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Service Training

BeneView T5

V 1.00
Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
Appearance
T5 Appearance
 Front View
1.Physiological alarm lamp
2.Technical alarm lamp
3. Display screen
4. Power On/Off Switch
5. AC power LED
6. Battery LED
7. Press to silence all
system sound
8. Press to pause,
restore or clear alarms
9. Press to freeze or
unfreeze waveforms
10. Press to start or stop
recordings
11. Press to start or stop
NIBP measurements
12. Main menu
13. Knob
T5 Appearance
 Side View
T5 Appearance
 Rear View

1. AC Power Input

2. USB Connectors

3.Auxiliary Output Connector

4. Defib Sync Connector

5. Network Connector

6. CIS connector

7. Digital Video Interface (DVI)

8. SMR connector

9. Equipotential Grounding Terminal


Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
Basic Parameters

ECG
--Electrocardiogram
--Electrocardiogram
Basic Parameters-ECG
What is ECG?
 Bioelectricity
A kind of electricity that produced by the electric excitation of
the heart, which can be detected through electrodes.
 A kind of continuous diagram recording Bioelectricity to
reflect all electric activities of the heart.

ECG Demo

RA
LA

RV
LV
Basic Parameters-ECG
 Typical ECG waveform

 P wave:
It records the electrical
activity of the heart's two
upper chambers (atria).

 QRS complex:
It records the electrical
activity of the heart's two
lower chambers (ventricles).

 T wave:
It records the heart's return
to the resting state.
Basic Parameters-ECG

Bipolar limb leads (3 leads):

- Lead I: RA (-) to LA (+) (Right Left, or lateral)

- Lead II: RA (-) to LF (+) (Superior Inferior)

- Lead III: LA (-) to LF (+) (Superior Inferior)


Basic Parameters-ECG

Augmented limb leads(5 leads):

- Lead aVR: RA (+) to [LA & LF] (-) (Rightward)

- Lead aVL: LA (+) to [RA & LF] (-) (Leftward)

- Lead aVF: LF (+) to [RA & LA] (-) (Inferior)


Basic Parameters-ECG

Places of 5 leads electrodes :

Lewis L
Yellow
- Lead aVR: RA (+) to [LA & LF] (-) (Rightward) R
Red

- Lead aVL: LA (+) to [RA & LF] (-) (Leftward) C


White
- Lead aVF: LF (+) to [RA & LA] (-) (Inferior)

N F
Black Green
Basic Parameters-ECG

Unipolar (+) chest leads(12 leads)—increase precision

- Leads V1, V2, V3: (Posterior Anterior)

- Leads V4, V5, V6:(Right Left, or lateral)


Basic Parameters-ECG

- ECG Lead Names Identification -

American (AHA) Standard European (IEC) Standard

Label Color Label Color

RA White R Red
LA Black L Yellow
LL Red F Green
RL Green N Black
V Brown C White
Basic Parameters-ECG
ECG Module
Basic Parameters-ECG

ECG Accessories
- Integrated / Separated
- Clip / Snap
- Defibrillation or not (w or w/o 1kohm)
- 3 leads / 5 leads / 12 leads
Basic Parameters-ECG
ECG Setup

Noise filter mode Bandwidth


 Surgery 1-15Hz(rigorous)
 Monitor 0.5-35Hz
 Diagnostic 0.05-100Hz(loose)
Basic Parameters-ECG
ECG Waveform Setup

CASCADE:
waveform of each channel is displayed in
two lines

HR FROM:
Heart rate source
Options: ECG, SPO2, IBP, AUTO and ALL

Gain:
Adjust the amplitude of the waveform
Basic Parameters-ECG
ECG Parameter Setup

SMART LEAD OFF: If there is a LEAD OFF in the HR-derived channel, the system will automatically
switch to another lead to restore the display of the ECG waveform in the HR-derived channel.
PACE: Switch "ON" for pace making patient or “OFF" for non-pace making patient
Display modes:
 NORMAL DISPLAY: To display 2 ECG waveforms for 5-lead (for 3-lead, only 1 ECG
waveform is displayed.)
 MULTI-LEADS DISPLAY: The waveform area on the screen displays 6 ECG waveforms
 HALF-SCAN MULTI-LEADS: 6 ECG waveforms are displayed on half of the screen.
Basic Parameters-ECG
ST segment analysis
- ISO: It is the base point, used to indicate the baseline point of the ST analysis.
Default value is 78ms.

- ST: It is the ST measurement point. Default value is 109ms.


- The span from ISO to ST reflects all ventricular process. So in
principle, there should be no baseline difference in this interval.

Normal range:
-0.05mV ~ +0.1mV
Basic Parameters-ECG

ST segment analysis

• ST analysis function can be switched on or off in ST analysis item.


• Measurement unit of ST segment: mV
• Measurement symbol of ST segment: “+”=elevating ; “-” =depressing
• Measurement range of ST segment :-2.0mV to +2.0mV
• ST elevation, possible acute myocardial infarction
• ST depression, possible heart anemia
Basic Parameters-ECG

Arrhythmia analysis

ASYSTOLE PVC premature ventricular beat


BIGEMINY VT>2 multi- PVC
BRADY bradycardia R ON T a kind of PVC that the R on
COUPLET TACHY tachycardia
MISSED BEATS TRIGEMINY
PNP pacer not paced VFIB/VTAC ventricular fibrillation /
PNC pace not capture tachycardia

PVC is a much more serious and frequent symptom in clinical operations.


Basic Parameters-ECG
Operation Notes:

 Prepare the patient’s skin prior to placing the electrodes.

 Replace electrodes every 24 hours or change their sites.

 Select the right type cable and setup in monitor

 Set the pace on/off correctly

 Select the right filter mode

 Setup the alarm limit.


Basic Parameters-ECG

ECG typical failures

1.Waveform not good

2.HR doubled

3.HR is good, but no waveform

4.Why it doesn’t work

5.Why there is only 1 waveform on the screen

6.COMM error
Basic Parameters-RESP
 The RESP display

1 3 2 4

1. Waveform name 5
2. RESP lead: I or II
3. Waveform gain
4. RESP label
5. RR: Respiration rate number
Basic parameters - RESP

Operation Notes:

 Keep RA and LA
electrodes horizontally

 Keep RA and LL
electrodes diagonally

 Avoid the liver and


ventricles areas
especially for neonate

 Set the Hold type


correctly (Auto or Manual)
Basic parameters - RESP

Typical failures

• Waveform is good, why the RR is so low?

• Why RESP no. and AWRR(CO2 monitoring) are usually


different?
Basic parameters

– SpO2
Basic parameters – SpO2

What is SpO2?

• Shows the percentage of hemoglobin molecules which have


combined with oxygen molecules to form ox hemoglobin

• Hb+O2=HbO2

• SpO2=HbO2/(HbO2+Hb) X 100%

The ratio of HBO2 to all hemoglobin.


Basic parameters – SpO2
SpO2 Module
Basic parameters – SpO2
Accessories

Mindray Nellcor KTMED (Vet)


Basic parameters – SpO2

Operations Notes

 Sensitivity

- Available options:
High, Med, Low

That is, more sensitive,


but less interference-
tolerance.
 NIBP Simul
During NIBP measurement,
Spo2 will automatically
stops, value of it will not
change.
SpO2 Display and Readings

PLETH waveform

Perfusion
Pulse rate
Normal SpO2 numeric range indicator
Adult ≥ 95%
Neonate 91%~94%
Basic parameters – SpO2

Operations notes:

 Select proper sensor for the patient and place the sensor correctly.

Adult finger sensor Neonatal sensor

Note:
To ensure the light from the sensor is facing right to the finger nail, the
extension cable should be on the back of your hand.
Spo2-Notes for operation

• Make sure the nail covers the light window. (The wire should be on the
upside of the hand.)

• Check per 2-3 hours the sensor placement and move it when the skin
deteriorates.

• Don’t place the sensor on an extremity that has a blood pressure


cuff,arterial catheter,or intravascular line.

• Pulse oximeter can overestimate the SPO2 value in the presence of Hb-CO,
Met-Hb or dye dilution chemicals.

• High oxygen levels may harm neonate’s eyes.


Spo2 measurement limitation

1. Intravascular dye injections

2. Excessive patient movement

3. Venous pulsations

4. Sensor temperature(maintain between 28 ℃ and 42 ℃ for best operation)

5. placement of the sensor on an extremity that has a blood pressure cuff,arterial


catheter,or intravascular line

6. Significant concentration of dysfunctional hemoglobin

7. Low perfusion

8. Poor skin deteriorates


Basic parameters

– NIBP
Basic Parameters-NIBP
Theory
The blood pressure is the vertical strength of blood applied
against the wall of the blood vessel as the heart pumps the blood
through the body.

The monitor measures the NIBP by oscillometry method.

SP=f1 (MP) mmHg

DP=f2 (MP)

SP MP DP t
Basic Parameters-NIBP
Apply the appropriate size of cuff to the patient, and make sure that the
symbol "Φ" is over the humerus artery. Ensure that the cuff is not
wrapped too tightly around the limb. Excessive tightness may cause
discoloration.

Make sure that the cuff edge falls within the range of mark <->.
If it does not, use a larger or smaller one which is suitable.
Basic Parameters-NIBP
NIBP Module
Operations Notes

 Display NIBP
1 Group Groups

 Interval
MANUAL or 1~480MIN

 NIBP STAT
Initiate 5 minutes of continuous,
sequential, automatic NIBP
measurement

 VeniPuncture
Use the NIBP cuff to cause sub-
diastolic pressure to block the venous
blood vessel and therefore help
venous punture
Basic Parameters-NIBP

 Heart rate range: 40 ~ 240 bpm.


 Blood pressure range: 50 ~ 250 mmHg.
 Patient Movement
 Cardiac Arrhythmia's
 Heart-lung Machine
 Pressure Changes
 Severe Shock
 Heart Rate Extremes
 NIBP Leakage Test

Patient Monitor
Basic Parameters-NIBP
NIBP Accuracy Test
Basic Parameters-NIBP
How to confirm when you think NIBP data are incorrect?

1. Use the same monitor to measure NIBP for a certain patient


(or normal people), this is to verify the reproducibility

2. Use the same monitor to measure NIBP for different patients,


this is to testify certain patient's own problem

3. Use different monitors to measure NIBP for a certain patient,


this is to testify certain monitor's problem

4. Different doctors use Ausculatory method to measure blood


pressure for certain patient, this is to avoid differences caused
by doctor's personal custom.
Typical Failure

NIBP reading is inaccurate

Resetting continuously?

COMM Error

Too much noise.


Basic parameters

– Temp
TEMP Principle
Principle

Transform temperature values into voltage using TEMP sensor .

The impedance will vary with different temperatures.

We obtain impedance changes, and then calculate the temperature.


TEMP Module
TEMP Accessory

Sensor type:

- YSI

Pediatric, skin-surface Adult, skin-surface Rectal


TEMP Factors

Factors which may influence temperature

 Difference between day and night within 1℃

 Difference about region and season higher temperature in the


summer

 Sex, age, mental and physical activities


Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
Optional Parameters

– IBP
Basic Parameters-IBP
Piercing skin&vas Intubate catheters into certain
blood vessel

Connecting

Transducers

Calculation

Real time blood pressure


waveform
Basic Parameters-IBP
IBP Module
IBP Accessories

Cable

Transducers
Basic Parameters-IBP

IBP MONITORING PARAMETERS


IBP Monitoring Procedure

Normal Pressure
saline Transducer
with
heparin

3-way
stopcock

Drip chamber Pressure transducer interface cable

Pressure line

Monitor
IBP Monitoring Procedure

1. Plug the pressure cable into the IBP connector on the monitor and
power on the monitor.

2. Zero the transducer

3. Prepare the pressure line and transducer by flushing the system with
normal saline solution. Make sure the tubing and transducer system is
free of air bubbles.

4. Connect the catheter to the pressure line, make sure there is no air
present in the catheter or pressure line.

5. Position the transducer so it is at the same level with the patient’s heart,
approximately mid-axillary line.

6. Verify the correct label is selected.


IBP Zeroing

Steps:
 Turn off patient stopcock before you start the zero procedure.
 The transducer must be vented to atmospheric pressure before the zero
procedure.
 The transducer should be placed at the same height level with the heart,
approximately mid-axially line.
★ Zero procedure should be performed before starting IBP monitoring or at least once
a day (or each time after connecting/disconnecting the cable)
IBP Calibration
IBP Calibration
1. Turn off the atmosphere stopcock before you start the calibration
procedure.
2. Attach the tubing to the manometer.
3. Make sure that patient is not on connection.
4. Connect the 3-way connector to the 3-way stopcock.
5. Open the port of the 3-way stopcock to the manometer.
6. Select the channel to be calibrated in the menu.
7. Inflate to make the mercury bar rise to the setup pressure value.
8. Adjust until the value in the menu is equal to the pressure value
shown by the mercury calibration.
9. Press Start button, the device will begin calibrating.
10.Wait for the calibrated result. You should take corresponding
measures based on the prompt information.
Optional Parameters

– C.O.
Basic parameters - C.O.

Measurement principle:

Thermodilution Technique

• Measure blood temperature,calculate cardiac output,


process hemodynamic calculation

• Perform up to 6 measurements before editing the average C.O.


and C.I.

• Prompt message on the screen will tell you when to inject.


C.O. - Sensor Connections

Monitor Cardiac Output Injection


Cable

Swan-Ganz Delivery System


Catheter

Inflator

IBP Temperature Sensor


C.O. - Measuring method
Blood Temperature Monitoring
C.O. - Measurement
CO Module
C.O. - Sensor Connections
C.O. - Measurement
Notes:
 Comp.Const
It represents the computation
constant related to the
catheter and injecta volume.
After replacing a catheter, you
should adjust this constant
according to the instruction.

 Autio IT: Pick “ON” or “OFF”


to select from two ways of
obtaining the injecta
temperature.
ON: the system obtains the
injecta temperature through
sampling.
OFF: directly display the
injecta temperature obtains
from the INJ.TEMP item.
C.O. – Measurement Window

1.C.O.: measured cardiac output

2.C.I.: cardiac index

3.BSA: body surface area

4.TB: temperature of blood

5.IT: temperature of injecta


C.O. – Edit Windows
Hemodynamic Calculation Window
C.O. – Parameter Window

The C.O. measurement only produces some parameter numerics in


the parameter window, and gives no waveform.
Contents

CO2
 Modules
 Principle
 Operation
 Calibrate & test
CO2 Modules

Side-stream (For Intubated or Non-intubated patient)

 Mindray side-stream (PM-9000 Express,PM-8000 Express,PM-


7000,T8,T5)
 Oridion Microstream® (PM-9000 Express,PM-8000 Express,PM-
7000,T8,T5)
CO2 Modules

Main-stream (For intubated patient only)

 Welch Allyn (PM-9000 Express / PM-7000)


 Novametrix Capnostat (For Beneview T8/T5)

Sensor
Adapter
CO2 Modules
CO2 Accessory
Comparison

Side-stream
Main stream
Mindray Oridion
Side-stream Microstream®
Patient Adult,Pediatric,Neonate Adult,Pediatric, Adult,Pediatric,Ne
Intubated Intubated or Non- onate;
intubated Intubated or Non-
intubated
Response time < 60 ms < 240 ms 2.9 S
Measure Delay No delay <2S 2.7 S
Sample air Never A few A few
leakage
Sensor price Expensive (reusable) Cheap( Cheap(
disposable) disposable)
Sensor break Some time never Never
Vapor block Nearly never A few Some times
CO2 - Principle
• Lambert
Lambert--Beer Law
Law::
Breath Rate
Vol %
− aLC
I = I0 ⋅ e
6 ETCO2
4
2
0 InspCO
Inhalation Exhalation Inhalation Exhalation
2

I0:The light transmitted from the source Typical CO2 Waveform

I: The light received


a:The absorption constant of the light
L:The effective length of the waveform
C:The concentration of the measured gas
The intensity of light will be determined by medium it has passed
through.
CO2 - Principle

Light processing Light Absorption Light detection


CO2 - operation

•N2O COMPEN ON: more than 30%.


•O2 COMPEN ON: more than 50%.
•Des COMPEN ON: Desflurane is contained
•Humidity Compen Body Temperature(37℃) and Pressure(47mmHg ),
Saturated(95% ).
Gas coming from lung is what we need to monitor, however, after sampled out
its status will change. So we should do some compensations.
CO2 - Operation
Notes:
1. Patient Type (Adult,Pediatric or Neo)

2. Ambient environment requirement(CO2<0.5%)

3. ATPD or BTPS

4. N2O, O2, Des compensation

5. Water trap (Reusable, but need replace)

6. Set the module to standby when not using

7. Not able to identify the water trap automatically


CO2 - Operation
Incorrect Gas Data Due To:
 Leakage in gas sampling system due to wear of parts.

 Incorrect zero reference measurement due to gas

leakage.

 Zero valve failure (HW error not detected by software).

 Aging of device.

 Gas sample humidity too high due to old Nafion tubing.


CO2 - Calibration
Notes:
1.Annual measurement check
2. All compensation is off
3. Zero calibration first
4. Full Accuracy mode(30s for
stabilization)
5. Check after calibration

CO2 content (3% to 7%)


CO2-Typical failure

1. CO2 too low / too high


- BTPS is on, or other compensation is on.
- Airway leakage or block

2. Airway leakage or block

3. COMM Error
,or whether the
- Check whether the hardware is connected,
software
supports the module

4. CO2 module doesn’t work


- Standby or not?

5. Too much noise


- Airway blocked or pump failed
AG - Principle

Measured Gas
 CO2
 O2
 N2O
 Anesthesia Agents (AA):
– Enflurane
– Isoflurane
– Sevoflurane
– Desflurane
– Halothane
AG - Principle

Absorption spectra for CO2 and N2O. CO2: 4.2µm


N2O: 3.9µm

Absorption spectra for anesthetic agents.


AG - Principle

• A broadband infrared radiation source


• Narrow optical band pass filters: seven gas wavelengths plus
reference wavelength
• Filters are mounted in a rapidly rotating filter wheel
AG - Operation
Sampling Way:Side
Side--stream
AG - Modules
AG - Operation
AG - Operation
The concentration of inspired drug with different
MAC (Vol%)
MAC Drug MACawake 0.65MAC MAC ED99MAC
Hal 0.31 0.50 0.77 1.00
(minimum alveolar
Enf 0.67 1.09 1.68 2.18
concentration): Iso 0.46 0.75 1.15 1.50
In this concentration, 50% Sev 0.68 1.11 1.71 2.22
patients will not react under Des 2.40 3.90 6.00 7.80
operation stimulation.
MACawake = 0.4×MAC
0.65MAC = 0.65×MAC
ED99MAC = 1.3×MAC

*FI: flow inspired *ET: end tidal


*The system can only display the waveform and value of
the maximum concentration anesthetic agent at one time.
AG - Operation
AG - Operation

 Patient Type (Select the right water trap). This will determine the flow rate.

 The default status of the multi-gas module after power on is STANDBY

 After 30 seconds since setting ‘MEASURE’ status, will show the value of ISO
accuracy,and after 10 minutes , will show the value of full accuracy

 Change the water trap every month ; change the water trap when there is a
prompt of block or pump noise becomes loud.

 Please take the water trap off when it is not used or set the work mode in
‘STANDBY’

 Ambient environment requirement(CO2<0.5%)

 Calibrate every year

 Leakage check every year


AG - Maintenance

Leakage Test
• Power up the system and allow the multi-gas module to enter full accuracy mode.
Set sample flow to 200 ml/min
• Block the sampling tubing connected to the water trap with the multi-gas analyzer
operating.
• Wait 30s for stabilization.
• Check that there is no air coming out of the Evac outlet by submerging the end of
the evacuation tub into water. There must not be more than 2 bubbles/15 seconds.
AG - Maintenance
Gas Measurement Check

The calibration gas must meet following specifications:


• Agent concentration in gas mixture must be >1.5%.
• CO2 concentration in gas mixture must be >1.5%.
• N2O concentration in gas mixture must be >40%.
• O2 concentration in gas mixture must be >40%.
AG - Maintenance
Gas Measurement Check

• Full accuracy mode.

• Open the gas cylinder valve and wait

30s for stabilization.

• Verify concentrations are within the

specifications.

• If the result is out of specifications, pls

perform calibration.
AG - Maintenance

 Monthly maintenance procedure

– Replace the water trap every month or more often if the monitor
indicates this.

 Annual maintenance procedure

– Perform a leakage test

– Perform a gas measurement check

– Recommended to replace internal Nafion tubing (or replace the


DRYLINE™ receptacle including the Nafion tubing).
Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
ICG Introduction
ICG introduction

• Technology
- What is ICG?
- Principle
- Advantage and disadvantage
- Validity

• Operation
- Module and accessories
- Operation procedure
- The ICG display
- Notes

• Clinical Application Limits


What is ICG?

• ICG (Impedance Cardiography)


- an accurate, reproducible and noninvasive method to obtain
hemodynamic information.
ICG Principle

• 4 dual sensors with 8 lead wires


placed on neck and chest

• Current transmitted and seeks


path of least resistance: blood
filled aorta
• Baseline impedance (resistance)
to signal is measured
• With each heartbeat, blood
volume and velocity in the aorta
change
• Corresponding change in
impedance is measured
• Baseline and changes in
impedance are used to measure
and calculate hemodynamic
parameters
ECG and ICG Waveforms

Q = Ventricular
ECG depolarization

B = Opening aortic
& pulmonic valves
∆Z
C = Maximal slope ∆Z

X = Closure aortic valve

Y = Closure of pulmonic
valve

O = Opening mitral
∆Z / ∆t valve / rapid filling
of ventricles

Time

Osypka MJ, Bernstein DP. AACN Clinical Issues. 1999;10(3):385-399.


Advantage and disadvantage

Thermal Dilution ICG Method


Method
Professional training Yes No
Measure time 15-20min 5min
Patient connections pulmonary artery 4 pairs of ICG electrodes
catheterization
Risk of Infection High Little
Disadvantage Discontinuous data, high No PAWP data
cost, risk of arrhythmias

Advantage Clinical standard, with PAWP Non-invasive, continuous


data data, low cost, high efficient
Validity

ICG Accuracy vs. Thermodilution in Post CABG


(N = 20 216 comparisons)
4.5

Correlation 4

0.92, p<0.001 3.5

3
Precision ICG CI
2.5
0.40 l/min/m2
2

Bias
1.5
0.07 l/min/m2
1
1 1.5 2 2.5 3 3.5 4 4.5
TD CI

Sageman WS, et al. J Cardiothorac Vasc Anesth. 2002;16(1):8-14.


How does it work?
ICG module
ICG Accessories
Operation procedure

1. Connect the module to


the monitor

2. Connect the cable to


monitor and patient

3. Prepare the patient’s


skin and place ICG
sensors on the patient.

4. Setup the patient Notes:


information, like height,  Two neck sensors placed on each side of the neck in parallel
weight, BP etc.  Two thorax sensors placed on each side of the thorax in
parallel, at the level with the xyphoid process.
What can we get from ICG?
The ICG Display
Parameters

Flow Stroke Volume / Index (SV / SI)


Cardiac Output / Index (CO / CI)

Resistance Systemic Vascular Resistance /


Index (SVR / SVRI)

Systolic Time Ratio (STR)


Contractility Pre-ejection Period (PEP)
LV Ejection Time (LVET)
Velocity Index (VI)
Acceleration Index (ACI)

Fluid Thoracic Fluid Content (TFC)


Parameters

Measured Parameters Calculated Parameters


– Thoracic Fluid Content (TFC) – Stroke Volume / Index (SV/SI)

– Heart Rate (HR) – Cardiac Output / Index


(CO/CI)
– Acceleration Index (ACI)
– Systemic Vascular Resistance
– Velocity Index (VI)
Calculate / Index (SVR/SVRI)

– Pre-ejection Period (PEP) – Left Stroke Work (LSW) / LSW


Index (LSWI)
– LV ejection Time (LVET)
– Systolic Time Ratio (STR)

– Delivered Oxygen Index


(eDO2I)
Notes
• Enter necessary patient information, like Height,
Weight etc.

• BP source (CVP、PA mean and Art mean)

• ICG averaging time (Range: 5-60 beats)

• Sensor placement

• Check the sensor, regularly & manually


- Press button on the front panel of ICG module.
- Click ‘Check sensor’ in the ICG Setup menu
Clinical Application Limits

Physical
– Height: 122 ~ 229cm
– Weight: 30 ~ 160kg

Precautions
– HR > 250 bpm
– Disease or Open-chest surgeries
– Severe Aortic Valve Regurgitation
– Septic Shock (End stage sepsis)
– Extremely High Blood Pressure (MAP > 130)
– Intra-Aortic Balloon Pump

Warning
– Minute Ventilation Pacemakers(MV Pacemakers)
Summary

• ICG provides accurate,safe and reproducible


measures of hemodynamics

• We cannot reliably estimate hemodynamics


by physical exam, but ICG can

• ICG has demonstrated clinical value


– Hypertension
– Heart Failure
– Pacemaker optimization
Bispectral Index
Content
 EEG Analysis Methods

 Bis method

 How to use Bis?

 How to maintain it?


EEG Analysis Methods
- 16 channel analogue recordings
EEG Frequency Ranges

• Beta (13-30 Hz)


Mental concentration. Low doses of sedatives

• Alpha (8-13Hz)
Alert, relaxed. Light anesthesia

• Theta (4-8Hz)
General anesthesia

• Delta (<4Hz)
Deep anesthesia. Ischaemia Overdose
Very ‘deep’ EEG Patterns

• Near-Suppression

• Burst-Suppression

• Isoelectric EEG
What is BIS?

BIS = bispectral index


• A practical EEG that measures the direct effects of
sedation on the brain

• Provides objective clinical information about your patient’s


sedation status

• Enables you to deliver more precise sedation

• Patient and drug independent


BIS-XP Technology, with 4. electrode
– Improved artefact detection via internal 2. EEG channel
– Improved EMG
– Improved near-suppression handling
– Filter to stop electrocautery interaction (Bovie resistance)

Unconscious Awake Eye Blinks

EEGs are typically Artifacts are typically


symmetrical asymmetrical
BIS Range Guidelines
for the ICU
The BIS Display

– BIS EEG waveform • Numerics:


BIS = Bispectral Index
SQI = Signal Quality Index (>50%)
– Muscle activity: SR = Suppression Ratio
EMG bar (Electromyographic SEF = Spectral Edge Frequency
Power) (Discard signal in fixed Frequency to
make calculation efficient)
TP = Total Power
BIS Module and Cable
BIS Sensors

Quatro

Pediatric

Semi-reusable
Sensor Application
 Apply sensor on forehead
at angle
2 Inches
 Circle #1: Centered, 2 inches (5cm)
above nose
 Circle #4: Above/Adjacent to
eyebrow
 Circle #3: Either temple between
corner of eye and hairline
 Press edges of sensor
 Circle all 4 elements

 Press each circle for 5 seconds


 Use fingertip
 Press firmly
Operation Notes

Smoothing Rate
• Options: 10s,15s, 30s
• Each BIS value is based on EEG data from the previous 10 or
30 seconds, depending on smoothing rate
(The same with SPO2 averaging time)
• The smaller rate you choose,the more susceptible it could be.

Response time
• 7.5 to 30 seconds, depending on smoothing rate
How to maintain Bis?

• Sensor Check (Default on.)


- The combined impedance of the signal electrodes plus the reference
electrode: Continuously and does not affect the EEG wave.
- The impedance of the ground electrode(2): Checked every 10 minutes
and takes approximately 4 seconds, causes an artifact in the EEG wave,
and the message [BIS Ground Checking] will be displayed

• Cyclic Impedance Check


- The exact impedance check of
each individual electrode.
- Will Causes a disturbed EEG wave.
Respiratory Mechanics
Contents

• Technology
- What is RM?
- Principle
- What can we get?

• Operation
- Module and accessories
- Operation procedure
- Operation Notes

• Calibration
What is RM?

RM = respiratory mechanics

The main objective of respiratory mechanics is to


monitor the mechanical properties of the airways
and respiratory tissues.
Principle

Bernoulli principle
The air velocity can determine its
pressure.

Video
V1<V2

P1>P2
Principle

The airway pressures are measured

The pressure difference together with the gas


concentration information is used to calculate flow.

The volume information is obtained by integrating


the flow signal.

Other parameter such as RR, I:E, etc.


Principle

Pressure Measured by a pressure transducer in the RM module.

Flow Differential pressure fixed orifice pneumotach.

Volume can be calculated by flow and time period.


RM: Regular Interface
What can we get?


 Monitor:

 3 Curves: Paw-Time, Flow-Time, Volume-Time

 2 Loops: F-V, P-V


- Pressure: PIP, Pplat, PEEP, Pmean
- Flow: PIF, PEF

 18 Parameters: - Volume: Tvi, Tve, Mvi, Mve

- Others: RMRR, I:E, Compl, RAW, FEV1.0, RSBI, NIP,


WOB

:4loops、120H trend、24H full-disclosure waveform review


 Storage:
What can we get?

3 waveforms:
1. Flow waveform
2. PAW waveform
3. Vol waveform

2 loops:
1. FV (flow-volume) loop
2. PV (paw-volume) loop
What can we get?

18 parameters:

1. Pressure parameters
PIP: peak inspiratory pressure (unit: cmH2O)
Pplat: plateau pressure (unit:cmH2O)
PEEP: positive end expiratory pressure (unit: cmH2O)
Pmean: mean pressure (unit: cmH2O)
What can we get?

2. Flow parameters
PIF: peak inspiratory flow (unit: L/min)
PEF: peak expiratory flow (unit: L/min)

3. Vol parameters
TVi: inspiratory tidal volume (unit: ml)
TVe: expiratory tidal volume (unit: ml)
MVi: inspirator minute volume (L)
MVe: expiratory minute volume (L)
What can we get?

4. Other parameters

RR:
RR respiratory rate (unit: rpm)
I: E
E: ratio of the inspiratory and expiratory time
Compl:
Compl compliance (unit: ml/cmH2O)
Raw:
Raw airway resistance (unit: cmH2O/L/s)
FEV1.0: first second forced expiratory volume (unit: %)
RSBI: rapid shallow breathing index (unit: rpm/L)
NIP: negative inspiratory pressure (cmH2O)
WOB: work of breathing (J/L)
Module and accessory
Accessories

Flow Sensors

- Hamilton Neonate disposable


- Hamilton Adult / Neonate disposable
- Hamilton Adult / Neonate reusable

To patient

Neonate Adult/Pediatric Adult/Pediatric


(Disposable) (Disposable) (Reusable)
Operation Procedures

1. Select an appropriate flow sensor in accordance with the


patient category.

2. Connect the small tubes of the flow sensor to the RM


connector of the
module using a color
-coded adapter.
(Blue one is toward
patient)

3. Insert the flow sensor


between the Y-piece of
up
the patient circuit and
the patient connection.
Operation Procedures

4. Select the RM parameter window to open the [RM Setup]


menu.

5. Select [Sensor Type] and then choose either [Disposable] or


[Reusable] according to the selected sensor.

6. Select [Ventilation Mode] and then choose either


[Spontaneous] or [Mechanical] according to the patient’s
ventilation status.
Operation Notes

• To avoid the affects of excessive moisture in the measurement circuit, insert


the flow sensor airway adapter in the breathing circuit with the tubes upright.

• Check for leaks in the breathing circuit system, as they may significantly affect
respiratory mechanics readings.

• Verify the Ventilation Mode. Improper settings of this function will cause
incorrect calculations of some parameters.

• Match the airway adapter you select to the appropriate patient category. Or
else may produce excessive ventilation resistance ,introduce excessive
airway dead-space, as well as inaccurate scales and alarm limits.

• Periodically check the flow sensor and tubing for excessive moisture or do
some clean work if necessary.
Calibration
• RM Module Zero Calibration
- A zero calibration is carried out automatically whenever the module is switched on
or connected. The 2nd zero calibration will be carried out 10 minutes later. And
after that, zero calibration will be triggered every 30 minutes.
- You can also start a manual zero calibration when there is a drift in the zero:
In the [RM Setup] menu, select [Zero RM].

• Flow Sensor Calibration


A calibration must be performed every time when the flow sensor is changed.

1. In the [RM Setup] menu, select [Calibrate RM >>].


2. Enter the positive factor provided on the flow sensor and select
[Calibrate].
3. Enter the negative factor provided on the flow sensor and select [Calibrate].
4. After the calibration is completed successfully, the last calibration time and the
message [Calibration Completed!] will be displayed. Otherwise, the message
[Calibration Failed!] will be displayed.
Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
Patient Monitor Diagram
and
Hardware Structure
Patient Monitor Structure

• Power Supply
• Main Control Part
• Parameter Measurement
• Man-machine Interface
• Other Auxiliary Functions
Block Diagram – T5
• Hardware Introduction
Parameters Module

EtCO2

Mainstream Microstream Sidestream Multi-Gas/O2 Multi-Gas/O2 +BIS

2- IBP C.O. BIS RM ICG MPM - 3/5/12 ECG, NIBP, Resp, SpO2, 2-
Temp, 2-IBP
Main Board
Power Board
Front Panel Assembly
Button Board
DVI Interface board
USB Interface Board
3-slot Module Rack Communication Board
MPM Module Rack Communication Board
CF Card Communication Board
Contents
 Appearance
 Basic Parameters
----ECG RESP SpO2 NIBP TEMP

 Optional Parameters
IBP CO CO2 AG

 Advance Parameters
ICG BIS RM

 Hardware Principle
 Software upgrade
Why upgrade?

 Get new features

 Solve bugs

 OEM solution

 Support new hardware


What do we need?

Solution 1:
1. PC with Net port
2. Crossover cable
3. Upgrade file and upgrade software

Solution 2:
1. PC with Net port
2. Standard patch cable
3. Hub or switch
4. Upgrade file and upgrade software
What do we need?
Step1: Prepare network cable

Net Port
How to Upgrade?– For Beneview series

Step 2: Install upgrade software


How to Upgrade?– For Beneview series

Step 2: Install upgrade software


How to upgrade?
Step 3: Features need
Confirm the software version software
upgrade
in patient monitor:

SYSTEM MENU -> VERSION


How to upgrade?
Step 4: Connect PC & Patient monitor
How to upgrade?
Step 5:
Config computer IP address

 CMS+ protocol:
IP address: 196.76.0.1
Sub mask: 255.255.0.0
Gateway: 196.76.0.2
How to upgrade?
Step 6:
Config monitor IP address
How to upgrade
Step 7:
Confirm connection with DOS command ‘ping ***.***.***.***’

Good connection √
(‘Lost =0’)

X Bad connection
(‘Request timed out’)
How to Upgrade

Step 8: Load new code files


How to Upgrade?

Step 9: Press and hold Alarm button and Power


button together
How to Upgrade?– For Beneview series

Wait for a few minutes till you see “update


successfully” message on the upgrade tool window.
Then click “stop” button to end upgrade process.
Thank you!