Advanced Training Workbook
Spectrum
TM
ST
ST
CPP
20
C V P
0
(13)
CPP
10
I C P
-10
(4/0)
ECG
NIBP
IBP
ALARMS
LEAD
START
ZERO ALL
LIMITS
STRIP
STANDBY
TRENDS
SIZE
INTERVAL
C.O.
MUTE ALL
CONT ECG
DISCHARGE
FREEZE
VIEW
STOP
PAWP
MUTE
PRINT TREND
MARK EVENT
DISPLAY NORMAL SCREEN
Introduction This training pack is designed for the healthcare professional that takes responsibility for patient care when using the Spectrum patient monitor. The workbook is provided as part of a training course, which the learner will have attended. During the training course the learners understanding and ability to use the Spectrum will be demonstrated by meeting the performance criteria for each assessment. Participants will be registered healthcare professionals and will have some previous experience of patient monitoring and interpretation of monitored vital signs. Use of the training pack and workbook will ensure a consistent standard of competency, which is intended to contribute to patient safety and optimal use of this product.
There are three sections to the workbook: Product Overview – Safety, preparation for use and an overview of this product are included in this section. Basic Parameters / Features – Demonstrates how to use the basic parameters and features which are provided on all Spectrum monitors. Additional Parameters / Features – Demonstrates how to use the additional parameters and features including the External Parameters Module which can be provided on all Spectrum monitors.
General Knowledge of monitoring and an understanding of the features and functions of the Spectrum monitor are prerequisites for its proper use. Do not operate the monitor before reading the operating instructions.
Product Overview Safety
2
General
3
Patient
4
Monitor
5
1
Safety ASSESSMENT
PERFORMANCE CRITERIA
Safety checks of the monitor
Ensures: • Monitor is clean • No visible signs of damage i.e. cracked case, all cables intact etc…
Connects and verifies mains power is connected
Connects: • Mains lead to the socket at the rear of the monitor • Mains plug to the wall socket • 2 green lights on the keypad indicate that mains is connected and the battery is charging
Switches: • ON/OFF rocker switch to ON
Description of the internal self test
• Internal self-tests will run to test the monitor
Verifies: • • • •
Monitor beeps Red and amber lights on the keypad illuminate Spectrum is displayed on the screen Monitor reverts to the normal display
Location of battery compartment
Locates:
Explanation of the battery operation
• • • •
Monitor has a battery indicator when operating on battery Symbol is displayed in the lower right hand corner of the display When the batteries are fully charged the battery indicator is filled in When the battery is low the indicator will only be filled partly to the left side of the battery symbol
Description of the battery run and charging time
• • •
When the battery has less than 15 minutes left, audibly, there are 2 beeps every minute and the battery symbol flashes The battery will take 16 hours to fully charge for a Lead Acid and 5 hours for a Lithium Ion from when it is fully discharged Battery will charge when the Spectrum is plugged into a wall outlet
• Battery compartment on the left side of the monitor
2
General ASSESSMENT
PERFORMANCE CRITERIA
Location and connection of parameter ports
Connects:
Use of front panel easy access keys
• Keys are used to access functions quickly and easily • Each set of keys come under a heading which is displayed along the top
Use of NORMAL SCREEN key
• Selecting this key returns the screen to normal monitoring mode
Use of the Navigator Control Knob
• •
• • • •
ECG cable SpO2 sensor NIBP hose Temperature probe
Rotating the Navigator Control Knob moves the highlighter around the menus, parameters and items within the menus Pressing the Navigator Control Knob selects the highlighted menu, parameter or items within the menus
3
Patient ASSESSMENT
PERFORMANCE CRITERIA
Admitting an adult, female, dob 11/05/73, weighing 60kg and 165cm in height
Patient • Patient size - Adult • Gender – Female • Date of Birth – 11 / 5 / 1973 • First name ***** • Last name ***** • ID# ***** • Bed# **** • Height – 165cm • Weight – 60kg
Identifies: • Patient details are displayed above the digital parameter tiles
1 2
Discharging the patient
• Discharge from monitor • Are you sure? Yes
3 Explanation of
key
• • •
• Switches monitor back on
Could be of use if the patient was being removed from the monitor e.g. a test away from the bedside During STANDBY: • Monitoring is discontinued • All alarms are suspended • Trend data is not cleared • No data acquisition at a central station NIBP mode needs re-activating by selecting
4
Monitor ASSESSMENT
PERFORMANCE CRITERIA
Setting the date and time
Monitor Setup • Advanced Setup • Set Date ** / ** / ** Set new date? Are you sure? Yes • Set Time ** : ** Set new time? Are you sure? Yes • Stored data is erased
Configuring the display to: 2nd waveform tile – Resp 3rd waveform tile – Pleth Digital tile – NIBP
Monitor Setup
Increasing the beep volume
Monitor Setup
• Display Setup • 2nd waveform tile – Resp • 3rd waveform tile – Pleth • Digital tile – NIBP • Previous Menu • Save Current – Are you sure? Yes
• Beep Volume • Increase to an accepted volume
5
6
Basic Parameters/Features Alarms
8
ECG
10
Respiration
12
SpO2
13
Temperature
15
NIBP
16
Trends
18
7
Alarms ASSESSMENT
PERFORMANCE CRITERIA
1 2
Setting alarm limits for the active parameters
Set Limits • • • •
The appropriate parameter The required alarm limits Repeat for all the desired parameters Exit
• Auto set will cause auto alarm limit functions to be set for active parameters above and below patient baseline at the time of activation
Explanation of the Auto set alarms Setting alarm limits for the parameters that are not in use
1 2
Alarm Setup • Set Limits • Parameters high and low limits as required
Explanation of the high priority alarm (Priority 1)
• Red flashing light is displayed above the alarm bell symbol on the keypad • Red flashing highlighter box is displayed on the violated parameter • Audible Alarm: 3 beeps followed by 2 beeps twice every 5 seconds
Explanation of the low priority alarm (Priority 2)
• Amber flashing light is displayed below the alarm bell symbol on the keypad • Amber flashing highlighter box is displayed on the violated parameter • Audible Alarm: 3 beeps every 30 seconds
Description of the when selected
key
• Suspends alarms on all the parameters for a programmed period of time • Crossed out speaker is displayed in the digital tiles • Message and timer count down the remaining mute time • If is selected within the programmed time the audio alarm tones are re-enabled
8
Alarms ASSESSMENT Description of the when selected
PERFORMANCE CRITERIA key
Recognising that the alarms are OFF for a parameter
• • • • •
Silences the violated parameter for a programmed period of time or until the alarm condition is no longer present whichever is the shorter New alarms that occur within this time will disable this mute and the alarm will sound Crossed out speaker is displayed next to the parameter A message and timer count down the remaining time Selecting within this time does NOT re-enable the audio alarms
• Crossed out bell is displayed in the digital parameter tile
Increasing the alarm volume
Monitor Setup • Alarm Volume • A louder beep
9
ECG ASSESSMENT
PERFORMANCE CRITERIA
Preparation for the electrodes
• Shave hair from electrode sites • Cleanse skin with alcohol to remove oil • Dry with a rough gauze to remove dry skin
Placement of the electrodes
• Refer to the diagrams in the Operating Instructions • Avoid placement of electrode patches over bony prominences • Avoid placement of electrode patches near a pacemaker
Selecting the ECG to Lead I
Increasing the size of the ECG waveform
Describing the amplification of the ECG waveform With ECG cable connected adjust the heart rate alarm limits: High to 160 bpm Low to 40 bpm
1 2 1 2
Through until Lead l is displayed on the ECG waveform tile
Through to increase or decrease the amplitude of the waveform
• The bar on the waveform tile denotes cm/mV, as the bar is increased, so is the cm/mV
1 2 3
Set Limits • • • •
10
HR High alarm to 160 bpm Low alarm to 40 bpm Exit
ECG ASSESSMENT Displaying the HR alarm limits in the ECG digital tile
Recognising the HR source
PERFORMANCE CRITERIA
1 2 3
Alarm Setup • Show HR limits • On
• Digital display of the HR is the same colour as its waveform tile source • Source: *** is displayed in the ECG digital tile below the HR
Changing the HR source to SpO2
ECG parameter tile • ECG Setup • HR source • SpO2
Recognises: • Colour and source have changed
New configuration as a default
Monitor Setup • Save Current • Are you sure? Yes
Indications that alert the staff to a HR alarm
• Red flashing light is displayed above the alarm bell symbol on the keypad • Red flashing highlighter box is displayed on the digital HR measurement • Audible Alarm: 3 beeps, followed by 2 beeps twice every 5 seconds
Increasing the ECG beep volume
Monitor Setup • A louder Beep Volume
11
Respiration ASSESSMENT
PERFORMANCE CRITERIA
Explanation of where the respiration measurements can be derived from
• ECG leads or • CO2 monitoring
Selecting the respiration source to be derived from the ECG Lead II
Resp
Increasing the amplitude of the respiration waveform
Resp
Explanation of Resp Source Auto Selecting the respiration alarm lower limit to 20rpm
• Resp Lead • II • Resp Source • ECG
• Scale • A higher scale • Scale is displayed on the Respiration waveform tile
• The respiration source will automatically switch to CO2 when a Filterline is connected and then switches to ECG when the Filter line is disconnected
1 2
Set Limits • Resp alarms • Lower alarm to 20 rpm
Indications that alert the staff to a low priority respiration alarm (Priority 2)
• • •
Amber flashing light is displayed below the alarm bell symbol on the keypad Amber flashing highlighter box is displayed on the digital Resp measurement Audible Alarm: 3 beeps every 30 seconds
Explanation of Apnoea alarm
• • •
Is a function of respiration Apnoea delay can be programmed from 10-60 seconds in Alarm Setup For respiration through the ECG lead, position the electrodes for maximum rise and fall of the chest
12
SpO2 ASSESSMENT
PERFORMANCE CRITERIA
Selection and placement of the correct sensor
• • • • • •
Disposable sensor selected for long term monitoring, an active patient, or to prevent cross infection Disposable sensors vary with dedicated weight ranges of the patient (refer to the instructions on the packet) Reusable sensor selected for spot check monitoring Reusable sensor is fitted so the diagram of a finger is showing on the upper side Ensures that there is no blockage of light e.g. nail polish Nail is in the correct position for the light window
Moving the Pleth waveform to an alternative tile
Monitor Setup
Switching the Sensor Off Audio to On
SpO2
• Display Setup • An alternative tile for Pleth
• Sensor Off Audio • On
• Monitor will give an audible beep when the SpO2 sensor is off the patient
With SpO2 sensor connected, adjust the low alarm limit to 96%
Description of the indications that alert the staff to a SpO2 low priority alarm (Priority 2)
1 2 • • •
Set Limits • SpO2 • Lower limit to 96
Amber flashing light is displayed below the alarm bell symbol on the keypad Amber flashing highlighter box is displayed on the digital SpO2 measurement Audible Alarm: 3 beeps every 30 seconds
13
SpO2 ASSESSMENT Changing the alarm priority to high (Priority 1)
PERFORMANCE CRITERIA
1 2
Alarm Setup • Set Limits • SpO2 • Priority 1
Switching SpO2 beep to On
Monitor Setup • Beep Volume • Increase to an accepted volume
14
Temperature ASSESSMENT
PERFORMANCE CRITERIA
Cleaning of the reusable probes
• Probes may be disinfected by washing with 70% isopropanol, then rinsed thoroughly with water • Refer to probe manufacturer’s instructions for sterilisation of reusable probes
Selecting a low temperature alarm of 35°C
1 2
Set Limits • Temp alarm limits • Low alarm to 35°C
15
NIBP ASSESSMENT
PERFORMANCE CRITERIA
Recognising the correct cuff size for a patient
• • • •
Applying a cuff to the patient
Wraps:
When the cuff is wrapped around the patient’s limb the INDEX LINE is within the MIN and MAX range that is marked on the cuff An incorrect cuff size may give inaccurate readings A cuff that is too narrow for the limb may result in high readings A cuff that is too large may give low readings
• Cuff snugly (but not too tight) around the limb
Ensures: • φ is in the correct position i.e. over brachial artery for the arm or femoral • • • •
for the leg Correct size is fitted No clothing is between the patient and the cuff Placement is not on a limb that is being utilised for any other medical procedure e.g. SpO2 sensor The limb is at the same level as the heart
Connects: • Hose to the cuff
Initiating a blood pressure reading
Applies:
Describing the monitor as it measures blood pressure
• • • •
• Cuff to the patient as described above
Pump inflates to the initial cuff pressure which is dependent on the patient size selected (Adult, Paediatric, Neonate) Cuff pressure is displayed in the NIBP digital parameter tile whilst the cuff is measuring Measured blood pressure is displayed in the NIBP digital parameter tile NIBP: Measuring is displayed in the lower information bar
16
NIBP ASSESSMENT Selecting the NIBP interval to 5 minutes
PERFORMANCE CRITERIA
1 2 3
• Continue pushing NIBP Interval button until 5 min is displayed in the NIBP tile
• Starts interval timer
Changing the initial cuff inflation pressure
1
NIBP • Set Start Pressure • Required pressure
Terminating an NIBP measurement • Postpones a scheduled measurement that has been selected
Setting the systolic high alarm to 110mmHg
1 2
Set Limits • NIBP Sys • Systolic high alarm to 110mmHg • Exit
Silencing the NIBP alarm
17
Trends ASSESSMENT
PERFORMANCE CRITERIA
Explanation of the TRENDS features
• Allows user to view a list or graph trend of patient stored data • In Paediatric and Neonate setup OxyCRG graph trend is available • Stores a maximum of 120 entries (Extended memory stores a maximum of 500)
Displaying the List Trend
Displaying the Graph Trends (Twice)
Displaying OxyCRG in paediatric or neonatal setup (Three times)
1
(Twice)
2
▼
▼
18
▼
• Scroll • Cursor to the specific time slot required • Zoom ▼
Retrieving a specific time slot on the Graph Trend display
Additional Parameters/Features Recorder
20
IBP
22
CO2 Monitoring
23
Gas Module
24
EPM (External Parameter Module)/Features EPM
26
C.O.
27
PAWP
29
Hemodynamic Calculations
31
Temperature
32
19
Recorder ASSESSMENT
PERFORMANCE CRITERIA
Replacing the recorder paper
Demonstrates: • • • • •
Storage of the printouts
Open the recorder Remove the empty spool Insert new roll between the two rounded tabs so that the paper is feeding off the spool from underneath Close the recorder door, leaving a small portion of paper visible from slot PLAIN, WHITE THERMAL Datascope paper is recommended
• Printouts need to be stored in a cool dry area • Extreme temperatures and humidity should be avoided
Setting the printer to print ECG 1 and Sp02
Select the printer to print from the Spectrum recorder
Initiating and stopping a printout
Print Setup • Waveform 1 • ECG 1 • Waveform 2 • Pleth • Normal Screen
1 2 1 2
Print Setup • Select Printer • Local
Initiates the printout
Stops the printout
20
Recorder
Initiating a List Trend printout
Initiating a Graph Trend printout
Retrieving and printing a specific time slot on the Graph Trend display
1 2 1 2 1 2
Initiates the printout
Stops the printout
Initiates the List Trend printout
(twice)
Initiates the Graph Trend printout
1 2 3
(twice)
▼
21
▼
• Scroll • Cursor to the specific time slot required • Zoom ▼
Initiating and stopping a continuous ECG printout
PERFORMANCE CRITERIA
▼
ASSESSMENT
IBP (Invasive Blood Pressure) ASSESSMENT
PERFORMANCE CRITERIA
Labeling the IBP1 tile to Art
IBP1 • Label • Art
Changing the scale to Measure from 0 to 320mmHg
Zeroing the invasive line
Art • Scale • 0 to 320mmHg
• Open transducer vent to air but closed to the patient
• Pressure display should indicate zeros
Printing an ECG and an Art waveform
Print Setup
1
• Waveform 1 • ECG 1 • Waveform 2 • Art • Normal Screen
2
22
CO2 Monitoring ASSESSMENT
PERFORMANCE CRITERIA
Setting up for an intubated patient
• Connect the sampling line to a breathing circuit
Setting up for a non-intubated patient
• Connect the nasal cannula to the patient
Changing the scale to 100mmHg
Setting the alarms to the recommended limits
Printing an ECG and a CO2 waveform
CO2 • Scale • 100mmHg
1 2
Set Limits • CO2 • Hi limit to • Low limit to
** **
Print Setup
1
• Waveform 1 • ECG • Waveform 2 • CO2
2
23
Gas Module ASSESSMENT Connects and verifies mains power is connected
PERFORMANCE CRITERIA Connects: • Mains lead to the input socket at the rear of the monitor • Mains plug to the wall socket
Switches: • ON/OFF push button switch to ON • Green light on the Gas Module indicates that mains is connected • GM: Warming Up is displayed on the Spectrum Monitor display
Location of gas scavenge outlet
Locates: • Exhaust port at the rear of the Gas Module
Location and connection of the patient gas sample catheter
Configuring the ComPort for the Gas Module
Connects: • Patient gas sample catheter to the input port
Switches: • ON/OFF rocker switch to ON while
DISCHARGE
• Set Up Serial Port 1 • GM II • Save current
Selecting CO2 units to measure as a %
Switches: • ON/OFF rocker switch to ON while • CO2 Units • % • Save current
Displaying CO2 in the 2nd waveform tile and saving as a default
Monitor Setup • Display Setup • 2nd waveform tile • RespOrCo2 • Previous Menu • Save current • Are you sure? Yes
24
DISCHARGE
Gas Module ASSESSMENT
PERFORMANCE CRITERIA
Displaying Gas parameters in the 1st digital tile
Monitor Setup • Display Setup • 1st digital tile • Gas
Changing the CO2 scale to 5%
CO2 • Scale • 5%
Selecting the Gas Agent to Iso
Setting the End-tidal CO2 : High alarm limit to 8.0% Low alarm limit to 3.0%
Description of the message displayed when the Gas Module is switched off
1 2 1 2 1 2 3
Gas • Select Agent • Iso
Set Limits • Et CO2 • High limit to 8.0 • Low limit to 3.0
• GM: Disconnected is displayed on the monitor
25
EPM (External Parameter Module) ASSESSMENT
PERFORMANCE CRITERIA
Location and connection of the External Parameter Module to the Spectrum
Connects module ensuring:
Removal of the External Parameter Module
Removes module ensuring:
Configuring the Spectrum for the External Parameter Module
Switches:
• • • •
Connectors are lined up Release buttons are pressed Slides module forward An audible “click” is heard (hooks are engaged)
• Release buttons are pressed • Slides module back • Lifts module up
• ON/OFF rocker switch to ON while pressing • Enable EPM • Yes • Save Current
Location and connection of External Parameter Module ports
Explanation of the IBP Zero All key
Connects: • Temperature probe • IBP3 and IBP4 cables (where appropriate)
• Zeros all invasive blood pressures simultaneously • Same function as the IBP key on the front panel
26
DISCHARGE
C.O. (Cardiac Output) ASSESSMENT Setting the C.O. menu for a person 165cm tall, weighing 60Kg.
Selecting an Edwards 8Fr catheter, injecting a volume of 10ml and utilising an In line Injectate Temp Sensor
Selecting Auto Start to On
Explanation of Auto Start On and Off
PERFORMANCE CRITERIA
1 2
C.O. Setup Menu • • • •
1 2
Height 165cm Weight 60Kg
C.O. Setup Menu • • • • • • • •
1 2
Catheter type Edwards Catheter size 8Fr Injectate Volume 10ml Injectate Temp Sensor In line
C.O. Setup Menu • Auto Start • On
• Auto Start On - Spectrum is automatically ready to inject when the baseline blood temperature is achieved. • Auto Start Off - Start C.O. is selected before the fluid is injected
27
C.O. (Cardiac Output) ASSESSMENT
Selecting the C.O. measurement duration to ** sec
Selecting the C.O. scale to ** °C
PERFORMANCE CRITERIA
1 2 1 2
C.O. Setup Menu • C.O. Time • **sec
C.O. Setup Menu • C.O. Scale • **°C
Saving the above Setup as a default
Monitor Setup • Save Current • Are you sure? Yes
28
PAWP (Pulmonary Artery Wedge Pressure) ASSESSMENT
PERFORMANCE CRITERIA
Explanation of Pulmonary Artery Wedge Pressure
• PAWP is a pressure measurement derived from a PA catheter. • When the PA distal balloon is inflated the catheter advances to the distal pulmonary artery and occludes the flow
Labelling the desired pressure tile to PA
Displaying ECG * as Parameter 1 in the Wedge display
Changing the PA scale 0 to 40mmHg and the Wedge speed to 6.25mm/s
Parameters • • • •
1 2
IBP1, 2,3 or 4 Label PA Normal Screen
Wedge Setup • Parameter 1 • ECG • Previous Menu
1 2
Wedge Setup • • • • •
29
PA Scale 0 to 40mmHg Wedge Speed 6.25mm/s Previous Menu
PAWP (Pulmonary Artery Wedge Pressure) ASSESSMENT Measuring the PAWP
Recognising the PAWP and the time the measurement was taken
Printing and stopping a Wedge waveform
Explanation of Reset Waves
PERFORMANCE CRITERIA
1 2
Measure • Reference line to the estimated wedge measurement • Measure • Accept
• PAWP** is displayed in the PA digital tile • @** . ** (time) is displayed alongside the pressure measurement
1 2
• Print Wedge (initiates recording) • Print Wedge (stops recording)
• Restarts the displayed waveforms on the wedge display
30
Hemodynamic Calculation ASSESSMENT
PERFORMANCE CRITERIA Functions
Selecting the Hemodynamic Calcs menu
• Hemo Calcs Menu
OR
1 2
Explanation of identifying the manually entered data
Selecting the Hemodynamic Calculations Log
• Hemo Calcs Menu
• An asterisk (*) marks the manually entered data
1 2
Hemo Calcs Menu • Hemo Log
Functions
Printing Hemodynamic Calculations
Clearing the Hemodynamics Calculations Log
• Hemo Calcs Menu • Hemo Log • Print Hemo Calcs
1 2
Hemo Calcs Menu • Hemo Log • Clear Log • Are you sure? Yes 31
Temperature ASSESSMENT
PERFORMANCE CRITERIA Temp
Selecting the Temperature tile to display ∆T
Setting the ∆T alarms to the recommended limit
• Display Delta • Yes
1 2
Set Limits • ∆T • Hi limit to ** • Low limit to **
32
Notes
Notes
Notes
Datascope Patient Monitoring Mindray (UK) Limited 3 Percy Road St John's Park Huntingdon PE29 6SZ United Kingdom Tel: +441480 416840 Fax: +441480 436588 uksales@datascopemonitors.eu ukservice@datascopemonitors.eu
www.datascopemonitors.us
Navigator™, Gas Module SE™ and View 12™ are U.S. trademarks of Mindray DS USA, Inc. Datascope®, Spectrum®, Passport 2® and Panorama® are U.S. registered trademarks of Mindray DS USA, Inc. Nellcor® is a U.S. registered trademark of Nellcor Puritan Bennett Inc. Microstream® is a U.S. registered trademark of Oridion Medical 1987 Ltd. Subject to change. © 2009 Datascope Corp.
PN Pending Written by Angie Cross UK Revision B