 184unparing 36user interface settingschanging 31VV electrode placement (ECG) 102venous puncture 159viewing arrhythmia waves 112viewing trends 191visible waves report 210
viiivisitor screen 25vislatching (arrhythmia alarms) 116vital signs report 196voltage setting 4volumealarm 44Wwarnings 9waveadjusting 28changing speed 29scale (CO2) 178scale (pressure) 166size (CO2) 178size (pressure) 166wave channel speed 29wave group speed 29wave sizeResp 143wave size (ECG)changing 97wave speedeeg speedwave speedglobal speed 29respiratory speed 29wave speed (Resp) 144what’s new 37wide alarms limits 50wired network connection symbol 249Zzeroeffect on pressure alarms 165zeroingpressure transducer 165

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