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Dash 3000/4000

Patient Monitor
Operators Manual

Software Version 4
2000966-171 Revision B

g GE Medical Systems
Information Technologies
gemedicalsystem.com
127(The information in this manual only applies to Dash 3000/4000
patient monitor software version 4. Due to continuing product
innovation, specifications in this manual are subject to change without
notice.

Listed below are GE Medical Systems Information Technologies trademarks used in this document. All other
trademarks contained herein are the property of their respective owners.

DASH, EAGLE, MULTI-LINK, MUSE, SAM, SOLAR, TRIM KNOB, and UNITY NETWORK are trademarks
of GE Medical Systems Information Technologies registered in the United States Patent and Trademark
Office.

12SL, CENTRALSCOPE, and MENTOR are trademarks of GE Medical Systems Information Technologies.

GE Medical Systems Information Technologies, 2002. All rights reserved.

T-2 Dash 3000/4000 Patient Monitor Revision B


2000966-171 7 August 2002
CE Marking Information

CE Marking Information 0459

Compliance
The Dash 3000/4000 patient monitor bears CE mark CE-0459 indicating
its conformity with the provisions of the Council Directive 93/42/EEC
concerning medical devices and fulfills the essential requirements of
Annex I of this directive. The product is in radio-interference protection
class A in accordance with EN 55011.

The country of manufacture can be found on the equipment labeling.

The product complies with the requirements of standard EN 60601-1-2


Electromagnetic Compatibility - Medical Electrical Equipment.

The safety and effectiveness of this device has been verified against
previously distributed devices. Although all standards applicable to
presently marketed devices may not be appropriate for prior devices (i.e.
electromagnetic compatibility standards), this device will not impair the
safe and effective use of those previously distributed devices. See users
information.

Electromagnetic Compatibility
Electromagnetic compatibility (EMC) information can be found in the
appendices chapter of this manual.

Radio and Telecommunication Terminal Equipment Directive


The monitor contains a transmitter. The transmitter bears a CE mark
indicating conformity with the essential requirements specified in Article
3 of the Council Directive 1999/5/EC of 9 March 1999 concerning Radio
Equipment and Telecommunications Terminal Equipment (R&TTE).

The essential requirements are as follows:

Article 3.1 (a) Health Safety; the product complies with the particular
medical device safety standards specified in the Medical Device Directive
93/42/EEC:

1. EN 60601-1 Medical electrical equipment: Part 1: General


requirements for safety - IEC 601-1:1988.
2. Amendment A1 to EN 60601-1 Medical electrical equipment: Part 1:
General requirements for safety - IEC 601-1:1998A11991.

3. Amendment A2 to EN 60601-1 Medical electrical equipment: Part 1:


General requirements for safety - IEC 601-1:1998/A2:1995 +
corrigendum June 1995.

Article 3.1 (b) EMC; the product complies with:

Revision B Dash 3000/4000 Patient Monitor CE-1


2000966-171
CE Marking Information

1. EN 60601-1-2 Medical electrical equipment: Part 1: General


requirements for safety - 2. Collateral standard: Electromagnetic
compatibility - requirements and test - IEC 601-1-2:1993.

2. EN 300 826: Electromagnetic compatibility and Radio spectrum


Matters (ERM); ElectroMagnetic Compatibility (EMC) standard for
2.4 GHz wideband transmission systems and HIgh PErformance
Radio Local Area Network (HIPERLAN) equipment.

Article 3.2 Protection of the Radio Spectrum: the product complies with:

n EN 300 328: Radio Equipment and Systems (RES); Wideband


transmission systems; Technical characteristics and test conditions
for data transmission equipment operating in the 2.4 GHz ISM band
and using spread spectrum modulation techniques.

General Information
n This manual is an integral part of the product and describes its
intended use. It should always be kept close to the equipment.
Observance of the manual is a prerequisite for proper product
performance and correct operation and ensures patient and operator
safety.

n The symbol means ATTENTION: Consult accompanying


documents.

n Information which refers only to certain versions of the product is


accompanied by the model number(s) of the product(s) concerned.
The model number is given on the nameplate of the product.

n The warranty does not cover damages resulting from the use of
accessories and consumables from other manufacturers.

n GE is responsible for the effects on safety, reliability, and


performance of the product, only if

n assembly operations, extensions, readjustments, modifications,


or repairs are carried out by persons authorized by GE.

n the electrical installation of the relevant room complies with the


requirements of the appropriate regulations; and,

n the device is used in accordance with the instructions for use.


n All publications are in conformity with the product specifications and
IEC publications on safety of electromedical equipment as well as
with UL and CSA requirements and AHA recommendations valid at
the time of printing.

n The GE quality management system complies with the international


standards DIN/EN/ISO 9001 and EN 46001, and the Council
Directive on Medical Devices 93/42/EEC Annex II.

CE-2 Dash 3000/4000 Patient Monitor Revision B


2000966-171
Contents
About This Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Manual Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Intended Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Revision History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Manual Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv


Product References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv
Illustrations and Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv

Monitor Defaults Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

1 The Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1


Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
The Monitoring System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
Dash 3000/4000 Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
Optional RAC 2A Module Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6
SAM Module Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
Optional Centralscope Central Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10
Optional Clinical Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11
Optional Wireless LAN System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
Optional Laser Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15
Controls and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16

Turning Power On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21


AC Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21
Battery Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21

Software Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22


Software Packages and Software Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22
Monitor Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24
Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24
Popup Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-27
Subordinate Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-28
Direct Action Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-29
Parameter Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-30
Information Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-31
Trim Knob Control Operation When Setting Alarm Limits . . . . . . . . . . . . . . . . . . 1-32

Graphing (Printing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-33


Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-33
Manual Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-33
Pressure Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-34
Graphing Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-35

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2000966-171
Graph Header . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-35

Putting the Monitor Into Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-36


Monitor Installation and Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-36
Performance Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-37

Language-Specific Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-38


French Language Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-38
Hungarian, Polish, and Russian, Language Information . . . . . . . . . . . . . . . . . . . 1-38
Chinese and Japanese Language Information . . . . . . . . . . . . . . . . . . . . . . . . . . 1-38

2 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
For Your Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Monitor Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Reference Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11

Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12
Underwriters Laboratories, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12
Equipment Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

3 Admit Discharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1


About Admitting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
You Must Admit to Activate Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
Monitors are Used in Different Ways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
For Which Application is the Monitor Set? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

Getting to the Admit Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

Standard Admit Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Rover Admit Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

Combo Admit Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

Rover Combo Admit Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Admit Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11


Change Admit Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11
Request Admit Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13
Recall Default . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13
Admit Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14
Admit Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14
Units of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-15

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Set Unit Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16
Set Bed Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17
Graph Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17
ECG Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-18

About Discharging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19


Discharge Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19

4 Alarm Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1


Smart Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

Alarm Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4


Patient Status Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4
System Status Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5
On-Screen Alarm Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5

Controlling Audio Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6


Silencing an Alarm for One Minute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6
Pausing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6
Alarm Pause Breakthrough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7
Turning Alarm Volume Off Permanently . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

Alarm Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8


Clear Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8
Alarm History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

Alarm Control Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9


All Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9
Arrhythmia Alarm Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12
Parameter Alarm Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-14
Alarm Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-16
Display Off Alarm Pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17
Clear Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-18
Alarm History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

5 Monitor Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1


Monitor Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3
Waveforms On / Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4
Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6
Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7
Parameters On / Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8
Graph Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9
Monitor Defaults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15
Monitor Defaults Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-16
Monitor Default Password . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-27

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Brightness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-28
Learn the Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-29
Software Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-30
Revision and ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-31
Service Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-32

6 CRG Trends Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1


CRG Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3
CRG Trends Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3
CRG Trends Event Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4
CRG Trends Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Document CRG Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

7 View Other Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1


Viewing Other Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

View Other Patients Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5


View Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6
View On Alarm Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6
Select a Bed to View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9
Select Another Care Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10
Graph Viewed Bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10

8 Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1


Patient Data Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
Alarm History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4
Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7
Graphic Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10
Cardiac Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13
Pulmonary Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17
Dose Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-22
CRG Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-31
Lab Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-32

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9 Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1
Battery Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3
Battery Run Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4
Battery Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

Battery Packs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6


Battery Charging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6
Conditioning a Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7
Battery Recycling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7

Battery Status Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8


Battery Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9

Battery Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10

10 Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1
Biocompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3

Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4

General Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-5


Exterior Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-5
Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-5

Cleaning Applied Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6


Cables and Leadwires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6
Capnostat Sensor and Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6

Technical Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7

Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7

Changing Graph Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8


Built-in Writer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8

Thermal Paper Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9

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11 ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3
Turning the ECG Parameter Off or On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Skin Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6

Electrode Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7


5-Leadwire Electrode Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7
3-Leadwire Electrode Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-8
Electrode Placement for Neonates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-9
Electrode Placement for Pacemaker Patients . . . . . . . . . . . . . . . . . . . . . . . . . . 11-10
10-Leadwire Electrode Configuration for 12SL Monitoring . . . . . . . . . . . . . . . . 11-10
Maintaining Quality ECG Signal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12
Surgical Considerations for Electrode Placement (Adults) . . . . . . . . . . . . . . . . 11-12

ESU ECG Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13


Electrosurgical Unit (ESU) Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13

ECG Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14


ECG Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14
Getting to the ECG Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-15

ECG Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-17


Display Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-17
ECG Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-19
Detect Pace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-20
ECG Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-24
View All ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-26
Clear V2-V6 Fail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-26
Arrhythmia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-27
Relearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-30
ST Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-31
Turn ST On and Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-33
ST Analysis Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-34
ECG Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-41
12 Lead ECG Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-42
Lead Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-51
More ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-52

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-54
Pacemaker Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-56

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12 Pressures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3
Assigned BP Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4
Zero Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5

Pressure Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6


Pressure Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6
Getting to the Pressure Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7

Pressure Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8


Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8
Full Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8
Cursor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9
Clear Cursor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9
Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10
Change Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11
Zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12
BP Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12
Calibrate Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13
Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13

Special Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14


IABP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14
Using the IABP Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-15
Smart BP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-19
Pulse Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-19
Disconnect Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-20

PA Wedge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-21
PA Wedge Menu Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-22
PA Insert Wedge Menu Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-23

General Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-30

Wedge Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-31

13 NBP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3

NBP Connector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-4

Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-5

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-6

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Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7

NBP Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8


NBP Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8
Getting to the NBP Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10

NBP Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-12


NBP Auto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-12
NBP Stat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-13
Review NBPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-14
NBP Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-15
Cuff Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-17
Clear NBP Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-17
Initial Inflation Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-18

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-19
NBP Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-19

14 SPO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-3
Primary Monitoring Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-4

Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-5
Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-6

Neonates and Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-7

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-8

Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9

Signal and Data Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10


Signal Strength Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10
Quality of SPO2 Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10
Stability of SPO2 Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-11

Masimo SET Configuration and Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12


No Implied License . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12
Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12

SPO2 Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13


SPO2 Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13
SPO2 and NBP Simultaneously . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13
Getting to the SPO2 Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-14

SPO2 Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15


Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15
Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15

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Rate Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-16
SPO2 Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-17
Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18
Averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18
Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18

Probe Off Patient Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-19

Pulse Search Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-20

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-21
SPO2 Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-21

15 Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3
Cardiac Output Washout Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-4
Influencing Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-4
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-4

Suggested Cardiac Output Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7

Bath Probe Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-8

In-Line Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-9

Cardiac Output Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-10


Cardiac Output Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-10
Cardiac Output Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-11
Getting to the Cardiac Output Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-13

Cardiac Output Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-14


Delete CO Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-14
Cardiac Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-14
Cardiac Output Now . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-15
BT Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-16
Print CO Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-17
Auto Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-17
Use: PAW (PAD, LA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-17
Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-19
Injectate Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-20
Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-21
Injectate Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-22
Computation Constant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-23
Cardiac Output Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-24

Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-25

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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-25
Cardiac Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-27

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-30
Procedural Prompts/Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-30
Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-31

16 Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3
General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5

Respiration Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6


Respiration Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6
Getting to the Respiration Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-7

Respiration Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-8


Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-8
Relearn Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-8
Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-9
Respiration Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-10
Auto Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-11
Manual Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-11
Cardiac Artifact Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-12
Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-12

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-13
Respiratory Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-13
Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-14

17 Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-3
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-3

Temperature Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-4


Temperature Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-4
Getting to the Temperature Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5

Temperature Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6


T1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6
T2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6
Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6
Temperature Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-8

x Dash 3000/4000 Patient Monitor Revision B


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Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-8

18 CO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3

Capnostat CO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4


General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4
Mainstream Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5

CO2 Monitoring Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6


CO2 Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6
Getting to the CO2 Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-7

CO2 Menu Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8


Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8
CO2 Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-9
CO2 Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10
N2O Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
O2 Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
CO2 Averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
Cal Sensor to Zero Cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
Calibrate Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11

Zero Capnostat Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-12

Calibrate Capnostat Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-13

Cleaning the Sensor and Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-14


Cleaning the Capnostat Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-14
Cleaning the Reusable Capnostat Adapters . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-14

Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-15
Capnostat Sensor Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-15
Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-16

Revision B Dash 3000/4000 Patient Monitor xi


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Appendix A Analog Output . . . . . . . . . . . . . . . . . . . . . . .A-1

Appendix B Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-1

Appendix C Software Packages . . . . . . . . . . . . . . . . . . .C-1

Appendix D Factory Defaults Adult-ICU Mode . . . . . .D-1

Appendix E Factory Defaults Neonatal-ICU Mode . . .E-1

Appendix F Factory Defaults Operating Room Mode F-1

Appendix G Certification . . . . . . . . . . . . . . . . . . . . . . . . G-1


Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-3

Electromagnetic Compatibility Compliance (EMC) . . . . . . . . . . . . . . . . . . . . . . . . G-3


Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-3
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-3

FCC Compliance Information Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-4

Appendix H Abbreviations . . . . . . . . . . . . . . . . . . . . . . .H-1

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1

xii Dash 3000/4000 Patient Monitor Revision B


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Preface: About This Manual

About This Manual


Manual Purpose
This manual contains the instructions necessary to operate the monitor
safely and in accordance with its functions and intended use.

Intended Audience
This manual is geared for clinical professionals. Clinical professionals
are expected to have working knowledge of medical procedures,
practices, and terminology as required for monitoring of critically ill
patients.

Revision History
Each page of the document has the document part number and revision
letter at the bottom of the page. The revision letter changes whenever
the document is updated.

Revision Date Comments

A 13 June 2002 Initial release of this document.

B 7 August 2002 Added alarm pause ECG parameter off


constraint.

Revision B Dash 3000/4000 Patient Monitor xiii


2000966-171
Preface: Manual Conventions

Manual Conventions
Product References
The following abbreviated product names are used in this manual to
identify common products.

Name Product

monitor Dash 3000/4000 patient monitor

central station Centralscope central station


Clinical Information Center

writer PRN 50 writer


Direct Digital Writer (DDW)

printer laser printer

Definitions
The following terms are used in this manual to describe various monitor
features and functions.

Item Definition

keys A labeled button found on the front of the monitor or on the


optional remote control.

menu Text which appears at the bottom of the display screen. A


menu is composed of a set of menu options.
menu option A choice found in a menu. A menu option is enclosed by a
rectangle.

screen text Any text that appears on the monitor display screen. In this
manual, screen text is shown in all italics (for example,
ECG, SAVING, etc.)

Illustrations and Names


All illustrations in this manual are provided as examples only. They may
not necessarily reflect your monitoring setup or data displayed on your
monitor.

In this manual, all names appearing in examples and illustrations are


fictitious. The use of any real persons name is purely coincidental.

xiv Dash 3000/4000 Patient Monitor Revision B


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Preface: Monitor Defaults Worksheet

Monitor Defaults Worksheet


You can customize alarm limits and levels as well as Patient-monitor type and default setting (circle one):
numerous display options. Your settings can be set up as
Monitor Defaults to be recalled with each discharge ADULT-ICU 0 1
procedure. Refer to the Monitor Setup chapter of this manual NEONATAL-ICU 0 1
for details. OPERATING ROOM 0 1

We have provided this worksheet as an optional reference 127(Changing patient-monitor type after setup erases
tool. Fill it out and keep it in a prominent place to refer to your monitor defaults and reinstates factory monitor
your setup. You may want to make additional copies of the defaults.
worksheet for future use before filling it out.

Date: _________________ Unit: __________________

Arrhythmia Alarm Levels Parameter Alarm Levels

Crisis Warning Advisory Message Crisis Warning Advisory Message


Asystole HR
VFib/VTac CO2 No
Breath
V Tach
PVC/min
VT > 2
ST
V Brady
ART
Couplet
PA
Bigeminy
CO2
Acc Vent
NBP
Pause
FEM
Trigeminy
UAC
R on T
GAS
PVC
CVP
Tachy
RA
Brady
UVC
Irregular
LA
ICP
SP
SVO2
TC
SPO2
ART Rate
BT
ICG
RR
Resp
Apnea
FEM Rate
UAC Rate
SPO2 Rate

Revision B Dash 3000/4000 Patient Monitor xv


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Preface: Monitor Defaults Worksheet

Parameter Alarm Levels


Parameter Limits
TMP
Low High
ICP
Parameter Limits
SP
Low High
CO2-Exp
HR
CO2-Insp
PVC/min
CO2-Resp
ST-I
No Breath
ST-II
SpO2
ST-III
SpO2-R
ST-V1
BT
ST-AVL
RR
ST-AVF
SVO2
ST-AVR
RR-Apnea
ST-V2
TEMP 1
ST-V3
TEMP 2
ST-V4
O2-Insp
ST-V5
O2-Exp
ST-V6
N2O-Insp
NBP-S
N2O-Exp
NBP-D
N2-Insp
NBP-M
N2-Exp
ART-S
SEV-Insp
ART-D
SEV-Exp
ART-M
DES-Insp
ART-R
DES-Exp
FEM-S
ENF-Insp
FEM-D
ENF-Exp
FEM-M
HAL-Insp
FEM-R
HAL-Exp
UAC-S
ISO-Insp
UAC-D
ISO-Exp
UAC-M
HE-Inps
UAC-R
HE-Exp
PA-S
AR-Inp
PA-D
AR-Exp
PA-M
CI
CVP
TFC
RA
UVC
LA

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Display Defaults Display Defaults

Patient Age N2O Compensation (OR only)


Display Mode O2 Compensation
Color Format RR Parameter
Primary ECG RR Lead
ECG Waveform 2 RR WF Speed
Arrhythmia SPO2 WF Speed
Detect Pace View On Alarm
Arterial Rate VOA Broadcast
Lead Analysis VOA Alert Tone
ST Analysis Remote Alarm Level
ST Templates Alarm Volume
ST V Lead Alarm Volume Off
ST Template 1 Min Alarm Volume
ST Template 2 Silence Alarm
ST Template 3 QRS Volume
Adjust ST Point Rate Volume
12 LD on ST History ECG Leads Fail
ECG WF Speed SPO2 Probe Off
Graph Waveform 2 SPO2 Pulse Search
Graph Waveform 3 Monitor ISO/DES
Graph Waveform 4 Display Limits
Alarm Graph Display Units
Timed Graph Units For Height
ART Disconnect Units For Weight
Smart BP Temperature Units
Arterial Scale CO2 Units
PA Scale O2 Units
CVP-RA-UVC Scale GAS Units
LA Scale NBP Limits Type
ICP Scale Arterial Limits Type
SP Scale PA Limits Type
BP WF Speed Menu Timeout
CO2 Scale ECG Filter
CO2 WF Speed BP Filter
NBP Auto QRS Width
ADULT Cuff Pressure CO2 Display Mode
PED Cuff Pressure Discharge Alert
NEO Cuff Pressure Vent WF Speed
CO Catheter Display MAC Value
CO Inj Temp Disable SAM HAL
CO Size Disable SAM ENF
CO Inj Vol Tech ID Field
CO Auto Mode ICG Primary Par

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Display Defaults Parameter Priority Defaults


Indicate which parameters you want to have priority in the
ICG Secondary Par1 first 6 positions on the display.
ICG Secondary Par2
ICG Secondary Par3 * When the ECG parameter is turned on, the ECG parameter
will always appear first and cannot be changed. However,
NBP Silence Alarm
when the ECG parameter is turned off, the SPO2 parameter
Pause Breakthru will always appear first and cannot be changed.
Masimo Averaging
ECG IntelliRate Parameter 1 ECG*
SPO2-NBP Interlock Parameter 2
ECG Parameter Parameter 3
Disconnection Option Parameter 4
Parameter 5
Parameter 6

Circle the other parameters you want to have priority after


position 6. Size of the parameter window determines how
many selections you can make (3 full size, 5 reduced size, or
combination thereof). The software prevents you from
selecting more parameters than allowable.

GAS RA* TEMP*


NBP UVC* ALARMS
ART LA*
FEM ICP*
UAC SP*
PA SPO2*
CO2 CO*
CVP* RESP*
* MAY BE DISPLAYED AS REDUCED SIZE
(determined by software)

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1 The Basics

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For your notes

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Components
The Monitoring System
The monitor can function by itself with a built-in writer, or it can be
cabled in with the optional Unity Network via Ethernet. Optional
components are, if using Wireless LAN or cabled to Ethernet, a
Centralscope central station and the Clinical Information Center
(CIC).

Dash 3000/4000 Monitor


This device is designed to monitor a fixed set of parameters including
ECG, noninvasive blood pressure, impedance respiration, SpO2, and
temperature. Invasive pressure and EtCO2 are optional features.
Additional specialized features include cardiac output, cardiac
calculations, pulmonary calculations, dose calculations, PA wedge (PA
wedge is only available with the invasive pressure option), SAM module
interface, and the ICG module interface.

AC Battery

Power

Charging Status

A B

Graph

NBP Go/Stop

Zero All

Trim Knob

Silence Alarm/
Admit

Charging Status Power Graph Go/StopNBP Go/Stop Zero All Silence Alarm/
A B Admit

Dash 4000

810B
901A

Dash 3000 Monitor, Front View Dash 4000 Monitor, Front View

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The Basics: Components

Right Side View


All of the patient cable connectors are located on the right side of the
monitor. The screen displays patient information in a logical, easily
understood format. A Trim Knob control provides single control
operation of virtually all monitor functions.

Patient Cable
Connectors

Monitor, Right Side View

Left Side View


On the left of the monitor, you can find the built-in writer and the
battery compartment.

Built-in WriterThe built-


in, 4 channel writer is
located in the center of the
left side of the monitor.

Battery Compartment
The battery packs are
located in this
compartment.

Monitor, Left Side View

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Back View
On the back of the monitor you will find all connectors for equipment and
network.

Line Voltage SelectorThis selector is factory set to


match the line voltage and frequency rating for your
country.

Network ConnectorA cable


Audible Alarm EnunciatorThe
can be connected to this port
internal speaker provides sound
for monitors used in patient
for audible alarms. For better
monitoring network
sound quality do not block
configurations.
speaker.

Aux PortUsed for:


RAC 2A module
housing and other
compatible auxiliary
Equipotential devices.
Terminal

Defib Sync ConnectorProvides


ECG analog output signals to
user-supplied equipment. A 5-
Monitor, Back View
AC Power volt, 2-millisecond artificial pacer
Connector spike is added to the analog
output when PACE is on and
detection occurs. Refer to
Appendices, Analog Output, for
details on signal output.

Refer to the service manual for system safety requirements when


connecting the monitor to accessory equipment.

Optional Alarm Light Indicator


An optional alarm light indicator can be built into the handle of the Dash
3000 monitor or into the display bezel of the Dash 4000 monitor. When
activated, the LED indicator flashes red for CRISIS patient status
alarms and yellow for WARNING patient status and system status
alarms.

Alarm Light Indicator

Dash 3000 Monitor, Alarm Light Dash 4000 Monitor, Alarm Light Indicator
Indicator

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Optional RAC 2A Module Housing


The RAC 2A module housing currently supports the SAM or ICG module.

RAC 2A Module Housing

An integral power supply is used to run the module housing and support
the needed voltages.

Housing Connectors
The module housing connects to the monitor via a communications cable
which plugs into the AUX port on the monitor and to the Auto Port on
the back of the module housing.

The module housing does not have an Analog Output connector.

AC Power
Power Switch

Auto Port

Async Comm

Back View of RAC 2A Module Housing

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How to Install and Remove a Module


A module can be easily installed and removed.

To install a module follow this procedure:

1. Facing the module housing, guide the back end of the module into the
slot.
2. Gently push the module into the housing. You will hear a click when
the module is fully inserted.
To remove a module follow this procedure:

1. Release levers are found on each side on the front of the module*.
2. Press and hold the release levers simultaneously and pull the module
out about six inches.
3. Once released, grasp the module firmly with both hands and remove
the rest of the way. Do not try to hold the module by the release
levers.
*The release levers for SAM modules are recessed in the side of the
protruding front of the module.

RAC 2A Module Housing

Release Levers

Removing a Sam Module

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Optional SAM Module Information


Disabling Halothane and Enflurane
When using the SAM module with the monitor, the detection of low
values of halothane and enflurane, due to non-analyzed gases in the
circuit, can be disabled.

This option defaults off. If you do not want the system to detect and
display low values for halothane and enflurane, you must turn DISABLE
SAM HAL and DISABLE SAM ENF on. These options are found under
SETUP DEFAULT DISPLAY in the Monitor Defaults Menu.

127(Halothane and enflurane values greater than 1% are displayed


in the Gas parameter window even when this feature is on.
Values less than 1% are not displayed.

Display MAC Value


When using the SAM module with the monitor, the current MAC value
can be displayed in the GAS parameter window. The MAC value is the
minimum alveolar concentration of an agent needed to produce an
anesthetizing effect in 50% of the population.

This option defaults off but can be turned on in Monitor Defaults under
SETUP DEFAULT DISPLAY. This option can also be turned on/off using
the DISPLAY MAC VALUE menu option from the Gas Menu.

When on, the MAC value is displayed in the third agent slot in the Gas
parameter window.

127(If N2O and two other agents are being displayed, the MAC value
will not appear in the Gas parameter window.

GAS Parameter Window Displaying MAC Value

:$51,1*
These MAC values correspond to healthy adults. Other
factors such as age and physical condition need to be
accounted for.

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Optional ICG Module The ICG module (impedance cardiography) measures and processes
patient hemodynamic data. For more information, see the Patient
Monitoring System Operators Manual Supplement for the Solar ICG
Module.

902A

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Optional Centralscope Central Station


127(The Unity Network is a purchased software option which must
be enabled before using this component or feature.
The Unity Network (Ethernet) establishes bed-to-bed communication
and allows patient data to be sent to an optional Centralscope central
station and to other monitors on the network. All devices must be
connected to the network.

The central station may have a built-in, 2-inch writer or a laser printer
for graphing (printing).

Centralscope Central Station

The Centralscope central station is generically referred to as the central


station throughout this manual.

Refer to the Centralscope central station operators manual for


instructions on operation.

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Optional Clinical Information Center


127(The Unity Network is a purchased software option which must
be enabled before using this component or feature.
The Unity Network (Ethernet) establishes bed-to-bed communication
and allows patient data to be sent to an optional Clinical Information
Center and to other monitors on the network. All devices must be
connected to the network.

Clinical Information Center

The Clinical Information Center is generically referred to as the central


station throughout this manual.

Refer to the Clinical Information Center operators manual for


instructions on operation.

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Optional Wireless LAN System


127(The Unity Network is a purchased software option which must
be enabled before using this component or feature.
The flexibility of the GE Unity Network is increased by using the
Wireless LAN system. The Wireless LAN system allows the user to roam
from one access point to another, maintaining a strong, seamless
connection to the Unity Network.

A monitor, with its optional built-in Wireless LAN, functionally performs


the same as a monitor connected directly to the Unity Network. It can be
viewed at the central station and by other GE monitors on the network
(i.e. Dash 3000/4000, Eagle 4000, and Solar patient monitors).
Monitors with Wireless LAN sends and receives patient data via the
access points of the Unity Network.

127(Wireless patient monitors that are moved from room to room


must have the monitor type configured as Rover or Rover/Combo
monitoring.

Access Points
To integrate the wireless network with the wired network, one or more
access points are necessary. An access point connects the wireless
monitor to the wired network infrastructure within the building, and
acts as a bridge between the wired and wireless networks. The areas
covered by each access point overlap to insure continuous coverage.

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Establish Communication
Approximately one minute after power-up of the wireless monitor (or any
other time during normal operation), perform one or more of the
following steps to verify network communication. If any one of these
steps is successful, the wireless monitor has access to the Unity Network.

n Select VIEW OTHER PATIENTS at the wireless monitor and


attempt to view a known bed on the network. Refer to the
appropriate monitors operators manual.
n View the wireless monitor from a central station on the network.
Refer to the appropriate central stations operators manual.
n Perform a LIST NETWORK from the central station on the network
and verify that the wireless monitor appears in the list. Refer to the
appropriate central station service manual.
n Ensure that the defaults and graph locations are set at the patient
monitor according to the appropriate operators manual.

Unity Network Switching and Priority

Hardwired or wireless network communication is transparent to the user


and is not indicated on the display.

The transition between hardwired and wireless network communication


occurs automatically when a Category 5 unshielded twisted pair cable is
disconnected from the Ethernet port of an RF LAN enabled monitor.
Hardwired communication is established when the cable is connected.
Each transition occurs within 3 seconds of connecting or disconnecting
an Ethernet cable. The hardwired Ethernet connection has priority when
an RF LAN card is installed.

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Troubleshooting

Loss of Waveform
Due to the nature of the Wireless LAN system, loss of waveform data
may occasionally occur. Intermittent small gaps in the display waveform
may be caused by radio-frequency interference.

Problem Solution
Loss of waveform occurs in a Call service personnel to determine if more access
specific location. points are required for better coverage or if there are
any compatibility issues between the Wireless LAN
and access points.

An intermittent radio-frequency Try to isolate the source and move the wireless
interference at 2.4 GHz is in monitor away from the interfering device.
close proximity to the wireless
monitor. Microwave ovens can be strong sources of 2.4 GHz
radio-frequency interference.

Remove the source of interference, if possible.

Communication Problems
Extended loss of communication will cause the NO COMM message to
appear at the central station. This fault may be due to one of the network
communication problems described in the table below.

Problem Solution

The monitor, with built-in Move the patient into the coverage area.
Wireless LAN adapter, was
moved outside the Wireless
LAN coverage area.

One of the access points in the Try moving the patient to another portion of the
system may have failed. Wireless LAN coverage area.

Replace a failed access point with one known to work


properly.

A strong radio-frequency Try to isolate the source and move the wireless
interference at 2.4 GHz is in monitor away from the interfering device.
close proximity to the Wireless
LAN adapter. Remove the source of interference, if possible.

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Optional Laser Printer


An optional laser printer (not shown) connects to the central station. It is
identified on the monitor as LASER when choosing a graph location.
(Refer to the Monitor Setup chapter for more details.)

When you choose the laser printer as the print window location, it can
print any printable information window when it is displayed and the
GRAPH GO/STOP key is pressed.

127(The GRAPH GO/STOP key is located on the monitor and on the


optional remote control.
When you choose the laser printer as the manual graph location, it will
print the waveforms as selected in Graph Setup when the GRAPH GO/
STOP key is pressed. It prints 20 seconds of waveforms per page in a
cascade format when the graph speed is set for 25 millimeters per
second. There will be a delay of approximately one minute until the first
page is printed, then it will run until all patient data is printed.

127(The one-minute delay does not mean the data printed is delayed.
It just takes that long for the information to be processed by the
laser printer. The amount of data printed will increase and the
delay will be longer if a speed slower than 25 mm/s is chosen.
When you choose the laser printer as the alarm graph location, it will
provide 20 seconds of waveforms per page in a cascade format, but again,
there will be a delay of one minute until the first page is printed.

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Controls and Indicators


Control Panel
On the control panel there are five control keys. Their functions are
described below. Press the control key to activate the function. The Trim
Knob control is also found on the control panel.

Dash 3000 Control Panel

AC Battery

Power
A
Charging Status

A B

Graph

B
NBP Go/Stop

C
Zero All

D Dash 4000 Control Panel


Trim Knob

F Charging Status
A B
Power Graph Go/StopNBP Go/Stop Zero All Silence Alarm/
Admit

Dash 4000
Silence Alarm/
Admit

E
810B

901A A B C D E F

Item Dash 4000 Icon Description

A Power The monitor will be powered at all times when plugged into AC power. This key turns
the monitoring function ON and OFF. When the monitoring function is turned off,
814A patient monitoring is discontinued; however, patient data already accumulated is
retained and the battery charging function continues.

127(To prevent inadvertently turning the monitoring function


ON or OFF, this key must be depressed for 0.25 seconds
before the function is activated.

B Graph Go/Stop Press this key once to start a graph run of the patients data. Press a second time to
stop. If pressed during an alarm graph run, the graph will run continuously until Graph
815A Go/Stop is pressed again. Note that an alarm graph run is usually an automatic 20-
second timed graph.
This key is also used to print a copy of non-real time screens. We refer to these as
information windows. Not all information windows can be printed. If a printable
information window is displayed, press Graph Go/Stop to print a copy. If a
nonprintable information window is displayed, pressing the Graph Go/Stop key prints
patient data as if the information window was not displayed.

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Item Dash 4000 Icon Description

C NBP Go/Stop This key starts one noninvasive blood pressure measurement. It can also be used at
any time to stop a measurement in process.
816A
In Operating Room Mode, if an auto mode time is set in monitor defaults, pressing the
NBP Go/Stop key starts the auto mode feature.

D Zero All This key zeros all invasive pressure lines which are open to atmosphere. Each
pressure can also be zeroed, if desired, with a menu option in the pressure menu.
817A

E Silence Alarm/ The function of this key can be set to NORMAL or SILENCE ONLY (refer to the Monitor
Admit Setup chapter, Setup Default Display). When set to NORMAL, this key silences a
818A current, audible alarm for 60 seconds. Only new alarms of equal or higher level
interrupt the silence command.

:$51,1*
Alarms do not sound, alarm histories are not stored,
alarm graphs do not print, and alarms are not sent
to the central stations during an Alarm Pause
condition.

Press the key twice during an alarm to start an alarm pause (five minutes for Adult-
ICU, 3 minutes for Neonatal-ICU). Press the key again during the alarm pause to
reactivate alarms.
If no alarm is sounding, press this key to start an alarm pause.
If your monitor is set up for Operating Room mode, you have three levels of alarm
pause:
n Press once (if an alarm is sounding you must press twice) to start a 5-minute alarm
pause;
n Press again to start a 15-minute alarm pause;
n Press again to start a permanent alarm pause;
n Press again to reactivate alarms.

When set to SILENCE ONLY, this key works as a silence key. Press once to silence
alarms; press again to reactivate alarms. Pressing this key when no alarms are
occurring does not affect the monitor.

This key also allows you to quickly admit a patient by simply pressing this key when the
monitor is in a discharged state.

F Trim Knob control The main operator control is the Trim Knob control. The Trim Knob control rotates in
either direction to highlight parameter labels and menu options. After highlighting the
desired selection, press the Trim Knob control to view a new menu or a small popup
menu. This procedure is referred to as select throughout the manual.
Remember, when using the Trim Knob control, rotate to highlight, then press to select.

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Optional Remote Control


An optional hand-held remote control is also available. This can be used
in addition to, or instead of the monitor control keys, allowing the
clinician a greater range of movement while operating the monitor. The
remote control contains a Trim Knob control and 18 function buttons. It
is also available in three versions, Adult, Neonatal, and Operating Room.

An optional holster is also available to hold the remote control.

remote control

Aux port DIDCA connector 900A

Remote Control Connection

The remote control connects to the monitor via a communications cable


which plugs into a DIDCA connector before it is inserted into the Aux
port on the monitor or the Dash Port docking station.

The table below shows the keys that appear on the remote control. It also
indicates which type(s) of remote control the key appears on, and gives a
brief description of its function.

Keys Keypad Type(s) Function

12-Lead Adult Opens the 12 Lead ECG Analysis menu.

Admit/Discharge Adult, Neonatal Opens a menu to admit or discharge a patient.

Airway Gases: CO2 Operating Room Opens the CO2 menu.

Airway Gases: Gas Operating Room Opens the Gas menu.

Alarm Volume Neonatal Opens a menu to adjust the audio alarm volume.

All Limits Adult, Neonatal Opens the All Limits menu to adjust the limits of currently monitored
parameters.

Cardiac Calcs Adult, Operating Room Opens the Cardiac Calcs menu.

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Keys Keypad Type(s) Function

Cardiac Output Adult, Operating Room Opens the Cardiac Output menu.

CRG Events Neonatal Opens the Document CRG Events window.

CRG Print Neonatal Prints the CRG waveforms.


CRG Recall Neonatal Opens the CRG Trends menu at the most recent CRG event.

Defaults Adult, Neonatal, Operating Room Opens the defaults menu.

Display On/Off Adult, Neonatal, Operating Room Turns the monitor display, audio alarms, and optional alarm light off and
on. Operating power (mains) is still on, and alarms remain active at the
central station. Also turns NBP off.

Dose Calcs Neonatal Enters the dose calculations program.

Graph Go/Stop Adult, Neonatal, Operating Room Initiates a graph run of patient data. Press the key again to stop.

Graphic Trends Adult, Operating Room Opens the Graphic Trends menu.

Main Menu Adult, Neonatal, Operating Room Returns to the main display.

NBP Auto Adult, Operating Room Opens the NBP Auto menu.

NBP Go/Stop Adult, Neonatal, Operating Room Initiates an NBP measurement. Pressing this key while a measurement is
in process stops that measurement.

NBP Stat Adult, Operating Room Starts five minutes of continuous, sequential NBP measurements.
New Case Operating Room Performs the direct action of discharging and then immediately admitting
a patient.

PA Wedge Adult, Operating Room Opens the PA Wedge menu.

QRS Volume Neonatal Opens a menu to adjust the volume of the QRS tone.

Resp Relearn Neonatal Starts a relearn of the patients respiration.

Silence Alarm Adult, Neonatal, Operating Room Refer to Controlling Audio Alarms on page 4-6 for important information
on the function of this key.

SpO2 Operating Room Opens the SpO2 menu.


Tabular Trends Operating Room Opens the Tabular Trends menu.

View Other Adult, Neonatal Opens the View Other Patients menu.

Vital Signs Adult, Neonatal Opens the Vital Signs menu.


Zero All Adult, Neonatal, Operating Room Zeros all invasive pressure lines that are open to atmosphere.

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Indicators
Power and battery indicators are also located on the front panel of the
monitor.

Indicator Dash 3000 Monitor Label Dash 4000 Monitor Label

AC power AC
819A

Battery power Battery


820A

Battery charge
A B
822A
A B
821A

AC Power Indicator
The indicator illuminates green when AC power is applied to the
monitor. The indicator is not illuminated when the monitor is not
powered.

Battery Power Indicator


The indicator illuminates yellow when the monitor is battery powered.
The indicator is not illuminated when the monitor is not powered or
when AC power is applied.

Battery Charging/Ready Indicator


An icon for each battery pack indicates its charging status. The battery
icon illuminates yellow when the respective battery is being charged. If
both batteries are present and require charging, then both icons will
illuminate even though they will be charged sequentially. The battery
icon illuminates green when the respective battery is fully charged.

When the monitor is operating under battery power the battery icons will
not be illuminated. The icons are also not illuminated when the
respective battery is either not being charged, not installed, or has failed.

127(No specific information is given to distinguish a failed battery


pack condition from a condition where the battery is not installed
or is not being charged.

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Turning Power On
AC Power
The monitor will be powered at all times when using AC power (there is
no AC power switch). The monitor is preset at the factory for a specific
AC voltage. Before applying power, be sure the power requirements
match your power supply. Refer to the label on the back of the unit for
the voltage and current requirements. Refer also to Power Requirements
in the Safety chapter of this manual.

When all cables are properly connected, press the power button to turn
the monitor on. All of the front panel indicators will illuminate until the
power-up sequence is complete. After approximately 10 seconds you
should see a display on the screen.

Normal Mode
Two modes of operation are available when using AC power. The monitor
will enter NORMAL mode when plugged into AC power and the
monitoring function is turned ON. Normal mode operation provides all
functional capabilities of the monitor including vital signs monitoring,
communications, and battery charging.

Standby Mode
The monitor will enter STANDBY mode when plugged into AC power
and the monitoring function is turned OFF. The battery charging
function is the only function provided when the monitor is Standby mode.

Off
To turn the monitor completely off, you must turn the monitoring
function off by pressing the POWER key on the front of the monitor, and
then disconnect AC power. Indicators are not illuminated when the
monitor is not powered.

127(When monitoring a patient from Combo or Rover Combo on


telemetry, you will not be able to turn off the power to the
monitor until you have discharged the patient. If you press the
Power key during telemetry monitoring, the Discharge menu
appears. See the Combo and Rover Combo Popup Menu to
Discharge on page 3-20 for detailed information about the popup
menu options.

Battery Power
Dual, exchangeable battery packs provide power to the monitor for
transport or whenever AC power is interrupted. (Refer to the Batteries
chapter for more detailed information.)

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Software Overview
Software Packages and Software Options
See Appendix C Software Packages on page C-1 for a complete
breakdown of the Basic, Cardiac, and Cardiopulmonary software
packages and the High Resolution CRG Trends software option.

Software Packages
The monitor comes configured with the Basic software package. This
package consists of standard-of-care parameters, lethal arrhythmia
detection, dose calculations, and features required by clinicians caring
for acutely ill patients.

Two additional software packages can be purchased separately or in any


combination. These packages provide a variety of features which allow
the monitor to be configured to best meet the needs of its intended
environment.

The Cardiac software package focuses on cardiac conductivity. Its


features include full arrhythmia analysis and storage, as well as ST
segment trending, storage, and templates. The ability to adjust the ST
measurement point is also included in this package.

The Cardiopulmonary software package centers upon cardiac and


pulmonary hemodynamics. Features include the PA insert and wedge
algorithms, the intra-aortic balloon pump algorithm, and the
thermodilution cardiac output algorithm, including predefined
computation constants for the catheters of major manufacturers. Also
included are cardiac and pulmonary calculations.

Software Options
Three software options can be purchased separately or in any
combination with the software packages and software options.

The High Resolution CRG Trends option provides storage of up to 100


CRG events, and up to 24 hours of CRG trend data, in addition to the
CRG feature set found in the Basic software package.

The 12SL ECG analysis program with Gender Specific Criteria and the
Acute Cardiac IschemiaTime Insensitive Predictive Instrument (ACI-
TIPI) analysis option uses recorded ECG data to produce a numerical
score which is the predicted probability of acute cardiac ischemia. In
addition, the gender specific criteria improves the detection of acute
myocardial infarctions (AMI) for adult women under the age of 60.

The Unity Network option enables you to view other patients on the
network, interface with a central station and other network devices, and
perform Combo or Rover Combo monitoring.

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How can you tell what software you have?


1. Select MORE MENUS from the monitors main display.
2. Select MONITOR SETUP from the menu displayed.
3. Select SOFTWARE CONFIGURATION from the Monitor Setup
Menu. An information window displays the software features this
monitor has available.

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Monitor Display
Care Unit and Bed Number

Monitor Default Name Patient Name

Date and Time

Parameter Waveforms

More Menus

809A
Battery Capacity Gauges

Monitor Display

Menus
A menu, like the name implies, is a selection of available options. These
options are displayed at the bottom of the screen and are accessed with
the Trim Knob control. Some menus may have some empty spaces. These
spaces are available for future software enhancements.

There are two important menu options to note. One or both of these
options is found in every menu with the exception of the Main Menu.

This option will always take you back to the Main


Menu. Use it when you are finished making
adjustments or accessing stored information.

This option allows you to back up to the previous


menu when a subordinate menu is displayed.

Think of these as escape or exit options.

Menu Timeout
The monitor automatically returns to the Main Menu (refer to the figure
below) when you have displayed another menu and have not used the
Trim Knob for 5 minutes (default time). This is a Monitor Default display
setting which can be set for a longer period of time or no timeout at all.
Some menus, such as Vital Signs and trends, are not affected by the
timeout setting. You must exit them using one of the exit options
described above.

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Main Menu
The Main Menu has one menu option, MORE MENUS, in the lower left
corner of the screen. With the Main Menu displayed, the screen shows all
monitored parameters and waveforms.

The Main Menu

From the Main Menu, you access a parameter menu by selecting the
appropriate parameter label, or you can access other menus (not related
to a specific parameter) by selecting the MORE MENUS option.

Parameter Menus
Each parameter has its own menu from which to access features. Below
is an example of the ECG parameter menu.

ECG Parameter Menu

The Main Menu must be displayed to access a parameter menu.

To access a parameter menu, highlight a parameter label, for example,


ECG, and then press the Trim Knob control.

Each parameter menu is discussed in detail in the specific parameter


chapter.

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More Menus
In the lower left corner of the Main Menu is the MORE MENUS option.
Select this option to display the following menu.

More Menus Menu

n ALARM CONTROLThis option displays a menu which allows you


to view and modify all alarm limits, change alarm levels, and adjust
alarm volume.
n VIEW OTHER PATIENTSThis option displays a menu which
allows you to select any bedside monitor on the network to view at
this monitor. This data can be displayed continuously, or you can
program the monitor to alert you when a bed alarms, then you
request a view. This is part of the Unity Network software option.
n PATIENT DATAThis option displays a menu which allows you to
view patient dataalarm history, vital sign history, and graphic
trendsand enter calculation programs.
n MONITOR SETUPThis option displays a menu which allows you
to set up the monitor to suit your needswaveforms displayed, color
scheme, parameters on/off, graph setup, monitor defaults, etc. The
service menu is accessed here also.
n ADMIT MENUThis option displays a menu to enter necessary
patient information and admit and discharge the patient to/from the
monitor. (In Operating Room mode, this option reads NEW CASE
SETUP.)
n BATTERY STATUSThis menu option opens a menu and
information window that provides current battery status
information.

Each of these options is covered in more detail in following chapters.

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The Basics: Software Overview

Popup Menus
When some menu options are selected, a small menu pops up around
the selected menu option. These are called popup menus. There are
different types of popup menus. Those most commonly used are described
below.

Note that with all popup menus, the original menu remains on the screen
but the options are dimmed. The popup menu must be closed before you
can select other options from the original menu.

Scrolling Popup

Scrolling Popup Menu

All available selections appear with the current selection highlighted.


The arrows are also highlighted indicating that the Trim Knob control
can be rotated (scrolled) to change the selection. When the Trim Knob
control is rotated, the new selection is highlighted and the change occurs
immediately on the screen so that the user can see if the selection is
appropriate before exiting the popup. Press the Trim Knob control to
close the popup menu.

Pointer Popup

Pointer Popup Menu

All available selections appear and a pointer (>) is displayed. The arrows
are highlighted indicating that the Trim Knob control can be rotated to
move the pointer to another selection. However, before the change is
actually implemented, the Trim Knob control must be pressed. The
popup menu closes and the change is in effect.

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Numeric Popup

Numeric Popup Menu

The available selections are many; therefore, only the current selection is
displayed. The arrows are highlighted indicating the Trim Knob control
can be rotated. Rotate the Trim Knob control to enter a new value. Using
the number keys on the optional remote control also changes the
displayed value in the popup menu. Like the Pointer Popup, the change
will not be in effect until the Trim Knob control is pressed.

127(When a numeric popup menu is open, the keys on the optional


remote control can only be used to enter numbers. Close the
numeric popup menu to access features using the optional
remote control keys.

Subordinate Menus
Whenever possible, short popup menus are displayed when selecting
menu options. In some cases, however, a whole new menu is displayed.
This is a menu within a menu, or a subordinate menu.

Many, but not all, subordinate menus have the PREVIOUS MENU
option to allow you to return to the previously displayed menu.

Following is an example of a subordinate menu:

Display the ECG Menu.

From the ECG Menu select ECG LIMITSthe entire ECG Menu is
replaced with the subordinate ECG Limits Menu.

Select PREVIOUS MENU to redisplay the ECG Menu.

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The Basics: Software Overview

Direct Action Menu Options


A direct action menu option, when selected, displays neither a popup
menu nor a subordinate menu. The option either turns a feature on or
off, or starts a processing function. For example, selecting the SMART
BP: ON option from the ART parameter menu turns the Smart BP
feature off. In ON/OFF cases, the menu option reflects the current state;
selecting it switches to the other state.

SMART BP: ON

SMART BP: OFF

Other direct action options start a process. For example, selecting the
RELEARN option from the ECG parameter menu tells the monitor to
immediately start to relearn the patients ECG rhythm. You cant stop
these processes as they are short term and stop automatically; therefore,
the words identifying the menu option do not change as in ON/OFF
actions.

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Parameter Windows
Parameter windows are displayed on the far right side of the screen, and,
when necessary, across the bottom. Every monitored parameter has a
parameter window.

Each parameter window has two partsa parameter label and digital
values. Depending on how you have set your defaults, limits and units of
measure may be displayed under the parameter label.
Digital Values Parameter
Label,
Limits, Units
of Measure

ART Parameter Window

Parameter windows are displayed in different sizes depending on the


display layout and the number of parameters you are monitoring. Below
is an example of parameter windows at double high size (twice the height
of a normal parameter block), normal size, and reduced size.

ART Parameter Window, Double High Size

The double high parameter window is displayed when monitoring in the


INDV 3 WFS (individual 3 waveforms) display mode.

CO Parameter Window, Normal Size

CO Parameter Window, Reduced Size

Parameters windows which may be displayed in reduced size when


positioned at the bottom of the screen are: CO, CVP, ICP, LA, RA, RR,
SP, SPO2, TP, and UVC.

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The Basics: Software Overview

Information Windows
Another window that is sometimes displayed on the screen is called an
information window. This large window is superimposed over the upper
left portion of the screen. Up to six parameter windows and 2 seconds of
all the real-time waveforms continue to be displayed.

Information windows are displayed when a HELP option is selected and


with certain menu options, such as LIMITS. The information window
contains instructions or other non-realtime information.

Below is an example of an information window:

Real-Time
Information Window
Waveforms

More
Information
Indicator

The Vital Signs Information Window

Sometimes an information window will contain a list, for example, vital


signs. The window is limited to the amount of information that can be
displayed at one time. There may be more information to view, but not
enough room to display it at one time. If this is the case, an arrow will be
displayed at the bottom of the information window (see the figure above).

If a popup menu is displayed with the window, you must turn the Trim
Knob control to scroll to more information. If a menu is displayed, as in
the example above, you must select the PAGE UP or PAGE DOWN
option to display more information.

There is more information. Scroll down or use PAGE DOWN to


display more information.

You are in the middle of the list. Scroll up or down, or use


PAGE UP or PAGE DOWN to display additional information.

You are at the end of the list. Scroll up or use PAGE UP to


display additional information.

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Trim Knob Control Operation When Setting Alarm Limits


127(The Trim Knob control is found on the monitor and on the
optional remote control. See Controls and Indicators on page 1-
16.

127(You can use the number keys on the optional remote control for
setting parameter limits.

Limits which trigger alarms for monitored parameters can be modified.


You should refer to the specific parameter chapter for details. When
setting alarm limits, the following information is helpful and applies to
most parameters:

The Trim Knob control will always increase (or decrease) the displayed
number in increments of one for the first five numbers. Thereafter, it
increases (or decreases) in increments of five. There may be situations
where the limit you wish to modify does not fall into this incremental
sequence. For example, the low heart rate limit default is 50. For your
patient, a limit of 44 is desired.

The fastest way to achieve this using the Trim Knob control is to use the
following procedure:

1. Open the HR LOW LIMIT popup menu. The number 50 is displayed.

HR LOW LIMIT Popup Menu

2. Rotate the Trim Knob control until the number reads 45. It will
follow this sequence: 49, 48, 47, 46, 45.
127(The next rotation will take the number to 40 which, in this
instance, is too low.
3. Close the popup menu when the number is 45 and immediately open
it again.
4. Rotate the Trim Knob control to 44.
127(Closing the popup menu and then reopening it allows you to
reset again in increments of one.

The same principle applies when setting limits for other parameters.

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The Basics: Graphing (Printing)

Graphing (Printing)
Devices
You can print displayed information using the monitors built-in writer
or, via the optional network, using an optional writer and/or an optional
laser printer. This manual refers to a PRN 50 and DDW (Direct Digital
Writer) as writers and a laser printer as a printer.

The writer may be the monitors built-in writer or a stand-alone writer


connected to another monitor. Your system may include one or more
central stations. Some central stations come equipped with a built-in
writer. A writer can also be connected to the central station. The optional
laser printer always connects to a central station.

Patient waveforms and most information windows can be printed. You


choose which waveforms you want to print, to which device you want to
print, a duration time, and the speed at which manual graphs are
printed. These menu options are all found in the Graph Setup menu.
Refer to the Monitor Setup chapter for details.

Manual Graphs
Waveforms and information windows are printed when the GRAPH GO/
STOP key on the monitor or remote control is pressed. The message
GRAPHING MANUAL or PRINTING WINDOW is displayed when a
manual graph is requested. There is a setting in the Graph Setup Menu
which allows you to set a time for how long a manual graph runs (e.g.,
continuous, 20-seconds, etc.).

127(A one millivolt ECG signal at normal (1X) size equals 10


millimeters on the graph paper.
All waveforms on a graph strip begin with 10 seconds of delayed
data. The header information printed with the waveforms is real-
time data.

Exclusive Graph Control


Once a manual graph is started, it can only be stopped from the same
source from which it was started or from the Graph Stop key on the
writer. This is to prevent two people at different sources starting a graph
at the same time, which results in one turning the graph on and the
other turning the graph off.

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Alarm Graphs
A graph strip is automatically printed when a Crisis or Warning alarm
occurs. An arrhythmia alarm graph will run until a normal sinus rhythm
is again detected or you manually stop the graph. Any other alarm graph
runs for 20 seconds or until you manually stop it.

127(To convert an arrhythmia alarm graph to a manual graph, you


must stop the graph using the Graph Stop key on the writer and
immediately restart the graph.

In Operating Room mode and Neonatal-ICU mode, the alarm graphing


default is off. There is a menu option in the Graph Setup menu (ALARM
GRAPH) to turn this feature on and off. This can be saved as a Monitor
Default. This option is not available in the Adult-ICU mode.

Pressure Scales
Invasive pressures will always graph on individual and full scales as
follows:

Displayed Scale Graph Scale


30 0-30 (PA, CVP, LA, RA, ICP)
40 0-45
60 0-60
100 0-90
160 0-150
200, 300 0-300
Auto 0-150 (ART, FEM, UAC, SP)
0-45 (PA, CVP, UVC, RA, LA, ICP)

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Graphing Messages
Following is a list of all graphing messages and what they indicate:

SAVINGthe device to which you want to print is busy or for some


reason inoperable. If it is an alarm graph, 20 seconds of data is saved
until it can print or another alarm graph occurs. The monitor only saves
for print the most recent alarm data. A manual graph is saved until you
press the GRAPH GO / STOP key or an alarm graph occurs.

GRAPHING MANUALa manual graph is in progress.

GRAPHING ALARMa crisis or warning alarm has occurred. An


automatic graph is run.

PRINTING WINDOWa manual graph of a printable information


window is in progress.

PAPER OUTthe writer/printer needs paper or a writer door is open.

127(If saved graph never prints or graph does not print at your
central station, check all graph locations then verify the graph
location setting. (Refer to GRAPH LOCATION in the Monitor
Setup chapter.)

Graph Header
The graph header which is printed with all patient waveforms, includes:
n type of graph (alarm, manual, or saved)
n *alarm violation* (if any)
n unit name, bed number, and patient name
n date and time
n patient-monitor type label (ICU has no label)
n alarm volume level (%)
n graph speed
n lead failed (if any)
n heart rate
n arrhythmia call (if any and arrhythmia is on)
n pace mode (if on)
n arrhythmia mode (off, lethal, or full)
n PVC count (if full arrhythmia is on)
n ST value (if on) for top displayed lead
n ECG filter (Hz range)
n values for all other monitored parameters

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The Basics: Putting the Monitor Into Operation

Putting the Monitor Into Operation


Monitor Installation and Connection

:$51,1*
Before using the monitor for the first time, please read
the information given in chapter 2 Safety.

The operating position does not influence the performance of the monitor
in any way.
n Choose a location which affords an unobstructed view of the monitor
screen and easy access to the operating controls.
n Set up the device in a location which affords sufficient ventilation.
The ventilation openings of the device must not be obstructed (by
external equipment, walls or blankets, for instance). The ambient
conditions specified in the Technical Specifications section of the
Dash 3000/4000 Patient Monitor Service Manual must be ensured at
all times.
n The monitor is designed to comply with the requirements of IEC
60601/EN 60601.
n Using the power cord supplied with the monitor, connect it to the
power line. Use only the original cord or an equivalent one.

:$51,1*
The monitor must be connected to a properly installed
power outlet with protective earth contacts only. If the
installation does not provide for a protective earth
conductor, disconnect the monitor from the power line
and operate it on battery power.

n For measurements in or near the heart we recommend connecting


the monitor to the potential equalization system. Use the green and
yellow potential equalization cable and connect it to the pin labeled
with the symbol.

n Our customer service engineers can be called in to connect the


monitor to a central station.

:$51,1*
For safety reasons, all connectors for patient cables and
sensor leads are designed to prevent inadvertent
disconnection, should someone pull on the leads. Do not
route cables in a way that they may present a stumbling
hazard. Do not install the monitor in a location where it
may drop on the patient. All consoles and brackets used
must have a raised edge at the front.

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n Monitors may be shipped with protective covers to protect unused


parameter connector inputs from dust and liquids.
127(Do not remove these covers, the parameter connectors do not
function.

:$51,1*
After connecting the monitor to the central station, verify
the function of the alarm system. This can be done, for
instance, by temporarily changing one of the alarm limits
to initiate an alarm.

Performance Check
n Turn on the device with the power switch on the front of the monitor.
All of the front panel indicators will illuminate until the power-up
sequence is complete.
n The monitor display appears after approximately 10 seconds.

After power up and during operation the monitor runs automatic self-
tests. When a malfunction is detected, the monitor displays a message
and a prompt, asking whether the user wishes to continue operation.

:$51,1*
If this message appears during operation, it is the
physicians responsibility to decide whether the unit is
still suitable for patient monitoring. As a general rule,
monitoring with this unit should continue only in
extremely urgent cases and under the supervision of a
physician. The unit must be repaired before being used
again on a patient. If this message appears after power
up, the unit must be repaired before being used on a
patient.

:$51,1*
After connecting the monitor to a central station, verify
the function of the alarm system. This can be done, for
instance, by temporarily changing one of the alarm limits
to initiate an alarm.

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The Basics: Language-Specific Information

Language-Specific Information
The following information describes differences in the monitor
functionality when the monitor is set to certain languages (Locale).

French Language Information


When the monitor Locale (language) is set to French_France, alarm
pause duration is three minutes. Refer to Pausing Alarms on page 4-6.

Hungarian, Polish, and Russian, Language Information


Special characters within alarm broadcasts, messages, patient name, site
name, or location fields that are sent over the Unity Network cannot be
displayed by equipment that does not support these languages. Special
characters may appear as either blanks, asterisks, a series of square
boxes, or no character is displayed at all because the ability to display
Cyrillic (Russian alphabet) and special Hungarian or Polish characters
does not exist on this equipment.

Chinese and Japanese Language Information


When the monitor Locale (language) is set to Japanese, the following
conditions apply:
n Text for alarm broadcast over the network is in English.
n All text input is in English only (i.e., text for unit name, bed name,
patient information, and custom default name).

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For Your Safety


Intended Use
The intended use of the monitoring system is to monitor physiologic
parameter data on adult, pediatric, and neonatal patients within a
hospital or facility providing patient care.

Physiologic data includes the parameters covered in this manual. The


monitoring system is also intended to provide physiologic data over the
optional Unity Network to clinical information systems. This information
can be displayed, trended, stored, and printed.

Terminology
The terms danger, warning, and caution are used throughout this
manual to point out hazards and to designate a degree or level or
seriousness. Familiarize yourself with their definitions and significance.

Hazard is defined as a source of potential injury to a person.

DANGER indicates an imminent hazard which, if not avoided, will


result in death or serious injury.

WARNING indicates a potential hazard or unsafe practice which, if not


avoided, could result in death or serious injury.

CAUTION indicates a potential hazard or unsafe practice which, if not


avoided, could result in minor personal injury or product/property
damage.

NOTE provides application tips or other useful information to assure


that you get the most from your equipment.

Monitor Safety
The safety statements presented in this chapter refer to the equipment
in general and, in most cases, apply to all aspects of the monitor. There
are additional safety statements in the parameter chapters which are
specific to that monitored parameter.

The order in which safety statements are presented in no way implies


order of importance.

Dangers
There are no dangers that refer to the equipment in general. Specific
"Danger" statements may be given in the respective sections of this
manual.

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Warnings

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ACCIDENTAL SPILLS To avoid electric shock or
device malfunction, liquids must not be allowed to enter
the device. If liquids have entered a device, take it out of
service and have it checked by a service technician before
it is used again.

ACCURACY If the accuracy of any value displayed on


the monitor, central station, or printed on a graph strip is
questionable, determine the patient's vital signs by
alternative means. Verify that all equipment is working
correctly.

ALARMS 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 a hazard to the patient. Remember that the
most reliable method of patient monitoring combines
close personal surveillance with correct operation of
monitoring equipment.

After connecting the monitor to the central station and/or


nurse-call system, verify the function of the alarm
system.

The functions of the alarm system for monitoring of the


patient must be verified at regular intervals.

BEFORE USE Before putting the system into


operation visually inspect all connecting cables for signs
of damage. Damaged cables and connectors must be
replaced immediately.

Before using the system, the operator must verify that it


is in correct working order and operating condition.

Periodically, and whenever the integrity of the product is


in doubt, test all functions.

CABLES Route all cables away from patient's throat


to avoid possible strangulation.

CONDUCTIVE CONNECTIONS Extreme care must


be exercised when applying medical electrical equipment.
Many parts of the human/machine circuit are conductive,
such as the patient, connectors, electrodes, transducers.
It is very important that these conductive parts do not
come into contact with other grounded, conductive parts
when connected to the isolated patient input of the
device. Such contact would bridge the patient's isolation
and cancel the protection provided by the isolated input.
In particular, there must be no contact of the neutral
electrode and ground.

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DEFIBRILLATION Do not come into contact with
patients during defibrillation. Otherwise serious injury
or death could result.

DISCHARGE TO CLEAR PATIENT DATA When


admitting a new patient, you must clear all previous
patient data from the system. To accomplish this,
disconnect patient cables then do a discharge.

DISCONNECTION FROM MAINS When


disconnecting the system from the power line, remove the
plug from the wall outlet first. Then you may disconnect
the power cord from the device. If you do not observe this
sequence, there is a risk of coming into contact with line
voltage by inserting metal objects, such as the pins of
leadwires, into the sockets of the power cord by mistake.

DISPOSAL Dispose of the packaging material,


observing the applicable waste control regulations and
keeping it out of children's reach.

EXPLOSION HAZARD Do not use this equipment in


the presence of flammable anesthetics, vapors or liquids.

INCOMPATIBILITY Wireless LAN equipment


contains an intentional RF radiator that has the
potential of interfering with other medical equipment,
including patient implanted devices. Be sure to perform
the electromagnetic compatibility test, as described in
the Wireless LAN System Installation and Service
Manual, before installation and any time new medical
equipment is added to the Wireless LAN coverage area.

INTERFACING OTHER EQUIPMENT Devices may


only be interconnected with each other or to parts of the
system when it has been determined by qualified
biomedical engineering personnel that there is no danger
to the patient, the operator, or the environment as a
result. In those instances where there is any element of
doubt concerning the safety of connected devices, the user
must contact the manufacturers concerned (or other
informed experts) for proper use. In all cases, safe and
proper operation should be verified with the applicable
manufacturer's instructions for use, and system
standards IEC 60601-1-1/EN 60601-1-1 must be complied
with.

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INTRACARDIAC APPLICATION When applying
devices intracardially, electrically conductive contact
with parts connected to the heart (pressure transducers,
metal tube connections and stopcocks, guide wires, etc.)
must be avoided in all cases.

To prevent electrical contact, we recommend the


following:

n always wear isolating rubber gloves,


n keep parts that are conductively connected to the
heart isolated from ground,
n if possible, do not use tube fittings or stopcocks made
of metal.
During intracardiac application of a device, a
defibrillator and pacemaker whose proper functioning
has been verified must be kept at hand.

LEAKAGE CURRENT TEST When interfacing with


other equipment, a test for leakage current must be
performed by qualified biomedical engineering personnel
before using with patients.

PATIENT AMBULATION A patient must be assisted


if ambulating with a roll-stand mounted monitor.

POWER SUPPLY The device must be connected to a


properly installed power outlet with protective earth
contacts only. If the installation does not provide for a
protective earth conductor, disconnect the monitor from
the power line and operate it on battery power, if
possible.

All devices of a system must be connected to the same


power supply circuit. Devices which are not connected to
the same circuit must be electrically isolated when
operated

PROTECTED LEADWIRES Only use protected


leadwires and patient cables with this monitor. The use
of unprotected leadwires and patient cables creates the
potential for making an electrical connection to ground or
to a high voltage power source which can cause serious
injury or death to the patient.

Unprotected Leadwire Protected Leadwire

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RATE METERS Keep pacemaker patients under close
observation. Rate meters may continue to count the
pacemaker rate during cardiac arrest and some
arrhythmias. Therefore, do not rely entirely on rate
meter alarms.

SITE REQUIREMENTS For safety reasons, all


connectors for patient cables and sensor leads are
designed to prevent inadvertent disconnection, should
someone pull on them. Do not route cables in a way that
they may present a stumbling hazard. For devices
installed above the patient, adequate precautions must
be taken to prevent them from dropping on the patient.

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Cautions

&$87,216
ACCESSORIES (SUPPLIES) To ensure patient safety,
use only parts and accessories manufactured or
recommended by GE Medical Systems Information
Technologies.

Parts and accessories used must meet the requirements


of the applicable IEC 60601 series safety standards and
essential performance standards, and/or the system
configuration must meet the requirements of the IEC
60601-1-1 medical electrical systems standard.

ACCESSORIES (EQUIPMENT) The use of


ACCESSORY equipment not complying with the
equivalent safety requirements of this equipment may
lead to a reduced level of safety of the resulting system.
Consideration relating to the choice shall include:
n use of the accessory in the PATIENT VICINITY; and
n evidence that the safety certification of the
ACCESSORY has been performed in accordance to
the appropriate IEC 60601-1 and/or IEC 60601-1-1
harmonized national standard.

BATTERY POWER If a device equipped with an


optional battery pack will not be used or not be connected
to the power line for a period of over six months, remove
the battery.

BEFORE INSTALLATION Compatibility is critical to


safe and effective use of this device. Please contact your
local sales or service representative prior to installation
to verify equipment compatibility.

CO2 PARAMETER INTERFERENCE Capnostat CO2


sensors with a serial number 26104 or greater require a
separation distance of 10 inches (0.25 meters) from the
Wireless LAN device to minimize potential interference.
CO2 sensors with a serial number less than 26104
require a separation distance of 8.2 feet (2.5 meters) and
are not recommended for use on monitoring equipment
equipped with the Wireless LAN option.

DEFIBRILLATOR PRECAUTIONS Patient signal


inputs labeled with the CF and BF symbols with paddles
are protected against damage resulting from
defibrillation voltages. To ensure proper defibrillator
protection, use only the recommended cables and
leadwires.

Proper placement of defibrillator paddles in relation to


the electrodes is required to ensure successful
defibrillation.

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DISPOSABLES Disposable devices are intended for
single use only. They should not be reused as
performance could degrade or contamination could occur.

DISPOSAL At the end of its service life, the product


described in this manual, as well as its accessories, must
be disposed of in compliance with the guidelines
regulating the disposal of such products. If you have
questions concerning disposal of the product, please
contact GE Medical Systems Information Technologies or
its representatives.

ELECTROCAUTERY PRECAUTIONS To prevent


unwanted skin burns, apply electrocautery electrodes as
far as possible from all other electrodes, a distance of at
least 15 cm/6 in. is recommended.

EMC Magnetic and electrical fields are capable of


interfering with the proper performance of the device.
For this reason make sure that all external devices
operated in the vicinity of the monitor comply with the
relevant EMC requirements. X-ray equipment or MRI
devices are a possible source of interference as they may
emit higher levels of electromagnetic radiation.

INSTRUCTIONS FOR USE For continued safe use of


this equipment, it is necessary that the listed
instructions are followed. However, instructions listed in
this manual in no way supersede established medical
practices concerning patient care.

LOSS OF DATA Should the monitor at any time


temporarily lose patient data, the potential exists that
active monitoring is not being done. Close patient
observation or alternate monitoring devices should be
used until monitor function is restored.

If the monitor does not automatically resume operation


within 60 seconds, power cycle the monitor using the
power on/off switch. Once monitoring is restored, you
should verify correct monitoring state and alarm
function.

Operation of an access point or Wireless LAN device in


close proximity to a microwave oven may cause loss of
patient data.

MAINTENANCE Regular preventive maintenance


should be carried out annually. You are responsible for
any requirements specific to your country.

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Safety: For Your Safety

&$87,216
MPSO The use of a multiple portable socket outlet
(MPSO) for a system will result in an enclosure leakage
current equal to the sum of all individual earth leakage
currents of the system if there is an interruption of the
MPSO protective earth conductor. Do not use an
additional extension cable with the MPSO as it will
increase the chance of the single protective earth
conductor interruption.

NEGLIGENCE GE Medical Systems Information


Technologies does not assume responsibility for damage
to the equipment caused by improperly vented cabinets,
improper or faulty power, or insufficient wall strength to
support equipment mounted on such walls.

OPERATOR Medical technical equipment such as this


monitor/monitoring system must only be used by persons
who have received adequate training in the use of such
equipment and who are capable of applying it properly.

POWER REQUIREMENTS Before connecting the


device to the power line, check that the voltage and
frequency ratings of the power line are the same as those
indicated on the unit's label. If this is not the case, do not
connect the system to the power line until you adjust the
unit to match the power source.

In U.S.A., if the installation of this equipment will use


240V rather than 120V, the source must be a center-
tapped, 240V, single-phase circuit.

RESTRICTED SALE U.S. federal law restricts this


device to sale by or on the order of a physician.

SUPERVISED USE This equipment is intended for


use under the direct supervision of a licensed health care
practitioner.

VENTILATION REQUIREMENTS Set up the device


in a location which affords sufficient ventilation. The
ventilation openings of the device must not be obstructed.
The ambient conditions specified in the technical
specifications must be ensured at all times.

ELECTRODES Whenever patient defibrillation is a


possibility, use non-polarizing (silver/silver chloride
construction) electrodes for ECG monitoring. Polarizing
electrodes (stainless steel or silver constructed) may
cause the electrodes to retain a residual charge after
defibrillation. A residual charge will block acquisition of
the ECG signal.

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Safety: For Your Safety

Notes
n Put the monitor in a location where you can easily see the screen and
access the operating controls.
n This product is not likely to cause abnormal operation of other
patient-connected equipment such as cardiac pacemaker or other
electrical stimulators. Exceptions are noted in the pacemaker
monitoring section, if applicable.
n This product is protected against the effects of cardiac defibrillator
discharges to ensure proper recovery, as required by test standards.
(The screen may blank during a defibrillator discharge but recovers
within seconds as required by test standards.)

Reference Literature
Medical Device Directive 93/42/EEC

EN 60601-1/1990 + A1: 1993 + A2: 1995: Medical electrical equipment.


General requirements for safety

EN 60601-1-1/9.1994 + A1 12.95: General requirements for safety.


Requirements for the safety of medical electrical systems.

IEC Publication 513/1994: Fundamental aspects of safety standards for


medical equipment.

ROY, O.Z.: Summary of cardiac fibrillation thresholds for 60-Hz currents


and voltages applied directly to the heart. Med. & Biol. Engn. &
Computing 18: 657...659 (1980).

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Safety: Classifications

Classifications
The equipment components are classified, according to IEC-60601-1, as:

Degree of safety of application


in the presence of a flammable

disinfection recommended by
anesthetic mixture with air or
with oxygen or nitrous oxide
Degree of protection against

Degree of protection against

Method(s) of sterilization or
Type of protection against

harmful ingress of water

Mode of operation
the manufacturer
electrical shock

electrical shock

I: Class I equipment
Dash 3000/4000 monitor I BFNBP Ordinary Not Suitable NA Continuous
BFSPO2 B: Type B applied part
BFCO2 BF: Type BF applied part
CFECG CF: Type CF applied part
CFTemp/ NA: Not applicable
CO Ordinary: Ordinary
CFResp equipment (enclosed
CFBP equipment without protection
ICG module NA BF Ordinary Not Suitable NA Continuous against ingress of water)
Not Suitable: Equipment not
Remote control NA Not Marked Ordinary Not Suitable NA Continuous suitable for use in the
presence of a flammable
anesthetic mixture with air or
with oxygen or nitrous oxide

Underwriters Laboratories, Inc.


Medical Equipment
With respect to electric shock, fire and mechanical hazards only in
accordance with UL 2601-1, and CAN/CSA C22.2 NO. 601.1.
4P41

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Safety: Classifications

Equipment Symbols
127(Some symbols may not appear on all equipment.

ATTENTION: Consult accompanying documents

CAUTION: To reduce the risk of electric shock, do NOT remove cover. Refer servicing to
qualified service personnel.

TYPE CF APPLIED PART: Isolated (floating) applied part suitable for intentional external and
internal application to the patient including direct cardiac application. "Paddles" outside the
127(The rating box indicate the applied part is defibrillator proof.
of protection [Medical Standard Definition:] F-type applied part (floating/isolated) complying with the
against electric specified requirements of IEC 60601-1/UL 2601-1/CSA 601.1 Medical Standards to provide a
shock (indicated by higher degree of protection against electric shock than that provided by type BF applied parts.
symbol for CF or
BF) is achieved only TYPE BF APPLIED PART: Isolated (floating) applied part suitable for intentional external and
when used with internal application to the patient excluding direct cardiac application. "Paddles" outside the
patient applied box indicate the applied part is defibrillator proof.
parts recommended [Medical Standard Definition:] F-type applied part (floating/isolated) complying with the
by GE Medical specified requirements of IEC 60601-1/UL 2601-1/CSA 601.1 Medical Standards to provide a
Systems higher degree of protection against electric shock than that provided by type B applied parts.
Information
Technologies.
TYPE B APPLIED PART: Non-isolated applied part suitable for intentional external and
internal application to the patient excluding direct cardiac application.
[Medical Standard Definition:] Applied part complying with the specified requirements of IEC
60601-1/UL 2601-1/CSA 601.1 Medical Standards to provide protection against electric
shock, particularly regarding allowable leakage current.
Fuse

Equipotentiality

Alternating current (AC)

Power; I = ON; O = OFF

PRESS Indicates where to press to open the door on the DDW.

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Safety: Classifications

For your notes

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3 Admit Discharge

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For your notes

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Admit Discharge: About Admitting

About Admitting
You Must Admit to Activate Alarms
Admitting a patient to the monitor is important. Audible alarms are OFF
and there will be no alarm graphs and alarm history until the monitor is
in the admit mode. The following message is displayed near the middle of
the screen to alert you to admit your patient:

ALL ALARMS OFF

ADMIT PATIENT TO ACTIVATE ALARMS

Monitors are Used in Different Ways


What you do to admit a patient to the monitor depends on how the
monitor is used. There are four ways in which the monitor is used.

The Unity Network is a purchased software option which must be


enabled before using the Combo or Rover Combo monitoring application.

STANDARDThis application uses a monitor mounted in the room.


It does not accommodate telemetry. A network connection is not
required unless you have a central station.

ROVERWith this application you can move, or rove, the monitor


to the patient, rather than moving the patient to a monitored room.
It does not accommodate telemetry. A network connection is not
required unless you have a central station.

COMBOThis application provides the option to acquire ECG data


from either the monitor or from a telemetry receiver cabinet. This
ECG data acquisition capability enhances basic telemetry
monitoring by providing additional access to all of the available
parameters from the monitor. A network connection is required.

ROVER COMBOThis application combines the mobility feature


of Rover monitoring with the telemetry compatibility of Combo
monitoring. A network connection is required.

It is determined at the time of installation which application applies. At


that time a menu option in the service mode is used to set your monitor
for one of the above applications. The information that is necessary for
successful admission to the monitor and the network is then provided in
the Admit Menu.

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Admit Discharge: About Admitting

Guidelines When Doing Combination Monitoring


127(The Unity Network is a purchased software option which must
be enabled before using the Combo or Rover Combo monitoring
application.

Here are some guidelines to remember when doing combination (Combo


and Rover Combo) monitoring:
n When monitoring ECG from telemetry, ECG limits and arrhythmia
alarm levels are not your monitor defaults but are the telemetry
defaults or as modified at the central station. You can, however,
adjust these settings at the monitor.
n Alarm histories (arrhythmia only) from the monitor are merged in
the telemetry system when switching ECG monitoring from monitor
to telemetry (CD Telemetry-LAN software version 5 or later is
required).
n When ECG monitoring is switched from telemetry to the monitor,
telemetry is automatically discharged and the most recent 36 alarm
histories are transferred to the monitor.
n When monitoring ECG from telemetry, the alarm pause feature (if
available on your transmitter) is honored at the monitor.
n If you switch ECG monitoring from telemetry to monitor, the ECG
limits, arrhythmia alarm levels, and display formats will be recalled
from Monitor Defaults.
n If you discharge the monitor and switch ECG monitoring from the
monitor to telemetry, the telemetry arrhythmia alarm levels will be
the same as the arrhythmia alarm levels supported by the monitor.
Therefore, when the monitor uses the Basic software package, only
lethal arrhythmia alarm levels will be detected from telemetry. If the
monitor has the Cardiac software package enabled, full arrhythmia
alarm levels will be detected from telemetry.

127(The Basic software package detects lethal arrhythmias and


the Cardiac software package detects full arrhythmias.

127(When monitoring a patient from Combo or Rover Combo on


telemetry, you will not be able to turn off the power to the
monitor until you have discharged the patient. If you press the
Power key during telemetry monitoring, the Discharge menu
appears. See the Combo and Rover Combo Popup Menu to
Discharge on page 3-20 for detailed information about the popup
menu options.

For Which Application is the Monitor Set?


The ADMIT HELP menu option opens an information window that tells
you the application for which the monitor is set along with admit
instructions for that application. Refer to this chapter, Admit Help, for
more detailed information.

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Admit Discharge: Getting to the Admit Menu

Getting to the Admit Menu


1. Select MORE MENUS from the Main Menu to display the following
menu.

More Menu Selections

2. Select ADMIT MENU. The admit menu and the Admit Information
window are displayed.

127(When monitoring ECG, entering the sex and age of the patient
will provide information needed for using the 12SL Algorithm
with Gender-Specific Analysis or the ACI-TIPI algorithm. The
12SL Algorithm with Gender Specific Analysis improves the
detection of acute myocardial infarctions (AMI) for adult women
under the age of 60.

542B

Admit Menu and Information Window

The admit menu displayed depends on how your monitor has been set up.
The following pages describe the various admit menus.

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Admit Discharge: Standard Admit Menu

Standard Admit Menu


With the Standard application, the monitor is permanently assigned to a
room. The unit name and bed number are assigned during installation.
The options you may need to adjust/enter are shown in the admit menu
below.

ADMIT MENU (Adult/Neonatal)Standard Application

NEW CASE SETUP (OR)Standard Application

CHANGE ADMIT INFOopen an information window with menu


options to enter/change patient information such as name, ID, etc.

REQUEST ADMIT INFOuse to request patient information from a


server with an interface to hospital information.

RECALL DEFAULTopen a popup menu that allow you to recall one of


the Multiple Monitor Defaults

ADMIT HELPopens an information window with admit help


information for the monitor application you are using.

127(This option is not found in OR mode.

ADMIT PATIENTa direct action menu option which admits the


patient to the monitor.

NEW CASEa direct action menu option which discharges the patients
data and, with no additional steps, readies the monitor for the next
patient (new admission).

127(This option is found in OR mode only.

UNITS OF MEASUREopens a popup menu that allow you to change


the units of measure for height and weight.

Refer to this chapter, Admit Menu Options, if you need more details on
these menu options.

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Admit Discharge: Rover Admit Menu

Rover Admit Menu


With the Rover application, the monitor may be on a cart which allows
you to move it from one room to another. The unit name and bed number,
in some cases, may need to be changed so they are included as options in
the admit menu.

ADMIT MENU (Adult/Neonatal)Rover Application

NEW CASE SETUP (OR)Rover Application

CHANGE ADMIT INFOopen an information window with menu


options to enter/change patient information such as name, ID, etc.

REQUEST ADMIT INFOuse to request patient information from a


server with an interface to hospital information.

RECALL DEFAULTopen a popup menu that allow you to recall one of


the Multiple Monitor Defaults.

ADMIT HELPopens an information window with admit help


information for the monitor application you are using.

127(This option is not found in OR mode.

ADMIT PATIENTa direct action menu option which admits the


patient to the monitor.

NEW CASEa direct action menu option which discharges the patients
data and, with no additional steps, readies the monitor for the next
patient (new admission).

127(This option is found in OR mode only.

UNITS OF MEASUREopens a popup menu that allow you to change


the units of measure for height and weight.

SET UNIT NAMEverify or change the unit name. The correct unit
name is essential for recognition at a central station and other network
devices.

SET BED NUMBERverify or change the assigned bed number. The


correct bed number is essential for recognition at a central station and
other network devices.

GRAPH LOCATIONdisplay a new menu to select writers for manual


and alarm graphs.

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Admit Discharge: Combo Admit Menu

Combo Admit Menu


127(The Unity Network is a purchased software option which must
be enabled before using the Combo monitoring application.
With the Combo application, the monitor is permanently assigned to a
room, and you have the ability to obtain patient ECG data from a module
or from a telemetry transmitter.

The unit name and bed number are assigned during installation. The
options you may need to adjust/enter are shown in the admit menu
below.

ADMIT MENU (Adult/Neonatal)Combo Application

NEW CASE SETUP (OR)Combo Application

127(It is not likely that the Combo application is used when the
monitor is set for Operating Room mode.

CHANGE ADMIT INFOopen an information window with menu


options to enter/change patient information such as name, ID, etc.

REQUEST ADMIT INFOuse to request patient information from a


server with an interface to hospital information.

RECALL DEFAULTopen a popup menu that allow you to recall one of


the Multiple Monitor Defaults.

ADMIT HELPopens an information window with admit help


information for the monitor application you are using.

127(This option is not found in OR mode.

ADMIT PATIENTa direct action menu option which admits the


patient to the monitor.

UNITS OF MEASUREopens a popup menu that allow you to change


the units of measure for height and weight.

ECG SOURCEchoose either the monitor or a telemetry transmitter


from which to receive the patients ECG data.

Refer to this chapter, Admit Menu Options, if you need more details on
these menu options.

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Admit Discharge: Rover Combo Admit Menu

Rover Combo Admit Menu


127(The Unity Network is a purchased software option which must
be enabled before using the Rover Combo monitoring application.
With this application you are combining the Rover and the Combo
applications into one. The monitor may be on a cart which allows you to
move it from one room to another and ECG data can be obtained from a
module or from a telemetry transmitter.

ADMIT MENU (Adult/Neonatal)Rover Combo Application

NEW CASE SETUP (OR)Rover Combo Application

127(It is not likely that the Rover Combo application is used when
the monitor is set for Operating Room mode.

CHANGE ADMIT INFOopen an information window with menu


options to enter/change patient information such as name, ID, etc.

REQUEST ADMIT INFOuse to request patient information from a


server with an interface to hospital information.

RECALL DEFAULTopen a popup menu that allow you to recall one of


the Multiple Monitor Defaults.

ADMIT HELPopens an information window with admit help


information for the monitor application you are using.

127(This option is not found in OR mode.

ADMIT PATIENTa direct action menu option which admits the


patient to the monitor.

UNITS OF MEASUREopens a popup menu that allow you to change


the units of measure for height and weight.

SET UNIT NAMEverify or change the unit name. The correct unit
name is essential for recognition at a central station and other network
devices.

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Admit Discharge: Rover Combo Admit Menu

SET BED NUMBERverify or change the assigned bed number. The


correct bed number is essential for recognition at a central station and
other network devices.

ECG SOURCEchoose either the monitor or a telemetry transmitter


from which to receive the patients ECG data.

Refer to this chapter, Admit Menu Options, if you need more details on
these menu options.

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Admit Discharge: Admit Menu Options

Admit Menu Options


Change Admit Info
The CHANGE ADMIT INFO option allows you to change or enter
information pertinent to the monitored patient.

1. Select CHANGE ADMIT INFO option from the Admit Menu. An


information window with menu options are displayed.


532B

CHANGE ADMIT INFO Popup Menu and Information Window

2. Rotate the Trim Knob control to move the pointer (>); press, turn,
press to enter characters or make selections.

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Admit Discharge: Admit Menu Options

3. When all information is entered select RETURN. A prompt appears


giving you the option to SAVE or DO NOT SAVE CHANGES.
Selecting an option will close the popup and return you to the
Change Admit Info menu.
Name: enter up to 10 characters for the first name and 16 characters
for the last name. The name (at least part if not all) is displayed on
the monitor and central station, and printed on all graph headers.
(Refer to the figure on page 3-16 for location of the patient name on
the monitor.)

Patient ID: enter up to 13 characters. This is important information


to enter if you have a MUSE Cardiology Information System or a
Lab Access Server. If not entered the monitor uses a default of all 9s
for MUSE system storage.

Sex: select male or female.

Birth Date: enter the patients birth date. AGE is automatically


calculated.

Age: automatically calculated when the birth date is entered. Age is


calculated in years for adults and weeks, days, or years for neonates
(weeks if age is greater than 14 days but less than 2 years, days if
age is less than 14 days, and years if age is greater than 2 years). If
you enter an age, the birth date is calculated with current day and
month and appropriate year.

Height, Weight: enter the patients height and weight.

Race: scroll through the selections in the popup menu to select the
patients race.

Secondary ID: if you need to enter a secondary ID, use this popup
menu to enter up to 13 characters.

Ref Physician: enter up to 16 characters for the referring


physicians name and/or number.

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Admit Discharge: Admit Menu Options

Request Admit Info


127(The Unity Network is a purchased software option which must
be enabled before using this component or feature.
If your monitoring system includes a Lab Access Server with an interface
to hospital information, selecting this option will display patient
information that was entered. (See the figure below.) If your system does
not have this equipment, a message is displayed below the menu when
you attempt to select this option.

Name, ID, Sex, and Birth Date


come from hospital information.

Age is calculated if a birth date has


been entered.

The remaining information will be


displayed if previously entered. If
necessary you can add to or
change the information displayed.

533B

REQUEST ADMIT INFO Information Window and Menu

Verify the accuracy of any displayed information. Use the CHANGE


ADMIT INFO option if any information needs to be corrected or
additional information entered.

127(If you change any information which was supplied


automatically, you may have to notify the appropriate hospital
personnel.

View Manual Admit Info


This option allows you to view admit information that has been entered
manually. This key is only displayed when patient data is retrieved from
a server with an interface to hospital information.

Recall Default
This menu option allows you to recall previously named monitor defaults
while monitoring an admitted patient. (Refer to the Monitor Setup
chapter, Monitor Defaults for more details.)

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Admit Discharge: Admit Menu Options

Admit Help
This option opens an information window that tells you the application
for which the monitor is set along with admit instructions for that
application.

1. Select MORE MENUS from the Main Menu.


2. Select ADMIT MENU.
3. Select ADMIT HELP to display the following popup menu and
information window.

ADMIT HELP Information Window

Admit Patient
Depending on how your monitor is set up, you will see either ADMIT
PATIENT or NEW CASE.

Admit Patient
This menu option is a direct action menu option which admits the patient
to the monitor. Simply select the key to admit the patient.

New Case
This menu option is found only when the monitor is set for Operating
Room mode and Standard or Rover admit menu.

It is a direct action menu option which, when selected, does both a


discharge and immediate admit.

All patient data from the previous patient is erased, the screen blanks for
a few seconds, and then the monitor is ready for the next patient.

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Admit Discharge: Admit Menu Options

Quick Admit
The Quick Admit feature allows you to admit a patient by simply
pressing the Silence Alarm/Admit key on the monitor or the Admit/
Discharge key on the optional remote control.

127(The Admit/Discharge key is only available in the Adult-ICU


and Neonatal-ICU remote controls.

Units of Measure
This menu option opens a popup menu that allow you to change the units
of measure for the weight displayed between LBS and KG and the units
of measure for the height displayed between CM and INCHES.

In neonatal mode, this option also allows you to change the units of
measure for the patients age displayed between days, weeks, and years.

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Admit Discharge: Admit Menu Options

Set Unit Name


This menu option is found in the Rover and Rover Combo admit menus.

The unit name is very important for sending information to central


stations and writers.

Find the unit name at the top right of the display (CCU, ICU, etc.). Is
this the name which identifies your unit?

Unit name /bed number Patient Name

Location of Unit, Bed Number and Name on the Monitor

If it is not the correct unit name follow this procedure to change it:

1. Select SET UNIT NAME option from the Admit Menu. An


information window is displayed with the available unit names.

SET UNIT NAME Popup Menu

2. Rotate the Trim Knob control to move the pointer (>) in front of the
correct unit name.
3. Press the Trim Knob control. The information window closes and the
new unit name appears at the top of the monitor.

127(If the monitor is not on the network, a text entry popup menu
will open.

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Admit Discharge: Admit Menu Options

Set Bed Number


This menu option is found in Rover and Rover Combo admit menus.

Another essential element to recognize the monitor on the network is the


bed number. Look to the right of the unit name on the display. The bed
number assigned to this monitor is displayed. (See the figure on the
previous page.)

Follow this procedure to confirm that the bed number is correct:

1. Select SET BED NUMBER from the Admit Menu. A popup menu
and information window are displayed.

SET BED NUMBER Popup Menu

2. Use the Trim Knob control to move the pointer in front of the correct
bed number.
3. If the bed number you need is not listed, select CREATE NEW BED.
A text entry popup menu opens.

127(If the monitor is not on the network, a text entry popup menu
will open.

Graph Location
The GRAPH LOCATION option displays a menu which allows you to
choose writers for alarm and manual graphs. This option is used mostly
if the monitor does not have the optional built-in writer. The graph
location should be changed whenever the monitor is moved from one unit
to another. Refer to GRAPH LOCATION in the Monitor Setup chapter
for more detailed information.

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Admit Discharge: Admit Menu Options

ECG Source
This menu option is found in Combo and Rover Combo admit menus.

This menu option, which is unique to those monitors which can obtain
ECG data from telemetry is used to tell the monitor where to get the
ECG information.

Follow this procedure:

1. Select ECG SOURCE: option from the Admit Menu. A popup menu
and an information window are displayed.

ECG SOURCE Popup Menu and Information Window

The information window lists the possible sources from which the
ECG data can be obtained. The transmitter numbers listed are those
transmitters assigned to the unit.
2. Rotate the Trim Knob control to move the pointer (>) in front of the
source of choice. Select MONITOR if your patients ECG cable is
connected to the monitor. If your patient is wearing a telemetry
transmitter, select the transmitter number that matches the one on
the back of the transmitter.
3. Press the Trim Knob control to close the popup menu and
information window. If you chose a transmitter number, that number
(TTX) needs to be admitted before it will appear in the ECG
parameter window.
4. Select ADMIT PATIENT to admit the transmitter. The TTX number
now appears in the bottom of the ECG parameter window.

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Admit Discharge: About Discharging

About Discharging

:$51,1*
DISCHARGE TO CLEAR PATIENT DATAWhen
admitting a new patient, you must clear all previous
patient data from the system. To accomplish this,
disconnect patient cables then do a discharge.

When it is no longer necessary to monitor a patient, a discharge


procedure must be done to clear the system of all patient data collected.
Monitor defaults are always recalled when a discharge is done. The last
unit name and bed number used are retained. Patient name is cleared.

To discharge a patient, select ADMIT MENU from the More Menus


selections. Depending on how your monitor is set up, you will see either
DISCHARGE PATIENT or NEW CASE.

Discharge Patient
This menu option indicates that the patient is admitted. You select it to
discharge the patient.

Standard and Rover Admit Menu


To discharge a patient from the Standard and Rover admit menu follow
this procedure:

1. Select MORE MENUS.


2. Select ADMIT MENU.
3. Select DISCHARGE PATIENT from the Admit Menu. A popup menu
opens.

Standard and Rover Popup Menu to Discharge

4. Disconnect all patient cables.


5. Rotate the Trim Knob control to move the pointer to DISCHARGE.
6. Press the Trim Knob control. The message DISCHARGED appears
at the top of the display and all data is cleared from the system.

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Admit Discharge: About Discharging

Combo and Rover Combo


To discharge a patient from the Combo and Rover Combo admit menu
follow this procedure:

1. Select MORE MENUS.


2. Select ADMIT MENU.
3. Select DISCHARGE PATIENT to display the following popup menu.

Combo and Rover Combo Popup Menu to Discharge

4. Rotate the Trim Knob control to move the pointer (>) in front of:
a. RETURN if you do not want to discharge.
b. MONITOR to discharge patient from the monitor only. If ECG
was from telemetry, telemetry will remain admitted, but will not
be monitored by this monitor. The central station will continue to
monitor the telemetry.
c. TELEMETRY to discharge patient from telemetry only. ECG will
automatically switch to monitor.
d. BOTH to discharge patient from telemetry and monitor.
5. Press the Trim Knob control to complete the discharge.

New Case
This menu option is displayed only when the monitor is set for Operating
Room mode and is found in Standard and Rover admit menus.

This menu option clears patient information from the monitor. With no
additional steps, the monitor is ready for the next patient (new
admission).

1. Select MORE MENUS.


2. Disconnect patient cables.
3. Select NEW CASE SETUP.
4. Select NEW CASE from the New Case Setup Menu.
5. Press the Trim Knob control. Patient information clears and the
monitor is automatically put in the admit state, ready for the next
patient. (You will never see the DISCHARGED message displayed.)

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4 Alarm Control

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Alarm Control: Smart Alarms

Smart Alarms
Alarm processing is not activated until the monitor has detected valid
physiologic data from the patient. This allows you to admit a patient and
proceed with necessary patient connections without bothersome alarm
tones. If during monitoring a new parameter is added, for example, pulse
oximetry, the alarm processing for that parameter will not be active until
valid physiologic data is detected.

127(To properly use the smart alarm feature, be sure to remove all
patient cables to the monitor prior to discharging. This assures
that no data is seen after a discharge.

:$51,1*
After an interruption of the electric power supply (e.g. for
an emergency power test) it is necessary to check
whether the alarm processing is active again and
whether an arrhythmia has occurred while the power
supply was interrupted.

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Alarm Control: Alarm Structure

Alarm Structure
The alarm structure of the monitor is divided into two classifications:
n Patient Status Alarms
n System Status Alarms

Within each classification there are levels which correlate to how severe
the condition is that is causing the alarm. The levels and how the
monitor responds to each are described below. Patient status alarms can,
in most cases, be moved from one level to another. Refer to this chapter,
Arrhythmia Alarm Level and Parameter Alarm Level.

Patient Status Alarms


Patient status alarms are triggered by patient condition which exceeds
parameter limits, or by an arrhythmia condition. Patient status alarms
provide you the highest priority information.

The levels within the Patient Status Alarm category and how the
monitor responds to each is shown in the following chart. The chart
begins with the most critical type of alarm (Crisis) and ends with the
least critical type of alarm (Message).

127(The optional built-in alarm light indicator is activated when a


patient status alarm occurs. It flashes red for CRISIS patient
status alarms and yellow for WARNING patient status alarms.

127((Only for monitors without arrhythmia detection.) For patients


at risk of asystole; it is recommended to assign the HR alarm to
the CRISIS level (when assigned to the WARNING level the HR
alarm will clear automatically after 3 minutes in cases of
continued asystole).

200

200
200

200

ARRHY

200

Patient Status Alarms Chart

127(The automatic alarm graph feature defaults off (factory defaults)


in Neonatal-ICU and Operating Room modes. This feature can be
turned on and saved as a Monitor Default. Refer to Monitor
Setup chapter.

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Alarm Control: Alarm Structure

System Status Alarms


System status alarms are triggered by mechanical or electrical problems
and are of lesser priority than patient status alarms. The levels within
the System Status Alarm category and how the monitor responds to each
are shown in the following chart.

127(The optional built-in alarm light indicator is activated (flashes


yellow) when a WARNING system status alarm occurs.

System Status Alarms Chart

Unlike patient status alarms, system status alarms cannot be moved


from one level to another.

On-Screen Alarm Help


The alarm structure information can be displayed on the monitor and
you can actually hear the tones associated with each level.

1. Select MORE MENUS from the Main Menu.


2. Select ALARM CONTROL to display the Alarm Control Menu.
3. Select ALARM HELP from the Alarm Control Menu. An information
window is displayed titled Patient Status Alarms.

Refer to this chapter, Alarm Help, for more details.

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Alarm Control: Controlling Audio Alarms

Controlling Audio Alarms


Silencing an Alarm for One Minute
To silence an alarm tone when it sounds, press the SILENCE ALARM/
ADMIT key on the front of the monitor or the Silence Alarm key on the
optional remote control. The current alarm will be silenced for 60 seconds
and the message SILENCED is displayed on the screen.

Any new alarm at an equal or greater level will sound and the silence
command is cancelled.

Pausing Alarms
An alarm pause tells the monitor that you do not want any alarms to
sound for several minutes (see below).

:$51,1*
Alarms do not sound, alarm histories are not stored,
alarm graphs do not print, and alarms are not sent to the
central stations during an Alarm Pause condition.

127(When the alarm pause breakthrough feature is turned on, crisis


alarms do sound during an alarm pause condition. However, the
alarm histories are not stored. Refer to Alarm Pause
Breakthrough on page 4-7.

127(When the monitor alarms are paused AND the ECG parameter
is turned off, the information in the alarm pause warning (above)
will apply. In addition, the following network devices will NOT
display an Alarm Pause text message for that monitor.
u CIC using software version 3.0 or earlier.
u Centralscope using any version of software.

To start an alarm pause, press the SILENCE ALARM/ADMIT key on


the front of the monitor or the Silence Alarm key on the optional remote
control. Press the key twice if an alarm is sounding when you want to
start an alarm pause.

The function of the SILENCE ALARM/ADMIT key must be set to


NORMAL to activate the alarm pause feature. Refer to SILENCE
ALARM/ADMIT on page 1-17.

ADULT-ICU mode:

If your monitor is set up for this mode, a five-minute alarm pause


occurs (3 minutes when the monitors language is set to French-
France). A count-down timer is displayed on the screen. Press the
SILENCE ALARM/ADMIT key on the monitor or the Silence
Alarm key on the optional remote control again to reactivate alarms
before the five-minute period elapses.

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NEONATAL-ICU mode:

If your monitor is set up for this mode, a three-minute alarm pause


occurs with a count-down timer displayed. Press the Press the
SILENCE ALARM/ADMIT key on the monitor or the Silence
Alarm key on the optional remote control again to reactivate alarms
before the three-minute period elapses.

OPERATING ROOM mode

If your monitor is set up for this mode, press the key once for a 5-
minute pause, press again for a 15-minute alarm pause, press again
for a permanent alarm pause (message will read ALARMS
PAUSED).

Press the SILENCE ALARM/ADMIT key on the monitor or Silence


Alarm key on the optional remote control again to turn alarms back on.

Alarm Pause Breakthrough


The alarm pause breakthrough feature allows any crisis level alarm to
break through (interrupt) an alarm pause condition. An audible alarm
sounds, the writer prints alarm graphs, and the optional built-in alarm
light indicator flashes red.

In other words, when this feature is turned on (set to CRISIS) in the


Setup Display Defaults window found in Monitor Defaults, crisis level
alarms will sound and/or flash, even if an alarm pause is in effect.

127(
Only alarms set to crisis level can break through an alarm pause.
Alarms set to any other alarm level will not break through the alarm
pause, even when the feature is turned on.

This feature is labeled as PAUSE BREAKTHRU in the Setup Display


Defaults window. It can be set to CRISIS, which indicates that the alarm
pause breakthrough feature is active, or OFF, in which case no alarms
will break through an alarm pause.

127(
Crisis alarms do not break through an alarm pause caused by
selecting the MONITOR/CENTRAL PAUSE option from the Alarm
Control menu. The MONITOR/CENTRAL PAUSE option is
intended for use when a patient is disconnected from the monitor.
Therefore no alarms break through this type of alarm pause.

Turning Alarm Volume Off Permanently


Refer to this chapter, Alarm Volume, for a procedure whereby you can
permanently turn the alarm volume off.

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Alarm Control: Alarm Window

Alarm Window
127(This feature defaults off when the monitor is set up for
Operating Room mode. It can be turned on with the Parameters
On/Off software option in the Monitor Setup Menu.

The Alarm window, which is displayed when you admit your patient to
the monitor, is used to automatically record any patient status alarm set
for Crisis, Warning, or Advisory level. The most recent four resolved
alarms are displayed in chronological order along with the extreme
parameter value and time stamp.

Alarm Window

The extreme numerical value for all active, displayed alarms is


continuously update. Active alarms are displayed in red. Upon resolution
of an active alarm, the alarm text will be displayed in the color
associated with the alarm parameter.

If you dont want to display this window, simply use the Parameters On/
Off menu option in the Monitor Setup Menu to turn it off. It will always
default on when you admit a new patient.

Clear Alarms
Information displayed in the window remains until you manually clear it
or you discharge the patient from the monitor. To manually clear the
information follow this procedure:

1. Select the ALRM label to display the Alarm Control Menu. Note that
the CLEAR ALARMS option is already highlighted.
2. Press the Trim Knob control to clear the data and exit the menu.

Alarm History
127(This option is part of the Cardiac software package.

Remember, any arrhythmia alarm set for Crisis, Warning, or Advisory


level will be stored in alarm history. ST references and ST alarms are
also stored in alarm history. To view alarm history follow this procedure:

1. Select the ALRM label to display the Alarm Control Menu.


2. Select the ALARM HISTORY option from the menu to display a list
of arrhythmia and ST events.

Refer to this chapter, Alarm History, for more details.

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Alarm Control: Alarm Control Menu

Alarm Control Menu


There are two ways to access the Alarm Control Menu.

Option One

1. Select MORE MENUS from the Main Menu.


2. Select ALARM CONTROL to display the Alarm Control Menu.

Option Two

1. Select ALRM label in the Alarm window to display the menu.

ALARM CONTROL Menu

n ALL LIMITSview a screen of all currently monitored parameters


and their alarm limits. Included also is the unit of measure for each.
Alarm limits can also be changed.
n ARRHYTHMIA ALARM LEVELview and adjust arrhythmia
alarm levels to other alarm levels.
n PARAMETER ALARM LEVELview and adjust parameter alarm
levels to other alarm levels.
n ALARM VOLadjust the volume of the alarm tone.
n ALARM HELPview on-screen help describing patient status
alarms and system status alarms. Press the Trim Knob control to
hear the tones associated with each level of alarm.
n DISPLAY OFF ALARM PAUSEturn the display off and pause the
alarms at the central station for this monitor.
n CLEAR ALARMSclear the alarm information displayed in the
ALRM window.
n ALARM HISTORYview stored arrhythmia alarm events
(waveforms). This option is available with the Cardiac software
package only.

All Limits
The ALL LIMITS menu option allows you to view the high and low alarm
limits and unit of measurement for each parameter currently monitored.
You can change the limits for any monitored parameter without having
to go into each individual parameter menu.

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Alarm Control: Alarm Control Menu

Viewing an All Limits Screen


1. Select ALL LIMITS option from the Alarm Control Menu.
2. An information window is displayed on the screen and a popup menu
is displayed in the menu area.

The parameters listed are only those


currently being monitored.

ALL LIMITS Popup Menu and Information Window

The information window shows a list of the patient parameters currently


monitored, the units by which they are measured, and the high and low
limits currently in effect.

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Alarm Control: Alarm Control Menu

Changing a Limit in the All Limits Screen


If you want to change one or more limits, follow the procedure below. Any
changes made with this menu option are temporary and will revert to
defaults upon discharge.

1. Rotate the Trim Knob control to move the pointer (>).


2. When the pointer is in front of the parameter you wish to change,
press the Trim Knob control. The parameter label highlights.
3. Rotate the Trim Knob control to highlight the low or high limit.
4. Press, then rotate the Trim Knob control to change the limit value.
5. Press the Trim Knob control again to complete the change. The new
limit is in effect immediately.
6. Rotate the Trim Knob control to highlight the parameter label, then
press to unhighlight. You can now move to another parameter if you
want.
7. When finished with all changes, move the pointer to RETURN, and
press the Trim Knob control to close the All Limits information
window.

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Alarm Control: Alarm Control Menu

Arrhythmia Alarm Level


The arrhythmia calls recognized by the monitor are assigned to one of
the four patient status alarm categories. ARRHYTHMIA ALARM
LEVEL option allows you to view the levels assigned to the arrhythmia
calls.

Viewing
127(The software package and the monitor default settings
determine what arrhythmias are listed.

Follow this procedure to display a list of the arrhythmia calls and the
alarm level to which each is assigned:

1. Select ARRHYTHMIA ALARM LEVEL option from the Alarm


Control Menu.
2. An information window is displayed on the screen and a popup menu
is displayed in the menu area.

The software package and


Monitor Defaults determine what
arrhythmias are listed.

This example is the Cardiac


software package with full
arrhythmia on.

ARRHYTHMIA ALARM LEVEL Popup Menu and Information Window

The information window shows a list of the arrhythmia calls on the left
with their corresponding alarm level to the right.

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Alarm Control: Alarm Control Menu

Adjusting
127(In the Basic software package, only Asystole, VFIB/VTAC, and
V TACH appear. Only V TACH can be moved to another level. All
other arrhythmia calls appear and are adjustable in the Cardiac
software package.

127(Asystole and ventricular fibrillation (V FIB/V TAC) cannot be


moved in the Adult-ICU or Neonatal-ICU mode.
If you want to move an arrhythmia call to another level, follow this
procedure. (In this example, we will change V BRADY from a Crisis level
to a Warning level.) Any changes made with this menu option are
temporary and will revert to defaults upon discharge.

Asystole and ventricular fibrillation (V FIB) cannot be moved when in


ICU (Adult and Neonatal) mode.

1. Rotate the Trim Knob control to move the pointer in front of


V BRADY.
2. Press the Trim Knob control. The level for the V BRADY call
highlights.
3. Rotate the Trim Knob control until WARNING is displayed.
4. Press the Trim Knob control to complete the change. The information
window is reorganized to include V BRADY as a WARNING alarm
and the change is in effect.
The information window remains open for you to make any other
changes.

5. When you have completed all changes, move the pointer to RETURN
and press the Trim Knob control to close the information window.

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Alarm Control: Alarm Control Menu

Parameter Alarm Level


Parameter alarms are assigned to one of the four patient status alarm
categories. The PARAMETER ALARM LEVEL option allows you to view
and reassign parameter alarms to other levels.

127(The heart rate limit alarm level cannot be set to the MESSAGE
level in Neonatal ICU mode.

If you want to move a parameter alarm to another level, use the


PARAMETER ALARM LEVEL option, and follow the same procedure as
described for arrhythmia alarm levels. Any changes made with this
menu option are temporary and will revert to defaults upon discharge.

The parameters listed are only those


currently being monitored.

PARAMETER ALARM LEVEL Popup Menu and Information Window

127(No waveforms are stored in alarm history for parameter alarms.

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Alarm Volume
To adjust the volume of the alarm tones, follow this procedure:

1. Select ALARM VOL option from the Alarm Control Menu.


2. A popup menu opens displaying all choices.

ALARM VOL Popup Menu

3. Rotate the Trim Knob control to change the selection. Each time the
control is rotated, you hear a tone at that volume. ALARM VOLUME
OFF message is displayed at the top of the screen if OFF is selected.
127(When in Neonatal-ICU mode, alarm volume cannot be
turned off. The lowest it can be set is 10%.

4. When you are satisfied with the volume level, press the Trim Knob
control to close the popup menu.

Any change made with this menu option is only temporary and will
revert to default upon discharge.

127(

The Alarm Volume options shown are dependent on the Min Alarm
Volume and Alarm Volume Off settings in the Setup Display window
found in Monitor Defaults.

Minimum Alarm Volume


The Setup Display window in Monitor Defaults offers a MIN ALARM
VOLUME setting. With this setting, you can control the minimum level
to which alarm volume can be set.

For example, if you do not want alarm volume to be less than 40%, you
would select 40% as the Min Alarm Volume default. The Alarm Volume
popup menu would not show any volume options lower than 40%.

If you set the Alarm Volume Off option to DISABLE (see below) in
Monitor Defaults, you MUST set a minimum alarm volume using this
setting.

Alarm Volume Off


The Setup Display window in Monitor Defaults offers an ALARM
VOLUME OFF setting. This default setting lets you determine whether
monitor alarm volume can be turned off using the Alarm Volume popup
menu. Choices are ENABLE and DISABLE. If DISABLE is selected as
the default setting, the option OFF will NOT appear in the Alarm
Volume popup menu.

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Alarm Control: Alarm Control Menu

Alarm Help
This menu option displays an information window on the screen with
information on alarms.
1. Select ALARM HELP from the Alarm Control Menu. An information
window is displayed titled Patient Status Alarms.

ARRHY

ARRHY

ARRHY

ALARM HELP Information Window

2. In the Patient Status Alarms information window:


a. Highlight CRISIS ALARM, WARNING ALARM, or ADVISORY
ALARM.
b. Press the Trim Knob control to hear the tone associated with that
level alarm.
3. Select NEXT WINDOW to display the System Status Alarms
window. Use the Trim Knob control to hear the tones.
4. Select CLOSE WINDOW to close the alarm status information
window and return to the Alarm Control Menu.

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Alarm Control: Alarm Control Menu

Display Off Alarm Pause


The DISPLAY OFF ALARM PAUSE option allows you to pause patient
and system level alarms at the bedside and/or at the central station.

Suppose you are temporarily removing your patient from the monitor.
You dont want to discharge the patient because then you would lose
collected patient data, yet you dont want the alarms associated with the
disconnect to be sounding at the central station. Use the MONITOR/
CENTRAL PAUSE option to turn off the display, optional alarm light
indicator, and pause alarms at the central station.

In another case, you may want to monitor a patient at the central station
without displaying or enunciating the patient alarms at the bedside. Use
the MONITOR/PAUSE option to turn off the monitor display and
optional alarm light indicator. The local alarm graphs will print and the
patient parameter data and all the alarms will be sent to the central
station.

127(Pressing the Display On/Off key on the optional remote control


will also turn off the display and all bedside alarms. Local alarm
graphs will print. All alarms and parameter data will be sent to
the central station.

Follow this procedure:

1. Select DISPLAY OFF ALARM PAUSE option from the Alarm


Control Menu. A popup menu is displayed.


554B

DISPLAY OFF ALARM PAUSE Popup Menu

2. Rotate the Trim Knob control to move the pointer to one of three
options; press the Trim Knob control to activate:
RETURNthis option allows you to close the popup menu without
making any changes.

MONITOR/CENTRAL PAUSEthis option will shut off the display


and pause alarms for this monitor. Alarms for this monitor are also
paused at the central station.

MONITOR PAUSEthis option will turn off the display and all
bedside alarms. In addition, local alarm graphs can be printed. All
alarms and parameter data will be sent to the central station.

3. If necessary, reconnect the patient to the monitor.


4. To turn on the display and optional alarm light indicator and to
reactivate the alarms all you have to do is press or turn the Trim
Knob control in either direction or press any key on the front panel.

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Alarm Control: Alarm Control Menu

Clear Alarms
This is a direct action menu option which, when selected, clears any
alarm information displayed in the ALARM window.

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Alarm Control: Alarm Control Menu

Alarm History
127(This option is part of the Cardiac software package.

The ALARM HISTORY option allows you to view waveforms of stored


arrhythmia and ST alarm events for Crisis, Warning, and Advisory
levels. ST References are also stored here. In Adult-ICU and Neonatal-
ICU modes, events are not stored in alarm history during an alarm
pause and if the monitor is in a discharged state.

1. Select ALARM HISTORY option from the Alarm Control Menu. A


popup menu and information window are displayed.

ALARM HISTORY Popup Menu and Information Window

The information window displays in chronological order, beginning


with the most recent event, arrhythmia and ST events classified as
Crisis, Warning, and Advisory alarms. A maximum of 36 arrhythmia
events and 10 ST events (including references) can be stored, with 15
being displayed at one time.

2. The pointer in the information window points to the most recent


event. If you want to view the waveform data for that event, press
the Trim Knob control. (Refer to the next page.) If you want to view
the waveform data for another event in the list, rotate the Trim Knob
control so the pointer is in front of that event. Press the Trim Knob
control to view the data.
If you dont want to view any waveforms, rotate the Trim Knob
control to move the pointer in front of RETURN. Press the Trim
Knob control. The information window closes and the Patient Data
Menu is displayed.

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Alarm Control: Alarm Control Menu

Select Alarm
3. Press the Trim Knob control when the pointer is in front of the event
you wish to view to display the applicable waveforms in the
information window. A new menu also appears in the menu area.
(The example below is an arrhythmia event. Please refer to Alarm
History in the Patient Data chapter for ST event information.)
Arrhythmia
Event Time of Event

Date of Event

Press the GRAPH GO / STOP


key to print the displayed alarm
data.

The Fourth of Four Events in


History

SELECT ALARM Menu and Information Window

127(When monitoring from For arrhythmia events, three leads of ECG are displayed for the event. If
telemetry, the event is stored at an ART line was being monitored at the time of the arrhythmia
the tower and the last 36 events occurrence, two leads of ECG and the ART waveform will be displayed
are viewable from the monitor. with the associated numerics.

127(The alarm history contains ten seconds of the arrhythmia event.


Because of the size of the display, only eight seconds of waveform
data is shown. For Asystole, the first 8 seconds of an event is
displayed. All other arrhythmia events display the last 8 seconds
of the event. When the event is graphed, all ten seconds of data is
printed.

The Select Alarm Menu options are:


n VIEW OLDER ALARMdisplay the next older event, if any, stored
in alarm history.
n VIEW NEWER ALARMdisplay the next newer event, if any, stored
in alarm history.
n DELETE ALARMopen a popup menu with YES and NO selections.
Select YES to delete the event displayed in the information window.
n ALARM HISTORYreturn to the chronological list of arrhythmia
events.

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5 Monitor Setup

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Monitor Setup: Monitor Setup Menu

Monitor Setup Menu


Whenever possible, we want you to be able to customize your monitor to
best suit your units and patients needs. The Monitor Setup menu allows
you to make changes and, in some cases, to save these changes as
monitor defaults to be recalled each time you discharge a patient.

Follow this procedure to access the Monitor Setup Menu:

1. Select MORE MENUS from the Main Menu.


2. Select MONITOR SETUP to display the Monitor Setup Menu.

MONITOR SETUP Menu

n WAVEFORMS ON / OFFreassign waveform positions on the


screen or turn some waveforms off.
n DISPLAYchoose a display mode which puts pressure waveforms on
an individual or full (common) scale.
n COLORchoose a color configuration.
n PARAMETERS ON / OFFclear unneeded parameter windows
from the display and turn them back on again when needed.
n GRAPH SETUPselect waveforms to be graphed, graph speed, and
where a graph will be printed.
n MONITOR DEFAULTSconfigure alarms, set alarm limits, and
establish display defaults to be recalled whenever a discharge is
performed.
n BRIGHTNESScontrol how bright the display is.
n LEARN THE MONITORdisplay information windows containing
basic instructions on operating the monitor.
n SOFTWARE CONFIGURATIONdisplay the monitors software
configuration.
n REVISION AND IDdisplay software revisions and hardware IDs.
n SERVICE MODEaccess a service mode (for qualified service
personnel).

Detailed information on each option is found in this chapter.

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Waveforms On / Off
The WAVEFORMS ON / OFF menu option allows you to reassign
waveforms on the display or turn an individual waveform off.

127(When the ECG parameter is turned off, the Waveform 1 option


displays the primary parameter monitoring the patient. This
cannot be changed until the ECG parameter is turned back on.
See Turning the ECG Parameter Off or On on page 11-4.

Individual Display Mode


1. Select WAVEFORMS ON / OFF from the Monitor Setup Menu. A
new set of menu options is displayed. Your display mode determines
the menu options available. (Refer to 5-6 for display mode details.) If
you are using the INDV 6 WFS display mode, the menu will look like
this:

WAVEFORMS ON / OFF MenuIndividual Mode

2. Select the WAVEFORM 2 menu option to display a popup menu.

WAVEFORM 2 Popup Menu

The choices in the popup menu indicate which waveforms can be


displayed in the second waveform position.

3. Rotate the Trim Knob control to move the pointer in front of the
waveform you would like to display in that position. Choose OFF if
you want no waveform displayed in that position.
4. Press the Trim Knob control to complete the change and close the
popup menu.

Use this same procedure for the other waveform positions.

Align Waveforms
When monitoring in the individual display mode, the waveforms will
automatically align with their respective parameter windows. You can
override alignment with the Waveforms On/Off Menu.

Use the ALIGN WAVEFORMS option in this menu to automatically


realign waveforms with their parameter windows.

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Monitor Setup: Monitor Setup Menu

Full Display Mode


If you are using a full display mode (refer to the next page), the menu
will look like this:

WAVEFORMS ON/OFF MenuFull Mode

The menu option FULL BP WAVEFORMS allows you to select the


pressure waveforms you want to display on the full scale. See the popup
menu below.


561B

FULL BP WAVEFORMS Popup Menu

The selections displayed are determined by how many pressures are


being monitored. The pressure waveforms currently on the full scale are
highlighted. Only two can be displayed at one time on the full scale.

Rotate and press the Trim Knob control to select or deselect pressure
waveforms.

127(You will notice that you have left and right scales. To position a
waveform on a right or left scale use the scales option in the
individual pressure menus.

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Display
The DISPLAY menu option controls whether you want individual 6
waveform scales, individual 3 waveform scales, a full scale for pressure
waveforms or a full scale with more grids for pressure waveforms.

127(You can select the display 1. Select DISPLAY: from the Monitor Setup Menu. A popup menu is
mode you want as a Monitor displayed.
Default. Refer to this chapter,
Monitor Defaults.

DISPLAY Popup Menu

2. Use the Trim Knob control to make your selection:

Individual 6 Waveform Display


INDV 6 WFSyou can display a maximum of six waveforms with
each having an independent scale. When monitoring with this
display mode, waveforms will automatically align with their
respective parameter windows.

Individual 3 Waveform Display


INDV 3 WFSyou can display a maximum of three waveforms with
each having an independent scale. When monitoring in this display
mode, the parameter window is displayed at double high size.
Waveforms will automatically align with their respective parameter
windows.

Full Display
FULLyou can display a maximum of five waveforms. The first two
waveform positions will be on individual scales. The next two
pressure waveforms can be displayed on the full (common) scale, and
the last waveform, if any, will be on an individual scale.

Full Grid Display


FULL GRIDFull mode with additional graticules displayed on the
screen. These additional graticules will not print when graphed.

127(When using FULL or FULL GRID, notice that you have left
and right scales. Read ART, FEM, UAC, and SP pressures
using the left scale markers. Read PA, CVP, RA, UVC, LA,
and ICP pressures using the right scale markers. You can
change a pressure from one side to the other in the individual
pressure parameter menus using the scales option. (UAC and
UVC are only available when monitor is set for Neonatal-
ICU.)

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Monitor Setup: Monitor Setup Menu

Color
Use the COLOR menu option to open a popup menu to select a color
format.
1. Select COLOR option from the Monitor Setup Menu. A popup menu
is displayed.


563B

COLOR Option Popup Menu

2. Use the Trim Knob control to move the pointer to the color format of
your choice:
u CLINICALgroups physiological functions by colorECG is
amber, hemodynamics are green, and cardiopulmonary and
temperature are blue.
u TRANSDUCERmatches a color to a specific transducerART.
FEM, and UAC labeled 1 are red, PA is yellow, LA and ICP are
white, CVP, RA, and UVC are blue, SP is green, CO and gas data
are white, all other physiological parameters are green.
127(The pressure colors are based on the priority set up in
Monitor Defaults. The arterial line (ART, FEM, and UAC) set
at the highest priority will be red and all others will be white.

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Monitor Setup: Monitor Setup Menu

Parameters On / Off
This menu option allows you to turn off and on specific parameters.
Turning a parameter off will remove the waveform as well as the
parameter windows. Alarms for that parameter are off and data is not
collected in vital signs.

127(When the ECG parameter is turned off, the SPO2 parameter


becomes the primary parameter used to monitor the patient. See
the SPO2 chapter for the conditions that apply when the ECG
parameter is turned off.

1. Select PARAMETERS ON / OFF option from the Monitor Setup


Menu. A popup menu opens and an information window is displayed
listing all parameters that have cables connected.

PARAMETERS ON / OFF Popup Menu and Information Window

The first column in the information window shows the parameter


name, the second column shows whether this parameter is on or off.

2. Rotate the Trim Knob control to move the pointer to the desired
parameter.
3. Press the Trim Knob control. If the parameter reads ON, pressing
the Trim Knob control turns it off and vice versa. The change is in
effect immediately. The information window remains open so you can
select another parameter if desired.
127(The ECG parameter cannot be turned off when the monitor
is connected to a Dash Responder defibrillator.

4. When finished, select RETURN to close the information window and


popup menu.

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Monitor Setup: Monitor Setup Menu

Graph Setup
This menu option displays a new menu from which you can change
certain aspects of your graphing capabilities.

127(When the ECG parameter is turned off, the Waveform 1 option


displays the primary parameter monitoring the patient. This
cannot be changed until the ECG parameter is turned back on.
See Turning the ECG Parameter Off or On on page 11-4.

Select GRAPH SETUP from the Monitor Setup Menu. A new menu is
displayed.

GRAPH SETUP Menu

n ECG 1designate the ECG lead graphed as position 1.


n WAVEFORM 2 (3, 4)designate the other waveforms to be graphed.
n GRAPH LOCATIONdisplay a new menu to select writers for
manual graphs, alarm graphs, information window data and 12 SL
analysis.
n ALARM GRAPHturn automatic alarm graphing on and off.
n SPEEDcontrol the speed at which a graph is run.
n TIMED GRAPHcontrol the duration of a manual graph.
n GRAPH BP INVASIVEselect and graph invasive BP waveforms.
More details on the Graph Setup Menu options follow.

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Monitor Setup: Monitor Setup Menu

ECG 1, Waveform 2, Waveform 3, Waveform 4


Each of these options designates a waveform to be printed on the graph
strip. You choose the waveforms; the system prioritizes them based on
the system priority defaults.

127(Although pressures may be displayed on a full scale, they will be


graphed on individual scales. You can verify the individual scales
by switching to individual display mode.

127(The PRN 50 does not reposition the ECG waveform when going
from 4 to 2 waveforms during a real time graph run. The graph
needs to be stopped and re-started.

Since all of these options are similar, only one, WAVEFORM 2, is


detailed below. Use this procedure for the other waveform options.

1. Select WAVEFORM 2 option from the Graph Setup Menu. A popup


menu opens displaying all choices. Choices available reflect the
parameters currently being monitored.

WAVEFORM 2 Popup Menu

2. Use the Trim Knob control to move the pointer in front of the
waveform you want to be graphed.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

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Monitor Setup: Monitor Setup Menu

Graph Location
The GRAPH LOCATION option displays a menu which allows you to
choose writers for alarm and manual graphs. This menu is shown in the
figure below.

GRAPH LOCATION Menu

n MANUAL GRAPH LOCATIONdesignate to which writer a graph


strip with patient waveforms will be printed. A manual graph is
started and stopped with the GRAPH GO / STOP key on the front of
the monitor or on the optional remote control.
n ALARM GRAPH LOCATIONdesignate to which writer an alarm
graph strip with patient waveforms will be printed. An alarm graph
is automatically started when a Crisis or Warning alarm occurs.
n PRINT WINDOW LOCATIONdesignate to which writer the data
from an information window will be printed. Other data which are
always sent to this location are:
ST

All ECG

Alarm Histories
ST history data will only print to a laser printer

PA Wedge
Cardiac Output waveform

12 SL analysis
12 SL waveforms will only print to a laser printer

n 12 LEAD PRINT LOCATIONdesignate to which laser printer a 12


SL analysis with patient waveforms will be printed. Only laser
printers are valid selections. If a laser printer does not exist on
the network, a location defined in the PRINT WINDOW LOCATION
is used.

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Monitor Setup: Monitor Setup Menu

1. Select MANUAL GRAPH LOCATION option from the Graph


Location Menu. A popup menu and information window are
displayed with a list of writers available on your network.

Only those writers designated with


the same unit name as the monitor
will be displayed.

MANUAL GRAPH LOCATION Popup Menu and Information Window

2. Rotate the Trim Knob control so the pointer is in front of the writer
you want your manual graphs to go to.
127(The change will not be in effect until the Trim Knob control
is pressed and the popup menu closed.

3. Press the Trim Knob control to confirm the change and close the
popup menu. The menu option displays the name of the writer where
the graph strip will print.

127(Graph locations cannot be set as Monitor Defaults; however,


upon discharge, the graph location designations will remain as
last selected.
If the selected writer/printer is removed from use, this menu
option will continue to show that removed device even though it
is no longer available. You will have to change it to another
available device. The SAVING message is displayed when
attempting to graph to an unavailable device.

The first column in the list shows the unit where the writer is located.
The second column shows the bed number or central station number to
which the writer is attached. The third column shows the type of
writerWRITER means it is a Direct Digital Writer, LASER means it is
a laser printer.

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Monitor Setup: Monitor Setup Menu

Alarm Graph
This menu option allows you to turn automatic alarm graphs off and on.
This is a direct action menu option. Selecting this option switches back
and forth between off and on.

ALARM GRAPH Option

An arrhythmia alarm graph continues to run until a normal sinus


rhythm is again detected, or until you manually stop it at the writer. All
other alarm graphs will run for 20-seconds.

127(To convert an arrhythmia alarm graph to a manual graph, you


must stop the graph using the GRAPH GO/STOP key on the
writer and immediately restart the graph.

Speed
The speed at which a graph strip is printed is controlled with this menu
option. The slower the speed, the more condensed the data will be. This
option affects manual graphs only and must be selected before starting
the graph.

127(Alarm graphs always run at 25 millimeters per second.

1. Select SPEED option from the Graph Setup Menu. A popup menu
opens displaying all choices.

SPEED Popup Menu

127(A laser printer does not support the 0.1 millimeters per second
speed.

2. Rotate the Trim Knob control so the pointer is in front of the speed
you want.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

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Monitor Setup: Monitor Setup Menu

Timed Graph
The duration at which a manual graph is printed is controlled with this
menu option.

1. Select TIMED GRAPH option from the Graph Setup Menu. A popup
menu opens displaying all choices.

TIMED GRAPH Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of your choice.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

Graph BP Invasive
This menu option opens a popup menu that allows you to select the
available BP waveforms for graphing.When this option is activated, BP
waveforms are the only graphable parameters. Waveforms will be
graphed on one scale using the full grid space.

1. Select GRAPH BP INVASIVE option from the Graph Setup Menu. A


popup menu opens displaying all choices.

GRAPH BP INVASIVE Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of the


pressure you want to graph.
3. Press the Trim Knob control to select or deselect the pressures. One
or all pressures can be selected.
4. Once your selection is complete, move the pointer to GRAPH and
press the Trim Knob control to start the graph and close the popup
menu. Select RETURN to exit the popup if you do not want to
initiate a graph.

You cannot change a BP selection while graphing. The graph will stop
when the GRAPH GO/STOP key on the front of the monitor or on the
optional remote control is pressed, or when the selected graph period
expires. If another type of graph is currently active, the Graph BP
Invasive selection will be ignored.

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Monitor Setup: Monitor Setup Menu

Monitor Defaults
Alarm levels, alarm limits, and many of your monitor settings can be set
up as Monitor Defaults. Multiple monitor defaults can only be set when
the monitor is in a discharged state. Multiple monitor defaults can be
recalled while monitoring an admitted patient.

Whenever the monitor mode is changed, (Adult-ICU, Neonatal-ICU,


Operating Room) any Monitor Defaults you have set up will revert to
factory default settings. The monitor mode, however, is usually
established at the time of installation and can only be changed in the
service menu.

&$87,21
If you disconnect a parameter cable at any point along
the cable or disconnect it from the module, and the
parameter window is removed from the monitor display,
all alarm limits may revert to the set monitor default
alarm limits when the cable is reconnected.

127(

The monitor can maintain an admitted patients settings and alarm


limits after one or more of the following events has occurred:

u disconnection of a parameter cable at any point along the cable,


u disconnection of the cable from the module, or
u turning off a parameter and then turning it back on.

To maintain the patient settings and alarm limits, select SAVE AS


SET from the Disconnection Option in the Setup Default Display
NRT.

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Monitor Setup: Monitor Setup Menu

Monitor Defaults Menu


To display the menu to set up your Monitor Defaults, select MONITOR
DEFAULTS from the Monitor Setup Menu.

MONITOR DEFAULTS Menu

127(Monitor Defaults can only be changed when the monitor is in a


discharged state. Changes made are in effect immediately but
admit must be done for fully functional alarms.

n SETUP DEFAULT ARRHYTHMIA ALARM LEVELSadjust


arrhythmia alarms to other alarm levels.
n SETUP DEFAULT PARAMETER ALARM LEVELSadjust
parameter alarm levels to other alarm levels.
n SETUP DEFAULT LIMITSset alarm limits for all parameters.
n SETUP DEFAULT DISPLAYdetermine display settings, such as
Smart BP on, color format, waveforms graphed, etc.
n SETUP DEFAULT PARAMETER PRIORITYdetermine the
priorities you want for display of parameters.
n RECALL DEFAULTrecall monitor defaults without performing a
discharge procedure.
n CUSTOM DEFAULTSmodify multiple monitor defaults.

Setup Default Arrhythmia Alarm Levels


The arrhythmia calls recognized by the monitor are assigned to one of
the four patient status alarm levels. SETUP DEFAULT ARRHYTHMIA
ALARM LEVELS option allows you to view the levels assigned as
defaults to the arrhythmia calls.

127(In the Basic software package, only Asystole, VFIB/VTAC, and


V TACH appear. Only V TACH can be moved to another level. All
other arrhythmia calls appear and are adjustable in the Cardiac
software package.

127(Asystole and ventricular fibrillation (V FIB/V TAC) cannot be


moved in the Adult-ICU or Neonatal-ICU mode.

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Monitor Setup: Monitor Setup Menu

Follow this procedure to display a list of arrhythmia calls and the alarm
level to which each is assigned:

1. Select SETUP DEFAULT ARRHYTHMIA ALARM LEVELS option


from the Monitor Defaults Menu. An information window is
displayed on the screen and a popup menu is displayed in the menu
area.

The arrhythmias listed are


determined by the software package
and whether arrhythmia is set for
lethal or full.

SETUP DEFAULT ARRHYTHMIA ALARM LEVELS


Popup Menu and Information Window

The information window shows a list of the arrhythmia calls on the left
with their corresponding alarm level to the right.

If you want to move an arrhythmia call to another level for your Monitor
Default, follow this procedure. (In this example we will change V TACH
from a Crisis to a Warning level.)

127(Asystole and VFIB/VTAC can only be moved when in Operating


Room mode.

1. Rotate the Trim Knob control to move the pointer (>) up and down
the list. Stop when the pointer is in front of V TACH.
2. Press the Trim Knob control. Notice that the level for the V TACH
call is highlighted.
3. Rotate the Trim Knob control until WARNING is displayed.
4. Press the Trim Knob control to complete the change. The information
window is reorganized to include V TACH as a WARNING alarm.
The information window remains open for you to make any other
changes.

5. When you have completed all changes, move the pointer to RETURN
and press the Trim Knob control to close the information window.

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Monitor Setup: Monitor Setup Menu

Setup Default Parameter Alarm Levels


You can set default alarm levels for all parameters supported by the
monitor.

1. Select the SETUP DEFAULT PARAMETER ALARM LEVELS


option from the Monitor Defaults menu to view and adjust default
alarm levels for parameters.
2. Follow the same procedure as described for changing arrhythmia
alarm level defaults.

All parameters which can be


monitored are listed.

SETUP DEFAULT PARAMETER ALARM LEVELS


Popup Menu and Information Window

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Monitor Setup: Monitor Setup Menu

Setup Default Limits


You can set default limits for all parameters also.

1. Select SETUP DEFAULT LIMITS from the Monitor Defaults Menu.


A popup menu and information window are displayed.

All parameters which can be


monitored are listed.

SETUP DEFAULT LIMITS Popup Menu and Information Window

2. Rotate the Trim Knob control to move the pointer (>) through the
list.
3. Press the Trim Knob control when the pointer is in front of the
parameter for which you want to change default limits. The
parameter label highlights.
4. Turn the Trim Knob control to highlight the low or high limit.
5. Press the Trim Knob control again and rotate to change the value.
Press the Trim Knob control to complete the change.
6. Rotate the Trim Knob control to highlight the parameter label and
press to unhighlight.
7. Select RETURN when all changes are completed. The popup menu
and information window close.

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Monitor Setup: Monitor Setup Menu

Setup Default Display


This menu option allows you to set up certain aspects of the display as
defaults.

1. Select SETUP DEFAULT DISPLAY option from the Monitor


Defaults Menu. A popup menu and information window open.

Items listed are determined by the


software package.

SETUP DEFAULT DISPLAY Popup Menu and Information Window

2. Using the rotate and press technique with the Trim Knob control,
select a display item and make the desired change.
3. Select RETURN when finished to close the popup menu and
information window.

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Monitor Setup: Monitor Setup Menu

Setup Default Parameter Priority


This menu option allows you to select how the parameter windows are
prioritized on the display.

1. Select SETUP DEFAULT PARAMETER PRIORITY option from the


Monitor Defaults Menu. A popup menu and information window
open.

SETUP DEFAULT PARAMETER PRIORITY


Popup Menu and Information Window

2. Using the rotate and press technique with the Trim Knob control,
select parameters for positions on the display.

The PARAMETER selections in the top half of the window are the ones
displayed as full-size windows on the right side of the screen. You control
the order of these when you designate a parameter for each position.

The parameters in the lower half of the window will be displayed at the
bottom of the screen only when there is no room at the side. Those
parameters designated with an asterisk can be displayed in a reduced
size to accommodate up to ten parameters. The software automatically
resizes a window when necessary. You can control the order parameters
are displayed by first deselecting the highlighted parameters in the
information window and then reselecting them in the order you want
them displayed (first selected, first displayed).

See the next page for additional information which may be helpful to you
when prioritizing parameters.

Here is some additional information regarding parameter priorities:


n The first parameter cannot be changed. It must always be ECG.
n If the second parameter is set for ECG or ST, the ECG parameter
window is always displayed as the larger size. This size window
occupies the space of TWO parameter windows.

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Monitor Setup: Monitor Setup Menu

n If only six parameters are being monitored then the windows will
occupy the six positions on the right side of the screen. These
windows are always the normal size windows. If monitoring more
than six parameters, some will occupy space at the bottom of the
screen.
n You can display a maximum of 10 parameters when some half-size
parameters are chosen. The software will not allow you to pick more
parameters than can be displayed.
n If you are not monitoring a designated parameter, the space is not
left blank, but filled with the next prioritized parameter. Should you
begin monitoring the designated parameter, the screen reconfigures
so the parameter occupies its designated space.
n Whenever possible waveforms will align with their parameter
window. You can override waveform alignment with the
WAVEFORMS ON/OFF option.
n You can realign waveforms to their parameter window with the
ALIGN WAVEFORMS option in the Waveforms On/Off Menu.

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Monitor Setup: Monitor Setup Menu

Recall Default
Multiple monitor defaults are a feature of the monitor. This menu option
allows you to recall previously named monitor defaults while monitoring
an admitted patient.

1. Select RECALL DEFAULT option from the Monitor Default Menu. A


popup menu opens and an information window is displayed listing
five sets of monitor defaults.

580B

RECALL DEFAULT Popup Menu and Information Window

2. Rotate the Trim Knob control to move the pointer to the default set
desired.
3. Press the Trim Knob control. The information window and popup
menu close.

In some cases you may have to temporarily override a default. For


example, it may be necessary to set different alarm limits for the needs of
a specific patient. The alarm limits you set are in effect until you change
them again or discharge the patient.

If you have made changes while monitoring a patient and then want to
recall the monitor defaults WITHOUT discharging the patient, use the
RECALL DEFAULT option.

The name of the monitor default you selected appears at the top of the
display.

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Monitor Setup: Monitor Setup Menu

Custom Defaults
Select CUSTOM DEFAULTS from the Monitor Defaults Menu to open a
popup menu and information window that allow you to change the name
of the monitor default entry or restore factory defaults.

127(The patient must be discharged before this menu can be opened.

581B

CUSTOM DEFAULT Popup Menu and Information Window

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Monitor Setup: Monitor Setup Menu

Name Defaults
1. Select NAME DEFAULTS option from the Custom Default Menu. A
new popup menu is displayed below the information window.
2. Rotate the Trim Knob control to move the pointer in the Custom
Default information window to the default name you wish to change.
3. Press the Trim Knob control. The selected default name appears in
the popup menu.

NAME DEFAULTS Popup Menu

4. Rotate the Trim Knob control to highlight the first character block.
Then press the Trim Knob control. The vertical arrows are now
highlighted. Rotate the Trim Knob control to scroll through
alphanumeric characters.
5. Press the Trim Knob control to set the desired character. The
horizontal arrows are now highlighted again. Rotate the Trim Knob
control to highlight another character block. Continue with the
rotate, press, rotate procedure until all characters have been entered.
You can enter up to 12 characters for each monitor default name.
6. When the change is complete, highlight NAME DEFAULTS and
press the Trim Knob control to return to the Custom Defaults
information window.

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Monitor Setup: Monitor Setup Menu

Restore Factory Defaults


This option allows you to restore the factory default settings.

1. Select RESTORE FACTORY DEFAULTS option from the Custom


Defaults Menu and position the arrow to the default you wish to have
overwritten by the factory default.


583B

CUSTOM DEFAULT Information Window and RESTORE FACTORY


DEFAULTS Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of your choice.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

Upon restoration, the custom default name will change to the factory
default name. The predefined names for the multiple monitor defaults
are determined by the patient-monitor mode:

NEO 0NEO 4

ADULT 0ADULT 4

OR 0OR 4

An asterisk ( * ) indicates that the user has modified the monitor default
values from the factory default. The asterisk is only displayed when the
predefined monitor default name is used (i.e. ADULT 1*).

When the patient is discharged, the monitor default recalled also


depends on the patient-monitor mode. If the patient-monitor mode is
ADULT or NEO the monitor default recalled is the first entry in the
Recall Default information window. If the monitor mode is OR, the
monitor default recalled is the currently active monitor default.

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Monitor Setup: Monitor Setup Menu

Monitor Default Password


Monitor Default password protection can be used to restrict access to the
Monitor Default menu. When the password protection is enabled,
selecting MONITOR DEFAULTS from the Monitor Setup Menu will
display a Monitor Default menu with limited options.

MONITOR DEFAULTS Menuwith Password Enabled

n RECALL DEFAULTrecall monitor defaults without performing a


discharge procedure.
n CHANGE DEFAULTSopen a popup menu to enter the password
that allows access to the complete Monitor Default menu.

Recall Defaults
This menu option allows you to recall previously named monitor defaults
while monitoring an admitted patient. Refer to Recall Defaults explained
in the Monitor Defaults Menu section of this chapter.

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Monitor Setup: Monitor Setup Menu

Change Defaults
Select CHANGE DEFAULTS option from the Monitor Defaults Menu to
display the Change Defaults popup menu and information window.

CHANGE DEFAULTS Popup Menu and Information Window

When the password is entered and the popup menu closed, the Monitor
Default Menu will be displayed with all options available.

In some cases you may not want password protection for the Monitor
Defaults menu. The password protection feature can be enabled or
disabled from a menu option in the Service Menu. (Refer to this chapter,
Service Mode.)

Brightness
This option is used to control the brightness of the monitors screen.

1. Select BRIGHTNESS option from the Monitor Setup Menu. A popup


menu is displayed with all choices.

BRIGHTNESS Popup Menu

2. Rotate the Trim Knob control to change the brightness of the display.
The change takes place immediately so you can judge the appropriate
percentage.
3. Press the Trim Knob control to close the popup menu.

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Monitor Setup: Monitor Setup Menu

Learn the Monitor


With the Mentor educational program, basic instructions for the new
user are presented right on the monitor.
1. Select LEARN THE MONITOR option from the Monitor Setup
Menu. The first of six information windows is displayed on the
screen.

LEARN THE MONITOR Information Window

2. Trim Knob control operation is now in the information window.


CLOSE WINDOW will close the Mentor information window and
NEXT WINDOW and PREVIOUS WINDOW enable you to move
forward and backward through the six windows.
The six Mentor information windows are:
Operating the Monitor

Skin Prep and Electrode Placement

Patient Status Alarms

System Status Alarms

Silencing Alarms and Graphing

NBP Procedure
127(Mentor information windows cannot be printed.

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Monitor Setup: Monitor Setup Menu

Software Configuration
It is important to know how to find out your monitors software
configuration. Follow this procedure.
1. Select SOFTWARE CONFIGURATION option from the Monitor
Setup Menu. A popup menu and information window are displayed.

588B

SOFTWARE CONFIGURATION Popup Menu and Information Window

2. Select OK to close the popup menu and information window.

127(The Enabled Software Options, listed in the above figure, are the
monitors optional configured features

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Monitor Setup: Monitor Setup Menu

Revision and ID
This menu option opens the Software Revision Display, Hardware ID
Display, and when applicable, peripheral device Revision Display
information windows. This information is most useful to service
personnel.

1. Select REVISION AND ID option from the Monitor Setup Menu. A


popup menu and the Software Revision Display information window
is displayed.
2. There are multiple pages of software revision information. Select
NEXT to display the next page of information.

589C

REVISION AND ID Popup Menu and Information Window

3. Continue to select NEXT to display the subsequent information


windows.
4. Select QUIT to close the popup menu and information window.

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Monitor Setup: Monitor Setup Menu

Service Mode
The service menu is meant for qualified service personnel and, therefore,
is password protected. If you select SERVICE MODE option from the
Monitor Setup Menu you will see a screen similar to the one shown
below.

SERVICE MODE Popup Menu and Information Window

When the password is entered and the popup menu closed, the Service
Mode Menu will be displayed.

591B

SERVICE MODE Menu

The service mode is used by qualified field engineers, factory service


personnel, and hospital biomedical engineers to set up, troubleshoot, and
repair the monitor. If you want more details please refer to the
appropriate product service manual.

Following is an explanation of Service Menu options which have been


mentioned in other places in the manual.

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Monitor Setup: Monitor Setup Menu

Patient-Monitor Type
In many places throughout the manual the patient-monitor type is
mentioned. Your monitor is set up for monitoring in one of three modes
with the PATIENT-MONITOR TYPE option:

Adult-ICUADULT,

Neonatal-ICUNEO, or

Operating RoomOR.

The monitor mode (shown above in all caps) appears next to the date
time line at the top of the display. (Refer to The Basics chapter,
Operation.)

Remember, when you change the patient-monitor type any Monitor


Defaults you have set will be lost and factory defaults will again be in
effect.

Menu Setup
Other options which affect your monitor are found in the Menu Setup
option.

Admit Menu
From the Admit Menu you can select the admit mode. The admit mode
determines the menu options you will use when admitting a patient to
the monitor. The admit modes are:

Standard,

Rover,

Combo, and

Rover Combo.

Monitor Defaults Password


Monitor Default password protection is used to restrict access to the
Monitor Default menu. The monitor default password feature can be
enabled or disabled using this option. The choices are:

Required, and
Not Required.

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Monitor Setup: Monitor Setup Menu

For your notes

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6 CRG Trends Display

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For your notes

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CRG Trends Display: CRG Trends

CRG Trends
CRG Trends Display
Follow this procedure to view the CRG trends:

1. Select MORE MENUS from the Main Menu.


2. Select PATIENT DATA.
3. Select CRG TRENDS. The CRG Trends window and CRG Trends
Menu are displayed. The primary ECG lead continues to be
displayed, as well as all of the parameter windows on the right side of
the screen.

127(There can be up to a two-minute delay before data can be


displayed when the system is first connected or when admitting a
new patient. Data is displayed on an even minute boundary in
either two-minute or six-hour segments. The display will update
automatically every two minutes when the most recent data
segment is currently displayed.

Viewing Mode

A maximum of three
trends can be
displayed

Cursor

Tic Mark Increments Message Area

CRG TRENDS Window and Menu

This display and menu are not affected by a time setting for the Menu
Timeout feature in Monitor Defaults. They do not time out. To redisplay
all waveforms and parameter windows, you must select MAIN MENU.

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CRG Trends Display: CRG Trends

CRG Trends Event Directory


The top portion of the CRG trends window is used to display a directory
of stored CRG events. A maximum of six events can be displayed in the
directory. Each event has an associated number, a minimum/maximum
alarm value (based on low or high alarm type) and an event start time.
An asterisk (*) indicates that you cannot access the trend trace data for
this event (the event may have just occurred and data may not be
available yet).

When the monitor is set for Neonatal-ICU mode and an apnea, brady or
desaturation alarm occurs within 30 seconds of the first alarm, the
monitor groups the alarms on one text line in the event directory (refer to
line 5 in the example below).

127(
When more than one alarm is grouped on a text line, each alarm
counts as a single event. Each event can be viewed separately, and
three separate events are recorded in the event directory.

824B

CRG Trends Window with Event Directory

For alarms to be stored in the event directory, alarms must be resolved


(patient condition has returned to within set limits) and have an alarm
level greater than message. The CRG trends directory is automatically
updated when a valid alarm is resolved. The directory can hold up to 100
events. Once the directory is full, and a new event occurs, the oldest
event in the directory is removed and the new event is added. However,
the trend traces are only stored for 24 hours. Therefore, it is possible to
have events stored in the directory for which traces are no longer
available.

All events in the event directory may be selected. Once an event is


selected, a 2-minute trend of the event is displayed in the trace area with
the event time centered.

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CRG Trends Display: CRG Trends

CRG Trends Menu Options


Locate Cursor
The LOCATE CURSOR option allows you to move the vertical cursor to a
specific time. The parameter values at the position of the cursor are then
displayed.

Zoom In/Out
The ZOOM IN and ZOOM OUT options allow you to zoom in to a
specified two-minute trend from any six-hour summary or zoom out to a
specified six-hour summary from any two-minute trend. The cursor
centers to the selected time associated with the displayed trace.

View Older/View Newer


The VIEW OLDER/VIEW NEWER options allow you to view older and
newer data.

Select Parameters
The SELECT PARAMETERS option opens a popup menu to select CRG
parameters to be displayed as trends. Your choices are HR, SPO2, MAP,
RESP, and CO2.

127(
There is a slight delay when a change is made to the display
while the requested data is being retrieved. Watch for the
RETRIEVING DATA message at the bottom of the trend
window.

Respiration Trend
The data for the respiration trend is as follows:

n Six-hour display
u In Neonatal-ICU mode it is apnea per 5 minutes. This prints as
apnea per 1 minute.
u In Adult-ICU and Operating Room modes, it is the respiration
rate.
n Two-minute display
u In all modes it is the respiration waveform.

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CRG Trends Display: CRG Trends

Select Event
This option opens a popup menu that allows you to select a specific CRG
event from the event directory. All events in the event directory may be
selected. Once an event is selected, a 2-minute trend of the event is
displayed in the trace area with the event time centered.

Delete Event
Events older than 24 hours and individual events with associated traces
can be permanently deleted using this option.

Selecting the DELETE EVENT option opens a popup menu with the
following options:
n NO Returns to the CRG Trends menu.
n YES Deletes the event selected (highlighted) in the event
directory.
n >24 HRS Deletes all events older than 24 hours and that no longer
have CRG trend traces associated with them.

Print Events
Use this option to print all available event entries in the event directory.
Events are graphed at the print window location.

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CRG Trends Display: Document CRG Events

Document CRG Events


The Document CRG Events feature is only available in Neonatal-ICU
mode when the patient is admitted to the monitor. This option provides a
list of events associated with the patients condition at a specific time.
These events can be edited, selected and stored in the event directory.

To access the Document CRG Events information window, follow this


procedure:

1. Select MORE MENUS from the main display.


2. Select PATIENT DATA.
3. Select CRG TRENDS.
4. Select DOCUMENT CRG EVENTS to display the following
information window and popup menu.

825B

Document CRG Events Popup Menu and Information Window

To edit events in the Document CRG Events information window, follow


this procedure:

1. Move the pointer (>) in front of the DATE/TIME selection.


2. Highlight the date/time selection (see figure) by pressing the Trim
Knob.
3. Scroll to a specific time. Press the Trim Knob control when the
specific time you want to edit appears.
4. Move the pointer to an event, then press the Trim Knob control. The
event will be highlighted and your selection will then appear in the
CRG Trends directory.
Select RETURN when all changes are completed. The popup menu and
information window close.

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CRG Trends Display: Troubleshooting

Troubleshooting
Problem: Solution:
Impedance respiration waveform
is too small or too large for the In the Respiration Menu, use either the RELEARN RESPIRATION
CRG Plus display. option or the AUTO SIZE option.

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7 View Other Patients

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View Other Patients: Viewing Other Patients

Viewing Other Patients


127(The Unity Network is a purchased software option which must
be enabled before using this feature.
A very popular feature of our monitor is the ability to be at one patients
bedside and use that monitor to view the data from another patients
monitor. The only criteria for this to happen is that the unit and monitor
you want to view must be on the same Unity Network.

127(A monitor is identified by The View On Alarm feature notifies you when a bed is in alarm so you
the bed number assigned. can then select it to be viewed. (Refer to this chapter, View On Alarm
Therefore, the terms monitor and Options.)
bed are used interchangeably.
The figure below is an example of a monitors display when viewing
another patient. The monitor you are viewing from is the host. The
patient data for the host monitor is always shown on the right. The
viewed patient data is always shown on the left. The message VIEWED
PATIENT appears at the bottom of the viewed patient portion of the
display. The unit and bed identifiers (as well as patient name if entered)
are shown on the host portion and the viewed patient portion.

The viewed patient data will remain on the screen until turned off or a
different patient is selected. All functions are still operational for the
host monitor and two seconds of waveform data continue to be displayed.
The menus displayed are for the host monitor only. If you access a
function with an information window, such as limits, the viewed patient
data will temporarily be overwritten by the information window.

Viewed Patient Data Host Patient Data

View Second Patient Display

The first six parameter windows and up to four waveforms will be


displayed for the viewed patient.

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View Other Patients: Viewing Other Patients

Here are some guidelines to remember when viewing another patient.

127(Make sure the monitor to be viewed is admitted.

If the monitor is discharged, parameter windows are displayed, but no


waveforms. DISCHARGED message is also displayed.

CO2 Monitoring on the Host Monitor

On the host monitor, be sure the CO2 waveform is positioned in the


sixth waveform position. Because of the slower sweep speed of the
CO2 waveform, any waveforms adjacent to or beneath that waveform
position on the viewed patient display are prevented from being
viewed.

CO2 Monitoring on the Viewed Patient Monitor

If monitoring CO2 on the viewed monitor, the CO2 waveform will not
be sent to the host monitor. However, the CO2 parameter window
will be sent for display at the host monitor. This is also true with
Vent and RM waveforms.

ST Trends and Complexes

ST trends and complexes are not sent to a host bed for viewing.

CRG Plus Display on the Viewed Patient Monitor

If the CRG Plus display is currently on at the viewed monitor, two


waveforms and six parameter windows are sent to the host monitor.
The CRG Plus display is not sent.

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View Other Patients: View Other Patients Menu

View Other Patients Menu


Select VIEW OTHER PATIENTS option from the Main Menu to display
this menu:

VIEW OTHER PATIENTS MenuAlarm Feature Off

VIEW OTHER PATIENTS MenuAlarm Feature On

n VIEW ALARMselect to display the patient data for the bed in


alarm.
n VIEW ON ALARM OPTIONSdisplay a new menu that allows you
to turn the View on Alarm options ON, OFF, or AUTO.
n SELECT A BED TO VIEWopen an information window from
which to select a bed to view.
n SELECT ANOTHER CARE UNITopen an information window
from which to select another care unit. This affects the list viewed in
SELECT A BED TO VIEW.
n GRAPH VIEWED BEDstart a 20-second graph of the viewed
patient data.

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View Other Patients: View Other Patients Menu

View Alarm
The VIEW ALARM option enables you to quickly display the data for a
bed that has an alarm. Follow this procedure:
1. Select VIEW OTHER PATIENTS from the Main Menu.
2. Select the VIEW ALARM option which displays the alarming bed you
want to viewin this example VIEW ALARM: BED3. A popup menu
opens and the display reconfigures to show the patient data for Bed 3
on the left.

VIEW ALARM Popup Menu

3. The choices in the popup menu are:


MAIN MENUreturn to the Main Menu.

RETURNclose the patient view and return to the View Other


Patients Menu.
GRAPH 20 SECstart a 20-second graph strip of the viewed patient
data.

SILENCEsilence alarms for 60 seconds at the monitor which is the


source of the viewed patient data. It is not possible to silence a bed in
the OR mode.

View On Alarm Options


Select VIEW ON ALARM OPTIONS to display a new menu with options
for viewing other beds in alarm.

VIEW ON ALARM OPTIONS Menu

The choices in the menu are:


n VIEW OTHER BEDS ON ALARM:opens a popup menu that allows
you to turn this feature OFF and ON, or use the AUTOmatic View on
Alarm feature.
n SEND AUTO VIEWS: toggles on and off the option to trigger
automatic viewing of the local bed in alarm throughout the care unit.
n ALERT TONE: toggles on and off the Automatic View on Alarm
audio signal.

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View Other Patients: View Other Patients Menu

View Other Beds on Alarm: ON


127(Only Patient Crisis, Patient Warning, and System Warning
alarms are identified with this feature.

This feature is very useful when you are in a patients room and want to
know when any other bed in that unit alarms. (The factory default is
OFF, but you can set it to default ON or AUTO in Monitor Defaults.)

When the feature is on, an alarm message line is displayed immediately


below the menu area of the display. This alarm message line, while on, is
displayed below all menus.

Alarm Message Line

Alarm Message Line with No Beds in Alarm

When a bed in the unit alarms, the bed number and reason for alarm will
be displayed in this message line. Note also that the first VIEW ALARM
option shows the bed in alarm. (See the figure below.)
Bed3 Heart Rate Alarm

Bed3 Heart Rate Alarm

Alarm Message Line with a Bed in Alarm

If multiple alarms occur, the beds with the most recent, highest alarm
level violated will be displayed and are prioritized. The highest priority
alarm will be displayed first. A maximum of four beds in alarm can be
displayed in the message line at any one time.

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View Other Patients: View Other Patients Menu

View Other Beds on Alarm: AUTO


127(The Prism server is required for the Automatic View on Alarm
feature to work.

The Automatic View on Alarm feature is activated when a Patient Crisis,


Patient Warning, or System Warning alarm occurs on a monitor with
SEND AUTO VIEWS turned on. All beds in the unit, with View Other
Beds on Alarm set to AUTO, will automatically enter a split-screen view
of the alarming bed and the Automatic View On Alarm popup menu will
open.

AUTOMATIC VIEW ON ALARM Popup Menu

The choices in the popup menu are:


n MAIN MENUclose the auto view and return to the Main Menu.
n RETURNclose the auto view and return to the View Other
Patients Menu.
n GRAPH 20 SECstart a 20-second graph strip of the viewed patient
data.
n SILENCEsilence alarms for 60 seconds at the monitor which is the
source of the viewed patient data. It is not possible to silence a bed in
the OR mode.

&$87,21
When View Other Beds on Alarm is in AUTO mode,
alarms must be silenced at the alarming bed or at a host
bed to allow the next alarm to be viewed.

If the alarm is silenced from the popup menu (see illustration), the
automatic view will be removed from each monitor in the unit. The
monitor which performed the silence will now retrieve parameter
and waveform data directly from the alarming bed as a VIEWED
PATIENT.

Alarms silenced at a central station or at the alarming bed will cause


all automatic views to be terminated. If the alarm condition exists
after the silenced period, or if a new alarm occurs, all other beds will
return to automatic view. The bed which initially silenced the alarm
will only view new alarms if the Automatic View on Alarm popup
menu was exited before the new alarm occurred.

n LAST EVENTretrieve the last arrhythmia event from the actual


alarming bed. The event is then displayed in a standard non-real
time history display with a simple OK popup menu which, when
selected, will clear the history display and return you to the View
Other Beds on Alarm Menu.

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View Other Patients: View Other Patients Menu

Select a Bed to View


To select a bed to view which is not in alarm, follow this procedure:
1. Select SELECT A BED TO VIEW option from the View Other
Patients Menu. An information window with the available beds to
view for one care unit are displayed. (See the following page to see
how to change the care unit.)

Only the beds in this care unit are


displayed.

The RETURN option allows you to close


this window without making any
changes.

SELECT A BED TO VIEW Popup Menu and Information Window

2. Rotate the Trim Knob control to move the pointer.


3. Press the Trim Knob control when it is in front of the bed you want to
view. The screen will reconfigure to display the selected patient data
on the left. The popup menu closes and the main menu is displayed.
Menu items displayed are for the host monitor only.

Turn the View Off


To turn the viewed bed off, select SELECT A BED TO VIEW again. The
information window as shown in the illustration above is displayed. The
pointer, however, will already be positioned in front of the viewed bed.
Just press the Trim Knob control to turn the view off and close the
information window.

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View Other Patients: View Other Patients Menu

Select Another Care Unit


If the patient you want to view is in another care unit, then you will need
to select this menu option to display an information window which lists
all the care units on the network. Follow this procedure:

1. Select SELECT ANOTHER CARE UNIT option from the View Other
Patients Menu. An information window with the units available on
the network is displayed.

SELECT ANOTHER CARE UNIT Popup Menu and Information Window

2. Rotate the Trim Knob control to move the pointer to the care unit
desired.
3. Press the Trim Knob control. The information window and popup
menu close.
4. Use the SELECT A BED TO VIEW option to designate the bed for
view. (Refer to the previous page.)

Graph Viewed Bed


Select this option to start a 20-second graph of the viewed patient data.
The waveforms appearing on the graph are those selected in the graph
setup menu on the monitor of the viewed patient. The device it is printed
to is the one chosen for manual graph location, in the graph location
menu on the monitor of the viewed patient, unless there is a local printer
attached to the viewing bed. In this case, the printout will go to the local
printer.

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8 Patient Data

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Patient Data: Patient Data Menu

Patient Data Menu


Select PATIENT DATA from the More Menu to display the menu:

PATIENT DATA Menu

n ALARM HISTORYview stored arrhythmia alarm events, ST


references, and ST alarm events. (Cardiac software package only.)
n VITAL SIGNS (TABULAR TRENDS)display the values for the
patients monitored parameters over the last 24 hours.
n GRAPHIC TRENDSplot trends for selected parameters.
n CARDIAC CALCSenter the cardiac calculations program.
(Cardiopulmonary software package only.)
n PULMONARY CALCSenter the pulmonary calculations
program.(Cardiopulmonary software package only.)
n DOSE CALCSenter the dose calculations program.
n CRG TRENDSview high-resolution CRG trends. (High Resolution
CRG Trends software option only.)
n LAB DATAaccess laboratory data for this patient from your
hospitals lab information system (LIS). A Lab Access Server with an
interface to the LIS is necessary for this feature to function.

Detailed information on each option is found in this chapter.

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Patient Data: Patient Data Menu

Alarm History
127(This options is part of the Cardiac software package.

The ALARM HISTORY option allows you to view waveforms of stored


arrhythmia and ST alarm events for Crisis, Warning, and Advisory
levels. In Adult-ICU and Neonatal-ICU modes, events are not stored in
alarm history during an alarm pause and if the monitor is in a
discharged state.

1. Select ALARM HISTORY option from the Patient Data Menu. A


popup menu and information window are displayed.

Press the GRAPH GO / STOP


key to print the displayed alarm
history list.

ALARM HISTORY Popup Menu and Information Window

Arrhythmia and ST Events


The information window displays in chronological order, beginning
with the most recent event, arrhythmia and ST events classified as
Crisis, Warning, and Advisory alarms. Also available for review are
ST references. A maximum of 36 arrhythmia events can be stored,
and 10 ST events (alarms and references) with 15 events being
displayed at one time.

2. The pointer in the information window points to the most recent


event. If you want to view the waveform data for that event, press
the Trim Knob control. (Refer to the next page.) If you want to view
the waveform data for another event in the list, rotate the Trim Knob
control so the pointer is in front of that event. Press the Trim Knob
control to view the data.
If you dont want to view any waveforms, rotate the Trim Knob
control to move the pointer in front of RETURN. Press the Trim
Knob control. The information window closes and the Patient Data
Menu is displayed.

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Patient Data: Patient Data Menu

Select Alarm (Arrhythmia Event)


Press the Trim Knob control when the pointer is in front of the event you
wish to view to display the applicable waveforms in the information
window. A new menu also appears in the menu area.
Arrhythmia
Event Time of Event

Date of Event

Press the GRAPH GO / STOP


key to print the displayed alarm
data.

The fourth of four events in


History

SELECT ALARM (Arrhythmia Event) Information Window and Menu

127(When monitoring from Three leads of ECG are displayed for an arrhythmia event. If an ART
telemetry, the event is stored at line was being monitored at the time of the arrhythmia occurrence, two
the tower and the last 36 events leads of ECG and the ART waveform will be displayed. Associated
are viewable from the monitor. numerics are included also. Ten seconds of data is presented in a
compressed format, but prints at 25 mm/sec.

The Select Alarm Menu options are:


n VIEW OLDER ALARMdisplay the next older event, if any, stored
in alarm history.
n VIEW NEWER ALARMdisplay the next newer event, if any, stored
in alarm history.
n DELETE ALARMopen a popup menu with YES and NO selections.
Select YES to delete the event displayed in the information window.
n ALARM HISTORYreturn to the chronological list of arrhythmia
events.

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Patient Data: Patient Data Menu

Select Alarm (ST Event)


If you select an ST alarm event or an ST reference, the information
window will look similar to the following:

Press the GRAPH GO / STOP


key to print the displayed data.
ST histories will only print to a
laser printer.

SELECT ALARM (ST Reference) Information Window and Menu

A QRS complex of all available leads (with the exception of AVR) is


displayed. If viewing an ST alarm event, an asterisk is displayed next to
each lead label in violation of set ST limits.

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Patient Data: Patient Data Menu

Vital Signs
127(Vital Signs is called TABULAR TRENDS if your monitor is in
the Operating Room mode.

Upon admit to the system, a history of the patients vital signs is


continually being collected. Follow this procedure to display this patient
data:

1. Select VITAL SIGNS (TABULAR TRENDS) from the Patient Data


Menu. An information window and new set of menu options are
displayed.
Current Date and Time

Press the GRAPH GO / STOP


key to print the vital signs
information.

OFF is displayed if alarms were


paused or the monitor was in
discharged state.

VITAL SIGNS Menu and Information Window

For most parameters, 24 hours of data is collected. Exceptions to this


24-hour limit are cardiac calculations and pulmonary calculations.
The last 20 cardiac calculations and the last 10 pulmonary
calculations are stored.

2. You cannot change any values in the Vital Signs but you can use the
menu options to move through all the data collected. Refer to the
following page for details.
Described below are the Vital Signs Menu options.

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Patient Data: Patient Data Menu

View Older / View Newer


Each of these direct action menu options will move the data displayed
either backward or forward in time if data is available.

Time Interval
Select TIME INTERVAL to choose the time interval between each of the
displayed columns of data. This does not affect data collection, only how
it is displayed.

TIME INTERVAL Popup Menu

1. Rotate the Trim Knob control to move the pointer in front of the time
interval of choice.
2. Press the Trim Knob control to close the popup menu and effect the
change.

Specific Time
Select SPECIFIC TIME option to open a popup menu which allows you
to enter a specific time you want to find and display in vital signs.

SPECIFIC TIME Popup Menu

1. Rotate the Trim Knob control to move the highlight into the date and
time. (The popup menu opens with the current date and time.)
2. Press the Trim Knob control when an element in the date or time is
highlighted. Rotate to make a change.
3. Press the Trim Knob control to complete the change, and rotate to
highlight the next element in the date and time.
4. Close the popup menu by rotating the Trim Knob control to highlight
SPECIFIC TIME, then press the Trim Knob control. The specific
time you requested (or the time closest to it if your TIME INTERVAL
is set for other than one minute) will appear in the middle column of
the information window.

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Patient Data: Patient Data Menu

Sort Data
The SORT DATA menu option allows you to sort the data to display the
collected data for an episodic parameterNBP, Card Calcs, or Pulm
Calcs.

127(If the GAS and ICG parameters are present on the monitor, they
will also be displayed in the Sort Data popup menu.

SORT DATA Popup Menu

Rotate and then press the Trim Knob control to make a selection. The
ALL DATA selection redisplays all the collected data.

Page Down and Page Up


These direct action menu options work just like VIEW OLDER and
VIEW NEWER but instead of moving the data in time, they display any
additional data not displayed on the screen due to space restrictions.

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Patient Data: Patient Data Menu

Graphic Trends
Another way of displaying collected patient data is through trends. A
trend is a graphic representation of one parameter over a specified period
of time. Every non-episodic parameter is sampled 30 times a minute. A
median value is determined and that value is stored for trend display at
one-minute resolution. Episodic parameters (NBP, etc.) are stored every
time one occurs.

Follow this procedure to view graphic trends:

1. Select GRAPHIC TRENDS from the Patient Data Menu. An


information window and new set of menu options are displayed.

The trend data will automatically


update while displayed. Refer to
this chapter, Time Period.

Press the GRAPH GO / STOP


key to print the displayed trends.

GRAPHIC TRENDS Menu and Information Window

The graphic trends for the last selected parameters are displayed.
Heart rate is the default if none were previously selected.

2. To select other parameters for trending follow the procedure on the


following page.

127(All trend data that is available at the monitor can be requested


by a network device viewing trends, e.g., central station.

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Patient Data: Patient Data Menu

Select Parameters
1. Select the SELECT PARAMETERS option from the Graphic Trends
Menu. A popup menu and the Vital Signs information window are
displayed.

Notice the pointer (>) and a


RETURN option in this
window.

SELECT PARAMETERS Popup Menu

2. To mark (highlight) a parameter for trending, rotate the Trim Knob


control to move the pointer and then press the Trim Knob control. In
this example HR is highlighted because that is the default.
Up to three parameters can be selected. Selecting a fourth will
unmark the first selection chosen.
127(NBP or an invasive pressure with a systolic, diastolic, and
mean value is considered one selection. For example, if you
select AR1-S, the other two parameters (AR1-D and AR1-M)
will also highlight. However, the trends for these parameters
will appear in only one trend window. If you only want to plot
one of the three pressure parameters, simply unmark those
you dont want. This is also true for inspired and expired
CO2.

3. When the parameters you want to plot as trends are highlighted,


move the pointer to RETURN and press the Trim Knob control. The
popup menu closes and the information window reconfigures to
display the trends.

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Patient Data: Patient Data Menu

Preset Trends
This menu option may be useful as a shortcut in plotting trends. Follow
this procedure.

1. Select PRESET TRENDS option from the Graphic Trends Menu. A


popup menu opens with preset combinations of parameters for
trending. (Choices available will vary with the patient-monitor type
for which your monitor is set.)

PRESET TRENDS Popup Menu (Adult-ICU)

2. Look at the parameter combinations. If one suits your needs, use the
Trim Knob control to move the pointer in front of it.
3. Press the Trim Knob control and the information window
immediately displays the parameters as graphic trends.
4. Select RETURN to close the popup menu.

The other menu options in the Graphic Trends Menu allow you to view
the trended data over the period of time it has been collected.

View Older/View Newer


Use these options to move backward and forward in time.

127(These options do not function when viewing in the 6-minute time


period.

Time Period
Use this option to open a popup menu to select a time period for viewing
the displayed trends.

TIME PERIOD Popup Menu

Displayed trends will automatically update. The frequency of the update


is based on the time period selected.
6 MINSupdates every 10 seconds
15, 30 MINSupdates every minute
1, 2, 4 HRSupdates every minute
8 HRSupdates every 2 minutes
12 HRSupdates every 4 minutes
24 HRSupdates every 6 minutes

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Patient Data: Patient Data Menu

Cardiac Calcs
127(This option is part of the Cardiopulmonary software package.
The cardiac calculations program is an integral part of the cardiac output
function of the monitor. Details on how to use the cardiac calcs program
with cardiac output is included in the Cardiac Output chapter.

Having cardiac calculations available in the Patient Data Menu allows


you to use the cardiac calculations program if doing cardiac output
measurements with a device other than the monitor.

Follow this procedure:

1. Select CARDIAC CALCS option from the Patient Data Menu. The
cardiac calculations information window and menu are displayed.

Weight and height will be


displayed if entered previously in
any calculations program.

CARDIAC CALCS Menu and Information Window

127(If a set of calculations is displayed, the last set of calculations


was never saved. There will be a date and time displayed at the
top of the window. Use the SAVE CALC option to save the set to
Vital Signs.

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Patient Data: Patient Data Menu

Change Value
2. Select CHANGE VALUE option from the Cardiac Calcs Menu to
enter or change monitored values in the information window. A
popup menu opens and the pointer and RETURN option are
displayed at the top of the window.
3. Rotate the Trim Knob control to move the pointer in front of CO.
Press the Trim Knob control once. A default value of 6.0 is displayed.

CHANGE VALUE Popup Menu

4. Rotate the Trim Knob control to change the value, then press the
Trim Knob control to enter the value and display the calculated
values.

Note that the current date is


assigned to the set of
calculations when the first value
is entered, and calculated
values are displayed.

Cardiac Output Value Entered

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Patient Data: Patient Data Menu

5. Use the Trim Knob control to enter other values.


6. When all values desired are entered, select RETURN to close the
popup menu.

Press the GRAPH GO / STOP


key to print the displayed
calculations.

Completed Set of Cardiac Calculations

Save Calc
7. Select SAVE CALC option from the Cardiac Calcs Menu to save the
displayed values to Vital Signs. The prompt SAVE OPERATION
COMPLETE will appear in the message line. If the message SAVE
OPERATION FAILED appears a CO value has not been entered, or
you already saved this set of calculations.

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Patient Data: Patient Data Menu

Review Calcs
8. To review all saved calculations, select the REVIEW CALCS option
from the Cardiac Calcs Menu. The Vital Signs information window is
displayed but notice that the data is sorted so cardiac calculations
appear first in the list.

Data is automatically sorted


so cardiac calculations
appear first.

REVIEW CALCS Menu and Information Window

Since you have entered the Vital Signs program, the Vital Signs
Menu options are displayed. However, when sorted as cardiac calcs
the TIME INTERVAL and SPECIFIC TIME options are non-
functional. Refer to this chapter, Vital Signs, for information about
the Vital Signs Menu options.

Weight and Height


The WEIGHT and HEIGHT options in the Cardiac Calcs Menu allow you
to switch the units of measurekilograms or pounds for weight and
centimeters or inches for height. Each of these is a direct action menu
option.

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Patient Data: Patient Data Menu

Pulmonary Calcs
127(This option is part of the Cardiopulmonary software package.
All aspects of oxygen uptake, transport, and delivery are necessary in the
assessment of the critically ill patient. These parameters cannot be
directly measured but are derived from monitored cardiopulmonary
variables.

Monitored/Measured Parameters
The monitored values are measured data from arterial blood gases, and
monitored ventilator parameters. These values are entered manually
and then used to derive pulmonary calculations. The chart below shows
the monitored/measured parameters, the labels used to identify these on
the screen, and the units of measure.

Monitored/Measured Parameters

Parameter Label Unit


Weight WEIGHT KG or LBS
Height HEIGHT CM or inches
Fractional inspired oxygen FiO2 %
Positive end expiratory pressure PEEP cmH2O
Respiration Rate RR bpm
Tidal volume TV mL
End inspiratory pressure PIP cmH2O
Cardiac output CO L/min
Barometric pressure PBAR mmHg
Hemoglobin Hb gm/100mL
Partial pressure of CO2 in arterial blood PaCO2 mmHg
Partial pressure of O2 in arterial blood PaO2 mmHg
Arterial oxygen saturation SaO2 %
Partial pressure of O2 in mixed venous PvO2 mmHg
Mixed venous oxygen saturation SvO2 %

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Patient Data: Patient Data Menu

Derived Pulmonary Calculations


The derived pulmonary calculation values are figured automatically. The
chart below shows the derived pulmonary calculations, the labels used to
identify these on the screen, the units of measure, and the formulas used.

Parameter Label Unit Formula


Body surface area BSA m 2
HT 0.725
x WT 0.425
x 0.007184
Dynamic compliance CEd mL/cmH2O TV
------------------------------
PIP PEEP
Minute volume MV L/min TV RR
------------------------
1000
Cardiac index CI L/min/m2 CO
-------------
BSA
Alveolar arterial oxygen AaDO2 mmHg PAO2 PaO2
gradient
Arterial oxygen content CaO2 mL/100 mL
Hb 1.39 SaO
-------------- + ( PaO 2 0.0031 )
2
100
Oxygen delivery index O2DI mL/min/m2 CaO2 x CI x 10
Mixed venous oxygen CvO2 mL/100 mL
Hb 1.39 S v O2
-------------- + ( P v O 2 0.0031 )
content 100
Arterial venous oxygen avO2 mL/100 mL CaO2 CvO2
content difference
Oxygen consumption index O2CI mL/min/m2 avO2 x CI x 10
Fick cardiac output FICK CO L/min VO2 I BSA
-------------------------------------------------------
( CaO2 CvO 2 ) 10
Oxygen extraction ratio O2R %
( CaO 2 CvO 2 ) 100
----------------------------------------------------------
CaO 2
Oxygenation ratio Pa/FiO2 % PaO2
------------------------------
FiO 2
------------- 100
100
Shunt fraction Qs/Qt %
SaO
Hb 1.39 1 --------------2 + [ 0.0031 ( PAO2 PaO 2 ) ] 100
100
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------
SvO
H b 1.39 1 --------------2 + [ 0.0031 ( PAO 2 P v O 2 ) ]
100
Alveolar pressure PAO2* mmHg
Fi O 2 PaCO 2
------------- ( PBAR 47 ) -------------------
100 0.8

* PAO2 does not appear in the pulmonary calculations display, but it is used to derive AaDO2.
References:
1 Chatburn, Robert and Lough, Marvin: Handbook of Respiratory Care. Year Book Medical Publishers, Inc., Chicago, 1990.
2 Marino, Paul: The ICU Book. Williams & Wilkin, Baltimore, 1998.
3 Tobin, Martin: Principles & Practice of Intensive Care Monitoring, McGraw-Hill, Inc., 1998.

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Patient Data: Patient Data Menu

Follow this procedure to use the pulmonary calculations program.

1. Select PULMONARY CALCS option from the Patient Data Menu. An


information window is displayed on the screen and a new set of menu
options is displayed in the menu area.

Weight and height will be


displayed if entered previously in
any calculations program.

Press the GRAPH GO / STOP key


to print the displayed calculations.

PULMONARY CALCS Menu and Information Window

If a set of calculations was previously saved, many of the values will


be displayed but without a date/time. This is designed to help speed
entry of another set of calculations since only some of the parameters
are usually affected. A date/time will be displayed when the first
change is made.

If a date/time is displayed with the values, the last set of calculations


was never saved. Use the SAVE CALC option to save the set to Vital
Signs. Exit the program with the Main Menu option and then
reenter. This needs to be done to clear the date and time from the
calculation.

Change Value
2. Select CHANGE VALUE option from the Pulmonary Calcs Menu to
enter or change monitored values (left column) in the information
window. A popup menu opens and the pointer and RETURN option
are displayed at the top of the window.
3. Rotate the Trim Knob control to move the pointer to the parameter
you want to enter or change. Press the Trim Knob control once. If no
previous value was displayed, a default value is displayed.
4. Rotate the Trim Knob control to change the value, then press the
Trim Knob control to enter the value. Calculated values will be
displayed as the data to obtain them is entered.
5. Select RETURN when all values desired are entered. The popup
menu closes and the RETURN option clears from the information
window.

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Patient Data: Patient Data Menu

Save Calc
6. Select SAVE CALC option from the Pulmonary Calcs Menu to save
the displayed values to Vital Signs. The prompt SAVE OPERATION
COMPLETE will appear in the message line. If the message SAVE
OPERATION FAILED appears you have already saved this set of
calculations.

Review Calcs
7. To review all saved calculations, select the REVIEW CALCS option
from the Pulmonary Calcs Menu. The Vital Signs information
window is displayed but notice that the pulmonary calculations
appear in the list first.

Data is automatically sorted


so pulmonary calculations
appear first.

REVIEW CALCS Menu and Information Window

Since you have entered the Vital Signs program, the Vital Signs
Menu options are displayed. However, when sorted for pulmonary
calcs the TIME INTERVAL and SPECIFIC TIME options are non-
functional.
The other menu options in the Pulmonary Calcs Menu are described
below:

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Patient Data: Patient Data Menu

Weight
WEIGHTchange the unit of measure between kilograms or pounds.
This is a direct action option.

Height
HEIGHTchange the unit of measure between centimeters or inches.
This is a direct action option.

Calculate
CALCULATEthis direct action option switches between calculating
O2CI or FICK CO. If CALCULATE: O2CI is selected, you enter a CO
value in the monitored column. If CALCULATE: FICK CO is selected,
you enter an O2CI value in the monitored column.

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Patient Data: Patient Data Menu

Dose Calcs
The intravenous administration of medications is a common practice.
Many drugs are titrated based on the patients physiologic response to
the medication. Accuracy and safety are always important in drug
therapy, and precise control of drug administration is essential. The dose
calculations feature is important because it provides an accurate and
safe method of determining drug dosage as well as the precision control
that is essential.

An order for a medication is either written by the physician or is a


standing protocol in the unit based on the patients condition. The order
will specify the drug and the dose to be administered. The nurse and/or
pharmacy will mix the drug in solution and then determine how fast to
administer the drug in order to deliver the proper drug dosage.

Neonates present a different approach to drug administration because


the amount of fluid to be administered is vital. Usually the drug dosage
is ordered and the flow rate in cc/hr is prescribed. The nurse must
determine the amount of drug to place in the solution to accomplish this
rate/dose combination.

In yet another instance, the physician will order a drug dosage to be


infused over a period of time. The amount of drug in solution may or may
not be specified. In this situation, the nurse must determine the rate that
is necessary to infuse the drug over the period of time ordered.

Still another situation occurs in crises where drugs are administered to


resuscitate the patient and then the dose is determined after the
response. The nurse will take the solution and drug quantity and the
rate of the infusion and determine the dose that the patient is actually
receiving.

The dose calculations program can be used in all of the above situations.
In addition, it also provides a titration table that can be used as the
drugs are titrated based on the patients physiologic response.

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Patient Data: Patient Data Menu

The dose calculations program has a library of commonly used drugs.


The drug libraries for the different monitor modes are:

Adult and OR Neonatal


Aminophylline Aminophylline
Dobutamine Dobutamine
Dopamine Dopamine
Epinephrine Epinephrine
Heparin Fentanyl
Inocor Heparin
Insulin Inocor
Isuprel Insulin
Lidocaine Midazolam
Neosynephrine Morphine
Nipride Neosynephrine
Nitroglycerin Prostaglandin E
Norepinephrine Tolazoline
Pitocin Drug A
Procainamide Drug B
Vasopressin Drug C
Drug A Drug D
Drug B
Drug C
Drug D

Drug A through Drug D are used for drugs not specified in the library.

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Patient Data: Patient Data Menu

To enter the dose calculations program, select DOSE CALCS option from
the Patient Data Menu. An information window and new set of menu
options are displayed.

DOSE CALCS Menu and Information Window

A brief description of each menu option is given below. More details are
provided on following pages.
n CHANGE VALUEenter or change values in the information
window.
n SAVE CALCsave the set of calculations for future reference. Up to
four sets can be saved but only one for each drug.
n RECALL SAVED CALCopen a popup menu to choose a set of saved
calculations to display.
n DELETE CALCopen a popup menu to choose one or more sets to
delete.
n TITRATION TABLEopen a popup menu and new information
window displaying a titration table of the drug.
n WEIGHTchange the units of measure for the patients weight.
n DRUG UNITSchange the drug units between grams and units.
(For use when you have labeled drugs A, B, C, and D.)
n DRUG QTY RANGEselect a range for quicker entry of a drug
quantity value when using a drug unknown to the system. (For use
when you have labeled drugs A, B, C, and D.)
n RESUSCITATION MEDICATIONSopen a popup menu and new
information window displaying resuscitation medications. This
feature is only available in the Neonatal mode.

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Patient Data: Patient Data Menu

Change Value
This option allows you to enter values in the information window using
the Trim Knob control. Enter a drug name first.

1. Select CHANGE VALUE option from the Dose Calcs Menu. A popup
menu opens and a pointer and RETURN option are displayed at the
top of the information window.

CHANGE VALUE Popup Menu and Information Window

2. Rotate the Trim Knob control to move the pointer to DRUG NAME.
3. Press the Trim Knob control. The first name in the drug library is
displayed.
4. Rotate the Trim Knob control to scroll through the library names.
When the drug name you want is displayed, press the Trim Knob
control.

127(If you are using a drug which is not in the list, choose DRUG A,
B, C, or D as its label. Make a note of the drug name which you
assigned as A, B, C, or D.

Use this procedure to enter other values. The order in which values are
entered is dependent on the type of patient you are monitoring (adult or
neonate) and how the order for the drug is given.

The following page has additional information on each element of the


dose calculations information window.

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Patient Data: Patient Data Menu

WEIGHTenter appropriate weight for patient.

SOL VOLUME (solution volume)a default value will be displayed


which varies with the patient-monitor type and drug name chosen.

DRUG QTY (drug quantity)if the drug quantity is entered in


milligrams (MG), the dose/kg/min will be micrograms. The drug quantity
will be calculated if the user enters a solution volume, a dose, and a rate.

127(Be sure to select the proper DRUG UNITS (MCG/MG or


UNITS) for the medication when using the A, B, C, or D labels.

DOSE/MIN, DOSE/HR, DOSE/KG/MINany one of these may be


entered manually. If the volume, quantity, and rate are entered, these
will be calculated for you. If you change the dose, the program will
recalculate the other dose values.

INF RATE (infusion rate)this value represents the number of cc/hr


that the solution infuses. If you change the infusion rate, the program
will recalculate the dose values.

DRIP RATEyou will need to change this value if you are administering
medication with a pump that counts drops and the pumps drop size is
not 60 gtt/cc.

DROP SIZEthis represents the administration setup used by the IV


pump.

INF TIME (infusion time)if you enter the solution volume, drug
quantity, and the infusion time, the program will calculate the infusion
rate and the dose.

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Patient Data: Patient Data Menu

Save Calc
This is a direct action option. Select SAVE CALC to store the set of dose
calculations displayed on the screen. You can display a set of saved calcs
by using the RECALL SAVED CALC option. Here are some guidelines to
remember when saving dose calcs:
n An incomplete calculation cannot be saved.
n If you save a calculation which has the same drug name as a
previously saved calculation, the new calculation will replace the
previous one.
n Four sets of calculations can be saved. When saving a fifth
calculation, an error message will be displayed asking that a
calculation be deleted before storing this calculation.
n All saved calculations are erased upon discharge.

Recall Saved Calc


Select this menu option to display a set of saved calculations. A popup
menu opens with the names of the saved calculations. Rotate the Trim
Knob control to move the pointer to the name you want to recall. In the
example below, DOPAMINE was selected.

If necessary, this calculation set


can be changed and resaved.

Press the GRAPH GO / STOP key


to print the displayed calculations.

RECALL SAVED CALC Popup Menu and Information Window

The information window immediately displays the requested set of


calculations. Select RETURN in the popup menu to close the popup
menu and return to the dose calcs menu. The recalled calculation
remains in the information window.

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Patient Data: Patient Data Menu

Delete Calc
Select this menu option to delete one or more sets of calculations. A
popup menu opens showing all saved calculations. Rotate the Trim Knob
control to move the pointer.

DELETE CALC Popup Menu

Press the Trim Knob control and the name highlights. You can highlight
as many as you wish to delete. If you accidentally highlight one you dont
want to delete, press the Trim Knob control again to unhighlight. Press
RETURN to complete the deletion process and close the popup menu.

127(If the calculation is displayed in the information window at the


time of deletion, it will remain on the display. However, if you
change the information window or exit the program, the deleted
calculation will no longer be available.

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Patient Data: Patient Data Menu

Titration Table
As mentioned earlier, the dose calcs feature does provide a titration
table. Follow this procedure:

1. Complete a drug dose calculation set. It is advisable to save the set


but it is not essential. The calculation for the drug you want to titrate
must be displayed on the screen.
2. Select TITRATION TABLE from the Dose Calcs Menu. A popup
menu is displayed and the titration table appears in the information
window.

Press the GRAPH GO / STOP


key to print the displayed
titration table.

TITRATION TABLE Popup Menu and Information Window

3. To close the titration table and popup menu, press the Trim Knob
control. The drug calculation set is redisplayed in the information
window.

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Patient Data: Patient Data Menu

Weight
Selecting this option switches units for the entered patients weight
between kilograms and pounds. Changing this does not affect any
calculations as drug dosage is always calculated per kilogram of weight.
If the patients weight is entered by pounds, the software converts to
kilograms (not seen by user) before calculating.

Drug Units
Selecting this option switches the drug units between grams (MCG/MG)
and UNITS. This option is used when labeling a drug A, B, C, or D since
it is unknown how the drug you labeled is normally measured.

Drug Quantity Range


Selecting this menu option determines the default when entering a value
for DRUG QTY. Again, this option is used when labeling a drug A, B, C,
or D.

DRUG QTY RANGE Popup Menu

Select 0.01-100 to enter 1.0 MG or UNITS for DRUG QTY.

Select 100-1000 to enter 10.0 MG or UNITS for DRUG QTY.

Select 1000-10,000 to enter 100.0 MG or UNITS for DRUG QTY.

Select >10,000 to enter 1000.0 MG or UNITS for DRUG QTY.

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Patient Data: Patient Data Menu

Resuscitation Medications
In the Neonatal mode, the dose calcs feature provides resuscitation
medication. Follow this procedure:

1. Enter patient weight into the dose calculation information window.


2. Select RESUSCITATION MEDICATIONS from the Dose Calcs
Menu. A popup menu is displayed and the resuscitation medications
appears in the information window.

Press the GRAPH GO / STOP


key to print the displayed
resuscitation medications.

RESUSCITATION MEDICATIONS Popup Menu


and Information Window

To close the information window and popup menu, press the Trim Knob
control. The drug calculation set is redisplayed in the information
window.

CRG Trends
127(This option is part of the High Resolution CRG Trends software
option only.

Selecting this option creates a high-resolution, trend window for up to


three CRG Trends parameters. A new menu is also displayed with this
window. Refer to the CRG Trends chapter for more details.

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Patient Data: Patient Data Menu

Lab Data
If your monitoring system includes a Lab Access Server and an interface
to the lab information system (LIS), you can access the patients
laboratory data at the monitor. While monitoring, you will be alerted
that new lab data for the patient is available when the lab data icon is
displayed at the top, middle of the monitors screen. This icon looks
similar to the one below.

Lab Data Icon

Select LAB DATA option from the Patient Data Menu to display a screen
similar to the one below. (If your system is not equipped with the
necessary equipment, a message will be displayed below the menu when
you attempt to select this option.)

Use the GRAPH GO/STOP


key to print to the print
window location.

LAB DATA Information Window

This information window lists, by groups, laboratory data that has been
entered in the LIS database. The date and time of the most current
report within the group is displayed also. Date/time stamps on reports
are assigned by the lab.

Rotate the Trim Knob control to move the pointer (>) in front of the group
you want to access. Press the Trim Knob control and another information
window is displayed. How the information is presented varies with the
type of report. See the following examples.

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Patient Data: Patient Data Menu

Example 1 is a list of reports associated with the selected group. Use the
menu keys (OLDER, NEWER, DOWN, UP) to view additional data if
there is any.

Use the GRAPH GO/STOP key


to print to the print window
location.

Lab Report Example 1

Example 2 is a list of associated reports presented in a tabular format. In


this example the VIEW RANGES AND UNITS feature is off. Use the
menu keys (OLDER, NEWER, DOWN, UP) to view additional data if
there is any.

Use the GRAPH GO/STOP


key to print to the print window
location.

Lab Report Example 2, Ranges and Units Off

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Patient Data: Patient Data Menu

Example 3 is the same lab report as shown in Example 2 only the VIEW
RANGES AND UNITS option has been turned on. Use the menu keys
(OLDER, NEWER, DOWN, UP) to view additional data.

Use the GRAPH GO/STOP key


to print to the print window
location.

Lab Report Example 3, Ranges and Units On

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9 Batteries

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For your notes

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Batteries: Battery Power

Battery Power
The monitor is designed to operate on battery power during transport or
whenever AC power is interrupted. A complete battery management
system allows you to obtain maximum battery performance. Audible and
visual alarms alert you when loss of power is imminent and on-screen
capacity gauges indicate battery charge condition and capacity.

The battery compartment is located on the lower left side of the monitor.
Battery indicators let you know when the monitor is using battery power.

Monitor with Battery Packs

:$51,1*
Make sure the batteries are completely inserted and that
the battery door is securely latched. Falling batteries
could seriously or fatally injure a neonatal patient.

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Batteries: Battery Power

Battery Run Time


Depending on usage, you can get up to two hours of run time per battery
for new, fully-charged batteries. Monitoring NBP, CO2 and SpO2 will
drain battery power faster than other parameters. The display
technology and brightness, graphing, and connection to a wireless
network can also alter battery run times.

127(A BATTERY LOW message at the top of the screen warns you
prior to complete loss of battery power. You should replace
battery or connect the monitor to an AC power source when the
message is displayed.

Battery Indicators
Battery indicators are located on the front panel of the monitor. They
alert you to when battery power is being used and the battery charging
status.

Charge Status Indicators Battery Power Indicator

Battery Power Indicator

Charge Status Indicators

Dash 3000 Monitors Control Panel Dash 4000 Monitors Control Panel

Battery Power Indicator


The indicator illuminates yellow when the monitor is battery powered.
The indicator is not illuminated when the monitor is not powered or
when AC power is applied.

Charge Status Indicators


An icon for each battery indicates its charging status. The battery icon
illuminates yellow when the respective battery is being charged. If both
batteries are present and require charging, then both icons will
illuminate even though they will be charged sequentially. The battery
icon illuminates green when the respective battery is fully charged.

When the monitor is operating under battery power the battery icons will
not be illuminated. The icons are also not illuminated when the
respective battery is either not being charged, not installed, or has failed.

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Batteries: Battery Power

Battery Status Indicator


The battery status indicators (not shown) are located within the battery
compartment. One green LED indicator is located above each of the two
battery slots and will illuminate when the unit is operating on DC power
from the respective battery.

Battery Capacity Gauge


On-screen capacity gauges indicate battery charge condition and
capacity. A battery capacity gauge for each battery present is displayed
below the parameter blocks in the lower right corner of the display. The
capacity gauge indicates the charge capacity (usable energy left) for each
battery.

MD______-

Battery Capacity Gauges

Location of Battery Capacity Gauges on the Monitor

The capacity gauges are filled in from left to right proportional with the
battery charge level. The solid portion represents the current charge
level of the battery as a percentage of its maximum charge level. The full
rated capacity of the type of battery installed is represented on the
capacity gauge by a dashed outline. The maximum charge level for the
battery is represented by a solid outline on the capacity gauge. As the
battery wears, this level becomes a smaller percentage of the full rated
capacity shown by the dashed line.

New battery, fully charged.

New battery, approximately 60% charged.

Old battery, fully charged.

Old battery, charged to approximately 75% of its current


capacity (less than half of its new capacity)

Battery status in question. Refer to the Battery


Status information window for specifics.
635A

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Batteries: Battery Packs

Battery Packs
The monitor uses two exchangeable battery packs. One battery pack can
easily be exchanged while the monitor operates from the other.

&$87,21
Leaks from battery cells can occur under extreme
conditions. The liquid is caustic to eyes and skin. If the
liquid comes into contact with eyes or skin, flush with
clean water and seek medical attention.

127(For optimal performance and safety use only batteries supplied


by GE (pn 419068-002).

Battery Charging
The battery is charged whenever the monitor is connected to AC power
regardless of whether or not the monitor is currently on. A fully depleted
battery will take approximately two hours to fully charge.

A battery experiences a short cycle when it is charged before it is


completely discharged. Short cycles result in a batterys full charge
capacity becoming a smaller percentage of its original capacity and
predicted run times becoming increasingly inaccurate. After too many
short cycles, the battery will request a CONDITIONING cycle. (Refer to
this section, Conditioning a Battery.) The length of time between
requests for conditioning cycles can be lengthened by using one battery
until it is empty before allowing it to be charged.

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Batteries: Battery Packs

Conditioning a Battery
A battery conditioning cycle is one complete, uninterrupted charge of the
battery then a complete, uninterrupted discharge of the battery followed
by a complete, uninterrupted recharge of the battery. Batteries should be
conditioned regularly to maintain their useful life. Condition a battery
once every two months, when the run time of the battery becomes
noticeably shorter, when the predicted run times become noticeably
inaccurate, or when the associated battery is requesting a conditioning
cycle (i.e.,CONDITION is displayed for BATTERY QUALITY in the
Battery Status information window).

Conditioning a battery is best done on an external charger (see


instructions included with the charger). However, a conditioning cycle
can also be run on the monitor.

To condition a battery on the monitor, follow this procedure:


1. Disconnect the monitor from the patient and remove it from service.
2. Insert the battery in need of conditioning in one of the battery slots
in the monitor, and leave the other slot EMPTY.
3. Apply AC power to the monitor and allow the battery to charge
uninterrupted until the Charging Status indicator on the front panel
turns green.
4. Remove AC power and allow the monitor to run from the battery
until it shuts off.
5. Apply AC power again to the monitor and allow the battery to charge
uninterrupted until the Charging Status indicator on the front panel
turns green.
6. This battery is now conditioned and the monitor can be returned to
service.

Battery Recycling
When the battery no longer holds a charge, it should be replaced. Remove
the old battery from the monitor and recycle it properly.

:$51,1*
Do NOT incinerate the battery or store at high
temperatures. It will explode at high temperatures.

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Batteries: Battery Status Menu

Battery Status Menu


This menu option opens a menu and information window that provides
current battery status information.
1. Select MORE MENUS from the Main Menu.
2. Select BATTERY STATUS to display the Battery Status Menu and
information window.

BATTERY STATUS Menu and Information Window

If a battery is not present, nothing is displayed in its column. If the


battery is NO COMM (communication with this battery has failed),
unknown is displayed for all rows except the SLOT STATUS row.

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Batteries: Battery Status Menu

Battery Help
This menu option opens an information window that includes the
following information:
n Definition of time remaining and time to charge
n Explanation of low battery alarms and messages
n Explanation of capacity gauges
n Explanation of when to dispose of a battery, and
n Definition of the conditions
u No Battery
u Full
u Charging
u In Use
u Failed
u Incompatible
u No Comm

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Batteries: Battery Alarms

Battery Alarms
There are three alarm conditions that activate battery associated alarms:
n Low Battery,
n Battery Failures, and
n Charger Failures.

The chart below describes the alarm condition and the type of alarm the
condition triggers.

Alarm Condition Alarm Response

Critical Low BatteryOnly 10 minutes Triggers a System WARNING alarm. The


per battery of run time remaining (10 message BATTERY LOW is displayed in the
minutes if one battery, 20 minutes if two ECG waveform area.
batteries).

Empty BatteryThere is no battery run Triggers a System WARNING alarm. The


time remaining. message POWERING DOWN is displayed in
the ECG waveform area.

Battery FailureA minor failure has Triggers a System MESSAGE alarm. The
occurred while using or charging the message CHECK BATTERY STATUS is
battery. displayed in the ECG waveform area.

Battery FailureA serious failure has Triggers a System WARNING alarm. The
occurred while using or charging the message BATTERY ERROR is displayed in
battery. the ECG waveform area.

Charger FailureCharger Triggers a System MESSAGE alarm. The


communications have failed. message CHECK BATT STATUS is
displayed in the ECG waveform area and the
message INTERNAL CHARGER FAILED,
CALL SERVICE is displayed in the Battery
Status information window.

Condition The battery is requesting a CONDITION is displayed in the Battery


conditioning cycle. Status information window.

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10 Maintenance

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For your notes

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Maintenance: Biocompatibility

Biocompatibility
When used as intended, the parts of the product described in this
operator manual, including accessories that come in contact with the
patient during the intended use, fulfill the biocompatibility requirements
of the applicable standards. If you have questions about this matter,
please contact GE or its representatives.

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Maintenance: Inspection

Inspection
An effective maintenance schedule should be established for your
monitoring equipment and reusable supplies. This should include
inspection as well as general cleaning on a regular basis. The
maintenance schedule must comply with the policies of your institutions
infection control unit and/or biomed department.

:$51,1*
Failure on the part of the responsible hospital or
institution employing the use of this monitoring
equipment to implement a satisfactory maintenance
schedule may cause undue equipment failure and
possible health hazards.

Check with your Biomedical Department to be sure preventive


maintenance and calibration has been done. The service manuals contain
detailed information.

Follow these guidelines when inspecting the equipment:


n Inspect the equipment for obvious physical damage and replace
damaged items.
n Inspect all cords for fraying or other damage. Inspect all plugs and
connectors for bent prongs or pins. Repair or replacement must be
performed by qualified service personnel.
n Inspect all cable insulation. Qualified service personnel should repair
or replace damaged or deteriorated cables.
In the United States, GE Service is available 24-hours a day by
calling 800-558-7044.

Outside the United States, please contact your sales/service office.

127(Refer to the service manual for more comprehensive checkout


procedures.

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Maintenance: General Cleaning

General Cleaning

:$51,1*
Disconnect the monitor from the power line before
cleaning or disinfecting its surface.

Exterior Surface
The equipment should be cleaned on a regular basis. (Comply with the
policies of your institutions infection control unit and/or biomed
department.) The exterior surfaces of the equipment may be cleaned with
a dampened, lint-free cloth. Use one of the following approved solutions:

n ammonia (diluted),
n Cidex,
n sodium hypochlorite bleach (diluted), or
n mild soap (diluted).

To avoid damage to the equipment, follow these rules:

&$87,21
Failure to follow these rules may melt, distort, or dull the
finish of the case, blur lettering on the labels, or cause
equipment failures.

n Always dilute the solutions according to the manufacturers


suggestions.
n Always wipe off all the cleaning solution with a dry cloth after
cleaning.
n Never use a cleaning substance containing wax.
n Never pour or spray water or any cleaning solution on the
equipment or permit fluids to run behind switches, into the
connectors, or into any ventilation openings in the equipment.
n Never use these cleaning agents:
u abrasive cleaners or solvents of any kind,
u acetone,
u ketone,
u alcohol based cleaning agents, or
u Betadine.

Display
To clean the display screen, use a soft, clean cloth dampened with a glass
cleaner. Never spray the glass cleaner directly onto the display, and
never use alcohol or hospital disinfectants like Cidex or Betadine.

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Maintenance: Cleaning Applied Parts

Cleaning Applied Parts


Cables and Leadwires

&$87,21
Do not use acetone or ketone solvents for cleaning; do not
use an autoclave or steam cleaner.

Cables and leadwires can be cleaned with a warm, damp cloth and mild
soap, or isopropyl alcohol wipes.

For more intensive disinfecting (near sterile) Ethylene Oxide (ETO) is


acceptable for but will reduce the useful lifetime of the cable or leadwire.

&$87,21
The decision to sterilize must be made per your
institutions requirements with an awareness of the
effect on the integrity of the cable or leadwire.

Capnostat Sensor and Adapter


Cleaning the Capnostat Sensor
n Clean the sensor surface with a damp cloth.
n Ensure the sensor windows are clean and dry.
n DO NOT immerse the sensor.
n DO NOT attempt to sterilize the sensor.

Cleaning the Reusable Capnostat Adapters


n An adapter can be cleaned by rinsing in a warm soapy solution,
followed by soaking in a liquid disinfectant, pasteurized, or cold
sterilized (glutaraldehyde). It should then be rinsed with sterile
water and dried.
n The adult and low volume dead space adapters may be sterilized
using ETO (ethylene oxide) gas method. They may also be sterilized
using a steam autoclave method but lifetime could be affected.
n Before reusing any adapter, ensure the windows are dry and residue-
free, and that the adapter has not been damaged during handling or
by the cleaning/sterilization process.

Other
For other applied parts such as temperature sensors, catheters, pulse
oximetry probes, and NBP cuffs, you must consult the manufacturer for
cleaning, sterilization, or disinfecting methods.

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Maintenance: Technical Maintenance

Technical Maintenance
Schematic diagrams, technical specifications, and other relevant
technical information can be found in the service manuals supplied with
this equipment. Comply with the policies of your institutions biomed
department, or the recommendations made within the Preventive
Maintenance section of the products service manual.

Technical Specifications
Technical specifications are located in the service manual.

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Maintenance: Changing Graph Paper

Changing Graph Paper


Built-in Writer
1. Open the door by pressing on the top of the writer, as indicated
below.

2. Remove the old paper spool and install a new paper roll. (The paper
contains a special coating on one side and must be installed
correctly.) Install the paper so it unrolls from the bottom.

3. Close the door. Make sure the paper protrudes through the opening.

4. Test the writer by initiating a graph strip (refer to The Basics


chapter, Graphing (Printing) for directions). Be sure to tear
downward when removing a graph strip from the writer.

127(If the graph strip is blank, the paper is probably installed


upside-down. Turn the spool over so the paper unwinds from the
other direction.

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Maintenance: Thermal Paper Storage

Thermal Paper Storage


To avoid deterioration or fading of traces, follow these precautions:

127(These precautions apply to both unused paper as well as paper


that has already been run through the writer.

n Store in cool, dark locations. Temperature must be below 80F


(27C). Relative humidity must be between 40% and 65%.
n Avoid exposure to bright light or ultraviolet sources such as sunlight,
fluorescent, and similar lighting which causes yellowing of paper and
fading of tracings.
n DO NOT STORE THERMAL PAPER WITH ANY OF THE
FOLLOWING:
u carbon and carbonless forms.
u non-thermal chart papers or any other products containing
tributyl phosphate, dibutyl phthalate, or any other organic
solvents. Many medical and industrial charts contain these
chemicals.
u document protectors, envelopes, and sheet separators containing
polyvinyl chloride or other vinyl chlorides.
n AVOID CONTACT WITH: cleaning fluids and solvents such as
alcohols, ketones, esters, ether, etc.
n DO NOT USE: mounting forms, pressure-sensitive tapes or labels
containing solvent-based adhesives.

To assure MAXIMUM TRACE IMAGE LIFE, thermal paper should be


stored separately in: manila folders, polyester or polyimide protectors.

Plastic document protectors, envelopes, or sheet separators made of


polystyrene, polypropylene, or polyethylene will not degrade thermal
traces in themselves. However, these materials afford no protection
against fading from external causes.

Use only mounting forms and pressure-sensitive tapes made with starch
or water-based adhesives.

Paper manufacturers advise us that these thermal products should


retain their traces when properly imaged and stored for about 3-5 years.
If your retention requirements exceed these guidelines, we recommend
you consider alternate image storage techniques.

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Maintenance: Thermal Paper Storage

For your notes

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11 ECG

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For your notes

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ECG: Introduction

Introduction
The information in this chapter will help you to successfully use all the
ECG monitoring features of your monitor. The ECG connector where the
patient cable is plugged into the monitor is shown below.

ECG Connector

ECG Connector

127(The signal input is a high-insulation port and it is defibrillator-


proof ( ).

The insulated input ensures patient safety and protects the device
during defibrillation and electrosurgery.

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ECG: Introduction

Turning the ECG Parameter Off or On


The ECG parameter can be turned off or on. When the ECG parameter is
turned off, the SPO2 parameter is the primary parameter for monitoring
the patient. See the SPO2 chapter for the SPO2 conditions that apply
when the ECG parameter is turned off.

Constraints of the ECG Parameter Off Setting


When the ECG parameter is turned off, the following apply.
n Connecting the ECG cable to the monitor will NOT turn on the ECG
parameter.
n When the monitor is connected to a Dash Responder defibrillator, the
ECG parameter will either automatically turn on or remain turned
on.
n When the monitor alarms are paused AND the ECG parameter is
turned off, the warning information in Pausing Alarms on page 4-6
will apply. In addition, the following network devices will NOT
display an Alarm Pause text message for that monitor.
u CIC using software version 3.0 or earlier.
u Centralscope using any version of software.

Turning the ECG Parameter Off or On


To always have the ECG parameter turned off or on as a monitor default,
complete the following steps.

1. Select the following menu options: More Menus > Monitor Setup >
Monitor Defaults > Setup Default Display.
2. Use the Trim Knob control to scroll down the list and select ECG
Parameter.
3. Select ON or OFF.

If you want to temporarily change the ECG parameter On/Off setting


from the monitor default setting, complete the following steps.

1. Select the following menu options: More Menus > Monitor Setup >
Parameters On/Off.
2. Use the Trim Knob control to scroll down the list and select ECG.
3. Press the Trim Knob control to change the setting. For more
information, see Parameters On / Off on page 5-8.
After you discharge the monitor, the ECG parameter On/Off setting
will return to the monitor default setting.

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ECG: Introduction

Checklist
1. Electrodes have been placed on the patient following proper skin
preparation.
127(When using snap leadwires, attach leadwires to electrodes
first then apply electrodes to the patient. This prevents the
gel from spreading and becoming ineffective as you attach
the snaps to the electrodes.
2. Leadwires are attached to electrodes on the patient.
3. Leadwires are connected to patient cable and patient cable is
connected to the monitor.
4. Verify the V-lead label is correct if using a 5-leadwire patient cable.
(Refer to this chapter, Identify V Lead.)
5. ECG setup is adjusted, if necessary. Follow detailed procedures
within this chapter.

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ECG: Skin Preparation

Skin Preparation
The quality of ECG information displayed on the monitor is a direct
result of the quality of the electrical signal received at the electrode.

Proper skin preparation is necessary for good signal quality at the


electrode. A good signal at the electrode provides the monitor with valid
information for processing the ECG data.

Choose flat, non-muscular areas to place electrodes then follow the


established prep protocol for your unit. Following is a suggested
guideline for skin preparation:

1. Shave hair from skin at chosen sites.


2. Gently rub skin surface at sites to remove dead skin cells.
3. Thoroughly cleanse the site with alcohol or a mild soap and water
solution. Be sure to remove all oily residue, dead skin cells, and
abrasives. Leftover abrasion particles can be a source of noise.
4. Dry the skin completely before applying the electrodes.

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ECG: Electrode Placement

Electrode Placement
The chart below shows the label used to identify each leadwire. Included
also is its associated color code per American Heart Association (AHA)
and International Electrotechnical Commission (IEC) standards.

Leadwire (Software Label) AHA Color AHA Label IEC Color IEC Label

RA (right arm) white RA red R


LA (left arm) black LA yellow L

RL (right leg) green RL black N

LL (left leg) red LL green F

V1 (precordial) brown V1 white C1

V2 (precordial) yellow V2 yellow C2

V3 (precordial) green V3 green C3

V4 (precordial) blue V4 brown C4

V5 (precordial) orange V5 black C5

V6 (precordial) purple V6 purple C6

5-Leadwire Electrode Placement


Following is a suggested configuration when using five leadwires:

AHA configuration IEC configuration

Right arm and left arm electrodes should be placed just below the right
and left clavicle.

Right leg and left leg electrodes should be placed on a non-muscular


surface on the lower edge of the rib cage.

The chest electrode should be placed according to the physicians


preference.

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ECG: Electrode Placement

3-Leadwire Electrode Placement


When a 5-leadwire electrode configuration is not desirable, a 3-leadwire
electrode configuration can be used.

AHA configuration IEC configuration

127(Electrode configuration will vary depending on the type of


leadwire set you are using. Refer to Three-leadwire
Configuration below.

Right arm and left arm electrodes should be placed just below the right
and left clavicle.

Left leg electrode should be placed on a non-muscular surface on the


lower edge of the rib cage.

Three-leadwire Configuration
The molded 3-leadwire sets can be placed in the 5-lead Multi-Link
patient cable.

Standard Molded 3-leadwire Set (Rotating Reference)

n Selectable lead I, II, or III cable with a rotating reference (right arm,
left arm, left leg)

Operation of the monitor with this standard cable allows you to select
one of three leads (I, II, or III) for monitoring.

When using the standard, 3-leadwire configuration, the following


operating conditions occur:
n LD ANALYSIS automatically switches to single lead analysis. If an
attempt is made to change to multi-lead analysis, a message MULTI
LEAD ANALYSIS NOT POSSIBLE WITH 3 LEAD CABLE will
appear briefly and no change will occur.
n DISPLAY LEAD choices are limited to I, II, and III.
n Any options usually allowing more than one ECG lead selection will
be disallowed. A message line is displayed briefly, indicating such.
n Respiration can be monitored from either lead I or II. It is not
dependent on the displayed lead.

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ECG: Electrode Placement

127(There is also an older style of 3-leadwire patient cables with a


fixed right leg reference:

Lead I cable with a fixed right leg reference (right arm, left
arm, left leg). Respiration is monitored from lead I only.

Lead II cable with a fixed left arm reference (right arm, left
leg, left arm). Respiration is monitored from lead II only.
Operation of the monitor with a fixed right leg reference is
limited to the fixed lead designated. If using a lead I cable,
respiration is monitored from lead I, etc. If in ADULT-ICU or
OPERATING ROOM mode, multi-lead analysis defaults on. With
a 3-leadwire cable with a fixed reference, you should change lead
analysis to single lead analysis.

Electrode Placement for Neonates

:$51,1*
Route cables away from patients throat to avoid possible
strangulation.

Because of the size of neonatal patients, there is usually only enough


room for a 3-leadwire electrode configuration. A 3-lead neonatal ECG
cable is available, and a Multi-Link DIN adapter is available for the 5-
lead Multi-Link cable. The right arm and left arm or right arm and left
leg electrodes are positioned on the right and left sides of the chest. The
third electrode (right leg) can be placed on either the right or left side of
the abdomen.

Lead II Lead I Lead II Lead I

AHA configuration IEC configuration

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ECG: Electrode Placement

Electrode Placement for Pacemaker Patients


Electrodes need to be repositioned to modify detection of the electrical
signals generated by the pacemaker. Following is a suggested
configuration:

127(When using this configuration, display Lead II as your primary


ECG lead.

AHA configuration IEC configuration

The right arm electrode is moved down to the 5th intercostal space, and
the left leg electrode is moved up to the 5th intercostal space.

127(After all electrodes are in place, ensure minimum of 1/2 mV of


signal is present on each lead (I, II, III, V).

10-Leadwire Electrode Configuration for 12SL Monitoring

:$51,1*
To assure accurate 12-lead analysis when using a 10-
leadwire patient cable, you must verify that the correct
leadwire block is plugged into the appropriate side of the
cable. The V2 through V6 leadwire block is color coded
brown.

On the following page is a suggested electrode configuration for


traditional monitoring, and an alternate, traditional, cardiology
configuration.

127(For the most accurate serial comparisons, use the same electrode
configuration as used on prior analyses for the patient.

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ECG: Electrode Placement

Traditional Monitoring AHA Traditional Cardiology AHA


Electrode Configuration Electrode Configuration

Traditional Monitoring IEC Traditional Cardiology IEC


Electrode Configuration Electrode Configuration

For traditional monitoring, right arm and left arm electrodes should be
placed just below the right and left clavicles. For traditional cardiology
(resting ECG), place them on the arms, off the torso.

For traditional monitoring, right leg and left leg electrodes should be
placed on a flat non-muscular surface below the rib cage. For traditional
cardiology (resting ECG), place them on the upper leg.

The six chest electrodes should be placed as indicated below:

1Fourth intercostal space at the right border of the sternum.

2Fourth intercostal space at the left border of the sternum.

3Midway between locations 2 and 4.

4At the mid-clavicular line in the fifth intercostal space.

5At the anterior axillary line on the same horizontal level as 4.


6At the mid-axillary line on the same horizontal level as 4 and 5.

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ECG: Electrode Placement

Maintaining Quality ECG Signal


Regardless of patient age, electrodes should be
replaced at least every 48 hours to maintain quality
signals during long-term monitoring. Over the
course of 48 hours, the electrode gel will start to dry
out and the adhesive will age. After a long period of
time, the patients sensitive skin also may be
irritated by the gel or adhesive causing discomfort.

Stabilize the electrode and leadwire with a leadwire


stress loop near the electrode. Tape the stress loop
to the patient. A secured stress loop prevents
leadwire rotation about the electrode snap, leadwire
tugging at the electrode, and ECG artifact.

Surgical Considerations for Electrode Placement (Adults)


Thorough skin preparation is very important to help keep ESU
interference to a minimum. Do a thorough skin prep to the skin next to
the grounding pad as well.

Place the right leg electrode close to the ESU grounding pad.

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ECG: ESU ECG Filters

ESU ECG Filters


Electrosurgical Unit (ESU) Cable
The Multi-Link ESU ECG patient cable is recommended when using the
monitor in the presence of an electrosurgical unit. This cable, with a
built-in ESU filter, helps reduce electrosurgical noise detected on the
ECG signal.

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ECG: ECG Monitoring Features

ECG Monitoring Features


ECG Display
An ECG waveform is always displayed at the top of the display.
Depending on the defaults more may be displayed.

Displayed also is an ECG parameter window. The size of the ECG


parameter window will vary depending on the Default Parameter
Priority settings in Monitor Defaults. Your software package and
parameter settings determine the information displayed in the window.
QRS Indicator Heart Rate
Pace Detection
Indicators
Heart Rate
Alarm Limits
PVC Count
(Full Arrhythmia
Only)
ST Analysis
ST Measurement Data
Point

ECG Parameter Window (Large)

ECG Parameter Window (Small)

The parameter window displays the current heart rate, pacemaker


indicators, PVC count (full arrhythmia only), and the ECG lead with the
greatest ST deviation (when ST analysis is on).

127(The ANTerior, INFerior, and LATeral ST data, as shown in the


first figure above, is only displayed when ST is selected as
PARAMETER 2 in Default Parameter Priority.

The monitor displays alarm limits, but you can choose to turn them off in
Monitor Defaults.

Also displayed are a QRS indicator (flashing heart) and a large, flashing
asterisk for each detected pacemaker spike (when pacemaker detection is
on).

Use the ECG parameter menu to make changes during monitoring.

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ECG: ECG Monitoring Features

Getting to the ECG Menu


To display the ECG Menu, use the Trim Knob control to select the ECG
parameter label. Remember, selecting with the Trim Knob control is a
two-step processrotate to highlight, then press to select.

Selecting the ECG Parameter Label

The ECG Menu is displayed at the bottom of the screen. The options
available in the menu vary with each software package.

ECG Menu

With the Trim Knob control, you can now select any of the displayed
options.

127(All options are listed. Your software package may not include
some of these.

n DISPLAY LEADchange the top displayed (primary) ECG lead.


n ECG SIZEchange the size of all ECG waveforms displayed and
graphed.
n DETECT PACEturn pacemaker detection on/off or access help.
n ECG LIMITSdisplay a new menu and an information window to
adjust heart rate alarm limits.
n VIEW ALL ECGdisplay six leads of ECG.
n CLEAR V2-V6 FAILclear the V2-V6 FAIL message displayed on
the screen when only using the 5-leadwire part of a 10-leadwire
cable.
n ARRHYTHMIAturn arrhythmia processing off/on. (Full and
Lethal choices are available in the Cardiac software package.)
n RELEARNrelearn the patients QRS pattern to enable more
accurate monitoring.
n ST ANALYSISturn on the ST analysis program.
n ECG FILTERselect one of four filters for the ECG signal.

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ECG: ECG Monitoring Features

n 12 LEAD ECG ANALYSISdisplay 12 leads of ECG with special


menu options for analyzing and printing.
n LD ANALYSISchoose single-lead or multi-lead processing of ECG
and arrhythmia.
n MORE ECGdisplay a new menu to turn the QRS tone on/off, adjust
volume when on, and specify the QRS width type.

Detailed information on each option is found in this chapter.

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ECG: ECG Menu Options

ECG Menu Options


Display Lead
This option enables you to change the lead currently displayed as the
primary leadthe one in the top trace position. This option is useful
when you are selecting a lead for pacemaker detection or analog output.

Follow this procedure:

1. Select DISPLAY LEAD option from the ECG Menu. A popup menu
opens showing all leads available. The lead currently displayed is
highlighted in the list of options.
127(There will only be one V lead choice even if you are using
a 10-leadwire cable. The V lead available is determined
by the V lead identified in the ST Menu.

DISPLAY LEAD Popup Menu

2. Rotate the Trim Knob control to change the displayed lead. The
change occurs immediately on the screen.
3. When you are satisfied with your selection, press the Trim Knob
control to close the popup menu.

127(If you are using a standard (selectable lead), three-leadwire


patient cable, the popup menu only has leads I, II, and III as
available choices.

Synchronized Cardioversion
The lead displayed in the top trace position, is the signal output to the
DEFIB SYNC connector on the rear of the monitor. The software
provides a defib sync pulse for digital synchronization and places a
return marker on the ECG waveform.

If the defibrillator is to be synchronized with the analog ECG signal,


review the patients ECG leads and place the one with the greatest
amplitude in the top position on the monitor.

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ECG: ECG Menu Options

Smart-Lead Fail
127(The smart-lead fail feature works only when using a 5-leadwire
or 10-leadwire electrode configuration.

The smart-lead fail feature is continually checking the integrity of the


electrodes to allow uninterrupted monitoring. Should the quality of an
electrode signal degrade to an inadequate level, a lead fail message will
be displayed. If the lead fail affects the ECG waveform monitored in the
top trace position on the screen, monitoring will automatically switch to
another lead. Refer to the chart below.

Message New lead monitored

RA FAIL Lead III

LL FAIL Lead I

LA FAIL Lead II

V FAIL Lead II

LEADS FAILED No waveforms displayedright leg fail or leads fail

If you are using a 10-leadwire electrode configuration you have the


additional V2-V6 leads. If one of these V leads fails while it is displayed
in the top trace position, monitoring will switch to lead II.

Individual lead fail messages will not be displayed when using single-
lead analysis, but lead switching will occur.

Leads Fail Patient Condition


There is a system alarm to alert you when more than one lead fails. In
OR mode, this leads fail patient condition defaults as a system
ADVISORY alarm. You can, however, set it as a CRISIS alarm in
Monitor Defaults.

In Adult-ICU and Neonatal-ICU modes this alarm defaults to a system


WARNING alarm but can also be set to a CRISIS alarm. Refer to Setup
Default Display section in Chapter 5, Monitor Setup.

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ECG: ECG Menu Options

ECG Size
This option enables you to change the size of all the ECG waveforms
displayed on the screen. This may be necessary when diagnosing or
problem solving. Normal size (1X) is recommended unless circumstances
require otherwise.

127(If a size other than 1X is used, the size is displayed on the left
side of the screen next to the ECG waveform.

Size 2X and greater will lower the QRS detection threshold. This
may be helpful for low amplitude QRS waveforms. Use with
caution since baseline artifact may be detected as a QRS.

Waveforms are graphed the same size as displayed.

ST complexes are displayed based on the ECG size selected but


always print at 1X size.

Follow this procedure:

1. Select ECG SIZE option from the ECG Menu. A popup menu opens
showing all sizes available. The current size of all displayed ECG
waveforms is highlighted.

ECG SIZE Popup Menu

2. Rotate the Trim Knob control to change the size. The change occurs
immediately on the screen and affects all displayed ECG waveforms.
3. When you are satisfied with your selection, press the Trim Knob
control to close the popup menu.

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ECG: ECG Menu Options

Detect Pace
Safety Considerations
Be aware of the following when monitoring a patient with a pacemaker.

:$51,1*6
FALSE CALLSFalse low heart rate indicators or false
asystole calls may result with certain pacemakers
because of electrical overshoots.

MONITORING PACEMAKER PATIENTSMonitoring


of pacemaker patients can only occur with the pace
program activated.

PACEMAKER SPIKEA white colored artificial


pacemaker spike is displayed in place of the actual
pacemaker spike. All pacemaker spikes appear uniform.
Do not diagnostically interpret pacemaker spike size and
shape.

PATIENT HAZARDA pacemaker pulse can be counted


as a QRS during asystole in either pace mode. Keep
pacemaker patients under close observation.

RATE METERSKeep pacemaker patients under close


observation. Rate meters may continue to count the
pacemaker rate during cardiac arrest and some
arrhythmias. Therefore, do not rely entirely on rate
meter alarms.

&$87,21
FDA POSTMARKET SAFETY ALERTThe United
States FDA Center for Devices and Radiological Health
issued a safety bulletin October 14, 1998. This bulletin
states that minute ventilation rate-adaptive
implantable pacemakers can occasionally interact with
certain cardiac monitoring and diagnostic equipment,
causing the pacemakers to pace at their maximum
programmed rate.

The FDA further recommends precautions to take into


consideration for patients with these types of
pacemakers. These precautions include disabling the rate
responsive mode and enabling an alternate pace mode.
For more information contact:

Office of Surveillance and Biometrics, CDRH, FDA


1350 Piccard Drive, Mail Stop HFZ-510
Rockville, MD 20850
U.S.A.

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127(ECG monitoring with patients on non-invasive transcutaneous


pacemakers may not be possible due to large amounts of energy
produced by these devices. Monitoring ECG with an external
device may be needed.

Monitoring Pacemaker Patients


The DETECT PACE menu option enables/disables the pacemaker
detection program. It must be used whenever the monitored patient has
a pacemaker. Pace detection choices are PACE 1, PACE 2, and OFF.

127(The OFF option turns pacemaker detection off. It does NOT


perform pacemaker detection. Either the PACE 2 or PACE 1
option MUST be used with patients who have pacemakers.

127(Moderate and maximum ECG filtering is not recommended with


pacemaker patients. (Refer to this chapter, ECG Filter.)

There are two pacemaker processing modes, PACE 1 and PACE 2. The
PACE 1 and PACE 2 modes use different algorithms for pacemaker
artifact rejection. The clinician must be the judge as to which mode is
better for each patient. The pacemaker detection program defaults off so
if you have a patient with a pacemaker, you will have to turn the
program on.

Follow this procedure:


1. Select DETECT PACE option from the ECG menu. A popup menu
opens.

DETECT PACE Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of your choice.
The PACE 2 mode is much more conservative in recognizing paced
QRS morphologies and is recommended for use whenever possible. It
is designed to minimize the possibility of counting pacemaker
artifact as QRS complexes during ASYSTOLE. If the monitor does
not adequately detect paced beats in the PACE 2 mode, then the user
may wish to try the PACE 1 mode.
127(Please observe all cautions as described when choosing the
PACE 1 mode of operation.

The PACE 1 mode allows successful detection of the largest variety of


paced QRS morphologies. As a direct consequence, this mode does
have a higher risk of counting pacemaker artifact as QRS complexes
during ASYSTOLE. For this reason, it is imperative that the user
keep patients with pacemakers under close observation. It is also
recommended that the user set the low heart rate limit on the
monitor close to the minimum pacing rate, and that the BRADY
arrhythmia alarm level be elevated to a WARNING or CRISIS level.

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3. Press the Trim Knob control to confirm the change and close the
popup menu.

When either pace mode is enabled, the software places a white colored
artificial spike on the waveform whenever the pacemaker triggers. When
pacemaker detection is on, it is indicated by a P in the patients ECG
parameter window.

For successful monitoring of pacemaker patients follow these


suggestions:
n Use recommended electrode placement. (Refer to the Electrode
Placement section in this chapter.)
n Brady, Pause, and Low Heart Rate are additional alarms available
for use when monitoring pacemaker patients.
n Problems you may experience are:
u heart rate double counting;
u inaccurate alarms for low heart rate or asystole;
u pacemaker spikes not recognized by the software.
n Possible solutions to above problems are:
u relearn arrhythmia;
u try an alternate electrode placement;
u try single-lead analysis;
u try switching to the other pace detection mode.
n Pacemaker mode:
In most cases, PACE 2 mode will effectively monitor a pacemaker
patient. However, if you are experiencing problems, select the
PACE 1 mode as an option, and observe all cautions as described for
the PACE 1 mode of operation.

For more information refer to Pacemaker Troubleshooting in this


chapter.

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Pace Help
Selecting HELP opens an information window that shows common
problems and solutions in regard to pacemaker detection. This
information window is shown below.

DETECT PACE HELP Popup Menu and Information Window

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ECG: ECG Menu Options

ECG Limits
This option provides an information window with a bar graph that shows
the alarm limits for heart rate and PVCs per minute. A limits menu is
displayed to allow you to adjust these limits and turn the PVC per
minute limit off/on.

Follow these procedures:

1. Select ECG LIMITS from the ECG Menu. An information window is


displayed on the screen and a related set of menu options is
displayed in the menu area.

ECG Parameter

High Range

High Limit

Low Limit

Low Range

ECG LIMITS Menu and Information Window

127(PVC limit is a feature in Cardiac software package only.

The information window shows the range as well as the alarm limits.
The pointers (>) indicate the current value of the patients heart rate
and the current PVC count for the last minute. As long as those
indicators remain between the high and low limits, there will be no
alarm. Should a limit be exceeded, an alarm will occur.

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Heart Rate
If the patients heart rate exceeds a limit, an alarm will occur. The
monitors response is dependent on the alarm category setting. If the
limits need to be adjusted, follow this procedure:

1. Select HR HIGH LIMIT option from the ECG LIMITS menu. (Follow
this same procedure with the HR LOW LIMIT.)
2. A popup menu opens with the current high heart rate alarm limit
displayed.

HR HIGH LIMIT Popup Menu

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until the
Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Select PREVIOUS MENU to return to the ECG menu.

PVCs Per Minute


127(This option is part of the Cardiac software package.

An alarm will also occur if the PVC count limit is violated. This is a PVC
per minute limit. Follow the above procedure using the PVC LIMIT
menu option.

This alarm feature defaults on with FULL arrhythmia. If full


arrhythmia is on, the PVC limit alarm can be independently turned off
with the PVC LIMIT ON menu option. This is a direct action menu
option which switches back and forth between off and on.

The number of PVCs detected over the last minute is displayed in the
ECG values window when FULL arrhythmia is on.

Artifact Alarm
ECG artifact will generate an alarm. All artifact begins at level 1 and
progresses to level 2 when noise on ECG lasts for 20 of the last 30
seconds.

127(Full arrhythmia n Level 1upon immediate detection of artifact the message


processing is suspended when the ARTIFACT is displayed. There is no alarm tone.
level 1 ARTIFACT message is n Level 2heart rate and PVC values change to X, an additional
displayed. Lethal arrhythmia is message, ARRHY SUSPEND, is displayed, and a System Warning
still active but its accuracy may be alarm (repeating foghorn tone) is heard.
hindered by the artifact.

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View All ECG


To view six leads of ECG on the display, follow this procedure:
1. Select VIEW ALL ECG option from the ECG Menu. A popup menu
opens and the display is reconfigured to show six ECG leadsI, II,
III, V, AVL, and AVF. (This is assuming you are using five electrodes
on your patient.)

VIEW ALL ECG Popup Menu

2. Press the Trim Knob control to close the popup menu and return to
the normal display.

Print All ECG


Press the GRAPH GO/STOP key on the front of the monitor when
VIEW ALL ECG option is selected to print the waveforms. The
information will be sent to the writer designated in the print window
location (refer to the Graph Setup section in the Monitor Setup chapter).

Clear V2-V6 Fail


There may be instances where you use our 10-leadwire cable for routine
monitoring. In these instances you may only use the standard 5-leadwire
portion of the cable. The monitor displays the message V2-V6 FAIL
when it does not detect the extra V leads. Use the CLEAR V2-V6 FAIL
menu option to clear the message from the screen.

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Arrhythmia
127(Arrhythmia messages will :$51,1*6
be displayed when ALARM VENTRICULAR ARRHYTHMIASThe arrhythmia
PAUSE, ALL ALARMS OFF, or analysis program is intended to detect ventricular
DISCHARGED is displayed, but arrhythmias. It is not designed to detect atrial or supra-
there are no alarm tones, print out ventricular arrhythmias. Occasionally it may incorrectly
or history storage. identify the presence or absence of an arrhythmia.
Therefore, a physician must analyze the arrhythmia
information in conjunction with other clinical findings.

SUSPENDED ANALYSISCertain conditions suspend


arrhythmia analysis. When suspended, arrhythmia
conditions are not detected and alarms associated with
arrhythmias do not occur. The messages which alert you
to the conditions causing suspended arrhythmia analysis
are: ARR OFF, ARRHY SUSPEND, LEADS FAIL,
ALARM PAUSE*, ALL ALARMS OFF*, and
DISCHARGED*.

The EK-Pro algorithm simultaneously uses leads I, II, III, and the V lead
for ECG and arrhythmia analysis. The Basic software package detects
lethal arrhythmias only. The Cardiac software package has full
arrhythmia analysis.

Lethal
Lethal arrhythmias are Asystole, VFib/VTac, and V Tach unless in
Neonatal-ICU mode. Then Asystole, VFib/VTac, and Brady are the lethal
arrhythmias. (Refer to this chapter, Arrhythmia Conditions, for
arrhythmia definitions.) To manually turn arrhythmia analysis off and
on, follow this procedure:

127(The message ARR OFF 1. Select ARRHYTHMIA option from the ECG Menu. A popup menu
appears in the ECG parameter opens. Choices are determined by the software package.
window when arrhythmia is
turned OFF. (This message is not
displayed when the monitor is in
Operating Room mode.)

Turning arrhythmia on
automatically starts a relearn ARRHYTHMIA Popup Menu
procedure.
2. Use the Trim Knob control to move the pointer in front of your choice,
then press. The change will not be in effect until the Trim Knob
control is pressed and the popup menu closed.

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Full
127(This option is part of the Cardiac software package.

Full arrhythmia expands the number of arrhythmias the program


detects. (Refer to the complete list below.)

Use the ARRHYTHMIA option in the ECG Menu to turn full arrhythmia
analysis on and off. (Refer to the previous page.)

Full arrhythmia analysis includes a PVC per minute limit alarm. The
number of PVCs detected over the last minute is displayed in the ECG
values window.

Arrhythmia Conditions
Following is an alphabetical list of the arrhythmia messages which will
be displayed when arrhythmia is on and the condition occurs. A
definition of each arrhythmia condition is included. How the monitor
responds to each condition is determined by the alarm level to which the
arrhythmia has been assigned. Refer to Alarm Control chapter,
Arrhythmia Alarm Level, to view the alarm level settings for
arrhythmias.

ACC VENT AdultAccelerated ventricular occurs when six or more


ventricular beats are detected with an average heart rate
for the ventricular beat between 50 and 100 beats per
minute.

0-2 yearsOccurs when six or more ventricular beats


are detected with an average heart rate for the
ventricular beat between 60 and 160 beats per minute.

3-10 yearsOccurs when six or more ventricular beats


are detected with an average heart rate for the
ventricular beat between 60 and 140 beats per minute.

11-13 yearsOccurs when six or more ventricular beats


are detected with an average heart rate for the
ventricular beat between 60 and 130 beats per minute.

ASYSTOLE Ventricular asystole occurs whenever the displayed heart


rate drops to zero.

BIGEMINY Occurs when two or more bigeminal cycles (a ventricular


beat followed by a non-ventricular beat) are detected.

BRADY Bradycardia is the average of the most recent eight R-to-


R intervals at a heart rate less than the set low heart
rate limit.

127(The Brady limit matches the low heart rate limit. If the
low heart rate limit is changed, the Brady limit changes.

COUPLET Occurs when two ventricular beats are detected and have
non-ventricular beats before and after the couplet. The
coupling interval must be less than 600 milliseconds.

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IRREGULAR Occurs when six consecutive normal R-to-R intervals


vary by 100 milliseconds or more.

PAUSE Occurs when the interval between two consecutive beats


exceeds three seconds.

PVC Isolated premature ventricular complexes occur when a


premature ventricular beat is detected and has non-
ventricular beats before and after.

R ON T Occurs when a ventricular complex is detected within the


repolarization period of a non-ventricular beat.

TACHY Tachycardia is four R-to-R intervals at a heart rate


greater than the set high heart rate limit.

127(The Tachy limit matches the high heart rate limit. If the
high heart rate limit is changed, the Tachy limit changes.

TRIGEMINY Occurs when two or more trigeminal cycles (a ventricular


beat followed by two non-ventricular beats) are detected.

V BRADY AdultVentricular bradycardia occurs when a run of


three or more ventricular beats is detected with an
average heart rate that is less than or equal to 50 beats
per minute.

0-2, 3-10, and 11-13 yearsOccurs when a run of three


or more ventricular beats is detected with an average
heart rate that is less than or equal to 60 beats per
minute.

VFIB/VTAC Ventricular fibrillation occurs when the ECG waveform


indicates a chaotic ventricular rhythm.

:$51,1*
VFIB/VTACH should not be considered a substitute for
the V TACH arrhythmia call. Efforts to lower the V
TACH alarm level can result in missed ventricular
tachycardia alarms.

V TACH AdultVentricular tachycardia occurs when a run of six


or more ventricular beats is detected with an average
heart rate greater than or equal to 100 beats per minute.
0-2 yearsOccurs when a run of six or more ventricular
beats is detected with an average heart rate greater than
or equal to 160 beats per minute.
3-10 yearsOccurs when a run of six or more
ventricular beats is detected with an average heart rate
greater than or equal to 140 beats per minute.
11-13 yearsOccurs when a run of six or more
ventricular beats is detected with an average heart rate
greater than or equal to 130 beats per minute.

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VT > 2 AdultVentricular tachycardia >2 occurs when a run of


ventricular beats is detected with a duration of less than
six beats but longer than two beats and with an average
heart rate that is greater than or equal to 100 beats per
minute.

0-2 yearsOccurs when a run of ventricular beats is


detected with a duration of less than six beats but longer
than two beats and with an average heart rate that is
greater than or equal to 160 beats per minute.

3-10 yearsOccurs when a run of ventricular beats is


detected with a duration of less than six beats but longer
than two beats and with an average heart rate that is
greater than or equal to 140 beats per minute.

11-13 yearsOccurs when a run of ventricular beats is


detected with a duration of less than six beats but longer
than two beats and with an average heart rate that is
greater than or equal to 130 beats per minute.

Relearn
During monitoring of ECG, it may be necessary to use the RELEARN
option when a dramatic change in the patients ECG pattern has
occurred. A change in the ECG pattern could result in:
n incorrect arrhythmia calls,
n loss of ST measurements, and/or
n inaccurate heart rate.

The RELEARN option will allow the monitor to learn the new ECG
pattern to correct arrhythmia calls and heart rate value, and restore ST
measurements.

Select RELEARN option from the ECG Menu. This is a direct action
option.

During the learning process, an X replaces the heart rate value in the
ECG values window.

127(Whenever arrhythmia is turned on, relearn automatically takes


place.

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ST Analysis
Numerics
The ST analysis program is performed on multiple leads simultaneously.
It identifies the ST segment of the QRS complex as beginning at the J
point and ending predetermined milliseconds following the J point.
(Refer to this chapter, Adjust ST.) The displayed ST numerics indicate
either a positive or negative deviation in relation to the isoelectric
reference point (I) which is also determined by the program.

When ST analysis is on, the lead with the greatest deviation is displayed
in the ECG parameter window.

Lead with
Greatest
Deviation

ECG Parameter Window with ST Analysis On

Or, if your Monitor Defaults have the second priority parameter as ST,
the ST values for all leads are displayed. The leads are classified in
groupsAnterior, Lateral, and Inferior.

This is the ST data from a 5-


leadwire cable.

If a 10-leadwire cable is
used, all the precordial leads
(V1-V6) are included.

ECG Large Parameter Window with ST Analysis On

The leads associated with each group are:


Anterior (ANT)V1, V2, V3, V4

Inferior (INF)II, III, AVF

Lateral (LAT)I, AVL, V5, V6


There is also an individual ST value displayed under each ECG lead
label for each ECG waveform displayed on the screen.

ST numerics will change to X if the monitor does not see a rhythm that
sufficiently matches the learned rhythm during the most recent 30
seconds of monitoring. If this rhythm is not an arrhythmia, the monitor
will resume display of ST values in about 30 seconds.

Numerics are updated approximately every two seconds. Negative


deviations are always preceded by a minus sign.

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Trends and Complexes


127(This option is part of the Cardiac software package.

Additionally, there is an ST display comprised of three, 30-minute ST


trends and three ECG complexes for leads I, II, and V. A summation
(SUM) trend of the absolute values of leads II, V, and I is displayed next
to both the ST Trend display and the ST Complex display. (See the figure
below.) The leads for this display are selectable and can be set in Monitor
Defaults. This display is treated as a waveform and can be turned off or
repositioned through the WAVEFORMS ON/OFF option in the Monitor
Setup Menu.

ST Trend Display
127(Trends and complexes are These are 30-minute, real-time trends. Each trend is marked with the
not available from a telemetry appropriate lead label. The leftmost trend shows scaling information
transmitter when using the default is +/ 2mm. There are three other scale choices available in
combination monitoring (Combo, the TREND SCALE menu option in the ST menu.
Rover Combo).
127(In Operating Room mode, the third trend is always a summation
(SUM) trend of the absolute values of all monitored leads, not
just those in the ST trend display.

Data is outside of the displayed


scale. See NOTE below.

ST Trends Display with Summation

127(When data falls outside of the upper or lower scale boundaries,


the trend appears at the end of the scale as a straight line. Adjust
the scale so the data is within the scale to see the true trend.

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ST Complex Display
A reference complex for each of the selected leads is displayed for visual
reference purposes when ST is on. After a short time, the program
displays a current ST complex for each lead. The current complex is
superimposed over the reference complex. These current complexes are
updated every 16 beats and can visually be compared to the reference
complex to see ST segment changes.

The I point and ST reference point are determined by the program and
marked with a vertical tick (gray color). The appropriate lead label is
displayed next to each complex.

Use the STORE NEW REFERENCES option to make the current


complexes the reference complexes. This does not affect ST analysis or
arrhythmia analysis.

The reference complex is in


back of the current complex.

ST Complexes Display

127(The reference complex is displayed in gray, the real-time


complex amber or green depending on your color setup.

Turn ST On and Off


Use the following procedure to turn ST analysis on.

Select ST ANALYSIS option from the ECG Menu. Your software package
determines what action occurs.

ST ANALYSIS ON (OFF) Option

With the Basic software package, selecting ST ANALYSIS is a direct


action option that turns the program on and off. When on, ST values are
displayed under each ECG lead label. The lead with the greatest
deviation and its value are displayed in the ECG parameter window. If
your monitor defaults are configured with ST as parameter 2, values for
all leads are displayed in the ECG parameter window.

With the Cardiac software package, selecting the ST ANALYSIS option


turns on the program and displays the ST menu. See the ST Analysis
Menu section below for more details.

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ST Analysis Menu
In the Cardiac software package, a new menu is displayed when ST
ANALYSIS is turned on. ST trends and complexes may also be displayed
(see above).

ST ANALYSIS Menu

TURN ST OFFturn ST analysis off and return to the Main Menu.

PRINT STprint a copy of the displayed ST trends and complexes.

STORE NEW REFERENCESdisplay a new set of reference complexes


on the screen to use for visual reference.

ST LIMITSdisplay an ST Menu and an information window to set and


adjust ST deviation limits.

IDENTIFY V LEADidentify or label the V lead being used for ECG and
ST analysis.

TREND SCALEselect another scale for the ST trends.

ST DISPLAY COMPLEXESchange displayed ST analysis from


complexes to trends.

ST DISPLAYchange the leads for the trends and complexes display.

INITIATE 12 LEAD ON ST HISTORY allow /disallow the initiation of


an automatic 12 lead analysis when an ST event is stored in history.

ADJUST ST POINTadjust the measurement point for ST.

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Print ST
Select PRINT ST option from the ST Menu to print a copy of the real-
time trends and the real-time complexes. The reference complexes are
not printed. The trend is printed first with the appropriate lead complex
immediately following. The lead label appears on the trend and the ST
value appears at the end of the lead complex. Invalid data is represented
by a buzz line. The ST data is sent to the writer designated in the print
window location.

127(Trends displayed on a 2 or 4mm scale will print on a 3mm scale.


Trends displayed on a 6 or 8mm scale will print on a 6mm scale.

Store New References


If you want to update the reference complexes shown on the display to
reflect current complexes, select STORE NEW REFERENCES option
from the ST menu. A popup menu opens with YES and NO options.

STORE NEW REFERENCES Popup Menu

Select YES if you are sure you want to replace the reference complexes.
The current complexes become the reference complexes. An ST
REFERENCE history is created and can be viewed in Alarm History.

127(Selecting STORE NEW REFERENCES does not affect actual ST


processing. It is for visual reference only.

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ST Limits
The ST LIMITS option provides an information window and a new set of
menu options. The information window lists all leads monitored, the
current value of each, and the low and high values that, if exceeded,
cause an ST alarm. ST is treated as a parameter and, therefore, to
change the alarm level you would use the PARAMETER ALARM LEVEL
option in the Alarm Control Menu.

Heres how the ST limits information window might look when


monitoring ST with a 5-leadwire ECG cable. The factory default limits
are +/ 2mm, with the ST parameter set for an Advisory alarm.

ST LIMITS Menu and Information Window

With the factory defaults, should any monitored lead have a deviation
greater or less than 2 millimeters, an alarm will sound and the event will
store in Alarm History. The alarm level must be set for Crisis, Warning
or Advisory, just like an arrhythmia alarm, for the event to be stored in
history.

ST Alarm History Criteria Not every ST alarm is stored in history.


The first lead in each group (Anterior, Inferior, Lateral) which exceeds
the limits triggers an ST history. Subsequent limit alarms in the same
group will not trigger an ST history. If all available leads within a group
return to within limits, and then any lead in that group exceeds the
limits, another ST history is stored.

Refer to Alarm History in the Patient Data chapter for information on


viewing an ST event which has been stored in history.

You can adjust the limits individually, all at once, or by lead group.

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The ADJUST INDIVIDUAL LIMITS option allows you to adjust each


lead and limit individually. This option works much like the ALL
LIMITS option in the Alarm Control Menu.

1. Rotate the Trim Knob control to move the pointer (>).


2. Press to highlight the selected lead label.
3. Rotate the Trim Knob control to highlight the low or high limit.
4. Press and rotate the Trim Knob control to change the value.
5. Press the Trim Knob control to complete the change.
6. Rotate the Trim Knob control to highlight the lead label again, then
press to unhighlight.
7. With nothing highlighted you can move the pointer to RETURN and
press the Trim Knob to exit.

The remaining adjust options, ADJUST ALL LIMITS, ADJUST INF


LIMITS, ADJUST LAT LIMITS, ADJUST ANT LIMITS, adjusts all
leads or specific groups. When you select one of these options, a popup
menu opens as shown in the figure below.

ADJUST ALL LIMITS for ST Popup Menu

The popup menu displays a deviation range, for example, +/ 2mm. You
can use the Trim Knob control to change this value. When you press the
Trim Knob control to exit the menu the monitor adjusts the low and high
limits around the current value of the lead(s).

For example, if lead II has a value of 0.3mm and the popup menu shows
a deviation range of +/ 2mm, the monitor automatically adjusts the low
limit to 2.3mm and the high limit to 1.7mm when the popup menu
closes.

To summarize, the ADJUST popup menus serve two purposes:


n Selecting causes an automatic adjustment of the limits on a group of
leads based on the deviation range displayed in the popup menu and
the current ST value for each lead in the group.
n The deviation range can be changed to tighten or loosen the limits.

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Identify V Lead
Select the IDENTIFY V LEAD option to open a popup menu. Its function
is somewhat different when using a 5-leadwire cable versus a 10-
leadwire cable.

IDENTIFY V LEAD Popup Menu

127(Changing the V lead Rotate the Trim Knob control to move the pointer to the V lead name of
affects the displayed V waveform, choice. Press the Trim Knob control to confirm the change and close the
analog output, what is sent over popup menu.
the network (Holter, MARS,
central station), the ST trend and IDENTIFY V LEAD Option with a 5-Leadwire Cable With a
template, graphing, and histories. standard, 5-leadwire patient cable, this menu option labels the V lead as
placed in your electrode configuration. This V lead is used in ST analysis
as well as arrhythmia analysis. With a 5-leadwire cable you only connect
one V lead, therefore, you must place the electrode in the V position you
want and then be certain the label matches the position. The monitor
defaults this label as V5, but you can change it here or in Monitor
Defaults (ST V LEAD). If you are displaying ST trends and complexes,
changing this label changes the label on the V lead trend and complex.

IDENTIFY V LEAD Option with a 10-Leadwire Cable With a 10-


leadwire patient cable with all V leads attached to the patient, ST
measurements are performed on all V leads. However, the arrhythmia
analysis program only uses one V lead and it is identified here. Changes
made with the IDENTIFY V LEAD menu option only affect the V lead
used for arrhythmia analysis. The monitor defaults this option to V5, but
you can change it here or in Monitor Defaults (ST V LEAD). If you are
displaying ST trends and complexes, using this option does not change
the label on the ST display. You need to use the ST DISPLAY option for
this.

Trend Scale
The TREND SCALE option opens a popup menu with alternative scale
choices for the real-time ST trends.

TREND SCALE Popup Menu

Rotate the Trim Knob control to move the pointer to another scale
selection. Press the Trim Knob control to confirm the change and close
the popup menu.

127(Trends displayed on a 2 or 4mm scale will print on a 3mm scale.


Trends displayed on a 6 or 8mm scale will print on a 6mm scale.

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ST Display Complexes
To change the displayed ST analysis from complexes to trends, select the
ST DISPLAY: Complexes option from the ST Menu. A popup menu opens
with TRENDS and COMPLEXES options.

ST DISPLAY: Complexes Popup Menu

Rotate the Trim Knob control to move the pointer to the desired
selection. Press the Trim Knob control to display that selection and close
the popup menu.

ST Display
The ST DISPLAY option opens a popup menu to allow you to choose up
to three leads for the ST trends and complexes display.

ST DISPLAY Popup Menu

You are allowed three choices. You must deselect (unhighlight) one to
select another. Use the Trim Knob control to move the pointer, then
press to select or deselect.

The monitor uses leads I, II, and V5 as defaults. You can change these in
Monitor Defaults.

With a 10-leadwire cable all the chest leads are available in this popup
menu.

127(When the monitor is set up for Operating Room mode, the trends
portion of the ST display is slightly different. The third ST
display choice is replaced with a summation (SUM) trend of all
leads.

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ECG: ECG Menu Options

Initiate 12 Lead On ST History


This direct action menu option enables/disables initiation of an
automatic 12-lead ECG analysis whenever an ST alarm is stored in
alarm history. Refer to this chapter, ST Limits, for criteria for storage of
an ST alarm.

Adjust ST Point
The ADJUST ST POINT option opens a popup menu to allow you to
adjust the measurement point for ST.

ADJUST ST POINT Popup Menu

There are six choices available. Rotate the Trim Knob control to move the
pointer to the desired ST measurement point. Press the Trim Knob
control to confirm the change and close the popup menu. The selected
measurement point will be displayed in the parameter window.

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ECG: ECG Menu Options

ECG Filter
The ECG FILTER option offers you four choices for filtering the ECG
waveform data on the display and graph strip.

127(Filters affect the ECG waveform only. ST analysis and


arrhythmia analysis are not affected by filter choice.

1. Select the ECG FILTER option to open a popup menu.

ECG FILTER Popup Menu

2. Rotate the Trim Knob control to move the pointer (>). The change
will not take effect until the Trim Knob control is pressed and the
popup menu closed. Press the Trim Knob to close the popup menu.
DIAGNOSTIC MODEprovides the least amount of filtering.

MONITORING MODErecommended for typical monitoring


applications.

MODERATE FILTERused to reduce high frequency interference,


i.e. ESU. Moderate ECG filtering is not recommended with
pacemaker patients.

MAXIMUM FILTERprovides maximum filtering; used to stabilize


the ECG baseline. Maximum ECG filtering is not recommended with
pacemaker patients.

:$51,1*
The MAXIMUM filter alters displayed ECG morphology.
Do not rely on ECG morphology for diagnostic purposes
when this filter is selected.

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ECG: ECG Menu Options

12 Lead ECG Analysis

:$51,1*
This device uses a computerized 12-lead ECG analysis
program which can be used as a tool in ECG tracing
interpretation. This computerized interpretation is only
significant when used in conjunction with clinical
findings. All computer-generated tracings should be
overread by a qualified physician.

To ensure accuracy, use only computer-generated


tracings and not the display for physician interpretation.

The intended use of this device is to record


electrocardiograms and vectorcardiograms from surface
ECG electrodes, not for positioning (floating) temporary
pacemaker leadwires, performing pericardiocentesis, or
other internal applications.

127(When monitoring ECG, entering the sex and age of the patient
will provide information needed for using the 12SL Algorithm
with Gender-Specific Analysis or the ACI-TIPI algorithm. The
12SL Algorithm with Gender Specific Analysis improves the
detection of acute myocardial infarctions (AMI) for adult women
under the age of 60.

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ECG: ECG Menu Options

The 12-lead ECG analysis program is accessed with this menu option.

1. Select 12 LEAD ECG ANALYSIS option from the ECG Menu. A new
menu is displayed and the screen is reconfigured to display 12 leads
of ECG.

12-Lead Analysis Display

All parameters continue to be monitored and values are displayed in


the respective parameter windows.

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ECG: ECG Menu Options

2. Use the Trim Knob control to select menu options for 12-lead
analysis.
u 12 LEAD ECG NOW start one 12-lead ECG analysis.
When the Technician ID option has been set to Optional or
Mandatory, an information window opens in which you can enter
the TECHNICIAN ID, OPTION FIELD, and ORDER NUMBER.

TECHNICIAN ID Opens a popup menu to enter up to four


digits for the technicians ID number.

127(

This option can be set to MANDATORY, OPTIONAL, or OFF in


the Setup Display Defaults window. If it is set to MANDATORY,
a manual 12-lead analysis cannot be taken until an ID number is
entered. If it is set to OPTIONAL, an ID is not required to be
entered before a manual 12-lead analysis is taken. If it is set to
OFF, simply select 12 LEAD ECG NOW to start a 12-lead ECG
analysis. The factory default setting is OFF.

OPTION FIELD Opens a popup menu in which you can enter


a two-digit option number.

ORDER NUMBER Opens a popup menu in which you can


enter up to nine digits for the order number.

RETURN Selecting RETURN initiates one 12-lead ECG


analysis.

u REVIEW 12 LEAD ECG TO TRANSMIT OR PRINTopen a


popup menu to transmit, print, or delete the analysis. The last
analysis will be available to re-print until another 12-lead
analysis is generated. Transmission of a 12-lead report is only
allowed once.
u 12 LEAD AUTOopen a popup menu to program the monitor to
automatically do 12-lead ECG analysis at specified time
intervals. (MUSE system is required for automatic printing and
storage, or a laser writer is required for automatic printing
without a MUSE system.)
u ADMIT MENUopen an information window to enter or change
patient information (name, age, ID, etc.).
u 12 LEAD ECG HELPdisplay an information window with a
summary of the process for 12-lead ECG analysis along with a
popup menu with selections for additional 12-lead analysis help
including skin prep and lead placement
u ACI-TIPI ANALYSISopen an information window to enter
patient information necessary for ACI-TIPI analysis.
u PREVIOUS MENUreturn to the ECG Menu.

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ECG: ECG Menu Options

Manual Method
1. Select 12 LEAD ECG ANALYSIS option from the ECG Menu. The
waveform area of the screen displays 12 leads of ECG.
2. Use the ADMIT MENU menu option to enter the patients age and
identification number. However, this information may already have
been entered when the patient was admitted to the monitor.
3. Select 12 LEAD ECG NOW from the 12 Lead ECG Analysis Menu.
If the Technician ID option has been set to OPTIONAL or
MANDATORY, an information window opens in which you can enter
the TECHNICIAN ID, OPTION FIELD, and ORDER NUMBER.

TECHNICIAN ID Opens a popup menu to enter up to four digits


for the technicians ID number.
127(

This option can be set to MANDATORY, OPTIONAL, or OFF in


the Setup Display Defaults window. If it is set to MANDATORY,
a manual 12-lead analysis cannot be taken until an ID number is
entered. If it is set to OPTIONAL, an ID is not required to be
entered before a manual 12-lead analysis is taken. If it is set to
OFF, simply select 12 LEAD ECG NOW to start a 12-lead ECG
analysis. The factory default setting is OFF.

OPTION FIELD Opens a popup menu in which you can enter


a two-digit option number.

ORDER NUMBER Opens a popup menu in which you can


enter up to nine digits for the order number.

RETURN Selecting RETURN initiates one 12-lead ECG


analysis.

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ECG: ECG Menu Options

4. Select RETURN to initiate a 12-Lead analysis. The message


PERFORMING ANALYSIS. PLEASE WAIT is displayed on the
screen. In approximately 30 seconds the analysis report will be
displayed with a popup menu.


679D

Review 12 Lead ECG Information Window and Popup Menu

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ECG: ECG Menu Options

5. In order to continue, you must choose one of the five options in the
popup menu:
TRANSMIT-PRINTsend the analysis to the MUSE system.
Printing will occur at the local DDW or laser printer which is
selected for the 12-lead Print Location or Print Window location.

TRANSMITsend the analysis to the MUSE system for storage.

PRINTsend the analysis to a local writer for printing (12-lead


Print Location or Print Window location). If it is a laser printer you
will get the analysis and waveforms. If it is a DDW, you will only get
the analysis.
DELETEerase the analysis without storing or printing.

RETURNreturn you to the 12-lead analysis display.

The popup menu closes after you make your selection.

Analysis Statement Printout


Depending on the central station and its software revision, analysis
statements seen on the monitor display will be dropped or worded
differently on the analysis report print at the central station.

Following is a chart indicating the possible anomalies.

Statements printed at earlier versions of


Analysis statements displayed at the monitor
central stations

SINUS RHYTHM NORMAL SINUS RHYTHM

WITH dropped

AND dropped

OR dropped

WIDE QRS RHYTHM UNDETERMINED RHYTHM

IDIOVENTRICULAR RHYTHM UNDETERMINED RHYTHM

WITH RETROGRADE CONDUCTION dropped


ABBERRANT CONDUCTION dropped

SINUS/ATRIAL CAPTURE dropped

LESS THAN 4 QRS COMPLEXES DETECTED, NO POOR DATA QUALITY, INTERPRETATION MAY BE
INTERPRETATION POSSIBLE ADVERSELY AFFECTED
MEMORY ALLOCATION FAILURE, NO ECG POOR DATA QUALITY, INTERPRETATION MAY BE
INTERPRETATION POSSIBLE ADVERSELY AFFECTED

FUSION COMPLEXES dropped

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ECG: ECG Menu Options

Automatic Method
This option automatically generates a 12-lead ECG analysis at set
intervals and automatically sends it to a MUSE system and/or a laser
printer. Once the interval is set, you can resume customary monitoring
and let the monitor do the 12 lead analysis.

1. Select 12 LEAD ECG ANALYSIS option from the ECG Menu. The
waveform area of the screen displays 12 leads of ECG.

127(This method requires a 2. Use the ADMIT INFO menu option:


MUSE system for automatic
u to enter the patients age and identification number.
storage and printing. If you have a
laser printer designated as your u to enter the Location number if your hospital has a MUSE
12-lead Print Location or Print system. The Location number identifies the care unit where the
Window Location, it will system is located.
automatically print there too. This information may already have been entered when the patient
was admitted to the monitor.

3. Select 12 LEAD AUTO option from the 12 Lead ECG Analysis Menu.
A popup menu opens with the time interval selections.

12 LEAD AUTO Popup Menu

4. Use the Trim Knob control to move the pointer to the desired time
interval.
A first column choice (12 HR - 90 MIN) means one analysis will be
done every X hours (minutes) until you turn it off.
A second column choice means one analysis will be done every X
minutes for X hours and then will automatically turn off.

Select OFF at any time to turn 12-lead analysis off.

5. Press the Trim Knob control. The first analysis begins immediately.
No further action is required.
127(You can do a manual analysis, if necessary, between
scheduled ones without interrupting the sequence.

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ECG: ECG Menu Options

ACI-TIPI Analysis
127(This feature is not
available in neonatal mode. ACI-
TIPI Analysis cannot be performed
on patients less than 16 years of
age.

127(When monitoring ECG, This option allows you to generate an Acute Cardiac Ischemia-Time
entering the sex and age of the Insensitive Predictive Instrument (ACI-TIPI) analysis.
patient will provide information
needed for using the 12SL 1. Select ACI-TIPI ANALYSIS option from the 12 Lead ECG Analysis
Algorithm with Gender-Specific Menu. A popup menu and the ACI-TIPI information window are
Analysis or the ACI-TIPI displayed.
algorithm. The 12SL Algorithm
with Gender Specific Analysis
improves the detection of acute
myocardial infarctions (AMI) for
adult women under the age of 60.

804B

ACI-TIPI Information Window and Popup Menu

2. Enter the chest pain information by moving the pointer to the


CHEST PAIN OR LEFT ARM PAIN selection and pressing, then
rotating the Trim Knob control to scroll through the options:
u NOT PRESENT
u CHIEF COMPLAINT
u SECONDARY COMPLAINT

127(ACI-TIPI Chest Pain information should be updated each


time you initiate an ACI-TIPI analysis.

3. If necessary, change the patients age range and sex using the same
procedure as above. The sex and age defaults to MALE and >50, or
the sex and age information may already have been entered when
the patient was admitted to the monitor.

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ECG: ECG Menu Options

4. If necessary, enter the TECHNICIAN ID, OPTION FIELD, and


ORDER NUMBER.
TECHNICIAN ID Allows you to enter up to four digits for the
technicians ID number.

127(

This option can be set to MANDATORY, OPTIONAL, or OFF in the


Setup Display Defaults window. If it is set to MANDATORY, a
manual ACI-TIPI analysis cannot be taken until an ID number is
entered. If it is set to OPTIONAL, a Technician ID is not required to
be entered before a manual ACI-TIPI analysis is taken. The factory
default setting is OFF.
OPTION FIELD Allows you to enter a two-digit option number.

ORDER NUMBER Allows you to enter up to nine digits for the


order number.

5. Select RETURN to initiate the ACI-TIPI analysis and return to the


12 Lead ECG Analysis menu.

ACI-TIPI Report
After the ACI-TIPI analysis, a report will be displayed with a popup
menu similar to the REVIEW 12 LEAD ECG popup, with the exception of
two new options:

12 LEAD ECG

ACI-TIPI

Selecting either option allows the user to view the analysis report prior
to printing or transmitting. The analysis report will be sent to the printer
and/or MUSE system along with the 12-lead waveform printout. The
printout or transmitted information, therefore, consists of two pages. The
first page is the 12-lead waveform; the second page is the ACI-TIPI
analysis report.

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ECG: ECG Menu Options

Lead Analysis
With the LEAD ANALYSIS option, you can elect to choose single lead
analysis or multi-lead analysis for ECG and arrhythmia analysis.

Multi-Lead Analysis
Multi-lead analysis examines ECG leads I, II, III, and the V lead
(whether they are displayed or not) to help eliminate false alarms and
improve the capability of the system to:
n detect beats which occur isoelectric to a single chest lead;
n discriminate artifact that appears in one lead compared to the other
lead vectors;
n provide a smart-lead fail feature where the failed lead is identified
and, if available, another lead is provided for display;
n continue arrhythmia processing even after a lead change.

Single Lead Analysis


Single lead analysis uses only the lead displayed in the top position on
the screen to process ECG and arrhythmia information.

When monitoring an adult, single lead analysis would be beneficial


when:
n using an external, temporary pacemaker with a Zoll interface cable;
n troubleshooting pacemaker detection and/or arrhythmia detection.

127(ECG is relearned whenever lead analysis is changed.

Changing Lead Analysis


To change the lead analysis, follow this procedure:

1. Select LD ANALYSIS option from the ECG menu. A popup menu


opens displaying the two options.

LD ANALYSIS Popup Menu

2. Rotate the Trim Knob control to place the pointer in front of your
choice. The change will not take effect until the Trim Knob control is
pressed and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

127(Because of the lead configuration used when monitoring


neonates, single-lead analysis defaults on with lead II in the top
trace position when the monitor is set up for Neonatal-ICU
monitoring mode.

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ECG: ECG Menu Options

More ECG
The MORE ECG option opens a menu with additional ECG settings.

MORE ECG Menu

QRS Volume
The QRS VOLUME option turns on a tone which sounds each time a
QRS complex is detected. You can adjust how loud you want this tone.
Follow this procedure:

127(QRS volume is not 1. Select QRS VOLUME option from the ECG Menu. A popup menu
available from a telemetry opens displaying all choices.
transmitter when using
combination monitoring (Combo,
Rover Combo).

QRS VOLUME Popup Menu

2. Rotate the Trim Knob control. Each time the Trim Knob control is
rotated, you will hear a tone at that volume.
3. When you are satisfied with the volume level, press the Trim Knob
control to close the popup menu.

127(Turning QRS volume on will automatically turn off the SPO2


rate volume, if on. (Refer to SPO2 chapter.)

When in OR mode, the 10% and 20% volume tone is slightly


quieter than the 10% and 20% volume tone in Adult-ICU or
Neonatal-ICU modes.

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ECG: ECG Menu Options

QRS Tone With Brady Alarm


This feature is only found in the Neonatal mode. With this feature, the
QRS tone automatically starts when the monitor alarms for bradycardia.
The QRS tones will stop when the bradycardia alarm stops.

127(The QRS tone with this feature is 20% louder than the set alarm
volume.
Be aware that during an alarm pause, the QRS tone will not sound, just
like any other alarm tone. The QRS tone is silenced with the SILENCE
ALARM/ADMIT key on the monitor or the Silence Alarm key on the
optional remote control.

To enable this feature (factory default is OFF):

1. Select QRS VOLUME from the MORE ECG menu.

QRS VOLUME Popup Menu in Neonatal Mode

2. With the Trim Knob control, highlight BRADY ALARM.


3. Press the Trim Knob control to set your selection and close the popup
menu.

127(Turning SPO2 RATE VOLUME on will turn this feature off

If you would like this to default on, refer to Monitor Defaults, Setup
Default Display in the manual.

QRS Width
The QRS WIDTH option opens a popup menu that allows you to specify
the QRS width type to NORMAL or NARROW. The selected width type
will be sent to the monitor for use in the ECG analysis algorithms.

An additional HELP option opens an information window with pertinent


information regarding width types. The QRS width type defaults to
narrow for Neonatal mode and normal for Adult and OR modes. QRS
width type can be setup in Monitor Defaults.

Speed
Use this menu option to open a popup menu to select a sweep speed for
all displayed ECG waveforms. Choices are 6.25, 12.5, and 25 (factory
default) millimeters per second.

127(Speeds of 6.25 mm/sec are not possible when only ECG


waveforms are displayed.

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ECG: Troubleshooting

Troubleshooting
Problem:
Inaccurate heart rate and/or false asystole

Solution:

Check ECG signal from patient:

1. Check/adjust lead placement.


2. Check/perform skin preparation.
3. Check/replace electrodes.

Check amplitude of ECG waveform:

1. Select ECG parameter label.


2. Select DISPLAY LEAD.
3. Scroll through all ECG leads and check for 0.5 mV amplitude at
normal (1X) size. (At least 0.5 mV amplitude is required for QRS
detection.) For borderline signals, validate on a graph.
4. If amplitudes are low, electrodes may need to be repositioned or
replaced.

Relearn arrhythmia:
1. Select ECG parameter label.
2. Select RELEARN.

IF PROBLEM CONTINUES AND ECG AMPLITUDE IS LOW:

1. Select ECG parameter label.


2. Select ECG SIZE.
3. Select 2X or higher.
4. Close the popup menu.
5. Select RELEARN.

IF PROBLEM CONTINUES: Change to single lead ECG detection and


processing:
1. Select ECG parameter label.
2. Select LD ANALYSIS.
3. Select SINGLE LEAD.
4. Select DISPLAY LEAD.
5. Assess all the ECG leads and change top ECG waveform to display
lead with greatest amplitude. (At least 0.5 mV amplitude is required
for QRS detection.)

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ECG: Troubleshooting

Problem:
False ventricular calls

Solution:

Check ECG signal from patient: (The chest lead may exhibit polarity
changes which may occasionally cause an inaccurate call.)

1. Check/adjust electrode placement.


2. Check/perform skin preparation.
3. Check/replace electrodes. (If the chest lead is a problem, move the
chest lead to another chest position or leg position.)
4. Relearn ECG:
a. Select ECG parameter label.
b. Select RELEARN.

IF PROBLEM CONTINUES:

1. Select ECG parameter label.


2. Select RELEARN.

Problem:
ST numerics displayed only for primary (top) lead

Solution:

Check whether single lead or multi-lead processing is selected. Numerics


will only be displayed for the primary lead if single lead processing is
active.

Problem:
ST measurement points for ISO or J are incorrect.

Solution:

1. Relearn ECG:
a. Select ECG parameter label.
b. Select RELEARN.
2. Adjust ST measurement point:
a. Select ECG parameter label.
b. Select ST ANALYSIS from ECG menu.
c. Select ADJUST ST POINT.

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ECG: Troubleshooting

Pacemaker Troubleshooting
There are two general things that occur when the pace mode is activated
for pacemaker patients:
1. Beats that would otherwise be classified as ventricular are instead
classified as V-paced if a ventricular pacemaker event is detected.
2. Residual pacemaker energy that might otherwise appear in the ECG
is removed, and a pacemaker enhancement spike is artificially
placed in the ECG.
Pace detection is indicated visually in the ECG parameter box. By
watching the ECG waveform, pace detection is indicated by uniform,
upright pacemaker enhancement spikes in the ECG data (both displayed
and graphed).

The pacemaker signal is acquired from the displayed ECG lead (top
trace).

Two effective approaches for improving pacemaker detection are:


n Change the displayed ECG trace to a different lead.
n Move the electrodes associated with the displayed trace.

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ECG: Troubleshooting

Problem: Solution:
Inaccurate pacemaker detection
Use pacemaker processing:

1. Select ECG parameter label.


2. Display the lead of ECG with the greatest amplitude in the top
waveform position.
3. Select DETECT PACE.
4. Select PACE 2 or PACE 1.

NOTES:
n In general, be aware that a pacemaker pulse could be falsely counted
as a QRS during asystole.
n Pace 1 pace mode analyzes the presence of a pacer spike, assesses the
waveform for residual pacemaker energy, and determines the
presence of an R wave following the pacer spike. If an event occurs
during the first few milliseconds following the pacer spike, it will be
counted.
n Pace 2 pace mode analyzes waveforms with the added capability of
minimizing the chance of counting severe residual pacemaker energy
as QRS complexes. In relation to the event rejection capability of
Pace 2 pace mode, certain morphologies may not be detected.
Arrhythmia calls like asystole or pause may be made with heart rate
identified as less than actual.

127(Again, pacemaker patients should be kept under close


observation.

The appropriate pace mode may be determined at the time the


pacemaker patient is admitted to the monitoring system. The PACE 2
mode is recommended for use whenever possible.

Check ECG signal from patient:

1. Check/adjust lead placement; refer to the Electrode Placement for


Pacemaker Patients section in this chapter.
2. Check/perform skin preparation.
3. Check/replace electrodes.

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ECG: Troubleshooting

For your notes

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12 Pressures

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For your notes

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Pressures: Introduction

Introduction
127(Invasive pressure monitoring is an optional feature that your
institution may not have purchased.
This chapter gives guidelines for preparation, adjusting setup, and
specialized features for invasive pressure monitoring. Detailed operating
procedures are given for the CVP pressure site. Other pressure sites
have menu items just like those in the CVP Menu so you can apply the
same principles when monitoring those sites. Note that when monitoring
a PA site, you may have the optional PA Wedge feature.

There are two blood pressure connectors (labeled BP) on the side of the
monitor as shown in the illustration below.

BP2

BP1

BP Connectors

127(The signal input is a high-insulation port and it is defibrillator-


proof ( ).

The insulated input ensures patient safety and protects the device
during defibrillation and electrosurgery.

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Pressures: Introduction

Assigned BP Names
Each invasive pressure connector is labeled BP on the monitor. For
convenience, the monitor has a specific pressure name assigned for each
BP connector. However, these names can be changed during the setup
procedure, so you can plug any pressure line to any connector. Having
names properly reflect the site is important for proper processing of the
waveform since different algorithms are used for processing different
pressure sites.

Site names supported and values displayed are:

arterial (ART)systolic, diastolic, and mean

femoral (FEM)systolic, diastolic, and mean

pulmonary artery (PA)systolic, diastolic, and mean

central venous (CVP)mean

left atrial (LA)mean

right atrial (RA)mean

intracranial (ICP)mean

special (SP)mean

Additional site names available in the Neonatal-ICU mode are:

umbilical artery catheter (UAC)systolic, diastolic and mean

umbilical venous catheter (UVC)mean

For reference purposes in this manual, we refer to the connectors as BP1


and BP2, beginning with the left-most connector. BP1 is assigned an
ART pressure label; BP2 is assigned PA.

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Pressures: Introduction

Zero Reference
Zeroing the pressure transducers is very important for accurate pressure
measurements. Transducers should be zeroed frequently and always
before initiating treatment changes based on the pressure data. You can
zero all transducers at one time or each one individually.

To zero all the pressure transducers at one time, follow this procedure:

1. Place the transducer at left atrial level.


2. Close the transducer stopcock(s) to the patient.
3. Open the venting stopcock(s) to air (atmosphere).
4. Press the Zero All key on the front panel of the monitor or optional
remote control.
5. Verify that zero reference has been established. (Watch the pressure
parameter windows for messages.)
6. Close the venting stopcock(s) to air (atmosphere).
7. Open the transducer stopcock(s) to the patient. Within seconds
pressure numerics should be displayed in the pressure parameter
windows.

Refer to this chapter, Pressure Menu Options, to zero a single pressure


transducer.

Checklist
1. Patient cable is attached to the BP connector on the monitor.
2. Transducers are level according to unit policy. (Recommended
standard is level of right/left atrium.)
3. All transducers are zeroed.
4. Any entrapped air is removed from the system.
127(Refer to the transducer manufacturers instructions for
suggested means of removing entrapped air from the
hydraulic system.
5. Pressure setup is adjusted, if necessary. Details are provided in this
chapter.

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Pressures: Pressure Monitoring Features

Pressure Monitoring Features


Pressure Information
A labeled, pressure waveform will be displayed when the patient cable is
connected to the monitor. After a zero reference procedure is done,
numerics are displayed in the pressure parameter windows on the right
side of the screen.

Diastolic Value
Systolic
Value

Limits and
Units

Pulse Rate Value Mean Value

ART Pressure Parameter Window

Mean Value

CVP Pressure Parameter Window

The current systolic, diastolic, and mean values are displayed. Some
pressures only display a mean value. Limits and the units of
measurement may also be displayed. For pressures with multiple values,
the limits are labeled (S=systolic, D=diastolic, M=mean). For sites
labeled ART, FEM, and UAC, a pulse rate value can be turned on.

The pressure monitoring features are found in the pressure menu. All
pressure menus include scales, cursor, site name, limits, zero, and
calibration. There are additional options in the ART and PA menus
which are detailed in this chapter, Special Features.

CPP Pressure
When both ART and ICP are monitored, a cerebral perfusion pressure
(CPP) value will be calculated and displayed in the ICP values window.
The formula for this is the mean ART pressure value minus the ICP
pressure value.

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Pressures: Pressure Monitoring Features

Getting to the Pressure Menu


To display a pressure menu, use the Trim Knob control to select the
pressure parameter label. In this example, we will use the CVP Menu.
Remember, selecting with the Trim Knob control is a two-step process
rotate to highlight, then press to select.

Selecting the CVP Parameter Label

The CVP Menu is displayed at the bottom of the screen.

CVP Menu

With the Trim Knob control, you now can select any of the displayed
options:
n SCALESchange the displayed scale for this pressure.
n CURSORdisplay a moveable cursor on the waveform.
n CLEAR CURSORremove the cursor from the waveform.
n LIMITSdisplay a new menu and an information window to adjust
alarm limits.
n CHANGE NAMEchange to another name.
n ZEROzero reference this transducer only.
n BP FILTERselect a 12 or 40Hz filter.
n CALIBRATE TRANSDUCERadjust transducer offset.
n SPEEDchange the sweep speed for the displayed pressure
waveform.

These menu options are found in all pressure menus. The only difference
is the site name, for example, CVP Cursor, PA Cursor, etc. More details
on each option are found in this chapter.

There are special features associated with ART and PA which are
explained in this chapter, Special Features.

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Pressures: Pressure Menu Options

Pressure Menu Options


In most cases, the CVP Menu is used in this section to demonstrate the
pressure menu options.

Scales
The SCALES option allows you to change the scale on which the
pressure waveform is displayed on the screen. Changing the scale
changes the size of the waveform. Scales can be set in Monitor Defaults.

Follow this procedure:

1. Select CVP SCALES option from the CVP Menu. A popup menu
opens showing the scale sizes available. The scale currently used is
designated with the pointer (>).

CVP SCALES Popup Menu

127(The auto scale is only an option once the pressure is zeroed.

2. With the Trim Knob control, move the pointer to the desired scale
size. The scale on the display will not change until the Trim Knob
control is pressed. Pressing the Trim Knob control also closes the
popup menu.
Selecting AUTO will calculate a scale based on the patients current
arterial blood pressure.

127(Auto scaled waveforms will graph on a slightly different


scale than displayed.

Full Scales
If the waveform is on a full scale, the menu option will read FULL
SCALES, and the popup menu will look like this:

FULL SCALES Popup Menu

It is with this popup menu that you can place the waveform on a right (R)
or left (L) scale.

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Pressures: Pressure Menu Options

Cursor
This option places a cursor (dashed, horizontal line) across the pressure
waveform. The cursor is moveable and is used to give accurate pressure
values at selected points on the pressure waveform. A numeric value is
displayed on the screen to the right of the cursor.

1. Select CVP CURSOR option from the CVP Menu. A popup menu
opens.

CVP CURSOR Popup Menu

When displaying the pressure waveforms on individual scales, the


monitor automatically calculates a scale and the new scale and
cursor are displayed with the waveform. A numeric cursor value is
displayed to the right of the cursor.

New Scale Cursor Cursor Value

Cursor on CVP Waveform

2. With the popup menu open, rotate the Trim Knob control to move the
cursor. The cursor value changes as you move the cursor.
3. Press the Trim Knob control to close the popup menu. The cursor
remains on the waveform.

127(In the FULL and FULL GRID display modes, only one cursor
can be displayed at a time, but it can be moved throughout the
entire full scale range.

The cursor remains on the screen until you turn it off (CLEAR
CURSOR), change the scale size, or change display mode.
When the cursor is removed, the pressure scale returns to the
scale used before the cursor was turned on.

Clear Cursor
To remove the cursor from the waveform, select CLEAR CURSOR option
from the pressure menu. This is a direct action menu option.

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Pressures: Pressure Menu Options

Limits
This option provides an information window with bar graphs that show
the alarm limits for displayed pressures (systolic, diastolic, and/or mean).
A new set of menu options is displayed to allow you to adjust these limits.

For this example, the ART information is used. Follow this procedure:

1. Select ART LIMITS option from the ART Menu. An information


window is displayed on the screen and a new set of menu options is
displayed in the menu area.
Pressure Parameter

High Range

High Limit

Low Limit

Low Range

ART LIMITS Menu and Information Window

The information window shows the range as well as the alarm limits.
The pointer (>) indicates the current value of that parameter for the
monitored patient. As long as that value remains between the high
and low limits, there will be no alarm. Should the value exceed one of
the limits, an alarm will occur.

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Pressures: Pressure Menu Options

2. To change a set limit, for example the high rate limit, select RATE
HIGH LIMIT option from the limits menu. A popup menu opens.

RATE HIGH LIMIT Popup Menu

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until the
Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Select PREVIOUS MENU to exit the limits menu and return to the
pressure menu. Follow this procedure to set any other pressure
parameter limits in this menu.

Change Name
This option allows you to change the designated name for this pressure
connector.

Having the names properly reflect the site is important for proper
processing of the waveform since different algorithms are used for
different pressure sites.

Follow this procedure to change a name:

1. Select CHANGE NAME option from the pressure menu. A popup


menu opens showing all choices. The name presently assigned is
designated with the pointer (>).

CHANGE NAME Popup Menu

2. Rotate the Trim Knob control to place the pointer in front of the
desired name. The change will not take effect until the popup menu
is closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu. This causes a change in the parameter window and the
Main Menu is displayed.

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Pressures: Pressure Menu Options

Zero
Use the ZERO option to zero this transducer only.
1. Place the transducer at left atrial level.
2. Close the transducer stopcock to the patient.
3. Open the venting stopcock to air (atmosphere).
4. Use the Trim Knob control to select (highlight and press) the ZERO
option in the pressure menu.
5. Verify that zero reference has been established. (Watch the pressure
parameter window messages.)
6. Close the venting stopcock to air (atmosphere).
7. Open the transducer stopcock to the patient. Within seconds
pressure numerics should be displayed in the pressure parameter
window.

BP Filter
Select the BP FILTER option to open a popup menu. Use the Trim Knob
control to select a 12 or 40Hz filter.

BP FILTER Popup Menu

The 12-Hz filter is recommended for typical monitoring applications. The


40-Hz filter allows higher frequency waveform components to be
processed. This may result in elevated pressure values.

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Pressures: Pressure Menu Options

Calibrate Transducer
The CALIBRATE TRANSDUCER option allows you to adjust the
monitor for any transducer error.

127(Error is determined when pressure calibration is measured with


another instrument such as a mercury manometer.

1. Select CALIBRATE TRANSDUCER option from the pressure menu.


A new menu is displayed with two options to adjust for transducer
error.

CALIBRATE TRANSDUCER Menu

2. Select one of the two menu options. Adjusting one option


automatically adjusts the other.
u CAL # 100Open a popup menu to enter the percentage of error.
Use this option when the calibration error is already known.
127(Always make sure the CAL# is at 100 when making a new
adjustment.

For example, if it is known that this transducer measured 2% high,


rotate the Trim Knob control to 102. When you close the popup menu
the monitor will now compensate for the error.

127(Or, if you apply a known pressure, such as 100, and the


monitor displays 102 for that pressure site, adjust the CAL#
to the number displayed.

127(You must close the popup menu before a change is displayed


in the values window.

u ADJUST TO MMHGOpen a popup menu to change the


millimeters of mercury.

Speed
Use this menu option to open a popup menu to select a sweep speed for
all displayed pressure waveforms. Choices are 6.25, 12.5, and 25 (factory
default) millimeters per second.

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Pressures: Special Features

Special Features
The features described in this section are not common to all pressures.
Some of these features are available with certain software packages as
noted.

IABP
127(This feature is part of the Cardiopulmonary software package.

127(The IABP feature is not available when the monitor is set up for
Neonatal-ICU mode.

Triggering
IMPORTANT GE recommends that the signal source used to trigger
an intra-aortic balloon pump (IABP) should be the balloon pump device
itself. This insures that the trigger signal is compatible with all modes of
the IABP. An extra set of ECG electrodes, or an additional connection
from the arterial line can be connected to the monitor to produce
waveforms on the monitors display for consolidated waveform viewing.

:$51,1*
PATIENT HAZARD: If you choose to trigger the balloon
pump from the monitor, contact the balloon pump
manufacturer directly for interface requirements as they
vary between manufacturers. Some trigger modes on
certain balloon pump devices may not be
compatible with GE Medical Systems Information
Technologies analog output signal, and use may
contribute to patient injury or sub-optimal
pumping results.

If you choose to use the monitor for triggering you must follow the
instructions below. Failure to follow these instructions may result in an
incompatible analog output signal which may contribute to patient
injury.

1. Contact the balloon pump manufacturer for interface


requirements. GE ECG analog output delay specification is shown
in the table below.

Product Maximum ECG Analog Output Delay Spec with Diagnostic ECG Filter*

Dash monitor less than 35 milliseconds

* Refer to Step 2

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Pressures: Special Features

2. Cable connection and ECG filter.


u Use the appropriate compatible analog output cable from GE.
u Cable the balloon pump to the monitor through the DEFIB SYNC
connector.
u Use the Diagnostic ECG filter (selected in the ECG menu).

3. Primary displayed ECG lead. If the balloon pump triggers off the
P wave of the QRS complex, review the patients ECG leads and place
the one with the greatest amplitude in the top (primary) position on
the monitors screen.
4. Pacemaker Detection. If the patient has a pacemaker, be sure
pacemaker detection is on (selected from the ECG menu). Failure to
turn pacemaker detection ON may cause poor beat detection which
may result in inadequate triggering of the balloon pump.
5. BP Filter. If the blood pressure is used to trigger the balloon pump,
use the 40Hz pressure filter (selected from the pressure menu).

Using the IABP Feature


The monitor measures arterial (femoral) pressure and displays both the
pressure waveform and numerical pressure values. The IABP feature
compensates for the irregularities in the pressure waveform caused by
the use of an intra-aortic balloon pump.

Turning IABP Program ON


To turn the IABP program on and off, select IABP option from the
pressure menu. When on, the parameter label will begin with an I as
shown in the figure below.

Parameter Label

ART Parameter Label with IABP On

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Pressures: Special Features

Displayed Values
Displayed pressure values are affected by the intra-aortic balloon pump.

The IABP program will display three values, for example 150 / 45 (98).
The first value, systolic, is the highest pressure in one cardiac cycle; the
second, diastolic, is the lowest pressure in one cardiac cycle; and the
third (mean) is the average pressure during one cardiac cycle.

The displayed numerical values are computing a rapidly varying


waveform generated during IABP treatment and do not always reflect a
true arterial pressure. For accuracy and reliability, always combine two
or more of the recommended methods listed below for reading arterial
and/or femoral blood pressure:
n the IABP waveform displayed on the screen (use scales for
evaluation),
n a printed copy of the waveform (use scales for evaluation), or
n the balloon pump display if available.

Since there are a number of points along the IABP waveform that could
be the displayed value, it is important for you to know which ones the
program chooses. The values displayed will differ depending on the
timing of the pump.

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Pressures: Special Features

For 1:1 or 1:2 Timing:

Systolic Numerics
n When the augmented diastole is greater that the patient systole, the
displayed systole will equal the augmented diastole. (See figure 1.)
n When the patient systole is greater than the augmented diastole, the
displayed systole will equal the patient systole. (See figure 2.)

Diastolic Numerics
n The displayed diastole will always equal the balloon end diastole.
(See figures below.)

Figure 1 Figure 2
Augmented Diastole > Patient Systole Patient Systole > Augmented Diastole

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Pressures: Special Features

For 1:3 or More Timing:

Systolic Numerics
n The displayed systolic numerics will switch between the augmented
diastole and patient systole. (See figure 3.)

Diastolic Numerics
u The displayed diastolic numerics will switch between the balloon
end diastole and the patient end diastole. (See figure 3.)

Figure 3

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Pressures: Special Features

Smart BP
Smart BP is a feature found in ART and FEM pressure menus.

127(The Smart BP feature is not available when the monitor is set up


for Neonatal-ICU mode.

Smart BP is an arterial (femoral) artifact rejection program which


substantially reduces the occurrences of needless alarms by eliminating
most of the alarms associated with zeroing the transducer, fast flushing
the system, and drawing blood.

When Smart BP is on, and the system recognizes one of these events, the
arterial (femoral) alarms are deactivated and the systolic and diastolic
numerics are replaced with Xs. The message ARTIFACT is displayed.
The mean pressure value is displayed throughout the artifact occurrence.

Safety Features: If zeroing, fast flushing, or drawing blood is not


accomplished within certain time frames, alarms will sound. When
artifact is detected, Smart BP begins to search for the return of a
pulsatile pressure. When 15-20 beats have been detected, numerics are
displayed and alarms are reactivated. If pressure remains below 10
mmHg for more than 14 seconds, the alarms will reactivate. During
sustained high pressure (drawing blood), you have a maximum of two
minutes before alarms reactivate.

To turn Smart BP on/off, select the SMART BP option from the pressure
menu. This feature can be set in Monitor Defaults.

Pulse Rate
Another special feature is PULSE RATE. This feature is found in ART,
FEM, and UAC (neonatal mode only) pressure sites. When turned on, a
Rate value is displayed in the appropriate parameter values window.

Pulse Rate On

Pulse Rate Displayed in ART Parameter Window

To turn the pulse rate value on and off, simply select PULSE RATE in
the applicable pressure menu. This feature can be set in Monitor
Defaults.

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Pressures: Special Features

Disconnect Alarm
The DISCONNECT ALARM feature is found in ART and FEM pressure
menus.

127(This feature is not available when the monitor is set up for


Neonatal-ICU mode.

If the mean pressure falls below 25mmHg and the disconnect alarm is
on, a Warning alarm sounds and the message DISCONNECTED is
displayed in the values window. Check your patient immediately in the
event the catheter has dislodged.

To turn this feature off and on, select DISCONNECT ALARM option
from the appropriate pressure menu. This feature can be set off or on in
Monitor Defaults. You cannot change the alarm level. It will always be a
warning alarm.

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Pressures: PA Wedge

PA Wedge
127(This option is part of the Cardiopulmonary software package.
PA Wedge is a feature found in the PA pressure menu.

There are two menu options for doing a PA wedge measurementPA


WEDGE and PA INSERT/WEDGE. The PA Insert/Wedge option is used
to emphasize the PA waveform and it offers two additional menu options.

The two modes for doing PA wedge measurement are auto mode and
manual mode. The auto mode allows you to perform a measurement
without having to touch the monitor once the program is started. The
manual mode overrides the auto mode and requires additional steps at
the monitor to complete the measurement.

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Pressures: PA Wedge

PA Wedge Menu Option


To start the PA wedge program from this option, select PA WEDGE from
the PA menu.

PA Menu

The auto mode defaults on.

127(Under certain conditions, the Manual mode may default on


instead of the Auto mode. See Auto Mode on page 12-27 for
more information.

A single beep sounds and INFLATE BALLOON is displayed in the PA


parameter window. The program is ready and waiting for the balloon to
be inflated.

PA Parameter Windows with Prompt

A PA Wedge Menu is also displayed with the following menu options.

PA WEDGE Menu

n REVIEW WEDGEuse after wedging in the manual mode to review


patient data.
n PA CURSORplace a moveable cursor on the real-time waveform
while wedge is being performed.
n MODE: AUTOuse to change modes (MANUAL/AUTO).
n NEW WEDGEuse to restart the wedge process if dissatisfied with
the previous measurement.
n GRAPH BP INVASIVEuse to graph invasive BP waveforms.

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Pressures: PA Wedge

PA Insert Wedge Menu Option


When PA INSERT/WEDGE is selected, the display changes to the Full
Grid mode and the primary ECG waveform is duplicated in the second
waveform slot. All BP waveforms, except the PA waveform, are removed
from the Full Grid region, and an ART, Resp, or CO2 waveform is
displayed in the seventh waveform position if available.

The PA Insert/Wedge menu is also displayed.

PA INSERT/WEDGE Display Mode and Menu

n REVIEW WEDGEuse after wedging in the manual mode to review


patient data.
n PA CURSORplace a moveable cursor on the real-time waveform
while wedge is being performed.
n MODE: AUTOuse to change modes (MANUAL/AUTO).
n NEW WEDGEuse to restart the wedge process if dissatisfied with
the previous measurement.
n FULL SCALESuse to change the Full Grid scale for the pressure
waveform.
n SPEEDuse to change the sweep speed of the waveform.
n GRAPH BP INVASIVEuse to select and graph invasive BP
waveforms.

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Pressures: PA Wedge

Review Wedge
When you select REVIEW WEDGE, the PA Wedge Review information
window appears and new menu items are displayed.

127(The REVIEW WEDGE Menu and Information Window will


display automatically at the end of a PA Wedge cycle when in
AUTO mode.

Program Cursor

Wedge Value and Time

REVIEW WEDGE Menu and Information Window from the


PA Wedge Menu Option

Program Cursor

Wedge Value and Time

REVIEW WEDGE Menu and Information Window from the PA Insert/


Wedge Menu Option

127(If CO2 is being monitored, the CO2 waveform will be displayed


in place of the respiration waveform.

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Pressures: PA Wedge

The review wedge menu options are:


n CARDIAC OUTPUTenter the PA wedge pressure value into
cardiac calculations and vital signs. The monitor automatically
enters the cardiac output program.
n MOVE WEDGE CURSORuse to reposition the cursor to change
the wedge value. Refer to more details on the following page.
n NEW WEDGEuse to restart the wedge process and return to the
PA Insert Wedge menu.
127(This option is available in the Review Wedge menu from the
PA Insert/Wedge option.

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Pressures: PA Wedge

Move Cursor
If you dont agree with the placement of the cursor for the PA wedge
pressure value, you can change it. While the PA wedge review
information is displayed:

1. Select MOVE WEDGE CURSOR option from the Review Wedge


menu. A popup menu opens and a solid line cursor is placed on top of
the dashed, program cursor in the review window.
127(If you placed a cursor on the waveform during the balloon
inflation, the solid line cursor represents that cursor. It may
or may not match the program cursor.

As you rotate the Trim Knob


control, the solid line cursor
moves and this CURSOR value
changes.

MOVE WEDGE CURSOR Popup Menu

2. Rotate the Trim Knob control. As the cursor moves, the CURSOR
value displayed at the bottom of the window changes. Note that the
original cursor position (dashed line) remains marked as a reference
point.
3. Press the Trim Knob control to close the popup menu. The word
CURSOR and its value are cleared and the PA WEDGE value
changes to reflect the new cursor (solid line) placement.
127(The PA wedge pressure value will not be displayed or
entered into cardiac calculations or vital signs until you exit
the program.

4. Select MAIN MENU or CARDIAC OUTPUT to exit the PA wedge


program. The most recent PA wedge pressure value and the time it
was obtained are displayed in the PA parameter window, and
entered into cardiac calculations and vital signs.

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Pressures: PA Wedge

Auto Mode
The Auto mode defaults on when the PA Wedge menu option is selected.
When the PA Insert/Wedge menu option is selected, the Manual mode
defaults on. Refer to Manual Mode on page 12-28 for more information.

127(
If you have already selected the PA INSERT/WEDGE menu option
and you later select the PA WEDGE menu option, the Manual mode
will be the default for the PA Wedge menu option, not the Auto mode.

1. Select the PA WEDGE option from the PA menu. The Auto mode
defaults on.
Or, select the PA INSERT/WEDGE option from the PA menu, then
select the MODE: MANUAL option to switch to the Auto mode.

Watch for the INFLATE BALLOON prompt. You will hear a single
beep when it is displayed.

2. Inflate the balloon. The PA program will look for inflation and begin
processing an end-expiration wedge value. The prompt in the
parameter window changes to WEDGE PROCESSING.
127(At this point select PA CURSOR from the PA Wedge or PA
Insert/Wedge menu if you want to place a moveable cursor on
the real-time wedged waveform. This in no way interferes
with the wedge value the program computes. In the review
mode, you can then compare your cursor placement to the
programs.

3. Deflate the balloon when you feel wedging is adequate (3-4


respiratory cycles, but no longer than 20 seconds). The prompt in the
parameter window now reads WEDGE COMPLETE.
A PA Wedge Review information window and menu are displayed on
the screen. The information window contains 20 seconds of
compressed waveform data (beginning with INFLATE BALLOON
message) for ECG, respiration (if waveform is displayed), and PA.
(Refer to this chapter, Review Wedge.)

127(If you do not deflate the balloon, the WEDGE COMPLETE


message and review window will automatically be displayed
after 20 seconds. If this occurs, be sure and deflate the
balloon before proceeding.

A program cursor (horizontal dashed line) is placed on the


compressed PA waveform at end expiration and a wedge value
relative to the cursor is displayed. The time of the measurement is
also displayed. The scale displayed is automatically determined from
the patient's PA data.

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Pressures: PA Wedge

Manual Mode
Under certain patient conditions (valvular disease or respiratory
variation in PA reading), the program is unable to detect the wedge. The
waveform indicates wedging but the program wont progress beyond the
inflate balloon prompt, or the program indicates WEDGE PROCESSING
but the balloon has not been inflated. In these cases, the MANUAL mode
should be used. Follow this procedure:

1. Select the PA INSERT/WEDGE option from the PA menu. The


Manual mode defaults on.
Or, select the PA WEDGE option from the PA menu, then select the
MODE: AUTO option to switch to the Manual mode.

The message MANUAL WEDGE appears in the PA parameter


window.

MANUAL WEDGE Message

2. Inflate the balloon. Watch the PA waveform for wedging. If you wish,
you can place a cursor on the wedged waveform at this point and
move it as desired.
3. Deflate the balloon when you feel wedging is adequate (3-4
respiratory cycles, but no more than 20 seconds).
4. The Manual mode will not automatically display the review data.
You must select REVIEW WEDGE. The program continues to collect
data until REVIEW WEDGE is selected. If you wait too long you will
lose the wedge data. The last 20 seconds of data will be displayed.
5. Select MOVE WEDGE CURSOR if you dont agree with the PA
wedge pressure value. (Refer to this section, Move Cursor.)

Full Scales
It is possible to change the scale of the pressure waveform. The FULL
SCALE option lets you to change the scale of the Full BP from its default
scale of 0 to 40 mmHg. Select this option to open a popup menu allowing
choices of 0 to 40, 60, 100, 160, 200, or 300 mmHg.

127(This option is only found in the PA Insert Wedge menu.

Sweep Speed
Use this menu option to open a popup menu to select a waveform sweep
speed. You can change the waveform sweep speed from the default 25
millimeters per second to 12.5 or 6.25 millimeters per second.

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Pressures: PA Wedge

Graph BP Invasive
This menu option opens a popup menu that allows you to select the
available BP waveforms for graphing.When this option is activated, BP
waveforms are the only graphable parameters. Waveforms will be
graphed on one scale using the full grid space.

You cannot change a BP selection while graphing. The graph will stop
when the GRAPH GO/STOP key on the front of the monitor or writer is
pressed. If another type of graph is currently active, the Graph BP
Invasive selection will be ignored. BP graphing goes to the manual graph
window location. (Refer to the Monitor Setup chapter, Graph BP
Invasive, for more details.)

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Pressures: General Troubleshooting

General Troubleshooting
Problem:
Displayed pressure values are different than expected

Solution:

Check tubing for bubbles.

Remove excessive tubing.

Check phlebostatic axis placement of transducer.

Rezero pressure:

1. Place the transducer at left atrial level.


2. Close transducer stopcock to patient.
3. Open the venting stopcock to air.
4. Press the Zero All key on the front panel of the monitor or optional
remote control.
5. Close the venting stopcock to air.
6. Open transducer stopcock to patient.

Is patient on IABP? If so, check to see if monitors IABP program is


turned on. Look for an I in the ART parameter window. If necessary,
turn IABP program on:

1. Select ART parameter label.


2. Select IABP: OFF. Menu option toggles to IABP: ON.

Problem:
Smart BP is on. Artifact is sensed without flush, draw, or zero

Solution:

Turn Smart BP OFF then ON. If problem persists, you may need to
disable Smart BP by turning it off for that pressure.

Use Alarm Pause feature prior to drawing blood to reduce unnecessary


alarms if Smart BP is disabled.

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Pressures: Wedge Troubleshooting

Wedge Troubleshooting
Problem: Solution:
Unable to detect wedge
Use the manual method for PA wedge measurement:

1. Select MODE: AUTO in the PA wedge menu. Selection toggles to


MANUAL.
2. Perform wedge measurement in manual mode following the
procedure in this chapter, Manual Mode.

Problem: Solution:
Monitor displays processing
wedge when balloon has not been Select NEW WEDGE to begin wedge processing again.
inflated
If wedge is again detected due to resp artifact on PA waveform, then use
the manual method for PA wedge measurement:

1. Select MODE: AUTO in the PA wedge menu. Selection toggles to


MANUAL.
2. Perform wedge measurement in manual mode following the
procedure in this chapter, Manual Mode.

Problem: Solution:
Displayed wedge measurement is
different than expected 1. Repeat wedge measurement allowing a minimum of three
respiratory cycles of data.
2. Verify end-expiration using the respiratory waveform on the display
and observing patient's breathing pattern.
3. Adjust PA wedge cursor to end-expiratory wedge value.

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Pressures: Wedge Troubleshooting

For your notes

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13 NBP

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For your notes

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NBP: Introduction

Introduction
A patients vital signs may vary dramatically during the use of
cardiovascular agents such as those that raise or lower blood pressure or
those that increase or decrease heart rate.

Because treatment protocol based on the patients blood pressure may


rely on specific values and differing measurement methods, clinicians
should note a possible variance from values obtained with this unit in
planning patient care management. The GE monitor values are based on
the oscillometric method of noninvasive blood pressure measurement
and correspond to comparisons with intra-aortic values within ANSI/
AAMI Standards for accuracy.

Automatic non-invasive blood pressure monitoring uses the oscillometric


method of measurement. To understand how this method works, we will
compare it to the auscultative method. With auscultation, the clinician
listens to the blood flow and determines the systolic and diastolic
pressures. The mean pressure can then be calculated with reference to
these pressures as long as the arterial pressure curve is normal.

Since the monitor cannot hear the blood flow, it measures cuff pressure
oscillation amplitudes. Oscillations are caused by blood pressure pulses
against the cuff. The oscillation with the greatest amplitude is the mean
pressure. This is the most accurate parameter measured by the
oscillometric method. Once the mean pressure is determined, the systolic
and diastolic pressures are calculated with reference to the mean.

Simply stated, auscultation measures systolic and diastolic pressures


and the mean pressure is calculated. The oscillometric method measures
the mean pressure and calculates the systolic and diastolic pressures.
Due to the difference in these methods, one cannot be used to check the
accuracy of the other.

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NBP: NBP Connector

NBP Connector
127(Due to the difference in these methods, one cannot be used to
check the accuracy of the other.

NBP Cable
Connector

NBP Connector

127(The NBP cable connector is a high-insulation port and it is


defibrillator-proof ( ).

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NBP: Safety

Safety

:$51,1*6
The NBP parameter will not measure blood pressure
effectively on patients who are experiencing seizures or
tremors.

Arrhythmias will increase the time required by the NBP


parameter to determine a blood pressure and may extend
the time beyond the capabilities of the parameter.

Devices that exert pressure on tissue have been


associated with purpura, skin avulsion, compartmental
syndrome, ischemia, and/or neuropathy. To minimize
these potential problems, especially when monitoring at
frequent intervals or over extended periods of time, make
sure the cuff is applied appropriately and examine the
cuff site and the limb distal to the cuff regularly for signs
of impeded blood flow.

Do not apply external pressure against the cuff while


monitoring. Doing so may cause inaccurate blood
pressure values.

Use care when placing the cuff on an extremity used to


monitor other patient parameters.

&$87,216
Accuracy of NBP measurement depends on using a cuff of
the proper size. It is essential to measure the
circumference of the limb and choose the proper size cuff.

The pulse rate derived from an NBP determination


(measurement) may differ from the heart rate derived
from an ECG waveform because the NBP parameter
measures actual peripheral pulses, not electrical signals
or contraction from the heart. Differences may occur
because electrical signals at the heart occasionally fail to
produce a peripheral pulse or the patient may have poor
peripheral perfusion. Also, if a patients beat-to-beat
pulse amplitude varies significantly (e.g., because of
pulsus alternans, atrial fibrillation, or the use of a rapid-
cycling artificial ventilator), blood pressure and pulse
rate readings can be erratic, and an alternate measuring
method should be used for confirmation.

127(
A patients vital signs may vary dramatically during the use of
cardiovascular agents such as those that raise or lower blood
pressure or those that increase or decrease heart rate.

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NBP: Checklist

Checklist
1. The module is securely inserted in the module housing.
2. A cuff appropriate for the limb size has been selected.
3. Cuff is properly placed on patient.
4. Patient cable is connected to module.
127(
Do not connect more than one NBP patient cable.

5. Tubes between the cuff and the monitor are not kinked or blocked.
6. Correct cuff size has been selected from the NBP menu.

:$51,1*
The cuff size selected in the NBP menu and the cuff size
used must be correct to obtain reliable NBP data and to
prevent overpressure in neonatal or pediatric use.

7. Start an NBP reading following Auto or Stat mode procedures as


detailed in this chapter, or use the NBP Go/Stop button on the
monitor or the remote control.

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NBP: Patient Preparation

Patient Preparation
Cuff selection and application are important. Inappropriate selection or
improper application of the cuff will result in erroneous measurements.

:$51,1*6
The system is designed for use with dual-hose cuffs and
tubing. The use of single-hose cuffs with dual hose tubing
can result in unreliable and inaccurate NBP data.

Do not place the cuff on a limb being used for A-V


fistulas, intravenous infusion or on any area where
circulation is compromised or has the potential to be
compromised.

Cuff selection:

1. Identify patient limb circumference.


2. Select appropriate cuff. The limb circumference is identified on each
cuff.

Cuff placement:

1. Confirm that the cuff is fully deflated before positioning it on the


patient.
2. Place cuff snugly around extremity being used.
3. Marking on cuff should match artery location.
4. Cuff should be one to two inches above the elbow if using the brachial
artery.
5. The air pad should be exactly over the brachial artery. Tubing should
be immediately to the right or left of the brachial artery to prevent
kinking when elbow is bent.
6. Position the patient so that no external pressure is applied against
the cuff while monitoring. External pressure may cause inaccurate
blood pressure values.

Other considerations:

1. Perform NBP measurements on the patients non-dominant arm.


2. Roll up sleeve before measurement. Only very thin fabrics will not
impair the measurement.
3. Place the arm on a surface level with the patients heart.
4. The palm of the hand should face up.

For further information on cuffs, please contact your sales/service


representative.

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NBP: NBP Monitoring Features

NBP Monitoring Features


NBP Information
There is no waveform displayed when monitoring with the noninvasive
blood pressure technique. However, numerics are displayed in the NBP
parameter window.

Systolic Value Diastolic Value

Limits and
Units

Time of Last Mean Value


Measurement and
Cuff Size

NBP Parameter Label and Windows

The current systolic, diastolic, and mean values are displayed. Limits
and the units of measurement may also be displayed. The limits
displayed are labeled (S=systolic, D=diastolic, M=mean). The cuff size
and time of last measurement are also displayed. The time is displayed
with a 24-hour clock. During a measurement, the cuff inflation pressure
(updated every second) is displayed in place of the mean value.

If AUTO mode is on, a countdown timer is displayed in the lower left


corner.

The NBP values change to Xs if no NBP monitoring has taken place for 2
hours in ADULT-ICU mode, 15 minutes in OPERATING ROOM mode,
and 12 hours in NEONATAL-ICU mode.

The NBP monitoring features are found in the NBP Menu. These
features include AUTO and STAT modes, reviewing previous NBP
measurements, cuff size, alarm limits, and clearing readings.

Mean Arterial Pressure


The following conditions may cause the NBP parameter block to display
the mean arterial pressure (MAP) value while the associated systolic and
diastolic values appear as Xs.
n Very low systolic and diastolic amplitude fluctuations (e.g. patients
in shock).
n Very small difference between the MAP and the systolic pressure or
the MAP and the diastolic pressure.
n Loss of system integrity (e.g. loose connections or worn parts).

Be sure to perform a visual inspection to ensure system integrity.

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NBP: NBP Monitoring Features

Systolic Search
127(The cuff target pressure must be higher than the patients
systolic pressure to obtain an accurate systolic and diastolic
reading.

If a systolic blood pressure cannot be found, the monitor will search for a
systolic reading by re-inflating the cuff at a higher pressure. This systolic
search may occur once per NBP determination. During a systolic search,
the maximum cuff inflation pressure will not exceed the normal pressure
range of the cuff.

NBP Go/Stop Key


The NBP GO/STOP key on the front of the monitor or on the optional
remote control is a quick way to take one measurement without going
into the NBP menu. It can also be used to stop a measurement already in
progress.

Display Off
If you turn the display off with the DISPLAY OFF ALARM PAUSE menu
option in the Alarm Control menu or by pressing the Display On/Off
key on the optional remote control, NBP is also turned off. This applies to
any manual, auto, and stat mode NBP measurements in progress.
Turning the display back on again will not restart any NBP
measurements.

Silence NBP Alarm > 1 Minute


NBP alarms can be silenced for greater than one minute. This option is
selected in the Monitor Defaults Menu, SETUP DEFAULT DISPLAY.

The NBP Silence Alarm defaults to NORMAL. The Normal setting


allows the silencing of the NBP limit alarm to function like the other
parameter limit alarms. However, when set to > 1 MINUTE, pressing the
SILENCE ALARM/ADMIT key on the monitor or Silence Alarm key
on the optional remote control silences the NBP limit alarm indefinitely.

The alarm level for NBP must be set, by the user, to Advisory or greater
to activate an audible alarm. Once the alarm is silenced, the alarm
converts to a Message alarm level and responds accordingly. Any new
NBP alarms will respond to the alarm level set by the user.

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NBP: NBP Monitoring Features

Getting to the NBP Menu


To display the NBP Menu, use the Trim Knob control to select the NBP
parameter label. Remember, selecting with the Trim Knob control is a
two-step processrotate to highlight, then press to select.

Selecting the NBP Parameter Label

The NBP Menu is displayed at the bottom of the screen. The options vary
depending on the monitoring mode.

NBP MenuNeonatal Mode

NBP MenuAdult and OR Mode

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NBP: NBP Monitoring Features

With the Trim Knob control, you now can select any of the displayed
options:
n NBP AUTOstart/stop the automatic mode; select appropriate time
interval.
n NBP STATstart 5 minutes of continuous, sequential NBP
measurements. (Not available in Neonatal-ICU mode.)
n REVIEW NBPSreview previous NBP measurements in Vital
Signs.
n NBP LIMITSdisplay an information window and a new menu to
adjust systolic, diastolic, and mean limits.
n CUFF SIZEselect the type of cuff being used (adult, pediatric,
neonatal).
n CLEAR NBP READINGremove the values from the NBP
parameter window.
n INITIAL INFLATION PRESSUREdetermine the target inflation
pressure for the first measurement.

Detailed information on each option is found in this chapter.

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NBP: NBP Menu Options

NBP Menu Options


NBP Auto

:$51,1*
Periodically check patient limb circulation distal to the
cuff. Check frequently when using auto NBP in 1 and 2
minute intervals. Intervals below 10 minutes are not
recommended for extended periods of time.

This option allows you to program the monitor to automatically take


NBP measurements at specific time intervals.

Follow this procedure:

1. Select NBP AUTO option from the NBP Menu. A popup menu opens
showing all choices.


711B

NBP AUTO Popup Menu

2. Rotate the Trim Knob control to move the pointer (>) to the desired
time interval. The change will not be in effect until the Trim Knob
control is pressed and the popup menu closed.
127(The NBP AUTO program is a timed cycle. If, when first
turned on, it is set to run at 5-minute intervals, the cuff
inflates immediately and then every 5 minutes thereafter. If
you change the timing interval (i.e., 15 minutes) without
turning AUTO off, the timing cycle does not start over. The
next cuff inflation will occur 15 minutes after the last
inflation and every 15 minutes thereafter. Turning AUTO off
and then on again restarts the timing cycle with an
immediate cuff inflation.

3. Press the Trim Knob control to confirm the change and close the
popup menu. A count-down timer is displayed in the NBP parameter
window when the time interval set (or remaining) is 60 minutes or
less. The last minute will count down in seconds.

127(Operating Room ModeIf an auto mode time is set in monitor


defaults, pressing the NBP GO/STOP key starts the auto mode
feature.

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NBP: NBP Menu Options

NBP Stat
127(The NBP STAT feature is not available when the monitor is set
up for Neonatal-ICU mode.
NBP STAT enables 5 minutes of continuous, sequential, automatic NBP
measurements.

Follow this procedure:


1. Select NBP STAT option from the NBP menu. A popup menu opens
displaying ON, OFF, and HELP options. The HELP option will open
an information window with more details on this feature.

NBP STAT Popup Menu

2. Rotate the Trim Knob control so the pointer (>) is in front of ON. The
change will not be in effect until the Trim Knob control is pressed
and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu. The first inflation occurs within seconds.

Repeat the procedure and select OFF to discontinue the STAT process
before the 5-minute period is up, or simply press the NBP GO / STOP
key on the front of the monitor.

Early Systolic Measurement


Early systolic measurement is a feature of the NBP STAT mode. As soon
as you enter NBP STAT mode, cuff inflations begins, a measurement is
taken, and the systolic, diastolic, and mean values are displayed.
Thereafter, the systolic value will be displayed shortly after the
measurement starts. When the measurement is complete the monitor
will beep and the diastolic and mean values will be displayed.

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NBP: NBP Menu Options

Review NBPs
The monitor can store up to 96 NBP readings which can be reviewed in
Vital Signs. This would be equivalent to running auto mode at 15 minute
intervals for 24 hours. Readings older than 24 hours are cleared from
Vital Signs.

1. Select REVIEW NBPS option from the NBP Menu. The Vital Signs
information window is displayed with the data sorted so NBP
readings appear first in the list.

REVIEW NBPS Menu and Information Window

2. Use the Trim Knob control to select menu options. Refer to the
Patient Data chapter, Vital Signs, to review details.
127(TIME INTERVAL and SPECIFIC TIME do not work with
episodic events such as NBP.
3. Select PREVIOUS MENU to return to the NBP Menu.

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NBP: NBP Menu Options

NBP Limits
This option provides an information window with bar graphs that show
the alarm limits for systolic, diastolic, and mean pressures. A new set of
menu options is displayed to allow you to adjust these limits.

Follow this procedure:

1. Select NBP LIMITS from the NBP Menu. An information window is


displayed on the screen and a new set of menu options is displayed in
the menu area.
Pressure
Parameter

High Range

High Limit

Low Limit

Low Range

NBP LIMITS Menu and Information Window

The information window shows the range as well as the alarm limits.
The pointer (>) indicates the current value of that parameter for the
monitored patient. As long as that value remains between the high
and low limits, there will be no alarm. Should the value exceed one of
the limits, an alarm will occur.

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NBP: NBP Menu Options

2. To change a set limit, for example the high systolic (SYS) limit, select
SYS HIGH LIMIT option from the limits menu. A popup menu
opens.

SYS HIGH LIMIT Popup Menu

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until
the Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Follow this procedure to set any other NBP limit. Select PREVIOUS
MENU to exit the limits menu and return to the NBP Menu.

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NBP: NBP Menu Options

Cuff Size
This option programs the monitor for the appropriate inflation pressure.
The cuff size setting is based on the patients age. There are three
choicesAdult, Pediatric, and Neonatal.

A label showing your choiceADULT, PED, NEOis displayed at the


bottom of the parameter window.

If you need to select a different size, follow this procedure:

1. Select CUFF SIZE option from the NBP Menu. A popup menu opens
displaying the three options.


716C

CUFF SIZE Popup Menu

2. Use the Trim Knob control to make your selection. The change will
not be in effect until the Trim Knob control is pressed and the popup
menu closed.
3. Press the Trim Knob control to close the popup menu.

Clear NBP Reading


If you want to remove the values displayed in the NBP parameter
window, select this option. The values will be replaced with Xs. This
action also removes those values from Vital Signs history.

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NBP: NBP Menu Options

Initial Inflation Pressure


This option allows you to set the target inflation pressure for the first
measurement
1. Select INITIAL INFLATION PRESSURE option from the NBP
Menu to display the following popup menu.

802B

INITIAL INFLATION PRESSURE Popup Menu

2. Rotate the Trim Knob control to scroll through the list of inflation
pressures. The choices available depends on the cuff size. For adult
and pediatric cuff size, the choice is 100 mmHg to 250 mmHg. The
choice for neonatal cuff size is 100 mmHg to 140 mmHg. Inflation
pressures are adjusted in increments of 5 mmHg. The default
inflation pressure settings are as follows:
Adult, 160 mmHg

Pediatric, 140 mmHg

Neonatal, 110 mmHg

3. Press the Trim Knob control to set the inflation pressure and close
the popup menu.
Cuff inflation thereafter is automatically determined by multiple factors
including mode of operation, cuff size and previous reading.

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NBP: Troubleshooting

Troubleshooting
NBP Status Messages
A status message will be displayed in the NBP values window if a
measurement is unable to be completed. Following is an alphabetical list
of the status messages with monitor response and action to take.

Status Message Monitor Response Solution

CUFF INFLATION OVER 5 MINS System status alarm. Auto Check cuff, if no air is in cuff, try another measurement. If
mode will shut off. problem persists, contact service.

If air is in cuff, remove cuff and contact service.

DEFLATION FAIL REMOVE CUFF System status alarm. Auto Remove cuff and contact service.
mode will shut off.

NBP HARDWARE MALFUNCTION System status alarm. Auto Contact service.


mode will shut off.

NO DETERMINATION System status alarm. Auto Check patient and cuff placement; try another
mode will shut off. measurement. If problem persists, contact service.

OVER PRESSURE System status alarm. Remove cuff and contact service.

PUMP TIMEOUT System status alarm Check connections between cuff and module; try another
(inflation failure/pressure leak) measurement. If problem persists, contact service.

Check for worn connector O rings. Contact service.

TOTAL TIMEOUT System status alarm. Auto Possible excessive patient movement or arrhythmia
(measurement > 3 minutes) mode will shut off. condition. Check patient; try another measurement.

For neonatal mode, the status message will appear after


90 seconds.

Any two consecutive NBP status messages will shut Auto mode off if it is
running.

A message will clear when the next measurement is initiated, or a


message can be cleared manually with the CLEAR NBP READING
option in the NBP menu.

An NBP status message will also be included in the graph header in an


abbreviated form, when applicable.

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NBP: Troubleshooting

Problem:
Erroneous NBP measurement

Solutions:

1. Check for proper cuff size:


a. Too small a cuff can give an erroneously high value.
b. Too large a cuff can give an erroneously low value.
2. Check for residual air left in the cuff from a previous measurement.
3. Make sure cuff is not too tight or too loose.
4. Make sure cuff and heart are at same level, otherwise hydrostatic
pressure will offset the NBP value.
5. Minimize patient movement during measurement.
6. Watch for pulsus paradoxis.
7. Check for leak in cuff or tubing.
8. Patient may have a weak pulse.
9. Calibration may be necessary.

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14 SPO2

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For your notes

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SPO2: Introduction

Introduction
127(SpO2 and SPO2 are used interchangeably in this chapter.
SPO2 monitoring is a noninvasive technique used to measure the
amount of oxygenated hemoglobin and pulse rate by measuring the
absorption of selected wavelengths of light. The light generated in the
probe passes through the tissue and is converted into an electrical signal
by the photodetector in the probe. The monitor processes the electrical
signal and displays on the screen a waveform and digital values for SpO2
and pulse rate.

The monitor offers two possible options for SpO2 monitoring, GE and
Masimo SET. This chapter provides guidelines for successful SPO2
monitoring with either configuration.

127(A Masimo SET label is displayed, next to the patient cable


connectors on the monitor, if your monitor is equipped with the
Masimo SET option.

SPO2 Cable
Connector

SPO2 Cable Connector

127(The signal input is a high-insulation port and it is defibrillator-


proof ( ).

The insulated input ensures patient safety and protects the


device during defibrillation and electrosurgery.

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SPO2: Introduction

SpO2 Probe Compatibility:


The GE SpO2 connector is compatible with Nellcor and GE probes. The
Masimo SET configuration is compatible with Masimo LNOP probes.

The SpO2 cable should plug into the SpO2 connector easily and securely.
Do not use excessive force to connect the cable. If the SpO2 cable does not
easily fit into the SpO2 connector, it is likely that you do not have the
appropriate cable for your SpO2 configuration.

Primary Monitoring Parameter


When the ECG parameter is turned off, the SPO2 parameter becomes the
primary monitoring parameter. See Turning the ECG Parameter Off or
On on page 11-4.

The following conditions apply when the ECG parameter is turned off.
n The SPO2 and SPO2 Rate parameter alarm levels default to a
warning.
n The SPO2 Pulse Search and SPO2 Probe Off system alarm levels
default to a system warning.
n The Waveforms On/Off menu and the Graph Setup menu will only
display SPO2 in the Waveform 1 setting.

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SPO2: Safety

Safety

:$51,1*6
APNEA A pulse oximeter should NOT be used as an
apnea monitor.

EARLY WARNING A pulse oximeter should be


considered an early warning device. As a trend toward
patient deoxygenation is indicated, blood samples should
be analyzed by a laboratory co-oximeter to completely
understand the patients condition.

EXPLOSION HAZARD Do not monitor SpO2 in the


presence of flammable anesthetics or other flammable
substance in combination with air, oxygen-enriched
environments, or nitrous oxide.

INACCURATE MEASUREMENTS Inaccurate


measurements may be caused by various patient or
mechanical conditions. These conditions include but are
not limited to: venous pulsations; hypotension; severe
vasoconstriction; severe anemia; hypothermia; shock;
cardiac arrest; sensor tension; sensor placement on the
same extremity as a blood pressure cuff, arterial catheter
or intravascular line; or arterial occlusion proximal to the
sensor.

INTERFERING SUBSTANCES Carboxyhemoglobin


may erroneously increase SpO2 readings. The level of
increase is approximately equal to the amount of
carboxyhemoglobin present. Dyes, or any substance
containing dyes, that change usual arterial pigmentation
may cause erroneous readings.

MASIMO SET CABLES AND PROBES Do NOT


immerse sensors or patient cables in water, solvents or
cleaning solutions. Do NOT reuse sensors intended for
single patient use. Do NOT sterilize sensors or patient
cables by irradiation, steam, or ethylene oxide.

MRI INTERFERENCE Do not monitor SpO2 or use


SpO2 probes during magnetic resonance imaging (MRI)
scanning. Induced current could potentially cause burns.
SpO2 monitoring may affect the MRI image, and the MRI
unit may affect the accuracy of the oximetry
measurements.

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SPO2: Safety

Measurements
If the accuracy of any measurement does not seem reasonable, first check
the patients vital signs by alternate means, then check the monitor for
proper SpO2 functioning.

Inaccurate pulse oximeter measurments may be caused by various


patient or mechanical conditions. See What things can create inaccurate
pulse oximeter readings? on page 14-24 for a list of examples.

SpO2 monitoring can be done during defibrillation, but the readings may
be inaccurate for a short time.

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SPO2: Neonates and Infants

Neonates and Infants


127(
This section is not applicable to monitoring SpO2 with the Masimo SET
configuration.

:$51,1*
The display of inaccurate pulse oximetry (SPO2) values
has been linked to the presence of poor signal strength or
artifact due to patient motion during signal analysis.
This condition is most likely to be encountered when the
monitor is used on neonates or infants. These same
conditions in adults do not impact the pulse oximetry
values to the same extent.

When using pulse oximetry on neonates and infants,


always observe the following precautions.

PRECAUTIONS

We recommend the application of the following criteria when using the


pulse oximetry function on neonates and infants:

1. The peripheral pulse rate (PPR) as determined by the pulse oximetry


function must be within 10% of the heart rate, and
2. the pulse oximetry signal strength indicator must have 2 or 3
asterisks displayed, and
3. six seconds of artifact-free waveform must be present, or
4. stable pulse oximetry values are displayed for six seconds.

Procedures or devices previously applied in your facility for pulse


oximetry monitoring should be used in the event that the pulse oximetry
value from the monitor cannot be validated by the above criteria.

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SPO2: Checklist

Checklist
1. SPO2 probe is correctly positioned on the patient. (Follow
instructions provided with the probe of choice.)
2. Patient cable is connected to the monitor.
3. SPO2 setup is adjusted, if necessary. Follow detailed procedures
within this chapter.

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SPO2: Patient Preparation

Patient Preparation
Prepare the patient for SPO2 monitoring using the following steps:
1. Choose the probe that is best suited to your patientear, finger,
disposable, reusable, etc.

127(
Nellcors RS-10 reflective probe is not recommended for use.
Contact Nellcor for other probe options.

2. Clean the surface of the probe before and after each patient use.
3. Following the instructions provided with the probe, correctly position
and attach the probe to your patient.

Be aware of the following general safety precautions when using SPO2


probes:

:$51,1*6
DATA VALIDITYDo not expose probe detector to
strong ambient light while monitoring a patient. A poor
signal may result.

DATA VALIDITYDo not allow tape to block the probe


light detector.

DATA VALIDITYCheck that the SPO2 waveform is


physiological in shape (not applicable when monitoring
SpO2 with the Masimo SET configuration).

PATIENT SAFETYProlonged monitoring may require


changing the probe site periodically. Move the probe if
there is any sign of skin irritation or impaired
circulation. Change the probe site at least every four
hours to prevent ischemic skin necrosis. Be particularly
careful when monitoring neonates. If required, reduce
the application periods to half the times recommended
above.

PATIENT SAFETYIf a probe is damaged in any way,


discontinue use immediately.

Be sure to read all literature accompanying probes for specific safety


information.

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SPO2: Signal and Data Validity

Signal and Data Validity


It is extremely important to determine that the probe is attached to the
patient correctly and the data is verifiable. To make this determination,
three indications from the monitor are of assistancesignal strength
indicator, quality of the SPO2 waveform, and the stability of the SPO2
values. It is critical to observe all three indications simultaneously when
ascertaining signal and data validity.

Signal Strength Indicator


The signal strength indicator is displayed within the SPO2 values
window. This indicator consists of 0, 1, 2, or 3 (strongest) asterisks
depending on the strength of the signal. Proper environmental conditions
and probe attachment will help to ensure a strong signal.

Quality of SPO2 Waveform


127(
This section is not applicable to monitoring SpO2 with the Masimo
SET configuration.

Under normal conditions, the SPO2 waveform corresponds to (but is not


proportional to) the arterial pressure waveform. The typical SPO2
waveform indicates not only a good waveform, but helps the user find a
probe placement with the least noise spikes present. The figure below
represents an SPO2 waveform of good quality.

Good Quality SPO2 Waveform

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SPO2: Signal and Data Validity

If noise (artifact) is seen on the waveform because of poor probe


placement, the photodetector may not be flush with the tissue. Check
that the probe is secured and the tissue sample is not too thick. Pulse
rate is determined from the SPO2 waveform which can be disrupted by a
cough or other hemodynamic pressure disturbances. Motion at the probe
site is indicated by noise spikes in the normal waveform. (See the figure
below.) It has been noted that letting the patient view the SPO2
waveform enables them to assist in reducing motion artifact.

SPO2 Waveform with Artifact

Stability of SPO2 Values


The stability of the displayed SPO2 values can also be used as an
indication of signal validity. Although stability is a relative term, with a
small amount of practice one can get a good feeling for changes that are
artifactual or physiological and the speed of each.

Messages are provided in the SPO2 values window to aid you in


successful SPO2 monitoring. (Refer to this chapter, Troubleshooting.)

:$51,1*
In the monitoring of patients the coincidence of adverse
conditions may lead to a disturbed signal going
unnoticed. In this situation artifacts are capable of
simulating a plausible parameter reading, so that the
monitor fails to sound an alarm. In order to ensure
reliable patient monitoring, the proper application of the
probe and the signal quality must be checked at regular
intervals.

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SPO2: Masimo SET Configuration and Probes

Masimo SET Configuration and Probes


The Masimo SET configuration is used to non-invasively measure the
amount of oxygenated hemoglobin and pulse rate. The absorption of
selected wavelengths of light is measured with Masimo LNOP probes.
Although this software processes the SpO2 measurements differently,
the function and appearance of SpO2 on your monitor is essentially the
same as SpO2 monitoring with the GE SpO2 software.

No Implied License
Possession or purchase of the Masimo SET configuration does not convey
any express or implied license to use the device with unauthorized
replacement parts which would, alone, or in combination with this
device, fall within the scope of one or more of the patents relating to this
device.

Probes
Before use, carefully read the Masimo LNOP probe directions for use.

Use only Masimo oximetry probes when monitoring SpO2 with the
Masimo SET configuration.

&$87,21
Tissue damage can be caused by incorrect application or
use of an LNOP probe, for example by wrapping the
probe too tightly. Inspect the probe site as directed in the
probes directions for use to ensure skin integrity and
correct positioning and adhesion of the probe.

Do not use damaged LNOP probes. Do not use an LNOP probe with
exposed optical components. Do not immerse the probe in water,
solvents, or cleaning solutions. The probes are not waterproof. Do not
sterilize by irradiation, steam, or ethylene oxide. See the cleaning
instructions in the directions for use for reusable Masimo LNOP probes.

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SPO2: SPO2 Monitoring Features

SPO2 Monitoring Features


SPO2 Information
A waveform, labeled SPO2, will be displayed on the screen when the
patient cable is connected to the monitor. Numerics are also displayed in
the SPO2 parameter windows on the right side of the screen.

127(Visual indication of the patients pulse is not proportional to the


pulse amplitude.

SPO2 Value
Strength of Signal
Indicator

Limits and
Units

Pulse Rate Value

SPO2 Parameter Window

The current SPO2 value and the derived pulse rate (RATE) are
displayed. The asterisks indicate the strength of the signal (three
asterisks indicate the strongest signal).

The GE SPO2 measurements are averaged over a 6-second period of time


in adult mode and 12 seconds in neonatal mode. The different averaging
time in neonatal mode is to help decrease false alarms related to patient
motion artifact.

The Masimo SET SPO2 measurements are averaged over a 8-second


period of time in adult mode and 8 seconds in neonatal mode.

The monitor display is updated every 2 seconds.

The SPO2 monitoring features are found in the SPO2 menu. These
features include waveform size, alarm limit adjustment, display of
RATE, RATE volume, SENSITIVITY, and AVERAGING.

SPO2 and NBP Simultaneously


When monitoring SpO2 and NBP simultaneously, a feature called SpO2-
NBP interlock is available. This is a feature that prevents SpO2 alarms
from sounding during an NBP measurement. However, if SPO2 is
alarming when an NBP measurement begins, SPO2 will continue to
alarm during the NBP measurement.

The SPO2-NBP interlock feature defaults ON. It can be turned on and off
using the Setup Default Display window in the Monitor Setup menu.

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SPO2: SPO2 Monitoring Features

Getting to the SPO2 Menu


To display the SPO2 menu, use the Trim Knob control to select the SPO2
parameter label. Remember, selecting with the Trim Knob control is a
two-step processrotate to highlight, then press to select.

Selecting the SPO2 Parameter Label

The SPO2 menu is displayed at the bottom of the screen. The menu
options that appear are dependent on the type of SPO2 software and
probe used.

SPO2 Menu GE and Nellcor Probes

823A

Masimo SET SPO2 Menu Masimo Probes

With the Trim Knob control, you now can select any of the displayed
options:
n SIZEadjust the size of the displayed SPO2 waveform.
n RATEturn the displayed rate value off and on.
n RATE VOLturn the rate volume on/off; adjust the volume when on.
n SPO2 LIMITSdisplay a new menu and an information window to
adjust SPO2 percent and rate (beats per minute) alarm limits.
n SENSITIVITY Adjusts the Masimo probe sensitivity.
n AVERAGING Adjusts the SPO2 averaging time, when using
Masimo-compatible probes.
n SPEEDchange the sweep speed for the displayed SPO2 waveform.

Detailed information on each option is found in this chapter.

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SPO2: SPO2 Menu Options

SPO2 Menu Options


Size
The SIZE option allows you to change the size of the displayed SPO2
waveform.

1. Select SIZE option from the SPO2 Menu. A popup menu opens
showing all sizes available. The current size is highlighted.

SIZE Popup Menu

2. Rotate the Trim Knob control to change the size. The change occurs
immediately on the screen.
3. When you are satisfied with your selection, press the Trim Knob
control to close the popup menu.

Rate
A pulse rate is derived from the SPO2 signal and is displayed in the
parameter window. You can turn this displayed rate off and on. Simply
select the RATE option from the SPO2 Menu. This is a direct action
menu option.

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SPO2: SPO2 Menu Options

Rate Volume
The RATE VOL option turns on a tone which sounds each time an SPO2
pulse is detected. This is a variable pitch tone which changes as the
patients saturation level changes; as the saturation level decreases, the
pitch of the tone also decreases. The volume of this tone can be adjusted
up or down.
1. Select RATE VOL option from the SPO2 Menu. A popup menu opens
displaying all choices.

RATE VOL Popup Menu

2. Rotate the Trim Knob control. You will hear the tone volume when
an option is highlighted. Press the Trim Knob control to confirm the
change and close the popup menu.

127(Turning the rate volume on will automatically turn the QRS


volume off.

When in OR mode, the 10% and 20% volume tones are slightly quieter
than the 10% and 20% volume tone in Adult-ICU and Neonatal-ICU
modes.

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SPO2: SPO2 Menu Options

SPO2 Limits
This option provides an information window with bar graphs that show
the alarm limits for SPO2 and pulse rate. A new set of menu options is
displayed to allow you to adjust these limits.

Follow this procedure:

1. Select SPO2 LIMITS option from the SPO2 Menu. An information


window is displayed on the screen and a new set of menu options is
displayed in the menu area.

Pressure Parameter

High Range

High Limit

Low Limit

Low Range

SPO2 LIMITS Menu and Information Window


The information window shows the range as well as the alarm limits.
The pointer (>) indicates the current value of that parameter for the
monitored patient. As long as that value remains between the high
and low limits, there will be no alarm. Should the value exceed one of
the limits, an alarm will occur.

2. To change a set limit, for example the SPO2 low limit, select SPO2
LOW LIMIT option from the limits menu. A popup menu opens.

SPO2 LOW LIMIT Popup Menu

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SPO2: SPO2 Menu Options

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until
the Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Follow this procedure to set any other SPO2 limit. Select PREVIOUS
MENU to exit the Limits Menu and return to the SPO2 Menu.

Sensitivity
127(
This menu option only appears when monitoring SpO2 using the
Masimo SET configuration.

The Sensitivity menu option allows you to select NORMAL or


MAXIMUM sensitivity. The default setting is NORMAL.
n Use the Normal sensitivity setting for normal patient monitoring
purposes.
n Use the Maximum sensitivity setting for improved low perfusion
performance and for faster tracking of rapid SpO2 saturation
changes.

&$87,21
Using the Maximum sensitivity setting delays the Probe
Off Patient detection alarm.

Averaging
127(
This menu option only appears when monitoring SpO2 using the
Masimo SET configuration.

The Averaging menu option provides the following selections for SpO2
averaging time: 4, 6, 8, 10, 12, 14, or 16 seconds. The default averaging
time for all monitoring modes is 8 seconds. The selected averaging time
is displayed on the Averaging menu option.

127(
For the 4- and 6-second averaging settings, the actual averaging
times may range from 2 to 4 seconds and 4 to 6 seconds, respectively.

Speed
Use this menu option to open a popup menu to select a sweep speed for
all displayed SPO2 waveforms. Choices are 6.25, 12.5, and 25 (factory
default) millimeters per second.

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SPO2: Probe Off Patient Condition

Probe Off Patient Condition


When using a reusable finger probe, there is a system alarm to alert you
when the probe is off the patient. The monitor defaults this probe off
patient condition as a System Warning alarm. You can, however, set it
as a System Advisory alarm in Monitor Defaults. Refer to Setup Default
Display section in Chapter 5, Monitor Setup. It is identified as SPO2
PROBE OFF in the Setup Display information window.

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SPO2: Pulse Search Condition

Pulse Search Condition


When using a reusable finger probe or a Masimo adhesive probe, there is
a system alarm to alert you when detection of a repeatable pulse has
ceased. This Pulse Search condition defaults to a system advisory
alarm. You can change it to a system warning alarm in Monitor Defaults.
Refer to the Setup Default Display section in Chapter 5, Monitor Setup.
It is identified as SPO2 PULSE SEARCH in the Setup Display
information window.

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SPO2: Troubleshooting

Troubleshooting
SPO2 Messages
Below is a list of system status alarm messages which may be displayed
in the SPO2 parameter window during monitoring. SPO2 messages will
appear in abbreviated form in graph headers.

If you are unable to resume SPO2 monitoring, call GE Service at 1-800-


558-7044 (US only). Outside the United States, please contact your sales/
service office.

LOW QUALITY SIGNAL


SPO2 data continues to be displayed, but the quality of the signal is
questionable. Check the patient and the probe.

PROBE IS OFF THE PATIENT


The disposable or reusable probe is off the patient. No SPO2 data is
displayed. Check the probe.

127(
The factory default for this alarm is system warning. You can set it to
be a system advisory alarm in your Monitor Defaults.

PROBE OR MODULE MALFUNCTION

No SpO2 data is displayed due to a hardware failure or an unrecognized


or defective probe. This message will only appear when monitoring SpO2
with the Masimo SET configuration.

Try the following solutions in order:

1. Change the probe.


2. Change the cable.
If the message remains, the system may have detected hardware
failures. These failures are recorded in the Input Error Log.

3. Call service.

127(
The factory default for this alarm is system warning.

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SPO2: Troubleshooting

POOR SIGNAL QUALITY DETECTED


The SPO2 signal is too low. No SPO2 data is displayed. This can be
due to a low patient pulse, patient motion, or some other
interference. Check the patient and the probe.

PULSE SEARCH
One of the following conditions is indicated:

u Defective or damaged probe.


u Defective or damaged cable.
u Probe is off of the patient.
u Detection by the monitor of a repeatable pulse has ceased.

Check the patient. Then, check the probe and cable; reposition or
replace as needed.

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SPO2: Troubleshooting

The following clinical questions are frequently asked about SPO2


monitoring. These may help in troubleshooting when monitoring SPO2.

Why does the monitor (pulse Arterial Blood Gas analyzers calculate the O2 saturation based on
oximeter) sometimes read normal values for pH, PaCO2, Hb, temperature, etc. (i.e., a normal
differently than an ABG? oxyhemoglobin dissociation curve). Depending on the patients
physiologic and metabolic status, his curve and all his values may be
shifted away from normal. Thus the oximeter, which measures O2
saturation, may not agree with the ABG.

A CO-Oximeter is an analyzer which also measures O2 saturation. The


saturation of hemoglobin may be much closer to a pulse oximeter in these
cases.

How does a pulse oximeter read All pulse oximeters utilize two wavelength absorption. This is because
the various types of hemoglobins? reduced hemoglobin (RHb) and oxyhemoglobin (HbO2) absorb these two
wavelengths differently. The hemoglobin saturation is then figured from
the measured amounts of the hemoglobins: (SpO2HbO2)/(HbO2 + RHb).
Carboxyhemoglobin (COHb) absorbs similarly to HbO2 and thus can
raise the SpO2. Normal levels of COHb are 1-2%. Methemoglobin
(MetHb) usually represents less than 1% total Hgb, but in cases such as
some IV dyes, antibiotics, etc. this level may go up sharply. MetHb
absorbs similarly to RHb, and thus could lower the SpO2 reading. Fetal
Hb absorbs like adult Hb, thus the oximeter has the same accuracy with
neonates and adults.

What effect can ambient light have Ambient light can have numerous effects. In the newborn, ICU bili lights
on pulse oximetry monitoring? can affect the readings of the oximeters. Outside light striking the probe
detector can give poor waveform and inaccurate readings. Sunlight or
bright indoor lights can have the same effect in other areas of the
hospital using oximetry. Error message of PROBE IS OFF PATIENT is
possible. Shielding the probe with opaque tape, the posey wrap or other
material can thus increase oximetry accuracyverified by good
waveform and signal strength.

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SPO2: Troubleshooting

What things can create inaccurate Certain IV dyes, such as methylene blue or indocyanine green, can affect
pulse oximeter readings? the readings. Methylene blue will give falsely low readings due to excess
absorption of the Red wavelength.

Nail polish, especially violets and blues, can also reduce the reading due
to the same absorption. Removal of the polish is always recommended.

Long nails, and artificial or acrylic nails can interfere with good LED/
detector opposition through the tissue.

Patients with deeply pigmented skin may be tough to monitor, although


finger pigmentation is usually less than the rest of the body.

Patients with Sickle Cell Anemia undergoing a sickling crisis may have
erroneous readings due to the absorption spectrum of HbS being
different than for normal adult Hb.

Severely jaundiced patients have high levels of bilirubin in their blood. A


product of bilirubin metabolism is CO and thus high levels of
carboxyhemoglobin can be formed, causing the oximeter to read
artificially high SPO2.

Patients with severe anemia can have low SPO2 readings.

Patients with heavy smoke inhalation can have transiently high CO


levels and thus a high amount of Carboxyhemoglobin.

Significant levels of dysfunctional hemoglobins (e.g., carboxyhemoglobin


or methemoglobin).

127(Certain antibiotics, such as the Sulfas, can create high levels of


methemoglobin. Methemoglobin is unable to bind O2 and will
absorb light similarly to reduced hemoglobin, thus giving an
artificially low SPO2.
Exposure to excessive illumination, such as surgical lamps, bilirubin
lamps, fluorescent lights, infrared heating lamps, or direct sunlight.

127(Exposure to excessive illumination can be corrected by covering


the probe with a dark or opaque material.

Incorrect probe application or use.

Sensor is too tight.

Venous pulsations.

Placement of a probe on an extremity with a blood pressure cuff, arterial


catheter, or intravascular line.

Excessive patient movement.

Excessive environmental motion or electromagnetic interference may


prevent tracking of pulse. Measurements may seem inappropriate or the
monitor may not seem to operate correctly.

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SPO2: Troubleshooting

What does electrosurgical Electrosurgical interference will be most obvious on the displayed
interference look like and how can waveform. It is a very spiky, erratic looking waveform caused by the
it be minimized? electrosurgical units overwhelming interference in the OR. It can result
in grossly inaccurate pulse oximeter parameters.

Electrosurgical interference can be minimized by:

Making sure the pulse oximeter probe is as far away from the return pad
and operating site as possible.

Making sure the probe is not between the return pad and operating site.

Keeping the power cord and probe cable away from the power cord of the
electrosurgical unit.

Plugging the electrosurgery unit into a separate set of outlets from the
monitor.

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SPO2: Troubleshooting

127(
This section is not applicable to monitoring SpO2 with the Masimo SET
configuration.

What does motion artifact look like, Motion artifact occurs with excessive motion of the probe, the cable
what problems can it cause, and leading to the probe or the cable/probe junction. In other words anything
how can it be corrected? that causes any of these things to move, like the patient moving his
hands, or the cable laying across the ventilator tubing and being moved
with every cycle, can cause motion artifact. A non-arterial, often erratic
looking waveform, and a pulse rate that does not coincide with the HR on
the ECG will result.

The main problem motion artifact can cause is erroneous SPO2 readings.

Motion artifact can be reduced, if not eliminated, by selecting a quieter


site on the patient. An ear probe if he refuses to keep his hands still, or
an adhesive probe on the toe, an adhesive probe on the little finger for an
adult, or on the sole of the foot in a newborn, can help greatly.

Cable movement can be reduced by applying the probe with the cable
leading toward the patient, then taping the cable to the side of the hand
or foot. In the case of the butterfly probe, the tape was designed to secure
the cable to the finger.

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15 Cardiac Output

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For your notes

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Cardiac Output: Introduction

Introduction
127(This option is part of the Cardiopulmonary software package.
The cardiac output (CO) program allows measurement of cardiac output
by use of a thermodilution catheter with information processed by the
monitor. A numeric value and, during measurement, a real-time cardiac
output washout curve are displayed on the monitors screen. The
program allows you to perform multiple measurements and to delete
those not wanted. Up to four measurements are retained. The program
will automatically average these and, when saved, enter the averaged
values into cardiac calcs and vital signs.

Connect the cardiac output patient cable to the TEMP/CO connector on


the front of the monitor. Because the cardiac output connector on the
monitor is also used for temperature, cardiac output and temperature
cannot be monitored at the same time.

TEMP/CO Cable
Connector

TEMP/CO Cable Connector

127(The signal input is a high-insulation port and it is defibrillator-


proof ( ).

The insulated input ensures patient safety and protects the


device during defibrillation and electrosurgery.

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Cardiac Output: Introduction

Cardiac Output Washout Curve


The washout curve, which appears on the screen after a CO injection,
shows the drop in blood temperature as the injectate mixes with the
blood. The peak of the curve indicates the maximum difference in the
patients baseline blood temperature and the temperature of the
injectate solution. As the mixture passes through the catheter and then
out the pulmonary artery, the temperature difference decreases as
indicated by the curve returning to baseline. A spike is displayed at the
onset of the curve, again at 70% of the maximum temperature difference,
and again at 35% of the maximum temperature difference. This curve is
reproduced in reduced size at the top of the trial chart.
70% Spike

35% Spike
Onset Spike

Baseline

Cardiac Output Washout Curve

Influencing Factors
Some of the factors which affect cardiac output are:
n The technique used in performing a cardiac output,
n Temperature of injectate solution,
n Volume of injectate solution,
n Patients baseline blood temperature,
n Patients inspiratory/expiratory cycle,
n Placement of catheter with relation to proximity of lung field,
n The swan ganz catheter itself,
n The patients rhythm and hemodynamic status, and
n Any other rapid IV solutions which are infused while the cardiac
output is being performed.

Technique
Following are some technique suggestions to obtain accurate cardiac
output:
n Always hold syringe by plunger, not barrel.
n Injectate solution must be cooler than the patients blood
temperature.
n Inject solution rapidly and smoothly.
n Inject over 4 to 5 seconds.
n Inject at end expiration.
n Wait 1 minute between injections to allow baseline to stabilize.

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Cardiac Output: Suggested Cardiac Output Procedure

Suggested Cardiac Output Procedure


Following is a summary of the entire cardiac output procedure. It is
provided to give you an overall picture of the process. The rest of the
chapter includes details and additional information which you should
read. This suggested procedure can be a handy reference once you are
familiar with the details.
1. Determine whether an in-line sensor or bath probe sensor is being
used for cardiac output. Set up cables and prepare the patient
accordingly. (Refer to setup diagrams on pages 15-8 and 15-9.)
2. Select the CO parameter label on the monitor. Depending on the
mode, you will see one of two messages: INJECT WHEN READY,
or PUSH CO NOW OR TURN AUTO ON. The CO menu and a
cardiac output trials chart are also displayed.
3. Adjustments can be made at this time using the menu options
provided. Adjustments you may need to make include:
a. Type of injectate temperature probein-line or bath probe
b. Injectate volume
c. Use of PAW, PAD, or LA in cardiac calculations
d. Type of catheter
e. Catheter size
f. Computation constant
127(If UNSTABLE BT DETECTED message is displayed, the
monitor cannot detect an injection. Refer to this chapter,
Troubleshooting.

4. When adjustments are complete, you can proceed. If the message


reads INJECT WHEN READY, proceed with the injection.
If the message reads PUSH CO NOW OR TURN AUTO ON, you
must either select CARDIAC OUTPUT NOW or select AUTO MODE
and turn it ON. Then watch for the INJECT NOW! message. Inject
when you see the message.

A few seconds after injecting, the washout curve begins to move


across the screen and the message COMPUTING CO is displayed.

5. If you want a copy of the washout curve, select PRINT CO CURVE


option with the Trim Knob control (do not use the GRAPH GO /
STOP key) when the curve is displayed on the screen.
The curve will continue to move across the screen. Soon the message
CO COMPLETE is displayed with a CO value. A manual graph of
the curve (if requested) is printed. In addition, the first column in the
chart is filled with values relevant to the cardiac output just
performed. Note also that an average is displayed in the AVG
column.
6. Perform another injection when prompted. You can do as many
injections as you want; however, the monitor only retains four. When
a fifth injection is done, the first is deleted, etc.

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Cardiac Output: Suggested Cardiac Output Procedure

7. When all injections are done, select DELETE CO TRIALS option if


you want to edit (delete) any of the displayed trials. The monitor will
recalculate the average CO.
8. If you want a copy of the cardiac output trials information, press the
GRAPH GO / STOP key on the monitor.
127(The washout curves on the screens chart do not print with
the rest of the information.

9. When editing is complete, select CARDIAC CALCS option. The


cardiac output information window is replaced with the cardiac
calculations information window. The average from the cardiac
output trials appears in the list of calculations.
10. If necessary, use the CHANGE VALUE option to edit any of the
monitored parameter values.
11. Press GRAPH GO / STOP key if you want a copy of this set of
cardiac calculations.
12. IMPORTANTWhen satisfied with the set of cardiac calculations,
select SAVE CALC option. This stores the set of calculations. You can
view all saved sets in Vital Signs.
13. Select REVIEW CALCS to enter the Vital Signs program and see the
Card Calcs data.

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Cardiac Output: Checklist

Checklist
1. Catheter is in place in the patient.
2. Cardiac output cable is connected to the monitor.
3. Depending on your setup choice, be sure that the:
u In-line sensor is securely connected to tubing, or
u Bath probe is correctly sensing injectate temperature.
4. Cardiac output default settings are adjusted, if necessary. Follow
detailed procedures within this chapter.

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Cardiac Output: Bath Probe Setup

Bath Probe Setup


Injectate or Proximal Port

Cable to Monitor
Balloon Inflation Port

Distal Port
Cable to
Transducer

PA Catheter

Bath Probe

BT Sensor CO Syringes
(Thermistor)

Cable Setup for Bath Probe Sensor

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Cardiac Output: In-Line Setup

In-Line Setup
CO Syringes
Solution

Injectate or
Proximal Port Cable to Monitor

Balloon Inflation Port

InLine
Sensor

Distal Port

Cable to Transducer
PA Catheter

BT Sensor
(Thermistor)

Cable Setup for In-Line Sensor

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Cardiac Output: Cardiac Output Monitoring Features

Cardiac Output Monitoring Features


Cardiac Output Information
When the cardiac output cable is attached to the monitor, a CO
parameter window is displayed. (A CO waveform is displayed only
during the injection procedure.)
Blood Temperature Value

Limits and
Units

CO Parameter Label and Windows

The parameter window displays the patients blood temperature. Blood


temperature limits and units of measurement may also be displayed.

After you have completed a set of cardiac output trials, entered cardiac
calculations and performed a SAVE CALC, the last average CO value
with a time stamp is displayed in the parameter window.

CO Parameter Label and Windows

The CO monitoring features are found in the CO menu. These features


include editing, adjusting limits, injectate volume, catheter size, entering
a different computation constant, and cardiac calculations.

127(A cardiac output measurement (injection) is also referred to as a


cardiac output trial.

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Cardiac Output: Cardiac Output Monitoring Features

Cardiac Output Trials


Upon entering the cardiac output program, you will see a display on the
screen similar to the one below.

127(If you have an Adult-ICU or an Operating Room optional remote


control, you can also access the cardiac output program by
pressing the Cardiac Output key.

The patient display automatically shifts to the individual display mode.


The fifth and sixth waveform displays are cleared and this space is
dedicated to the cardiac output waveform. An information window is
displayed where the cardiac output trial information can be viewed.
Upon exiting the program, the display returns to the previous
configuration.

Cardiac Output Auto Mode

The information window displays for each cardiac output trial a review
CO curve, the derived CO value, and the patients heart rate and other
vital signs at the time of the cardiac output. Any cardiac rhythm
disturbances (row labeled RHY) will also be noted. Additionally, if the
patients height and weight have been entered in cardiac calcs, other
calculated parameters, for example, CI, will be displayed. (To view all
calculated parameters you need to enter cardiac calculations.)

127(The last average CO value and time are cleared from the
parameter window after the first new CO trial is completed.

Lets take a closer look at the area of the screen where the waveform will
be displayed.

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Cardiac Output: Cardiac Output Monitoring Features

The last CO trial value will be displayed here


Program messages and the washout until the next message is displayed.
curve appear here.

Look here following an injection to see what computation This is the baseline.
constant (CC), injectate temp (IT), and patient blood
temp (BT) were used to calculate CO.

CO Screen Information

If auto mode is on and a stable baseline is detected, the INJECT WHEN


READY message is displayed.

This message means exactly what it says; make your injection when you
are ready. If necessary you can make adjustments to the injectate
volume, temperature, catheter, and catheter size before beginning an
injection. (Refer to procedures for these options in this section.)

If manual mode is on, the message PUSH CO NOW OR TURN AUTO


ON is displayed. You must either select CARDIAC OUTPUT NOW
option or the AUTO MODE option to proceed.

Following is what occurs on the display as an injection is made:

1. A new message, COMPUTING CO, is displayed and the real-time


cardiac output washout curve begins to move across the screen.
2. The message CO COMPLETE is displayed with the CO value.
3. The first blank column in the information window is filled with
values obtained from the cardiac output procedure. Note that a
miniature version of the washout curve is shown above the column.

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Cardiac Output: Cardiac Output Monitoring Features

Getting to the Cardiac Output Menu


To display the CO menu, use the Trim Knob control to select the CO
parameter label. The CO menu is displayed at the bottom of the screen.
You can perform a cardiac output trial when ready, or use the Trim Knob
control to select any menu option.

127(If you have an Adult-ICU or an Operating Room optional remote


control, you can also access the cardiac output menu by pressing
the Cardiac Output key.

Cardiac Output Menu


n DELETE CO TRIALSdelete those trials not acceptable.
n CARDIAC CALCSenter the cardiac calculations program.
n CARDIAC OUTPUT NOWperform one measurement each time
this option is selected. Use this option when audo mode is off.
n BT LIMITSa new menu is displayed with an information window
to adjust blood temperature limits. There is also a menu option to
change units between Celsius and Fahrenheit.
n PRINT CO CURVEprint a copy of the CO waveform.
n AUTO MODEturn auto mode off and on.
n USE: PAW*select PAW, PAD, or LA to be factored in the cardiac
calculations.
n CATHETER*select the catheter type.
n INJECT TEMP*choose injectate temperature probe (in-line or
bath).
n SIZE*change the catheter French size.
n INJECT VOL*adjust the injectate volume.
n COMPUTATION CONSTANT*enter a different computation
constant.
n CARDIAC OUTPUT HELPdisplay an information window with
troubleshooting information.
* Changing after one or more trials have been performed will erase the
trials.

Detailed information on each option is found in this section.

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Cardiac Output: Cardiac Output Menu Options

Cardiac Output Menu Options


Delete CO Trials
The monitor displays up to four cardiac output trials. If a fifth trial is
made, the oldest trial is deleted, and so on. The AVG (average) column
keeps a running average of the displayed cardiac output trials. You can
delete any or all of the displayed trials. Follow this procedure:

1. Select DELETE CO TRIALS option from the cardiac output menu. A


popup menu opens. The numbers shown in the popup menu
correspond to the numbers at the top of each column in the trials
window. In the example below, the first four trial numbers are
displayed for editing.

DELETE CO TRIALS Popup Menu

2. If you want to delete trial 2, rotate the Trim Knob control so the
pointer (>) is in front of the number 2.
3. Press the Trim Knob control. The number highlights. The popup
menu remains open so you can select another trial to delete if you
wish. If you change your mind and dont want to delete just press the
Trim Knob control again to deselect (unhighlight) the number.
4. When the appropriate numbers are highlighted, rotate the Trim
Knob control so the pointer is in front of RETURN.
5. Press the Trim Knob control. The popup menu closes and the selected
trials are deleted from the cardiac output trials window.
6. Select CARDIAC CALCS option. (Refer to Cardiac Calculations in
this chapter.)

Cardiac Calcs
See this chapter, Cardiac Calculations.

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Cardiac Output: Cardiac Output Menu Options

Cardiac Output Now


Use the CARDIAC OUTPUT NOW option when auto mode is off.

When auto mode is off, the monitor does not search for a stable baseline
and, therefore, you decide when to begin the injection procedure. When
you are ready, select CARDIAC OUTPUT NOW option and inject when
you see the INJECT NOW! message. This mode may be preferred with
patients with extreme blood temperature fluctuations.

Particularly important with this option is that you inject immediately


upon seeing the INJECT NOW! message. If you wait too long to make
the injection, the monitor will cycle itself and the message PUSH CO
NOW OR TURN AUTO ON is displayed again.

To use the Cardiac Output Now option, follow this procedure:

1. Select CARDIAC OUTPUT NOW option from the cardiac output


menu. Watch for the INJECT NOW! message then make your CO
injection.
2. The COMPUTING CO message is displayed and the cardiac output
waveform begins to move across the screen.
3. The message CO COMPLETE is displayed with the new CO value.

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Cardiac Output: Cardiac Output Menu Options

BT Limits
This option provides an information window with a bar graph that shows
the alarm limits for blood temperature. A new set of menu options is
displayed to allow you to adjust the limits.

Follow this procedure:

1. Select BT LIMITS option from the CO Menu. An information window


is displayed on the screen and a new set of menu options is displayed
in the menu area.

High range and, in this


example, high limit too.

Low Limit

Low Range

BT LIMITS Menu and Information Window

The information window shows the range as well as the alarm limits.
The pointer (>) indicates the current blood temperature value for the
monitored patient. As long as that value remains between the high
and low limits, there will be no alarm. Should the value exceed one of
the limits, an alarm will occur.

2. To change a set limit, for example the low blood temp limit, select BT
LOW LIMIT option from the limits menu. A popup menu opens.

BT LOW LIMIT Popup Menu

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Cardiac Output: Cardiac Output Menu Options

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will NOT be in effect until
the Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Follow this procedure to set the high limit. Select PREVIOUS MENU
to exit the limits menu and return to the CO Menu.

Units
This direct action menu option switches the units of measurement for
blood temperature and injectate temperature between Celsius and
Fahrenheit.

Print CO Curve
Selecting this option will print the real-time cardiac output curve to the
designated manual graph location. The request for a print can be made
any time during the measurement process. This is a direct action menu
option. The message GRAPHING MANUAL will be displayed when the
waveform is printing. If you dont see the message immediately, it means
you requested the graph early in the process. The monitor remembers
your request, and will start printing when the measurement is complete.

If you press the GRAPH GO/STOP key during a measurement, only the
information window data will be printed. You must use the Trim Knob
control and select PRINT CO CURVE if you want the CO curve printed.

Auto Mode
Select the AUTO MODE menu option to open a popup menu from which
you can turn the auto mode off and on. This can be set as a Monitor
Default. (The factory default is AUTO MODE: ON.)

AUTO MODE Popup Menu

When auto mode is on, the monitor automatically searches for a stable
baseline temperature by averaging approximately 8.5 seconds of the
patients blood temperature. Once a stable baseline is established, the
message INJECT WHEN READY is displayed, and you can proceed.

Use: PAW (PAD, LA)


This option allows you to select one of three pressure values pulmonary
artery wedge (PAW), pulmonary artery diastolic (PAD), or left atrial
(LA)to be used in the calculations.

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Cardiac Output: Cardiac Output Menu Options

Follow this procedure:

1. Select USE option from the CO menu. A popup menu opens


displaying all options.

USE Popup Menu

2. Rotate the Trim Knob control to move the pointer (>) in front of the
pressure desired. The change will NOT be in effect until the Trim
Knob control is pressed and the popup menu closed.
127(It is recommended that you adjust the pressure selection
before an injection is begun. If you select this option and
make a change after one or more cardiac output trials have
been done, the trials will be deleted. This does not affect any
calculations already saved.

3. Press the Trim Knob control to confirm the change and close the
popup menu.

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Cardiac Output: Cardiac Output Menu Options

Catheter
Use this option to change catheter types. Selecting another catheter type
causes the monitor to automatically guide you through INJECT TEMP,
SIZE, and INJECT VOL options to assure that your setup is the one you
want. You do not need to enter a computation constant as the software
calculates one based on the manufacturer selected and the temp, size and
volume settings.

127(It is recommended that a catheter change be made before an


injection is begun. If you select this option and make a change
after one or more cardiac output trials have been done, the trials
will be deleted. This does not affect any calculations already
saved.

1. Select CATHETER from the CO Menu. A popup menu is displayed.

CATHETER Popup Menu

2. Use the Trim Knob control to move the pointer (>) to the catheter
manufacturer of choice, then press the Trim Knob control. The
monitor automatically opens the temp, size, and volume popups.

127(Selecting OTHER automatically opens the computation constant


popup menu. You will have to manually enter the computation
constant found in the literature for the catheter you are using.

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Cardiac Output: Cardiac Output Menu Options

Injectate Temperature
The temperature of the injectate is determined by the type of sensor
usedin-line or bath probe. It is important to have the monitor set for
the type of sensor used to assure a valid CO reading. Changing this
option will cause the monitor to calculate a new computation constant
when the next trial is done.

If you need to change this option, follow this procedure:

127(It is recommended that you make this adjustment BEFORE an


injection is begun. If you select this option and make a change
AFTER one or more cardiac output trials have been done, the
trials will be deleted. This does NOT affect any calculations
already saved.

1. Select INJECT TEMP option from the CO Menu. A popup menu


opens displaying the two choices.

INJECT TEMP Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of BATH. The
change will not be in effect until the Trim Knob control is pressed
and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

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Cardiac Output: Cardiac Output Menu Options

Size
This option allows you to select the size of the catheter being used.
Changing this option will cause the monitor to calculate a new
computation constant when the next trial is done.

127(It is recommended that you make this adjustment BEFORE an


injection is begun. If you select this option and make a change
AFTER one or more cardiac output trials have been done, the
trials will be deleted. This does not affect any calculations
already saved.

If you need to change the size, follow this procedure:

1. Select SIZE option from the CO Menu. A popup menu is displayed


showing all options.

SIZE Popup Menu

2. Rotate the Trim Knob control to move the pointer (>) in front of the
size you want. The change will NOT be in effect until the Trim Knob
control is pressed and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

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Cardiac Output: Cardiac Output Menu Options

Injectate Volume
If you want to change the injectate volume, follow the procedure below.
When using a Baxter, Abbott, Ohmeda, or Arrow catheter setup,
changing this option will cause the monitor to calculate a new
computation constant when the next trial is done.

127(It is recommended that you make this adjustment BEFORE an


injection is begun. If you select this option and make a change
AFTER one or more cardiac output trials have been done, the
trials will be deleted. This does not affect any calculations
already saved.

1. Select INJECT VOL option from the CO Menu. A popup menu opens
displaying all options.

INJECT VOL Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of the volume
desired. The change will NOT be in effect until the Trim Knob control
is pressed and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu.

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Cardiac Output: Cardiac Output Menu Options

Computation Constant
The computation constant is the important factor in an accurate cardiac
output value. If you are using a Baxter, Abbott, Ohmeda, or Arrow
catheter, the software will automatically enter a computation constant.
Whenever INJECT VOL (volume), INJECT TEMP (type of sensor), and
SIZE (catheter size) are changed in the menu, a new computation
constant will automatically be computed and used.
This option is used when you are using a brand of catheter other than
those listed in the CATHETER option. Consult the catheter
manufacturers package insert to find the recommended computation
constant for your setup.
To enter the new computation constant, follow this procedure:

127(If you select this option and make a change AFTER one or more
cardiac output trials have been done, the trials will be deleted.
This does not affect any calculations already saved.

The computation constant will read 0.000 when the cable is first
connected and prior to the first injection. If you MANUALLY set
this option to 0.000, you will be unable to successfully complete a
cardiac output trial.

When you manually enter a computation constant, the other


menu options (volume, temp and size) are not needed. You may
go ahead and change them to reflect your setup, but they have no
effect on the software.

1. Select COMPUTATION CONSTANT option from the CO Menu. A


popup menu is displayed.

COMPUTATION CONSTANT Popup Menu

2. Rotate the Trim Knob control or use the number keys on the optional
remote control to change the displayed number. The change will
NOT be in effect until the Trim Knob control is pressed and the
popup menu is closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu. The CC value displayed to the left in the waveform area
will not reflect the change you made until after the first cardiac
output trial is complete. Notice that the CATHETER menu option
will read CATHETER: OTHER.

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Cardiac Output: Cardiac Output Menu Options

Cardiac Output Help


Selecting this option will open a popup menu and an information
window. The information window contains technique tips as well as some
possible reasons for an unstable baseline message. Press the Trim Knob
control to close the popup menu and the information window.

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Cardiac Output: Cardiac Calculations

Cardiac Calculations
Introduction
The cardiac calculations program displays important hemodynamic
parameter values. These parameters are separated into two
classifications: monitored parameters and calculated parameters. A
menu is provided to change or enter a monitored parameter value.

Monitored Parameters
The monitored parameter values are obtained from available monitored
patient data. Only two values must be entered manually: weight and
height.

The chart below shows the monitored parameters, the labels used to
identify these parameters on the screen, and the units of measure.

Monitored Parameters

Parameter Label Units

Cardiac Output CO L/MIN


Heart Rate HR BPM

Mean Arterial Pressure MAP mmHg

Central Venous Pressure CVP mmHg


Pulmonary Artery Mean PAM mmHg

Pulmonary Artery Wedge* PAW mmHg

Pulmonary Artery Diastolic* PAD mmHg

Left Atrial* LA mmHg

Weight WEIGHT KG or LBS

Height HEIGHT CM or INCHES


* Menu selectable; only one is used at a time

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Cardiac Output: Cardiac Calculations

Calculated Parameters
The calculated parameter values are figured automatically. The chart
below shows the calculated parameters, the labels used to identify these
parameters on the screen, the units of measure, and the formulas used.

Calculated Parameters

Parameter Label Units Formula

Body Surface Area BSA m2 HT0.725 WT0.425 0.007184

Cardiac Index CI L/min/m2 CO/BSA

Stroke Volume SV mL/beat CO/HR 1000


Systemic Vascular Resistance SVR dyn sec cm5 [(MAPCVP) 79.92]/CO

Systemic Vascular Resistance Index SVRI dyn sec cm5 m2 SVR BSA

Pulmonary Vascular Resistance PVR dyn sec cm5 [(PAMPAW) 79.92]/CO*

Pulmonary Vascular Resistance Index PVRI dyn sec cm5 m2 PVR BSA

Left Ventricular Stroke Work Index LVSWI g m/m2 [SV (MAPPAW) 0.0136]/BSA*

Right Ventricular Stroke Work Index RVSWI g m/m2 [SV (PAMCVP) 0.0136]/BSA

* If using pulmonary artery diastolic (PAD) pressure or left atrial (LA) pressure, PAW will be substituted with PAD or LA.

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Cardiac Output: Cardiac Calculations

Cardiac Calcs
Follow this procedure to enter the cardiac calculations program upon
completion of cardiac output trials.
1. Select CARDIAC CALCS option from the CO Menu. An information
window is displayed on the screen and a new set of menu options is
displayed in the menu area.

127(If you have an Adult-ICU or Operating Room optional remote


control, you can also access Cardiac Calcs by pressing the
Cardiac Calcs key.

CARDIAC CALCS Menu and Information Window

The information window displays the monitored and calculated


parameter values relating to your last cardiac output trials.

2. With the Trim Knob control, you now can select any of the displayed
options:
u CHANGE VALUEenter or change a monitored value.
u SAVE CALCsave the set of calculations; can be reviewed in
Vital Signs.
u REVIEW CALCSenter Vital Signs to review all saved calcs.
u WEIGHTchange the units of measure for weight between
kilograms and pounds.
u HEIGHTchange the units of measure for height between
centimeters and inches.

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Cardiac Output: Cardiac Calculations

Change Value
When this option is selected, you can change values (or enter new values)
for the monitored parameters. Follow this procedure:

1. Select CHANGE VALUE option from the Cardiac Calcs Menu. A


popup menu opens and a pointer (>) and the RETURN option are
displayed at the top of the information window.

CHANGE VALUE Popup Menu

2. Rotate the Trim Knob control to move the pointer.


3. Press the Trim Knob control when the pointer is in front of the
parameter you want to change. The value of that parameter will
highlight.
4. Rotate the Trim Knob control to change the value.
5. When satisfied, press the Trim Knob control. If another parameter
needs to be modified, rotate the Trim Knob control, etc.
6. When finished, move the pointer to RETURN and press the Trim
Knob control. The popup menu closes and the calculated values
change to reflect any changes made to the monitored parameters.

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Cardiac Output: Cardiac Calculations

The remaining Cardiac Calcs Menu options are direct action options.
Highlighting and then pressing the Trim Knob control will effect an
immediate result.

Save Calc
Selecting SAVE CALC option saves the calculation and enters the
appropriate values into cardiac calculations and vital signs.

127(The monitor saves 20 cardiac calculations. These saved


calculations are not limited to a 24-hour time period.

Weight
Selecting WEIGHT option switches the weight units of measure between
kilograms and pounds.

Height
Selecting HEIGHT option switches the height units of measure between
centimeters and inches.

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Cardiac Output: Troubleshooting

Troubleshooting
Procedural Prompts/Messages
During the injection procedure you may see some of the following
prompts/messages displayed on the screen. These have been listed
alphabetically.

CO COMPLETE
The numeric value of the CO has been calculated and displayed on
the screen.

COMPUTING CO
CO waveform has been displayed and now the monitor is preparing
the numeric results.

INJECT NOW!
The stat (CARDIAC OUTPUT NOW) option has been selected. Make
your injection immediately.

INJECT WHEN READY


The auto mode is on and the monitor has sensed a stable baseline
temperature. Make your injection when ready.
PLEASE WAIT
The monitor is searching for a stable baseline temperature.

PUSH CO NOW OR TURN AUTO ON


Auto mode is off. You have the option of using the CARDIAC
OUTPUT NOW menu option, or turning auto mode on with the
AUTO MODE menu option.

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Cardiac Output: Troubleshooting

Error Messages
CO IS TOO LOW TO DISPLAY or CO IS TOO HIGH TO DISPLAY
The cardiac output range that the monitor is able to calculate is 0.2L
to 20L.

NO CO DUE TO BT SENSOR FAIL


A cable may be loose or there is a hardware failure.

NO CO DUE TO IT SENSOR FAIL


A cable may be loose or there is a hardware failure.

UNSTABLE BT DETECTED
The monitor cannot detect a stable baseline temperature. The
message clears after 12 seconds only if a stable baseline temperature
is found. If message does not clear, check your patient and setup. If
message persists call GE Service or contact your sales/service
representative.

The following messages replace the IT or BT values in the CO waveform


area. In addition, the BT messages are displayed in the CO parameter
window:

BT TOO LOW or BT TOO HIGH


Blood temperature is too low or too high or there is a sensor
hardward failure.

IT TOO LOW or IT TOO HIGH


Injectate temperature is too low or too high or there is a sensor
hardware failure.

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Cardiac Output: Troubleshooting

Problem: Solutions:
Inaccurate Cardiac Output Values
1. Techniquethe technique used in performing a cardiac output is
important to understand since this is a major influencing factor in
obtaining accurate cardiac output values.
a. If room temperature solution is used, be sure the bag is not in a
heated area in the room and is not touching other solutions or
equipment. This is important so the solution temperature will
not be different than the room air temperature sensed through
the bath or in-line sensor. A temperature difference could give an
inaccurate reading.
b. When doing an injection, always hold the syringe by the plunger
and not by the barrel. The temperature of the solution increases
at a slower rate if the barrel is not held in the palm of the hand
and, therefore, reduces the amount of error in a cardiac output
value.
127(When In-Line is being used, along with iced injectate, the
initial temperature displayed will be the room temperature.
However, when the solution is injected, the temperature
displayed will decrease.

c. It is recommended to inject rapidly and smoothly into the


proximal port of the Swan-Ganz catheter, usually within 4 to 5
seconds.
d. Allow at least 1 to 1-1/2 minutes between injections to allow the
baseline to stabilize.
e. It is also recommended to inject at the patients end expiration.
This helps to reduce any respiratory noise and therefore lessen
error.
f. A minimum temperature difference of 10 is recommended
between the patient temperature and solution temperature.
2. Respirationthe patients inspiratory/expiratory cycle and
placement of the catheter affects the cardiac output value. Whenever
the patient inhales and exhales, the thermistor at the tip of the
catheter senses a change in the patients blood temperature.
Therefore, placement of the catheter with relationship to proximity
of the lung fields affects the baseline. During inspiration, the
patients blood temperature decreases and during expiration it
increases.
If there is a significant amount of respiratory noise on the patients
baseline, the monitor may try to calculate a cardiac output even if no
injection was performed. This is because the monitor does not
differentiate between breaths and injections. It looks for a change in
baseline temperature.
a. If patient is alert, have him/her exhale and hold for injection.
b. Check catheter placement.

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Cardiac Output: Troubleshooting

3. Baseline blood temperatureas little as a half of a degree Celsius


change in blood temperature, due to respiratory noise, may cause a
CO value to be displayed when an injection has not been performed.
Using AUTO mode allows the monitor to look for a stable baseline
before allowing an injection.
4. Swan-Ganz catheterthe catheter itself may be damaged (e.g.,
defective thermistor or defective tubing).
5. Hemodynamicsthe patients rhythm can affect the cardiac output
value. If cardiac output trials are being done at a time when the
patient has dysrhythmias, you may notice a discrepancy in the
cardiac output values.
6. Rapid IV solutionsany rapid IV solution which is infusing at the
time when the solution is injected can alter the cardiac output value.
Maintain a constant rate, or if possible, stop the solution 30 seconds
before the CO injection and then restart the infusion after the
cardiac output is calculated.
7. IT temp fluctuationif the IT temp is fluctuating, check IT cable
connection.

Problem: Solution:
Cardiac Output Value Lower Than
Expected 1. Decrease the volume injected.
2. Increase the temperature of the injectate.
127(Cardiac output must be computed within 20 seconds.
Decreasing the volume and increasing the temperature will
give you a smaller differential change and should increase
the chance of computing a cardiac output within the 20-
second period.

Problem: Solution:
Cardiac Output Value Higher
Than Expected 1. Increase the volume injected.
2. Decrease the temperature of the injectate.

127(Cardiac output must be computed within 20 seconds. Increasing


the volume and decreasing the temperature will give you a
greater differential change.

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Cardiac Output: Troubleshooting

For your notes

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16 Respiration

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For your notes

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Respiration: Introduction

Introduction
Respiration monitoring can be done with any ECG cable. Refer to the
ECG chapter for patient preparation and electrode placement.

This chapter gives guidelines for adjusting respiration setup, and


problem solving. The illustration below shows the location of the
connector on the front of the monitor used for impedance respiration
monitoring.

ECG/Resp Cable
Connector

ECG/Resp Connector

127(The signal input is a high-insulation port and it is defibrillator-


proof ( ).

The insulated input ensures patient safety and protects the


device during defibrillation and electrosurgery.

127(Respiration monitoring is not adversely affected by the use of an


ESU ECG filter.

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Respiration: Introduction

General Information

:$51,1*6
APNEA EVENTS The monitor may not detect all
episodes of inadequate breathing, nor does it distinguish
between central, obstructive and mixed apnea events.

ELECTRODE CONFIGURATION impedance


respiration monitoring is not reliable when ECG
electrodes are placed on the limbs.

Respiration is detected by measuring thoracic impedance. When


respiration is monitored a small AC signal is applied through ECG lead I
or ECG lead II. This AC signal appears between the right arm and left
arm electrodes or the right arm and left leg electrodes, depending on the
selected ECG lead. The lead selected is dependent on the type of
breather the patient is. (See the figures below.)

127(The figures below are used to show the relationship between


breathing and ECG lead. They do not represent an electrode
configuration.

ECG Lead I for ECG Lead II for


Upper Chest Breather Abdominal Breather

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Respiration: Introduction

When starting respiration monitoring, the monitor learns the patients


respiration pattern. Eight breaths are averaged and the average
amplitude of the respiration waveform is found. Detection sensitivity is
automatically set at 40% of the average amplitude.

127(The message LEARNING is displayed in the RR values


window during this process.
Markers displayed on the waveform show this 40% detection range. One
marker is at inspiration, the other at expiration. The detection
sensitivity can be manually adjusted by using the SENSITIVITY option
from the respiration menu.

The waveform size is also set automatically during the learning process,
but may be adjusted if necessary.

127(Respiration detection is not dependent on the size of the


waveform. Size is for visual purposes only.

Even though the same electrodes are used for ECG and respiration
monitoring, it is possible to get a lead fail message for respiration
without one for ECG. The impedance may be too high for respiration
detection, but the electrode is still good for ECG. (Refer to Smart-Lead
Fail in the ECG Monitoring chapter.)

Checklist
Since respiration monitoring is so closely linked with ECG monitoring,
patient preparation and electrode placement are important. Please refer
to the ECG Monitoring chapter for guidelines.

1. Electrodes have been placed on the patient following proper skin


preparation.
2. Leadwires are attached to electrodes on the patient.
3. Leadwires are connected to patient cable and patient cable is
connected to the monitor.
4. Respiration setup is adjusted, if necessary. Follow detailed
procedures within this chapter.

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Respiration: Respiration Monitoring Features

Respiration Monitoring Features


Respiration Information
When respiration monitoring is on, a labeled respiration waveform is
displayed when the learning process is complete. (Refer to this chapter,
General Information.) The label includes the ECG lead used to derive the
respiration waveform, for example, RR II.

Numerics are displayed in the RR parameter window on the right side of


the screen.
Respiration Rate
Breath
Indicator

Limits and
Lead
Units
Monitored

RR Parameter Window

The parameter window displays the current respiration rate and the
ECG lead used to monitor respiration. A flashing breath indicator (lung
symbol) is displayed with each breath detection. Alarm limits may be
displayed for respiration rate and apnea.

The respiration monitoring features are found in the RR parameter


menu. These features include lead, relearn, sensitivity, limits, size, and
cardiac artifact alarm.

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Respiration: Respiration Monitoring Features

Getting to the Respiration Menu


To display the Respiration Menu, use the Trim Knob control to select the
RR parameter label. Remember, selecting with the Trim Knob control is
a two-step processrotate to highlight, then press to select.

127(If the parameter label is not displayed, select PARAMETERS


ON/OFF option in the Monitor Setup Menu to turn respiration
on. Then select the RR parameter label.

Selecting the RR Parameter Label

The Respiration Menu is displayed at the bottom of the screen.

Respiration Menu

With the Trim Knob control, you now can select any of the displayed
options.
n LEADchange the lead from which the respiration rate is derived.
n RELEARN RESPIRATIONtell the monitor to examine and relearn
the patients respiration pattern.
n SENSITIVITYincrease or decrease the sensitivity setting.
n RESPIRATION LIMITSdisplay a new menu and an information
window to adjust respiration rate and apnea alarm limits.
n AUTO SIZEautomatically size the respiration waveform to fit in a
predetermined area on the screen.
n MANUAL SIZEmanually increase or decrease the size of the
respiration waveform.
n CARDIAC ARTIFACT ALARMturn the artifact alarm off and on.
n SPEEDchange the sweep speed for the displayed respiration
waveform.

Detailed information on each option is found in this chapter.

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Respiration: Respiration Menu Options

Respiration Menu Options


Lead
You have two choices for the respiration leadlead I and lead II. This
menu option, when selected, automatically switches the monitored lead
for respiration. The label of the lead currently being monitored (I or II)
appears in the menu option, in the lower left corner of the RR parameter
window, and with the waveform label.

Changing leads automatically starts the relearn process.

127(If you are monitoring with a fixed-lead 3-lead cable, respiration


can only be obtained from the lead for which the cable is
manufactured. For example, if your cable is a fixed lead II cable,
you will see a LD I FAIL message in the RR parameter window
should you try to change the respiration lead.

Relearn Respiration
A learning process always takes place for a few seconds whenever
respiration monitoring is started. If your patients breathing pattern
changes after the initial learning process has taken place, it may be
necessary to relearn.

Select RELEARN RESPIRATION option from the respiration menu.


This is a direct action menu option.

The message LEARNING will be displayed in the RR values window.


(There is no respiration rate displayed during the learning process.)
When learning is complete, the message will clear and the respiration
rate will be displayed.

127(Sensitivity is reset at 40% and the waveform is automatically


sized.

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Respiration: Respiration Menu Options

Sensitivity
During the learning process, the monitor automatically sets the detection
sensitivity at 40% of the average amplitude. Markers are displayed on
the waveform showing the detection points at inspiration and expiration.
If you need to change the detection sensitivity because of varying
amplitudes or artifact, follow this procedure.
1. Select SENSITIVITY option from the respiration menu. A popup
menu opens showing the choices available. Any change is effective
immediately. The lower the percentage, the greater the detection
sensitivity.

SENSITIVITY Popup Menu

2. As you change the sensitivity percentage, the markers will move on


the waveform. This adjustment occurs immediately. When you are
satisfied with the detection sensitivity, press the Trim Knob control
to close the popup menu.

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Respiration: Respiration Menu Options

Respiration Limits
This option provides an information window with bar graphs that show
the alarm limits for respiration rate and apnea. A new set of menu
options is displayed to allow you to adjust these limits.

Follow this procedure:

1. Select RESPIRATION LIMITS option from the Respiration Menu.


An information window is displayed on the screen and a new set of
menu options is displayed in the menu area.

Respiration
High Range
Parameter

High Limit

Low Limit

Low Range

RESPIRATION LIMITS Menu and Information Window

The information window shows the range as well as the alarm limits.
Where applicable, a pointer (>) indicates the current value of that
parameter for the monitored patient. As long as that value remains
between the high and low limits, there will be no alarm. Should the
value reach or exceed one of the limits, an alarm will occur.

2. To change a set limit, for example the resp high limit, select RESP
HIGH LIMIT option from the limits menu. A popup menu opens.

RESP HIGH LIMIT Popup Menu

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Respiration: Respiration Menu Options

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until
the Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Follow this procedure to set the apnea limit. Select PREVIOUS
MENU to exit the limits menu and return to the Respiration Menu.

Auto Size
127(The size of the waveform has no effect on the detection capability
of the program.

During the learning process, the displayed waveform is automatically


sized to fit a predetermined area of the screen. During monitoring, the
size may have been changed manually (see below). Select AUTO SIZE
option to automatically resize the waveform to fit the predetermined
area. This is a direct action menu option.

Manual Size
If desired, you can manually change the size of the respiration waveform.

1. Select MANUAL SIZE option from the Respiration Menu. A popup


menu opens displaying the choices available.

MANUAL SIZE Popup Menu

2. Rotate the Trim Knob control to highlight another size. The change
will occur immediately.
3. When you are satisfied with the size, press the Trim Knob control to
close the popup menu.

127(The manual size you select will be cancelled if you change the
lead from which respiration is derived. When you change leads,
the learning process is started and the waveform is automatically
sized.

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Respiration: Respiration Menu Options

Cardiac Artifact Alarm


The cardiac artifact alarm alerts you to the fact that the respiration rate
is within 5% of the heart rate (over 30 consecutive breaths). If this
happens, the respiration program may be counting heart beat artifact as
respiration. The cardiac artifact alarm is an Advisory alarm
ARTIFACT is displayed in the RR values window, and a 1-beep tone
sounds.

There is no adjustable limit for this alarm, but you can turn it off and on.

:$51,1*
If the cardiac artifact alarm is turned off, apnea events
may not be detected.

Select CARDIAC ARTIFACT ALARM option from the Respiration Menu


to turn the alarm off and on. This is a direct action menu option.

Speed
Use this menu option to open a popup menu to select a sweep speed for
all displayed respiration waveforms. Choices are 6.25, 12.5, and 25
(factory default) millimeters per second.

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Respiration: Troubleshooting

Troubleshooting
Respiratory Waveform
Illustrated below is a respiratory waveform which is regular and even.
The inspiration and expiration markers are identified.
Inspiration Marker Expiration Marker

Regular and Even

Cardiac Artifact
In cases where there is cardiac artifact, if the detection sensitivity
percentage is set too low, the artifact will be detected as breaths.
Increase the detection sensitivity percentage until the markers
correctly identify each inspiration and expiration. See the markers in the
figures below. (A = artifact, B = breath)

Incorrect Detection

Correct Detection

Varying Amplitudes
Some waveforms may show a combination of shallow and deep breaths. If
the detection sensitivity percentage is set too high, the shallow breaths
will not be detected. Decrease the detection sensitivity percentage until
the markers correctly identify each inspiration and expiration. See the
markers in the figures below. (B = breath)

Incorrect Detection

Correct Detection

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Respiration: Troubleshooting

Messages
Below is a list of all the messages which may be displayed in the RR
parameter window during respiration monitoring. What each of these
messages mean as well as action to take is included. These messages
may appear in abbreviated form if the parameter window is sized smaller
due to the number of parameters being monitored. The abbreviated form,
if there is one, is shown in parenthesis.

LEARNING
The monitor takes approximately 8 breaths to learn the patients
respiration pattern before displaying a respiration value. Learning
automatically occurs whenever respiration is turned on and when
the lead from which respiration is determined is switched.

APNEA
CHECK THE PATIENT. This is an alarm condition which requires
action. Breathing has not been detected for a predetermined period of
time (seconds). If necessary, the apnea limit can be changed. Refer to
16-10.

ARTIFACT
CHECK THE PATIENT. This is an alarm condition which requires
action. The monitor is unable to successfully determine respiration.
If it is determined that patient condition is not the cause, it may be
necessary to reprep the patients skin and change the electrodes to
resume monitoring of respiration.

LD I FAIL or LD II FAIL
CHECK THE PATIENT. This is an alarm condition which requires
action. The lead monitoring respiration has failed. You can manually
switch respiration detection to the other lead (refer to page 15-8). Or
it may be necessary to reprep the patients skin and change the
electrodes.

LEADS FAIL (LDS FAIL)


CHECK THE PATIENT. This is an alarm condition which requires
action. It may be necessary to reprep the patients skin and change
the electrodes.

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17 Temperature

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For your notes

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Temperature: Introduction

Introduction
Two temperature sites can be monitored with the monitor. Because the
temperature connector on the monitor is also used for cardiac output, you
cannot monitor temperature and cardiac output at the same time.

TEMP/CO Cable
Connector

TEMP/CO Cable Connector

127(The TEMP/CO cable connector is a high-insulation port and it is


defibrillator-proof ( ).

Checklist
1. The temperature probe(s) is correctly positioned on the patient.
(Follow appropriate medical procedures.)
2. If using the dual temperature cable, the switch is turned to 400 or
700 depending on the type of probe used.
3. Temperature cable is attached to the monitor.
4. Temperature setup is adjusted, if necessary. Follow detailed
procedures within this chapter.

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Temperature: Temperature Monitoring Features

Temperature Monitoring Features


Temperature Information
Temperature monitoring provides numerical information onlyno
waveform. As with other parameters, numerics are displayed in the
temperature (TP) parameter window on the right side of the screen.

Temp Value

Temp Limits
for One Site

Temp Sites
and Units

Temperature Parameter Window

The parameter window displays the current temperature values with the
unit of measurement. If your defaults are set up to display limits, the T1
limits are displayed.

127(When both temperature sites are being monitored, the alarm


limits for the T1 site only are displayed in the limits window. If
the T1 site is turned off, the displayed alarm limits automatically
switch to the T2 alarm limits.
You can monitor a patients temperature at multiple sites. Both internal
and external temperature sensors may be used. The monitor calculates
the monitored temperatures and displays their values on the screen. The
temperature sites are identified in the values window as T1 and T2.

The monitor is compatible with both YSI series 400 and 700 probes. If
you are using the dual temperature cable, you must select 400 or 700
(depending on the type of probe) for correct operation. (See the figure
below.) The switch is located on the cable.
Slide switch

YSI 400 Series Dual Temperature Cable


Temperature Cable Selection Switch

The temperature cable is plugged into the TEMP/CO cable connector on


the monitor. The temperature monitoring features are found in the
Temperature Parameter Menu.

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Temperature: Temperature Monitoring Features

Getting to the Temperature Menu


To display the Temperature menu use the Trim Knob control to select
the TP parameter label. Remember, selecting with the Trim Knob control
is a two-step processrotate to highlight, then press to select.

Selecting the TP Parameter Label

The Temperature menu is displayed at the bottom of the screen.

Temperature Menu

With the Trim Knob control, you now can select any of the displayed
options:
n T1turn the T1 temperature site off and on.
n T2turn the T2 temperature site off and on.
n UNITSswitch the units of measurement between Celsius and
Fahrenheit.
n TEMPERATURE LIMITSdisplay a new menu and an information
window to adjust alarm limits for both temperature sites.

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Temperature: Temperature Menu Options

Temperature Menu Options


T1
This direct action menu option turns monitoring off and on at
temperature site 1. When off, no values are displayed in the temperature
parameter windows.

T2
This direct action menu option turns monitoring off and on at
temperature site 2. When off, no values are displayed in the temperature
parameter windows.

Units
This direct action menu option switches the units of measure between
Celsius (C) and Fahrenheit (F).

Temperature Limits
This option provides an information window with bar graphs that show
the alarm limits for both temperature sites. A new set of menu options is
displayed to allow you to adjust these limits.

Follow this procedure:


1. Select TEMPERATURE LIMITS option from the Temperature
Menu. An information window is displayed on the screen and a new
set of menu options is displayed in the menu area.

Temperature Site

High Range

High Limit

Low Limit

Low Range

TEMPERATURE LIMITS Menu and Information Window

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Temperature: Temperature Menu Options

The information window shows the range as well as the alarm limits.
The pointer (>) indicates the current temperature value for the
monitored patient. As long as that value remains between the high
and low limits, there will be no alarm. Should the value exceed one of
the limits, an alarm will occur.

2. To change a set limit, for example the low temperature limit for the
T1 site, select T1 LOW LIMIT option from the limits menu. A popup
menu opens.

T1 LOW LIMIT Popup Menu

3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until
the Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Follow this procedure to set other limits. Select PREVIOUS MENU
to exit the limits menu and return to the Temperature menu.

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Temperature: Troubleshooting

Troubleshooting
Messages
If you experience some problems with temperature monitoring, one of the
following messages may be displayed in the TP parameter window:

CAL CHECK

There is a 0.1C deviation between the temperature value and the


internal calibration. No temperature value will be displayed. Service
on the monitor is required.

CAL FAIL

There is a 1C deviation between the temperature value sensed and


the internal calibration. No temperature value will be displayed.
Service on the monitor is required.

SENSOR

No sensor is detected. Either no sensor is present or a sensor has


failed. If no sensor is present, turn the temperature site OFF to clear
the message.

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18 CO2

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For your notes

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CO2: Introduction

Introduction
End-tidal CO2 monitoring (referred to as CO2 monitoring in this
manual) is a continuous, noninvasive technique for determining the
concentration of CO2 (carbon dioxide) in respiratory gas by measuring
the absorption of infrared light of specific wavelengths.

The light generated in the analyzer bench is passed through respiratory


gas samples. The amount of absorption by CO2 in the sample is
measured and digitized by the photodetector. The monitor processes the
electronic signal and displays a waveform (labeled CO2) and digital
values for expired CO2 (EXP), inspired CO2 (INSP), and respiratory rate
(RR).

The monitor is equipped to monitor intubated patients using the


mainstream method where the sensor is placed in the patients airway.

CO2 Connector

CO2 Connector

Checklist
1. Sensor cable is attached to the CO2 connector on the monitor.
127(The CO2 parameter window is not displayed until the sensor
cable is connected to the monitor.

2. The CO2 parameter is turned on (see Monitor Setup, Parameter On/


Off).
3. CO2 sensor is calibrated.
4. Sensor is properly positioned on the adapter.
5. CO2 adapter is calibrated.

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CO2: Capnostat CO2 Sensor

Capnostat CO2 Sensor


General Information

:$51,1*
The Capnostat CO2 sensor should not be used in the
close proximity of wireless networking equipment or in
the presence of strong electromagnetic fields such as
those generated by radio station transmitters, citizens
band radios, cellular phones, etc. Using the Capnostat
sensor under the above conditions may cause one or all of
the following to occur:
n Noise may be induced on the capnogram.
n The CO2 parameter values may be replaced by X.
n The message CHECK ADAPTER ADAPTER CAL
may be displayed in the parameter window.
Normal operation will resume when the source of
interference is removed.

The monitor must be used with a Capnostat sensor and airway adapter.
The sensor cable is equipped with two cells. The -0- cell is used for
zeroing (calibration) of the sensor and the REF cell is used for verifying
sensor accuracy.
Capnostat Sensor

Capnostat Airway Adapter

Capnostat Sensor
Cable to Module

-0- Cell
REF Cell

Capnostat Sensor, Cable, and Airway Adapter

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CO2: Capnostat CO2 Sensor

Mainstream Setup
The mainstream setup is as follows:
1. Connect the Capnostat sensor cable to the monitor. If the message
CAL SENSOR TO ZERO CELL appears, zero the sensor (refer to
Zero Capnostat Sensor in this chapter).
2. Select the appropriate airway adapter:
u Adult/Pediatric (black, 5 cc dead space) or
u Neonatal (red, 0.5 cc dead space).
3. Snap the Capnostat sensor onto the airway adapter. If the message
CHECK ADAPTER ADAPTER CAL appears, calibrate the adapter
(refer to the section Capnostat Adapter Calibration in this chapter).
4. Position the airway adapter in the patients respiratory circuit (as
close to the patient as possible) between the endotracheal tube and
the ventilator circuit.

:$51,1*
Always position the sensor with adapter in an upright
position to avoid collection of fluids on the windows of the
adapter. Large concentrations of fluids at this point will
obstruct gas analysis.

Sensor Cable

Capnostat Sensor
Reference and (upright position)
Zero Cells

To Patient
Endotracheal Tube

Capnostat Airway Adapter

Mainstream Setup

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CO2: CO2 Monitoring Features

CO2 Monitoring Features


CO2 Information
When the Capnostat sensor is first connected to the monitor, there is
about a two-minute warming up period. The message WARMING UP is
displayed in the CO2 parameter window.

After the warm-up period when the patient is properly connected and
breath is detected, numerics are displayed in the CO2 parameter window
and a CO2 waveform may be displayed on the screen.

127(The CO2 waveform sweep speed on the screen is set at 6.25


millimeters per second which is considerably slower than other
displayed waveforms. This is done in order to show several
breaths on the screen at once. You can change this speed if
needed.

When a new Capnostat sensor is connected, the message CAL SENSOR


TO ZERO CELL is displayed. You must zero the Capnostat sensor
before monitoring can start. This is normal, as anytime a new Capnostat
sensor is used, it must be zeroed. (Refer to this chapter, Zero Capnostat
Sensor.)
Inspired and Expired
Respiration Rate CO2 Values

Limits
and Units

CO2 Parameter Window

The parameter window displays the values for inspired and expired CO2
and a respiration rate. Units of measurement and limits for expired CO2
may be displayed.

The CO2 monitoring features are found in the CO2 menu. The basic
features include units of measure, scales, limits, and speed.

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CO2: CO2 Monitoring Features

Getting to the CO2 Menu


To display the CO2 menu, use the Trim Knob control to select the CO2
parameter label. Remember, selecting with the Trim Knob control is a
two-step processrotate to highlight, then press to select.

Selecting the CO2 Parameter Label

The CO2 menu is displayed at the bottom of the screen.

CO2 Menu

With the Trim Knob control, you now can select any of the displayed
options.
n UNITSchange the units of measure for inspired and expired CO2.
n CO2 SCALEchoose a scale for the displayed CO2 capnogram.
n CO2 LIMITSdisplay a new menu and an information window to
adjust expired CO2, inspired CO2, respiration rate, and no breath
limits.
n N2O COMPENSATIONcompensate for the effect of N2O on CO2
readings. (Functional in operating room mode only.)
n O2 COMPENSATIONcompensate for the effect of O2 on CO2
readings.
n CO2 AVERAGINGopen a popup menu to select a time for
averaging CO2.
n CAL SENSOR TO ZERO CELLopen a popup menu to zero the
sensor.
n CALIBRATE ADAPTERopen a popup menu to calibrate the
adapter.
n SPEEDchange the sweep speed of the displayed CO2 waveform.

Detailed information on each option is found in this chapter.

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CO2: CO2 Menu Options

CO2 Menu Options


Units
This option allows you to choose the unit of measure for expired and
inspired CO2. The choices are mmHg,%, or kPa (kilopascals).

127(Respiration is always measured in breaths per minute, and No


Breath is always measured in seconds.

Follow this procedure if you want to change the units of measure for
CO2:

1. Select UNITS option from the CO2 Menu. A popup menu opens
displaying the three options.

UNITS Popup Menu

2. Rotate the Trim Knob control so the pointer (>) is in front of your
choice. The change will not be in effect until the Trim Knob control is
pressed and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu. Note that the menu option now indicates the units
selected. The units are also displayed in the limits parameter
window.

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CO2: CO2 Menu Options

CO2 Scale
This option allows you to choose an appropriate scale for the displayed
CO2 waveform. The scale choices will be different depending on the units
of measure being used. A waveform that exceeds the allowed display area
on the screen will be flattened on top. Adjust the scale to reduce the
waveform size. Selecting a large scale value reduces the size of the
waveform. Conversely, a smaller scale value increases the size of the
waveform.

Follow this procedure if you want to change the scale:

1. Select SCALE option from the CO2 Menu. A popup menu opens
displaying your options.

SCALE Popup Menu

2. Rotate the Trim Knob control so the pointer is in front of your choice.
The change will not be in effect until the Trim Knob control is
pressed and the popup menu closed.
3. Press the Trim Knob control to confirm the change and close the
popup menu. Note that the menu option now indicates the scale of
your choice. The scale lines on the screen also reflect your choice.

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CO2: CO2 Menu Options

CO2 Limits
This option provides an information window with bar graphs that show
the alarm limits for EXP, INSP, RESP and NO BREATH. A new set of
menu options is displayed to allow you to adjust these limits.

Follow this procedure if you want to change a limit:

1. Select CO2 LIMITS option from the CO2 Menu. An information


window is displayed on the screen and a new set of menu options is
displayed in the menu area.

High Range

High Limit

Low Limit

Low Range

CO2 LIMITS Menu and Information Window


The information window shows each CO2 parameters range as well
as the alarm limits. A pointer (>) indicates the current value of that
parameter for the monitored patient. As long as that value remains
between the high and low limits, there will be no alarm. Should a
value exceed one of the limits, an alarm will occur.

2. To change a set limit, for example the resp high limit, select RESP
HIGH LIMIT option from the limits menu. A popup menu opens.

RESP HIGH LIMIT Popup Menu


3. Rotate the Trim Knob control and the value displayed will change.
The bar graph is also adjusted. The limit will not be in effect until
the Trim Knob control is pressed and the popup menu closed.
4. Press the Trim Knob control to confirm the change and close the
popup menu.
5. Follow this procedure to set any other CO2 parameter limits. Select
PREVIOUS MENU to exit the limits menu and return to the CO2
menu.

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CO2: CO2 Menu Options

N2O Compensation
127(This feature functions only when the monitor is in the Operating
Room mode.
The presence of nitrous oxide causes the CO2 value to be higher than the
actual value. Use this option to compensate for the presence of N2O.

This is a direct action menu option which switches between 0-40% N2O
and >40% N2O. Your selection depends on the amount of N2O present.

O2 Compensation
The presence of a large concentration of oxygen causes the CO2 value to
be lower than the actual value. Use this option to compensate for the
presence of O2.

This is a direct action menu option which switches between 0-60% O2


and >60% O2. Your selection depends on the amount of O2 present.

127(O2 and N2O concentrations may be obtained from an analyzer


on the anesthesia machine. O2 may be obtained from an oxygen
analyzer.

CO2 Averaging
Select this menu option to open a popup menu to select a time interval
for averaging CO2:

SINGLE BREATHCO2 value is calculated for every breath

10 SECONDSCO2 value is calculated using 10 seconds of data

20 SECONDSCO2 value is calculated using 20 seconds of data

Cal Sensor to Zero Cell


Use this menu option to zero the Capnostat sensor. This is required
anytime a new sensor is connected to the monitor. (Refer to this chapter,
Zero Capnostat Sensor.)

Calibrate Adapter
Use this menu option to calibrate the Capnostat airway adapter. This is
required whenever adapter types are changed or when the monitor
requests it. (Refer to this chapter, Calibrate Capnostat Adapter.)

Speed
Use this menu option to open a popup menu to select a sweep speed for
the displayed CO2 waveform. Choices are 6.25 (default), 12.5, and 25
millimeters per second.

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CO2: Zero Capnostat Sensor

Zero Capnostat Sensor


There are two messages that indicate the need to zero the sensor: CAL
SENSOR TO ZERO CELL and NOT CALIBRATED.

The sensor cable has two cells as shown in the figure below. One is
marked -0- (zero), and one is marked REF (reference).

This end must Capnostat


be connected to Sensor
the monitor.

-0- Cell
REF Cell

Zeroing the Sensor

To zero the sensor follow this procedure:

1. Remove the adapter from the sensor but be certain the sensor cable
is still connected to the monitor.
2. Place the sensor on the cell marked 0. (See the figure above.)
3. Select CAL SENSOR TO ZERO CELL option from the CO2 Menu. A
popup menu with READY and ABORT choices is displayed.

CAL SENSOR TO ZERO CELL Popup Menu

4. Select READY. The message CALIBRATING is displayed in the


CO2 parameter window. When calibration is complete, the popup
menu clears and an EXP value of 0 is displayed in place of the
message.
5. Remove the sensor from the 0 cell and place it on the REF cell. An
EXP value of 38mmHg (2mmHg) is displayed. If the value is not
within this range, the sensor is out of tolerance and should be
replaced.

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CO2: Calibrate Capnostat Adapter

Calibrate Capnostat Adapter


The message CHECK ADAPTER ADAPTER CAL indicates the need to
calibrate the adapter. Before calibrating, make sure the airway adapter
is clean and clear of foreign matter. An adapter calibration is required
under the following conditions:
n Whenever you change adapter types, for example, adult to low dead
space, or reusable to disposable.
n When the monitor requests it (CHECK ADAPTER ADAPTER CAL
message).

Follow this procedure to calibrate the adapter:

1. Place the sensor and adapter away from all sources of CO2, including
the patients and your own exhaled breath, and ventilator exhaust
valves.
2. With the adapter connected to the sensor and the sensor connected to
the monitor, select CALIBRATE ADAPTER option from the CO2
Menu. A popup menu with READY and ABORT choices is displayed.

CALIBRATE ADAPTER Popup Menu

3. Select READY. The message CALIBRATING is displayed in the


CO2 parameter window. When calibration is complete, the popup
menu closes and the message clears.

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CO2: Cleaning the Sensor and Adapter

Cleaning the Sensor and Adapter


Cleaning the Capnostat Sensor
n Clean the sensor surface with a damp cloth.
n Ensure the sensor windows are clean and dry.
n Do NOT immerse the sensor.
n Do NOT attempt to sterilize the sensor.

Cleaning the Reusable Capnostat Adapters


n An adapter can be cleaned by rinsing in a warm soapy solution,
followed by soaking in a liquid disinfectant, pasteurized, or cold
sterilized (glutaraldehyde). It should then be rinsed with sterile
water and dried.
n The adult and low volume dead space adapters may be sterilized
using the ETO (ethylene oxide) gas method. They may also be
sterilized using a steam autoclave method but lifetime could be
affected.
n Before reusing any adapter, ensure the windows are dry and residue-
free, and that the adapter has not been damaged during handling or
by the cleaning/sterilization process.

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CO2: Troubleshooting

Troubleshooting
Capnostat Sensor Check
The sensor cable has two cells as shown in the figure below. One is
marked -0- (zero), and one is marked Ref (reference). Whenever you
suspect incorrect values or sensor failure, perform a sensor check.

This end must Capnostat


be connected to Sensor
the monitor.

-0- Cell
REF Cell

Sensor Check and Calibration Cells

Sensor Check:
1. Remove the adapter from the sensor but be certain that the sensor
cable is still connected to the monitor.
2. Place the sensor on the cell marked Ref. Depending on the units of
measure, you should see a reading of 38 mmHg (2) on the display. If
the displayed value is within range, you can resume monitoring. If
the sensor is not within range, an error message, NOT
CALIBRATED, will be displayed. You must calibrate the sensor to
the zero cell (refer to Zero Capnostat Sensor in this chapter).

Literature: :$51,1*
The end-tidal CO2 value (etCO2) is in most cases
Bhavani-Shankar, K. et al: considerably lower than the CO2 partial pressure
Capnometry and anaesthesia determined by blood-gas analysis. The major clinical
(Review Article). Can. J. Anaesth. reasons are:
39, 617632 (1992) n dead-space ventilation, ventilation/perfusion
mismatch
Raemer, D.B. et al: Variation in
pCO2 between Arterial Blood and n drop in cardiac output
Peak Expired Gas during n alveolar shunts
Anaesthesia. Anesth. Analg. 62, n incomplete emptying of the alveoli
10651069 (1983)
TECHNICAL REASONS (MUST BE CORRECTED):
n leak in the respiration tube system
n hypothermia, but blood-gas analysis at 37C
n anesthesia gases (correction possible for O2 and N2O
only)

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CO2: Troubleshooting

Messages
Following is a list of some of the messages that may appear on the
monitor when monitoring CO2. The message should clear when normal
operating criteria are met or a solution is found. If a message persists,
call GE for service 1-800-558-7044 (US only). Outside the United States,
please contact your sales/service office.
CAL SENSOR TO ZERO CELL
Cause: A new sensor was introduced into the system or possible
signal drift in sensor electronics.
Solution: Zero CO2 sensor. (Refer to this chapter, Zero Capnostat
Sensor.)
CANNOT CALIBRATE
Cause: Message appears when attempting calibration in an
unstable condition such as sensor still warming up, or
other error condition.
Solution: Calibrate sensor when no error condition exists.
CHECK ADAPTER ADAPTER CAL
Cause: Adapter is not attached to sensor, adapter is obstructed,
or adapter used is of a different type than the one last
calibrated to sensor.
Solution: Check connections. Check for possible obstructions in
the adapter. Calibrate adapter.
INCOMPATIBLE SENSOR
Cause: Capnostat sensor is of older type and not supported by
monitor software.
Solution: Use only a Mainstream Capnostat III CO2 sensor.
NO BREATH DETECTED
Cause: No breath detected or sensor is disconnected from
patient airway.
Solution: Check the patient and all patient connections.
NOT CALIBRATED
Cause: Sensor signal is out of tolerance.
Solution: Calibrate the sensor on the Zero cell and then on the
Reference cell to double check.
SERVICE CO2 SENSOR
Cause: CO2 sensor feature failure.
Solution: Call GE for service or contact your sales/service
representative.
SERVICE CO2 SENSOR-SENSOR TEMP
Cause: CO2 sensor is too warm.
Solution: Remove sensor from external heat source. If message
persists, call GE for service or contact your sales/service
representative.
WARMING UP
Cause: Appears whenever a sensor is first plugged in and when
a sensor is first powered on.
Solution: Message will clear when warmed up. If it persists
beyond 4 minutes, call GE for service or contact your
sales/service representative.

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A Appendix A Analog
Output

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For your notes

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Appendix A Analog Output:

The configuration for the analog output is detailed below. Analog output
is obtained through the Defib Sync connector on the rear of the monitor.

ECG ANALOG OUTPUT:

Top displayed lead including augmented leads. If pace is on there is an


enhanced pacer pulse (5 volts at 2 milliseconds) when pacemaker
triggering is detected.

In the event of a LEAD FAIL, refer to the following:

Lead Failed ECG Analog Out


Right arm III
Left arm II
Left leg I
Chest II
Right leg Buzz*
*A right leg lead fail causes an all LEADS FAIL on the
screen and a buzz is output.

NOTES:

1. All ECG outputs are 1 volt per millivolt Referred To Input.


2. In single lead mode, if the specified lead is not available, a buzz will
be output.

BP ANALOG OUTPUT:

127(A buzz will be sent to the analog out if the BP is not zeroed.

n The pressure labeled ART is sent to the analog out.


n If both BPs are labeled ART, then BP-1 will be sent to the analog out.
n If there is no pressure labeled ART, then BP-1 will be sent to the
analog out.

All BP outputs are 10 mV/mmHg when zeroed.

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Appendix A Analog Output:

For your notes

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B Appendix B Supplies

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For your notes

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Appendix B Supplies:

To ensure patient safety, use only supplies manufactured or


recommended by GE. Your local sales representative can provide current
supplies lists, or you can contact GE Supplies. (Refer to How to Reach
Us at the front of this manual.)

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Appendix B Supplies:

For your notes

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C Appendix C Software
Packages

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For your notes

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Appendix C Software Packages:

The monitor comes with the Basic software package. Two additional
software packages and three additional software options can be
purchased separately or in any combination.
n Cardiac software package
n Cardiopulmonary software package
n High Resolution CRG Trends software option
n 12SL ECG analysis program with Gender Specific Criteria and ACI-
TIPI Analysis software option
n Unity Network software option

For an overview of these software features and for instructions on how to


tell which software features are installed on your monitor, refer to
Software Packages and Software Options on page 1-22.

Software Feature Matrix


Basic Cardio- High
Cardiac
Capability or Feature Software pulmonary Resolution
Package
Package Package CRG Trends
6-trace color display X
On-screen invasive BP site labels X
Common scale and individual scale BP displays X
Right-left overlapping BP scale display X
Waveform and numeric alignment X
Mentor on-screen operational support X
Adult, neonate, and OR customization X
User-programmable, monitor default/monitor setup X
CRG Plus X
Storage of up to 100 CRG events X
Storage of up to 24 hours of CRG trend data X
Simultaneous, multi-lead ECG acquisition X
3-lead or 5-lead ECG cable compatibility X
Pacemaker detection/rejection X
Smart-lead fail X
All ECG display format X
Lethal arrhythmia detection package (Asystole, VTach, and VFib alarms) X
Full arrhythmia package w/alarm level adjust X
Multi-lead arrhythmia storage and recall X
Multi-lead ST segment measurement7 leads X
12-lead ST segment monitoring12 leads X
Multi-lead ST segment template and trending X
Multi-lead ST segment history storage X
Selectable ST points X
12SL ECG analysis program X

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Appendix C Software Packages:

Software Feature Matrix

Basic Cardio- High


Cardiac
Capability or Feature Software pulmonary Resolution
Package
Package Package CRG Trends
Automatic 12 lead on ST alarm X
Respiration monitoring and apnea detection X
2 invasive BP channels X
Invasive BP measurement cursor X
Arterial disconnect alarm X
Arterial Smart BP function X
Intra-aortic balloon pump BP algorithm X
PA Wedge measurement program X
PA Insert Wedge measurement program X
Non-invasive BP (NBP) measurement X
NBP cuffs/measurement for adult, pediatric, neonate X
NBP manual, automatic, and stat measurement modes X
Pulse oximetry monitoring X
Pulse oximetry desaturation tones X
Pulse oximetryNellcor probe compatibility X
Pulse oximetry factory probe compatibility X
Temperature monitoring support X
Thermodilution cardiac output support X
Cardiac computation constants stored for major manufacturers X
Cardiac calculations X
EtCO2 monitoring support X
SAM (Smart Anesthesia Multi-gas module) interface X
Tabular trends24 hr X
Graphic trending24 hr X
Pulmonary calculations w/fick CO calculation X
Dose calculationsadult/neonate X
High/low alarms, all parameters X
Alarm window X
Multi-level, user-programmable, graded alarms package X
Laser printer support X
2-inch and 4-inch direct digital writer (DDW) support X
View other patient (float) X
View on alarm X
Auto view on alarm (requires Prism information server) X
LAN combo (telemetry/hardwire monitoring) X

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D Appendix D
Factory Defaults
Adult-ICU Mode

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For your notes

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Appendix D Factory Defaults Adult-ICU Mode:

Following are the factory-set monitor defaults for the Adult-ICU Mode. You can change these using the
Monitor Defaults feature. Monitor defaults are recalled upon discharge. Refer to the Monitor Setup chapter.

Arrhythmia Alarm Levels Parameter Alarm Levels


Crisis Warning Advisory Message Crisis Warning Advisory Message
Asystole HR
VFib/VTac CO2 No
V Tach Breath
VT > 2 PVC/min
V Brady ST
Couplet ART
Bigeminy PA
Acc Vent SPO2 *
Pause CO2
Trigeminy NBP
R on T FEM
PVC UAC
Tachy GAS
Brady CVP
Irregular RA
UVC
LA
ICP
SP
SVO2
TC
ART Rate
SPO2
Rate*
BT
RR
Resp
Apnea
FEM Rate
UAC Rate
CCO
ICG
TMP
* When the ECG parameter is turned off, these SPO2 alarm level
defaults are elevated from a Message to a Warning.

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Appendix D Factory Defaults Adult-ICU Mode:

Parameter Limits Parameter Limits


Low High Low High
HR 50 150 CO2-Insp 5
PVC/min 6 CO2-Resp 5 30
ST-I 2.0 2.0 No Breath 20
ST-II 2.0 2.0 SpO2 90 105
ST-III 2.0 2.0 SpO2-R 50 150
ST-V1 2.0 2.0 BT 30.0C/86.0F 42.0C/107.6F
ST-AVL 2.0 2.0 SVO2 60 80
ST-AVF 2.0 2.0 RR 5 30
ST-AVR 2.0 2.0 RR-Apnea 20
ST-V2 2.0 2.0 TEMP 1 30.0C/86.0F 42.0C/107.6F
ST-V3 2.0 2.0 TEMP 2 30.0C/86.0F 42.0C/107.6F
ST-V4 2.0 2.0 O2-Insp 18 102
ST-V5 2.0 2.0 O2-Exp 1 102
ST-V6 2.0 2.0 N2O-Insp 1.0 80.0
NBP-S 80 200 N2O-Exp 1.0 80.0
NBP-D 20 120 N2-Insp -1.0 85.0
NBP-M 40 140 N2-Exp -1.0 85.0
ART-S 80 200 SEV-Insp 1.0 7.0
ART-D 20 120 SEV-Exp 1.0 7.0
ART-M 40 140 DES-Insp 1.0 12.0
ART-R 50 150 DES-Exp 1.0 12.0
FEM-S 80 200 ENF-Insp 1.0 7.0
FEM-D 20 120 ENF-Exp 1.0 7.0
FEM-M 40 140 HAL-Insp 1.0 7.0
FEM-R 50 150 HAL-Exp 1.0 7.0
UAC-S 80 200 HE-Insp -1.0 7.0
UAC-D 20 120 HE-Exp -1.0 7.0
UAC-M 40 140 ISO-Insp 1.0 7.0
UAC-R 50 150 ISO-Exp 1.0 7.0
PA-S 99 350 AR-Inp -1.0 7.0
PA-D 99 350 AR-Exp -1.0 7.0
PA-M 99 350 CI 1.5 5.0
CVP 99 350 TFC 10 60
RA 99 350
UVC 99 350
LA 99 350
ICP 99 350
SP 99 350
CO2-Exp 1 50

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Appendix D Factory Defaults Adult-ICU Mode:

Display Defaults Display Defaults


Patient Age Adult O2 Compensation 0-60% O2
Display Mode Indv 6 WFS RR Parameter Off
Color Format Transducer RR Lead II
Primary ECG II RR WF Speed 25
ECG Waveform 2 V1 SPO2 WF Speed 25
Arrhythmia Full View On Alarm Off
Detect Pace Off VOA Broadcast Off
Arterial Rate On VOA Alert Tone Off
Lead Analysis Multi-lead Remote Alarm Level Crisis
ST Analysis Off Alarm Volume Off Enable
ST Templates Off Min Alarm Volume 10%
ST V Lead V5 Alarm Volume 70%
ST Template 1 II Silence Alarm Normal
ST Template 2 V5 QRS Volume Off
ST Template 3 I Rate Volume Off
Adjust ST Point J + 60 MS ECG Leads Fail Sys Warning
12 LD on ST History Off SPO2 Probe Off* Sys Warning
ECG WF Speed 25 SPO2 Pulse Search* Sys Advisory
Graph Waveform 2 ART Monitor ISO/DES Isoflurane
Graph Waveform 3 Off Display Limits On
Graph Waveform 4 Off Display Units Off
Alarm Graph On Units For Height CM
Timed Graph Continuous Units For Weight KG
ART Disconnect On Temperature Units C DEG
Smart BP On CO2 Units MMHG
Arterial Scale 160 O2 Units %
PA Scale 60 GAS Units %
CVP-RA-UVC Scale 30 NBP Limits Type Systolic
LA Scale 30 Arterial Limits Type Systolic
ICP Scale 30 PA Limits Type Diastolic
SP Scale 160 Menu Timeout 5 minutes
BP WF Speed 25 ECG Filter Monitoring
CO2 Scale 50 BP Filter 12 Hz
CO2 WF Speed 6.25 QRS Width Normal
NBP Auto Off CO2 Display Mode Auto
ADULT Cuff Pressure 160 MMHG Discharge Alert Off
PED Cuff Pressure 140 MMHG Vent WF Speed 6.25
NEO Cuff Pressure 110 MMHG Display MAC Value Off
CO Catheter Baxter Disable SAM HAL Off
CO Inj Temp In-Line Disable SAM ENF Off
CO Size 7.5 Tech ID Field Off
CO Inj Vol 10CC * When the ECG parameter is turned off, the alarm level
CO Auto Mode On default is a minimum of a System Warning.

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Appendix D Factory Defaults Adult-ICU Mode:

Display Defaults Parameter Priority Defaults


The following parameters, when monitored, will
ICG Primary Par CI always appear in parameter windows at the right
ICG Secondary Par1 CO side of the display.
ICG Secondary Par2 SVR
* When the ECG parameter is turned on, the ECG parameter
ICG Secondary Par3 TFC
will always appear first and cannot be changed. However,
NBP Silence Alarm Normal when the ECG parameter is turned off, the SPO2 parameter
Pause Breakthru Crisis will always appear first and cannot be changed.
Masimo Averaging 8 secs
ECG IntelliRate On Parameter 1 ECG*
SPO2-NBP Interlock On Parameter 2 ECG
ECG Parameter On Parameter 3 ART
Disconnection Option To Default Parameter 4 PA
Parameter 5 SPO2
Parameter 6 CO2

The highlighted parameters below appear in


parameter windows at the bottom of the display only
when there is no room at the side.

GAS CVP* CO*

NBP RA* CCO

ART UVC* RESP

FEM LA* TEMP*

UAC ICP* TC

PA SP* UO*

CO2 SVO2 ICG

VENT* SPO2 ALARMS

* MAY BE DISPLAYED AS REDUCED SIZE (determined by


software)

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E Appendix E
Factory Defaults
Neonatal-ICU Mode

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For your notes

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Appendix E Factory Defaults Neonatal-ICU Mode:

Following are the factory-set monitor defaults for the Neonatal-ICU Mode. You can change these using the
Monitor Defaults feature. Monitor defaults are recalled upon discharge. Refer to the Monitor Setup chapter.

Arrhythmia Alarm Levels Parameter Alarm Levels


Crisis Warning Advisory Message Crisis Warning Advisory Message
Asystole Resp
VFib/VTac Apnea
Brady HR
CO2 No
Breath
Vent
PVC/min
ST
UAC
UVC
SPO2*
NBP
CO2
ART
FEM
GAS
PA
CVP
RA
LA
ICP
SP
SVO2
TC
UAC Rate
RR
ICG
SPO2
Rate*
ART Rate
FEM Rate
TMP
BT
CCO
ICG
* When the ECG parameter is turned off, these SPO2 alarm level
defaults are elevated from a Message to a Warning.

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Appendix E Factory Defaults Neonatal-ICU Mode:

Parameter Limits Parameter Limits


Low High Low High
HR 90 200 CO2-Insp 5
PVC/min 6 CO2-Resp 15 100
ST-I 2.0 2.0 No Breath 15
ST-II 2.0 2.0 SpO2 88 100
ST-III 2.0 2.0 SpO2-R 90 200
ST-V1 2.0 2.0 BT 30.0C/86.0F 42.0C/107.6F
ST-AVL 2.0 2.0 SVO2 60 80
ST-AVF 2.0 2.0 RR 15 100
ST-AVR 2.0 2.0 RR-Apnea 15
ST-V2 2.0 2.0 TEMP 1 30.0C/86.0F 42.0C/107.6F
ST-V3 2.0 2.0 TEMP 2 30.0C/86.0F 42.0C/107.6F
ST-V4 2.0 2.0 O2-Insp 18 102
ST-V5 2.0 2.0 O2-Exp 1 102
ST-V6 2.0 2.0 N2O-Insp 1.0 80.0
NBP-S 40 100 N2O-Exp 1.0 80.0
NBP-D 20 60 N2-Insp -1.0 85
NBP-M 30 70 N2-Exp -1.0 85
ART-S 40 100 SEV-Insp 1.0 7.0
ART-D 20 60 SEV-Exp 1.0 7.0
ART-M 30 70 DES-Insp 1.0 12.0
ART-R 90 200 DES-Exp 1.0 12.0
FEM-S 40 100 ENF-Insp 1.0 7.0
FEM-D 20 60 ENF-Exp 1.0 7.0
FEM-M 30 70 HAL-Insp 1.0 7.0
FEM-R 90 200 HAL-Exp 1.0 7.0
UAC-S 40 100 HE-Insp -1.0 7.0
UAC-D 20 60 HE-Exp -1.0 7.0
UAC-M 30 70 ISO-Insp 1.0 7.0
UAC-R 90 200 ISO-Exp 1.0 7.0
PA-S 99 350 AR-Inp -1.0 7.0
PA-D 99 350 AR-Exp -1.0 7.0
PA-M 99 350 CI 1.5 5.0
CVP 99 350 TFC 10 60
RA 99 350
UVC 99 350
LA 99 350
ICP 99 350
SP 99 350
CO2-Exp 1 50

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Appendix E Factory Defaults Neonatal-ICU Mode:

Display Defaults Display Defaults


Patient Age 0-2 CO Auto Mode On
Display Mode Indv 6 WFS O2 Compensation 0-60% O2
Color Format Transducer RR Parameter On
Primary ECG II RR Lead II
ECG Waveform 2 Off RR WF Speed 25
Arrhythmia Lethal SPO2 WF Speed 25
Detect Pace Off View On Alarm Off
Arterial Rate On VOA Broadcast Off
Lead Analysis Multi-lead VOA Alert Tone Off
ST Analysis Off Remote Alarm Level Crisis
ST Templates Off Alarm Volume Off Disable
ST V Lead V5 Min Alarm Volume 10%
ST Template 1 II Alarm Volume 70%
ST Template 2 V5 Silence Alarm Normal
ST Template 3 I QRS Volume Off
Adjust ST Point J + 30 MS Rate Volume Off
12 LD on ST History Off ECG Leads Fail Sys Warning
ECG WF Speed 25 SPO2 Probe Off* Sys Warning
Graph Waveform 2 ART SPO2 Pulse Search* Sys Advisory
Graph Waveform 3 RR Monitor ISO/DES Isoflurane
Graph Waveform 4 Off Display Limits On
Alarm Graph Off Display Units Off
Timed Graph Continuous Units For Height CM
Arterial Scale 100 Units For Weight KG
PA Scale 60 Temperature Units C DEG
CVP-RA-UVC Scale 30 CO2 Units MMHG
LA Scale 30 O2 Units %
ICP Scale 30 GAS Units %
SP Scale 160 NBP Limits Type Systolic
BP WF Speed 25 Arterial Limits Type Systolic
CO2 Scale 50 PA Limits Type Diastolic
CO2 WF Speed 6.25 Menu Timeout 5 minutes
NBP Auto Off ECG Filter Monitoring
ADULT Cuff Pressure 160 MMHG BP Filter 12 Hz
PED Cuff Pressure 140 MMHG QRS Width Narrow
NEO Cuff Pressure 110 MMHG CO2 Display Mode Auto
CO Catheter Baxter Discharge Alert Off
CO Inj Temp In-Line Vent WF Speed 6.25
CO Size 7.5 * When the ECG parameter is turned off, the alarm level
CO Inj Vol 10CC default is a minimum of a System Warning.

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Appendix E Factory Defaults Neonatal-ICU Mode:

Display Defaults Parameter Priority Defaults


The following parameters, when monitored, will
Display MAC Value Off always appear in parameter windows at the right
Disable SAM HAL Off side of the display.
Disable SAM ENF Off
* When the ECG parameter is turned on, the ECG parameter
Tech ID Field Off will always appear first and cannot be changed. However,
ICG Primary Par CI when the ECG parameter is turned off, the SPO2 parameter
ICG Secondary Par1 CO will always appear first and cannot be changed.

ICG Secondary Par2 SVR


Parameter 1 ECG*
ICG Secondary Par3 TFC
Parameter 2 UAC
NBP Silence Alarm Normal
Parameter 3 UVC
Pause Breakthru Crisis
Parameter 4 RR
Masimo Averaging 8 secs
Parameter 5 SPO2
ECG Intelli Rate On
Parameter 6 NBP
SPO2-NBP Interlock On
ECG Parameter On The highlighted parameters below appear in
Disconnection Option To Default parameter windows at the bottom of the display only
when there is no room at the side.

VENT* NBP SVO2*

ART CVP* TC

FEM RA* TEMP*

UAC UVC* CO*

PA LA* CCO

CO2 ICP* UO*

GAS SP* ICG

RESP* SPO2* ALARMS

* MAY BE DISPLAYED AS REDUCED SIZE (determined by


software)

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F Appendix F
Factory Defaults
Operating Room Mode

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For your notes

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Appendix F Factory Defaults Operating Room Mode:

Following are the factory-set monitor defaults for the Operating Room Mode. You can change these using the
Monitor Defaults feature. Monitor defaults are recalled upon discharge. Refer to the Monitor Setup chapter.

Arrhythmia Alarm Levels Parameter Alarm Levels


Crisis Warning Advisory Message Crisis Warning Advisory Message
Asystole HR
VFib/VTac PVC/min
V Tach ST
NBP
ART
PA
SPO2*
CO2
CO2 No
Breath
GAS
FEM
UAC
CVP
RA
UVC
LA
ICP
SP
SVO2
TC
ART Rate
SPO2
Rate*
TMP
BT
RR
ICG
Resp
Apnea
FEM Rate
UAC Rate
CCO
ICG
* When the ECG parameter is turned off, these SPO2 alarm level
defaults are elevated from a Message to a Warning.

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Appendix F Factory Defaults Operating Room Mode:

Parameter Limits Parameter Limits


Low High Low High
HR 1 150 CO2-Insp 5
PVC/min 6 CO2-Resp 1 200
ST-I 2.0 2.0 No Breath 30
ST-II 2.0 2.0 SpO2 90 105
ST-III 2.0 2.0 SpO2-R 1 150
ST-V1 2.0 2.0 BT 0.0C/32.0F 42.0C/107.6F
ST-AVL 2.0 2.0 SVO2 60 80
ST-AVF 2.0 2.0 RR 1 200
ST-AVR 2.0 2.0 RR-Apnea 20
ST-V2 2.0 2.0 TEMP 1 0.0C/32.0F 42.0C/107.6F
ST-V3 2.0 2.0 TEMP 2 0.0C/32.0F 42.0C/107.6F
ST-V4 2.0 2.0 O2-Insp 18 102
ST-V5 2.0 2.0 O2-Exp 1 102
ST-V6