SPACELABS 1050 (90369) by Teresa Elguer

Ultraview 1050 Monitor 90369

E C G

II MON PACED ST = 0.16 A=0 ROW 5 120 40

VI ST = 0.00

11:32 11:33 11:34 11:35 11:36

110/ 113/ 113/ 82/ 108/

69( 73( 69( 51( 67(

84) 88) 84) 64) 83)

11:37 11:37 11:38 11:39 11:40

110/ 104/ 114/ 103/ 116/

73( 67( 73( 70( 64(

82) 79) 85) 78) 80)

LAST BP = 11:40 03/30

N I B P

Lightweight, compact, highly portable

■

Shares same touchscreen controls as other Ultraview Care Network™ and PCMS™ monitors of appropriate levels

■

Compatible with the full line of Ultraview Care Network and PCMS modules

■

Large, 10.4-inch (26.42 cm), TFT color display with 140° viewing angle

HELP MONITOR SETUP

■

SPECIAL FUNCTIONS

ALM SUSPEND S P O 2

■

69 bpm

100

■

Advanced power management system maximizes battery performance during transport; includes battery “fuel-gauge”

■

Optional interactive bed-to-bed Ethernet communication

■

Instant “Quicknet” 10BaseT Ethernet connection

■

Optional wireless Ethernet with one to five outbound waveforms and numeric vital signs transmitted at 2.4 GHz

■

Optional built-in 2-channel recorder

■

Optional mainstream EtCO2, O2, and Min CO2

■

Support for up to 250 nodes on a network with the Expanded Network feature

RECORD

% 85

116 64

m m H g

( 80 ) S 150 100

PREVIOUS MENU

Data Shuttle® option allows up to 24 hours of patient data to be transferred to other Ultraview Care Network and PCMS monitors

NORMAL SCREEN

PRINTER CONTROLS

SPECIFICATIONS Touchscreen — With the exception of power (ON/OFF), all controls are on-screen touchkeys; touch is sensed by infrared optical devices; optional controls include mouse and keyboard Waveform Capacity — four, five, or six waveforms Module Capacity — 90369 accepts one Ultraview or PCMS module internally and will support up to two additional modules using the 90499 module housing

Parameter Capacity — 18 parameters utilizing Ultraview and PCMS modules as well as Flexport® interfaces Trends — 24 hours of trend data can be displayed Graphic — 1-, 2-, 6-,12- or 24-hour segments; data is stored in 1-minute resolutions (6-hour segment is the default)

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Ultraview 1050 Monitor 90369

SPECIFICATIONS Tabular — Time increments of 1, 5, 10, 15, or 30 minutes; 1, 1.5 or 3 hours (1 hour is the default) Remote View/Alarm Watch — When equipped with the Ethernet option, the 1050 provides a waveform display from a remote bedside or telemetry patient on the Ultraview network either on request (Remote View) and/or in response to an alarm (Alarm Watch); the 1050 provides a waveform display from up to 32 selected beds; an Ultraview bedside monitor can be remotely viewed by up to 16 network devices simultaneously (e.g., monitors, workstations) Display — Trace Height:

1.65 in (4.2 cm) 2.36 in (6.0 cm)

Sweep Speed: A variety of speeds are available under module control Ethernet Communication — 10BaseT telephone-style modular connector (RJ45) provided Wireless Ethernet Capability — Provides 2.4 GHz frequency-hopping spread-spectrum communication; the wireless Ethernet will send one to five waveforms and numeric vital signs to the Ultraview Care Network Color TFT Display (TFT) — Resolution —

640 by 480 pixels

Size —

8.31 in (21.12 cm) wide 6.24 in (15.84 cm) high

Software Updates — Software updates including new features and capabilities are easily updated over the network Options — F — Ethernet interface, SDLC, audio I/O, video, alarm, serial; provides noninteractive bed-to-bed communication H — Capnography, Ethernet interface, SDLC, audio I/O, video, alarm, serial N — Vital Signs Calculations O — Drug Dose Calculations P — Interactive Network Functions — Adds interactive remote view and alarm watch capabilities for parameters displayed from remote bedsides and remote functionality for all trends (requires option F or H) Q — Data Shuttle to transfer patient information to another monitor R — Patient Data Logger U — Dual Channel Internal Recorder Z — Wireless Ethernet Communication 04 — Four waveforms

05 — Five waveforms 06 — Six waveforms

ELECTRICAL SPECIFICATIONS Mains Power — Line voltage: 100-240 VAC; Frequency: 50-60 Hz Batteries — Both sealed-lead acid (SLA) and Spacelabs Medical nickel metal hydride (NiMH) are supported. One or two 12 V (2.30 Ah SLA or 2.45 Ah NiMH) batteries may be used, providing up to 2.0 hours of operation (TFT display) for up to 300 charge/discharge cycles with SLA and up to 2.5 hours of operation (TFT display) for up to 600 charge/ discharge cycles with NiMH; operating time is dependent on configuration and usage; 1.5 hours are required to charge batteries to 100% of capacity with AC connected to rear panel and mains switch in the OFF position, 3-hour charge time required with the mains switch in the ON position Power Fail Backup — Will maintain patient data for a minimum of three minutes Isolation — Chassis leakage current not greater than 300 µA (meets AAMI, UL2601-1, CSA #601.1 and IEC 601-1 standards)

PHYSICAL DIMENSIONS Height: Depth: Width: Weight:

8.3 in (21.1 cm) 6.2 in (15.8 cm) 11.7 in (29.7 cm) 10.0 Ibs (4.6 kg)

DUAL CHANNEL INTERNAL RECORDER — Option U Printing Method — Thermal array print head Resolution — Eight dots per mm vertical and 32 dots per mm horizontal at 25mm per second sweep speed Paper — Heat-sensitive paper, 50mm wide x 30m long, available in a roll Traces — All monitored parameters, including waveforms and graphic trends, full annotation included Frequency Response — Determined by the parameter recorded Chart Speed — 1.56, 3.12, 6.25, 12.5, 25 and 50mm per second (depending on the monitor sweep speed selected) Alarm Record — Records any parameters in an alarm state when “Record on Alarm” is active Auto Run — 20 seconds or duration of alarm violation (whichever is longer)

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SPECIFICATIONS Controls — Continue, Slow, Stop, Unit Off Indicators — Paper Out, Unit Off Record — Allows selection of up to two active monitor channels plus trends

ACCESSORIES 119-0251-01

100-240 volt AC converter Note: This AC converter is mandatory and is included at no charge

146-0018-00

Rechargeable sealed-lead acid (SLA) battery

146-0055-00

Rechargeable nickel metal hydride (NiMH) battery Note: NiMH batteries require units with a minimum serial number of 369-1XXXXX. SLA batteries may be used with all serial number units.

010-1114-00

External sealed-lead acid battery charger (not compatible with NiMH battery packs); recharges 1 to 4 removable SLA batteries; 100-240 V

ENVIRONMENTAL REQUIREMENTS Storage — Temperature:

-13° to 140°F (-25° to 60°C)

Humidity:

95% (non-condensing)

Altitude:

0 to 40,000 ft (0 to 12,192 m)

Operating — Temperature:

32° to 122°F (0° to 50°C)

Humidity:

95% (non-condensing)

Altitude:

0 to 15,000 ft (0 to 4,572 m)

ELECTROMAGNETIC COMPATIBILITY EN60601-1-2, 1993-04 Emissions — (CISPR 11) EN55011, Class B EN61000-3-2:

Harmonics

016-0347-00

Wall mount

EN6100-3-3:

Flicker

016-0369-00

Mil-Std-461D:

RE101

Bed rail mount (for 90369 without capnography option)

016-0369-01

Bed rail mount (for 90369 with capnography option)

016-0447-00

Roll Stand

040-0992-00

Conversion Kit 10BaseT to AUI Mouse

Immunity — IEC 1000-4-2:

ESD, 8 kV contact/15 kV air

IEC 1000-4-3:

RF Fields, 20 volts/meter, 26 MHz to 1 GHz

IEC 1000-4-4:

Burst, 1 kV data and I/O ports/2 kV power ports

010-0609-00

IEC 1000-4-5:

Surge, 1 kV differential/ 2 kV common mode

IEC 1000-4-6:

Conducted RF, 3 volt r.m.s. 150 kHz to 80 MHz

For information about required supplies, please refer to the Spacelabs Medical Supplies Products Catalog

IEC1000-4-8:

Magnetic Field (50/60 Hz), 60 Amps/meter

IEC 1000-4-11: Power quality, voltage and frequency variations Mil-Std 461D:

CS101, 12 volt r.m.s. 10 kHz to 150 kHz

Mil-Std 461D:

CS114, 120 dBµA 10 kHz to 400 MHz

REGULATORY APPROVALS ETL listed and meets standard UL2601-1 for electrical safety; approved by CSA; CE marked in accordance with the Medical Device Directive, 93/42/EEC

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Ultraview 1050 Monitor 90369

Ultraview 1050 Monitor 90369 Spacelabs Medical, Inc. 15220 N.E. 40th Street P.O. Box 97013 Redmond, WA 98073-9713 Telephone: (425) 882-3700 Fax: (425) 885-4877 Telex: 4740085 SPL UI Ultraview, Ultraview Care Network, PCMS, Data Shuttle and Flexport are trademarks of Spacelabs Medical, Inc. Other brands and product names are trademarks of their respective owners. All specifications are subject to change without notice. www.spacelabs.com ÂŠ Spacelabs Medical, Inc. 2001 061-0750-00 Rev. M 05/2001

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Ultraview Care Networkâ&#x201E;˘ Operations Manual 070-1001-15 Rev. A

Copyright 2001 Spacelabs Medical, Inc. All rights reserved. Contents of this publication may not be reproduced in any form without the written permission of Spacelabs Medical, Inc. Products of Spacelabs Medical are covered by U.S. and foreign patents and/or pending patents. Printed in U.S.A. Specifications and price change privileges are reserved. Spacelabs Medical considers itself responsible for the effects on safety, reliability and performance of the equipment only if: • • •

assembly operations, re-adjustments, modifications or repairs are carried out by persons authorized by Spacelabs Medical, and the electrical installation of the relevant room complies with the requirements of the standard in force, and the equipment is used in accordance with the operations manual.

Spacelabs Medical will make available, on request, such circuit diagrams, component part lists, descriptions, calibration instructions or other information which will assist appropriately qualified technical personnel to repair those parts of the equipment which are classified by Spacelabs Medical as field repairable. CORPORATE OFFICES Spacelabs Medical, Inc. 15220 N.E. 40th Street P.O. Box 97013 Redmond, WA 98073-9713 U.S.A.

Spacelabs Medical Instruments (Tianjin) Co. Ltd. 6th Floor, Wang Jing Building 9 Wang Jing Zhong Huan South Road Chaoyang District, Beijing 100015

Telephone: 425-882-3700 Fax: 425-885-4877 Telex: 4740085 SPL UI

CHINA

Spacelabs Medical Products Pty. Ltd. Macquarie View Estates Unit 1, 112-118 Talavera Road North Ryde, N.S.W. 2113

Authorized EC Representative:

AUSTRALIA Telephone: 61-2-9878-6644 Fax: 61-2-9878-4820 Spacelabs Medical Products GmbH Jochen Rindt Straße 25 1230 Vienna AUSTRIA Telephone: 43-1-616 52 37 Fax: 43-1-616 52 37-11 Spacelabs Medical B.V. Airport Boulevard Office Park Bessenveldstraat 25A 1831 Diegem BELGIUM Telephone: 32 2 7164026 Fax: 32 2 7164114 Spacelabs Medical Products, Ltd. 151 Superior Boulevard, Unit 1 Mississauga, Ontario L5T 2L1 CANADA Telephone: 905-670-5880 Fax: 905-670-5883 Spacelabs Produits Medicaux Ltée 6030 rue Vanden Abeele St. Laurent, Quebec H4S 1R9

Telephone: 86-10-6438 1705 Fax: 86-10-6438 1707

Spacelabs Medical Sarl 6, Allée des Saules Europarc 94042 Créteil Cedex FRANCE Telephone: 33 (0) 1 45.13.22.44 Fax: 33 (0) 1 45.13.22.00 Spacelabs Medical GmbH Justus-Liebig-Straße 3 41564 Kaarst GERMANY Telephone: 49-(0)2131-92670 Fax: 49-(0)2131-926721 Spacelabs Medical Limited Suite 901 Tower 1 China Hong Kong City 33 Canton Road, Tsimshatsui Kowloon

Spacelabs Medical S.r.l. Via Montecatini, 13 20144 Milano ITALY Telephone: 39-(0)-2/48958203 Fax: 39-(0)-2/48958204 Spacelabs Medical Ltd. 2F-3, No. 161. Sung Te Road Taipei, Taiwan R.O.C. TAIWAN Telephone: 8862-2759-7228 Fax: 8862-2759-9060 Spacelabs Medical B.V. Ringveste 9 A 3992 DD Houten THE NETHERLANDS Telephone: 31-(0)-30-638 5050 Fax: 31-(0)-30-638 5059 Spacelabs Medical Ltd. Eskdale Road Winnersh Triangle, Wokingham Berkshire RG41 5TS UNITED KINGDOM Telephone: 44-1189-448411 Fax: 44-1189-448006

HONG KONG Telephone: 852-2376-1370 Fax: 852-2376-2502 Spacelabs Medical, Inc. C/O Impulse Business Club F-22 South Extension Part 1 New Delhi 110049 INDIA Telephone: 911 1464 5002 Fax: 911 1464 5007

CANADA Telephone: 514-335-2669 Fax: 514-335-1042

CAUTION: • US Federal law restricts the devices documented herein to sale by, or on the order of, a physician.

Spacelabs Medical is committed to providing comprehensive customer support beginning with your initial inquiry through purchase, training, and service for the life of your Spacelabs Medical equipment. If you need our help along the way, we offer these guidelines for fast, efficient response.

Acquiring Equipment Sales Representative 800-522-7025 (U.S.A.) or call your local office

To discuss your monitoring or clinical information needs, to schedule product demonstrations, to order equipment, or to schedule in-service education

Delivery Information 800-251-9910 (U.S.A.) or call your local office

To find out when you can expect delivery of your Spacelabs Medical equipment

Supplies Products 800-223-6467 (U.S.A.) or call your local office

To order compatible supplies and accessories for your equipment

Getting Started Sales Representative 800-522-7025 (U.S.A.) or call your local office

To arrange in-service education sessions

Answering Other Needs Clinical Applications 800-522-7025 (U.S.A.) or 425-882-3700 or call your local office

To answer specific questions on arrhythmia products and clinically related issues

First Call™ National Dispatch Center 800-522-7025 (U.S.A.) 800-942-7968 (Canada)

To call for service or to contact your assigned customer service representative

Technical Support - Monitoring/Anesthesia 800-522-7025 (U.S.A.) or 425-882-3700 or call your local office

For technical support of all Ultraview Care Network™ monitoring products and anesthesia products

Technical Support - Intesys Clinical Information Systems 800-210-0247 (U.S.A.) or 425-882-3700 or call your local office

For technical support of BirthNet®, Caremaster®, Chartmaster®, QuIC, and WinDNA® products

Service Parts Department 800-547-8805 (U.S.A.) or 425-867-2039 or call your local office

For parts ordering and pricing information

Service Training Department 800-251-9910 (U.S.A.) or call your local office Regional Service Manager 800-522-7025 (U.S.A.) 800-942-7968 (Canada) or call your local office

To arrange training of hospital biomedical and anesthesia personnel To obtain answers to general questions concerning service issues and service contracts

Contacting Your Local Offices Outside the U.S. Mississauga, Ontario Canada 905-670-5880

Kaarst Germany 49-(0)2131-92670

Kowloon Hong Kong 852-2376-1370

Taipei Taiwan 8862-2759-7228

Créteil France 33 (0) 1 45.13.22.44

Vienna Austria 43-1-616 52 37

Milano Italy 39-(0)-2/48958203

Beijing China 86-10-6438-1705

Wokingham Berkshire, U.K. 44-1189-448411

New Delhi India 911 1464 5002

Diegem Belgium 32 2 7164026

About This Manual Ultraview Care Network Operations Manual documents a complete range of patient monitoring functions for critical care. While each module may monitor one or more vital sign parameters, the operation of individual parameters stays the same throughout the system. This CD-ROM manual is organized by operating functions rather than by specific products. Monitor and parameter functions are presented in the CD-ROM titled Ultraview Care Network Operations Manual (P/N 084-0701-xx).

Quick Information

Brief troubleshooting information for each function is found at the end of each chapter. Troubleshooting tips suggest solutions to the most frequent problems. At the beginning of each chapter you will find illustrations of the monitor keys that appear on all Ultraview monitors.

Operating Instructions

Each vital sign chapter contains a clinical overview, a description of the screen display, operating instructions, error messages, and other pertinent information.

Product Compatibility If your system does not contain a feature described in this manual: •

Your product may contain an earlier version of software. Refer to the original documentation that accompanied your system.

•

Your system configuration, including options ordered, may be different from the configurations described in this manual. Refer to the notes in this manual describing features likely to be impacted by system configuration.

Before moving a component from one network to another, be certain that the component’s software version is compatible with that required by the second network. If in doubt, have a qualified service person verify compatibility between the component and the network. Use only Spacelabs Medical parts and accessories with your Spacelabs Medical components. Other parts may degrade performance or damage the components. Refer to the Spacelabs Medical Supplies Products Catalog for the part numbers and descriptions of additional parts and accessories.

Chapter

Contents 1

Page

System Introduction and Network Basics System Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 Monitor Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4 Network Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9 Watching Alarms Remotely â&#x20AC;&#x201D; Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10 Viewing Remote Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11 Full Bed Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12 Ultraview IWC Monitor Context Manager Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12 Reviewing Remote Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13 Non-Networked Telemetry Central Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

Alarms Directory of Keys -Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4 Default Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5 Identifying Alarm Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5 Adjusting Alarm Tones/Key Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 Controlling Alarms via the TONE RESET/ALM SUSPEND Key . . . . . . . . . . . . . . . . . . . . . . . 2-7 Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 Automatic Recording of an Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12 Alarm Paging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Admit/Discharge Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3 Entering New Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3 Changing Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6 Selecting Patient Type and Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 Discharging a Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

Printing Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bedside Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . System Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Printer Module in the Ultraview Portable Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4-1 4-2 4-3 4-4 4-5 4-5

Ultraview Care Network

PrintMaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 Printing Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10 Selecting Print Duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11 Printer Key Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12 Recording Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-13 Printing via Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-14 Defining Preselected Recording Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-15 Loading Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-16 Paper Out Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17 Record Vitals Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-18

Bedside Transport/Monitors Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5 6-Trace Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 Identifying Special Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 Bedside and Transport Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6 UCW and Ultraview 1700 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8 Setting Up Priorities and Colors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10 Data Shuttle Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13 Ultraview Portable Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15 Wireless Network Interface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-18 Outbound Parameters Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-19 Ultraview Portable Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-22 Ultraview Portable with Capnography (Option G or H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-24 Maternal Obstetrical Monitor - 94000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-25

Central Monitors Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-Trace Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Central Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UCW and Ultraview 1700 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Data Communications Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-Networked Telemetry Central Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-1 6-2 6-3 6-4 6-4 6-5 6-6 6-8 6-9

Module Configuration Manager Directory of Keys - for configurations with ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Directory of Keys - for configurations without ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Directory of Keys - for telemetry configurations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting User-Defined Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Storing Changed Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7-1 7-2 7-3 7-4 7-5 7-5 7-6

Ultraview Care Network Operations Manual

Selecting Alarm Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6 Parameter Configurations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7 Transferring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-32 Retrieving User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-32 Restoring Factory Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-33 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-33

ECG Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2 ECG Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7 Selecting Adult or Neonate Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9 Monitoring Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10 Selecting ECG Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12 Displaying Additional Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12 Checking the ECG Amplitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13 Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13 Adjusting Tones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13 Changing the Display Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14 Selecting Primary and Alternate Heart Rate Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14 Suspending/Resuming ECG Processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15 Printing ECG Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15 Restoring Default Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16 Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16 ECG Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16

Arrhythmia Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2 Setting Up Arrhythmia Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5 Reviewing Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8 Controlling Arrhythmia Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9 Clearing a Class or Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9 Merging Classes/Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9 Plotting Arrhythmia Trend Graphs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-11 Printing Arrhythmia Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-12 Arrhythmia Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13

ST Analysis Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3 Setting Up ST Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4 Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4

iii

Ultraview Care Network

Selecting Leads for ST Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reviewing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clearing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Viewing ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting the ST Trend Timebase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Printing ST Segment Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10-5 10-6 10-6 10-7 10-7 10-8

12 - Lead Diagnostics Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Initiating a 12-Lead Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Automatic Scheduling of 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Saving and Clearing 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Report Directory Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-1 11-2 11-3 11-3 11-4 11-4 11-5 11-5

Respiration Directory of Keys - ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1 Directory of Keys - Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2 Directory of Keys - Varitrend 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4 Setting Up Respiration Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5 Selecting Adult or Infant Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6 Turning Respiratory Waveform On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Adjusting Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Selecting Respiration Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Adjusting Respiration Sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8 Using the Cardiovascular Artifact Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9 Configuring Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9 Printing Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11

Temperature Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Up Temperature Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting or Adjusting Temperature Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recording Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13-1 13-2 13-2 13-3 13-4 13-4 13-4

Fetal Monitoring Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2

Ultraview Care Network Operations Manual

Fetal Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2 Starting Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-4 Ultrasound Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-6 Uterine Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-8 ECG Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9 Intrauterine Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10 Main Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12 Fetal Heart Rate Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12 Bradycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13 Tachycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15 Recorder Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-16 Module Configuration Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-22 Telemetry Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-25 Mermaid Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-26

NIBP Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-2 Setting Up NIBP Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-4 Setting or Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5 Selecting Adult or Neonatal Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5 Displaying Heart (Pulse) Rate Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6 Initiating a Manual Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6 Setting Automatic Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6 Stopping a Measurement in Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7 Displaying New or Previous Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7 Recording BP Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-8 Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-8

Pressure Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-2 Setting Up Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3 Zeroing the Pressure Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5 Selecting Numeric Display Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5 Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5 Displaying Waveforms with Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6 Freezing the Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6 Changing the Waveform Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6 Selecting the Waveform Measurement Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6 Storing Values for Trending. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-7 Recording Pressure Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-7 Setting Artifact Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-7 Selecting a Filter Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-8

Ultraview Care Network

Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-8 Factory Default Pressure Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-9

Cardiac Output Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-2 Setup Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-4 Entering the Computational Constant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-4 Entering Patient Height/Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5 Measuring Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5 Averaging Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5 Clearing Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6 Storing Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6 Stopping Curve Drawing and Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6 Selecting Index Normalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6 Displaying Cardiac Index and Cardiac Output Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-7 Displaying Calculations Table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-7 Editing Vital Sign Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-8 View Additional Table Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-9 Recording Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-9 Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-9 Cables and Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-10

SpO2 Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Up SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ensuring Accurate Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting or Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting Data Averaging Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Using SpO2 with Intra-Aortic Balloon Pumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adjusting Tone Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Modifying Waveform Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Viewing Pulse Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Using the Sensorwatch Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-1 18-2 18-3 18-4 18-5 18-5 18-5 18-5 18-6 18-6 18-6 18-6 18-7 18-7 18-8

SvO2 Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Up SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preparing the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Performing Pre-insertion (in vitro) Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inserting the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19-1 19-2 19-3 19-4 19-4 19-6 19-6

Ultraview Care Network Operations Manual

Performing Light Intensity Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-7 Performing In Vivo Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-7 Displaying Intensity Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-7 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-8 Setting the Light Intensity Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-8 Adjusting Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-8 Obtaining Oximetry Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9 Printing Oximetry Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9 Storing or Reading Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9 Correcting Out-of-Range Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-10 Correcting Insufficient Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-11 Correcting Calibration Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-11 Correcting Optical Module Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-11 Correcting SvO2 Display Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-12 Ensuring Catheter Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-12

Calculations Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . 20-1 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-3 Setting Up Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-3 Setting Up Drug Dosage Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-4 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-5 Hemodynamic Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-9 Respiration Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-11 Oxygenation Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-12 Renal Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-14 Drug Dosage Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-15 Using the Drug Name List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-21

Trends Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . 21-1 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-2 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-4 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-5 Printing the Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-6 Graphic Trends Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-7 Tabular Trends Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-8

Remote Keypad Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-2 Setting Up the Remote Keypad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-2 Selecting a Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-4 Operating Menu Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-4 Recording a Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-4 Programming Access Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-5

vii

Ultraview Care Network

Remote Display Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UCW-ID Rear Panel Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Up the Secondary Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copying Stored Values of the Primary Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Restoring a Stored Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copying Primary Attributes to the Secondary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resetting Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tracking or Locking Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adjusting Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23-1 23-2 23-2 23-4 23-4 23-4 23-4 23-5 23-6

TE Mode Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-2 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-3

Digital Telemetry Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-2 Setting Up ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-6 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-8 Monitoring Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-9 Selecting Options for Lead Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-10 Assigning a Telemetry Channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-12 Tuning a Receiver Module for a Bedside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-12 Entering Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-12 Changing the Display Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-13 Acknowledging Signal Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-13 Setting Battery Status Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-13 Controlling Patient-Initiated Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-13 Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-14 Digital Telemetry Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-14

Patient Data Logger Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Data Printouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26-1 26-2 26-4 26-5

DNA Directory of Keys - UCW and Ultraview 1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-2 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-3

BIS Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Initialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

viii

28-1 28-2 28-6 28-6

Ultraview Care Network Operations Manual

Normal Bedside Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-8 Remote View Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-11 Split Screen Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-12 Numeric Key Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-12 BIS Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-13 BIS Alarm Limits Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-14 Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-14 BIS Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-17 Display Format Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-18 Plot Scales Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-19 Time Scale Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-19 Size Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-19 Sweep Speed Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-20 Advanced Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-20 Low Frequency Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-21 High Frequency Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-21 Line Frequency Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-21 Print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-21 Start/Stop Procedure Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-22 Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-22 Prompt Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-23 Recording and Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-24 Help Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-24 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-27 Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-28 Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-30

Capnography Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-2 Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-4 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-6 Alarm Status and Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-7 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-8 Adjusting the Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-9 Turning the Waveform Display Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-9 Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-9 Selecting a Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-9 Adjusting the Tone Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-10 Turning the Tone Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-10 Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-10 Freezing the Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-10 Calibrating O2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-10 Calibrating the Airway Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-11 Calibrating the CO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-11 Performing a 100% O2 Span . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-12 Selecting Gas Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-12 Restoring Default Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-12

Ultraview Care Network

Multigas Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-2 Multigas Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-5 Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-6 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-8 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-10 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-12 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-14 Turning the Waveform Display Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-14 Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-14 Selecting a Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-15 Selecting an Agent ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-15 Selecting Stand By Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-16 Selecting a Pump Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-16 Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-16 Freezing the Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-16 Replacing the Water Trap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-17 Replacing the Gas Analyzer Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-17 Initiating a Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-17 Suspending Sampling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-19 Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-19

Ultraview Care Network Product Specifications System Safety Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Equipment Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Equipment Maintenance Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ultraview Care Network Module Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31-1 31-3 31-4 31-4

Cleaning and Sterilization Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tru-Cuff Noninvasive Blood Pressure Cuffs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Capnography Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cables and Lead Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ultrasound Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnostic Messages Symbols

32-1 32-1 32-2 32-2 32-3 32-4 32-4

System Introduction and Network Basics 1

This chapter gives an overview of the Ultraview Care Network™ products, provides basic system operating instructions, and describes network functions. Information regarding the operation of clinical information system products are contained under separate cover. Please refer to their respective operations manuals.

hlo 1

a N dul IB t P

o2 hl

P1 2 P3 -4

n N eo IB na P ta l

de fla te

module 2

90367 1030 Monitor 90369 Ultraview™ 1050 Monitor

O C

Ultraview™

modules

90491 Module Housing

S pO

90496 Ultraview™ Command Module

90386 UCW-ID

90364 Ultraview™ 1600 Monitor 90387 Ultraview™ 1700 Monitor

90385 UCW® Monitor 90363 Ultraview™ 1500 Monitor E C G E C G

♥

II MON ST= 0.08 A=0

? ROW 5 120 40

HELP

MONITOR SETUP

V3 ST=-0.16

R X SPECIAL FUNCTIONS

R E S P

S P O 2

15:55 16:54 16:55 16:56 16:57

110/ 68( 84) mmHg 115/ 68( 77) mmHg 113/ 55( 88) mmHg 108/ 56( 82) mmHg 116/ 62( 83) mmHg

N HR= 69 (ECG) HR= 69 (ECG) LAST BP= I B HR= 69 (ECG) 16:57 HR= 69 (ECG) P HR= 69 (ECG) 02/21

RA-LA

30 0

116 62

TONE RESET ALM SUSPEND

RECORD

68 *bpm

97%

100 85 PREVIOUS MENUS

( 83) m m H g

S 150 100

NORMAL SCREEN

21 FEB 1994

90499 Module Housing

91416 Color Display with Touchscreen Figure 1-1: Ultraview Care Network Monitor Family

CAUTION: • Federal law restricts these devices to sale by, or on the order of, a physician.

1-1

System Introduction and Network Basics Contents System Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Monitor Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Network Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Watching Alarms Remotely — Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . .10 Viewing Remote Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Full Bed Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Ultraview IWC Monitor Context Manager Connection . . . . . . . . . . . . . . . . . . .12 Reviewing Remote Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Non-Networked Telemetry Central Option . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

System Basics Ultraview Care Network monitors provide a consistent operator interface across all bedside and central monitoring environments. Monitors installed on a network provide access from monitor to monitor and enable you to control the remote data. Networked monitors enable you to view waveforms and numeric values of patient parameters, review vital sign and ECG arrhythmia and ST history, and record patient data automatically during alarm events. Refer to Network Basics on page 1-9 for more information. •

•

1-2

Central stations display patient specific parameters, remote alarms, and alarm limits that are based on the setting of the bedside as determined by the primary caregiver. Refer to Central Monitors on page 6-1 for detailed information on the system capabilities. The Remote View feature enables you to monitor two patients simultaneously. Remote views of waveforms and numerics are nearly identical in display and function to the parameter at the originating monitor. Alarms, trends, menu keys, and recordings are accessible through a Remote View. Refer to Viewing Remote Parameters on page 1-11 and Alarms on page 2-1 for more information. The Universal Clinical Workstation (UCW) or 90387 Ultraview 1700’s Full Bed Review feature enables you to view multiple parameters on a UCW and Ultraview 1700 bedside monitor from any other UCW or Ultraview 1700 bedside or central monitor on the network. Refer to Full Bed Review on page 1-12 for more information. The Alarm Watch feature notifies you when an alarm occurs on any other monitor on the network. Refer to Alarm Watch on page 2-8 for more information. Vital signs trending provides minute-by-minute recording of parameter data for review and for documentation in the patient record. You select the format and interval for trending. Refer to Trends on page 21-1. Optional calculations features provide automatic calculation and trending of advanced clinical variables including hemodynamic, renal, oxygenation, ventilation calculations, and drug dosage. Refer to Calculations on page 20-1.

System Introduction and Network Basics

91416-A/B Color Display Capabilities The 91416-A/B color display with touchscreen provides different funtionality when its used with different monitors. • •

The 91416-A functions exactly as a 90385 UCW when its used in conjunction with the 90386 UCW independent display or with the 90387 Ultraview 1700. The 91416-B functions exactly as a 90363 Ultraview 1500 when its used in conjunction with the 90364 Ultraview 1600.

For instructions on using the 91416-A/B display refer to all references for either the 90363 Ultraview 1500 (91416-B) or 90385 UCW (91416-A). WARNING: • Due to the potential for electromagnetic interference, portable communication transmitters and cellular phones should not be operated within 3.5 feet (1.07 meters) of the patient, patient leads, or associated patient monitoring equipment.

•

All references to the Universal Clinical Workstation or UCW include the Universal Clinical Workstation-Independent Display (UCW-ID), and all the available features of the UCW-ID.

Monitor Basics Ultraview Care Network monitors use modules to monitor various clinical parameters. For example: • • •

Electrocardiograph (ECG). Refer to ECG on page 8-1. Noninvasive Blood Pressure (NIBP). Refer to NIBP on page 15-1. Cardiac Output (CO). Refer to Cardiac Output on page 17-1.

Remote module housing units may be used with Ultraview Care Network monitors to house additional modules. The 90385 UCW, 90363 Ultraview 1500, 90364 Ultraview 1600, and 90387 Ultraview 1700 monitors must use a remote module housing unit to house any of its modules. • •

Each 90499 module housing holds up to two modules. Each 90491 module housing holds up to four modules.

An external power supply is needed whenever a module housing is used. A separate power supply is required for the 90491 module housing.

1-3

Ultraview Care Network

Power Failure WARNING: • In the case of a power failure, the remote module housing (90491 or 90499) provides +5 V of power to maintain data integrity. •

If the power is interrupted to the remote module housing but not to the monitor, the module will remain active and the following will occur: •

waveforms will go flat (as if the patient has no vital signs) or will be totally lost;

•

parameter values will go to the minimum limit or ??? (except for non-invasive pressure, which will display the last value before the power failure); and

•

alarms may sound for low limit violations or for conditions such as Asystole, Leads Off, Loss of Signal, or Adapter Disconnected.

•

If any of the above conditions occur, check to determine whether or not power has been interrupted to the remote module housing and reestablish AC power.

•

Do not allow the Ultraview 1600, Ultraview 1700, or the 90499 module housing to be left turned ON without power applied for long periods of time or the memory backup batteries will be depleted.

Modules are designed with default settings for alarms and various other parameter settings (for example, NIBP reading frequency) which you may adjust to meet the needs of your patients. When events occur that might cause the selected limits or values to return to the monitor default settings, the monitor may display a CHECK SETUP key in the ECG zone combined with a low priority alarm tone (refer to Setting Alarm Limits on page 2-5 for details on alarm priorities). To cancel the message and the alarm, simply touch the CHECK SETUP key on the screen. The following describes the events that will cause the CHECK SETUP key to appear. Event

1-4

Reason

Monitor power ON

Any time you power ON a monitor, all parameters are reset to their default values or to the values set the last time the monitor was in use. It is very important to review the parameter limits and/or their values and adjust them appropriately for the current patient.

When you insert an ECG module

Because the module values will come up with default settings, it is important to review and reset the limits and/or values for that particular patient.

An error is detected and the monitor resets

The monitor has detected an error that cannot be corrected through other means.

System Introduction and Network Basics

â&#x20AC;˘

Check Setup is an optional feature on the ECG channel. Contact your system administrator if your system does not have this feature.

Inserting Modules Insert a module into the bedside monitor (Ultraviewâ&#x201E;˘ Portable) or into the remote module housing as shown below. Ultraview Portable

patient module slot

right side view

remote module housing

90499 Module Housing

Figure 1-2: Ultraview Care Network Module Insertion

Patient Preparation To prepare the patient for monitoring, attach the patient cable, and connect the patient cable to the module. Touch a parameter key, then touch the menu keys as needed to set up monitoring for a specific parameter.

1-5

Ultraview Care Network

Using the Monitor Screen Ultraview Care Network monitors employ touchscreen technology for interaction with the system. To activate a menu or parameter key, simply touch the key on the screen.

Using the Screen Keys The Ultraview Care Network monitors use keys on the screen to execute monitor functions. The monitor keys are located to the far right side of the screen and have standard functions regardless of the parameter being monitored. The menu keys appear along the bottom of the screen as menu items. The (physiological) parameter keys appear next to the parameter display. Some monitors (for example, the UCW) display these keys pictorially as icons, but the key names and functionality are the same for all Ultraview Care Network monitors. monitor keys

parameter keys

E C G

II MON PACED ST = 0.16 A=0 ROW 5 120 40

VI ST = 0.00

HELP MONITOR SETUP SPECIAL FUNCTIONS

ALM SUSPEND S P O 2

E C G

II ST=0.16 A=0 11:32

11:33 11:34 11:35 11:36

110/ 113/ 113/ 82/ 108/

69( 73( 69( 51( 67(

84) 88) 84) 64) 83)

11:37 11:37 11:38 11:39 11:40

110/ 104/ 114/ 103/ 116/

73( 67( 73( 70( 64(

82) 79) 85) 78) 80)

LAST BP = 11:40 03/30

N I B P

69 bpm

100

116 64

m m H g

RECORD

PREVIOUS MENU (80) S

150 100

NORMAL SCREEN

PRINTER CONTROLS

message area menu line

TEMP 34.7

HELP: Access controls that pertain to ECG ECG MENU ALARM LIMITS

SIZE

SETUP

LEAD SELECT

CHANNEL FORMAT

SUSPEND PROCESSING

monitor keys (icons)

menu keys

Figure 1-3: Ultraview Portable and UCW Screen Keys Menu and Parameter Keys The menu and parameter keys appear on the monitor screen as displayed in Figure 1-3: Ultraview Portable and UCW Screen Keys. • •

Touch a parameter key to display a set of menu keys for that parameter Touch a menu key to control a monitoring function, for example, ALARM LIMITS

Keys that are currently active appear in bold lettering. Inactive keys appear in dim lettering. When you touch an inactive key an error tone will sound.

1-6

System Introduction and Network Basics

To obtain help about a menu key: 1 2

Touch HELP. Touch the desired menu key.

To customize your monitor: 1 2

Touch the HELP key, and then the key in question, to display a description of its function in the system message area above the menu line.

Touch MONITOR SETUP. Select any menu key.

Touch the MONITOR SETUP key to display a menu that enables you to adjust tones, enter patient data, modify the screen format, set time and date, adjust brightness, determine battery status (Ultraview Portables only), and specify printing characteristics. The UCW and Ultraview 1700, enables you to display a clock, stopwatch, or timer in the lower right corner of the screen. Touch the clock to display the clock menu. The Ultraview Portables, 1500 and 1600 monitors display a digital clock at the bottom right of the screen. Refer to Bedside Transport/Monitors on page 5-1 and Central Monitors on page 6-1 for a detailed explanation of the functions that apply to your system.

To activate additional functions: 1 2

Touch SPECIAL FUNCTIONS. Select any menu key.

To temporarily silence alarm tones: 1

Touch TONE RESET/ALM SUSPEND once to silence for 45 seconds. Touch TONE RESET/ALM SUSPEND again (within 45 seconds) to suspend alarms for three minutes (bedside only).

To record a parameter: 1 2

Touch RECORD once. Select up to four flashing parameter keys.

To change the screen display: 1 2

Touch PREVIOUS MENU to return to last menu. Touch NORMAL SCREEN to remove the menu from the screen.

Touch the SPECIAL FUNCTIONS key to display a menu that enables you to view remote parameters, activate automatic notification of remote alarms, view trends of vital sign data and clinical and drug calculations, and use other optional network applications.

When you touch the TONE RESET/ALM SUSPEND key once during an alarm condition it will silence the alarms for 45 seconds at the unit where the key was touched (bedside or central). Touching the key again during the initial 45 second suspension will silence the alarms for three minutes at the bedside only. Refer to Alarms on page 2-1 for more details.

You may use either a system printer or a printer module for recording patient data. Recordings of monitored data can be generated by touching the RECORD key and then touching up to four flashing parameter keys (depending on the printer capacity). Refer to Printing on page 4-1 for more details.

Touch the PREVIOUS MENU key to move back one menu level. From the Main Menu level, touch PREVIOUS MENU to remove the current menu from the display and close the application window. Touch the NORMAL SCREEN key to close any active application window, and its menus, or to return to the basic display.

Using the Keyboard A keyboard can be used for certain applications like Calculations and Admit/Discharge. An on-screen, pop-up keyboard is provided for all local applications, but you may also use an external keyboard. Refer to Using the Keyboard on page 3-4 for keyboard displays. Use the arrow keys and TAB key on the keyboard to move within an application window.

1-7

Ultraview Care Network

Using the Mouse If your system is equipped with a mouse it may be used with selected functions in lieu of the keyboard or touchscreen. Click the left mouse button on a menu key to activate the key. You may also click the left mouse button on a windowâ&#x20AC;&#x2122;s application bar to drag the window to a new location (UCW and Ultraview 1700 only).

Using the UCW and Ultraview 1700 Screen The UCW and Ultraview 1700 use windows to display certain clinical applications. When a window is active, all keyboard, mouse, and remote keypad interactions are active for that particular application. Active windows are surrounded by a green border and inactive windows have blue borders.

â&#x20AC;˘

Only one application window can be active on the screen at any one time.

You may display your UCW or Ultraview 1700 window in a variety of ways: To activate a window: Touch any portion of the window. If a window is not displayed, touch the SPECIAL FUNCTIONS key and then touch the desired application icon. To move a window: Touch the title bar at the top of the window and drag it to its new position. The window will not move over protected regions of the screen, for example: highest priority parameters, hard keys, or the menu line. To resize a window: Touch the appropriate key to minimize, reduce, enlarge, or return to default size of the window. Window resizing is only available in certain applications. To create a window icon: Touch the SPECIAL FUNCTIONS key, touch the icon associated with the application, and then touch the button at the top right corner of the screen. When an icon is created for an application it is stored in memory and the window is removed from the screen. To scroll through data within a window: Use the scroll bar on the bottom of the application screen. The length of the scroll bar slider is proportional to the amount of data to be scrolled through. The more data to be scrolled through, the shorter the slider. When there is less data, the slider is longer. Touch the right arrow on the scroll bar to move data over one column from the left. Moving a table to the right allows older data to the left to be displayed. Newer records are displayed to the right, older records to the left. Use the scroll bar trough to scroll through entire pages of data. Touch the trough to the left of the

1-8

System Introduction and Network Basics

slider to scroll across one page of columns to the right. Touch the trough to the right of the slider to scroll across one page of columns to the left. Touch and drag the slider to scroll through pages of data quickly in the direction it is dragged.

slider

trough

scroll bar arrow

Figure 1-4: Scroll Bar

Network Basics To aid in understanding the concept of a network operation, consider your need to communicate between beds in a single care unit. While you are in the care unit at a bedside monitor, you can view parameter waveforms from another bed and control those parameters just as if you were at that remote bedside. Advanced networking allows remote access and interaction with Clinical and Drug Calculations, Tabular Trends, Graphic Trends, and parameters from remote beds. Standard networking allows the remote viewing of single parameters from bedside to bedside, and bedside to central. The Full Bed Review feature on the UCW and Ultraview 1700 allows remote viewing of the entire bedside monitor. If you need to review information from another unit on the network, you can do so by specifying the unit as well as the bed. For example, if you have a need for frequent communication between your care unit and another care unit, those units would be designated as subnets on your networked system. This identification typically appears on the keys in the appropriate menus.

1-9

Ultraview Care Network

The following figure illustrates a possible network configuration.

Subnet #2 Emergency Room

Subnet #1 Intensive Care Unit

NETWORK Figure 1-5: Network Configuration Although the presence of the network is invisible to you as you operate any monitor on the system, decisions were made during installation to configure the system according to your hospital’s specifications. Typically, hospitals designate a system administrator for this task. This manual directs you to refer questions to that individual where system operation may differ according to the decisions made by your hospital.

Watching Alarms Remotely — Alarm Watch To enable Alarm Watch: 1 Touch SPECIAL FUNCTIONS. 2 Touch ALARM WATCH. 2a Select ALARM WATCH ENABLE (UCW and Ultraview 1700 only). 3 Select a bed on the subnet. or 3a Select another subnet, then select a bed. 4 Select desired bed ON.

With the network Alarm Watch function enabled you will be notified of all alarms at all monitors. Once a monitor has been set up to Alarm Watch a bed, any alarm from that bed is reported. WARNING: • The Alarm Watch function is not automatically enabled. You must first select the bed that the central or bedside monitor should Alarm Watch. •

Alarm conditions for parameters not currently displayed on the central monitor will only be reported at a central monitor when Alarm Watch is enabled at the central monitor.

Refer to Alarm Watch on page 2-8 for details concerning the Alarm Watch function.

1-10

System Introduction and Network Basics

Viewing Remote Parameters To view remote parameters from a bedside monitor: 1 Touch SPECIAL FUNCTIONS. 2 Touch REMOTE VIEW. 2a Touch REMOTE VIEW. ENABLE (UCW and Ultraview 1700 only). 3 Select a bed on the subnet. or 4 Select another subnet, then select a bed. 5 Select desired parameter ON.

Each parameter on a bedside monitor can be independently viewed (Remote View) on any other bedside or central monitor on the network. Remote View is also available with the Ultraview Workstation. Remote views of parameters can be identical in display and function to the local bedside, with the addition of the patient name, bed identification label, and the Full Bed Review feature on the UCW or Ultraview 1700. If enabled by your system administrator alarms and menu keys operate the same at the remote monitor as they do at the local bedside. Bedside monitors can have parameters remotely viewed by up to 16 other devices.

•

Your network protocol may not enable you to make remote alarm limit changes or to remotely control a parameter. If you have a question regarding this function, ask your system administrator.

To view remote parameters from a central monitor (UCW and Ultraview 1700):

Remotely viewed parameters occupy the lowest zone on the screen of a bedside monitor. On the central monitor each remote parameter is assigned a specific display position. Every Remote View zone is separated from other zones by a dividing line or by a border that extends around the entire display zone.

1 2 3

When a bedside monitor is set up to remotely view a parameter from another bedside, a one-second advisory tone sounds at the onset of the alarm condition. The remote alarm tones must be active at that bedside monitor.

4 5

Touch MONITOR SETUP. Touch SCREEN FORMAT. Select a subnet or bed as appropriate from pop-up window. Select a parameter and color. Select the destination display zone.

Arrhythmia and ST segment review data can also be viewed from remote monitors if optional Arrhythmia and ST segment analysis software is part of your system. WARNING: • Remote View and Alarm Watch are mutually exclusive functions on the bedside monitor. Selecting to remotely view a parameter at a bedside inactivates the Alarm Watch function at that monitor. When you need to control or continually observe a parameter from a remote monitor, use the Remote View function. When you wish to have remote notification of alarms, use the Alarm Watch function.

•

Your network protocol may not allow you to control remotely viewed parameters. If you have a question regarding this function, ask your system administrator.

1-11

Ultraview Care Network

Full Bed Review Available on UCW and Ultraview 1700 Only To activate Full Bed Review from a bedside monitor: 1 2 3

Touch SPECIAL FUNCTIONS. Touch REMOTE VIEW. Select subnet or bed as appropriate from pop-up window. Touch FBR.

To activate Full Bed Review from a central monitor: 1 2 3

Touch MONITOR SETUP. Touch SCREEN FORMAT. Select subnet or bed as appropriate from pop-up window. Touch FBR.

To exit the Full Bed Review window: 1

Touch oval box in upper left corner of window.

The Full Bed Review (FBR) feature is available only on the UCW or Ultraview 1700. This feature enables you to view parameters displayed in the first seven zones of a bedside UCW or Ultraview 1700 from any other bedside or central UCW or Ultraview 1700 on the network. The Full Bed Review display is nearly identical to the display of the local monitor. Touch the FBR key to display the popup Full Bed Review window. •

•

Full Bed Review can be activated at a bedside monitor by pressing the FBR key in the Remote View Bed Selection window, or in any Remote View or Alarm Watch zone. Full Bed Review can be activated from a central monitor by pressing the FBR key in either the Screen Format window, in the Alarm Watch zone, or in any parameter’s zone.

The ECG parameter will display as a numeric key, with 12-lead ECG monitoring in Full View mode. Other parameters will be displayed in the waveform zones in the Full Bed Review window. In Split View, seven ECG waveforms will be displayed in the waveform zones and any other parameters from the same bedside will be displayed as numeric keys in the Full Bed Review window. To dismiss the Full Bed Review window, touch the oval box that appears in the upper left corner of the window.

Ultraview IWC Monitor Context Manager Connection Available on UCW and Ultraview 1700 Only The Ultraview Integrated Work Center (IWC) Monitor Context Manager connection feature is available only for central stations on UCW and Ultraview 1700 monitors. This feature enables you to send patient data and vital sign information from the central UCW to an IWC Monitor Context Manager on the network. This option replaces the Full Bed Review button with the IWC button on all the waveforms displayed in central zones or in an alarm watch window. However, Full Bed Review is still available by using the FBR key for each Full Bed Review-capable bed in the Screen Format window. Ultraview IWC Monitor Context Manager transmission can be activated from a central monitor by pressing the IWC key in either the Alarm Watch zone or in any parameter’s zone.

1-12

System Introduction and Network Basics

Setup — System Administrator To transmit patient and waveform data to the IWC Monitor Context Manager, your system administrator must first configure the correct IP address and port number on the network. • •

•

Access the Ultraview IWC Setup screen from the System Administrator menu. Enter the correct TCP/IP address and port number for the IWC Monitor Context Manager on the network in the appropriate areas on the setup screen. Select OK to accept the new values.

Reviewing Remote Trends To display a trend from a remote monitor:

Retrospective vital sign review through either graphic or tabular trends provides minute-by-minute access to data from any monitor on the network.

1 2

Touch SPECIAL FUNCTIONS Touch REMOTE TRENDS/ CALCS 3a Select a bed on the subnet, or 3b Select another subnet, then select a bed 4 Touch GRAPHIC TRENDS or TABULAR TRENDS To display trend data from a remote monitor (UCW and Ultraview 1700): 1 2

Touch SPECIAL FUNCTIONS Touch GRAPHIC TRENDS or TABULAR TRENDS 3 Select REMOTE BED 4a Select a bed on the subnet, or 4b Select another subnet, then select a bed

Non-Networked Telemetry Central Option This option uses a central monitor which cannot be a part of the network. The Remote View and Alarm Watch functions are not available with this option. Any keys related to the viewing of parameters, trends, or calculations from a remote location are also not available.

1-13

Alarms

Directory of Keys -Ultraview Portable/1500/1600 Monitors Adjusting Alarm Tones MONITOR SETUP MONITOR SETUP ADMIT/ DISCH.

TONES

MONITOR CONFIG.

RECORDER CONFIG.

MONITOR SETUP - Select type of tone to change LOCAL ALARMS

REMOTE ALARMS

ALARM WATCH

KEY TONE

MONITOR SETUP - ALARM TONE TONE ON OFF

VOLUME

Setting Up Automatic Alarm Recordings MONITOR SETUP

ADMIT/ DISCH.

TONES

OTHER RECORDINGS TO

ALARM RECORDINGS TO

MONITOR SETUP MONITOR CONFIG.

RECORDER CONFIGURATION RECORDING This key appears only if enabled by your DURATION System Administrator

THIS MONITOR

RECORDER CONFIG.

ALARM PARAMS

RECORDING DESTINATION

NETWORK

THIS MONITOR

BOTH

Number of Recorder Channels These keys appear only when a printer 2 4 module is inserted in the monitor

NETWORK

VITALS SETUP

Select parameters which require alarm recordings from BED X ECG ON OFF

RESP ON OFF

ART ON OFF

PA ON OFF

CVP ON OFF

RAP ON OFF

ICP ON OFF

LAP ON OFF

SPO2 ON OFF

VENT ON OFF

GAS ON OFF

TEMP ON OFF

IV ON OFF

EEG ON OFF

Select parameters which require alarm recordings from BED X PRS ON OFF

UA ON OFF

NIBP ON OFF

ETCO2 ON OFF

Select parameters which require alarm recordings from BED X PO+ET ON OFF

SVO2 ON OFF

TCP ON OFF

UV ON OFF

INCUB ON OFF

OTHER ON OFF

Setting Up Alarm Watch SPECIAL FUNCTIONS SPECIAL FUNCTIONS REMOTE VIEW

ALARM WATCH

RV/AW OFF

LOCAL TRENDS/CALCS

REMOTE TRENDS/CALCS

OTHER APPLICATION (if installed)

ALARM WATCH - Select bed(s) for ALARM WATCH 1001 ON OFF

1002 ON OFF

1003 ON OFF

1004 ON OFF

NET 02

NET 03

NET 04

3006 ON OFF

3007 ON OFF

ALARM WATCH - Select bed(s) for ALARM WATCH in subnet NET03 3001 ON OFF

3002 ON OFF

•

3003 ON OFF

3004 ON OFF

3005 ON OFF

Based on features purchased, more or fewer keys may appear here than on your menu screens.

2-1

Alarms

Directory of Keys - UCW and Ultraview 1700 Adjusting Alarm Tones MONITOR SETUP ADMIT/ TONES DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS

MONITOR SETUP - Select types of tone to change: LOCAL ALARMS

REMOTE ALARMS

ALARM WATCH

KEY TONE

MONITOR SETUP - Remote alarm tone TONE ON OFF

VOLUME

Setting Up Alarm Watch

ICU

NICU

BED01 BED01

! 2-2

•

BED02

MICU

BED03

CCU

BED04

BED05

BED06

BED07

Based on features purchased, more or fewer keys may appear here than on your menu screens.

Privileged Access

Directory of Keys - UCW and Ultraview 1700 Setting Up Automatic Alarm Recordings MONITOR SETUP TONES

ADMIT/ DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS

CLINICAL ACCESS (user name is CLINICAL)

CSR LEVEL: Select Option BIOMED LEVEL: Select Parameter

CLINICAL LEVEL: Select Parameter SCALED DISPLAY

TIME/ DATE

RECORDER CONFIGURATION

PRESELECTED RECORDINGS

USER ACCESS ENABLE

Number of Recorder Channels

Recorder Configuration: REC DURATION 12 sec 20 sec

UNITS OF MEASURE

RECORD ALARM PARAMETERS

RECORDING DESTINATION

ALARM SETUP

These keys appear only when a printer module is attached to the UCW or Ultraview 1700

Bedside parameter pop-up window

2-3

Alarms

Overview This chapter describes how to use the Alarm Watch feature, set alarm limits, silence and suspend alarms, set alarm tones, and specify parameters for automatic alarm recordings. When a parameter goes into alarm on a local bedside monitor, the corresponding parameter key flashes on the screen, an alarm message is displayed, and an alarm tone sounds (unless tones are disabled). You can also choose to automatically record the parameter in alarm on a bedside or network printer. Networked monitors enable you to monitor alarm conditions at both the central and bedside monitors simultaneously through the Alarm Watch feature. WARNING: â&#x20AC;˘ Alarm conditions for which you want to be alerted must be set to ON or enabled at the location where you want to be alerted, bedside or central. You can enable them from the local bed, remote bed, or central.

â&#x20AC;˘

Define your own default settings for alarm limits, alarm priorities, recordings, and other attributes with the Module Configuration Manager feature. Refer to Module Configuration Manager on page 7-1 for further details.

Default Alarm Limits Factory default alarm limit settings are activated whenever the monitor is powered ON, whenever a module is inserted, or when a parameter is enabled. You can modify these settings to meet your own protocols. Refer to the Alarm section of the appropriate parameter chapter in this manual for details concerning setting or adjusting alarm limits for a specific parameter.

2-4

Alarms

Setting Alarm Limits To set alarm limits: 1 2 3 4 5

Touch a parameter key (ECG, TEMP, etc.). Touch ALARM LIMITS. Ensure ALARMS ON is set. Select HI = or LO =. Use arrow keys to adjust.

You can change parameter alarm limits by using the parameter’s Alarm Limits menu. The steps to the left illustrate the minimum procedure used to adjust high and low alarm limits for a parameter.

•

Parameters may contain additional alarm limit features not listed here. Read the specific parameter chapter (for example, ECG or NIBP) in this manual for details.

•

To set fetal alert limits, please refer to Fetal Monitoring on page 14-1 for further details.

Identifying Alarm Levels Alarm conditions are visually and audibly prioritized as high, medium, or low. Table 1: Bedside Alarms Priority

Tone Type*

Visual

Tone Duration

High (Level 1)

continuous tone, or 2 bursts of 5 tones every 15 seconds

flashing key; message appears in red on color monitors

until the alarm condition is resolved, the alarm is suspended, or the tone is reset

Medium

intermittent tone (one second ON, one second OFF), or burst of 3 tones every 30 seconds

flashing key; message appears in yellow on color monitors

until the alarm condition is resolved, the alarm is suspended, or the tone is reset

Low (Level 2)

intermittent tone (one second ON, four seconds OFF), or 1 tone every 30 seconds

flashing key; message appears in yellow on color monitors

until the alarm condition is resolved, the alarm is suspended, or the tone is reset

* The repetition rate for the tone bursts on the High and Medium levels may be adjusted for all monitors by your system administrator. The repetition rate for the tone bursts on the Low level can be adjusted for Ultraview Portable, 1500, and 1600 monitors by your system administrator. WARNING: • Parameters shown in the ECG waveform zone in Enhanced Vital Signs mode do not alarm at the central station. Only parameters set via the Alarm Watch mode will alarm as set up by the system administrator.

2-5

Ultraview Care Network

Table 2: Alarm Watch and Remote View Alarms Priority

Tone Type*

Visual

Tone Duration

High

Central continuous tone, or 2 bursts of 5 tones every 15 seconds Bedside one single tone

flashing key; message appears in red on color monitors

Central until the alarm condition is resolved or the tone is reset Bedside one-second

Medium

Central intermittent tone (one second ON, one second OFF), or burst of tones every 30 seconds Bedside one single tone

flashing key; message appears in yellow on color monitors

Central until the alarm condition is resolved or the tone is reset Bedside one-second

Low

Central intermittent tone (one second ON, four seconds OFF), or one tone every 30 seconds Bedside one single tone

flashing key; message appears in yellow on color monitors

Central until the alarm condition is resolved or the tone is reset Bedside one-second

* The repetition rate for the tone bursts on the High and Medium levels can be adjusted for all monitors by your system administrator. The repetition rate for the tone bursts on the Low level can be adjusted for Ultraview portable, 1500, and 1600 monitors by your system administrator.

Adjusting Alarm Tones/Key Tones To set local alarm tones or key tones: 1 2 3 4 5

Touch MONITOR SETUP. Touch TONES. Select LOCAL ALARMS or KEY TONE. Select TONES ON. Use VOLUME↑ and VOLUME↓ keys to adjust.

You can turn the alarm tone ON or OFF and adjust the tone volume for local alarms, Remote View alarms, or Alarm Watch alarms. While you are adjusting tone volume, a tone sounds briefly as an example of the new level. Alarm tones refer to the sound associated with an alarm condition. Key tones sound each time you touch a screen key. Volume adjustments affect only the monitor where the adjustment is made. The tone volume of an alarm notification at a remote monitor must be adjusted at that monitor. It cannot be adjusted remotely. A visual alarm notification is displayed until the condition is resolved, even if you disable the alarm tones at that monitor.

To set alarm watch tones or remote view tones:

Alarm Watch tones sound when the Alarm Watch feature is active and an alarm condition exists on a watched monitor. The Alarm Watch feature must be enabled via the Special Functions menu for the Alarm Watch tone to sound.

1 2 3

The Remote View alarm tone only sounds when a remotely viewed parameter goes into alarm.

4 5

2-6

Touch MONITOR SETUP. Touch TONES. Select ALARM WATCH or REMOTE ALARMS. Select TONES ON. Use VOLUME↑ and VOLUME↓ keys to adjust.

WARNING: • Disabling alarm tones via Monitor Setup at a bedside or at a central monitor eliminates alarm tones for all alarm conditions at that monitor, even in the case of lifethreatening events.

Alarms

Controlling Alarms via the TONE RESET/ALM SUSPEND Key During an Alarm Condition To silence an alarm tone for 45 seconds at any monitor, touch the TONE RESET/ALM SUSPEND key once.

If you touch TONE RESET/ALM SUSPEND once at a monitor during an alarm condition: •

To resume alarm tones at a central monitor, touch the TONE RESET/ALM SUSPEND key again. • To suspend all alarms at a bedside monitor for 3 minutes, touch the TONE RESET/ALM SUSPEND key again within 45 seconds.

•

At a bedside monitor, when you touch the TONE RESET/ALM SUSPEND again within 45 seconds: •

Note: If alarms resume the second time the key is touched, your bedside monitor may be configured differently for this feature. Contact your system administrator for details.

All alarms and alarm recordings are suspended for 3 minutes. No alarms sound for any reason during this period, and no new alarm recordings are produced.

! • •

To resume normal alarm operation at a bedside monitor within the 3-minute period, touch the TONE RESET/ALM SUSPEND or RESUME ALARMS (Ultraview Portable, 1500, and 1600 monitors) key again.

The alarm tone is silenced at that monitor for 45 seconds, but the alarm tone continues to sound at other monitors. If the alarm condition continues, the alarm tone resumes at that monitor at the end of the 45-second period. If another parameter goes into alarm during this period, or if the initial condition ends and then begins again, the alarm tone will again sound at that monitor. The message ALARM TONES SUSPENDED FOR 45 SECONDS is displayed only on that monitor. All flashing parameter keys continue to flash.

•

The ALM SUSPEND feature is only available at bedside monitors. If this feature has been disabled (set to OFF), the TONE RESET/ALM SUSPEND key does not suspend alarms.

A message is displayed to indicate that all alarms are suspended. Trend data may not be collected. This feature can be enabled or disabled only by your system administrator.

Normal alarm operation can be resumed within the 3-minute time period by touching the TONE RESET/ALM SUSPEND or RESUME ALARMS (Ultraview Portable, 1500, and 1600 monitors) key again.

•

The Ultraview Portable, 1500, and 1600 monitors relabel the ALM SUSPEND key as RESUME ALARMS after the first key touch.

In the Absence of an Alarm Condition To suspend alarms at a bedside monitor when no alarm is sounding, touch the TONE RESET/ALM SUSPEND key once.

•

The Ultraview Portable, 1500, and 1600 monitors relabel the TONE RESET/ALM SUSPEND key as ALARM SUSPEND after the first key touch.

Touching the TONE RESET/ALM SUSPEND key once when no parameters are in an alarm condition suspends the alarms at the bedside monitor. (Refer to During an Alarm Condition on page 2-7.)

2-7

Ultraview Care Network

To resume alarms at a bedside monitor, touch the TONE RESET/ALM SUSPEND key again.

•

You cannot suspend alarms from a central monitor. However, you can silence alarm tones for 45 seconds. Touching this key has no effect if it is touched at the central monitor when no alarm is sounding.

Alarm Watch To enable Alarm Watch: 1 2 3

Touch SPECIAL FUNCTIONS. Touch ALARM WATCH. Select ALARM WATCH ENABLE (UCW and Ultraview 1700 only). 4a Select a bed on the subnet. or 4b Select another subnet, then select a bed. 5 Select desired bed ON. To disable Alarm Watch (Ultraview Portable, 1500, or 1600 monitor): 1 2

Touch SPECIAL FUNCTIONS. Select RV/AW OFF.

To disable Alarm Watch (UCW and Ultraview 1700): 1 2 3

Touch SPECIAL FUNCTIONS. Touch ALARM WATCH. Select ALARM WATCH DISABLE.

With the network Alarm Watch feature, you can be notified at a local bedside or central monitor of all alarms from a remote bed. The Alarm Watch feature defaults to its last setting when the monitor is turned ON. The local monitor displays the message ALARM WATCH ON when the Alarm Watch feature for a remote bed is active. On a central monitor, the message AW OFF also displays for each bed not selected for Alarm Watch.

•

A central monitor can be configured with the Central Alarm Watch Manager to automatically Alarm Watch every bed it is currently monitoring.

•

Refer to Central Alarm Watch Manager (available on Ultraview UCW and Ultraview 1700 only) on page 2-10.

•

Contact your system administrator.

Refer to Viewing Remote Parameters on page 1-11 for more information. The listed limits for the number of devices that can remotely view a monitor apply to Alarm Watch-initiated remote views. When a parameter from a monitor that is under Alarm Watch goes into alarm, a message such as ALARM WATCH – BED 28 ECG CHANNEL IN ALARM displays on the message line of the alarm-watching monitor. A one-time advisory tone sounds at the watching bedside or central monitor. The corresponding waveform appears in the lowest zone on the screen of the alarm-watching monitor, unless: • •

another alarm-watched parameter is in alarm and its waveform already occupies that zone at the watching monitor, or a parameter is displayed in the lowest zone of the monitor and its parameter key has been activated displaying a menu.

•

Using the Alarm Setup menu, your system administrator may select the number of tones sounded in the Alarm Watch advisory tone. This feature (not available on all monitors) enables the system administrator to select single or triple tones.

When a waveform for an Alarm Watch parameter in alarm displays, the appropriate tone sounds at the bedside and central monitors (sounds once at bedside, and continues for the duration of the alarm at the central). Only one Alarm Watch waveform can be viewed at a time. When subsequent, concurrent alarms occur for one patient or other patients on Alarm Watch, a message displays, a one-second advisory tone sounds, and the corresponding waveform automatically displays. Remember to enable Alarm Watch tones in the Monitor Setup menu to produce audible alarms.

2-8

Alarms

To de-select beds for Alarm Watch: 1 Touch SPECIAL FUNCTIONS. 2 Touch ALARM WATCH. 3a Touch the bed to de-select. or 3b Touch DESELECT ALL (UCW and Ultraview 1700 only).

On some monitors, your system administrator can initiate the Alarm Watch feature enabling you to rotate the visible active alarms through the Alarm Watch display zone on the screen. Active alarms being monitored will rotate in and out of the display zone at an interval set by your system administrator. The Alarm Watch rotation time, signal tone, and rotation algorithm can be determined using the ALARM WATCH SETUP menu, accessed by touching the PRIVILEGED ACCESS key.

ALARM WATCH SETUP

ALARM WATCH TONE SINGLE TRIPLE

ROTATE ALARM WATCH ON OFF

ALARM WATCH ROTATION ROATATION TIME 15 SEC 30 SEC PRIORITY SIMPLE

ALARM WATCH TONE — enables the system administrator to select the number of tones sounded in the Alarm Watch advisory tone. ROTATE ALARM WATCH — enables the system administrator to turn the rotation of alarms ON or OFF. If you select OFF, the ALARM WATCH ROTATION and the ROTATION TIME options are unavailable. ALARM WATCH ROTATION — enables the system administrator to select either a rotation system allowing the higher priority alarms to rotate into the window more often (Priority) or a simple rotation system allowing all alarms equal time in the rotation regardless of the alarm priority. ROTATION TIME — selects the interval between rotations in the Alarm Watch window. If multiple alarms occur simultaneously, the messages displayed cycle from one to another every three seconds (up to a maximum of ten alarms) until all alarm conditions are resolved, or until you disable alarms at either the local monitor (through Remote View) or the remote monitor. WARNING: • Using the Alarm Watch feature, you can watch for alarms from 32 other monitors. However, more than ten remote alarms cannot be reported simultaneously to any monitor using the Alarm Watch feature. •

Remote View and Alarm Watch are mutually exclusive features on bedside monitors. If you select to Remote View a parameter the Alarm Watch feature at that monitor is inactivated.

To resume Alarm Watch, touch the ALARM WATCH or ALARM WATCH ENABLE (on the UCW and Ultraview 1700) key. Alarm Watch is resumed for all previously selected patients. You can also add patients for Alarm Watch. The ALARM WATCH ON message displays in the message zone whenever one or more remote beds are selected for Alarm Watch from that local monitor. If your hospital protocol requires remote monitoring of all alarms, you can activate Alarm Watch during the setup of your bedside or central monitors. Alarm Watch remains ON as long as you do not power down the monitor.

2-9

Ultraview Care Network

Alarm Tone Manager (available on Ultraview UCW and Ultraview 1700 only)

•

The Alarm Tone Manager must be set by a system administrator with a Biomed level of privileged access.

The Alarm Tone Manager provides two levels of managing alarm notifications. • •

If this feature is ENABLED, it will not allow individual alarm tones to be permanently disabled. The system administrator can set a minimum volume for alarm tones ensuring that they are always at a safe and audible level.

•

The factory default for the Alarm Tone Manager is OFF, which inhibits access to the ALARM TONES keys in the Monitor Setup menu.

•

Contact your system administrator.

Setting Tone Volumes

MINIMUM VOLUME ON OFF

Figure 2-1: MINIMUM VOLUME key (Bedside monitor) To set minimum tone volumes when the Alarm Tone Manager is active: 1.

Set the desired minimum volume on each of the Alarm menus.

Access the BIOMED menu and touch the MORE key until the MINIMUM VOLUME key displays.

Touch MINIMUM VOLUME ON.

Central Alarm Watch Manager (available on Ultraview UCW and Ultraview 1700 only) The Central Alarm Watch Manager automatically activates the Alarm Watch feature for all currently monitored beds.

2-10

•

The factory default is Auto Alarm Watch ON and access to the Auto Alarm Watch feature DISABLED.

•

The Central Alarm Watch Manager must be set by a system administrator with a Biomed level of privileged access.

•

Contact your system administrator.

Alarms

Activating the Central Alarm Watch Manager

AUTO ALARM WATCH ON OFF

Figure 2-2: AUTO ALARM WATCH Key To activate the Central Alarm Watch Manager: 1.

Access the BIOMED menu and touch the MORE key until the AUTO ALARM WATCH ON/OFF key is displayed.

2a. Touch ON to enable the Alarm Watch feature on the central monitoring station. When this key is activated, the central monitor automatically watches the parameters of every bed displayed on the central monitor. or 2b. Touch OFF to manually select the beds you wish to monitor via the Alarm Watch feature. Enabling or Disabling Auto Alarm Watch Access

AUTO ALARM WATCH ACCESS ENABLE DISABLE

Figure 2-3: AUTO ALARM WATCH ACCESS Key To enable or disable Auto Alarm Watch Access: 1.

Press the MORE key until the AUTO WATCH ACCESS ENABLE/DISABLE key displays.

2a. Touch ENABLE to allow the Auto Alarm watched beds to be manipulated using the controls of the Alarm Watch feature. or 2b. Touch DISABLE to prevent Auto Alarm watched beds from being deselected in any way.

â&#x20AC;˘

When the Central Alarm Watch Manager is activated, it will display alarms for each bedside that has the Alarm Watch feature enabled. The central monitor continues watching for alarm conditions from the selected bedside monitors until you disable Alarm Watch for that bedside monitor or disable the Auto Alarm Watch feature altogether.

2-11

Ultraview Care Network

Automatic Recording of an Alarm To select parameters for alarm recording and generate automatic recordings on a bedside recorder: 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch RECORDER CONFIG. Select RECORDING DESTINATION. Select a destination for the alarm recording. Touch PREVIOUS MENU. Touch ALARM PARAMS. Select parameter key(s) ON to initiate a recording in case of alarm. If the parameter key is OFF, no alarm recording is produced for that parameter in an alarm condition.

To select parameters for alarm recording and generate automatic recordings on a bedside recorder (UCW or Ultraview 1700): 1 2 3 4 5 6 7 8 9

2-12

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch RECORDER CONFIGURATION. Select RECORDING DESTINATION. Select a destination for the alarm recording. Touch PREVIOUS MENU. Touch RECORD ALARM PARAMETERS. Select parameter key(s) ON to initiate a recording in case of alarm. If the parameter key is OFF, no alarm recording is produced for that parameter in an alarm condition.

Touch the ALARM PARAMS key or the RECORD ALARM PARAMETERS key on the UCW or Ultraview 1700 to display a menu of parameters that can initiate alarm recordings on a bedside recorder and on a network printer if the parameter goes into an alarm condition. Recording on a network printer is configurationdependent. See your system administrator for details. If alarm recordings are disabled for a parameter, no alarm recording is produced on either the bedside or network printer. However, the designated alarm tones are still generated and alarm messages are displayed. Alarm recordings print the last 12 or 20 seconds (selectable under RECORDING DURATION) of a waveform or print until the alarm stops or is suspended, whichever is longer. To stop a recording at the bedside printer, touch STOP or UNIT OFF on the printer module. When a bedside recorder is present in the monitor and is selected and online, an alarm recording is automatically directed to that recorder. Use the key labeled OTHER ON/OFF for any new parameter not yet on the alarm parameters menu.

•

Spacelabs Medical strongly recommends verifying alarm parameter settings on the monitor once per shift and upon each admission.

•

If a printer is not attached to the monitor, the recorder channel (1, 2, 4) keys do not appear in the menu.

Alarms

Alarm Paging The alarm paging interface is designed to provide clinicians with patient alarm information when used in conjunction with other manufacturer’s paging systems. Using the paging system, a page is sent to the clinician’s pager when a bed goes into alarm and the alarm meets the clinician-selected criteria. The page message identifies the bed and parameter in alarm, and other alarm-specific information. The UCW or Ultraview 1700 monitor connected to the paging system is referred to as the Paging Master and is the only monitor in the system that provides a user interface for paging setup and pager bed assignments. WARNING: • DO NOT use the Paging System as a replacement for the primary arrhythmia or any other life-threatening alarm modality. Reception of pages cannot be assured or verified. •

The system has limited capacity, and if the system throughput capacity is exceeded, certain pages may be canceled and/or discarded. Paging systems are not medical devices and are known to have “dead spots” where transmissions cannot be received. Paging systems may also be subject to electrical interference and other causes of malfunction. The alarm paging interface is intended to augment alarm notification; it is not intended or designed to replace monitoring personnel, good clinical judgment, the Alarm Watch function of the monitor, or to be used in place of bedside and remote alarm notification.

The default configuration for alarm paging consists of parameter alarm levels set to ECG high priority, RESP high priority, and SPO2 high priority (refer to Figure 2-6: Alarm Paging Setup Window). The default state (no pagers assigned to beds) disables the paging feature until pagers are defined and assigned to the monitored beds. The following system limitations apply to alarm paging: • • • • • •

A Paging Master can support a maximum of 64 pagers. A maximum of 64 beds (including telemetry) can be configured for alarm paging from a single Paging Master. The valid pager number range is from 0 to 999. A maximum of eight parameters can be selected for alarm paging per bed. A maximum of eight pagers can be assigned per bed. Each alarm condition assigned to a pager must be configured in the Module Configuration Manager by setting the A/W setting to ON (refer to Module Configuration Manager on page 7-1).

The alarm paging feature is designed so that higher priority alarms are sent before any pending lower priority alarms. Paging messages with equal priorities are sent in the order received. If no paging messages are waiting to be sent to pagers, it takes seven to ten seconds from the time a bed goes into alarm until the first configured pager receives the alarm page. Additional pagers assigned to the alarming bed/parameter will begin to receive pages at one- to two-second intervals. A

2-13

Ultraview Care Network

single paging system configured for two pagers per bed can support a sustained rate of five parameters going into alarm per minute. With eight pagers assigned to each bed, approximately three alarm parameters can be supported. The sustained rate at which pages can be successfully transmitted to the pagers is also a function of the bedside monitor (number of parameters, Full Bed Review, Remote Display Interface). The system is capable of handling large bursts of paging requests. However, if the system receives a sustained load of paging requests beyond its throughput capabilities, a warning dialog displays at the Paging Master. The dialog box also indicates that one or more pages was discarded, and the last message discarded is displayed. After the paging system is configured through the BIOMED menu and is connected to the Paging Master with the serial cable, the Paging Bed Selection window is used to select beds for alarm paging. This window is accessed using the PAGER SETUP key on the MONITOR SETUP menu (refer to Figure 2-4: Monitor Setup Menu). MONITOR SETUP ADMIT/ TONES DISCHARGE

PRIMARY CONFIGURATION

SECONDARY CONFIGURATION

PAGER SETUP

PRIVILEGED ACCESS

Figure 2-4: Monitor Setup Menu

If pagers are assigned to a bed and that bed key is touched: 1 2

The key appears highlighted with a darker gray background. The pager assignment for that bed displays in the bottom portion of the window. The MODIFY SETTING key is undithered. Touching this key displays the Alarm Paging Setup window.

The upper portion of the Paging Bed Selection window (Figure 2-5: Bed Selection Window for Paging) displays subnet keys in the first row and bed keys in the second row. Use the subnet keys to select the subnet of beds for which you are making pager assignments. Once a subnet is designated by the corresponding subnet key, a new set of bed keys displays in the second row.

If no pagers are assigned to a bed and the bed key is touched, the Alarm Paging Setup window displays: 1

Touch the REVIEW SETTINGS key to display the Review Settings Window. Touch the TEST PAGER key to display the Test Pager window. Figure 2-5: Bed Selection Window for Paging The bed name appears on the bottom of the bed key. When one or more pagers are assigned to a bed, the bed name text displays in white on a dark navy blue background. Otherwise, the bed name text displays in black on a gray background.

2-14

Alarms

Figure 2-6: Alarm Paging Setup Window The Alarm Paging Setup window (Figure 2-6: Alarm Paging Setup Window) provides a mechanism for the clinician to define paging criteria on a per-bed basis. This window contains: • • •

Parameter keys Pagers list Action keys (located at the bottom of the window)

Each parameter key cycles through the following four alarm paging states each time the key is touched: • • • •

High Priority - pages are generated only for high priority alarms Medium Priority- pages are generated for medium and high priority alarms Low Priority - pages are generated for low, medium, and high priority alarms Off - no pages are generated

When the number of alarm paging parameter settings (other than the OFF state) reaches the maximum number of parameters configured per bed (eight), you cannot change any parameters from the OFF state to any other state until one of those eight parameters is reset to the OFF state. If you attempt to select the ninth parameter, a warning message displays below the parameter keys, accompanied by an audible error tone. Use the Pagers list to assign pagers to specific beds. Each time a key is selected for an item in the pager assignment list, that item is selected or deselected on a toggle basis. A maximum of eight pagers can be assigned to a bed. Maximum system performance is achieved by minimizing the number of pagers assigned per bed. If you attempt to assign a ninth pager to a bed, a warning message displays below the parameter keys, accompanied by an audible error tone. The Alarm Paging Setup action keys function as follows: • • • • •

SET TO DEFAULTS — restores parameter settings to the default configuration. UNDO CHANGES — restores both parameter settings and pager selections to the configurations displayed before changes were made. CLEAR ALL — sets all parameter settings to OFF and clears all pager assignment selections. DONE — saves all changes and returns to the Paging Bed Selection window. CANCEL — ignores all changes and returns to the Paging Bed Selection window.

2-15

Ultraview Care Network

•

If using 90343 telemetry, ECG must be active in the alarm paging setup for NIBP and SpO2 alarms to be paged.

29 Oct 2001

Figure 2-7: Review Settings Window The Review Settings window (Figure 2-7: Review Settings Window) provides a summary of current pager assignments for all beds. If all pager assignments cannot be displayed in a single window, you can navigate through the windows using the NEXT PAGE and PREVIOUS PAGE keys. The Review Settings window keys function as follows: • • • •

NEXT PAGE — enables you to view the next page of settings (if the last page is displayed, this key is unavailable) PREVIOUS PAGE — enables you to view the previous page of settings (if the first page is displayed, this key is unavailable) PRINT — sends the current display to the designated printer using the BIOMED printer selection menus PAGING SETUP — closes this window and returns to the Paging Bed Selection window

The Pager Log window (refer to Figure 2-8: Pager Log Window) provides a summary of the last 36 pages sent from a station. Each entry lists the date and time the page was sent, the destination pager, the page status, the bed number, the priority level and, if available, the parameter. If all page entries cannot be displayed in a single window, you can navigate through the window using the NEXT PAGE and PREVIOUS PAGE keys.

2-16

Alarms

Figure 2-8: Pager Log Window The Pager Log window keys function as follows: • • • •

Figure 2-9: Pager Test Window

2-17

Ultraview Care Network

The Pager Test window (Figure 2-9: Pager Test Window) enables you to send a pre-defined message to selected pagers to verify proper operation of the paging system. The pager list shows a list of the pagers configured for the system. Each time the pager number for a particular pager in the list is selected, that pager is selected or deselected on a toggle basis. After the desired set of pagers is selected, you can send the test messages to the selected pagers by touching the SEND PAGE key. The Test Page window keys function as follows: • • • •

SEND PAGE — sends test messages with the text “Test Page” to the selected pagers. SELECT ALL PAGERS — selects all pagers as a destination for the test message. DESELECT ALL PAGERS — deselects all currently selected pagers. PAGING SETUP — closes this window and returns to the Paging Bed Selection window.

2-18

•

The Test Pager function can be used to verify that pages are being sent correctly. If pages are not being received at the page receiver, send a manual page using the paging transmitter to isolate the source of the problem.

Alarms Troubleshooting Guide Clinical Situation Duplicate alarm recordings print at the bedside and system printer

No alarm recordings are printed

Possible Cause ■

■

■ ■ ■ ■ ■ Alarms continue to violate after touching TONE RESET

No alarm notification occurs at a central monitor

■

■ ■

CANNOT INTERACT WITH ALARM WATCH parameter displayed

CANNOT deselect ALARM WATCH

■

Alarm recording directed to both bedside and network printers under the RECORDING DESTINATION key.

Parameters for alarm recordings are set to OFF.

Bedside printer is OFF. The alarms have not been directed to the bedside printer. ALARMS SUSPENDED for 3 minutes. System printer is not identified as one of two network printers. Printer is out of paper.

More than one alarm may be in violation.

The Alarm Watch function is not active. Parameters not displayed.

The monitor may not be configured to allow interaction with remote parameters.

The Ultraview Central Monitor is configured with Central Alarm Watch Manager to prevent deselection of automatically alarm watched beds.

Solution ■

■

■ ■ ■ ■ ■ ■

■ ■

Select THIS MONITOR or NETWORK for alarm recordings.

Select parameters for alarm recordings from the Alarm Parameters menu or Record Alarm Parameters (UCW and Ultraview 1700) window. Turn bedside printer ON. Ensure that THIS MONITOR or BOTH is selected. Ensure that alarms are not suspended. Have your system administrator verify configuration. Load paper into printer.

Touch TONE RESET/ALM SUSPEND again.

Activate Alarm Watch for the desired beds at the central. Display the desired parameters using SCREEN FORMAT under MONITOR SETUP.

■

Contact your system administrator.

■

Contact your system administrator.

Admit/Discharge

Directory of Keys - Ultraview Portable/1500/1600 Monitors To enter patient name, ID, or other data MONITOR SETUP MONITOR SETUP ADMIT/ DISCH.

TONES

MONITOR CONFIG.

RECORDER CONFIG.

For bedside monitors ADMIT/DISCHARGE - Select function CHANGE DATA

ADMIT

DISCHARGE

ADMIT- Purge existing data for this bed? YES

DATE OF BIRTH

NAME

HEIGHT in/cm

WEIGHT lb/kg

BSA m2

MALE FEMALE

ADULT NEONATE

ADMIT/DISCHARGE - Patient’s Date of Birth: DDMMM YYYY MONTH

DAY

YEAR

↑

↓

ENTER

Enter patient name/ID for bed xx

Keyboard Menu

To enter height, weight, BSA (and calculations with Clinical Calculations feature)

66.9

REMOVE KEYPAD

RESTORE

+/-

•

NOTE: HEIGHT pop-up keypad shown as an example

CLEAR

ENTER Pop-up Keypad

Based on features purchased, more or fewer keys may appear here than on your menu screens.

3-1

Admit/Discharge

Directory of Keys - UCW and Ultraview 1700 To enter patient name, ID, or other data:

MONITOR SETUP TONES

ADMIT/ DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS For central monitoring MONITOR SETUP-Admit/Discharge: Select Bed

For bedside monitoring

NICU

ICU

BED01 BED01

BED02

MICU

BED03

CCU

BED04

BED05

BED06

BED07

ADMIT/DISCHARGE - Select function ADMIT

CHANGE DATA

DISCHARGE

Admit - Purge existing data for this bed? YES

! 3-2

â&#x20AC;˘

Based on features purchased, more or fewer keys may appear here than on your menu screens.

Admit/Discharge

Overview This chapter describes how to enter new patient data, change data for an existing patient, and delete patient data from a Ultraview Care Network monitor.

Entering New Patient Information To enter new patient information (Ultraview Portable, 1500, and 1600): 1 Touch MONITOR SETUP. 2 Touch ADMIT/DISCH. 3a Select a subnet or a bed (central only). 3b If you select a subnet, then a bed. 4 Touch ADMIT. 5 Select YES to purge the existing data. 6 Select ID and/or NAME. 7 Enter information using the keyboard menu. 8 Touch ENTER. 9 Touch PREVIOUS MENU (if necessary). 10 Select DATE OF BIRTH and enter MONTH, DAY, and YEAR. 11 Touch ENTER. 12 Touch PREVIOUS MENU. 13 Select HEIGHT and/or WEIGHT and enter information using the pop-up keypad or menu. 14 Touch ENTER. 15 Touch MALE/FEMALE until the correct gender is highlighted. 16 Touch ADULT/NEONATE until the relevant selection is highlighted.

3-3

You may access the Admit/Discharge menu on either the central or bedside monitor. However, if you are accessing this menu at a central monitor, you must also select the patient’s bed (this is not necessary at a bedside monitor). The only information required when admitting a patient to the system is the patient’s name (up to 40 characters). Entering the patient’s ID number (up to 15 characters) is optional.

Ultraview Care Network

Using the Keyboard To enter new patient information (UCW and Ultraview 1700): 1 Touch MONITOR SETUP. 2 Touch ADMIT/DISCHARGE. 3a Select a subnet or a bed (central only). 3b If you select a subnet, then a bed. 4 Touch ADMIT. 5 Select YES to purge the existing data. 6 Select the desired field on the pop-up window. 7 Enter information using the keyboard or keyboard menu. 8 Touch ENTER. 9 Select ADULT or NEONATE. 10 Select patient gender (MALE or FEMALE). 11 Touch ACCEPT to store new patient data.

A keyboard is displayed on the monitor screen as you begin the process of admitting or changing data on a patient. The keyboard shown in Figure 3-1: OnScreen Keyboard appears on all monitors (except the UCW and Ultraview 1700) when you touch the NAME or ID key under the ADMIT or CHANGE DATA keys. Use the on-screen keyboard to enter or change the patient’s name or ID. The keyboard shown in Figure 3-2: UCW and Ultraview 1700 Pop-up Keyboard (Windows-Based) appears on the UCW and Ultraview 1700 monitor screen when you touch the ADMIT or CHANGE DATA keys. You may also use the external computer keyboard to enter patient data with the UCW and Ultraview 1700. RESTART

BACK SPACE

CLEAR

(

)

“

CAPS LOCK SHIFT

ENTER

Figure 3-1: On-Screen Keyboard

Figure 3-2: UCW and Ultraview 1700 Pop-up Keyboard (Windows-Based)

3-4

Admit/Discharge

Keyboard Characteristics Character Keys Each character key you select (A to Z, 0 to 9, dash, comma, period, and space) is displayed in the prompt line. Function Keys DEL deletes the character to the LEFT of the cursor. â&#x2020;? moves the cursor left one position. â&#x2020;&#x2019; moves the cursor right one position. RESTART redisplays the last name or value stored and deletes all earlier changes. CLEAR deletes the currently displayed name or value. ENTER stores the data which is displayed in the prompt line into system memory. TAB moves the cursor to the next field (UCW and Ultraview 1700 only). CAPS LOCK locks the keyboard in all caps mode. SHIFT toggles the shift mode on and off. INS inserts the selected data in the current space (UCW and Ultraview 1700 only). ACCEPT enters data into the system and completes the admit (UCW and Ultraview 1700 only).

3-5

Ultraview Care Network

Changing Patient Information To change patient information (Ultraview Portable, 1500, and 1600): 1 2 3 4 5

Touch MONITOR SETUP. Touch ADMIT/DISCH. Touch CHANGE DATA. Select ID or NAME. Enter information using the keyboard menu. 6 Touch ENTER. 7 Select HEIGHT, WEIGHT, or BSA and enter new information using the pop-up keypad. 8 Touch ENTER. 9 Select DATE OF BIRTH and enter MONTH, DAY, and YEAR. 10 Touch ENTER. 11 Touch MALE/FEMALE until the correct gender is highlighted. 12 Touch ADULT/NEONATE until the relevant selection is highlighted. To change patient information (UCW and Ultraview 1700): 1 Touch MONITOR SETUP. 2 Touch ADMIT/DISCHARGE. 3a Select a subnet or a bed (central only). 3b If you select a subnet, or a bed. 4 Touch CHANGE DATA. 5 Select the desired field on the pop-up window. 6 Enter information using the keyboard or keyboard menu. 7 Touch ENTER. 8 Touch ACCEPT to store changed patient data.

3-6

To alter any existing patient information, use the CHANGE DATA key. This key does not function when there is no patient name or ID number stored in the system.

Changing Height, Weight, and BSA The default values for height, weight, and Body Surface Area (BSA) are displayed if other values are not available (except in UCW and Ultraview 1700, v. 1.05.56). The system automatically computes BSA from the values entered for height and weight and uses this BSA value to obtain indexed values for physiologic calculations such as Cardiac Output. Toggle the ADULT/NEONATE key to display the respective adult and neonatal default values for height, weight, and BSA.

â&#x20AC;˘

On central monitors, the ADULT/NEONATE key appears dotted if the remote monitor where the admit/discharge occurs does not support the patient type selection.

Admit/Discharge

Table 1: Height, Weight, BSA Default Value lists the default values and valid ranges for height, weight, and BSA. You can adjust the values up or down within the valid range. The values last set for height, weight, and BSA remain until manually changed. Use the pop-up keypad or the keyboard to change the values. Table 1: Height, Weight, BSA Default Value

Label

Name

Default Value Adult Neonatal

Units

Valid Range

BSA

Body Surface Area

1.81

0.11

0.03 - 3.69

Height

cm in

170 66.9

35 13.8

20 - 215 7.9 - 84.6

Weight

kg lb

70.000 154.324

1.500 3.307

0.2 - 250.0 0.441- 551.1

Using the Pop-up Keypad on Ultraview Portable, 1500, and 1600 Monitors When you select either the HEIGHT, WEIGHT, or BSA parameter key on the monitor, a popup keypad will appear with the selected parameter in the upper left corner. The current parameter value is displayed in the upper right corner, as shown in Figure 3-3: Monitor Pop-Up Keypad. This value can be displayed in either U.S or metric units (see your system administrator for details). You can change this parameter value using the arrow keys, or you can use the keypad numbers to enter up to seven digits, including a decimal point. The system recognizes any value within the range that displays immediately below the keypad.

66.9

HT 7

REMOVE KEYPAD

RESTORE

+/-

CLEAR

ENTER

Figure 3-3: Monitor Pop-Up Keypad Numeric Keys The 0 - 9 and decimal point keys allow you to enter numeric data. Function Keys â&#x2020;&#x2018; â&#x2020;&#x201C; increases or decreases the displayed value by 1.0, 0.1, 0.01, or 0.001 depending on the resolution of the input value.

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Ultraview Care Network

ENTER stores the value displayed in the top right corner of the keypad in system memory. The ENTER key must be touched to store the value. CLEAR sets the value in the top right corner of the keypad to 0. RESTORE returns the previous value or displays the stored value. REMOVE KEYPAD clears the keypad from the screen and restores the previously displayed value. +/- This key is disabled. Using the UCW and Ultraview 1700 Keyboard On the UCW and Ultraview 1700, use the TAB key to move to the field, then enter the desired height, weight, and BSA changes in the fields that appear in the upper right portion of the on-screen keyboard. The changed values are not stored into memory until the ENTER and the ACCEPT keys are touched.

Changing Patient Date of Birth The Admit window contains fields for changing the patient’s date of birth. Numeric values are entered in each field through the external or onscreen keyboards (UCW and Ultraview 1700 only).

Selecting Patient Type and Gender To select the patient type, touch the ADULT/NEONATE key. Once the selection has been made, it is stored in the monitor’s memory and either ADULT or NEONATE is highlighted. If you use one patient type exclusively, your system administrator may set the selection to that specific type. To select the patient gender, touch the MALE/FEMALE key. Once the selection has been made, it is stored in the monitor’s memory and either MALE or FEMALE is highlighted.

Discharging a Patient To discharge a patient: 1 Touch MONITOR SETUP. 2 Touch ADMIT/DISCH. 3a Select a subnet or a bed (central only). 3b If you select a subnet, or a bed. 4 Touch DISCHARGE. 5 Select YES to purge the existing data.

3-8

To clear the bedside monitor of existing patient information, touch the DISCHARGE key. You can now purge the existing patient data.

Admit/Discharge Troubleshooting Guide Clinical Situation Patient name incorrect as entered on keyboard menu

Possible Cause

Solution

■ Name exceeds 40 character maxi-

■ Re-enter name using 40 characters

mum and system has written over some characters.

■ No patient name or ID number stored in system.

or less.

■ Enter name or ID number.

Printing

Directory of Keys - Ultraview Portable/1500/1600 Monitors To set up the printer on a bedside: MONITOR SETUP

ADMIT/ DISCH.

TONES

MONITOR CONFIG.

RECORDER CONFIG.

Number of Recorder Channels RECORDING DURATION

ALARM PARAMS

RECORDING DESTINATION

VITALS SETUP

These keys appear only when a printer module is inserted in the monitor

ALARM RECORDINGS TO THIS MONITOR NETWORK

BOTH

OTHER RECORDINGS TO THIS MONITOR NETWORK

To obtain recordings from the monitor: RECORD

Touch RECORD once

Touch RECORD twice

RECORDING MENU CONTINUOUS RECORD

RECORD ALL

RECORD PRESELECTED A

RECORD PRESELECTED B

PRINT VITAL SIGNS

Touch this key, then touch the desired parameter key (up to four), for each parameter to be continuously recorded

To control recordings from the monitor using the system printer module: SYSTEM PRINTER MODULE

PRINTER (1 - 8)

PRINTER CONTROL MENU STOP RECORDING

CONVERT TO CONTINUOUS

•

SLOW OFF

PRINTER ON OFF

Based on features purchased, more or fewer keys may appear here than on your menu screens.

4-1

Printing

Directory of Keys - UCW and Ultraview 1700 To set up the printer on a bedside MONITOR SETUP

ADMIT/ DISCHARGE

TONES

MONITOR CONFIGURATION

PRIVILEGED ACCESS

CLINICAL ACCESS (user name is CLINICAL)

CLINICAL LEVEL: Select Parameter SCALED DISPLAY

TIME/ DATE

RECORDER CONFIGURATION

PRESELECTED RECORDINGS

UNITS OF MEASURE

USER ACCESS ENABLE

ALARM SETUP

PRESELECTED RECORDINGS - Select configuration to change PRESELECTED B

PRESELECTED A

Select option to change - A: ALL BEDSIDE PARAM(S), THIS SUBNET SELECT TYPE

SELECT BED

Select beds/subnets - A: TYPE = ALL BEDSIDE PARAM(S) ALL SUBNETS

THIS SUBNET

THIS MONITOR

ALL BEDS ON THIS MONITOR

Select recording type - A: Beds = THIS SUBNET CONFIGURED PARAMETERS

FIRST 2 BEDSIDEPARAM(S) CLINICAL LEVEL: Recorder Configuration: REC DURATION 12 sec 20 sec

RECORD ALARM PARAMETERS

Number of Recorder Channels RECORDING DESTINATION

These keys appear only when a printer module is attached to the UCW

Refer to “To obtain recordings from the monitor” and “To control recordings from the monitor using the system printer module” on the previous page for more UCW and Ultraview 1700 keys.

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Printing

Contents Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . .1 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Bedside Printer Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 System Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Printer Module in the Ultraview Portable Monitors . . . . . . . . . . . . . . . . . . . . . . .5 PrintMaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Printing Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Selecting Print Duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Printer Key Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Recording Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Printing via Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Defining Preselected Recording Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Loading Paper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Paper Out Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Record Vitals Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Printing Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Overview This chapter documents the printing functions of the following printing components: • • • • •

90449 bedside printer module 90469 (2- and 4-channel) system printer module Record Vitals Report Ultraview Portables 90838 PrintMaster laser printer

The chapter reviews each printer and includes information and instructions about its features. Printers can provide strip chart recordings of the following: •

•

Automatic recordings of any parameter in an alarm condition (if configured in the MCM and if the Record Alarms Parameters function is enabled for that parameter) Parameter data such as: - Patient name, bed name, and time and date of recording - Vital signs, edgeprint annotation, and scaling information - Waveform data (including timing tick marks and a grid) - Arrhythmia/ST segments

•

4-3

Non-waveform data displayed on the screen such as graphic trends, data tables, hemodynamic calculations, and cardiac output

Ultraview Care Network

Bedside Printer Module The 90449 bedside printer module is a 2-channel printer that provides automatic and manual recordings of parameter data on 50mm fanfold paper.

Figure 4-1: 90449 Bedside Printer Module The bedside printer module prints recordings of parameters in alarm conditions, requested waveforms, and non-waveform data.

4-4

â&#x20AC;˘

The bedside printer is not designed for use as a system printer and will not function correctly if used in this manner.

Printing

System Printer Module The 90469 system printer module is a 2- or 4-channel printer that provides automatic and manual recordings of parameter data on 50mm or 120mm fanfold paper.

Figure 4-2: 90469 System Printer Module The Ultraview Care Network system printer module prints recordings of parameters in alarm conditions, requested waveforms, and non-waveform data such as: • • • •

tabular trends hemodynamic calculations drug dose calculations graphic trends waveform data

Printer Module in the Ultraview Portable Monitors The printers in the Ultraview Portable Monitors are two-channel printers that provide automatic and manual recordings of parameter data on 50mm roll paper. The printers print recordings of parameters in alarm conditions, requested waveforms, and non-waveform data.

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Ultraview Care Network

PrintMaster The 90838 PrintMaster is a four-channel printer that provides automatic and manual recordings of parameter data on 8 1/2 x 11 or A4 paper.

í˘´

í˘ł

í˘˛ í˘ą

í˘ˇ

í˘ś

í˘ľ Figure 4-3: PrintMaster

í˘ą display panel í˘˛ top cover release í˘ł top printout tray í˘´ rear cover release í˘ľ central processing unit í˘ś paper drawer í˘ˇ front cover release The PrintMaster printer functions the same as the bedside and system printer modules in that it prints recordings of parameters in alarm conditions, requested waveforms, and non-waveform data.

4-6

Printing

Clearing Paper Jams If a paper jam occurs, a message will indicate the location of the jam. Once the jam is cleared, the cover closed, and the printer warmed up, the printer will print all the pages affected by the jam. One of three paper jam messages may appear on the printer display: PAPER INPUT JAM

PAPER FEED JAM

PAPER EXIT JAM

Pull out the paper drawer.

Remove the sheet that did not feed.

Inspect remaining sheets to see they are not wrinkled or stuck together.

Close the paper drawer.

Open and close the top cover to clear the paper jam message.

Open the top cover.

CAUTION! THE FUSING UNIT IS HOT.

Lift out the image drum cartridge.

Carefully remove the jammed paper.

Replace the image drum cartridge.

Close the top cover.

Open the top cover and the rear cover to release the roller pressure.

CAUTION! THE FUSING UNIT IS HOT.

Pull the paper out from the rear or inside of the printer.

Close the top and rear covers.

Terminating a Print Job To terminate an undesired multi-page print job that is currently printing, power the printer OFF (until the front panel lights go out) then turn it back ON. This cancels any print job in process.

Replacing the Toner Cartridge When the TONER LOW message appears on the printer display: 1.

Open the top cover.

Lift and pull the toner cartridge out at an angle.

Insert the new cartridge.

Close the top cover.

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Ultraview Care Network

Printer Display Messages Message Text

4-8

Reason

ON-LINE

Ready to receive data

OFF-LINE

Not ready to receive data

DATA PRESENT

Print data is in buffer

PRINTING

Data is being received and printed

POWER SAVING

Power saving mode is active

LOW TONER

Toner is running out: 100 more pages can be printed when this message is first displayed

TONER EMPTY REPLACE TNR CART

Toner cartridge is empty; printer will stop receiving printing until toner cartridge is replaced

TONER SENSOR

Malfunction of toner sensor is detected

RESET

Manual reset was initiated; all temporary fonts and macros are deleted

PRINT FONTS

Font page is printing

DRUM CLEANING

Drum cleaning page is printing

PRINT DEMO PAGE

Demo page is printing

PRINT MENU

Menu page is printing

CHANGE DRUM

Drum near 90% of life; change drum and reset drum counter

FUSER LIFE

Fuser near end of life; contact service

COPY nnn/mmm

Indicates number of copies printed; nnn = page being printed; mmm = total copies requested

STACKER FULL REMOVE THE PAPER

Paper exit bin is full; printing is stopped until paper is removed

mmmmm MANUAL PAPER REQUEST

Insert requested paper; printing is stopped until paper is provided or RECOVER is pressed; mmmmm = requested size

mmmmm ttttttt PAPER REQUEST

Paper size mmmmm requested at tray ttttttt; printing is stopped until paper is provided or RECOVER is pressed

PAPER OUT ttttttt

Paper is out at tray ttttttt; printing is stopped until paper is provided

ERROR MEMORY OVERFLOW

Page data exceeds available memory; press RECOVER to continue; adjust RASTER BUFFER, RECEIVE BUFFER, and/or FONT PROTECT in Menu and resend job

ERROR RECEIVE BUFFER OVERFLOW

Receive buffer overflow; data was lost; press RECOVER to continue; resend job

Printing

Message Text

Reason

ERROR PRINT OVERRUN

Data too complex for current RASTER BUFFER setting; increase RASTER BUFFER value and resend job or add memory; press RECOVER to continue

ERROR HOST I/F

Host interface error; data was lost; press RECOVER to continue; resend job

CARD NOT FOUND PLEASE REINSERT

Font card removed; reinstall card; press RECOVER to continue; resend job

ERROR PAPER SIZE CHECK ttttttt

Incorrect paper size detected for tray ttttttt; provide correct paper size; press RECOVER to continue

PAPER INPUT JAM CHECK ttttttt

Paper jammed while being supplied from tray ttttttt; clear jam and open/close top cover

PAPER FEED JAM CHECK tttttttt

Paper jammed during feeding from tray tttttttt; clear jam and open/close top cover

PAPER EXIT JAM REMOVE THE PAPER

Paper jammed during exit; clear jam and open/close top cover

COVER OPEN

Close cover

EEPROM RESETTING

EEPROM resetting to factory defaults; returns to ON-LINE

ERROR CARD FORMAT CHECK

Font card installed has invalid data; turn off printer to clear error

ERROR CARD REMOVED ON-LINE

Font card removed while ON-LINE; turn off printer to clear error

ERROR CONTROLLER nn On -aaaaaaaa

Controller error, nn = error type Power off printer to clear error; if error continues contact your Spacelabs Medical Customer Service Representative

88888888 88888888

Displayed when power is turned on; this is done to test all LEDs and LCD segments

INITIALIZING

Controller is being initialized at power ON

RESET TO SAVE

Press RESET to save menu changes; menu changes cannot be reset automatically because data is present in buffer

The PrintMaster will beep every 15 seconds under the following conditions: •

paper jam

•

missing toner cartridge

•

top cover or back door open

•

power to printer is OFF

•

power cord is disconnected

•

printer cable is disconnected

•

printer in Not Ready mode

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Ultraview Care Network

Printing Priorities Each Spacelabs Medical network-connected patient monitor is capable of sending recordings to two network printers. With two printers available to monitors on the network, printer selection rules are used to strike the best possible balance to: • • •

generate the most timely output of high priority recordings; ensure that subsequent recordings from one patient over a short time span are processed by one printer; and use paper as efficiently as possible.

When the printing load is heavy these objectives may conflict. The factors that are taken into consideration when a print request occurs include: • • • • • •

Are either of the two printers outputting, holding in memory queue, or loading in queue a print job from this monitor? Are either of the printers idle? Is the record request a high priority request (alarm vs. manual)? Are either of the printers currently printing a continuous recording? Are either of the printers’ queues full? Which of the printers is the preferred size for this request (1, 2, or 4 channels)?

At the time of a printing request, the monitor from which the request is coming evaluates both of the available printers one at a time, leading to a score for each of the two printers. Each printer’s evaluation passes all the way through the priority tree from the top score to the score at the bottom of the tree. The printer generating the highest score gets the job. If the evaluation produces the same score for each printer, the print job is sent to the printer designated as the primary printer for that monitor. The printing rules mentioned work best when the two printers are sharing the printing load. The monitor automatically determines which printer is best for each type of recording. Another configuration designates one printer as the primary printer and the other as the backup printer. All recordings are sent to the primary printer, unless it is unable to print, for the following reasons: • • • • • •

off-line out of paper disconnected from network powered OFF all print queues full printer unable to accept recording type

If the primary printer is unable to print, the recordings are then sent to the backup printer, unless it is also unable to print for the reasons listed above. Some networks are configured so that recordings from a given monitor go to only one of the printers on the network. In this case only one printer would be available instead of two during possible times of simultaneous multiple bed alarms. The selection rules would not be applicable, and print performance would be affected.

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Printing

The following list defines recording priorities in descending order: Highest •

alarm recording or a manual recording request via a monitor

•

RECORD ALL request via a bedside monitor

•

RECORD ALL request via a central monitor

•

non-waveform recordings

Lowest •

all Arrhythmia/ST classes

In all network printing cases: • • •

High priority print jobs bump lower priority jobs. For instance, an alarm recording will bump graphic trends to a lower position in the print queue. A fully loaded printer will bump graphic trends out of the queue. A high priority request erases as many lower priority requests as needed to make room for the data it contains.

•

A status message is not displayed when a print request replacement occurs.

Selecting Print Duration Waveform Data To select print duration from the monitor: 1 2 3

Touch MONITOR SETUP. Touch RECORDER CONFIG. Touch RECORDING DURATION to change length of time for printing.

To select print duration from the monitor (UCW and Ultraview 1700 only): 1 2 3 4 5

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch RECORDER CONFIGURATION. Touch REC DURATION to change length of time for printing.

In the absence of an alarm condition, the print request origin determines the length of time that waveform data (ECG, ART, RESP, etc.) is recorded. Recordings requested via the monitor are either 12 or 20 seconds in duration. This is selectable via the RECORDING DURATION key. Recordings start with a few seconds of data received just prior to the print request followed by real time data.

•

If the recording duration has been preset by your system administrator the RECORDING DURATION key will not display.

Non-Waveform Data The length of time the printer requires to record non-waveform data, such as graphs and data tables, depends on the complexity of the data and cannot be pre-determined.

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Ultraview Care Network

Printer Key Functions To access printer control keys from the monitor: 1 2 3

Touch NORMAL SCREEN. Touch PRINTER CONTROLS. Select the desired printer module key.

Ultraview Portable Monitors; Bedside and System Printer Modules Printer control keys for the bedside printer module are on the module front. The Ultraview Portable printer is also controlled by keys on the monitor itself. The system printer module has printer control keys both on the module front and on the monitor screen. Table 1: Key Descriptions Key

Function

SLOW ON/OFF

Changes the print speed of waveform recordings to 6.25mm/second. Pressing SLOW a second time returns the printer to the current system sweep speed. SLOW has no effect on the print speed of non-waveform recordings (data tables, graphics, etc.).

CONTINUE

•

STOP RECORDING

• •

PRINTER ON/OFF

4-12

When the printer is off-line, press this key to feed roll paper at 25mm/second, or to feed one sheet of perforated paper through printer module. When the printer is on-line and currently printing a 12- or 20-second waveform recording, press CONTINUE to convert to a continuous recording. If you press CONTINUE the 12- or 20-second recording completes, followed by a horizontal line, then the current data. The horizontal line appears even on recordings which are not in a queue, but are the only request. Stops any printing currently in progress and moves to the next print request in the queue. Stops any roll paper advance currently in progress.

Takes the printer off-line without turning the power OFF. Alarms and print requests are now ignored. An LED (located either in the key or on the front panel of system printer) illuminates when this function is selected.

Printing

Recording Alarms An alarm recording may be triggered whenever a parameter enters an alarm condition. Recordings in the process of printing cannot be interrupted or delayed by a new alarm condition.

â&#x20AC;˘

Parameter alarm recordings can be set to OFF so that a printer will not respond to an alarm condition (the alarm tone and accompanying alarm message are unaffected). Refer to Controlling Alarms via the TONE RESET/ALM SUSPEND Key on page 2-7 for more details.

The RECORDING DESTINATION menu contains keys that direct alarm recordings to a bedside recorder, a network printer, or both. All other recordings may be directed only to a bedside printer or a network printer, but not both. Alarm recordings begin with several seconds of pre-alarm waveform data and continue for as long as the alarm condition exists (a minimum of 12 seconds).

â&#x20AC;˘

12-lead ECG reports will always print to the 90838 printer, if available, regardless of the destination settings for the recording.

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Ultraview Care Network

Printing via Monitors Non-Waveform Data To start a manual recording via the monitor: 1 2

Touch RECORD. Touch up to four flashing parameter keys. 3a Touch CANCEL RECORD SELECTION(S) to terminate. or 3b Touch STOP RECORDING in PRINTER CONTROLS menu to terminate. To print group recordings via the monitor: 1 Touch RECORD twice. 2a Touch RECORD ALL. or 2b Touch RECORD PRESELECTED A or B.

Whenever you display non-waveform data on either the central or bedside monitors, a PRINT key displays. The RECORD key is not functional for printing non-waveform data. As a result, non-waveform data must be displayed before it can be recorded. Non-waveform data usually occupies a minimum of two slots in the printer’s queue due to the volume of information being sent. This means that a single nonwaveform recording may take up as much room on the strip chart as two simultaneous waveform recordings. If the data cannot fit on the strip at one time, it is separated horizontally, printing first the top half and then the bottom half of the data.

Waveform Data Waveform data is recorded using the RECORD key on the monitor.

To start a continuous recording via the monitor: 1 2

Touch RECORD. Touch CONTINUOUS RECORD, then touch the desired parameter key (up to four, for each parameter to be continuously recorded. Touch CANCEL RECORD SELECTION to restart the selection process.

1 Touch RECORD. 2a Touch STOP CONT. RECORD. or 2b Touch STOP RECORDING in PRINTER CONTROLS.

Requests for recording waveform data are limited to only those waveform parameters that are currently displayed on the screen (except ECG where all leads print).

•

If a parameter menu is left on the screen, the CONTINUOUS RECORD key is not displayed.

Each time you touch RECORD on the monitor, the CONTINUOUS RECORD key displays and waveform parameter keys flash for up to four seconds. You must make your key selection within this four-second window. This window stays open for an additional two to four seconds each time a key is selected. Once the parameter keys stop flashing, any waveforms that have been selected are automatically sent to the printer for recording. Touch the RECORD key twice to display the Recording menu. From the Recording menu you can: • •

To stop a continuous recording via the monitor:

•

record all parameters currently on this screen by touching RECORD ALL; initiate a preselected group of recordings by touching PRESELECTED A or PRESELECTED B; or select PRINT VITAL SIGNS to manually print the vital signs you have selected (refer to Record Vitals Report on page 4-18 for more information).

RECORD ALL and PRESELECTED A OR B recordings are eight seconds in duration.

Group Recordings The printers record all the requested parameters on one patient before beginning on the parameters of the next patient. Under no circumstances will the printer combine the parameters of different patients onto the same strip chart. Recordings in the process of being printed cannot be interrupted or delayed by additional print requests.

4-14

Printing

Defining Preselected Recording Keys To define the PRESELECTED A and B parameters (UCW and Ultraview 1700): 1 2 3

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter Clinical user name and password. 4 Touch PRESELECTED RECORDINGS. 5 Touch key to be defined (A or B). 6 Touch SELECT TYPE. 7a Touch FIRST 2 BEDSIDE PARAM(S) and use arrow keys to cycle through parameter selections: ALL BEDSIDE PARAM(S) or FIRST n BEDSIDE PARAM(S) (where n is 1, 2, 4 or 8).

The Preselected Recordings function enables you to define which beds and parameters will be automatically recorded. The preselected group is established the system administrator. For UCW and Ultraview 1700s, it is set up through the Clinical Privileged Access menu.

or 7b Touch CONFIGURED PARAMETERS and toggle desired parameters ON or OFF. 8 Touch PREVIOUS menu twice to define the remaining PRESELECTED key. To define the PRESELECTED A and B beds (UCW and Ultraview 1700): 1 2 3

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter Clinical user name and password. 4 Touch PRESELECTED RECORDINGS. 5 Touch key to be defined (A or B). 6 Touch SELECT BEDS. 7 Select ALL SUBNETS. or 8a Select THIS SUBNET. or 8b Select THIS MONITOR. 9 Touch PREVIOUS menu twice to define the remaining PRESELECTED key.

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Ultraview Care Network

Loading Paper To load paper in a bedside printer module (2-channel only): 1

Press eject button next to PAPER OUT light. 2 Withdraw plastic paper tray. 3 Discard old cardboard retainer inside tray. 4 Remove label from new paper but keep cardboard retainer in place around one end. 5 Start inserting paper into tray, beginning with cardboard retainer end. 6 With paper halfway into tray, lift up spring-loaded roller. 7 Bring out top fold of paper from under top end of cardboard retainer. 8 Bring top fold over top of springloaded roller. 9 Release spring-loaded roller onto remainder of paper. 10 Insert stack fully. 11 Unfold paper and position over top of black roller at end of tray. 12 Slide tray completely back into printer module.

Bedside Printer Module The small black rectangular cue mark on the bedside printer paper must face out and be at the bottom of the tray when loading paper into the tray.

Note orientation of small cue mark Figure 4-4: Bedside Printer Module Paper Tray Each recording starts at the Z-fold perforation and blank sheets are not placed between successive print requests.

System Printer Module To load paper in a system printer module (2- or 4-channel): 1

Press eject button next to PAPER OUT light. 2 Withdraw plastic paper tray. 3 Discard old cardboard retainer inside tray (2-channel only). 4 Remove label from new paper but keep cardboard retainer in place around one end (2-channel only). 5 Discard 4-channel container. 6 Start inserting paper into tray, beginning with cardboard retainer end (2-channel only). 7 Make sure black squares are in the top left corner of the pages (4-channel). 8 Insert stack fully. 9 Unfold paper and position over top of black roller at end of tray. 10 Slide tray completely back into printer module.

4-16

The system printer module has a slide-out plastic tray that accepts packets of Z-fold paper. The 2-channel printer uses 50mm wide and 27m long paper. The 4-channel printer uses 120mm wide and 45.7m long paper. Each sheet has a small black rectangular cue mark located along the edge used to load the paper into the tray.

cue mark

paper roller

4-channel

cue mark

paper roller

2-channel

Figure 4-5: System Printer Module Paper Trays (top view)

Printing

Ultraview Portable Printers To load paper in the Ultraview Portable Printer: 1 2 3 4 5

Press release button on door. Open paper tray door all the way. Snap new roll into place. Pull out 6 to 12 inches of paper. Close door.

The Ultraview Portable monitor’s printer uses 50mm wide by 30m long rolls of thermal paper. The printer has an automatic self-feed mechanism for threading the paper through the rollers.

Figure 4-6: Loading Printer Paper

PrintMaster The PrintMaster printer has a slide-out paper drawer that accepts up to 500 pages of letter or A4-sized copy paper. Slide the drawer out of the printer, place the paper (according to orientation) into the cassette, and place the cassette back into the printer.

Paper Out Conditions WARNING: • While printers are off-line, or out of paper, they will ignore any new alarm that would normally start a recording, and no alarm or requested recordings will go into a queue. All printers signal a paper out condition by periodically sounding a tone. The PrintMaster will beep every 15 seconds when there is no paper in the cassette, or the cassette is not loaded. In addition, the PrintMaster and the bedside printer module flash the PAPER OUT light, while the 2-channel and 4-channel system printer modules display a LOCAL PRINTER PAPER OUT message. On the Ultraview Portable monitor’s printer, the PAPER OUT tone does not sound if the local alarm tone key is set to OFF. After reloading paper in the system printer module, the paper-feed mechanism ejects a sheet to verify proper paper feeding. For the paper-feed mechanism to work, you must leave the printer power ON while you are loading paper. CAUTION: • Removing a bedside or system printer module from the monitor to load paper causes an immediate loss of pending print requests.

4-17

Ultraview Care Network

Record Vitals Report To define the details of a report: 1 2 3 4

5 6 7 8

Touch MONITOR SETUP. Touch RECORDER CONFIG. Touch VITALS SETUP. Touch DATA INTERVAL and select an interval for report history. Touch PREVIOUS MENU. Touch START TIME and select a time period for report history. Touch PREVIOUS MENU. Touch SELECT PARAMETERS and select the parameters you wish to include in the report. Touch PREVIOUS MENU.

The Record Vitals Report: • • •

provides manual recordings of parameter data on 50mm roll paper can only be printed to the monitor’s internal recorder prints recordings of parameters, waveform, and non-waveform data VITALS SETUP Configure parameters or start vitals recording DATA INTERVAL

SELECT PARAMETERS

START TIME

PRINT VITAL SIGNS

Figure 4-7: Vitals Setup Menu Keys

Data Interval You may choose a time interval ranging from 1-minute to 60-minutes, specifically, 1-, 2-, 3-, 5-, 10-, 15-, 30-, and 60-minute intervals. You can also select NIBP ON/OFF and other parameter data from that reading time. If you select NIBP ON, you are not required to select an interval. NIBP readings appear in the report based on the time that you take the readings. If you do not choose an interval or NIBP ON before printing, the message VITALS REPORT ERROR prints.

Start Time You may print vital sign measurements ranging from those taken in the past hour to those taken in the last 24-hours, specifically, 1-, 2-, 4-, 8-, 12-, and 24-hours.

Select Parameters You may choose the parameters you wish to have included in the report. If you choose a vital sign for which no data is available, ??? appears on the report. The following is an example of a vitals report. A blank space to enter notes is standard in every report.

Time

HR BPM

Resp RPM

Temp 1C

07:50

37.8

07:52

37.8

07:54

37.8

07:56

37.8

Figure 4-8: Vitals Report

4-18

Notes

Printing

Print Vitals To print a manual report with the Record Vitals Report option: 1

Touch VITALS SETUP, PRINT VITAL SIGNS. or Touch RECORD twice and touch PRINT VITAL SIGNS.

To print the report, touch PRINT VITALS or touch RECORD twice and then touch PRINT VITAL SIGNS.

â&#x20AC;˘

Be sure to choose the data interval, the start time, and the parameters you wish to include on the report before printing.

4-19

Printing Troubleshooting Guide Clinical Situation Printer displays PAPER OUT message

Possible Cause ■ Printer is out of paper.

Solution ■ Load paper (refer to Loading Paper on page 4-16).

■ Printer door is open. ■ Paper was loaded improperly. Printer fails to print selftest strip

Message UNABLE TO RECORD THE REQUESTED CHANNEL is displayed

CONTINUOUS RECORD key not displayed

■ Failed internal diagnostics.

■ Notify qualified service person.

■ Printer not active. ■ Printer not selected by a system

■ Toggle PRINTER ON/OFF key. ■ Check with your hospital biomed or

administrator.

system administrator.

■ Printer is out of paper.

■ Load paper.

■ Menu is at the bottom of the screen.

■ Touch NORMAL SCREEN, then RECORD.

Bedside Transport/Monitors

Directory of Keys - Ultraview Portable/1500/1600 Monitors Refer to System Introduction chapter

HELP

MONITOR SETUP ADMIT/ DISCH.

TONES

MONITOR CONFIG.

RECORDER CONFIG.

PRIVILEGED ACCESS

refer to Printing ADMIT/DISCHARGE MENU - Select function CHANGE DATA

ADMIT

DISCHARGE

MONITOR SETUP - Select type of tone to change LOCAL ALARMS

REMOTE ALARMS

ALARM WATCH

KEY TONE

MONITOR CONFIGURATION

DC Power

AC Power

ENERGY SAVING MODE ON OFF

SCREEN BRIGHTNESS NORMAL DIM

Ultraview portable only

BRIGHTNESS CONTRAST

Ultraview 1500 only

PARAMETER CONFIG Refer to Setting up Priorities and Colors in this chapter

SPECIAL APPLICATIONS

SPECIAL FUNCTIONS REMOTE VIEW

ALARM WATCH

RV/AW OFF

LOCAL TRENDS/CALCS

REMOTE TRENDS/CALCS

Refer to Alarms chapter TONE RESET ALM SUSPEND

Refer to Printing chapter RECORD

Refer to System Introduction chapter

5-1

Bedside Transport/Monitors

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP TONES

ADMIT/ DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS

Refer to Privileged Access Directory on next page

MONITOR CONFIGURATION - Primary Monitor PARAMETER CONTRAST BRIGHTNESS CONFIGURATION

ADMIT/DISCHARGE - Select function CHANGE DISCHARGE ADMIT DATA

CLOCK ON OFF

ACTIVATE SCREEN SAVER

Refer to Setting Up Priorities and Colors in this chapter

MONITOR SETUP - Select types of tone to change LOCAL ALARMS

REMOTE ALARMS

Refer to Refer to System Alarms Introduction chapter chapter

ALARM WATCH

KEY TONE

LOCAL BED

REMOTE BED

Refer to Alarms chapter TONE RESET ALM SUSPEND

Select bed Refer to Printing chapter RECORD

Refer to System Introduction chapter

! 5-2

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

Privileged Access

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP TONES

ADMIT/ DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS

CLINICAL ACCESS (user name is CLINICAL)

CLINICAL LEVEL: Select Parameter SCALED DISPLAY

TIME/ DATE

RECORDER CONFIGURATION

PRESELECTED RECORDINGS

USER ACCESS ENABLE

UNITS OF MEASURE

inches cm

mmHg kPa

ALARM SETUP

lb kg

CLINICAL Level: Select Parameter MOUSE CONTROL

CHANGE CLINICAL PASSWORD

REMOTE KEYPAD STATION ADDRESS

RESET MONITOR

Alarm Setup: Select parameter to change REMOTE ALARM ACCESS ON

OFF

TREND SUSPEND ON

OFF

ALARM RELAY

QRS/SPO2 TONE ENABLE ALWAYS

DURING ALARM

CLINICAL Level - USER ACCESS - Enable user access to functions PATIENT TYPE ON

ZONE COLORING

OFF

AW COLORING ON

OFF

PARAMETER CONFIG ON

OFF

PRESELECTED RECORDINGS: Select configuration to change PRESELECTED A

MONITOR SETUP - Time/Date 10:06 TIME 24 HOUR HOURS DATE AM/PM

RECORD ALARM PARAMETERS

MINUTES

↑

↓

OFF

SUBNET ACCESS

PRESELECTED B

Recorder Configuration: REC DURATION 12 sec. 20 sec

ALARM SUSP BUTTON

OFF

These keys appear only when a printer module is attached to the UCW

ENTER

MINOR GRATICULE: 2 divisions MINOR GRATICULES ON OFF

↑

↓

FULL SCALE SIZE 4 Zones 6 Zones

5-3

Bedside Transport/Monitors Contents Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . .1 Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 6-Trace Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Identifying Special Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Bedside and Transport Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 UCW and Ultraview 1700 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Setting Up Priorities and Colors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Data Shuttle Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Ultraview Portable Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Wireless Network Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Outbound Parameters Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Ultraview Portable Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Ultraview Portable with Capnography (Option G or H) . . . . . . . . . . . . . . . . . . .24 Maternal Obstetrical Monitor - 94000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Bedside/Transport Monitor Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . .30

Overview This chapter describes the functions and features of bedside and transport monitors. Refer to the Directory of Keys on the previous pages for help in locating functions not described in this chapter. The Ultraview Care Network family of monitors and modules have built-in error detection and recovery circuitry. This circuitry, together with special software, enables the monitor to re-initialize and continue to function if an error occurs. When the system detects an error that cannot be corrected through other means, the bedside monitor re-initializes or resets (blanks). Normally, a reset involves very little loss of patient monitoring time (approximately five seconds) and, with few exceptions, all operator set inputs (alarm limits, pressure labels, transducer offsets, etc.) are retained. The entire process of restoring the bedside monitor following a reset, takes approximately 20 seconds, depending upon the number of parameters being monitored. In some cases, stored trend data will be lost when the monitor resets. If this occurs, the lost data may indicate a hardware condition that requires corrective action. The system will then initiate the start-up diagnostics to check the monitorâ&#x20AC;&#x2122;s operation and fully recover the data. This process takes approximately ten seconds longer. If a bedside monitor resets, the bedside monitor displays CHECK SETUP in the ECG zone to alert you to check all limits and values and ensure that the monitor has restored all preset values. (Refer to Power Failure on page 1-4 for more information.) This also occurs when the monitor is turned ON or when an ECG module has been inserted. Your system administrator may disable the CHECK SETUP feature.

5-4

Bedside Transport/Monitors

WARNING: â&#x20AC;˘ Due to the potential for electromagnetic interference, portable communication transmitters and cellular phones should not be operated within 3.5 feet of the patient, patient leads, or associated patient monitoring equipment.

Display Detail All monitoring data originates at the bedside. Parameter modules plug into the monitor itself or into a remote module housing to obtain patient information, including waveforms and numeric displays. The bedside screen may (optionally) display up to eight full waveform zones. If more than eight zones are used, zones 9 through 24 appear at the bottom of the screen as numeric values. When you activate a numeric value key, that parameter is displayed in the lowest priority display zone.

Universal Clinical Workstation/ Ultraview 1500

Ultraview Portable Monitor

Figure 5-1: Bedside and Transport Monitors

5-5

Ultraview Care Network

6-Trace Mode The 6-trace mode feature includes automatic screen formatting that increases the font size and zone size for alphanumeric text. UCW and Ultraview 1700 bedside monitors that are configured for six or fewer zones will always utilize this feature.

•

The 6-trace mode is a system administrator-enabled feature for UCW and Ultraview 1700 monitors.

When the 6-trace mode is enabled, UCW and Ultraview 1700 monitors that are configured for 7 or 8 waveforms will only display six parameter zones and will always display the larger zone and text. Additional parameters will be displayed in the keys below the waveforms. When the 6-trace mode is disabled, additional parameters will be displayed in a smaller zone and font size so that as many parameters as possible may be displayed.

Identifying Special Applications If your monitor has access to Special Applications, additional keys identifying those functions appear in the Special Functions menu. Touch the SPECIAL FUNCTIONS key to access the applications. Special applications include: • • •

Terminal Emulation (TE) mode (refer to TE Mode on page 24-1) Patient Data Logger (refer to Patient Data Logger on page 26-1) Dynamic Network Access (DNA) (refer to DNA on page 27-1) (UCW and Ultraview 1700 only)

Bedside and Transport Monitor Features Adjusting Screen Brightness and Contrast To adjust screen clarity: 1 Touch MONITOR SETUP. 2a Touch MONITOR CONFIG. or 2b Touch MONITOR CONFIGURATION (UCW and Ultraview 1700 only). 3a Touch BRIGHTNESS. or 3b Touch CONTRAST. 3c Touch BRIGHTNESS/CONTRAST (for Ultraview 1500 only). 4 Use arrow keys to adjust.

5-6

Using the Monitor Setup menu you may increase or decrease the monitors’ screen contrast and brightness. Ultraview Portable monitors contain a SCREEN BRIGHTNESS key for monitors operating on AC power enabling you to set the screen to NORMAL or DIM. Setting the screen to DIM also enables the power saving features such as shutting off the LEDs and disabling the mouse and keyboard. The screen will also dim approximately 30 seconds after the last time a key is touched or after the final alarm ends. Ultraview Portable monitors operating on DC (battery) power contain an ENERGY SAVING MODE ON/OFF key that enables and disables the power saving features.

Bedside Transport/Monitors

Setting QRS Tones To set the QRS tones: 1 Touch MONITOR SETUP. 2 Touch PRIVILEGED ACCESS. 3a Enter user name “Clinical” and password (UCW and Ultraview 1700 only). 3b Enter password (Ultraview Portable, 1500, and 1600 only). 4 Touch ALARM SETUP. 5 Touch MORE. 6 Select QRS/SPO2 TONE ENABLE ALWAYS or QRS/SPO2 TONE ENABLE DURING ALARM.

The QRS tone is the sound the monitor generates with each detected R wave. • • • • •

The tone may be modulated with the current SpO2 value. When the QRS/SPO2 TONE ENABLE switch is set to ALWAYS, the QRS tone will sound at all times. When set to DURING ALARM, the tones will only sound during an alarm condition. The default is ALWAYS. You must have “privileged access” to enable this feature.

•

Before the QRS tone can be set, it must first be enabled via the ECG Setup menu (refer to ECG Setup on page 8-3 for more information).

Setting QRS tones is controlled by your system administrator.

Using Scaled Displays To adjust the scaled display (UCW and Ultraview 1700): 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch SCALED DISPLAY. Select MINOR GRATICULE ON. Use arrow keys to adjust. Touch FULL SCALE SIZE to select 4 or 6 zones.

Bedside monitors display up to four scaled pressures simultaneously. You may set full-scale pressures to occupy either four or six zones (the six zone option is available only with an 8-trace UCW and Ultraview 1700). Monitors optionally display minor graticule lines that may be adjusted (with the UCW and Ultraview 1700 you must have “privileged access” to enable this feature). Minor graticules are small dashed line segments that appear between the full scale graticule lines.

To adjust the scaled display (Ultraview Portable, 1500, and 1600): 1 2 3 4 5

Touch MONITOR SETUP. Touch MONITOR CONFIG. Touch MINOR GRATICULE. Select MINOR GRATICULE ON. Use arrow keys to adjust.

5-7

Ultraview Care Network

Setting the Time and Date To change the network or internal system time and date (UCW and Ultraview 1700 only): 1 2 3 4 5a 5b 6a

6b 7 8

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch TIME/DATE. Select TIME. or Select DATE. Select 24 HOURS or AM/PM (12-hour). or Select MONTH, DAY, and YEAR. Use arrow keys to set time or date. Touch ENTER.

The TIME/DATE key controls both the time and date menus. The current time or date displays above the menu. The time displays in either 12- or 24-hour format. Network monitors display the network time; standalone monitors display the internal system time. Touch ENTER to make the time/date change permanent in the system.

•

Setting the time on any networked monitor sets the time for all monitors on that network.

UCW and Ultraview 1700 Features Using Mouse Control

To adjust the mouse speed: 1 2 3 4 5 6

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch MORE. Touch MOUSE CONTROL. Use the sliders to adjust either MOUSE TRACKING SPEED or DOUBLE-CLICK SPEED.

If you are using a mouse with your UCW or Ultraview 1700, you may use the Mouse Control Pad to control its speed. You may adjust the speed at which the cursor moves across the screen (mouse tracking speed), or you may adjust the speed at which the UCW or Ultraview 1700 registers a double-click (double-click speed). To save your changes and exit the Mouse Control Pad select the SAVE button. To exit without saving, select the REMOVE PAD button. To test your double-click speed changes, select the TEST button. It will change color when your UCW registers the double click.

Figure 5-2: Mouse Control Pad

5-8

Bedside Transport/Monitors

Using the System Clock To access the clock menu: 1 2 3 4 5

Touch MONITOR SETUP. Touch MONITOR CONFIGURATION. Select CLOCK ON. Touch the clock that appears in the lower right of the screen. Select ANALOG, DIGITAL, STOPWATCH or TIMER.

A system clock can be continually displayed in the lower right corner of the screen in either analog or digital format. The clock feature may also be used as a stopwatch or timer.

02 AUG 2001

analog

digital

stopwatch

timer

Figure 5-3: Clock Display Formats

Activating the Screen Saver To activate the screen saver: 1 2 3

Touch MONITOR SETUP. Touch MONITOR CONFIGURATION. Touch ACTIVATE SCREEN SAVER.

Activating the screen saver blanks the screen (displaying only the Spacelabs Medical logo). You may also disable the screen saver by touching the screen, clicking (or dragging) the mouse, or pressing any key on the keyboard.

â&#x20AC;˘

The screen will automatically be restored by an incoming alarm condition.

5-9

Ultraview Care Network

Setting Up Priorities and Colors Use the User Defined Screen Displays to change a parameter priority or color (UCW and Ultraview 1700): 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch MONITOR CONFIGURATION. Touch PARAMETER CONFIGURATION. Select a parameter. Select the destination priority. Select a color. Select the parameter key to be colored (the key and waveform will appear in the chosen color). Touch STORE to store local color and priority settings.

To change a parameter priority (Ultraview Portable/1500/1600): 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch MONITOR CONFIG. Touch PARAMETER CONFIG. Select a parameter. Select the destination priority. Select a color. Select the parameter key to be colored (the key and waveform will appear in the chosen color). Touch STORE to store color and priority settings.

Table 1: Parameter Priority/Color Chart lists default priorities and colors for each screen parameter. Table 1: Parameter Priority/Color Chart Channel Type

Priority

Color

ECG1

Electrocardiogram (first lead)

Green

ECG2

Electrocardiogram (second lead)

Green

RESP

Respiration

Cyan

VARI

Varitrend

White

ART

Arterial Pressure

Red

Umbilical Artery Pressure

Red

Pulmonary Arterial Pressure

Yellow

Umbilical Vein Pressure

Blue

CVP

Central Venous Pressure

Blue

RAP

Right Atrial Pressure

Blue

ICP

Intracranial Pressure

Magenta

LAP

Left Atrial Pressure

Red

PRS

Other Pressure (general)

Magenta

UNLP

Unlabeled Pressure

Blue

ETCO2

End Tidal CO2 (Capnography)

White

SpO2 (SaO2)

Pulse Oximetry (O2 Saturation)

Green

NIBP

Noninvasive Blood Pressure

Red

SvO2

Venous O2 Saturation

Magenta

TCP

Partial Pressure of Transcutaneous O2

White

EEG

Electroencephalogram

Blue

GAS

Gas Analyzer Flexport 速 Interface

White

Cardiac Output

Magenta

TEMP

Temperature

White

INCUB WARMR

Incubator/Warmer

White

PO + ET

SpO2 and ETCO2 Flexport Interface

White

Infusion Flexport Interface

White

VENT

Ventilator Flexport Interface

White

OTHER

5-10

Name

Bedside Transport/Monitors

Figure 5-4: Ultraview UCW and Ultraview 1700 Parameter Configuration Screen

Not available on Ultraview 1030 monitors ART

CVP

ECG1

WHITE

1 ECG1

2 ECG2

3 RESP

4 VARI

ECG2

EEG

ETCO2

GAS

RED

5 ART

6 UA

7 PA

8 UV

ICP

INCUB WARMR

LAP

GREEN

9 CVP

10 RAP

11 ICP

12 LAP

NIBP

OTHER

PO+ET

BLUE

13 PRS

14 UNLP

15 ETCO2

16 SPO2

PRS

RAP

RESP

SPO2

YELLOW

17 NIBP

18 SVO2

19 TCP

20 EEG

SVO2

TCP

TEMP

CYAN

21 GAS

22 CO

23 TEMP

24 INCUB

UNLP

VARI

VENT

MAGENTA

PO+ET

26 IV

27 VENT

28 OTHER

INS BLANK

DEL BLANK

STORE

RESTORE

FACTORY DEFAULTS

Figure 5-5: Ultraview Portable, 1500, 1600 Parameter Configuration Screen

•

Your monitor or workstation may not be configured to allow changes to parameter priorities or colors. Contact your system administrator for details.

The Parameter Configuration screen enables you to change the monitor’s default priorities and colors. For the UCW and Ultraview 1700, the default is the local priority and color template, which is viewed in the DISPLAY PRIORITIES key.

5-11

Ultraview Care Network

Each parameter is displayed in order, and is based upon its assigned priority. The highest priority appears at the top of the screen. Blank parameter keys enable you to insert a space above, between, or below other parameters. Blanks of any priority can be inserted into a template by selecting the blank and putting it into the desired location. This causes a blank zone to be inserted into the corresponding display area and pushes down all active parameters with a lower priority. The Named Configuration keys (for the Ultraview UCW and Ultraview 1700) are detailed lists of priorities and colors established for each particular monitor. The default names for these keys are A, B, and C.

•

You can modify the names using the EDIT NAME key.

When you touch a NAMED CONFIGURATION key it will immediately change the display to match that key’s last stored configuration list. CAUTION: • Changes to any of the information on the configuration lists will immediately appear on the monitor’s display. These changes are LOST if they are not stored in the monitor’s non-volatile memory before the configuration list is removed from the display or another of the Named Configuration keys is selected. The EDIT NAME key is used to change the NAMED CONFIGURATION key. 1.

Touch the EDIT NAME key to display a keyboard window and an input cell.

Enter or change the name of the NAMED CONFIGURATION key.

Touch ACCEPT or CANCEL to institute the changes.

For the UCW, the DISPLAY PRIORITIES key displays a list of the currently active parameters, or all possible parameters, ordered by priority. Touch LOCAL to display only this bed’s currently active parameters. STORE - causes the currently displayed parameter priorities and colors to be stored in memory. RESTORE - causes the last stored local priority and color settings to be stored from memory. FACTORY DEFAULTS - causes the factory default priority and color settings to be restored.

5-12

Bedside Transport/Monitors

Data Shuttle Option The Data Shuttle option enables you to transfer patient admit data (e.g., age, gender, name, and BSA) and up to 24 hours of trend and episodic data from one monitor to another using a 90496 Ultraview Command Module. You can transfer data acquired through any Ultraview Care Network module or Flexport interface. Before you shuttle data from one monitor to another, you must first transfer the data from the source monitor into a 90496 module. When you remove the module from the source monitor and insert it into the receiving monitor, data can be transferred to the receiving monitor.

•

The time and date set on both the sending and receiving monitors must be identical for the data transfer to be successful.

Transferring Data to the Module To transfer data: 1 2 3 4

Touch ECG. Touch SETUP. Select TRANSFER DATA. Remove module after DATA TRANSFER COMPLETED is displayed.

If your monitor and module support the Data Shuttle option, the monitor displays a TRANSFER DATA key in your ECG Setup menu. When you wish to transfer data (for example when transporting a monitored patient from one unit to another), touch the TRANSFER DATA key to initiate data transfer into the module. The monitor will then display the message TRANSFERRING PATIENT DATA INTO MODULE.

•

The Data Shuttle option is only available in bedside or transport monitors. Central monitors do not display keys and messages related to data transfer.

•

If you insert a module that supports the Data Shuttle option into a monitor that does not have the option, the monitor will not display data transfer messages and keys.

Once the data is completely transferred, the monitor sounds a tone and displays the message DATA TRANSFER COMPLETED below the UPDATE TRANSFER and CANCEL TRANSFER keys. The module is now ready to be removed from that monitor. UPDATE TRANSFER T

CANCEL TRANSFER C

E C G DATA TRANSFER COMPLETED

Figure 5-6: Data Transfer Complete Display If you do not transfer the module to the receiving monitor immediately, the source monitor will be storing new data, but the module’s transfer data is not automatically updated. After two minutes, a tone will sound once each minute to remind you to update the module with the newly acquired data and the monitor will display the message DATA TRANSFER COMPLETED.

5-13

Ultraview Care Network

The message DATA IS XX MINUTES OLD displays the amount of time that has elapsed since you last transferred the data. The monitor updates this message each minute.

To update transfer data: 1

Touch UPDATE TRANSFER.

Updating the Data Transfer If time has elapsed between data transfer into the module and module removal, you may wish to update the transferred data before you remove the module. To update this data, touch UPDATE TRANSFER. While the data is being updated, the monitor re-displays the message TRANSFERRING PATIENT DATA INTO MODULE.

•

Parameter information acquired between the time you transfer data and the time you remove the module is lost. The monitor indicates this lost information as a gap in the trends of the parameters involved when you retrieve the data.

•

To provide seamless trend information, remove the module and insert it into the receiving monitor within 30 to 45 seconds after you transfer the data. If there is a delay in completing the data shuttle, update the transfer data just before you remove the module.

•

If the module has been out of the monitor for 10 or more minutes, all data will be lost.

Canceling the Data Transfer Before Module Removal To cancel data transfer: 1.

Touch CANCEL TRANSFER.

Touch the CANCEL TRANSFER key to clear all data transfer messages and keys from the ECG display zone and purge previously transferred data from the module. The monitor will then reactivate the TRANSFER DATA key in the ECG Setup menu.

Retrieving Transfer Data To receive transferred data: 1 2

Touch RETRIEVE DATA. Touch YES.

When you insert the module into the receiving monitor, the monitor displays the RETRIEVE DATA and CANCEL TRANSFER keys and sounds a low priority alarm tone every five seconds until you either cancel the data transfer or retrieve the data. The monitor also displays the patient name associated with the data to be transferred and, if applicable, the patient name associated with the data that currently resides in the monitor. When you touch the RETRIEVE DATA key, the monitor displays YES and NO keys along with the message: YES purges the monitor’s data and retrieves data from the module NO cancels this action

5-14

Bedside Transport/Monitors

Touch NO to return to the previous screen. Touch YES to transfer the data from the module into the receiving monitor and purge any data previously stored in that monitor. RETRIEVE DATA T

CANCEL TRANSFER C

E C G Module: Jones, B Monitor: Adams, S

Figure 5-7: Retrieving Transfer Data Display Once you initiate data retrieval, the monitor removes all data transfer-related keys from the ECG display zone and displays the message TRANSFERRING PATIENT DATA INTO MONITOR. When the data retrieval into the monitor is complete, the monitor displays the message DATA TRANSFER COMPLETED. for one minute. When you insert a module loaded with transfer data, you cannot purge a prior patient's data (while data is being transferred) using the monitor’s Admit or Discharge menus. If you attempt to purge patient data in this manner, the monitor will display the message: Purge is not allowed during transport.

Canceling the Data Transfer After Module Insertion To cancel data transfer: 1 2 3

Insert module into receiving monitor. Touch CANCEL TRANSFER. Touch YES.

To Cancel a data transfer touch the CANCEL TRANSFER key, the monitor displays YES and NO keys along with the message: YES purges data previously transferred into the module NO cancels this action Touch YES to confirm your desire to cancel the data transfer and reactivate the TRANSFER DATA key in the ECG Setup menu. Touch NO to return to the previous screen.

Ultraview Portable Batteries Each transport monitor is shipped with one 12 V battery. Monitors will accept two. Batteries may be changed during battery or AC operation without losing data, provided that one charged battery remains connected at all times during the exchange. A green LED in the lower-right corner of the front panel will flash when the batteries are charging and will be continually illuminated once the batteries are fully charged. Sealed Lead Acid (SLA) Sealed Lead Acid batteries only need to be charged for about four hours prior to use. When storing, be sure to maintain their charge or to “top charge” them every three months. These batteries are compatible with all portable monitors.

5-15

Ultraview Care Network

Nickel Metal Hydride (NiMH) Prior to use, Nickel Metal Hydride batteries should be run through three charge/discharge cycles in the monitor. This will ensure that during the first transport maximum run time will be possible. No other maintenance is required for this battery type. NiMH batteries may only be used in the Ultraview Portables, with serial numbers starting at 369-1xxxxx or 367-1xxxxx.

battery compartment door

LED

power on/off switch battery

Ultraview Portable

Figure 5-8: Ultraview Portable Monitor Battery Installation

Battery Status Messages Ultraview Portables provide you with several battery condition status messages. Battery Charged — A Solid Green LED A solid green LED indicates the battery, or batteries, installed into the monitor are fully charged and are ready to be used. It functions with the monitor powered ON and with the monitor powered OFF.

•

If a battery is not installed, a solid green LED will also display.

Battery Charging — A Flashing Green LED A flashing green LED indicates the battery, or batteries, installed in the monitor are not fully charged and are not ready to be used. The flashing is different than the battery fault detection flash. The flashing LED turns on and off in a constant pattern, with no delays. It functions with the monitor powered ON and with the monitor powered OFF.

5-16

Bedside Transport/Monitors

Battery Fault Detected — An Intermittent Flashing Green LED An intermittent flashing green LED indicates that either battery A or battery B is faulty. Faulty batteries are determined to be batteries which do not hold a charge or batteries which attempt to charge too long. The flashing is different than the battery charging flash. The intermittent signal will display a solid green LED for one-second, then display a flashing LED for one-second in a repeating pattern. An error log message is also added to the CMOS error log for review by your system administrator. To determine whether one battery, or both, is faulty, power the monitor ON using the front panel switch, and observe the display message. The message will display along the bottom of the monitor indicating whether one, or both, of the batteries are faulty. Replace the faulty battery with a fully charged battery. Battery Gauge The battery gauge is always present in the lower-right corner of the display when the monitor is powered ON and not plugged into AC power. This gauge indicates the approximate battery capacity. For example, the gauge will display:

•

a fully charged battery

•

3/4 battery charge remaining

•

1/2 battery charge remaining

•

1/4 battery charge remaining

•

minimum battery charge remaining •

When the battery power reaches 1/2 battery charge remaining, recordings that drain large amounts of power can cause the monitor to power OFF without warning.

Recordings are automatically inhibited when the battery power reaches 1/2 battery charge remaining.

•

When the battery power becomes critically low (approximately 1/4 battery charge remaining), the monitor may power OFF at anytime, depending on monitor loading.

The entire battery gauge flashes emphasizing this danger warning.

5-17

Ultraview Care Network

Wireless Network Interface The Wireless Network Interface (WNI) provides Ultraview monitors and UCW bedside monitors with a connection to the Spacelabs Medical Ethernet network. This enables the wireless bedside monitor to communicate with a central station and other networked devices. The WNI provides wireless transmission of up to five waveforms along with associated numerics, alarms, trends, arrhythmia, ST, and Flexport Interface systems data. Alarm Watch and Remote Trends are not restricted. Standard with Option Z in the UCW and Ultraview monitors, bed-to-bed communications enable a bedside to Remote View or Alarm Watch other beds on the wireless or hardwired network.

5-18

Bedside Transport/Monitors

Outbound Parameters Menu To select parameters to be monitored: 1 2 3

Touch MONITOR SETUP. Touch OUTBOUND PARAMETERS. Select the parameters you wish to display (up to 5 for UCW and Ultraview monitors).

To change parameters: 1 2 3 4

To view the Outbound Parameters menu, touch the OUTBOUND PARAMETERS key in the Monitor Setup menu.

Touch MONITOR SETUP. Touch OUTBOUND PARAMETERS. Deselect the parameter key that you wish to stop displaying. Select the parameter you wish to display.

Figure 5-9: Monitor Setup When a parameter key is ON the parameter is available for selection in another monitor’s Remote View menu and Select Outbound Parameters menu. If two parameters have identical labels, both parameters will display. The maximum number of parameters that can be set depends upon the monitor’s specific configuration for wireless networking. When the maximum number of parameters is reached the remaining parameters that were not selected become unavailable. The UCW monitor’s default outbound parameter selection is ECG1 when turned ON.

Figure 5-10: Select Outbound Parameters Menu All parameters, including the parameters that are set to OFF in this menu, are displayed by other monitors that are set to ALARM WATCH this monitor. If an outbound parameter is set to OFF, all existing attachments (Remote Views) for that parameter will be dropped.

•

Setting OTHER to ON selects any unlisted channel types such as VARI, CO, and unlabeled pressures.

5-19

Ultraview Care Network

Wireless Ethernet Connection Ultraview Portable Monitors (Option Z) In wireless mode, the monitor maintains network communication with a central station through the Wireless Network Interface (WNI) that is connected to the standard Spacelabs Medical hardwired Ethernet network. Wireless communication is automatically disabled when the monitor is directly hardwired to the network using its network port, and enabled when the hardwired port is disconnected.

Figure 5-11: Rear Panel Ultraview Portable

5-20

Bedside Transport/Monitors

Optional Model 90310 Wireless Network Interface antenna connectors connects to network AUI port on UCW or to AUI multiport for wireless network rack mounting hardware (single or double)

達

status LEDs

channel selection thumbwheel

power LED

Figure 5-12: 90310 Front panel

Figure 5-13: 90310 Rear panel

5-21

Ultraview Care Network

Ultraview Portable Connections External Power Supply Connection To connect to an external power supply: 1 2

Attach the DC outlet cable to J1. Connect the power cord of the external power supply to an AC outlet.

The connection for the external power supply is shown in Figure 5-14: Ultraview Portable External Power Supply Connection. The green LED on the front panel will display ON whenever the unit is powered by an external power supply.

J1 - external power supply connection

DC outlet cable

external power supply

Figure 5-14: Ultraview Portable External Power Supply Connection Ultraview Portables also provide an external Flexport interface connection (refer to Figure 5-15: Ultraview Portable External Flexport Connection - Interface Connector Option F or G).

5-22

Bedside Transport/Monitors

SDLC cable P/N 012-0152-00 SDLC terminator SDLC connection flexport interface

external device

modular cable P/N 012-0182-00

transition connector Figure 5-15: Ultraview Portable External Flexport Connection Interface Connector Option F or G

To connect to the 10BaseT port for network communication: 1

Ethernet Connection - Options F or G for Ultraview Portables

Plug either end of cable assembly 175-0951-XX into the modular jack connection on the back of the monitor.

Network communication is done through the 10BaseT cable assembly only. 2

remote alarm connection

Plug the other end of the cable into the wall in a wall plate with an eight pin modular jack connector.

10BaseT cable assembly P/N 175-0951-XX

patient module slot J1 - external power supply connection modular jack connection

Figure 5-16: Ultraview Portables 10BaseT Network Connection

5-23

Ultraview Care Network

Ultraview Portable with Capnography (Option G or H) To start capnography monitoring: Plug the mainstream EtCO2 sensor cable into the EtCO2 receptacle on the capnography panel. 2 Perform sensor calibration, if necessary. 3 Prepare the patient according to hospital procedures. 4 Select the appropriate airway adapter (neonate or adult). 5 Verify that the windows are clean and dry. 6 Place the sensor head over the airway adapter and perform an adapter calibration, if necessary. 7 Remove the airway adapter from the sensor head. 8 Insert the airway adapter into the ventilator circuit and Ballard style tracheal suction system (if present) as shown. 9 Attach the sensor head to the airway adapter. 10 Make the other connections as shown. 11 Ensure that the sensor head is always positioned above the ventilator circuit so that moisture will not enter the adapter.

Option G adds mainstream EtCO2 monitoring to Ultraview portable.

capnography panel

O2 EtCO2 O2 adapter cable endotracheal tube ventilator

sensor cable

sensor head

expiratory circuit

O2 airway adapter

inspiratory circuit ventilator circuit mainstream airway adapter

humidifier O2 sensor

Figure 5-17: Ultraview Portables Rear Panel with Option G or H

5-24

Bedside Transport/Monitors

Maternal Obstetrical Monitor - 94000 The Maternal Obstetrical Monitor (MOM) is a fetal monitor which, when used with an Ultraview Command Module or other Ultraview modules, provides the optional ability to monitor maternal ECG, NIBP, temperature, and SpO2. The multiple trace screen enables simultaneous display of real-time fetal and maternal ECG and maternal SpO2. Both internal and external fetal monitoring capabilities are provided. The monitor provides networking capabilities to Spacelabs Medical monitors through an Ethernet network, BirthNet, and other manufacturers’ fetal data management systems. Data for the fetal heart rate and uterine activity can be captured using telemetry or Mermaid wireless technology options. WARNING: • Shock hazards may exist if this instrument is not properly grounded. Protection against electrical shock is provided by grounding the chassis with a three-wire cable and plug. The grounding wire must not be removed or defeated. Grounding reliability can only be assured if connected to a receptacle marked Hospital Only or Hospital Grade. •

To reduce the risk of electric shock, do not remove the protective covers. Only qualified Spacelabs Medical personnel should service the instrument.

•

There is a risk of explosion if the instrument is operated in the presence of flammable anesthetics.

•

Always inspect the transducer face, housing, cable, and power cord before using the instrument. If the transducer is cracked or chipped, or if the power cord is frayed, broken, or otherwise damaged, call a qualified technician. Do not use the transducer or the monitor on a patient.

•

Always disconnect the instrument from the power supply prior to cleaning the monitor.

•

The total system chassis risk current should not exceed 300 µA @ 120V, 500 µA @ 240V.

•

Do not operate this instrument if it is wet or if condensation is present.

•

During recharging, the wireless transducers may become hot or warm to the touch. Allow the wireless transducers to cool prior to using them on a patient.

•

An intentional reset will occur if the processors lose communication with each other. Under these circumstances, the main processor will self-reset and the communication will be re-established after the startup sequence. A solid triangle is printed on the 60-bpm line of the FHR scale to differentiate this type of reset from others. A small gap in the heart rate tracing will result.

5-25

Ultraview Care Network

CAUTION: • Excessive bending or twisting of a transducer cable may cause failure or intermittent operation of the transducer.

5-26

•

Do not sterilize a transducer using gas, heat, or liquid methods. Do not autoclave a transducer. These sterilization methods may permanently damage the transducer.

•

This instrument is not intended for use with defibrillators.

•

Disposal of these devices and all accessories must be in accordance with local and federal laws.

•

Due to the potential for electromagnetic interference, electronic devices (for example, portable communication transmitters, cellular telephones, personal computers, electronic toys, and other medical devices) should not be operated within 3.5 feet (1.07 meters) of the patient, patient leads, or associated patient monitoring equipment until evaluated by the Biomedical Engineering staff.

•

If the integrity of the external protective earth conductor is in doubt, the equipment must be operated from its internal power source.

•

The fetal module is an IEC 601-1 Class I device with type B, BF, and CF patient connectors. Type B equipment provides a particular degree of protection against electric shock, particularly regarding allowable leakage current (not to exceed 0.1 mA) and reliability of the protective earth connection (if present). Type BF equipment meets the criteria above for B with an F-type applied part. An F-type applied part is isolated from all other parts of the equipment to such a degree that the patient leakage current allowable in single fault condition is not exceeded with a voltage equal to 1.1 times the highest rated mains voltage applied between the applied part and earth. Type CF equipment provides a degree of protection higher than that for type BF against electroshock, particularly regarding allowable leakage currents (not to exceed 0.01 mA), and having an F-type applied part.

•

Water ingress for the fetal module is IPX0; water ingress for the Mermaid transducers is IPX7 per IEC 529.

•

The MOM unit is not approved for transport applications.

Bedside Transport/Monitors

Front Panel

í˘ą

í˘˛ í˘ł

í˘´ í˘ľ

í˘ś

í˘ˇ

í˘ą Power ON/OFF í˘˛ Recorder drawer release button í˘ł Fetal chart recorder í˘´ FHR 1 connector (either ultrasound or ECG) í˘ľ UA connector í˘ś FHR 2 connector (ultrasound only) í˘ˇ Battery charging light

Right Side Panel

í˘ą í˘˛ í˘ł í˘´

í˘ą Telemetry antenna connector (optional) í˘˛ Mermaid wireless connector (optional) í˘ł Ultraview Module (optional) í˘´ J1 - External power supply connector 5-27

Ultraview Care Network

Left Side Panel

í˘ą

í˘˛ í˘´

í˘ł

í˘ą Maternal chart recorder (optional) í˘˛ Event marker connector í˘ł Ethernet connector (Ultraview Care Network) í˘´ Battery compartment door

Rear Panel

í˘ą í˘ą J4 - Other I/O í˘˛ J3 - RS485 port - Birthnet í˘ł J2 - External device port - RS232

5-28

í˘˛

í˘ł

Bedside Transport/Monitors

WARNING: • The use of accessory equipment that does not comply with the monitor’s safety requirements may lead to a reduced level of safety. Consideration should be given to the use of the accessory in the vicinity of a patient. The safety certification of the accessory must be performed in accordance with the appropriate IEC 601-1 and/or IEC 601-1-1 harmonized national standard. •

EMC compliance may be compromised by the connection of accessory and/or peripheral equipment. Compliance of accessory and/or peripheral equipment must be considered to ensure continued EMC compliance.

5-29

Bedside/Transport Monitor Troubleshooting Guide Clinical Situation Cannot change parameter priority or colors Changed parameter priority or colors on an Ultraview 1030/1050, 1500, or 1600 monitor are lost Transport monitor has no DC power

Possible Cause ■ Monitor may not be set up to allow

Solution ■ Contact your system administrator.

the user to change priority or colors.

■ The STORE key was not touched after the selection was made.

■ Touch the STORE key to make changes permanent.

■ The monitor was not plugged into an ■ Plug the monitor into an AC outlet to AC outlet while not in use.

recharge batteries to 80% power (refer to Battery Gauge on page 517).

Central Monitors

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP SCREEN FORMAT

TONES

ADMIT/ DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS refer to Privileged Access Directory on the next page

Select bed (or subnet, then bed) Refer to pop-up window below

MONITOR CONFIGURATION BRIGHTNESS

Select parameter Refer to Selecting Waveforms for Display in this chapter

CONTRAST

CLOCK ON

OFF

ACTIVATE SCREEN SAVER

refer to Admit/Discharge chapter

MONITOR SETUP - Select types of tone to change Select waveform zone

LOCAL BED

REMOTE ALARMS

This key is dithered in central mode

NICU

ICU

BED01 BED01

BED02

ALARM WATCH

REMOTE BED

MICU

BED03

KEY TONE

This key is dithered when the remote option is not installed

CCU

BED04

BED05

BED06

BED07

RECORD

Touch RECORD twice

Touch RECORD once, then up to 4 flashing parameter keys

RECORDING MENU CONTINUOUS RECORD

•

STOP CONT RECORD

CANCEL RECORD SELECTION(S)

RECORD ALL

RECORD PRESELECTED A

RECORD PRESELECTED B

Based on features purchased, more or fewer keys may appear here than on your menu screens.

6-1

Privileged Access

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP SCREEN FORMAT

ADMIT/ DISCHARGE

TONES

MONITOR CONFIGURATION

PRIVILEGED ACCESS

CLINICAL ACCESS (user name is CLINICAL)

CLINICAL LEVEL: Select Parameter SCALED DISPLAY

RECORDER CONFIGURATION

TIME/ DATE

PRESELECTED RECORDINGS

UNITS OF MEASURE

mmHg kPa

Refer to Printing chapter

USER ACCESS ENABLE

inches cm

ALARM SETUP

lb kg

CLINICAL Level: Select Parameter REMOTE KEYPAD STATION ADDRESS

CHANGE CLINICAL PASSWORD

MOUSE CONTROL

RESET MONITOR

Alarm Setup: Select parameter to change REMOTE ALARM ACCESS ON

TREND SUSPEND

OFF

ALARM RELAY

OFF

QRS/SPO2 TONE ENABLE ALWAYS

DURING ALARM

CLINICAL Level - USER ACCESS - Enable user access to functions PATIENT TYPE ON

ZONE COLORING

OFF

AW COLORING

OFF

PARAMETER CONFIG ON

PRESELECTED RECORDINGS: Select configuration to change PRESELECTED A

PRESELECTED B

MONITOR SETUP - Time/Date 10:06 TIME 24 HOUR HOURS DATE AM/PM

MINUTES

MINOR GRATICULE: 2 divisions MINOR GRATICULES OFF ON

6-2

FULL SCALE SIZE 4 Zones 6 Zones

ENTER

OFF

ALARM SUSP BUTTON ON OFF

SUBNET ACCESS

OFF

Central Monitors

Contents Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 6-Trace Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Central Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 UCW and Ultraview 1700 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Data Communications Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Non-Networked Telemetry Central Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Central Monitors Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Overview The central monitor provides full monitoring control of remote parameters including display and alarms, with both visual and audible annunciation. All waveform and current numeric data, arrhythmia, ST segment, and trends are available with central monitoring. The Ultraview Care Network family of monitors and modules have built-in error detection and recovery circuitry. This circuitry, together with special software, allows the central to re-initialize and continue to function if an error occurs. When the system detects an error that cannot be corrected through other means, the central monitor re-initializes or resets (blanks). Normally, a reset involves very little loss of patient monitoring time (approximately five seconds) and, with few exceptions, all operator set inputs (for example, alarm limits, pressure labels, transducer offsets, etc.) are retained. The entire process of restoring the central display following a reset, takes approximately 20 seconds, depending upon the number of parameters being monitored. In some cases, stored trend data will be lost when the monitor resets. Typically, this is indicative of a hardware condition that requires corrective action. In this case, the system initiates the start-up diagnostics to check the monitorâ&#x20AC;&#x2122;s operation so that full recovery takes approximately ten seconds longer. If a bedside monitor has reset, the central and bedside monitors display CHECK SETUP in the ECG zone to alert you to check all limits and values and ensure that the monitors have restored all preset values. Refer to Power Failure on page 1-4 for more information. This also occurs when the monitors are turned ON or when an ECG module has been inserted. However, your system administrator may disable this CHECK SETUP feature. CAUTION: â&#x20AC;˘ Due to the potential for electromagnetic interference, electronic devices (for example, portable communication transmitters, cellular telephones, personal computers, electronic toys, and other medical devices) should not be operated within 3.5 feet (1.1 meters) of the patient, patient leads, or associated monitoring equipment until evaluated by the Biomedical Engineering staff.

6-3

Ultraview Care Network

Display Detail UCW and Ultraview 1700 central monitor screens can display up to 8 full waveform zones. The split screen option allows for a maximum of 12 or 16 zones to be displayed.

Figure 6-1: UCW Split Screen Central Display

6-Trace Option The 6-trace mode feature includes automatic screen formatting that increases the font and zone size for alphanumeric text. The larger font and zone size always appears on central monitors configured for 4-, 5-, 6-, and 12-trace operation because no more than 6 full zones can have parameters assigned. For monitors configured for 7-traces, the larger zone will be used as long as you do not assign a parameter to the last zone. For 16-trace monitors, the larger zone will be used as long as you do assign parameters to the top 12 zones. When a parameter is assigned to any of the lower 4 zones, the display will automatically resize to the smaller zone and the smaller font sizes.

6-4

Central Monitors

Central Monitor Features Selecting Waveforms for Display To select remote parameters for display: 1 2 3 4 5

Touch MONITOR SETUP. Touch SCREEN FORMAT. Select bed (or subnet, then bed). Select the parameter(s) to be displayed. Select a zone.

Use the SCREEN FORMAT key in the Monitor Setup menu to assign remote parameters to specific display zones. Names of the subnet and bedside keys are assigned by your system administrator. One to 8 waveform zones may be displayed across the entire screen. Split screen central monitors may display 16 waveform zones, with 1 at the top, left zone on the display, and zone 9 appearing in the 1st zone upper right.

Setting the Time and Date To change the network or internal system time and date: 1 2 3 4 5a 5b 6a

6b 7 8

The TIME/DATE key controls both the time and date menus. The current time or date is displayed above the menu. Time is displayed in either 12- or 24-hour format. Network monitors display the network time and stand-alone monitors display the internal system time. The system will not make any time/date change permanent until you touch ENTER.

•

Setting the time on any networked monitor sets time for all monitors on that network.

6-5

Ultraview Care Network

UCW and Ultraview 1700 Features Using Mouse Control To adjust the mouse speed: 1 2 3 4 5 6

Figure 6-2: Mouse Control Pad To enable/disable the clock: 1 2

Touch MONITOR SETUP. Touch MONITOR CONFIGURATION. 3a Select CLOCK ON to enable the clock. or 3b Select CLOCK OFF to disable the clock.

Using the System Clock A system clock can be continually displayed in the lower right corner of the screen in either analog or digital format. The clock feature may also be used as a stopwatch or timer.

To access the clock menu: 1 2 3 4 5

6-6

Touch MONITOR SETUP. Touch MONITOR CONFIGURATION. Select CLOCK ON. Touch the clock that appears in the lower right of the screen. Select ANALOG, DIGITAL, STOPWATCH or TIMER.

02 AUG 2001

analog

digital

stopwatch

timer

Figure 6-3: Clock Display Formats

Central Monitors

Activating the Screen Saver To activate the screen saver: 1 2 3

Touch MONITOR SETUP. Touch MONITOR CONFIGURATION. Touch ACTIVATE SCREEN SAVER.

•

The screen will automatically be restored by an incoming alarm condition.

Assigning Color to a Zone To select remote parameters for display: 1 Touch MONITOR SETUP. 2 Touch SCREEN FORMAT. 3a Select a bed. or 3b Select a subnet, then a bed. 4 Touch parameter key to be displayed. 5 Touch empty waveform zone in which to display the parameter. To assign color to a zone: 1 2 3 4

Touch MONITOR SETUP. Touch SCREEN FORMAT. Touch the desired color. Touch the zone to be colored.

The central monitor enables you to choose the color of the zones. RESTORE COLORS — restores the last stored color settings from memory. FACTORY DEFAULTS — restores the zone colors to the factory color setting of white. OVERWRITE ZONE/INSERT ZONE — toggles to either replace a zone that has already been assigned a parameter, or to insert a zone assignment into a block of assigned zones. Select OVERWRITE ZONE, after you select the new parameter, to drop the previously assigned parameter channel and replace it with the new parameter. INSERT ZONE — moves the assigned zone and all other zones immediately adjacent to the assigned zone down one zone, and the new zone is inserted above them. If this causes an assigned zone to disappear from the screen, a warning box will appear prompting you to complete or cancel the insert. CLEAR ZONE — clears the zone assignment and returns the zone to an unassigned state. Touch CLEAR ZONE, then touch the zone from which you wish to remove an assignment.

ICU NICU

BED01

CCU

BED02

BED03

BED04

BED05

BED06

BED07

Figure 6-4: Central Display Format Screen (UCW and Ultraview 1700)

6-7

Ultraview Care Network

Data Communications Watch To enable Data Communications Watch (must have system administrator menu access):

The Data Communications Watch (DCW) feature displays a Data Communications Interrupted (DCI) message on the central when the centralâ&#x20AC;&#x2122;s communication link to a bedside/remote monitor is interrupted.

1 2 3

A bedside monitor may drop from the central display because of a power interruption at the bedside, Ethernet failure, or other circumstance. As soon as a communication loss is detected by the central monitor, a DCI notification will be displayed on the screen in place of each channel that lost communication, and an alarm tone will sound if enabled (refer to Enabling Alarms (Optional) on page 6-9).

4 5 6 7 8

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter system administrator login and password. Touch MORE. Touch DATA COMM WATCH. Select COMM WATCH ON. Select ALARM ON to enable DCW alarms. Select ADMIT REQUIRED ON to enable DCW for admitted patients only.

Keys will be displayed in the waveform zone of the interrupted channel to permit disabling of the alarm tone associated with the interruption, and to remove the zone from the display. The DCI notification shows the bed name, patient name and the parameter key label of the lost channel, as shown in Figure 6-5: DCI Notification Display.

DATA COMMUNICATIONS INTERRUPTED E

REMOVE PATIENT ZONE?

C BED 01 JONES, B

YES

Figure 6-5: DCI Notification Display

â&#x20AC;˘

The Data Communications Watch feature is enabled only through the system administrator menu.

The parameter key (ECG in the above example) will also flash (if DCW alarms are enabled) when the DCI notification is displayed on the screen. Touch this key to display a status message at the bottom of the screen noting the time and date that communication with the lost channel was interrupted. Press YES to remove all DCI notifications associated with the same bedside from the central display. Unless the zone is re-assigned by the user, the central will continue to attempt communication with the remote monitor. Once communication is restored, the patient data is displayed in the zones again. Press NO to silence the alarms (if enabled), but to continue display of the DCI notification. All alarms for that bedside monitor are silenced simultaneously. The NO key becomes dithered (inactive) after it is pressed.

6-8

Central Monitors

Enabling Alarms (Optional) When activated, this option causes an alarm to sound and the parameter key to flash when the DCI notification is displayed. This option must be enabled through the Biomed menu. A flashing parameter key and low level alarm tone, signifying an alarm condition, will occur as soon as the central detects a communication loss. Alarm conditions will continue until either YES or NO is pressed on the DCI notification, a new parameter is assigned to the zone, or communication is restored.

Enabling Detection for Admitted Patients (Optional) If ADMIT REQUIRED is ON, communication will be watched for only those remote monitors having admitted patients. If ADMIT REQUIRED is OFF, communications will be watched for all patients on the central monitor.

Non-Networked Telemetry Central Option The Remote View and Alarm Watch features are not available on a central monitor with the non-networked telemetry option. Any keys related to the viewing of parameters, trends, or calculations from a remote location are not available.

6-9

Central Monitors Troubleshooting Guide Clinical Situation Cannot assign color to a zone

Cannot assign a parameter to a zone

Cannot access the clock menu

CANNOT deselect ALARM WATCH

Possible Cause ■ Monitor may not be set up to allow

Solution ■ Contact your system administrator.

you to assign colors.

■ Zone may not have been cleared of previous assigned waveforms.

■ Clock may have been left in STOPWATCH or TIMER mode.

■ The Ultraview Central Monitor is configured with Central Alarm Watch Manager to prevent deselection of automatically alarm watched beds.

■ Select CLEAR ZONE, then touch the zone in which to display the new parameter. Repeat the initial SCREEN FORMAT steps.

■ Touch the clock/timer display, then touch PREVIOUS MENU to restore the clock.

■ Contact your system administrator.

Module Configuration Manager

Directory of Keys - for configurations with ECG E C G

ECG MENU

ALARM LIMITS

SIZE

LEAD CONTROL

SETUP

DISPLAY FORMAT

SUSPEND PROCESSING

RELEARN

REVIEW

ECG - SETUP

SWEEP SPEED

QRS TONE

PACED

MONITOR EXTENDED

RATE SOURCE

CONFIG

YES NO

RESTORE SETTINGS

TRANSFER DATA

YES ECG - CONFIG

ADULT INFANT

ARR ON OFF

See your system administrator for access to this key

HIDDEN KEY

DEFAULT STORAGE MENU

USER SETTINGS

RETRIEVE SETTINGS

TRANSFER SETTINGS

FACTORY DEFAULTS

YES USER SETTINGS - CHANNEL SELECT

ECG

RESP

VARITREND

PRES

SPO2

NIBP

TEMP

User Settings screens appear here (Refer to Display Detail) SELECT PARAMETER

CURSOR

CHANGE VALUE

PAGE X OF X

PRINT PAGE

STORE

YES

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

7-1

Module Configuration Manager

Directory of Keys - for configurations without ECG T E M P

TEMP MENU RESTORE SETTINGS

ALARM LIMITS

See your system administrator for access to this key

HIDDEN KEY

DEFAULT STORAGE MENU USER SETTINGS

TRANSFER SETTINGS

RETRIEVE SETTINGS

FACTORY DEFAULTS

YES

USER SETTINGS - CHANNEL SELECT PRES

SPO2

TEMP

User Settings screens appear here (Refer to Display Detail)

SELECT PARAMETER CURSOR

CURSOR

CHANGE VALUE

PAGE X OF X PREV PAGE

PRINT PAGE

STORE

YES

! 7-2

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

Module Configuration Manager

Directory of Keys - for telemetry configurations E C G

ECG MENU

ALARM LIMITS

SIZE

LEAD SELECT

SETUP

CHANNEL FORMAT

SUSPEND PROCESSING

RELEARN

REVIEW

ECG - SETUP

SWEEP SPEED

QRS TONE

PACED

MONITOR EXTENDED

RESTORE SETTINGS

CONFIG

YES NO

YES

TM SETUP

ECG - CONFIG

ADULT INFANT

ARR ON OFF

HIDDEN KEY

See your system administrator for access to this key

DEFAULT STORAGE MENU

USER SETTINGS

TRANSFER SETTINGS

RETRIEVE SETTINGS

YES SELECT PARAMETER

CURSOR

FACTORY DEFAULTS

NO CHANGE VALUE

PAGE X OF X

PRINT PAGE

STORE

YES

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

7-3

Module Configuration Manager Contents Directory of Keys - for configurations with ECG . . . . . . . . . . . . . . . . . . . . . . . . 1 Directory of Keys - for configurations without ECG . . . . . . . . . . . . . . . . . . . . . . 2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Setting User-Defined Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Storing Changed Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Selecting Alarm Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Parameter Configurations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Transferring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Retrieving User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Restoring Factory Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Overview The Module Configuration Manager feature provides the capability to define and store all user-configurable options within your module. Once a module has been configured, these settings will control its operation whenever the module is powered ON. To ensure standardization of multiple modules, settings may be transferred from one configured module to another. Settings are first transferred from a configured module to the monitor (using the TRANSFER SETTINGS key), then retrieved from the monitor into other modules (using the RETRIEVE SETTINGS key). The Restore Settings feature changes all the module’s parameter userconfigurable options to the defaults previously stored as user settings.

•

User-configurable parameters are available based on the options in your module. For example, if your module does not have the Arrhythmia Processing feature (MultiView I), parameters related to arrhythmia detection and alarms will not be available.

•

User-defined settings which have been transferred to the monitor’s memory are available for retrieval into other modules until (1) the monitor is powered OFF or (2) a patient is admitted or discharged with a purge of data.

Depending on the parameter configuration of the module, the Module Configuration Manager feature is accessible through either the ECG or TEMP parameter key. For module configurations without ECG, use the TEMP key. For module configurations with ECG, use the ECG key.

•

The TEMP key will only be displayed if a temperature probe is connected to the module.

7-4

Module Configuration Manager

Display Detail The User Settings screens list all user-configurable options for ECG, respiration, Varitrend 3, temperature, invasive pressure, non-invasive blood pressure, and SpO2. From these screens you can change and store the options in your module. Figure 7-1: ECG User Settings Screen illustrates the ECG User Settings screen which is used to change and store ECG rate alarm limits. In this example, LEARNED has been chosen as the adult rate alarms type. The parameter configuration tables in this chapter list all available options, the available user settings, and the factory defaults for each parameter.

PARAMETER DESCRIPTION

VALUE

ECG RATE ALARMS (INFANT) - TYPE LEARNED - HIGH RATE 220 - LOW RATE 100 - HIGH RATE OFFSET 50 - LOW RATE OFFSET 50 - DELAY 3

ECG RATE ALARMS (ADULT) - TYPE LEARNED - HIGH RATE 180 - LOW RATE 40 - HIGH RATE OFFSET 50 - LOW RATE OFFSET 50

Set ECG alarm type to learned or fixed limits SELECT PARAMETER CURSOR

í˘ą

CHANGE VALUE

CURSOR

PAGE 1 OF 7

í˘˛

í˘ł

í˘´

PRINT PAGE

STORE

í˘ľ

í˘ś

Figure 7-1: ECG User Settings Screen

í˘ą CURSORâ&#x2020;&#x2018; AND CURSORâ&#x2020;&#x201C; keys scroll through the two columns of parameters on the screen.

í˘˛ â&#x2020;&#x2018; and â&#x2020;&#x201C; keys scroll the list of valid settings for the highlighted parameter. í˘ł PREV PAGE key returns to the previous screen. í˘´ NEXT PAGE key advances to the next screen. í˘ľ PRINT PAGE key prints the current screen. í˘ś STORE key stores the currently selected settings as defaults.

Setting User-Defined Default Values Use the User Settings screens to change and store settings. If the setting for the selected parameter cannot be changed, the message THIS SETTING CANNOT BE CHANGED will be displayed. The ability to access the Module Configuration Manager screens can either be visible to all users or remain hidden. The factory default setting is Invisible. Adjust the DEFAULT STORAGE key to the Visible setting in the ECG configuration table to enable user access to this function.

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Ultraview Care Network

Storing Changed Settings Touch the STORE key after entering configuration changes for any parameter in the module. This action stores only the currently selected settings for all parameters in that module. The Patient Admit/Discharge function (available in the ECG configuration screen) allows you to SAVE the changes in the alarm limit settings as the default settings for future patients, or RESTORE the original default settings upon discharge of that patient or admission of a new patient. The Save setting is commonly used in environments where multiple patients are monitored for short periods of time, for example, the operating room. Selecting SAVE allows you to save specific settings from patient to patient until the module is removed or the monitor is powered OFF. The Restore setting is more commonly used in environments where it is desirable to initialize alarm limit settings for each patient, for example, the critical care unit or the intensive care unit. Selecting RESTORE returns the module to the default settings upon patient admission or discharge. Your selection on the ECG Configuration screen applies to all parameters.

Selecting Alarm Attributes The Alarm Watch feature can be independently configured for all parameters including: tone types (high, medium, low, or none). Whether a specific alarm condition triggers an automatic recording or whether alarms will be watched under the Alarm Watch feature. In the Monitor Setup menu, individual parameters may be selected for automatic alarm recording. If alarm recording is enabled for a particular parameter, for example ECG, you can further specify which alarms will generate a recording. You can also specify which alarms will be watched using the Alarm Watch feature. For example, if you have selected a patient for Alarm Watch, but you do not want to be alerted to LEAD OFF conditions remotely, select Alarm Watch OFF for that condition in the corresponding Alarm Attributes screens. Refer to the Alarm Attributes tables in this chapter for available user-defined settings and factory defaults for the individual parameters.

7-6

Module Configuration Manager

Parameter Configurations ECG To review or change settings: 1 2 3 4 5 6a 6b 6c 6d 6e 6f 6g 7

8 9 10

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch USER SETTINGS. Select ECG. or Select RESP. or Select VARITREND. or Select PRESSURE. or Select SPO2. or Select NIBP. or Select TEMP. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. Use ↑ and ↓ to change the settings. Touch NEXT PAGE to continue to next screen of parameters. Touch STORE to save the new settings.

Heart rate alarms can be set to fixed values or based upon the patient’s learned heart rate. The learned heart rate is known as a result of ECG monitoring. If the learned option is selected, you must specify high and low offset values. The high and low rate alarm limits specify boundaries of the maximum available settings. To automatically set heart rate alarms to: •

40 beats above and 40 beats below the patient's learned heart rate

•

not to exceed a high rate of 200 and a low rate of 30

Adjust the default settings as follows: Type HIGH RATE

Learned 200

LOW RATE

HIGH RATE OFFSET

LOW RATE OFFSET

When selecting the fixed option, you only need to adjust the high and low rate settings. Heart rate alarms can be set independently for the adult mode and the infant mode. In the infant mode, you can select a delay between the time of initiation of monitoring and alarm activation (0-3 minutes). This provides a period of time for the patient to calm down after electrode application. ST alarms can be set to identify regional and global changes. Specific leads can be selectively included or excluded to provide more specific information. The Check Setup feature provides a visual and audible prompt for you to assess the patient setup before initiating monitoring or following a monitor reset or ECG module change. You can disable this feature by setting it to OFF.

7-7

Ultraview Care Network

If you do not want to suspend ECG processing or disable ECG alarms, set the CONTROL setting to OFF.

â&#x20AC;˘

For telemetry, some settings may or may not be available depending on whether the module is used in a central or bedside monitor.

â&#x20AC;˘

For Ultraview Digital Telemetry (multiparameter), default settings for SpO2 and NIBP may be found as part of the ECG channel. Telemetry ECG parameter configuration and alarm attributes are found in separate tables in this chapter following the tables for the hardwired (non-telemetry) products. Refer to Table 1: ECG Parameter Configuration and Table 2: ECG Alarm Attributes for non-telemetry products. Refer to Table 3: ECG Parameter Configuration (Telemetry Only) and Table 4: ECG Alarm Attributes (Telemetry Only) for telemetry products. Table 1: ECG Parameter Configuration

Parameter

Factory Defaults

Available User Settings

ECG Rate Alarms (Adult) Rate Alarm Type

Learned or fixed limits

Learned

High Rate Alarm Limit

5 to 300 BPM

180 BPM

Low Rate Alarm Limit

0 to 200 BPM

40 BPM

High Rate Offset 5 to 80 BPM (only applies to learned limits)

50 BPM

Low Rate Offset 5 to 80 BPM (only applies to learned limits)

50 BPM

ECG Rate Alarms (infant)

7-8

Rate Alarm Type

Learned or fixed limits

Fixed

High Rate Alarm Limit

5 to 300 BPM

220 BPM

Low Rate Alarm Limit

0 to 200 BPM

100 BPM

High Rate Offset 5 to 80 BPM (only applies to learned limits)

50 BPM

Low Rate Offset 5 to 80 BPM (only applies to learned limits)

50 BPM

Infant Alarm Delay (for ECG and Resp alarms)

0 to 3 minutes

3 minutes

ECG Mode

Adult/Infant

Adult

Sweep Speed

50, 25, or 12.5 mm/sec.

25 mm/sec.

Respiration

On/Off

Varitrend

On/Off

Off

QRS Tone (local only)

On/Off

Off

QRS Volume (local only)

1 (soft) to 8 (loud)

SpO2 Pitch Modulation of QRS Tone

On/Off

Off

User Settings

Module Configuration Manager

Parameter

Factory Defaults

Available User Settings

Display Resolution

Monitor/Extended

Monitor

Arrhythmia Processing

On/Off

Abnormals in a Row

2 to 10 or Off

Abnormals/Minute

1 to 99 or Off

Off

Review

On/Off

1st Lead Selection

Limb, V, or augmented lead

1st Lead Waveform Size

2.00 mV/cm - 0.10 mV/cm

0.50 mV/cm

2nd Lead Selection

Limb, V, or augmented lead

2nd Lead Waveform Size

2.00 mV/cm - 0.10 mV/cm

0.50 mV/cm

ST Alarm (single lead)

0.00 mm (Off) to 9.00 mm

1.0 mm

ST Alarm (multi-lead)

0.00 mm (Off) to 8.75 mm

0.50 mm

ST Alarm (I)

On/Off

ST Alarm (II)

On/Off

ST Alarm (III)

On/Off

ST Alarm (AVR)

On/Off

ST Alarm (AVL)

On/Off

ST Alarm (AVF)

On/Off

ST Alarm (V1)

On/Off

ST Alarm (V2)

On/Off

ST Alarm (V3)

On/Off

ST Alarm (V4)

On/Off

ST Alarm (V5)

On/Off

ST Alarm (V6)

On/Off

Automatic Lead Switch

On/Off

Single Lead Alarm

On/Off

Off

Primary Rate Source

ECG/ART/SPO2/UA

ECG

Alternate Rate Source (ECG)

On/Off

Alternate Rate Source (ART)

On/Off

Alternate Rate Source (SPO2) On/Off

Alternate Rate Source (UA)

On/Off

Enhanced Vital Signs

On/Off

Off

Display Format

Full view, Split view, 2-lead, 1-lead, or Cascade

1-lead

Save ST Time Interval

Off, 5, 10, 15, 30, or 60 minutes

15 minutes

User Settings

7-9

Ultraview Care Network

Parameter

Factory Defaults

Available User Settings

ST Trend Scale

-5 to 0 mm 0 to 5 mm -2 to 0 mm 0 to 2 mm -1 to 1 mm -2 to 2 mm -5 to 5 mm -10 to 10 mm

+/- 2.0 mm

ST Trend Timebase

1.5, 3, 6, 12, or 24 hours

6 hours

Real-Time ST Trend

On/Off

Off

Real-Time Trend Timebase

15 or 30 minutes

30 minutes

Auto Report

Off; 30 minutes; 1, 2, 4, 8, 24 hours

Off

Auto Print

On/Off

Off

Report Format

Standard -1, Cabrera-1, Standard-3, Cabrera-3

Standard-1

Check Setup

On/Off

Line Frequency

50 Hz, 60 Hz

60 Hz

Control

On/Off

Default Storage Key

Visible/Invisible

Invisible

Patient Admit/Discharge

Save/Restore

Restore

Select HLO Parameters

ECG1/P1, ECG1/RESP, ECG1/ECG2, P1/P2

ECG1/P1

User Settings

Table 2: ECG Alarm Attributes

7-10

User Settings

Factory Defaults

Available User Settings

Alarm Watch

User Settings

Factory Defaults

Available User Settings

User Settings

Alarm Type

Alarm Recording

Factory Defaults

Available User Settings

Tone Type

Asystole

VFIB

High Rate

H,M,L,N

Y,N

Low Rate

H,M,L,N

Y,N

Run

H,M,L,N

Y,N

Couplet

H,M,L,N

Y,N

Module Configuration Manager

Factory Defaults

Tach

H,M,L,N

Y,N

ABN/MIN

H,M,L,N

Y,N

ST Single-lead

H,M,L,N

Y,N

ST Multi-lead

H,M,L,N

Y,N

Classes Full

H,M,L,N

Y,N

CH 1 & 2 Lead Off H,M,L,N

Y,N

CH 1 Lead Off

H,M,L,N

Y,N

CH 2 Lead Off

H,M,L,N

Y,N

Low Voltage

H,M,L,N

Y,N

Noisy Signal

H,M,L,N

Y,N

HR Unavailable

H,M,L,N

Y,N

User Settings

Alarm Watch Available User Settings

User Settings

Factory Defaults

User Settings

Available User Settings

Alarm Recording

Factory Defaults

Alarm Type

Available User Settings

Tone Type

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

•

Alarm attributes for asystole and ventricular fibrillation cannot be changed. •

If ECG alarms are enabled, episodes of asystole and ventricular fibrillation will always trigger a high alarm tone.

•

If ECG alarm recording is enabled, asystole and ventricular fibrillation will always trigger a recording.

•

If Alarm Watch is enabled for a patient, asystole and ventricular fibrillation will always trigger an alarm notification.

•

Setting tone type to NONE automatically sets alarm recording and alarm watch to NO for that alarm. Changing tone type from NONE to any other setting returns alarm recording and alarm watch to factory defaults.

•

Setting tone type to NONE for high rate, low rate, ABN/MIN, or run causes the affected alarm limit to be displayed in reverse video in the ECG display zone.

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Ultraview Care Network

Table 3: ECG Parameter Configuration (Telemetry Only)

Parameter

7-12

Factory Defaults

Available User Settings

ECG Rate Alarms (Adult)

Rate Alarm Type

Learned/Fixed

Learned

High Rate Alarm Limit

5 to 300 BPM

180 BPM

Low Rate Alarm Limit

0 to 200 BPM

40 BPM

High Rate Offset (only applies to learned limits)

5 to 80 BPM

50 BPM

Low Rate Offset (only applies to learned limits)

5 to 80 BPM

50 BPM

ECG Rate Alarms (Infant)

Rate Alarm Type

Learned/Fixed

Learned

High Rate Alarm Limit

5 to 300 BPM

220 BPM

Low Rate Alarm Limit

0 to 200 BPM

100 BPM

High Rate Offset (only applies to learned limits)

5 to 80 BPM

50 BPM

Low Rate Offset (only applies to learned limits)

5 to 80 BPM

50 BPM

Infant Alarm Delay (for ECG and Resp alarms)

0 to 3 minutes

3 minutes

2nd Lead Display

On/Off

Off

ECG Mode

Adult/Infant

Adult

Sweep Speed

50, 25, or 12.5 mm/sec.

25 mm/sec.

Enhanced Vital Signs

On/Off

Off

ST Trend Timebase

1.5, 3, 6, 12, or 24 hours

6 hours

QRS Tone (local only)

On/Off

Off

QRS Volume (local only)

1 (soft) to 8 (loud)

SpO2 Pitch Modulation of QRS Tone On/Off

Off

Display Resolution

Monitor

Monitor/Extended

Arrhythmia Processing

On/Off

Abnormals in a Row

2 to 10 or Off

Abnormals/Minute

1 to 99 or Off

Off

Review

On/Off

1st Lead Selection

Limb, V, augmented or MCL lead VI

1st Lead Waveform Size

2.00 mV/cm - 0.10 mV/cm

0.5 mV/cm

2nd Lead Selection

Limb, V, augmented or MCL lead II

2nd Lead Waveform Size

2.00 mV/cm - 0.10 mV/cm

0.5 mV/cm

ST Level Alarm (channel 1)

On/Off

Off

ST Level Alarm Type

Learned/Fixed

Learned

High Level Alarm Limit (only applies to fixed limits)

-8.75 mm to 9.00 mm

1.00 mm

Low Level Alarm Limit (only applies to fixed limits)

-9.00 mm to 8.75 mm

- 1.00 mm

User Settings On

Module Configuration Manager

Parameter

Factory Defaults

Available User Settings

High Level Offset (only applies to learned limits)

0.25 mm to 9.00 mm

1.00 mm

Low Level Offset (only applies to learned limits)

0.25 mm to 9.00 mm

1.00 mm

ST Change Alarm (channel 1)

On/Off

Off

Max-Min. Change Within 5 Minutes (delta)

0.25 mm to 9.00 mm

1.00 mm

ST Level Alarm (channel 2)

On/Off

Off

ST Level Alarm Type

Learned/Fixed

Learned

High Level Alarm Limit (only applies to fixed limits)

-8.75 mm to 9.00 mm

1.00 mm

Low Level Alarm Limit (only applies to fixed limits)

-9.00 mm to 8.75 mm

- 1.00 mm

High Level Offset (only applies to learned limits)

0.25 mm to 9.00 mm

1.00 mm

Low Level Offset (only applies to learned limits)

0.25 mm to 9.00 mm

1.00 mm

ST Change Alarm (channel 2)

On/Off

Off

Max-Min. Change Within 5 Minutes (delta)

0.25 mm to 9.00 mm

1.00 mm

Check Setup Key

On/Off

Line Frequency

50 Hz, 60 Hz

60 Hz

Control (controls ALARM ON/OFF and SUSPEND PROCESSING keys)

On/Off

Automatic Lead Switch

On/Off

Single Lead Alarm

On/Off

Off

Default Storage Key

Visible/Invisible

Invisible

Low Battery Alarm

On/Off

Patient Record

On/Off

Off

Telemetry Bed Assignment

Temporary/Permanent

Temporary

Patient Admit/Discharge

Save/Restore

Restore

Frequency Band

North America UHF, North America VHF, European Telecom, United Kingdom, Australia, Spain, Sweden, Finland, New Zealand, Norway, Singapore, South Africa

North America UHF

Primary Heart Rate Source

ECG/ART/SPO2/UA

ECG

Alternate Rate Source (ECG)

On/Off

Alternate Rate Source (ART)

On/Off

Alternate Rate Source (SPO2)

On/Off

Alternate Rate Source (UA)

On/Off

Multiparameter Telemetry

On/Off

Telemetry SpO2 Alarms (only if multiparameter is On)

User Settings

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Ultraview Care Network

Parameter SpO2 High Limit (only if multiparameter is On)

51% - 100%

100%

SpO2 Low Limit (only if multiparameter is On)

50% - 99%

85%

SpO2 Limit Alarm Delay (only if multiparameter is On)

0 to 30 seconds

15 seconds

SpO2 Message Alarm Delay (only if multiparameter is On)

0 to 60 seconds

20 seconds

Telemetry NIBP Alarms (only if multiparameter is On)

NIBP Systolic High Limit (only if multiparameter is On)

35 to 260 mmHg

150 mmHg

NIBP Systolic Low Limit (only if multiparameter is On)

30 to 255 mmHg

100 mmHg

NIBP Diastolic High Limit (only if multiparameter is On)

35 to 260 mmHg

100 mmHg

NIBP Diastolic Low Limit (only if multiparameter is On)

30 to 255 mmHg

60 mmHg

NIBP Mean High Limit (only if multiparameter is On)

35 to 260 mmHg

110 mmHg

NIBP Mean Low Limit (only if multiparameter is On)

30 to 255 mmHg

90 mmHg

7-14

Factory Defaults

Available User Settings

â&#x20AC;˘

User Settings

Multiparameter telemetry displays ECG, SpO2, and NIBP data all in the ECG channel. Alarm messages are displayed in order of priority.

Module Configuration Manager

Table 4: ECG Alarm Attributes (Telemetry Only)

User Settings

Factory Defaults

Available User Settings

Alarm Watch

User Settings

Factory Defaults

Available User Settings

User Settings

Alarm Type

Alarm Recording

Factory Defaults

Available User Settings

Tone Type

Asystole

VFIB

High Rate

H,M,L,N

Y,N

Low Rate

H,M,L,N

Y,N

Run

H,M,L,N

Y,N

Couplet

H,M,L,N

Y,N

Tach

H,M,L,N

Y,N

ABN/MIN

H,M,L,N

Y,N

ST High/Low

H,M,L,N

Y,N

ST Change

H,M,L,N

Y,N

Classes Full

H,M,L,N

Y,N

CH 1 & 2 Lead Off H,M,L,N

Y,N

CH 1 Lead Off

H,M,L,N

Y,N

CH 2 Lead Off

H,M,L,N

Y,N

Low Voltage

H,M,L,N

Y,N

Noisy Signal

H,M,L,N

Y,N

Squelch

H,M,L,N

Y,N

Signal Interference

H,M,L,N

Y,N

Low Battery

H,M,L,N

Y,N

SpO2 Monitor Fail

H,M,L,N

SpO2 High Limit

H,M,L,N

Y,N

SpO2 Low Limit

H,M,L,N

Y,N

SpO2 Faulty Sensor

H,M,L,N

SpO2 Sensor Disconnected

H,M,L,N

SpO2 Ambient Light Intf.

H,M,L,N

7-15

Ultraview Care Network

H,M,L,N

SpO2 Insufficient Signal

H,M,L,N

SpO2 Noisy Signal

H,M,L,N

NIBP Cable Disconnected

H,M,L,N

NIBP Unavailable (xx)

H,M,L,N

NIBP Reading Failure (xx)

H,M,L,N

NIBP Air Leak

H,M,L,N

NIBP Loose or No Cuff

H,M,L,N

NIBP Patient Cancelled

H,M,L,N

NIBP Low Battery

H,M,L,N

NIBP Low Battery Backup

H,M,L,N

NIBP Kinked Hose

H,M,L,N

NIBP Event Code (xx)

H,M,L,N

NIBP Sys High Limit

H,M,L,N

Y,N

NIBP Sys Low Limit

H,M,L,N

Y,N

NIBP Dia High Limit

H,M,L,N

Y,N

NIBP Dia High Limit

H,M,L,N

Y,N

NIBP Mean High Limit

H,M,L,N

Y,N

NIBP Mean Low Limit

H,M,L,N

Y,N

User Settings

Factory Defaults

Available User Settings

SpO2 Sensor Off Patient

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

7-16

Alarm Watch

User Settings

Factory Defaults

Available User Settings

Alarm Recording

User Settings

Factory Defaults

Alarm Type

Available User Settings

Tone Type

Module Configuration Manager

•

Messages and alarms beginning with “SpO2” or “NIBP” apply only when the Ultraview Multiparameter Digital Telemetry transmitter is used and multiparameter operation is enabled by the MCM Multiparameter Telemetry ON setting. [Refer to Table 3: ECG Parameter Configuration (Telemetry Only)].

•

Alarm attributes for asystole and ventricular fibrillation cannot be changed. •

If ECG alarms are enabled, episodes of asystole and ventricular fibrillation will always trigger a high alarm tone.

•

If ECG alarm recording is enabled, asystole and ventricular fibrillation will always trigger a recording.

•

If Alarm Watch is enabled for a patient, asystole and ventricular fibrillation will always trigger an alarm notification.

•

Setting tone type to NONE for high rate, low rate, ABN/MIN, or run causes the affected alarm limit to be displayed in reverse video in the ECG display zone.

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Ultraview Care Network

Respiration To review or change Respiration settings: 1 2 3 4

Respiration alarms can be set independently for the adult and infant mode. In the adult mode, respiratory rate alarms can be set as determined following initiation of respiratory monitoring. If you select the learned option, the high rate alarm limit is set at 1.5 times the learned rate. The low rate alarm limit is set to 0. The high limit is never automatically set above 150 breaths per minute (BPM) or lower than 30 BPM in the learned model.

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key three times. 5 Touch USER SETTINGS. • Respiratory rate and apnea alarms cannot be disabled in the 6 Select RESP. infant mode. 7 Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 8 Use ↑ and ↓ to change the settings. Table 5: Respiration Parameter Configuration 9 Touch NEXT PAGE to continue to next screen of parameters. 10 Touch STORE to save the new Available User Factory User Parameter settings. Settings Defaults Settings 11 Touch YES when the STORE Rate Alarms (adult) On/Off Off ALL CHANNEL DEFAULTS High Rate Alarm Type Learned/Fixed Learned message is displayed. High Rate Alarm Limit 1 to 200 breaths/min. 50 breaths/min. (only applies to fixed limits)

7-18

Low Rate Alarm Limit (only applies to fixed limits)

0 to 195 breaths/min.

Apnea Alarm

On/Off

Off

Apnea Duration

5 to 40 seconds

20 sec.

Breathing Pattern

Shallow/Normal

Normal

Rate Alarms (infant)

High Rate Alarm Type

Learned/Fixed

Fixed

High Rate Alarm Limit

1 to 200 breaths/min.

100 breaths/min.

Low Rate Alarm Limit

0 to 195 breaths/min.

10 breaths/min.

Apnea Alarm

Apnea Duration

5 to 40 seconds

20 sec.

Breathing Pattern

Shallow/Normal

Shallow

Waveform Display

On/Off

Waveform Size

2.00 - 0.10 ohms/cm

1.00 ohms/cm

CVA Filter

On/Off

Lead Selection

RA-LA, RL-LA, RA-LL, RL-LL

RA-LA

Sweep Speed

25,12.5, 6.25 or 1.56 mm/sec.

12.5 mm/sec.

Breath Tone (local only)

On/Off

Off

Breath Tone Volume (local only)

1 (soft) to 8 (loud)

Module Configuration Manager

Table 6: Respiration Alarm Attributes

Apnea

High Rate

H,M,L,N

Low Rate Loss of Signal

Y,N

H,M,L,N

Y,N

User Settings

Factory Defaults

Available User Settings

Alarm Watch

User Settings

Factory Defaults

Available User Settings

User Settings

Alarm Type

Alarm Recording

Factory Defaults

Available User Settings

Tone Type

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

•

Alarms attributes for apnea cannot be changed. •

If RESP alarms are enabled, episodes of apnea will always trigger a high alarm tone.

•

If RESP alarm recording is enabled, apnea will always trigger a recording.

•

If Alarm Watch is enabled for a patient, apnea will always trigger an alarm notification.

•

Setting tone type to NONE for high rate or low rate alarms causes the affected alarm limit to be displayed in reverse video in the RESP display zone.

7-19

Ultraview Care Network

Varitrend 3 To review or change Varitrend 3 settings: 1 2 3 4 5 6 7

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch USER SETTINGS. Select VARITREND. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 8 Use ↑ and ↓ to change the settings. 9 Touch NEXT PAGE to continue to next screen of parameters. 10 Touch STORE to save the new settings. 11 Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

7-20

Default settings and individual parameter scales for the Varitrend timebase and display are adjustable. Definitions for up to five events can be pre-selected to describe concurrent changes in heart rate, respiration rate, or saturation level that may be of specific clinical interest. Table 7: Varitrend 3 Parameter Configuration Parameter

Available User Settings

Factory Defaults

Trend Timebase

1.5 min. or 3.0 min.

1.5 min.

Resp Display

Rate or waveform

Waveform

Resp Waveform Size

+/- 0.3 ohms +/- 0.5 ohms +/- 1.0 ohms +/- 2.0 ohms +/- 6.0 ohms

+/- 2.0 ohms

Resp Rate Scale

AUTOSCALE 0 to 50 0 to100 0 to150 0 to 200

AUTOSCALE

Heart Rate Scale

AUTOSCALE 0 to100 0 to150 50 to150 0 to 200 100 to 200 0 to 250 100 to 250 0 to 300 100 to 300

AUTOSCALE

SpO2 Scale

AUTOSCALE 0 to100 25 to100 50 to100 75 to100

AUTOSCALE

Auto Alarm Recording

On/Off

Off

Bradycardia Limit (event 1)

0 to150 BPM or Off

Off

Tachycardia Limit (event 1)

100 to 300 BPM or Off Off

Apnea Limit (event 1)

10 to 40 seconds or Off

Off

SpO2 Limit (event 1)

25 to 95% or Off

Off

Bradycardia Limit (event 2)

0 to150 BPM or Off

Off

Tachycardia Limit (event 2)

100 to 300 BPM or Off Off

Apnea Limit (event 2)

10 to 40 seconds or Off

Off

User Settings

Module Configuration Manager

Parameter

Available User Settings

Factory Defaults

SpO2 Limit (event 2)

25 to 95% or Off

Off

Bradycardia Limit (event 3)

0 to150 BPM or Off

Off

Tachycardia Limit (event 3)

100 to 300 BPM or Off Off

Apnea Limit (event 3)

10 to 40 seconds or Off

Off

SpO2 Limit (event 3)

25 to 95% or Off

Off

Bradycardia Limit (event 4)

0 to150 BPM or Off

Off

Tachycardia Limit (event 4)

100 to 300 BPM or Off Off

Apnea Limit (event 4)

10 to 40 seconds or Off

Off

SpO2 Limit (event 4)

25 to 95% or Off

Off

Bradycardia Limit (event 5)

0 to150 BPM or Off

Off

Tachycardia Limit (event 5)

100 to 300 BPM or Off Off

Apnea Limit (event 5)

10 to 40 seconds or Off

Off

SpO2 Limit (event 5)

25 to 95% or Off

Off

User Settings

7-21

Ultraview Care Network

Non-Invasive Blood Pressure To review or change NIBP settings: 1 2 3 4 5 6 7

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch USER SETTINGS. Select NIBP. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 8 Use ↑ and ↓ to change the settings. 9 Touch NEXT PAGE to continue to next screen of parameters. 10 Touch STORE to save the new settings. 11 Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

7-22

Non-invasive blood pressure (NIBP) alarms can be set independently for the adult and infant modes. Default settings for systolic, diastolic and mean alarm limits are fully adjustable within the specified ranges. To have measurements automatically initiated at regular intervals, you can select from the list of AUTO INTERVALS. After connecting a cuff to the patient, set AUTO to ON in the NIBP menu and NIBP measurements will be automatic. Table 8: NIBP Parameter Configuration Table Parameter

Available User Settings

Factory Defaults

Systolic Alarm (adult)

On/Off

Off

High Alarm Limit

45 to 260 mmHg

150 mmHg

Low Alarm Limit

40 to 255 mmHg

100 mmHg

Diastolic Alarm (adult)

On/Off

Off

High Alarm Limit

45 to 260 mmHg

100 mmHg

Low Alarm Limit

40 to 255 mmHg

60 mmHg

Mean Alarm (adult)

On/Off

Off

High Alarm Limit

45 to 260 mmHg

110 mmHg

Low Alarm Limit

40 to 255 mmHg

90 mmHg

Systolic Alarm (infant)

On/Off

Off

High Alarm Limit

15 to 150 mmHg

85 mmHg

Low Alarm Limit

10 to 145 mmHg

55 mmHg

Diastolic Alarm (infant) On/Off

Off

High Alarm Limit

15 to 150 mmHg

75 mmHg

Low Alarm Limit

10 to 145 mmHg

45 mmHg

Mean Alarm (infant)

On/Off

Off

High Alarm Limit

15 to 150 mmHg

80 mmHg

Low Alarm Limit

10 to 145 mmHg

50 mmHg

NIBP Mode

Adult/Neonate

Adult

Display Pulse Rate

Yes/No

Yes

Auto interval

1 to 10 minutes by 1 15 minutes 15 to 55 minutes by 5 1, 2, 4, or 8 hours

User Settings

Module Configuration Manager

Table 9: NIBP Alarm Attributes

Factory Defaults

Systolic

H,M,L,N

Y,N

Diastolic

H,M,L,N

Y,N

Mean

H,M,L,N

Y,N

No Reading

H,M,L,N

Y,N

System Fault

H,M,L,N

Y,N

Remove Cuff

H,M,L,N

Y,N

User Settings

Alarm Watch Available User Settings

User Settings

Factory Defaults

Available User Settings

Alarm Recording

User Settings

Factory Defaults

Alarm Type

Available User Settings

Tone Type

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

7-23

Ultraview Care Network

Temperature

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch USER SETTINGS. Select TEMP. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 8 Use ↑ and ↓ to change the settings. 9 Touch STORE to save the new settings. 10 Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed. Module Configurations without ECG

Default Storage Key

Visible/Invisible

Invisible

Patient Admit/Discharge

Save/Restore

Restore

Off

High Alarm Limit

0.1° - 50.0°C

37.5°C

Low Alarm Limit

0.0° - 49.9°C

36.5°C

Temperature 2 Alarms

On/Off

Off

High Alarm Limit

0.1° - 50.0°C

37.5°C

Low Alarm Limit

0.0° - 49.9°C

36.5°C

Delta Alarms

On/Off

Off

High Alarm Limit

0.1° - 50.0°C

2.0°C

Low Alarm Limit

0.0° - 49.9°C

0.0°C

Table 11: Temperature Alarm Attributes Alarm Watch

T1 High Limit H,M,L,N

Y,N

T1 Low Limit

H,M,L,N

Y,N

T2 High Limit H,M,L,N

Y,N

T2 Low Limit

H,M,L,N

Y,N

DT High Limit

H,M,L,N

Y,N

DT Low Limit

H,M,L,N

Y,N

User Settings

Alarm Type

Alarm Recording

User Settings

Tone Type

Factory Defaults

On/Off

Available User Settings

User Settings

Factory Defaults

Temperature 1 Alarms

User Settings

Touch TEMP. Touch the hidden key 3 times. Touch USER SETTINGS. Select TEMP. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. Use ↑ and ↓ to change the settings. Touch STORE to save the new settings. Touch YES when the STORE ALL CHANNEL DEFAULTS is displayed.

Available User Settings

Parameter

Factory Defaults

1 2 3 4 5

Table 10: Temperature Parameter Configuration

Available User Settings

1 2 3 4 5 6 7

Factory Defaults

Module Configurations with ECG

Default settings for high and low temperature alarm limits are adjustable, as well as the settings for the delta temperature.

Available User Settings

To review or change Temperature settings:

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

! 7-24

•

Setting the tone type to NONE automatically sets the alarm recording and alarm watch to NO for that alarm. Changing the tone type from NONE to any other setting returns the alarm recording and alarm watch to the factory defaults.

Module Configuration Manager

Invasive Pressure To review or change Invasive Pressure settings: Module Configurations with ECG 1 2 3 4 5 6 7

Invasive pressure parameters can be independently configured for each of two or four pressure channels. The alarm type must be set to Fixed for the user-defined alarm limit settings to be functional for high and low pressure alarm limits. If the alarm type is set to the Learned mode, high and low alarm limits are set according to the patient’s learned pressure.

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch USER SETTINGS. Select PRESSURE. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 8 Use ↑ and ↓ to change the settings. 9 Touch NEXT PAGE to continue to next screen of parameters. 10 Touch STORE to save the new settings. 11 Touch YES when the STORE ALL CHANNEL DEFAULTS is displayed.

Label (P3)

PRS

Module configurations without ECG

ICP, LAP, RAP, CVP, PA, ART, UA, UV, or PRS

Scales

On/Off/Auto

Off

Top of Scale

10 to 500 mmHg

200 mmHg

Filter Frequency

3, 8, 12, 15, 18, 21, 25, 30, 12 Hz 35, 40 Hz

Sweep Speed

50, 25, 12.5, 6.25 mm/sec., Same as ECG or same as ECG

1 2 3 4 5

6 7 8 9

Touch TEMP. Touch the hidden key 3 times. Touch USER SETTINGS. Select PRESSURE. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. Use ↑ and ↓ to change the settings. Touch NEXT PAGE to continue to next screen of parameters. Touch STORE to save the new settings. Touch YES when the STORE ALL CHANNEL DEFAULTS is displayed.

The factory default label is: • • • •

ART for the first pressure channel label PA for the second pressure channel PRS for the third channel CVP for the fourth channel

The associated alarm limit defaults correspond to typical pressure values for the respective catheter site. Table 12: Invasive Pressure Parameter Configuration Parameter

Available User Settings

Factory Defaults

Artifact Rejection On/Off

Off

Numeric Size

Systolic/Diastolic Large Mean Large All Large

Systolic/Diastolic Large

Alarm Type

Learned/Fixed

Learned

Systolic Alarm

On/Off

Off

High Alarm Limit -45 to 300 mmHg or Off

180 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

100 mmHg

Diastolic Alarm

On/Off

Off

High Alarm Limit -45 to 300 mmHg or Off

120 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

60 mmHg

Mean Alarm

On/Off

Off

High Alarm Limit -45 to 300 mmHg or Off

130 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

80 mmHg

CPP Alarm

On/Off

Off

High Alarm Limit -45 to 300 mmHg or Off

50 mmHg

Low Alarm Limit

0 mmHg

-50 to 295 mmHg or Off

User Settings

7-25

Ultraview Care Network

Table 13: Pressure Parameter Configuration Table (Channel 1) Parameter

7-26

Available User Settings

Factory Defaults

Label (P1)

ICP, LAP, RAP, CVP, PA, ART, UA, UV, PRS

ART

Scales

On/Off

Off

Top of Scale

10 to 500 mmHg or Auto

200 mmHg

Filter Frequency

3, 8, 12, 15, 18, 21, 25, 30, 35, 40 Hz

12 Hz

Sweep Speed

50, 25, 12.5, 6.25 mm/sec., or same as ECG

same as ECG

Artifact Rejection

On/Off

Off

Numeric Size

Sys/Dia Large Mean Large All Large

Sys/Dia Large

Alarm Type

Learned/Fixed

Learned

Systolic Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

180 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

100 mmHg

Diastolic Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

120 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

60 mmHg

Mean Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

130 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

80 mmHg

CPP Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

50 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

0 mmHg

User Settings

Module Configuration Manager

Table 14: Pressure Parameter Configuration Table (Channel 2) Parameter

Available User Settings

Factory Defaults

Label (P2)

ICP, LAP, RAP, CVP, PA, ART, UA, UV, or PRS

Scales

On/Off/Auto

Off

Top of Scale

10 to 500 mmHg

50 mmHg

Filter Frequency

3, 8, 12, 15, 18, 21, 25, 30, 35, 40 Hz

12 Hz

Sweep Speed

50, 25, 12.5, 6.25 mm/sec., or same as ECG

Same as ECG

Artifact Rejection

On/Off

Numeric Size

Systolic/Diastolic Large Mean Large All Large

Systolic/Diastolic Large

Alarm Type

Learned/Fixed

Learned

Systolic Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

50 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

10 mmHg

Diastolic Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

20 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

0 mmHg

Mean Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

20 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

5 mmHg

CPP Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

50 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

0 mmHg

User Settings

7-27

Ultraview Care Network

Table 15: Pressure Parameter Configuration Table (Channel 4) Parameter

7-28

Available User Settings

Factory Defaults

Label (P4)

ICP, LAP, RAP, CVP, PA, ART, UA, UV, or PRS

CVP

Scales

On/Off/Auto

Off

Top of Scale

10 to 500 mmHg

50 mmHg

Filter Frequency

3, 8, 12, 15, 18, 21, 25, 30, 35, 40 Hz

12 Hz

Sweep Speed

50, 25, 12.5, 6.25 mm/sec, or same as ECG

Same as ECG

Artifact Rejection

On/Off

Off

Numeric Size

Systolic/Diastolic Large Mean Large All Large

Systolic/Diastolic Large

Alarm Type

Learned/Fixed

Learned

Systolic Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

50 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

10 mmHg

Diastolic Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

20 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

0 mmHg

Mean Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

20 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

5 mmHg

CPP Alarm

On/Off

Off

High Alarm Limit

-45 to 300 mmHg or Off

50 mmHg

Low Alarm Limit

-50 to 295 mmHg or Off

0 mmHg

User Settings

Module Configuration Manager

Table 16: Invasive Pressure Alarm Attributes

CH1 Systolic

Factory Defaults

H,M,L,N

Y,N

CH1 Diastolic H,M,L,N

Y,N

CH1 Mean

H,M,L,N

Y,N

CH1 CCP

H,M,L,N

Y,N

CH2 Systolic

H,M,L,N

Y,N

CH2 Diastolic H,M,L,N

Y,N

CH2 Mean

H,M,L,N

Y,N

CH2 CCP

H,M,L,N

Y,N

CH3 Systolic

H,M,L,N

Y,N

CH3 Diastolic H,M,L,N

Y,N

CH3 Mean

H,M,L,N

Y,N

CH3 CCP

H,M,L,N

Y,N

CH4 Systolic

H,M,L,N

Y,N

CH4 Diastolic H,M,L,N

Y,N

CH4 Mean

H,M,L,N

Y,N

CH4 CCP

H,M,L,N

Y,N

User Settings

Alarm Watch Available User Settings

User Settings

Factory Defaults

Available User Settings

Alarm Recording

User Settings

Factory Defaults

Alarm Type

Available User Settings

Tone Type

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

â&#x20AC;˘

7-29

Ultraview Care Network

To review or change SpO2 settings: Module Configurations with ECG 1 2 3 4 5 6 7

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch USER SETTINGS. Select SPO2. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 8 Use ↑ and ↓ to change the settings. 9 Touch NEXT PAGE to continue to next screen of parameters. 10 Touch STORE to save the new settings. Module Configurations without ECG 1 2 3 4 5

6 7 8

Touch TEMP. Touch the hidden key 3 times. Touch USER SETTINGS. Select SPO2. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. Use ↑ and ↓ to change the settings. Touch NEXT PAGE to continue to next screen of parameters. Touch STORE to save the new settings.

7-30

SpO2 Default settings can be adjusted for high and low SpO2 alarm limits and settings for alarm priority. Table 17: SpO2 Parameter Configuration Parameter

Available User Settings

Factory Defaults

SpO2 Alarms

High Alarm limit

51 to 100%

100%

Low Alarm limit

50 to 99%

85%

Limit Alarm Delay

0 to 30 seconds

15 sec.

Message Alarm Delay

0 to 60 seconds

20 sec.

Data Averaging Time

4, 8, or 16 seconds

8 sec.

Pulse Tone (local only)

On/Off

Off

Pulse Tone Volume (local only)

1 (soft) to 8 (loud)

Pulse Rate Display

On/Off

Motion Detection

On/Off

User Settings

Module Configuration Manager

Table 18: SpO2 Alarm Attributes

Factory Defaults

High Limit

H,M,L,N

Y,N

Low Limit

H,M,L,N

Y,N

Adapter Disconnected

H,M,L,N

Y,N

Sensor Disconnected

H,M,L,N

Y,N

Sensor Off Patient

H,M,L,N

Y,N

Insufficient Signal

H,M,L,N

Y,N

Light Interference

H,M,L,N

Y,N

Noisy Signal

H,M,L,N

Y,N

Low Signal Strength

H,M,L,N

Y,N

User Settings

Alarm Watch Available User Settings

User Settings

Factory Defaults

Available User Settings

Alarm Recording

User Settings

Factory Defaults

Alarm Type

Available User Settings

Tone Type

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No

â&#x20AC;˘

Ultraview Digital Telemetry SpO2 default settings are described under ECG in Table 3: ECG Parameter Configuration (Telemetry Only) and Table 4: ECG Alarm Attributes (Telemetry Only).

7-31

Ultraview Care Network

Transferring User-Defined Settings To transfer user-defined settings from the module into the monitor: Module Configurations with ECG 1 2 3 4 5 6

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch TRANSFER SETTINGS. Select YES.

Once you have configured the settings on your module you may transfer these settings to the monitor for subsequent retrieval into other modules. (Refer to Retrieving User-Defined Settings on page 7-32.) When the transfer of settings into the monitor is complete, the transfer successful message will be displayed.

•

Module Configurations without ECG 1 2 3 4

User-defined default settings that have been transferred to the monitor’s memory are available for retrieval into other modules until (1) the monitor is powered OFF or (2) a patient is admitted to or discharged from that monitor with a Purge Data/Yes.

Touch TEMP. Touch the hidden key 3 times. Touch TRANSFER SETTINGS. Select YES.

Retrieving User-Defined Settings To retrieve user-defined settings from the monitor into another module:

To standardize the user-configurable options for similar modules, you can configure a single module and transfer its settings to the monitor for subsequent retrieval into other modules.

Module Configurations with ECG

First, transfer the settings from the configured module into the monitor. Insert a second module or remote module housing into the monitor and retrieve the settings.

1 2 3 4 5 6

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch RETRIEVE SETTINGS. Select YES.

Module Configurations without ECG 1 2 3 4

7-32

Touch TEMP. Touch the hidden key 3 times. Touch RETRIEVE SETTINGS. Select YES.

When the retrieval of data into the module is complete, a RETRIEVAL SUCCESSFUL message will be displayed. If settings have not been previously transferred into the monitor, a RETRIEVAL FAILED message will be displayed.

•

User-defined default settings that have been transferred to the monitor’s memory are available for retrieval into other modules until (1) a monitor is powered OFF or (2) a patient is admitted to or discharged from that monitor with a Purge Data/Yes.

•

Once retrieved, alarm ON/OFF status and alarm limits for all parameters will be reset according to the newly retrieved settings.

Module Configuration Manager

Restoring Factory Settings To restore factory settings: Module Configurations with ECG 1 2 3 4 5 6

Touch ECG. Touch SETUP. Touch CONFIG. Touch the hidden key 3 times. Touch FACTORY DEFAULTS. Select YES.

The Factory Default feature changes the user-configurable settings for all parameters in the module to the factory default settings.

â&#x20AC;˘

Alarm ON/OFF status and alarm limits for all parameters are reset to the factory default settings.

Module Configurations without ECG 1 2 3 4

Touch TEMP. Touch the hidden key 3 times. Touch FACTORY DEFAULTS. Select YES.

Restoring User-Defined Settings To restore user-defined settings: Module Configurations with ECG 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

The Restore Settings feature changes the user-configurable settings for all parameters in the module to the defaults previously stored as user settings.

â&#x20AC;˘

Once restored, alarm ON/OFF status and alarm limits for all parameters in the module are reset to the previously stored user settings.

Module Configurations without ECG 1 2 3

Touch TEMP. Touch RESTORE SETTINGS. Select YES.

7-33

ECG

Directory of Keys E C G

ECG MENU ALARM LIMITS

SIZE

LEAD CONTROL

SETUP

DISPLAY FORMAT

SUSPEND PROCESSING

RELEARN

REVIEW

ECG - REVIEW ST REVIEW

REPORT REVIEW

ARRHYTHMIA REVIEW

REAL TIME ST TREND

PRINT MENU ARR CLASSES

ST SEGMENTS

ALL LEADS

PRINT ALL

CANCEL PRINT

ECG - RELEARN CLEAR MEMORY

SAVE MEMORY TREND DISPLAY ON

ECG - SUSPEND PROCESSING YES

OFF

TREND TIMEBASE 15 MIN / 30 MIN

ECG - DISPLAY FORMAT SPLIT VIEW FULL VIEW ON OFF ON OFF

2 LEAD ON OFF

VARITREND ON OFF

RESP ON OFF

CASCADE ON OFF

NEXT VIEW

ECG - LEAD CONTROL 1st LEAD xx

2nd LEAD xx

AUTO LEAD SWITCH ON OFF

SINGLE LEAD ALARM ON OFF

ECG - SETUP SWEEP SPEED

PACED YES NO

MONITOR EXTENDED

QRS TONE

CONFIG

RATE SOURCE

RESTORE SETTINGS

TRANSFER DATA

RESTORE all user settings within this module YES Select primary heart rate source ECG

ART

SPO2

Enable alternate rate source(s) ECG ON OFF

ART ON OFF

UA ON OFF

SPO2 ON OFF

ECG - CONFIG ADULT INFANT

ARR ON OFF

ECG - QRS TONE TONE ON OFF

VOLUME

SPO2 PITCH ON OFF

ECG - SWEEP SPEED 50 mm/sec

25 mm/sec

12.5 mm/sec

ECG - SIZE SIZE

1 mV CAL

SIZE

1 mV/cm

ECG - ALARM LIMITS ALARMS ON OFF

HI= 130

•

LO= 40

ABN IN ROW=5

ABN PER MIN=OFF

SINGLE ST = 1.00

MULTI ST = 0.50

ST LEADS

Based on features purchased, more or fewer keys may appear here than on your menu screens.

8-1

ECG

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 ECG Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Selecting Adult or Neonate Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Monitoring Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Selecting ECG Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Displaying Additional Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Checking the ECG Amplitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Adjusting Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Changing the Display Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Selecting Primary and Alternate Heart Rate Source. . . . . . . . . . . . . . . . . . . . .14 Suspending/Resuming ECG Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Printing ECG Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 ECG Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 ECG Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Overview When used in conjunction with a Spacelabs Medical Ultraview Care Network monitor, the ECG function provides a means for continuous monitoring of electrocardiographic signals. It can detect abnormal cardiac rhythms, including life-threatening arrhythmias such as asystole, ventricular fibrillation, and ventricular tachycardia. The basic ECG software provides alarms for high and low heart rates, ventricular fibrillation, and asystole. The MultiView I option provides enhanced arrhythmia detection and alarm capability. MultiView 1 detects ventricular tachycardia, couplets, and single abnormal beats in addition to the detection and alarm capabilities of the basic ECG software. The MultiView II option expands arrhythmia detection to include pauses and tachycardias of a supraventricular origin. This option also offers storage capabilities so that trends of arrhythmia episodes, as well as dominant, ventricular-paced and AV-paced rhythms, can be reviewed, edited, and printed. Refer to Arrhythmia on page 9-1 for detailed information about the MultiView options. The diagnostic ECG feature, which meets all of the requirements and standards for electrocardiographic devices, provides the capability to obtain a diagnostic 12lead report as a function of the monitoring system. The 12-lead report is a set of diagnostic-quality electrocardiographic waveforms that accurately represent both the detailed cardiac cycle and the cardiac rhythm.

8-2

ECG

The ECG function: •

detects and displays a waveform representing each cardiac cycle

•

determines lead configuration options

•

displays heart rate (heart rate is computed from an average of eight beats with a provision for immediately updating the heart rate should the rate slow suddenly)

•

detects pacemaker pulses

•

initiates ECG-related alarms when limits are violated

•

acquires, displays, and prints diagnostic-quality 12-lead reports

ECG traces for multiple leads can be displayed, however, ECG monitoring is always performed on two leads. Lead faults are identified by a message on the screen. If automatic lead switching is enabled, the system automatically switches to another appropriate lead to continue monitoring in the event of a lead fault. WARNING: • Following a lead switch and until the patient’s rate and morphology are learned, some ECG alarms are not active. Alarms for ventricular fibrillation and asystole continue to be active. However, ECG alarms for high rate, low rate, run, couplet, abnormal per minute, and tachycardia are not.

•

Monitor input circuits are protected for electrosurgical equipment and defibrillator use.

•

Cardiac pacemakers or other electrical stimulators do not affect and are not affected by operation of this unit.

•

You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-1 for further information.

ECG Setup The ECG waveform area displays the CHECK SETUP key when: • • •

the monitor is powered ON a module is inserted following a monitor reset and an alarm sounds

Touch the ECG key to dismiss the CHECK SETUP key and silence the alarm. Verify that the system configuration (for example, alarm limits or lead selection, etc.) is appropriate before you begin, or resume, monitoring.

•

If the Check Setup feature has been disabled, the CHECK SETUP key is not displayed, and the associated alarm tone will not sound. Contact your system administrator to enable this feature.

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Ultraview Care Network

WARNING: • Signals resulting from devices such as Automatic Implantable Cardiac Defibrillators (AICD) may momentarily blank the ECG trace rather than display an out-of-range signal. In such cases, it may not be apparent that the AICD has fired and the condition of the patient should be checked. In all instances of AICD firing, the monitor will redisplay the ECG waveform within five seconds.

Accessories WARNING: • Use only monitoring cables and safety lead wires to protect against accidental connection to electrical power cords or outlets. Failure to do so may result in adverse health consequences or death. Use silver/silver-chloride electrodes or their equivalent, and always connect all electrodes required for a particular lead. Missing electrodes may result in the loss of ECG tracing.

•

Use only Spacelabs Medical recommended electrodes. Some electrodes may be subject to large offset potentials due to polarization. Recovery time after application of defibrillator pulses may be especially compromised. Squeeze bulb electrodes, commonly used for diagnostic ECG recording, may be particularly vulnerable to this effect.

CAUTION: • Use only patient cables and lead wires specified by Spacelabs Medical. Other cables and lead wires may degrade performance and may damage the monitor during defibrillation or high frequency electrosurgery. NonSpacelabs Medical cables and lead wires may also change the required input impedance and DC offset voltage, affecting monitor performance.

8-4

•

Do not use stainless steel electrodes.

•

Place the electrodes as far away from the electrosurgery site as possible because considerable high frequency current may flow into the electrodes. This can cause patient burns, especially if a defect is present in the neutral cable of the electrosurgical unit. Placing electrodes too close to the electrosurgery site can also cause a noisy ECG trace.

•

Do not allow conductive parts of electrode leads or connectors, including the neutral electrode, to contact other conductive parts, including the ground.

•

Poor cable dress or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit heart rate alarms. Refer to Patient Preparation and Electrode Application on page 85 for details on proper electrode preparation and application.

ECG

Patient Preparation and Electrode Application To prepare the patient: 1 2

3 4 5

Attach lead wires to the electrodes before applying them to the patient. If you attach the lead wires after you apply the electrodes, you may displace some of the conductive gel and degrade the signal.

Wash area with soap and water. If necessary, shave the area where you plan to position the electrodes. Clean the skin with alcohol. Dry the skin thoroughly. Abrade the skin.

Always connect all electrodes for the selected leads to acquire an ECG waveform. Place electrodes over flat, nonmuscular areas of the body to minimize muscle artifact. Figure 8-1: Electrode Application shows the correct procedure for applying electrodes to a patient. Be sure to press firmly around the entire edge of the adhesive surface. Do not apply pressure over the gel column itself as this may result in air-trapping and gel dispersal.

To apply ECG electrodes: 1 2

Attach electrode to lead wire. Apply electrode to patient skin.

1. Attach electrode to lead wire

2. Apply electrode to skin

Figure 8-1: Electrode Application Table 1: Electrode Color and Identifier Codes lists electrode color and identifier codes. Table 1: Electrode Color and Identifier Codes AHA Electrode Identifier

AHA Color Code

IEC Electrode Identifier

Electrode Placement Right Arm

IEC Color Code

White

Red

Black

Left Arm

Yellow

Red

Left Leg

Green

Right Leg

Black

Brown/Red

4th Intercostal - Right Sternum

White/Red

Brown/Yellow

4th Intercostal - Left Sternum

White/Yellow

Brown/Green

Midway Between V2 and V4

White/Green

Brown/Blue

5th Intercostal - Left Midclavicular C4

White/Brown

Brown/Orange

Left Anterior Axillary Line at V4

White/Black

Brown/Violet

Left Midaxillary Line at V4

White/Violet

Brown

Chest

White

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Ultraview Care Network

V2 (C2) V3 (C3) V4 (C4) V5 (C5) V6 (C6)

V1 (C1)

5 Electrodes I, II, III, aVR, aVL, aVF, V1 - V6

V2 (C2) V3 (C3) V4 (C4) V5 (C5) V6 (C6)

V1 (C1)

4 Electrodes I, II, III, aVR, aVL, aVF

3 Electrodes I, II, III

10 Electrodes

Chest electrodes must be appropriately placed on the patientâ&#x20AC;&#x2122;s chest to view precordial leads.

Chest electrodes must be appropriately relocated on patientâ&#x20AC;&#x2122;s chest to view alternate precordial leads.

Figure 8-2: Adult Electrode Placement

Maximum Impedance Change: Position RA and LA electrodes at the nipple level, midaxillary line. Position LL below the diaphragm, preferably below the umbilicus.

Alternate Method: Position RA and LA electrodes at the 2nd intercostal space, midclavicular line. Position LL below the diaphragm, preferably below the umbilicus.

Figure 8-3: Neonate Electrode Placement

8-6

ECG

Display Detail Your ECG display may differ from the one shown here depending on: 1) the type of monitor you are using, 2) the options in your module, 3) which functions you have enabled, and 4) which patient type you have selected. The illustrations below show the displays with arrhythmia and ST analysis ON.

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MON PACED A/M 10 ST=0.00 ROW 4 A=3 120 40

AVR

II AVL

I 0.16 II 0.00 III 1.44 V1 -1.44 V2 2.88 V3 1.44

III AVF V1

AVR AVL AVF V4 V5 V6

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Figure 8-4: Bedside Monitor Display (Full View)

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Figure 8-5: Central Monitor Display (Split Screen)

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Ultraview Care Network

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Figure 8-6: Central Monitor Display

í˘ą ECG trace for first lead í˘˛ Bed name í˘ł ECG key for first lead í˘´ QRS indicator (flashes once per detected beat) í˘ľ ECG lead designator í˘ś Display resolution (monitor or extended) í˘ˇ Paced operation indication (pacemaker detection is enabled) í˘¸ Abnormals per minute alarm limit * í˘š ST segment level for first lead** (the asterisk indicates ST alarms are enabled)

ě?&#x2026; Abnormals in a row alarm limit * ě?&#x2C6; ECG rate alarm limits. Split-screen central monitors display a bell symbol when alarms are enabled; bedside monitors display the rate alarm limits (120/40)

ě?&#x2030; Abnormals per minute counter * ě&#x201D;&#x2C6; Current heart rate ě&#x201D;&#x2030; Arterial pressure ě&#x201D;&#x160; Pulmonary artery pressure ě&#x201D;&#x2039; ST segment level for 12 leads ** ě&#x201D;&#x152; ECG traces for 12 leads ě&#x201D;? SpO2 level ě&#x201D;&#x17D; Respiration rate ě&#x201D;? Non-invasive blood pressure * Only appears with the MultiView I or II option in the adult mode with arrhythmia detection enabled. ** Only appears in adult mode with the ST analysis option.

8-8

ECG

•

If the enhanced vital sign display feature is enabled, you can view SpO2, respiration rate, and non-invasive pressure in the ECG zone on central or remote bedside monitors. However, no alarms are active.

Selecting Adult or Neonate Mode To specify the patient type: 1 2 3 4

Touch ECG. Touch SETUP. Touch CONFIG. Select ADULT or INFANT.

The ECG function provides both adult and neonate operational modes. When you select adult or infant, ECG alarm limits are adjusted based on your selection. WARNING: • When the system is in the neonate mode, ECG and respiration alarm activation can be delayed from zero to three minutes. The factory default setting for alarm delay is three minutes. Closely observe the patient during this period.

Monitoring Paced Patients To monitor paced patients: 1 2 3

Touch ECG. Touch SETUP. Select PACED YES.

When you monitor pacemaker patients, use the Paced feature to automatically enhance pacemaker spikes for display and eliminate them from the heart rate counter. To prevent pacemaker pulses from being counted as actual beats, specialized circuitry removes the pacemaker pulses from the ECG signal and replaces them with pacemaker flags. If the interval between the pacemaker pulse and the QRS complex is greater than 150 milliseconds, the beat is considered to have originated in the atria, and is not classified as a paced beat.

•

The optimal leads for monitoring paced patients may vary. To select an optimal trace, sequence through the available leads. If pacemaker spikes are not detected or if the heart rate is incorrectly counted, select another lead or change electrode position.

WARNING: • ECG detection circuitry may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely upon ECG rate alarms. Keep pacemaker patients under close surveillance. •

During electrosurgical activity, the system may not accurately detect paced beats due to the electrical interference.

•

The system may insert pacemaker flags into the ECG signal in response to signals that are not pacemaker pulses. Therefore, if you use a Spacelabs Medical monitor to observe pacemaker performance, you must take into account all possible sources of pacemaker flags.

•

Use the pacemaker manufacturer's performance analyzer as the primary means of evaluating pacemaker operation.

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Ultraview Care Network

To check capture threshold: 1 2 3 4 5 6 7

8 9 10 11 12 13

Touch ECG. Touch SETUP. Select PACED NO. Select EXTENDED. Touch SWEEP SPEED. Select 50 mm/sec. Perform capture threshold verification procedure according to your protocol. Touch ECG. Touch SETUP. Select PACED YES. Select MONITOR. Touch SWEEP SPEED. Select desired speed.

When using temporary transvenous pacemakers, you may want to check the pacemaker capture threshold on a regular basis (refer to your hospital protocol for frequency and procedure). Since the pacemaker flag substituted by the monitor does not represent the true amplitude of the detected pacemaker pulse, you will need to temporarily deactivate the Ultraview Care Network pacemaker software to check the capture threshold. In addition, placing the display in the extended mode and changing the sweep speed to 50 mm/sec will enhance the resolution and improve visualization of the pacemaker pulse amplitude. Remember to return to the monitor mode, reactivate pacemaker detection, and reset desired sweep speed after checking the capture threshold. Permanent transvenous pacemakers employing a bipolar lead system are capable of obtaining capture of the cardiac muscle at a much lower current than those with unipolar lead systems. For optimal paced rhythm detection, the pacemaker pulse and QRS complex must be of sufficient voltage. To determine if the monitor is correctly detecting the pacemaker pulses, verify that the Paced mode is activated. Each paced beat should have a pacemaker flag superimposed on the ECG trace at the appropriate point prior to the QRS complex. If flags are not consistently observed, sequence through the available leads for a better lead, or reposition electrodes, to optimize pacemaker detection. Check the amplitude of the QRS complex by inserting a 1 mV calibration pulse in the ECG trace as described in Checking the ECG Amplitude on page 8-12.

Setting and Adjusting Alarms To set or adjust rate alarms: 1 2 3 4 5

Touch ECG. Touch ALARM LIMITS. Touch ALARMS ON. Touch HI = or LO = key. Use arrow keys to adjust.

ECG alarms default to the ON position when the module is inserted into a monitor that is powered ON. Events that can cause an ECG alarm include: • • •

High or low rate Ventricular fibrillation (VFIB) Asystole WARNING: • If ECG monitoring is interrupted and subsequently resumed during an asystole event, 5-6 seconds will elapse prior to the monitor sounding and displaying the Asystole alarm. •

If ECG monitoring is initiated during an asystole event, 1011 seconds will elapse prior to the monitor sounding and displaying an Asystole alarm.

Additional conditions which can cause an alarm with the MultiView I or II options include: •

Abnormals in a Row (Couplets or Runs)

•

Abnormals per Minute

•

Tachycardia (of supraventricular origin)

•

If the alarm limit for high rate, low rate, abnormals per minute (A/M) or abnormals in a row (ROW) is displayed in reverse video, this is an indication that alarm tone, alarm recording, and alarm watch have been disabled for the indicated alarm.

Refer to Arrhythmia on page 9-1 for details concerning arrhythmia alarms or to ST Analysis on page 10-1 for details concerning ST alarms.

8-10

ECG

Initial Alarm Limits for Heart Rate At the completion of a learn sequence (refer to Learning the Dominant Waveform on page 9-3), the rate alarm limits are initialized using fixed or learned criteria. When you change the adult/neonate configuration, the system changes the alarm limits accordingly. You can adjust these limits up or down as needed.

Alarms Table 2: ECG AlarmsTable shows the conditions for which an alarm may be initiated. Table 2: ECG Alarms Alarm

Cause Of Alarm

Display Indication

VFIB

Ventricular fibrillation detected

VFIB

Asystole

>5 seconds with no QRS detected

Heart rate 0; flashing low rate limit; ASYSTOLE

High Heart Rate

High limit violated

Flashing high limit and HI RATE ALARM

Low Heart Rate

Low limit violated

Flashing low limit and LO RATE ALARM

Chan 1 & 2 - Leads Off One or more of the electrodes for both ECG leads are off or loose

No ECG trace and CHAN 1 & 2 LEADS OFF

Chan 1 - Lead Off

One or more of the electrodes for the No ECG trace and first ECG lead are off or loose CHAN 1 - LEADS OFF

Chan 2 - Lead Off

One or more of the electrodes for the No ECG trace and second ECG lead are off or loose CHAN 2 - LEADS OFF

Rate Source Unavailable

Heart rate is not available from either HR UNAVAILABLE the primary or any alternate heart rate source

Noisy Signal

Excessive noise, artifact or baseline shift

NOISY SIGNAL

Low ECG Voltage

QRS amplitude is between 0.16 and 0.20 mV (adult only)

ECG VOLTAGE TOO LOW

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Ultraview Care Network

Selecting ECG Leads To change the lead selection: 1 2 3 4

Touch ECG. Touch LEAD CONTROL. Touch 1ST LEAD or 2ND LEAD. Select lead.

When you select a precordial lead, a help message appears that describes the proper location for the chest electrode. For example, if you select V1, the message (C) 4TH INTERCOSTAL SPACE, RIGHT STERNAL BORDER is displayed. No message appears when you choose to display a limb or augmented lead (for example, I, II, III, AVR, AVL, or AVF).

•

Changing your selection for the first lead may change the selection for the second lead.

When you change lead selections, the new waveform is displayed and the learn sequence is automatically initiated. If you change lead selections while processing is suspended, the module initiates the learn sequence when you resume processing. WARNING: • Following a lead switch and until the patient’s rate and morphology are learned, some ECG alarms are not active. Alarms for ventricular fibrillation and asystole continue to be active; however, some ECG alarms (high rate, low rate, run, couplet, abnormal per minute, and tachycardia) are not.

Displaying Additional Waveforms To display six traces (requires 12-lead cable):

Multiple ECG traces can be displayed by selecting either FULL VIEW, SPLIT VIEW, 2ND LEAD or CASCADE.

1 2 3

A second waveform zone can be used to display either a second ECG lead or a cascaded trace from the first ECG zone. However, you cannot display both a second ECG trace and a cascaded ECG trace at the same time.

Touch ECG. Touch DISPLAY FORMAT. Select SPLIT VIEW ON.

To display twelve traces (requires 12-lead cable): 1 2 3

Touch ECG. Touch DISPLAY FORMAT. Select FULL VIEW ON.

Data in a cascaded ECG trace wraps from the first waveform zone into the second to display 12 seconds of data for the selected lead. While the cascaded trace is displayed, the text in the parameter key for the second zone displays STOP. Touching the STOP key freezes the trace for viewing. While the display is frozen, the text in the key displays START. Touching the key again unfreezes the trace.

Checking the ECG Amplitude To check the ECG amplitude: 1 2 3

Touch ECG. Touch SIZE. Touch 1 mV CAL.

8-12

Touching the 1 mV CAL key inserts a 1 mV amplitude calibration pulse into all ECG tracings. Use this calibration pulse as a reference to determine whether the amplitude of the ECG waveform exceeds the minimum voltage threshold. For ECG detection, the QRS amplitude must be at least 0.2 - 0.5 mV in an adult and 0.15 - 0.5 mV in a neonate.

ECG

Adjusting Waveform Size To adjust waveform size: 1 Touch ECG. 2 Touch SIZE. 3a Touch the arrow keys to adjust. or 3b Touch the 1mV/cm key to standardize.

You can increase or decrease the display size of the ECG waveform. This changes the displayed size only and does not affect the signal gain. When you touch the 1 mV/cm key, you set the ECG waveform size to 1 millivolt per centimeter. This standardizes the waveform to aid in accurately viewing QRS complexes for ST segment deviation. The factory default setting for ECG waveform size is 0.5 mV/cm.

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When displaying multiple ECG leads in the split-view or fullview format, the waveform size of all leads is adjusted simultaneously.

Adjusting Sweep Speed To adjust the sweep speed: 1 2 3 4

Touch ECG. Touch SETUP. Touch SWEEP SPEED. Select the desired sweep speed.

The sweep speed determines the speed at which the ECG traces move across the screen. When multiple ECG traces are displayed, changes to SWEEP SPEED affect all waveform traces. Available sweep speeds are 12.5, 25, or 50 mm/second. The factory default setting is 25 mm/second.

â&#x20AC;˘

Changing the ECG sweep speed may also change the speed of the invasive pressure waveforms. Refer to Pressure on page 16-1 for more details.

Adjusting Tones To set the QRS tone: 1 2 3 4 5

Touch ECG. Touch SETUP. Touch QRS TONE. Select TONE ON. Use arrow keys to adjust volume.

The QRS tone is the sound the monitor generates with each detected R wave. When you enable the QRS tone, you can adjust the volume and select whether to modulate the tone with the current SpO2 value. The factory default setting for QRS tone is OFF. The factory default setting for SpO2 pitch is OFF. In this setting, the monitor uses the default pitch for the QRS tone. When you enable the SpO2 pitch tone, the monitor modulates the pitch of the QRS tone higher or lower depending on the current SpO2 value. When you disable the QRS tone, the system automatically turns SpO2 pitch modulation OFF.

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Ultraview Care Network

Changing the Display Resolution To change the display resolution: 1 2 3

Touch ECG. Touch SETUP. Select MONITOR or EXTENDED.

The MONITOR/EXTENDED key determines the display resolution of the ECG traces. • •

The Monitor mode displays a reduced frequency range (0.50 - 40 Hz), but filters out more noise for better viewing. The Extended mode displays a broader frequency range (0.05 - 150 Hz), but also more noise.

•

Changing the display resolution does not change the waveform bandwidth used to analyze the ECG signals for arrhythmia and ST segment level.

The factory default setting for display resolution is monitor mode.

Selecting Primary and Alternate Heart Rate Source To select a primary heart rate source: 1 2 3 4

Touch ECG. Touch SETUP. Touch RATE SOURCE. Select the desired primary rate source (ECG, ART, UA, or SPO2).

To enable alternate rate sources: 1 2 3 4

8-14

Touch ECG. Touch SETUP. Touch RATE SOURCE. Set the desired alternate source(s) to ON (ECG, ART, UA, and/or SPO2).

You may select a primary rate source as well as enable alternate rate sources. Rate sources include ECG, ART (arterial pressure), UA (umbilical artery) and SpO2. If you enable one or more alternate sources, a heart rate will be displayed, if available, from either the primary or an alternate source. If you do not enable any alternate sources, a heart rate will only be displayed if the primary rate source is available. If a heart rate is not available from any source, the message HR UNAVAILABLE is displayed in the ECG waveform zone, and ??? replace the rate numbers.

•

If ART is to be used as an alternate heart rate source, Spacelabs Medical recommends setting up each monitor with only one arterial pressure channel.

•

Use of SpO2 as the primary heart rate source is not recommended by Spacelabs Medical.

CAUTION: • Cardiovascular Artifact (CVA) detection is disabled for the respiration channel when using an alternate heart rate source.

ECG

Suspending/Resuming ECG Processing To suspend ECG processing: 1 2 3

Touch ECG. Touch SUSPEND PROCESSING. Touch YES.

When you touch YES in the Suspend Processing menu, ECG and respiration waveforms continue to be displayed, but no processing occurs. If you touch NO, the display returns to the ECG menu without affecting ECG and respiration processing. When you suspend ECG processing: •

To resume ECG processing: 1 2 3

Touch ECG. Touch RESUME PROCESSING. Touch YES.

•

• • •

the message ECG PROCESSING SUSPENDED appears in the ECG waveform zone. In modules with the respiration option RESP PROCESSING SUSPENDED appears in the respiration waveform zone. question marks replace the heart rate immediately and replace the ST segment value after 30 seconds. If an alternate heart rate source is available, the new heart rate is displayed. Question marks (???) will continue to display for the ST segment value. the message ECG ALM OFF replaces the alarm limits (if no alternate rate source is available). the keys in the ECG Alarm Limits menu display dotted outlines to indicate they are disabled (if no alternate rate source is available). the key SUSPEND PROCESSING changes to RESUME PROCESSING.

Printing ECG Recordings To print recordings of all leads:

All printouts of ECG data are annotated with the following:

1 2 3

•

bed identification

•

time and date of the printout

•

lead designator

Touch ECG. Touch PRINT. Touch ALL LEADS.

To print a 12-lead report: 1 2 3 4 5

Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Touch STAT REPORT. Touch PRINT.

To print a 12-lead report at pre-selected intervals: 1 2 3 4

Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Select AUTO REPORT of 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, or 24 hours. Touch AUTO PRINT ON.

Depending on the printer model and software version, the ALL LEADS recording can be printed on a single page or as consecutive two- or four-channel recordings. For these recording formats, 6.25-seconds of waveform data will be printed for all available leads. If your using a 90838 Printmaster and if all the leads are connected, touching the STAT REPORT key will provide a 12-lead report. For this recording format, 2.5seconds of waveform data will be printed for each lead plus 10-seconds of waveform data for a rhythm lead. A 12-lead report can be scheduled to print at regular time intervals using the AUTO REPORT and AUTO PRINT features. Available intervals are 30-minutes, 1-hour, 2-hours, 4-hours, 8-hours, and 24-hours.

•

A printer (with 1.10.04 version software or greater) is required for the STAT REPORT feature.

•

A 12-lead report cannot be printed using the 90449 printer module.

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Ultraview Care Network

Restoring Default Settings To restore default settings: 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

Using the Module Configuration Manager feature, you can restore all default settings. User-configurable settings are described in Setting User-Defined Default Values on page 7-5. After the default settings are restored, the system initiates a learn sequence. Following the learn sequence, rate and ST alarm limits are reset.

•

RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

Power Failure In the case of a power failure, the remote module housing (90499) provides +5V of power to maintain data integrity. If the power is interrupted to the remote module housing but not to the monitor, the following will occur: • • • • •

all parameters will display ??? in the numeric zone ECG will display Channel 1& 2 Leads Off Respiration will display Loss of Signal Cardiac output will display Catheter Fault and Probe Fail SpO2 will display Adapter Disconnected

ECG Problem Solving In general, if ECG signal quality is poor (as evidenced by wandering baseline, excessive noise, or muscle or respiration artifact), try the following solutions: •

Ensure that the patient's skin was properly prepared.

•

Ensure that all electrodes are firmly attached and in good condition.

•

Ensure that the electrodes are positioned on a flat, non-muscular area.

•

Ensure that lead wires are properly fastened and in good condition.

If this fails to resolve the problem, select a different lead. By following the instructions provided in this chapter and discussed during inservice education, you can avoid most common monitoring problems. If a problem occurs, consult the ECG Troubleshooting Guide on page 8-18. The following additional information should help you resolve a few of the more complex problems.

Lead Fault Indication If a lead fault occurs, the message CHECK XX is displayed in the ECG waveform zone, where XX identifies the failed or missing electrode. If automatic lead switching is enabled, the module selects another lead automatically so that monitoring is uninterrupted. If automatic lead switching is disabled, a LEAD OFF message is displayed.

8-16

ECG

Noise Detection Upon detection of noise, a NOISY SIGNAL message is displayed in the ECG waveform zone. If both the 1st and 2nd leads are noisy, the module suspends processing temporarily. If the noise persists for ten seconds, the system sounds a tone. When the noise disappears, the message and tone cease.

•

If monitoring is interrupted due to overload or saturation of the input amplifiers, including overload caused by a defibrillator discharge, the ECG trace is displayed as an out-of-range signal accompanied by a NOISY SIGNAL or an HR UNAVAILABLE message, or both. If the overload or saturation condition persists, the ECG trace is displayed as a flat line signal accompanied by an ASYSTOLE message.

•

If the displayed waveform does not appear noisy, but the NOISY SIGNAL message persists, check all leads for noise before calling a qualified service person.

False Alarms Careful attention to skin preparation and electrode application, especially during setup, will reduce false alarms. Should false alarms occur, check for the following: •

• •

•

There may be excessive noise on the signal (the most common cause of false alarms). Electrodes misplaced over muscles or a poor lead connection can cause significant noise when the patient moves. Heart rate limits may be set too close to patient's heart rate. Check to see if this is the case and adjust the limits as necessary. The ECG amplitude may have dropped below the R-wave detector threshold level causing false low rate alarms. Reposition the electrodes to obtain a QRS amplitude of at least 0.20 mV (adult) and 0.15 mV (neonate). QRS frequency components and shape may be unsatisfactory for accurate beat detection and classification. Make necessary changes in electrodes, electrode sites or lead selection to restore a good signal. In some cases, VFIB may resemble previously classified abnormal beats which may cause VFIB to be detected as a RUN. If this occurs, use the waveform display as the primary indication of condition. The module may not recognize some beats as morphologically different from the learned dominant beat. You may be able to improve performance by changing electrode positions or switching to a lead setting that provides better differentiation between the dominant and abnormal beats.

8-17

ECG Troubleshooting Guide Clinical Situation AC noise

Possible Cause ■ Display resolution set to extended

Solution ■ Select monitor mode (0.5 - 40 Hz).

mode (0.05 to 150 Hz).

■ Electrodes dry.

■ Repeat skin preparation and apply new moist electrodes.

■ Patient cable entwined with other

■ Separate patient cable from all other cables.

electrical devices. Baseline wanders

■ Patient moving excessively.

■ Use stress loops to secure lead wires and cable to the patient.

■ Respiration artifact.

■ Select another lead or reposition the electrodes.

■ Electrodes dry.

■ Repeat skin preparation and apply new moist electrodes.

Low amplitude ECG

■ Skin improperly prepared. ■ Abrade skin and reapply electrodes. ■ Lead selected not showing QRS com- ■ Check 12-lead ECG to determine better plex with greatest amplitude.

■ Electrodes could be positioned too

monitoring lead and reposition electrodes.

■ Select another lead or reposition electrodes.

near bone or muscle mass. Module won’t learn

■ ECG signal too noisy for initialization. ■ Improve signal quality by repeating skin preparation and/or repositioning electrodes.

■ ECG voltage below threshold. ECG VOLTAGE TOO LOW message may be displayed.

No ECG trace

■ Perform the following steps as needed. ■ 1. Check cables, lead wires and electrodes, then relearn patient rhythm.

■ 2. Change lead or reposition electrodes.

■ Improper attachment of ECG connec- ■ Remove, then re-plug the connector into the tor cable to the module/or leads off.

module or reconnect the leads.

■ LEDs flashing on front panel of mod- ■ Call a qualified service person. ule.

■ Module is not seated into the monitor ■ Remove, then reinsert the module or or remote housing. Excessive alarms

■ Electrodes dry.

exchange the module.

■ Repeat skin preparation and apply new moist electrodes.

■ Alarm limits set too close to patient’s ■ Readjust alarm limit. normal heart rate.

■ Excessive interference: patient cable ■ Reroute cables and leads. or wires routed too close to other electrical devices.

■ Excessive patient movement or mus- ■ Reposition electrodes and use stress loops cle tremor.

to secure lead wires and cable to the patient.

Arrhythmia

Directory of Keys E C G

ECG MENU ALARM LIMITS

SETUP

SIZE

DISPLAY FORMAT

LEAD CONTROL

ECG - RELEARN

SUSPEND PROCESSING

RELEARN

REVIEW

ECG - PRINT

CLEAR MEMORY

ARR CLASSES

SAVE MEMORY

ST SEGMENTS

ALL LEADS

PRINT ALL

CANCEL PRINT

ECG REVIEW ARRHYTHMIA REVIEW

ST REVIEW

REPORT REVIEW

REAL TIME ST TREND TREND DISPLAY OFF ON

TREND TIMEBASE 15 MIN / 30 MIN

REVIEW RUN 1

DOM

CPL 0

ABN 3

TACH

PAUSE 8

CLASS TREND

GROUP TREND

PACED 1

ARRHYTHMIA REVIEW LEAD VI II

ALARM YES NO

CLEAR

MERGE

PRIOR CLASS

NEXT CLASS

Do you wish to clear the entire class or the most recent occurrence? ENTIRE CLASS

LAST EVENT

Merge these classes or select another class. MERGE CLASSES

MERGE TRENDS

PRIOR CLASS

NEXT CLASS

CLASS TREND TIMEBASE 6 HOURS

INCLUDE YES NO

CURSOR L R

PRIOR CLASS

NEXT CLASS

CURSOR L R

PRIOR CLASS

NEXT CLASS

GROUP TREND TIMEBASE 6 HOURS ECG - ALARM LIMITS ALARMS ON

HI= 130

OFF

•

LO= 40

ABN IN ROW=5

ABN PER MIN=OFF

SINGLE ST = 1.00

MULTI ST = 0.50

ST LEADS

Based on features purchased, more or fewer keys may appear here than on your menu screens.

9-1

Arrhythmia

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up Arrhythmia Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Reviewing Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Controlling Arrhythmia Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Clearing a Class or Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Merging Classes/Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Plotting Arrhythmia Trend Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Printing Arrhythmia Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Arrhythmia Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Arrhythmia Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Overview Two levels of arrhythmia detection and review are available in Spacelabs Medical monitors. The MultiView I option provides enhanced arrhythmia detection and alarms for ventricular tachycardia, couplets, and single abnormal beats in addition to the detection and alarm capabilities for high and low heart rates, ventricular fibrillation, and asystole. The MultiView II option expands arrhythmia detection to include pauses and tachycardias of a supraventricular origin. This option also offers storage capabilities so that trends of arrhythmia episodes as well as dominant and paced rhythms can be reviewed, edited and printed.

9-2

â&#x20AC;˘

No arrhythmia detection system can correctly detect and classify all arrhythmias 100% of the time. Use sound clinical judgement when monitoring patients with arrhythmias.

â&#x20AC;˘

You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-1 for further details.

Arrhythmia

Setting Up Arrhythmia Monitoring To set up arrhythmia monitoring: 1 2 3 4 5 6

Set up system and patient for standard ECG monitoring. Touch ECG. Touch SETUP. Touch CONFIG. Ensure ADULT is selected. Select ARR ON.

With the MultiView I or II option, the ARR ON/OFF key (located in the Config menu under Setup) can be used to selectively enable or disable arrhythmia detection functions. Arrhythmia detection must be enabled if you wish to establish a new dominant waveform (refer to Relearning the Dominant Waveform on page 9-4 for more details).

•

The Arrhythmia ON/OFF key is only available in modules with the MultiView I or II options.

To disable arrhythmia detection: 1 2 3 4

Touch ECG. Touch SETUP. Touch CONFIG. Select ARR OFF.

When you turn arrhythmia detection ON •

IN LEARN appears above the ECG tracing in the first zone

•

the RELEARN key is present in the ECG menu

•

ABN IN ROW and ABN PER MIN keys are present in the Alarm Limits menu

•

ECG alarms are momentarily deactivated until the learn sequence completes

•

Rate and ST alarm limits are initialized

•

Abnormals in a Row and Abnormals per Minute alarm limits are initialized

When you turn arrhythmia detection OFF •

IN LEARN appears above the ECG tracing in the first zone

•

no arrhythmia detection features or menus are displayed

•

ECG alarms are momentarily deactivated until the learn sequence completes

•

Rate and ST alarm limits are initialized

Learning the Dominant Waveform During the learn sequence, IN LEARN is displayed on the monitor while the system establishes the heart rate and begins to classify each beat. Rate alarms are set based on this learned heart rate (if they have not been previously set to Fixed in the Module Configuration Manager). The first non-premature beat that occurs ten times is established as the dominant class. When the learn sequence is completed, the IN LEARN message disappears. Examples of actions that initiate a learn sequence are: •

Power ON

•

Module insertion

•

Changing patient type (adult/infant)

•

Enabling/disabling arrhythmia detection

•

Patient admission via the Admit/Discharge menu

The system will not classify a paced beat as the dominant class. If the patient is 100% paced and there is no dominant class at the end of the learn sequence, the first single, non-paced beat detected five times becomes the dominant class.

9-3

Ultraview Care Network

Detecting Abnormal Beats The system compares each incoming beat with the dominant class. It examines morphology and the intervals between both the previous and following beats to determine whether the beat does or does not match the dominant. If the system determines the beat is abnormal, it compares the new beat with each of the abnormal shapes categorized since the learn sequence was completed. If the current beat fails to match any of the existing shapes (and after five occurrences), the system classifies it as a new abnormal class.

Detecting Pauses The system classifies an R-R interval that is 1.8 times (or 80%) longer than the average R-R interval as a pause. The last beat detected preceding the pause is displayed to the left of center in the pause class. The system does not count two consecutive, long R-R intervals both in the pause class. Instead, it assumes that a sudden rate change occurred and updates the heart rate immediately.

Detecting Paced Beats If the Paced mode is enabled in the ECG Setup menu and the system does not detect a paced beat during the learn sequence, a paced class will be created once the system detects the first paced beat. The system identifies two different types of paced beats: • •

paced AV-paced

The paced class is created for ventricular-paced beats defined as a QRS complex which is preceded by a single pacemaker pulse. The AV-paced class is created for beats that are preceded by two pacemaker pulses. The QRS complex must follow the pacemaker pulse within 150 msec for the beat to be classified into either paced class. If the pacemaker pulse precedes the QRS complex by more than 150 msec, the beat may be triggered by an atrial pacemaker and is not classified in either paced class.

Relearning the Dominant Waveform To relearn the dominant waveform: 1 2 3

Touch ECG. Touch RELEARN. Select SAVE MEMORY or CLEAR MEMORY.

You can relearn the dominant rhythm and establish a new dominant at any time during monitoring. After touching the RELEARN key, you can either clear the memory or save the memory. Once a selection is made, the relearn sequence is initiated during which ECG alarms are suspended. The old dominant is labeled as exdominant and stored as an abnormal class. WARNING: • Until the patient’s rate and morphology are learned, ECG alarms for high rate, low rate, run, couplet, abnormal per minute, and tachycardia are not active.

9-4

Arrhythmia

Selecting CLEAR MEMORY clears all arrhythmia and ST segment data and resets the Abnormals per Minute, Abnormals in a Row, and ST segment alarms. Upon completion of the learn sequence, ECG alarms are enabled and rate alarms limits are reset. Selecting SAVE MEMORY saves all previously-acquired arrhythmia and ST segment data. Once the learn sequence is completed, ECG alarms are enabled and rate alarms are reset. The Abnormals per Minute and Abnormals in a Row alarms remain unchanged. If ST segment level alarms were enabled prior to the relearn sequence, they will be reset.

Automatic Dominant Class Update The system uses the following rules to update the dominant class: •

•

An abnormal class that occurs more frequently than 50% of all beats in the previous 60 seconds, and occurs three beats more frequently than the current dominant during that period, automatically becomes the new dominant class. The old dominant is put into an abnormal class and given the status EXDOMINANT. This class can become dominant again and has the same characteristics as any other active class.

The message, NEW DOMINANT, is displayed above the ECG trace for 60 seconds after the new dominant is established.

Setting and Adjusting Alarms To set or adjust alarms for abnormal beats (arrhythmia detection must be enabled): 1 2 3 4 5

Touch ECG. Touch ALARM LIMITS. Touch ALARMS ON. Select ABN IN ROW = or ABN PER MIN =. Use arrow keys to adjust.

In addition to the alarms described in the ECG chapter, the MultiView I or II options provide alarms for these additional conditions.

Abnormals in a Row Alarm Following the learn sequence, the Abnormals in a Row alarm limit is set based on either factory defaults or user-defined settings. You can adjust the alarm limit from two to ten or you can deactivate it. •

•

Setting the Abnormals in a Row alarm limit to three or greater will initiate a RUN ALARM message when three or more consecutive abnormal beats (at a rate greater than 90 BPM) occur. Setting the Abnormals in a Row alarm limit to two will initiate a COUPLET ALARM message when two consecutive abnormal beats occur.

The factory default setting for the Abnormals in a Row limit is five.

Abnormals per Minute Alarm Following the learn sequence, the Abnormals per Minute alarm limit is set based on either factory defaults or user-defined settings. You can adjust the alarm limit from 1 to 99, or you can deactivate it.

9-5

Ultraview Care Network

The factory default setting for the Abnormals per Minute limit is OFF.

•

If the alarm limit for high rate, low rate, ABN/MIN, or ABN IN ROW is displayed in reverse video, this is an indication that alarm tone, alarm recording, and alarm watch have been disabled for the indicated alarm.

Table 1: Classification of Events describes the arrhythmias detected with the MultiView I or II options (with arrhythmia detection enabled). Table 1: Classification of Events

TYPE OF CLASS

DEFINING CHARACTERISTICS

PREMATURITY REQUIRED

ABNORMAL

1 beat of abnormal morphology

COUPLET

2 consecutive beats of abnormal morphology

No for the first beat; Yes for the second beat *

RUN

3 or more consecutive beats of abnormal morphology

No for the first beat; Yes for each subsequent beat *

MAX # OF CLASSES ALLOWED

TYPE OF WAVEFORM STORAGE Qualifying occurrence (5th) + most recent

Qualifying occurrence (3rd) + most recent

6 seconds of each occurrence. First in, first out. Saves longest Run and Pause

PAUSE

An R-R interval that is 1.8 x (or 80%) longer than normal

ASYSTOLE

Absence of QRS for 5 seconds or more

6 seconds of last occurrence stored as a pause when following normal beats

PACED

1 pacemaker flag followed by a QRS (within 150 msec)

First paced beat occurrence each minute (PACED key must be set to YES)

AV PACED

2 pacemaker flags followed by a QRS

First paced beat occurrence each minute (PACED key must be set to YES)

TACH (SUPRA VENTRICULAR)

≥ 5 or more premature dominant beats in a row

Yes *

6 seconds of last occurrence

VFIB

6 seconds of last occurrence

DOMINANT

Qualifying occurrence (10th) + the most recent each minute

* Prematurity is defined as an instantaneous R-R interval that is (1) 15% premature as compared to the average R-R interval and, (2) <666 msec for couplets and runs, and <500 msec for tachycardias of a supraventricular origin.

9-6

Arrhythmia

Reviewing Arrhythmias To review arrhythmias: 1 2 3 4

Touch ECG. Touch REVIEW. Select an arrhythmia class type for review. Select NEXT CLASS or PRIOR CLASS keys to progress through the review.

â&#x20AC;˘

Arrhythmia Review and Edit functions are only available in modules with the MultiView II option in the ADULT mode, and with both arrhythmia detection and review enabled.

Selecting Arrhythmia Classes The numerical value for each arrhythmia key indicates the number of occurrences that the system has stored. If none have been detected, the numerical value inside the key is 0 and the key outline is dotted. For classes that only store the last occurrence of that type of arrhythmia (for example, tachycardias of a supraventricular origin), a value is not displayed. The system updates the menu as new classes are created.

Selecting Leads for Review When you access the Arrhythmia Review menu, the LEAD key text changes to indicate which leads were being monitored the last time the displayed event occurred. The lead associated with the currently displayed waveform is highlighted. You can change the lead selection by touching the LEAD key.

Multiple Arrhythmia Classes The system distinguishes between classes of the same type that have different morphologies by assigning numbers to each class. The class number is displayed to the right of the class type; for example, ABNORMAL 1. The system will display, in sequence, up to 32 different runs and/or pauses. However, the system always keeps the longest run or pause. If the system detects one more pause and/or run than it can store, it replaces the oldest run or pause with the new one (that is, first in-first out).

Updating Classes The system updates the review waveform once each minute for the dominant, paced and AV paced classes. Otherwise, it updates with each occurrence.

9-7

Ultraview Care Network

Display Detail The system stores and displays arrhythmia review data in two categories: non-template forming classes and template-forming classes. The non-template forming class displays a waveform that is 6.25 seconds long and is representative of the most recent occurrence. The template-forming class displays two waveforms. The waveform on the left is 1.25 seconds long; the arrhythmia that originated the class is centered. The waveform on the right is 4.5 seconds in length and the most recent occurrence of the class is centered. The lead, frequency, and time and date of last occurrence appear to the right of each presentation.

Lead II

Non-template Forming Class Example (Tachycardia)

Last MINUTE:

Last HOUR:

Last

04:44AM

OCCURRENCE: 5 Feb. 2001

Lead VI

Template Forming Class Example (Couplet)

Last MINUTE:

Last HOUR:

Last

04:40PM

OCCURRENCE: 5 Feb. 2001

Figure 9-1: Arrhythmia Waveforms

9-8

Arrhythmia

Controlling Arrhythmia Alarms To control arrhythmia alarms: 1 2 3 4 5

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select CPL, ABN or TACH. Select ALARM YES or NO.

To clear a class or the most recent event in a class: 1 2 3 4 5 6

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Touch CLEAR. Select ENTIRE CLASS or LAST EVENT.

Touch ALARM YES or NO to enable or disable alarms for couplets, single abnormals, or tachycardia. Disabling alarms for a specific arrhythmia prevents alarm generation for subsequent detection of that arrhythmia class. At least one episode of the class must be stored before the alarm can be disabled.

Clearing a Class or Event When you clear a class, the system removes it from memory. Touch the ENTIRE CLASS key to clear the displayed class and template from memory and from the trend buffer. When the system finishes clearing the class, the Arrhythmia Review menu appears and displays the next class. Touch the LAST EVENT key to remove only the most recent occurrence of the displayed class from memory. The LAST EVENT key is only active for abnormal and couplet classes. When you clear the most recent event: • • •

the system removes the most recent occurrence of that class from memory. the system displays the message The last occurrence of this class was deleted in place of the cleared waveform. the system updates the frequency and last occurrence totals. The system does not redisplay the updated information until you redisplay the class.

Merging Classes/Trends To merge class or trend data: 1 2 3 4 5 6

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Touch MERGE. Use PRIOR CLASS or NEXT CLASS to display the two classes you wish to merge. Select MERGE CLASSES or MERGE TRENDS.

Merging enables you to take two different classes or trends from the same group and merge them together into a single class, combining the trend history and time of last occurrence. When the module is frequently storing a single morphology as two different classes, merging the classes opens up storage for new classes while saving all arrhythmia data.

Merging Classes Two classes may be merged when the system interprets two abnormal beats as different classes but the clinician sees them as the same class. This could occur if a patient's dominant beat is experiencing frequent changes in polarity or when the electrodes have been repositioned. At the start of merging two classes, one class appears on the left side of the screen and the second class appears on the right side. The message “Merge these classes or select another class” appears at the bottom of the screen. If the two classes look clinically the same, they can be merged by touching the MERGE CLASSES key. Once merged, the first beat will be displayed as a template on the left side of the screen with the message (M1) following the class title. Any subsequent beat that fits any of the merged templates will then be stored in that class.

9-9

Ultraview Care Network

You can merge a maximum of two classes into a third class. The following constraints apply to merging classes: • • • •

Two single templates can be merged into a class with one template. One class of two (previously merged) templates can be merged with one additional template. If a class has been merged once, then (M1) follows the class number, for example, ABNORMAL 12 (M1). If a class has been merged twice, then (M2) follows the class number, for example, ABNORMAL 12 (M2).

Merging Trends There is no limit to the number of trends that you can merge. Merging trends of arrhythmia data deletes the template for the class that has been merged. If an arrhythmia event occurs that matches the merged class, a new class will be created. If you want to combine the data for two routinely recurring arrhythmia classes, merge the classes rather than merge the trends. Merging classes permits the two classes to be stored and trended together on an ongoing basis. If you want to combine an active arrhythmia class with an inactive class, merge the trends. An example of an inactive arrhythmia class is the dominant morphology associated with a previous lead selection.

Merge Constraints The following additional constraints apply to merging individual classes or trends: • • • • •

9-10

If the system cannot merge any of the existing classes or trends, the MERGE key is disabled (the key will appear dotted) in menus for those classes/trends. Only classes/trends that the system can merge are presented. Single abnormal classes/trends can be merged with each other, or with the dominant, paced, or AV paced classes/trends. Couplets can only be merged with couplets. Runs and pauses cannot be merged.

Arrhythmia

Plotting Arrhythmia Trend Graphs To plot a trend graph:

When you plot trend graphs the display area consists of:

1 2 3

•

4 5

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class for review. Select CLASS TREND or GROUP TREND.

ABNORMAL 1

•

a 1.5-second segment of the selected class waveform on the left (individual class trends only). a trend graph of the selected class, or group of classes, on the right. Refer to Figure 9-2: Abnormal Class Trend.

When you select CLASS TREND, the trend graph plots occurrences of events that match that particular class. The total number of events that occurred during the time period between the cursors appears below the trend graph.

100

HR 10

PER 1 MIN

0 12:17

From 12:18 to 18:17 Total = 612

18:17

Figure 9-2: Abnormal Class Trend When you select GROUP TREND, the trend graph plots occurrences of all events in that group of classes along with the average heart rate. For example, the group trend for abnormals plots the occurrences of all single abnormals regardless of the class in which they were stored. • •

The dominant group trend graph displays the total of all abnormal beats, including beats in runs, over the selected timebase. A total of all events specific to the selected class over the selected timebase is displayed for all other trended classes.

Each trend graph is displayed with two scales: • •

the scale on the left represents heart rate the scale on the right displays the number of arrhythmias over the trended period.

Scales are automatically selected, based on the heart rate and arrhythmia values. To select a timebase for class or group trends:

Selecting a Timebase

1 2 3

You can also select the time period over which the system trends arrhythmia data. The factory default setting is 6 hours. Resolution for each timebase is shown below.

4 5 6

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Select CLASS TREND or GROUP TREND. Select TIMEBASE (6,12, or 24 hours).

Resolution

Timebase

1 minute

= 6-hour trend graph

2 minutes

= 12-hour trend graph

4 minutes

= 24-hour trend graph

9-11

Ultraview Care Network

Excluding Classes from Trends To exclude a class in a group trend: 1 2 3 4 5 6

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Touch CLASS TREND. Select INCLUDE NO.

Use this function to exclude specific classes from the group trend for that class as well as from the dominant trend graph (only valid with CPL and ABN classes). This function defaults to YES indicating that all classes will be included. When you select a class, the template for that class displays on the screen. It is followed by a trend graph that plots all of the occurrences of that class over the selected trend graph timebase.

Positioning the Cursors To position the cursors on the trend graph: 1 2

Touch the CURSOR to highlight either the L or R portion. Touch the trend plot to position the cursor near the desired point. Use the arrow keys for adjustment of the cursor.

The cursors are small, bright lines that move along the bottom of the trend display and allow you to view the number of trended events that occurred between any two points in time displayed on the trend graph. Initially, the left (L) cursor is located flush with the left edge of the trend graph, and the right (R) cursor is located flush with the right edge of the trend graph. The number of trended events between, and inclusive of, the cursor points appear below the trend graph. If the cursors move past each other, the L cursor becomes the R cursor and vice versa. The highlighted L or R portion of the CURSOR key changes accordingly.

Printing Arrhythmia Data To print recordings of ALL arrhythmia events: 1 2 3 4

Touch ECG. Touch PRINT. or Touch PRINT ALL. Touch ARR CLASSES.

To print selected arrhythmia classes: 1 2 3 4 5

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Touch PRINT.

To print selected arrhythmia trends: 1 2 3 4 5

9-12

Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Select CLASS TREND or GROUP TREND.

All printouts of ECG or arrhythmia data are annotated with the following data: •

Bed identification

•

Time and date of the printout

•

Lead designator

You can print all arrhythmia data for all classes or individually selected classes. You can also print individually selected arrhythmia trend plots. Selecting PRINT ALL prints all ST events and all arrhythmia classes. PRINT ALL also prints all leads.

Arrhythmia

Arrhythmia Problem Solving Refer to ECG on page 8-1 for additional monitoring tips.

False Alarms Careful attention to good monitoring techniques, especially during setup, will reduce false alarms. When false alarms occur, check the following: •

•

Multiple classes with atrial fibrillation or flutter waveforms. Either 1) merge these classes with the dominant or another abnormal class, 2) deactivate the alarms for these classes, or 3) consider deactivating the Abnormals per Minute alarm. Repetitive artifact mimicking QRS complexes. Review the morphology of abnormal classes that are triggering alarms. Either merge these abnormal classes together or deactivate the alarm for these classes. In some cases VFIB may resemble previously classified abnormal beats which may cause VFIB to be detected as a RUN. If this occurs, use the waveform display as the primary indication of condition. Some beats may not be recognized as morphologically different from the learned, dominant beat. You may be able to improve performance by changing electrode positions or switching to a lead setting that provides better differentiation between the dominant and abnormal beats.

Abnormal Beats Misclassified There are a number of possible situations that might cause beats to be improperly classified (either too many or too few). • • •

If the message NOISY SIGNAL is displayed, too much noise is present on either one, or both, ECG channels. If the message ECG VOLTAGE TOO LOW is displayed, the signal level is below the threshold for QRS detection. Some beats are not recognized as being different from the learned dominant beat.

You may be able to improve performance in these cases by changing electrode positions or by switching to a lead setting that provides a better signal or allows abnormal beats to be more clearly differentiated from dominant beats.

No Couplet or Run Alarms If alarms do not occur as expected, check the following: •

•

Abnormal in a Row alarm limit may be set too high to generate alarm for couplets. When you wish to be alerted for couplets, set Abnormal in a Row alarm limit to 2. Abnormal beat(s) may not meet the classification criteria of 15% prematurity (for the second beat in a couplet or subsequent beats — at 90 BPM — in a run) and R-R intervals of less than or equal to 666 msec. No action is indicated. An Abnormal in a Row alarm (COUPLET or RUN) will not be generated unless both criteria are met. Processing may have been suspended or the signal quality may be poor. Resume processing or check electrodes for other causes of a poor signal.

9-13

Ultraview Care Network

Previous Abnormal Classes Missing in Arrhythmia Review If you find that previously classified abnormal beats are no longer stored for review, one of the following conditions have occurred: • • •

The class has been cleared. Memory was cleared using the RELEARN key or data was purged during the Admit/Discharge function. A module error recovery reset occurred.

Classes Full The total number of abnormal and couplet classes that can be stored is 12. When the system detects the 13th class, the message CLASSES FULL is displayed with an alert tone (if tone is set to ON). All subsequent alarm events will initiate an alarm, even if classes are full. A “classes full” condition can be cleared by: • • •

Merging one or more classes Merging one or more trends Deleting one or more abnormal or couplet classes

9-14

•

All alarm events occurring when classes are full will initiate an appropriate alarm.

Arrhythmia Troubleshooting Guide Clinical Situation Abnormal beat not detected

Possible Cause ■ Module receiving inadequate signal; NOISY SIGNAL or ECG VOLTAGE TOO LOW messages appear. Noise level is over allowable range, or signal level is below QRS detection threshold.

■ Some beats not recognized as morphologically different from the learned dominant beat.

■ System has not seen 5 abnormals or

Solution ■ Make the necessary adjustments to restore good signal.

■ Check all leads to determine a better monitoring lead or select another lead.

■ Remove the cause of the noise.

■ No action required; some events that may be diagnosed as abnormal by a skilled clinician may not meet the module’s criteria for abnormality.

■ No action is required.

3 couplets of like morphology to generate a class.

■ Arrhythmia detection is not enabled.

■ Enable arrhythmia detection through the ECG Setup menu.

False Alarms

NOTE: Careful attention to good monitoring technique, especially setup, will keep false alarms at a low level. If false alarms do occur, however, check the following:

■ Noise on the signal caused by poor electrode application is the most common cause of false alarms.

■ Multiple abnormal classes with atrial fibrillation or flutter waveforms.

■ Remove the cause of the noise. ■ Deactivate alarm for the classes that fill up with repetitive artifact; do not clear these classes.

■ Merge the class with the dominant or another abnormal class.

■ Deactivate alarm for these classes, or consider deactivating the ABN PER MIN alarm.

■ Atrial fibrillation continually triggering

■ Consider deactivating TACH alarm.

TACH alarm.

■ Limits set too close to patient’s heart

■ Check and adjust the alarm limits.

rate.

■ Amplitude of ECG signal has dropped below threshold of R-wave detector.

■ Reposition electrodes and relearn patient’s rhythm.

ST Analysis

Directory of Keys E C G

ECG MENU ALARM LIMITS

SETUP

SIZE

LEAD CONTROL

DISPLAY FORMAT

SUSPEND PROCESSING

RELEARN

REVIEW

ECG REVIEW ST REVIEW

ARRHYTHMIA REVIEW

REPORT REVIEW

REAL TIME ST TREND

TREND DISPLAY ON OFF

TREND TIMEBASE 15 MIN / 30 MIN

ST REVIEW - ST SEGMENT LEVELS at HR:MN DAY-MONTH-YEAR TIME SAVE

CLEAR

YES

PRIOR SET

TREND

NEXT SET

SAVE SET

TREND OF ST SEGMENT LEVEL TIMEBASE 6 HOURS

ST SCALE

Do you wish to clear the displayed ST data? YES

ECG - ALARM LIMITS ALARMS HI= 130 ON OFF

LO= 40

ABN IN ROW=5

ABN PER MIN=OFF

SINGLE ST = 1.00

MULTI ST = 0.50

ST LEADS

Highlighted leads are included in ST alarms. Touch to include or exclude. I

•

III

AVF

AVL

AVR

Based on features purchased, more or fewer keys may appear here than on your menu screens.

10-1

ST Analysis

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Setting Up ST Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Selecting Leads for ST Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Reviewing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Clearing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Viewing ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Selecting the ST Trend Timebase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Printing ST Segment Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 ST Analysis Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Overview The ST analysis function monitors changes to the ST segment level.

•

The significance of ST changes can only be determined by a clinician.

•

The value of ST segment measurements may be affected by: - wide complex QRSs (for example, bundle branch block). - Wolff-Parkinson-White (WPW) syndrome. - fusion beats classified as dominants.

Since the ST segment is composed of frequencies at the lower end of the frequency range (0.05 Hz), the system automatically analyzes the ST segment at 0.05 Hz regardless of whether the display mode is set to monitor or extended. ST segment analysis starts during the ECG learn sequence. Based on the dominant waveform, the PR (isoelectric), J, and ST points are automatically identified for each beat. The amplitude difference between the ST point and the PR point is referred to as the ST segment level.

10-2

•

You can define your own default settings for alarm limits. Refer to Default Alarm Limits on page 2-4 for further details.

ST Analysis

Display Detail The current ST segment level is displayed for all leads to the right of the ECG parameter key in the split view and the full view modes. Question marks (???) are displayed when the current ST segment level is not available, or as OFF when the lead is not connected. The ST segment data display is updated at 3-second intervals.

í˘ą II

E C G I

AVR

AVL

III

AVF

MON A/M 10 ROW 4 120 40

A=0

70 I II III V1 V2 V3

í˘˛ í˘ł

AVR 0.16 AVL 0.24 AVF 0.16 V4 -0.16 V5 -0.16 V6 -0.16

0.16 0.00 1.44 -1.44 2.88 4.32

í˘´

Figure 10-1: ST Segment Display (Full View)

í˘ą II

E C G

MON A/M 10 ROW 4 120 40

A=0

í˘ł

I II III V1 V2 V3

0.16 0.00 1.44 -1.44 2.88 4.32

í˘˛

AVR 0.16 AVL 0.24 AVF 0.16 V4 -0.16 V5 -0.16 V6 -0.16

í˘´

Figure 10-2: ST Segment Display (Split View)

í˘ą

ECG lead designator

í˘˛

Abnormals per minute counter

í˘ł

Current heart rate

í˘´

ST segment levels

10-3

Ultraview Care Network

Setting Up ST Monitoring To set up ST monitoring: 1 2 3 4 5

Set up system and patient for standard ECG monitoring. Touch ECG. Touch SETUP. Touch CONFIG. Select ADULT.

ST analysis is performed on all available ECG leads, even if they are not currently displayed. Setup for ST monitoring is the same as for ECG monitoring. Refer to ECG on page 8-1 for setup details.

•

ST Analysis and Review functions are only available in the adult mode in modules with the ST option.

Adjusting Alarms To set or adjust ST alarms: 1 2 3 4

Touch ECG. Touch ALARM LIMITS. Select SINGLE ST or MULTI ST. Use arrow keys to adjust.

You can adjust alarm limits in increments of 0.25 mm as needed for both single lead ST and multiple lead ST. ST alarms can be activated manually or automatically once the system has acquired an ST segment measurement. Typically, the system acquires this data within 30-60 seconds after completion of the learn sequence.

•

Disabling ECG alarms also disables ST alarms.

The SINGLE ST alarm allows you to monitor for localized changes that may only be detectable in a single lead. An ST alarm for a SINGLE LEAD will activate if the ST level for any one lead exceeds the SINGLE ST alarm limit, with respect to its current reference level. The factory default setting for the single lead ST alarm limit is 1.00 mm. The MULTI ST alarm allows you to monitor for global changes that may be detectable in multiple leads. An ST alarm for MULTIPLE LEADS will activate if the ST level for three or more leads exceeds the MULTI ST alarm limit, with respect to each lead’s current reference level. The factory default setting for the multi-lead ST alarm limit is 0.50 mm.

•

The MULTI ST alarm limit cannot be set above the SINGLE ST alarm limit if both alarms are enabled.

At the time that ST monitoring is initiated, the current reference level for all leads is set to 0.00 mm (isoelectric). A SINGLE ST alarm will activate if any lead has an initial ST level that exceeds the SINGLE ST alarm limit. Or, a MULTI ST alarm will activate if three or more leads have initial ST levels that exceed the MULTI ST alarm limit. Whenever a SINGLE or MULTI ST alarm is activated, the reference level for all leads is automatically reset based on each lead’s current ST level. This allows changes in ST levels to be dynamically tracked throughout the patient’s course of treatment.

10-4

ST Analysis

As shown in Figure 10-3: ST Segment Alarm Function, when the patient’s ST segment trend line rises and violates the first alarm threshold, a new baseline and a new upper alarm threshold are established (the amount of change needed to set off another alarm is denoted by Delta). The lower alarm threshold remains unchanged. Though the patient’s ST segment continues to climb, it does not reach the new alarm threshold, so a new upper limit is not set. When the ST level declines, the alarm threshold also declines until the original alarm thresholds are re-established. As the patient’s ST level continues to decline, a new threshold is established when an alarm condition occurs.

Thick line is the measured ST level. Solid line is the ST alarm baseline. Dashed line is the alarm threshold.

Figure 10-3: ST Segment Alarm Function As a second example, assume the SINGLE ST alarm is set at 1.00 mm. The initial ST amplitude for a particular lead is +0.60 mm. Based on the initial reference level of 0.00 mm, an alarm would activate if the ST level exceeds +1.00 mm. Therefore, no alarm occurs. Instantaneously, the ST level increases to +1.20 mm. SINGLE ST alarm occurs and the new reference level for the lead is set to +1.20 mm. The next ST alarm for that lead, assuming no changes are made in other leads, would be activated at +2.20 mm.

Selecting Leads for ST Alarms To select or deselect leads for ST alarms: 1 2 3 4

Touch ECG. Touch ALARM LIMITS. Touch ST LEADS. Select or deselect leads.

Touching the ST LEADS key allows you to select which leads are to be used to generate ST alarms. Leads that are not clinically relevant for a patient can be disabled to allow tighter limits to be placed on more clinically significant leads. All highlighted leads will be used to generate ST alarms. The factory default setting is all leads included.

10-5

Ultraview Care Network

Reviewing ST Data To review ST data: 1 2 3

Touch ECG. Touch REVIEW. Touch ST REVIEW.

Use the ST Review menu to display and review ST segment data. A snapshot of ST segments for all available leads is displayed. The time and date of the ST snapshot is displayed on the menu prompt line. Touch the PRIOR SET or NEXT SET key to display ST data at other time points. Figure 10-4: ST Segment Display is an example of a ST segment snapshot. Nine ST snapshots can be stored for display. The oldest ST snapshot, not marked as SAVED, will be deleted to make room to store a new snapshot. To save an ST snapshot, touch the SAVE SET key. ST snapshots are automatically stored whenever an ST alarm occurs or at preselected time intervals. To store the ST snapshots at periodic intervals, select TIME SAVE YES. Available intervals are 5-, 10-, 15-, 30- or 60-minutes (only available in Module Configuration Manager). The factory default setting for the time save interval is 15 minutes.

I 0.16 mm

II 0.00 mm

III 1.44 mm

AVR 0.16 mm

AVL 0.24 mm

AVF 0.16 mm

V1 0.16 mm

V4 -0.16 mm

V2 2.88 mm

V3 4.32 mm

V6 -0.16 mm

Figure 10-4: ST Segment Display

Clearing ST Data To clear the displayed ST data: 1 2 3 4 5

10-6

Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch CLEAR. Select YES.

Touching the CLEAR key and then confirming your choice by selecting YES clears the currently displayed data for all leads from memory. Data is also cleared from the trends.

ST Analysis

Viewing ST Trends To view ST trends: 1 2 3 4 5

Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch ST TREND. Touch the trend plot near the desired data point. Then use arrow keys to adjust the cursor position.

Trends showing deviations in ST segment level are displayed for each lead monitored in the past 24 hours. Touching the trend graph or one of the arrow keys in the menu produces a cursor on the baseline of the trend plot. Position this cursor at a point of interest in the trend to determine the ST segment level for all displayed leads at that time. A measurement for each lead is displayed in the table to the right of the trend display. Figure 10-5: ST Trend Display shows an example of a trend display. The graph plots deviations in ST segment level over time.

I V1

AVR V4

II V2

AVL V5

III V3

AVF V6

ST VALUES at 03:38 0.16 AVR 0.16 0.00 AVL 0.24 1.44 AVF 0.16 -1.44 V4 -0.16 2.88 V5 OFF 4.32 V6 -0.16

I II III V1 V2 V3

SCALE -2 mm to 2 mm 00:00

06:00

06:00 00:00

Figure 10-5: ST Trend Display

Selecting the ST Trend Timebase To select a timebase: 1 2 3 4 5

Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch ST TREND. Select TIMEBASE of 1.5, 3, 6, 12, or 24 hour.

You can select the time period over which the ST data is displayed in a trended format. Resolution for each timebase is shown below. Resolution

Timebase

30-seconds

1.5-hours

1-minute

3-hours

2-minutes

6-hours

4-minutes

12-hours

8-minutes

24-hours

Available timebases are 1.5-, 3-, 6-, 12-, or 24-hours. The factory default setting for the ST trend timebase is 6-hours.

10-7

Ultraview Care Network

Printing ST Segment Data To print all ST segment data:

Printouts of ST segment data are annotated with the following:

1 2 3

•

bed identification

•

time and date of the printout

•

lead designator

Touch ECG. Touch PRINT. Touch ST SEGMENTS.

To print selected ST segments: 1 2 3 4

Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch PRINT.

To print the current trend data: 1 2 3 4 5

10-8

Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch ST TREND. Touch PRINT.

ST segment waveforms can be printed from either the PRINT or ST REVIEW menu. To print all the available ST segment waveforms, use the PRINT menu. To print only selected ST segment waveforms or ST trends, use the ST REVIEW menu.

•

ST Segment data cannot be printed with the 90449 printer module.

ST Analysis Troubleshooting Guide Clinical Situation No access to ST analysis functions

ST = ?? is displayed

Possible Cause

Solution

■ The system must learn the ST seg-

■ Wait until the system analyzes suffi-

ment level before it can provide access to ST analysis functions.

■ Infrequent occurrence of dominant beats.

■ ECG amplitude may be insufficient to detect QRS complexes.

cient QRS complexes to calculate the ST segment level (approximately one minute).

■ ST analysis not performed on paced, premature dominant or abnormal beats.

■ Check QRS amplitude.

12 - Lead Diagnostics

Directory of Keys E C G

ECG MENU ALARM LIMITS

SIZE

SETUP

LEAD CONTROL

DISPLAY FORMAT

SUSPEND PROCESSING

RELEARN

REVIEW

ECG - REVIEW ST REVIEW

ECG - REPORT REVIEW STAT REPORT

ARRHYTHMIA REVIEW

REPORT REVIEW

REAL TIME ST TREND

HR:MN DAY-MONTH-YEAR

AUTO REPORT XX MIN

AUTO PRINT ON OFF

MORE TEXT

SAVE

CLEAR

Do you wish to clear the displayed ECG report? YES

DIR

TREND DISPLAY ON OFF

TREND TIMEBASE 15 MIN / 30 MIN

ECG - REPORT DIRECTORY DISPLAY

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

11-1

12 - Lead Diagnostics

Overview The 12-lead report function acquires and displays 12 ECG vectors in the same format as an electrocardiograph. Diagnostic electrocardiographic devices obtain conventional ECG signatures that accurately represent both the detailed waveforms in each cardiac cycle and the beat-to-beat variability to determine cardiac rhythm. Prior to analysis, the ECG data is split into two different paths: one to the module’s monitoring functions and the other to the diagnostic functions. Consistent with the ANSI/AAMI specifications for diagnostic electrocardiographic devices, the data in the diagnostic path is acquired at 500 samples per second. The output from both the monitoring and diagnostic functions are combined and transferred to the bedside monitor for display and distribution to the Ultraview Care Network.

11-2

•

No automated analysis is completely reliable. A physician should read all ECG results.

•

Special problems exist with pediatric ECGs because of the considerable differences in the signal characteristics of adult and infants and because of the evolution of the ECG patterns from birth to adolescence.

•

Digital systems produce a noticeable modulating effect from one cycle to the next, particularly in pediatric ECGs. This phenomenon, which is not physiologic, is due to the asynchronism between data acquisition sample rate and the peak of the QRS waveform.

12 - Lead Diagnostics

Display Detail The 12-lead report display shows 2.5 seconds of waveform data per lead. Presentation of the leads may be in a standard format (refer to Figure 11-1: 12-Lead Report Display) or the Cabrera format. When analysis is complete, measurements and diagnostic statements are displayed above the waveform data (requires option D).

í˘ą

í˘˛

Vent. rate: 60 BPM PR interval: 162 ms QRS duration: 88 ms QT/QTc: 360/360 ms P-QRS-T axes: 50 44 51

SINUS BRADYCARDIA NORMAL ECG

AVR

AVL

III

AVF

Figure 11-1: 12-Lead Report Display

í˘ą measurement and interpretation data (requires Option D) í˘˛ ECG traces for 12 leads (2.5 seconds/lead)

Initiating a 12-Lead Report To initiate a 12-lead ECG report: 1 2 3 4

Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Touch STAT REPORT.

You can acquire a 12-lead report by touching STAT REPORT. Initiating a STAT REPORT will not affect the automatic schedule.

â&#x20AC;˘

When monitoring paced patients, ECG processing and the pacepulse detection function will be suspended for 10 seconds whenever acquisition of an ECG report is in process. Temporarily suspending these functions allows the actual pacepulse to be displayed/printed in the 12-lead report without interfering with arrhythmia analysis.

â&#x20AC;˘

If the STAT REPORT key is labeled LEADS OFF, one or more of the 12 leads is disconnected. Check all electrode connections before proceeding.

11-3

Ultraview Care Network

Automatic Scheduling of 12-Lead Reports To schedule 12-lead ECG reports: 1 2 3 4

Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Select AUTO REPORT of 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, or 24 hours. Touch AUTO PRINT ON or OFF.

12-lead reports can be acquired automatically by selecting an interval time using the AUTO REPORT key. User-selectable intervals include 30-minutes or 1-, 2-, 4-, 8-, or 24-hours. Selecting OFF will disable this feature. 12-lead reports can be printed as they are acquired by selecting AUTO PRINT ON, or saved in memory for review and printing at a later time by selecting AUTO PRINT OFF. Touching the PRINT key at any time will print the displayed diagnostic report.

•

Automatic 12-lead reports are inhibited whenever the ECG signal is not of sufficient quality to produce a diagnostic report.

Saving and Clearing 12-Lead Reports To save/clear a 12-lead ECG report: 1 2 3 4a

Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Touch SAVE (while the report is displayed). or 4b Touch CLEAR (while the report is displayed). 4c Touch YES to confirm (for CLEAR only).

11-4

All 12-lead reports are stored in the module’s memory. The module can store multiple 12-lead reports (the exact number depends upon the ECG waveforms). When the module’s report memory is full, the oldest report that has not been saved is replaced by the newest report. To retain the currently displayed report in memory indefinitely, touch the SAVE key. To clear the currently displayed report from memory, touch the CLEAR key and then confirm your choice by selecting YES.

•

If your monitoring system is interfaced to a Pyramis ECG Management System and you are using a single module to acquire 12-lead reports at multiple bedsides, clear the 12-lead report(s) from memory before proceeding to the next patient’s bedside.

12 - Lead Diagnostics

Report Directory Display To view directory of 12-lead ECG reports:

Touching the DIR key will display a directory of 12-lead reports. The time and date of each report is shown with the summary diagnosis.

1 2 3 4

Use the arrow keys to select the report of interest, then touch the DISPLAY key to display the selected diagnostic report.

Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Touch DIR.

Reports that have been saved will be marked as YES in column three.

•

TIME 1:00 1:30 2:00 2:30 3:00 3:30 AM

A summary statement (column 4) is only displayed if option D is present.

DATE 28 AUG 28 AUG 28 AUG 28 AUG 28 AUG 28 AUG

SAVED YES

YES YES

DIAGNOSIS ABNORMAL ECG NORMAL ECG NORMAL ECG NORMAL ECG ABNORMAL ECG NORMAL ECG

Figure 11-2: Report Directory Display

Patient Demographics The patient’s gender, date of birth, height, and weight are required by the diagnostic ECG algorithm. This information is entered via the patient Admit function. If patient demographic information is not entered, the diagnostic ECG algorithm will use the following defaults: Table 1: Patient Demographic Default Values Demographic Date of birth

•

Default value 40 years

Gender

Male

Height

5’10”

Weight

180 lbs

For an accurate diagnosis, the patient’s demographics must be entered correctly.

11-5

Respiration

Directory of Keys - ECG E C G

ECG MENU ALARM LIMITS

SIZE

LEAD CONTROL

SETUP

DISPLAY FORMAT

SUSPEND PROCESSING

RELEARN

REVIEW

ECG - DISPLAY FORMAT FULL VIEW ON OFF

SPLIT VIEW ON OFF

2 LEAD ON OFF

CASCADE ON OFF

RESP ON OFF

VARITREND ON OFF

NEXT VIEW

ECG - SETUP SWEEP SPEED

QRS TONE

MONITOR EXTENDED

PACED YES NO

CONFIG

RATE SOURCE

RESTORE SETTINGS

TRANSFER DATA

ECG - CONFIG ADULT ARR INFANT ON OFF R E S P

V A R I

Refer to Refer to Respiration Varitrend 3

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

12-1

Respiration

Directory of Keys - Respiration R E S P

RESP MENU ALARM LIMITS

SIZE

SWEEP SPEED

RESP TONE

WAVEFORM ON OFF

LEAD SELECT

SHALLOW NORMAL

CVA FILTER ON OFF

RESP - LEAD SELECT RL - LA

RA - LA

RA - LL

RL -LL

RESP - TONE TONE ON OFF

VOLUME

RESP - SWEEP SPEED 25 mm/sec

12.5 mm/sec

6.25 mm/sec

1.56 mm/sec

RESP - SIZE SIZE

RESP - ALARM LIMITS HI/LO HI = 10 ON OFF

! 12-2

•

SIZE

LO = 1

APNEA ON OFF

APNEA = OFF

Based on features purchased, more or fewer keys may appear here than on your menu screens.

Respiration

Directory of Keys - Varitrend 3 V A R I

VARITREND MENU RESP RATE 1.5 MIN RESP WAVE 3.0 MIN

SIZE

EVENT TREND

VARITREND - SIZE MENU HR SCALE

RESP WAVE SIZE

SPO2 SCALE

VARITREND - EVENT TREND MENU CLEAR EVENT

DEFINE EVENT

TREND

PRIOR EVENT

NEXT EVENT

VARITREND - TREND MENU TIMEBASE 6 HOURS

VARITREND - CLEAR MENU CLEAR THIS EVENT

CLEAR ALL EVENTS

VARITREND - DEFINE EVENT MENU BRADY HR 100

ON OFF

•

TACH OFF

APNEA 20 sec

SP02 85%

ENTER

Based on features purchased, more or fewer keys may appear here than on your menu screens.

12-3

Respiration

Contents Directory of Keys - ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Directory of Keys - Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Directory of Keys - Varitrend 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Setting Up Respiration Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Selecting Adult or Infant Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Turning Respiratory Waveform On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Adjusting Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Selecting Respiration Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Adjusting Respiration Sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Using the Cardiovascular Artifact Filter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Configuring Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Printing Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Respiration Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Overview The respiration function detects and displays a waveform that: • • • •

represents each breath. provides the respiration rate. detects and rejects cardiovascular artifact. initiates alarms when limits are violated for either the respiration rate or apnea.

Changes in thoracic impedance during patient inspiration and expiration provide respiration data through the use of the ECG cable. Lead selection for respiration is independent of lead selection for ECG, even though both receive data from the same electrodes. Varitrend 3, an optional feature in some modules, generates a graph that plots heart rate, SpO2, and respiratory rates. You can view this plot on the monitor or print it on a system or bedside printer. The Event Trend feature of Varitrend 3 enables you to screen for apparent life threatening events such as bradycardia, with desaturation, or apnea accompanied by a change in heart rate. This feature plots bradycardia, tachycardia, apnea and desaturation trends for viewing and printing. A 24-hour trend of events is maintained and up to 48 events are stored in memory. Refer to Configuring Varitrend 3 Graphs on page 12-9 for more details.

! 12-4

•

You can define your own default settings for alarm limits and the display configuration. Refer to Setting User-Defined Default Values on page 7-5 for further details.

Respiration

Setting Up Respiration Monitoring To set up respiration monitoring: 1 2 3 4 5 6 7

Attach the patient ECG leads. Plug the ECG cable into the moduleâ&#x20AC;&#x2122;s ECG input. Touch ECG. Touch DISPLAY FORMAT. Select RESP ON. Touch RESP. Select additional keys as necessary.

Refer to the Directory of Keys - Respiration on page 12-2 for a flow diagram of respiration keys and menus.

â&#x20AC;˘

If the RESP ON/OFF key does not appear in the ECG Display Format menu, your module does not include the respiration option.

â&#x20AC;˘

The RESP key must be ON in the ECG Display Format menu to display the RESP parameter key.

CAUTION: â&#x20AC;˘ If you suspend ECG processing using the SUSPEND PROCESSING key in the ECG menu, you also suspend respiration processing.

Display Detail Respiration appears on the monitor in the following format:

í˘ą

í˘˛ R E S P

í˘ł

*RA-LA

í˘´

í˘ľ

APN 15s 20 í˘ś 15

18 í˘¸

í˘ˇ

Figure 12-1: Respiration Display

í˘ą respiration trace í˘˛ respiration parameter key í˘ł respiration indicator (flashes once per detected breath) í˘´ selected lead for respiration í˘ľ apnea alarm limit in seconds í˘ś high respiratory rate alarm limit í˘ˇ low respiratory rate alarm limit í˘¸ current respiratory rate

12-5

Ultraview Care Network

Selecting Adult or Infant Mode To specify the patient type: 1 2 3 4

Touch ECG. Touch SETUP. Touch CONFIG. Select ADULT or INFANT.

The respiration function provides both adult and infant operational modes to optimize monitoring accuracy. When you select adult or infant, RESP alarm limits and breath detection sensitivity are adjusted based upon your selection. CAUTION: • When the system is in the infant mode, respiration alarm activation can be delayed for up to three minutes. (The factory default setting for alarm delay is three minutes.) Closely observe the patient during this period.

Setting and Adjusting Alarms To set or adjust rate alarms: 1 2 3 4 5

Touch RESP. Touch ALARM LIMITS. Select HI/LO ON. Select HI= or LO=. Use arrow keys to adjust.

The factory default setting for respiratory rate alarms is OFF in the adult mode and ON in the infant mode. Once respiratory alarms are enabled, the factory default settings are as follows: High Rate Adult

150% of learned rate; not below 30 breaths/minute

0 breaths/minute

Infant

100 breaths/minute

10 breaths/minute

To set or adjust apnea alarms: 1 2 3 4 5

Touch RESP. Touch ALARM LIMITS. Select APNEA ON. Touch APNEA=. Use arrow keys to adjust.

Low Rate

The factory default setting for apnea alarms is OFF in the adult mode and ON in the infant mode. When active, the factory default setting is 20 seconds in both modes. The apnea alarm setting is adjustable from 5-40 seconds, or the alarm can be disabled. Refer to Setting Alarm Limits on page 2-5 for details on system alarm operation.

•

If the alarm limit for high rate or low rate is displayed in reverse video, the alarm tone, alarm recording, and alarm watch have been disabled.

Apnea Alarms Apnea alarm limit is the maximum duration allowed between breaths before the respiration rate is set to zero. The apnea alarm limit may be set from 5 to 40 seconds in 5-second increments. • •

12-6

If the APNEA ALARM is turned ON, the APNEA ALARM will sound after the apnea limit is reached. If the APNEA ALARM is turned OFF, the respiration rate will be set to zero after 20 seconds or when the apnea alarm limit is reached, whichever is greater. If the low rate alarm is ON, it will sound 10 seconds after the rate is set to zero.

Respiration

Turning Respiratory Waveform On/Off To turn the respiration waveform display ON or OFF:

You may choose to turn the respiration waveform OFF and display only the respiration numeric values.

1 2

The factory default setting for respiration waveform is ON.

Touch RESP. Select WAVEFORM ON/OFF.

Adjusting Waveform Size To adjust respiratory waveform size: 1 2 3

Touch RESP. Touch SIZE. Adjust waveform size using SIZE ↑ or SIZE ↓.

You can increase or decrease the size of the respiration waveform display. This changes the displayed size only, and does not affect the signal gain or breath detection sensitivity.

Adjusting Sweep Speed To select a respiration sweep speed: 1 2 3

Touch RESP. Touch SWEEP SPEED. Touch the appropriate mm/sec key.

The sweep speed determines the rate at which the respiration waveform moves across the screen. Sweep speed selections are 25-, 12.5- (factory default), 6.25-, or 1.56-mm/sec.

Adjusting Respiration Tone To adjust the respiration tone volume:

You can select an audible tone to sound with each respiratory cycle. The tone volume is adjustable or can be disabled.

1 2 3 4

The factory default setting for tone is OFF.

Touch RESP. Touch RESP TONE. Select TONE ON. Adjust tone volume using VOLUME↑ or VOLUME↓.

Selecting Respiration Leads To select respiration leads:

Respiration lead selections are RL-LA, RA-LA, RA-LL, and RL-LL.

1 2 3

•

Touch RESP. Touch LEAD SELECT. Select the appropriate lead configuration.

• •

RA-LA represents the line of maximum respiratory effort in adults and chest-breathing infants. RA-LL represents the line of maximum respiratory effort in abdominal-breathing infants. The factory default setting for respiration lead selection is RA-LA.

•

When a good respiration signal cannot be attained from the selected lead, the message LOSS OF SIGNAL is displayed and ??? appears in place of the respiratory rate.

12-7

Ultraview Care Network

Maximum Impedance Change: Position RA and LA electrodes at the nipple level, midaxillary line. Position LL below the diaphragm, preferably below the umbilicus.

Alternate Method: Position RA and LA electrodes at the 2nd intercostal space, midclavicular line. Position LL below the diaphragm, preferably below the umbilicus.

Figure 12-2: Infant Electrode Placement

Adjusting Respiration Sensitivity To adjust respiration monitoring sensitivity: 1 2

Touch RESP. Select SHALLOW or NORMAL.

Two input sensitivities for respiration monitoring are available. You can set them based on the patientâ&#x20AC;&#x2122;s respiratory effort; shallow or normal. Use the shallow mode if the monitor has difficulty counting the respiratory rate and/or the waveform is difficult to read. Selecting the SHALLOW mode also lowers the detection sensitivity nearer to the low amplitude waveform of infants. The factory default for sensitivity is NORMAL in the adult mode, and SHALLOW in the infant mode.

Using the Cardiovascular Artifact Filter To enable the CVA filter: 1 2

Touch RESP. Select CVA FILTER ON.

To disable the CVA filter: 1 2

Touch RESP. Select CVA FILTER OFF.

Respiration is monitored based on impedance changes which occur with the expansion and contraction of the chest. However, the physical action of the heart pumping blood and the flow of blood through the vasculature also creates changes in impedance known as cardiovascular artifact (CVA). In the absence of respiration, for example, during episodes of apnea, it is possible for a waveform to appear in the respiration zone which represents CVA rather than true respirations. In such cases, the rate of the CVA would be the same as the heart rate. The Spacelabs Medical CVA detection filter provides a method of discriminating between true respiratory effort and cardiac activity. The filter checks for coincidence between the respiratory and the heart rate. If the rates are the same, the digital display for respiratory rate changes to CVA, a CVA message appears in the waveform zone, and an apnea alarm is triggered if the apnea alarm has been

12-8

Respiration

enabled. This minimizes the possibility of apneic episodes being undetected due to CVA. Episodes of CVA will be reflected as a respiratory rate of zero in the trends. If the patient’s respiratory and heart rates are actually identical, you may want to disable the CVA filter. WARNING: • If you disable the CVA detection filter, you will not be alerted to the presence of CVA if it replaces the respiration waveform.

Restoring User-Defined Settings To restore user-defined settings: 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

With the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-5.

•

Module Configuration Manager is an optional feature for some modules. Your module may not contain this option.

•

RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

•

Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.

Configuring Varitrend 3 Graphs To turn Varitrend 3 ON or OFF: 1 2 3

Touch ECG. Touch DISPLAY FORMAT. Select VARITREND ON or OFF.

In Varitrend 3, trends for heart rate and SpO2 are displayed in the upper half of the zone. Either the respiration rate trend or the compressed respiration waveform is displayed in the lower half of the zone.

•

If the VARITREND ON/OFF key does not appear in the ECG Display Format menu, your module does not include the Varitrend option.

Setting the Time Scale To set the horizontal time scale: 1 2

Touch VARI. Select 1.5 MIN or 3.0 MIN.

You can set the time scale for the horizontal axis at either 1.5- or 3.0-minutes.

Selecting Respiratory Display Type To select the type of respiratory display: 1 2

Touch VARI. Select RESP RATE or RESP WAVE.

The lower graph displays the trend for either the respiration rate or the compressed respiration waveform. • •

RESP RATE displays the current respiration rate trend. RESP WAVE displays a compressed respiration waveform.

12-9

Ultraview Care Network

Selecting Respiratory Rate Scale To select respiration rate scale: 1 2 3 4 5

Touch VARI. Touch RESP RATE. Touch SIZE. Touch RESP RATE SCALE. Use arrow keys to adjust.

You can adjust the scale for the respiration rate trend. Scale selections include 0-50, 0-100, 0-150, or 0-200 breaths/minute.

Selecting Respiratory Waveform Size To select a respiration waveform: 1 2 3 4

Touch VARI. Touch SIZE. Touch RESP WAVE SIZE. Use arrow keys to adjust.

You can trend a compressed respiration waveform. In this mode, the message RESP WAVEFORM appears next to the vertical axis instead of scale values.

Selecting Heart Rate Scale To select heart rate scale: 1 2 3 4

Touch VARI. Touch SIZE. Touch HR SCALE. Use arrow keys to adjust.

To select an SpO2 scale: 1 2 3 4

Touch VARI. Touch SIZE. Touch SPO2 SCALE. Use arrow keys to adjust.

You can plot heart rate. Scale selections include 0-100, 0-150, 0-200, 0-250, 0-300, 50-150, 100-200, 100-250, and 100-300 beats/minute.

Selecting SpO2 Scale You can plot SpO2. Scale selections include 0-100, 25-100, 50-100, and 75-100%.

Defining Events To access Event Trend: 1 2

Touch VARI. Touch EVENT TREND.

To define an event: 1 2 3 4 5 6

Touch VARI. Touch EVENT TREND. Touch DEFINE EVENT. Select event(s) to define. Use arrow keys to adjust. Touch ENTER.

12-10

The Event Trend feature of Varitrend 3 enables you to store events that represent a change in a patient’s condition based on multiple variables. You can define criteria for up to five different events. For example, you may want to store episodes where the heart rate drops to less than 100 bpm, apnea lasts for more than 20 seconds, or the SpO2 value drops to less than 85%. The patient’s status will be continually checked against each event definition. If any of the criteria are violated, a snapshot of the Varitrend 3 display representing this deviation will be stored. The event will also be added to the event trend.

Respiration

Displaying Event Trends To display event trends: 1 2 3

Touch VARI. Touch EVENT TREND. Touch TREND.

To clear events: 1 2 3 4

Touch VARI. Touch EVENT TREND. Touch CLEAR EVENT. Select CLEAR THIS EVENT or CLEAR ALL EVENTS.

To print events: 1 2 3

Touch VARI. Touch EVENT TREND. Touch PRINT.

To print event trends: 1 2 3 4

Touch VARI. Touch EVENT TREND. Touch TREND. Touch PRINT.

Events are trended according to their duration and frequency. Regardless of the defining criteria, all events are plotted (grouped) together in the event trend graph. You can select to view these trends in 6-, 12-, or 24-hour time periods. Resolution for each timebase is shown below (15-minutes for a 6-hour trend, 30-minutes for a 12-hour trend, 60-minutes for a 24-hour trend). The top trend displays the duration of the longest event in each time period. The bottom trend displays the number of events that occurred during each time period. Scaling, for the vertical axis for each trend, is automatically adjusted based upon patient data.

60 Longest 30 EVENT (seconds) 0

Event bar graph

60-minute resolution

18:30

06:30

0 18:30

Number of Events

Figure 12-3: Event Trend Graph

â&#x20AC;˘

Events longer than 4-minutes will be reported as 4-minute events.

Clearing Events If you choose to clear a single event the data that represents that episode will be removed from the event trends. You may also clear all events and trends. This will have no effect on the event definitions.

Printing Varitrend 3 Graphs To print a Varitrend 3 graph: 1 2

Touch VARI. Touch PRINT.

You may produce a recording of the currently displayed Varitrend 3 graph. Refer to Printing on page 4-1 for a complete overview of printer functions.

12-11

Respiration Troubleshooting Guide Clinical Situation Inaccurate respiratory rate or 0 displayed. Question marks displayed instead of rate

Possible Cause ■ Respiration too shallow for normal detection.

■ ECG electrode contact or placement poor.

■ Incorrect lead selection for respiration.

■ CVA artifact.

Solution ■ Touch the SHALLOW/NORMAL key to highlight SHALLOW.

■ Apply new electrodes. Make sure to properly prepare the skin; position electrodes on the chest where the chest expansion is the greatest.

■ Select the appropriate lead. Best lead selection is typically RA-LA for adults and RA-LL for infants.

■ Assess the patient for apnea. Reselect lead for better signal quality.

No respiration waveform. LOSS OF SIGNAL message is displayed

No respiration waveform is displayed

■ ECG electrodes or patient cable not attached.

■ Select another lead. ■ Reconnect the leads or the patient cable.

■ Channels have not been configured to display respiration.

■ Select RESP ON in the ECG Display Format menu.

Temperature

Directory of Keys One Temperature T E M P

keys may not be displayed

keys may not be displayed TEMP MENU

RESTORE SETTINGS

ALARM LIMITS

YES

TEMP - ALARM LIMITS ALARMS ON OFF

HI= OFF

LO= OFF

Two Temperatures (same module)

T E M P

keys may not be displayed

keys may not be displayed TEMP MENU

RESTORE SETTINGS

ALARM LIMITS

YES

TEMP - ALARM LIMITS ALARMS ON OFF

HI= OFF

LO= OFF

TEMP 1

TEMP 2

DELTA TEMP

Alternate key display ALARMS ON OFF

•

HI= OFF

LO= OFF

TEMP 3

TEMP 4

DELTA TEMP

Based on features purchased, more or fewer keys may appear here than on your menu screens.

13-1

Temperature

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up Temperature Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Setting or Adjusting Temperature Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . .4 Recording Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Temperature Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Overview Either one or two temperature inputs can be monitored. Whenever two temperatures from the same module are monitored, a delta value (temperature difference between the two readings) is calculated. Temperatures are displayed in degrees centigrade only. You can set independent high and low alarm limits for each temperature, and the delta temperature.

Setting Up Temperature Monitoring To set up temperature monitoring: 1 2 3 4

13-2

Attach the temperature probe(s) to the patient. Plug the temperature probe(s) into the module. Touch TEMP. Select additional keys as needed during monitoring.

Attach the temperature probe(s) to the patient and then to the module. The TEMP key and temperature values now appear on the monitor screen. Touch TEMP to display the Temperature menu.

â&#x20AC;˘

You can define your own default settings for alarm limits. Refer to Setting User-Defined Default Values on page 7-5 for further details.

Temperature

Display Detail Temperature readings appear on the monitor screen as soon as you plug a temperature probe into the module.

í˘ł

í˘ą T E M P

38.0

í˘˛ í˘´ T1 o

38.5 37.5

í˘ľ T E M P

í˘ś

35.1 38.0

C T2

DT 2.9 T1 ON T2 ON DT OFF

í˘ˇ

Figure 13-1: Temperature Display

í˘ą temperature parameter key í˘˛ temperature label í˘ł single channel temperature reading í˘´ high and low temperature alarm limits í˘ľ two temperatures (T1/T2 or T3/T4) í˘ś delta temperature (DT) í˘ˇ status of temperature alarms

â&#x20AC;˘

When alarm limits are set on more than one temperature, the alarm limits for only one temperature will be displayed. To view the alarm limits, touch TEMP, then ALARM LIMITS, then select the TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP key.

13-3

Ultraview Care Network

Setting or Adjusting Temperature Alarm Limits To set or adjust alarm limits 1 2 3

4 5 6

Touch TEMP. Touch ALARM LIMITS. Select TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP. Select ALARMS ON. Select HI= or LO=. Use arrow keys to adjust limit.

High and low alarm limits can be set for T1 (T3), T2 (T4), and the temperature difference (DT) between two temperatures. The factory default settings for high and low temperature alarms are 37.5°C and 36.5°C. Refer to Default Alarm Limits on page 2-4 for details on system alarm operation.

Recording Temperatures To print a strip chart of current temperature readings: 1 2

Touch RECORD. Touch TEMP while it flashes.

You can send currently displayed temperature readings to a bedside recorder or system printer. Refer to Printing on page 4-1 for an overview of system printing information.

Restoring User-Defined Settings To restore user-defined settings: Configurations without ECG 1 2 3

Touch TEMP. Touch RESTORE SETTINGS. Select YES.

To restore user-defined settings: Configurations with ECG 1 2 3 4

13-4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

With the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-5.

•

RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

Temperature Troubleshooting Guide Clinical Situation Intermittent or no operation

Temperature not displayed

Possible Cause

Solution

■ Module error.

■ Call a qualified service person.

■ Module not inserted correctly.

■ Reinsert the module.

■ Probe not connected to module.

■ Reconnect the probe.

Fetal Monitoring

Directory of Keys F E T A L

FETAL MAIN MENU F-ALERT RESET

SETUP

RECORDER ON OFF

PAPER FEED

AUDIO X XX%

FETAL ECG

F ALERT LIMITS

PRINT PERIOD

MARK

UA REF

FETAL SETUP MENU TWIN SHIFT

TOCO SENS

RESTORE SETTINGS

FETAL - FETAL ECG MENU SIZE

SIZE

WAVEFORM

X mm/sec

OFF

ECG PLOT ON

OFF

ECG HR EDIT ON

OFF

FETAL - TOCO SENS MENU LOW

MEDIUM

HIGH

FETAL - TWIN SHIFT MENU AUTO

MANUAL

NO SHIFT

FETAL - F-ALERT LIMITS MENU F-ALERT ON OFF

•

HI= XXX

LO= XXX

Based on features purchased, more or fewer keys may appear here than on your menu screens.

14-1

Fetal Monitoring

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Fetal Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Starting Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Ultrasound Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Uterine Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Intrauterine Pressure Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Fetal Heart Rate Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Bradycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Tachycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Recorder Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Telemetry Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Mermaid Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Overview This chapter describes the fetal monitor functionality of the Spacelabs Medical Maternal Obstetrical Monitor (MOM). For instructions on optional maternal parameters such as ECG, SpO2, temperature, and NIBP refer to the appropriate chapter of this manual.

Fetal Display Detail The fetal module automatically allocates a single display zone when it establishes communication with the Maternal Obstetrical Monitor. This zone consists of numeric values and messages. When an internal fetal ECG electrode is applied to the patient, a second zone displays the fetal ECG waveform from channel 1. This zone does not display when using ultrasound-monitoring technique. For singleton births, this display will appear as follows:

í˘ą

í˘ł

â&#x2122;Ľ

í˘´

í˘ś

â&#x153;&#x2018;â&#x153;&#x201C; â&#x153;&#x2018;â&#x153;&#x201C;

FHR1 (US) UC (EXT)

FHR1 (US)

144 144 í˘˛

í˘¸

UA (EXT)

67 25 í˘ľ

ě?&#x2026;

F E T A L

TIME and DATE PATIENTâ&#x20AC;&#x2122;S NAME PATIENTâ&#x20AC;&#x2122;S NAME RM 1003 ROOM 1003 ALERT ON PAPER OUT

ě?&#x2C6;

í˘ˇ Figure 14-1: Singleton Birth Display

14-2

Fetal Monitoring

For a twin pregnancy, the display appears as follows:

í˘ą

í˘ł

â&#x2122;Ľ

í˘ś

í˘¸

FHR1 (ECG)

UA (EXT)

FHR1 (US)

UC (EXT)

136 144 í˘˛

í˘´

32 67 í˘ˇ

í˘ł

â&#x2122;Ľ

í˘´

ě?&#x2030; ě?&#x2026;

FHR2 (US)

125 í˘š

F E T A L

TIME and DATE PATIENTâ&#x20AC;&#x2122;S NAME ROOM 1003 PATIENTâ&#x20AC;&#x2122;S NAME RM 1003 ALERT ON PAPER OUT

ě?&#x2C6;

í˘ľ

ě&#x201D;&#x2C6; Figure 14-2: Twin Display

í˘ą heart beat indicator (flashes once per detected beat) í˘˛ channel 1 heart rate (beats per minute) í˘ł FHR channel label í˘´ source of heart rate signal (US = ultrasound, ECG = spiral ECG) í˘ľ signal indicator (full = good signal; half full = adequate; empty = poor or no signal)

í˘ś UA channel label í˘ˇ uterine activity measure (units for Toco; mmHg or kPa for IUP) í˘¸ source (Ext for Toco; mmHg, or kPa for IUP) í˘š channel 2 heart rate (beats per minute) ě?&#x2026; fetal parameter key ě?&#x2C6; status messages (appear when appropriate) ě?&#x2030; time, date, patient name and room number ě&#x201D;&#x2C6; fetal ECG trace from spiral electrode

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Ultraview Care Network

Starting Operation Power ON To prepare the monitor for operation: 1.

Plug the appropriate end of the power supply cord into the monitor’s right side panel receptacle labeled J1.

Secure the connector with the screw that is provided.

Plug the other end of the power cord into a properly grounded three-wire outlet marked Hospital Grade or Hospital Only.

Press the main power switch ON. The monitor will perform a self-test. •

If the MOM unit is powered OFF for a period of three minutes, all data, including the patient’s name, is purged from memory.

Standalone unit (not connected to BirthNet): The patient’s name will flash on the display if all of the following conditions are met: •

if a patient’s name has been admitted through the monitor setup.

•

the patient was not discharged from the monitor before powering OFF the monitor.

•

the unit was not powered OFF for a period greater than three minutes.

If the flashing name is correct, the clinician should confirm the identity of the patient by touching the F-ALERT RESET key. Following confirmation, the patient’s name will print on the fetal strip and will continue to print every 20 minutes. If incorrect, use the MONITOR SETUP/ADMIT DISCHARGE key to admit the new patient. Under standalone conditions, the patient’s name will also flash if no fetal heart rate data has been received for a period of 10 minutes on channel 1. Touch the FALERT RESET key to confirm the patient’s name. When connected to BirthNet, the patient’s name will flash the first time the monitor intercepts a name from BirthNet (after power ON) to inform the clinician of the identity of the patient. Touch the F-ALERT RESET key to confirm the information. The patient name will also automatically print on the fetal strip. Subsequent admission through BirthNet will not cause the name to flash if the monitor has not been powered OFF between patients.

! 14-4

•

The Admit/Discharge feature of the monitor is primarily a standalone feature. Use of this feature when connected to BirthNet might create a situation where the name of the patient entered under ADMIT in Monitor Setup will appear on the maternal strip while the fetal strip is identified with the patient’s name from BirthNet. If the hospital chooses to use the Admit/Discharge function, it is recommend that the monitor be powered OFF for three minutes between patients.

Fetal Monitoring

Under standalone or BirthNet connections, when the monitor is in fetal heart rate alert status, the clinician will have to first touch the F-ALERT RESET to reset the alert, and again, to confirm the patient’s name.

Loading Chart Paper To advance and calibrate the fetal recorder paper:

To load chart paper:

Press the Recorder Release button and slide the drawer out to reveal the paper bin.

Pull out one or two sheets of paper from the top of a new packet and place the remaining packet of paper into the recorder drawer. Position the top of the paper (fetal heart rate scale) toward the left of the drawer with the printed side facing up.

Slide the recorder door back until it snaps securely in place. Make sure that the leading two sheets of paper hang out of the monitor.

Touch PAPER FEED.

•

For the protection and proper performance of the recorder, use only paper approved by Spacelabs Medical. Failure to use approved paper may result in a malfunction.

Calibration Calibration provides a functional check of the equipment and helps ensure a reliable recording. Calibration should be performed before beginning a recording and can be done at any time during monitoring. To calibrate: 1.

Touch the FETAL key.

Touch the PAPER FEED key.

FHR 1–150, UA –50, and FHR 2–180 will be displayed and the recorder will print corresponding lines on the fetal strip chart.

•

Following calibration, check that the recorder printed a line at 150 and 180 to ensure the paper is the correct scale.

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Ultraview Care Network

Ultrasound Monitoring Channel 1 The ultrasound transducer sends sound waves into the uterine cavity and detects echoes returning from objects in the path. The monitor uses auto-correlation to analyze these echoes from moving objects, specifically the fetal heart. The rhythm of the motion is used to compute the fetal heart rate. To produce a reliable recording, the transducer must be positioned properly to send sound waves directly at the fetal heart.

•

To obtain consistent, reliable information, proper application of transducers is essential.

Ultrasound Transducer Preparation and Application The transducer connections are color-coded and uniquely keyed. 1.

Plug the ultrasound transducer (green) connector into the FHR1 (green) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.

Apply a generous amount of gel over the face of the ultrasound transducer.

! 3.

•

Remember to calibrate the monitor each time you begin a monitoring session. Refer to Calibration on page 14-5.

Place the transducer on the mother’s abdomen and gently move it along the abdomen to locate the sharpest and clearest fetal heart sounds.

14-6

The gel is necessary to ensure that good signals are produced by the transducer. Use enough gel to cover the flat transducer face before it is placed on the mother’s abdomen. Add additional gel, if necessary, to improve the signal.

Adjust the volume as necessary to hear the fetal heart sounds while positioning the ultrasound transducer.

! 4.

•

Keep the transducer face in contact with the abdomen. Tilt the transducer to locate the clearest heart sounds, then reposition it in the direction of the tilt until you hear the best signal while the transducer is flat on the abdomen.

The transducer should be held securely in place with the transducer belts without causing discomfort to the patient.

Check the mother’s pulse. Be sure it does not coincide with the displayed heart rate. If it does, the transducer may be detecting the maternal blood flow, rather than the fetal heart beat. Reposition the transducer toward the fetal heart.

Fetal Monitoring

Channel 2 To set the twin FHR shift: 1 2 3

Touch the SETUP key on the main fetal menu. Touch the TWIN SHIFT key. Select MANUAL, AUTO, or NO SHIFT mode.

The monitor is equipped with a second FHR connector to provide simultaneous monitoring of twins. Both fetuses can be monitored using ultrasound transducers. Ultrasound transducer preparation and application for the second fetus is the same as for a single fetus. Volume controls for both channels are located on screen.

•

Make sure that both transducers are not directed at the same fetus. Review the information on Differentiation of Fetal Heart Rate on page 14-7 and Coincidence Recognition on page 14-7.

Differentiation of Fetal Heart Rate To aid in distinguishing twin fetal heart rates, the operator can select one of three modes for presentation of the fetal heart rate data for the second fetus. The three modes are: • • •

FHR2 prints on the same scale as FHR1 FHR2 prints on a scale 30 bpm below FHR1 (twin shift manual setting) FHR2 shifts to a scale 30 bpm below FHR1 when the monitor detects the two FHRs to be in proximity to each other (auto setting). To differentiate twin FHRs on the fetal strip chart, the FHR2 trend prints in a light gray compared to the darker FHR1 trend. When twin fetal heart rates intersect, the FHR2 trend prints dots only, rather than a line, to enhance the distinction between the two. Finally, the recorder prints HR2 every 10 minutes with a dotted line pointing to the FHR2 trend. If the 30-bpm offset is activated, the message will read HR2, Add 30.

•

Once shifted, FHR2 will remain on this alternate scale until the monitor detects a consistent pattern of baseline separation between the two fetal heart rates. In many cases, this alternate scale may remain in effect throughout the delivery.

Coincidence Recognition The system has a coincidence recognition feature to detect the same heart rates between FHR1 and FHR2 over a period of time. When a coincidence is suspected, the monitor prints a question mark (?) on the strip chart to notify the clinician.

•

If these marks appear, the FHR1 and FHR2 signals may be from the same fetus. Re-check the ultrasound transducer positions. If necessary, reposition the transducers to capture the fetal heart rates from different fetuses.

•

This detection may not occur if channel 1 is in ECG mode and channel 2 is ultrasound, because of the difference in signal processing.

•

This detection may not occur if one or both of the ultrasound channels have a poor signal quality.

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Ultraview Care Network

Uterine Activity The Toco transducer detects uterine activity by sensing changes in tension on the abdomen. Although absolute uterine pressure cannot be measured by this method, the Toco transducer does provide a reliable indication of the timing and approximate duration of contractions.

â&#x20AC;˘

Do not use any kind of gel on the Toco transducer.

Toco Transducer Preparation and Application To initialize uterine activity: 1 2

Touch the UA REF key. Touch YES to confirm.

To set the Toco sensitivity: 1 2 3

Touch the SETUP key on the main fetal menu. Touch the TOCO SENS key. Select LOW, MEDIUM, or HIGH sensitivity.

Plug the Toco transducer (yellow) connector into the UA (yellow) connector on the front of the monitor. The groove on the Toco transducer connector must be aligned properly.

Position the transducer on the maternal abdomen. The best location is usually midline between the fundus and the umbilicus.

The transducer should be held securely in place with the transducer belts without causing discomfort to the patient.

To initialize, touch the UA REF key. The UA display will reset to 20 units momentarily.

14-8

â&#x20AC;˘

Toco sensitivity can be set at three different levels enabling you to adjust the sensitivity to meet the specific needs of a particular patient.

Fetal Monitoring

ECG Monitoring In addition to ultrasound, channel 1 is designed to monitor fetal heart rate using an invasive spiral electrode to obtain the fetal ECG and derive the heart rate. The ECG (internal) mode is generally considered the most accurate and reliable method to obtain a fetal heart rate.

Fetal ECG Electrode Preparation and Application WARNING: • Because the tip of the fetal spiral electrode is designed to penetrate the fetal skin, it may present the possibility of trauma, hemorrhage, or infection. Therefore, these electrodes should only be used under aseptic conditions. Refer to contraindications and application instructions on the electrode manufacturer’s packaging.

•

To apply the fetal ECG spiral electrode, the membranes must be ruptured.

•

If both the fetal heart rate and uterine activity are to be monitored using internal techniques, it is generally recommended that the intra-uterine catheter be inserted before the attachment of the spiral electrode.

Prepare an area on the patient’s upper thigh or, preferably, on the lower abdomen by cleaning with an alcohol swab. Allow to dry.

Apply a pre-gelled ECG skin electrode to the prepared area.

Plug the leg clip (green) connector into the FHR 1 (green) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.

•

To acquire ECG data, the leg clip must be connected to FHR channel 1.

•

The leg clip does not work on FHR channel 2.

Apply the fetal spiral electrode according to the instructions on the manufacturer’s packaging.

Once the spiral electrode has been attached, press the top of each push post on the leg clip to reveal a slot. Insert each wire (two) from the electrode into each slot on the leg clip. There are no color-coded requirements, either wire can be inserted into either post.

Gently pull the wires to make sure they are firmly attached to the leg clip. They should not disconnect.

Attach the leg clip to the pre-gelled skin ECG electrode on the patient’s thigh or abdomen.

Check that the monitor is receiving appropriate signals, and adjust the audio key to hear the tone (R-wave detection), as necessary.

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Ultraview Care Network

Intrauterine Pressure Monitoring Actual intrauterine pressure, including contraction frequency, duration, intensity, and uterine tone (pressure between contractions), is measured using an intrauterine catheter and pressure transducer. Application techniques for internal pressure catheters are considered to be beyond the scope of this manual. Consult the manufacturer’s instructions included with the package for proper application techniques. WARNING: • When inserting the intrauterine pressure catheter, the membranes must be ruptured.

Pressure Transducer Preparation and Application: Reusable Pressure Transducer (Fluid Filled Catheter) 1.

Follow manufacturer’s instructions on the preparation and insertion of the intrauterine catheter.

Level the pressure transducer with the maternal xiphoid or the top of the fundus.

Plug the pressure transducer (yellow) connector into the UA (yellow) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.

Attach a 3-way stopcock (from the intrauterine catheter kit) to the side port of the pressure transducer (strain gauge). Attach a pressure relief valve or deadend stopper to the top port.

Once the intrauterine catheter has been inserted, remove the catheter guide, and attach the catheter to the 3-way stopcock.

Fill a 20 cc syringe with sterile water and attach it to the 3-way stopcock.

Turn the handle of the stopcock toward the pressure transducer and flush the catheter with at least 5 cc of sterile water.

•

Check to ensure that all of the air bubbles have been removed.

•

If there are still air bubbles in the dome, repeat the process.

Turn the handle of the stopcock toward the catheter.

Lift the cap on the pressure relief valve or remove the dead-end stopper on the top of the pressure transducer (strain gauge) dome to vent the dome. Flush the transducer with 1 to 2 cc of sterile water. CAUTION: • Do not attempt to force water into the transducer dome unless it is vented to the air. Permanent damage to the transducer may result.

10. Touch the RECORDER key to turn the recorder ON. 11. Touch the UA REF key to initialize.

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Fetal Monitoring

12. Press Yes to confirm the initialization. The UA display should read 0 (zero). Release the cap on the pressure relief valve or replace the dead-end stopper to reseal the dome.

•

Check to see that all of the air bubbles have been removed.

•

If there are still air bubbles in the dome, repeat the process.

13. Turn the handle of the stopcock toward the syringe to begin recording uterine activity.

•

Between contractions, the UA channel should not return to zero. This is the measure of the uterine resting tone.

If, during monitoring, the UA channel does not appear to be accurately recording contractions or the tracing of the contractions looks jagged or angular, either the catheter has collected debris from the amniotic fluid or it contains air bubbles. If this happens, take the following steps: 1.

Turn the 3-way stopcock toward the pressure transducer.

Flush with 5-10 ml of sterile water.

Turn the handle of the stopcock toward the syringe.

Check the recording.

Transducer-Tipped Catheter  Disposable Application techniques for internal pressure transducers are considered to be beyond the scope of this manual. Consult the manufacturers instructions included with the package for proper application technique.

To initialize uterine activity: 1 2

Touch the UA REF key. Press Yes to confirm.

Plug the intrauterine pressure catheter (yellow) connector into the UA (yellow) connectors on the front of the monitor.

Touch the UA REF key to initialize.

Press Yes to confirm the initialization. The UA display on the monitor should read 0 (zero) and the strip chart should record 0 (zero).

Follow manufacturer’s instructions on the preparation and application of the intrauterine pressure catheter.

•

To check that the system is operational, it is often helpful to ask the patient to cough. This should produce an artifact on the fetal strip chart recording.

•

Utah Medical IPC 400 is the only catheter-tipped transducer recommended for use with this monitor.

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Ultraview Care Network

Main Menu When the FETAL key is touched, the menu will appear at the bottom of the screen. This menu will remain on screen during the monitoring session, unless the operator accesses another menu screen. To return the to Main menu, touch the FETAL key.

Fetal Heart Rate Alerts To turn F-Alert ON or OFF: 1 2 3

Touch the SETUP key on the main fetal menu. Touch the F-ALERT limits key. Select F-ALERT ON or OFF.

To set fetal alert limits: 1 2 3 4 5

Touch the SETUP key on the main fetal menu. Touch the F-ALERT limits key. Select F-ALERT ON. Select the HI= or LO= key. Use the arrow keys to adjust the limits.

To silence and reset the alert: 1

Touch F-ALERT RESET.

14-12

The fetal module provides two alert conditions for fetal heart rate: operator-set limits and pattern recognition. The fetal heart rate pattern recognition alert function activates if the bradycardia or tachycardia alert limits are violated for a preset period of time or if heart rate patterns described below occur. The alert function serves the purpose of notifying the care giver of a potential condition that might be developing and should not replace any of the care giver’s functions.

•

When an alert condition occurs, the monitor provides several indications. Alert reset removes these indications.

•

A message flashes Heart Rate F-Alert.

•

The FETAL key will flash.

•

A tone will sound if tones are enabled.

The monitor will generate an alert when twenty consecutive, one-second samples of fetal heart rate are below the operator-set limit. The factory default is 84 bpm.

Fetal Monitoring

Bradycardia Alert Type 1 The heart rate is divided into eight groups of 20 seconds each. Group H represents the current 20 seconds. An alert will activate if Groups G and H are below 90 bpm.

Figure 14-3: Type 1 Bradycardia Alert CAUTION: • Any time the alert activates, the heart rate must return to normal before the Alert can be reactivated. Reset the alert by pressing the F-ALERT RESET key on the screen.

•

If a group of heart rates is less than 30 bpm, the algorithm considers this condition a loss of signal and a NO ALERT will occur.

•

All representations of fetal heart rates in this chapter are computer generated.

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Ultraview Care Network

Type 2 An alert will activate if: • • • • •

Group H is less than Group F; and Group G is less than Group E; and Group F is less than Group D; and Group E is less than Group C; and Group H is below Group C by more than 30 bpm.

Figure 14-4: Type 2 Bradycardia Alert

Type 3 An alert will activate if the average of Groups G and H is lower than the average of Groups A, B, C, and D by more than 40 bpm.

Figure 14-5: Type 3 Bradycardia Alert

14-14

Fetal Monitoring

Tachycardia Alert The monitor analyzes the fetal heart rate for tachycardia using the following algorithms. The heart rate is divided into eight groups of 20 seconds each.

Type 1 An alert will activate if: • •

Group C is less than 180 bpm, and Groups F, G, and H are each greater than or equal to 190 bpm.

Figure 14-6: Type 1 Tachycardia Alert

•

The most recent Heart Rate Group is H; Heart Rate Group A must not be zero.

Type 2 An alert will activate if Group A is less than the tachycardia limit set by the operator, and Groups B, C, D, E, F, G, and H are each greater than or equal to the tachycardia limit set by the operator. The example shown below has the limit set at 180 bpm.

Figure 14-7: Type 2 Tachycardia Alert

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Ultraview Care Network

Recorder Operations The monitor is automatically programmed to print predetermined data items on the fetal strip chart. The following two strips identify the data items and illustrate how twin FHRs print on the strip. The recorder will also print values from maternal monitoring parameters. When installed with the BirthNet Obstetrical Data Management System, designated data items entered in BirthNet will also print on the strip.

Figure 14-8: Twin Fetal Heart Rates on the Same Scale

14-16

Fetal Monitoring

í˘ł

í˘˛

í˘ą

í˘ľ

í˘´

Figure 14-9: Twin Fetal Heart Rates on Same Scale, then Shifted to Separate Scales These messages print according to the following schedule: Table 1: Print Time Intervals DATA ITEM

TIME INTERVALS

í˘ą Time and Date

Every 5-minutes

í˘˛ Recorder Speed

5-, 20-, 35-, and 50-minutes after the hour

í˘ł HR Mode

5-, 20-, 35-, and 50-minutes after the hour

í˘´ Uterine contraction mode

5-, 20-, 35-, and 50-minutes after the hour

í˘ľ Monitor ID #

10-, 25-, 40-, and 55-minutes after the hour

Twin Shift (when selected)

Every 10-minutes â&#x20AC;&#x153;HR2 add 30â&#x20AC;? prints

? (for signal coincidence)

Upon detection

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Ultraview Care Network

Event Marker Functions To mark an event on the fetal strip: 1

Touch the MARK key.

To mark an event on the strip chart recorder, touch the MARK key on the screen. The recorder will print a black bar at the top of the heart rate scale. The monitor is also equipped with an external Event Marker. When the external Event Marker is pressed, the recorder prints an arrow at the top of the heart rate scale.

Printing Heart Rates Over 240 bpm (ECG only) To set the time interval for SpO2 and MHR parameters to print on the fetal strip: 1 2 3

Touch the SETUP key on the main fetal menu. Touch PRINT PERIOD. Select numeric value equal to the number of minutes to set the time interval for SpO2 and MHR parameters to print on the fetal strip.

When a spiral electrode is in use and the heart rate exceeds 240 bpm, the numeric value (up to 300) is displayed on the screen. On the fetal strip chart, the monitor will automatically plot the scale at half-rate when the heart rate is over 240 bpm (i.e., if the heart rate is 250 bpm, it plots at 125 bpm). A two-dot bar prints on the top of the fetal strip chart to indicate this half-rate scale is in effect. When the heart rate falls below 240 bpm, the monitor resumes normal plotting procedures.

Maternal Parameters The maternal physiological data (such as SpO2, NIBP, etc.) from the Ultraview Command Module or other Spacelabs Medical modules is printed on the fetal strip at designated intervals (1- to 60-minutes).

•

Maternal SpO2 and heart rate values are printed on the strip as MSpO2 and MHR.

ECG HR Edit To set ECG HR Edit: 1 2 3

Touch the SETUP key on the main fetal menu. Touch the FETAL ECG key. Select ECG HR Edit ON or OFF.

The fetal module can recognize and edit fetal heart rate changes between two consecutive heart beats that are greater than 30 beats per minute. If ECG edit is ON, connecting (slew) lines between consecutive heart rates are not plotted. Under these circumstances, the tracing appears to have gaps.

ECG Plots To set ECG plot: 1 2 3

Touch the SETUP key on the main fetal menu. Touch the FETAL ECG key. Select ECG PLOT ON or OFF.

When monitoring in the ECG mode (spiral electrode), the monitor can be setup to print short “rhythm strips”. If a change in heart rate greater than 20 bpm between two consecutive fetal ECG complexes is detected, this change triggers the monitor to plot the ECG rhythm strip, representing approximately 4-seconds of data: 2-seconds before and 2-seconds after the triggering event.

•

The monitor does not recognize another triggering event until the rhythm plot is complete. Following completion, the monitor will recognize and plot the next event.

•

Artifacts may also trigger the monitor to plot the fetal ECG.

The ECG rhythm strip feature can also be triggered manually. When the Event Marker is pressed (and the ECG HR is not plotting), a small arrow appears on the strip and the ECG rhythm strip plots.

14-18

Fetal Monitoring

The ECG data is presented at standard 25 mm/sec, although the monitor runs at 3 cm/min. It will take about three and a half minutes at 3 cm/min. for an entire ECG rhythm strip to print.

â&#x20AC;˘

Arrows indicate the triggering event.

Figure 14-10: ECG Rhythm Strip

Figure 14-11: ECG Rhythm Strip

Variability Trend Plots When operating in ECG mode, a trend of fetal heart rate variability is automatically calculated and plotted. This X-Y graph, printed every 10 minutes, is computed by combining long-term and short-term heart rate variability. One point is plotted for each 128 heart beats.

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Ultraview Care Network

The X-axis corresponds to time, and the Y-axis corresponds to the value of variability for each measurement. The Y-axis is divided into three levels of variability: â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

above average average below average

The most recent data is represented at the right side of the graph and it takes approximately 100 minutes of monitoring for the variability plot to reach its full capacity.

Figure 14-12: Above-Average Variability Plot

Figure 14-13: Average Variability Plot

14-20

Fetal Monitoring

Figure 14-14: Below-Average Variability Plot

•

The Variability Trend Graph is only generated in direct ECG mode from FHR channel 1.

•

Variability data is not meant to indicate the status or well being of the fetus.

•

Variability data is a mathematical expression of the variability of the fetal heart rate displayed in a convenient way.

Paper Out Memory If the recorder runs out of chart paper, the screen flashes PAPER OUT in the dedicated status area on the screen. When this condition occurs, the monitor continues to collect and store fetal heart rate and uterine activity data up to one hour (40 minutes if monitoring twins). Once the paper is replaced, the monitor prints the stored data at 12 times real time. A vertical line marks the start and end points, along with the messages MEM START and MEM END. When the stored data has been printed, normal (realtime) recording resumes.

To disable the fetal recorder: 1

Select RECORDER OFF.

•

All collected data is erased when the recorder is powered OFF.

•

If you wish to print the collected data, do not power OFF the recorder when replacing the paper.

•

To terminate a print session on the fetal strip chart, select RECORDER OFF.

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Ultraview Care Network

Module Configuration Manager The Module Configuration Manager feature provides the capability to define and store all user-configurable options for the fetal parameter. Once configured, these settings control its operation whenever the monitor is powered ON.

Display Detail The User Settings screens list all user-configurable options. From these screens you can change and store the options in your monitor. Figure 14-15: User Settings Screen illustrates the User Settings screen which is used to change and store fetal rate alarm limits. The parameter configuration table in this chapter lists all available options, the available user settings, and the factory defaults for each parameter.

PARAMETER DESCRIPTION

VALUE

FETAL RATE ALERT - HIGH RATE - LOW RATE

OFF 180 84

FETAL ECG WAVEFORM - FECG WAVEFORM SIZE - FECG SWEEP SPEED

ON 1.00 25

PARAMETER DESCRIPTION TWIN SHIFT TOCO SENSITIVITY ECG PLOT ECG EDIT EXTERNAL DEVICE PRINT PERIOD

VALUE NO SHIFT MEDIUM ON OFF NONE 10

Enable / disable Fetal rate alert.

SELECT PARAMETER CURSOR

í˘ą

CHANGE VALUE

CURSOR

PAGE 1 OF 7

í˘˛

í˘ł

í˘´

PRINT PAGE

STORE

í˘ľ

í˘ś

Figure 14-15: User Settings Screen

í˘ą CURSORâ&#x2020;&#x2018; AND CURSORâ&#x2020;&#x201C; keys scroll through the two columns of parameters on the screen.

14-22

Fetal Monitoring

The ability to access the Module Configuration Manager screens can either be visible to all users or remain hidden. The factory default setting is INVISIBLE. Adjust the SYSTEM SETUP key to the VISIBLE setting to enable user access to this function.

Storing Changed Settings Touch the STORE key after entering configuration changes for any page. This action stores the currently selected settings for all entries. The Patient Admit/Discharge function allows you to SAVE the changes in the alarm limit settings as the default settings for future patients, or RESTORE the original default settings upon discharge of that patient or admission of a new patient.

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Ultraview Care Network

Parameter Configurations To review or change settings: 1 2 3 4 5 6

Touch FETAL. Touch SETUP. Touch the hidden key 3 times. Touch DEFAULT STORAGE. Touch USER SETTINGS. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 7 Use ↑ and ↓ to change the settings. 8 Touch NEXT PAGE to continue to next screen of parameters. 9 Touch STORE to save the new settings. 10 Touch YES when the Yes/No message is displayed.

Table 2: Fetal Parameter Configuration Parameter

Available User Settings

Factory Defaults

Fetal Rate Alert

On/Off

Off

High Rate Limit

160-210 bpm

180 bpm

Low Rate Limit

70-130 bpm

84 bpm

FECG Waveform

On/Off

FECG Waveform Size

0.10-2.00

1.00

FECG Sweep Speed

25 or 50 mm/sec

25 mm/sec

Twin Shift

Auto/Manual/No shift

No shift

Toco Sensitivity

High/Medium/Low

Medium

ECG Plot

On/Off

ECG Edit

On/Off

Off

External Device

None

Print Period

1-60 minutes

10 minutes

Chart Recorder

On/Off

Speed

1, 2, or 3 cm/minute

3 cm/minute

Heat

1/2/3

Alignment

0-10

Scale

USA/INTL

USA

Variability Plot

On/Off

CIM Protocol

A/B

CIM Baud Rate

9.6k/19.2k

9.6k

Modem ID

0-255

Simulator

On/Off

Off

Begin Address

0-127

End Address

0-127

Increment

1-64

System Setup Key

Visible/Invisible

Invisible

Patient Admit/Discharge Save/Restore

User Settings

Restore

Table 3: Fetal Alert Attributes Alarm Type

Fetal Heart Rate Alert

14-24

Tone Type Available User Settings

Factory Defaults

Medium

Alarm Recording User Settings

Available User Settings

Factory Defaults

User Settings

Alarm Watch Available User Settings

Factory Defaults

Y/N

User Settings

Fetal Monitoring

Telemetry Option Each fetal monitor can be equipped with a fetal telemetry system to provide continuous monitoring of an ambulatory patient. The patient carries a small transmitting device that transmits signals to the fetal monitor for recording. The fetal telemetry system transmits ultrasound, Toco, and nurse call information to a corresponding receiver connected to the fetal monitor. Fetal Monitor Telemetry Operating Instructions 1.

Open the battery compartment and install a fresh 9-volt alkaline battery.

Insert the antenna into the antenna jack on the transmitter.

Ensure that either the whip antenna or extended range antenna system is attached to the fetal monitor. The whip antenna should be extended at least two sections.

Power ON the transmitter.

Apply the ultrasound transducer and Toco transducer. (Refer to Ultrasound Transducer Preparation and Application on page 14-6 and Toco Transducer Preparation and Application on page 14-8.) The data from the telemetry unit is transmitted to the fetal monitor for display and printing on the strip chart.

The unit is supplied with headphones that allow the patient to listen to the fetal heart sounds. The patient should continually hear fetal heart sounds through the earphones. She should be instructed to move the ultrasound transducer slightly if the sound quality diminishes. If unable to reestablish the heart sounds, the patient should notify her clinician.

When the red Nurse Call button on the transmitter is pressed, an audible tone emits from the fetal monitor. To cancel the tone, touch the F-ALERT RESET key on the Fetal Main menu.

•

When the transmitter is powered ON, it should emit a short tone to indicate that the battery is good. If the battery is low, the transmitter emits a steady tone until depleted. Replace the battery if the transmitter is emitting a steady tone or is depleted.

•

If the patient exceeds the receiving range, the signal may be weak or may drop out. The patient should return to within range of the fetal monitor.

•

Certain locations may require that the whip antenna be fully extended to enhance reception.

•

Each telemetry unit (transmitter) operates on a specific radio frequency and is uniquely paired with a receiver internal to the fetal module. These must remain together to operate properly.

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Ultraview Care Network

Mermaid Option The Mermaid option is designed to enhance the birthing experience for mothers who require continuous monitoring but would like to relax in a shower or tub, or to move around without being “tethered” to a monitor. The patient wears a small transmit badge that is attached to the waterproof ultrasound and toco transducers by a short cable. Mermaid differs from telemetry in that the transmission of the fetal heart rate and uterine contractions take place through infrared technology rather than radio frequencies. The transducers run on batteries that will last for up to 16 hours. Recharge time is about one hour. You may have some minor interference from lights in the patient’s room, or the patient may move beyond the range of the system. If this should happen, either move the receiver to a location with a better view of the patient, or have the patient move closer to the antenna.

Monitoring Procedure 1.

Make sure that the Maternal Obstetrical Monitor is attached to the Mermaid receiver system. The connector is located on the right side panel of the Maternal Obstetrical Monitor.

Attach a battery pack (a) to the Mermaid Toco transducer by aligning the ridge with the transducer cable connector (b). The battery pack should fall into the transducer element with a noticeable movement. c

Figure 14-16: Wireless Transducer  Mermaid System

14-26

Twist the battery pack clockwise slightly to lock it into the Toco transducer. Repeat the procedure for the Mermaid ultrasound transducer.

Pin the transmit badge (c) to the patient’s clothing (preferably at shoulder level) with the clasp or use the necklace provided. Clothing or blankets must not cover the badge.

Attach either of the blue connectors (d) on the transmit badge to the Mermaid Toco transducer.

Position the Mermaid Toco transducer on the patient’s abdomen using the same technique as conventional transducers. Refer to Toco Transducer Preparation and Application on page 14-8 for more information.

Attach the other blue connector (d) on the transmit badge to the Mermaid ultrasound transducer.

Fetal Monitoring

Position the Mermaid Ultrasound transducer using the same technique as conventional transducers. Refer to Ultrasound Transducer Preparation and Application on page 14-6 for more information.

When the monitoring session is finished, remove the battery packs and the transmit badge from the transducers. Follow hospital procedures for cleaning the equipment. Refer to Cleaning and Sterilization on page 32-1.

10. Store the transducer elements and transmit badge in the compartment in the rear of the recharger unit. 11. Store the battery in the charger by following the steps outlined below. CAUTION: â&#x20AC;˘ Patients wearing Mermaid transducers should not wander into areas where another Mermaid system is operating. This would interfere with the other patientâ&#x20AC;&#x2122;s data.

Recharging Batteries 1.

The battery packs are enclosed in the top half of the Mermaid ultrasound and Toco transducers. To remove the packs (a) from the transducer elements, twist the pack counterclockwise. There will be a noticeable movement. Simply pull the battery pack to disengage.

Insert a battery pack (a) in the docking station (e) on the recharger by aligning the ridge with the red dot. The battery pack should fall into the docking station with a noticeable movement. f

Figure 14-17: Wireless Transducer ďŁ§ Mermaid System 3.

Twist the battery pack clockwise slightly to lock it into the docking station. The bottom of the transducers do not need to be charged and should be stored along with the transmit badge in the compartment located in the rear of the recharger unit (f).

The amber light (g) on the recharger unit indicates that the battery pack is being charged. A green light (h) indicates that charging is complete. It may take up to one hour to reach a full charge. The battery packs may be left on the charger when the transducers are not in use.

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Ultraview Care Network

Each battery pack has three green lights (i) to indicate the remaining charge. The lights automatically power ON whenever the battery pack is attached to the transducer or is being charged.

14-28

â&#x20AC;˘

Thoroughly dry the battery pack before inserting it into the charger.

â&#x20AC;˘

Three lights indicate full a charge and up to 16 hours of operation. Two lights indicate that at least two hours of monitoring time is left. One light indicates that less than two hours of monitoring time is left. When the one light starts to flash, less than 15 minutes of battery capacity is left.

NIBP

Directory of Keys N I B P

ADULT NIBP - MENU ALARM LIMITS

START BP

TIME INTRVL

PREV 5 READINGS

NEXT 5 READINGS

CHANGE CONFIG

NIBP - CHANGE CONFIGURATION DISPLAY PR ON OFF

TIME INTERVAL for automatic readings = q xx yyy AUTO ON OFF

ADULT NEONATAL

ADULT NIBP - ALARM LIMITS ALARMS ON OFF

HI= 150

•

LO= 100

SYS

DIA

MEAN

Based on features purchased, more or fewer keys may appear here than on your menu screens.

15-1

NIBP

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up NIBP Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Setting or Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Selecting Adult or Neonatal Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Displaying Heart (Pulse) Rate Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Initiating a Manual Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Setting Automatic Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Stopping a Measurement in Progress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Displaying New or Previous Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Recording BP Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Overview Noninvasive blood pressure (NIBP) uses oscillometric monitoring to measure systolic (S), diastolic (D), and mean (M) arterial blood pressures. The Ultraview Care Network monitor displays these readings and the time the measurement was initiated. You can also display heart rate. The monitor can display up to ten readings at one time and store up to 120 readings.

15-2

•

Blood pressure measurements determined with this module are equivalent to those obtained by a trained observer using the cuff/stethoscope auscultation method, within the limits prescribed by the American National Standard, Electronic or automated sphygmomanometers.

•

Use only cuffs specified by Spacelabs Medical. Other cuffs may adversely affect performance and measurement accuracy.

•

There are no hazards associated with using non-invasive blood pressure equipment during defibrillation or high-frequency electrosurgery because both the cuff and cuff tubing are nonconductive materials.

•

You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-5 for further information.

NIBP

Setting Up NIBP Monitoring To set up NIBP monitoring: 1

2 3 4

Attach the cuff tube to the appropriate module front panel connector. Attach the cuff to the patient. Touch NIBP. Touch additional screen keys as needed.

Proper cuff selection and application is essential in ensuring the accuracy of NIBP readings. To select the proper cuff, first measure the circumference of the limb at its midpoint. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff. When applied, the index line on a correctly sized cuff will fall within the designated range markings on the cuff. If the cuff is too wide for the patient, the reading will be falsely lowered. If too narrow, the reading will be falsely elevated. Undersizing the cuff results in the greatest chance of error, so a variety of cuff sizes should be available to accommodate your full patient population. The cuff should be snugly applied. When the cuff is properly applied to an adult, you should be able to insert one finger between the cuff and the limb. If you can insert two fingers, the cuff is too loose which may result in falsely elevated readings. Ensure that the inflation tube is not kinked or occluded when the cuff is applied. During blood pressure measurement, the inflated cuff reduces blood flow to the limb to which it is applied. Do not apply a cuff to a limb that has restricted blood flow. Check the patient periodically to ensure cuff application does not impair limb circulation. CAUTION: • Do not use extensions or adapters with the neonatal inflation tube, other than those specified. •

Do not apply the cuff to an extremity with restricted or otherwise compromised blood flow.

•

Do not apply the cuff to a limb being monitored with a pulse oximetry sensor. SpO2 readings will be affected during NIBP monitoring.

•

Do not apply the cuff to any extremity being used for intravenous infusion or catheterization.

•

Do not apply the cuff to any area of breached or injured skin.

WARNING: • Cuff tubing connectors may incorporate luer fittings. Exercise caution when used in proximity with intravenous fluid lines. •

Inadvertent connection of cuff tubing with luer fittings to intravascular fluid systems could allow air to be pumped into a blood vessel.

Patient Factors Affecting Readings Excess patient movement, speech, or muscle contractions (as a result of severe pain or shivering) can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would during manual readings. Avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain. Some arrhythmias may cause beat-to-beat pressure fluctuations that can make obtaining NIBP readings more difficult. Increased variability of readings can result from these pressure variations. If it becomes difficult to obtain readings in the

15-3

Ultraview Care Network

presence of arrhythmia, pressure should be temporarily verified using another method. Pressure also varies cyclically with normal respiration. With deep respirations, or in certain patients, this effect may be enhanced, increasing reading variability. For patients in shock, indirect methods of measuring pressure (auscultatory, oscillometric, doppler) may not be reliable because of peripheral vascular changes. These changes include peripheral vasoconstriction and diminished peripheral circulation resulting from shunting of blood to central organs. In some cases, peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure. In such cases, measuring a cuff pressure may be impossible or give misleading results. Direct (invasive) blood pressure measurements should be considered in patients with signs of shock or any patient who rapidly becomes unstable for unknown reasons.

Display Detail Figure 15-1: Displays illustrates typical NIBP displays. You can view NIBP readings from any Ultraview Care Network bedside or central monitor on a network. NIBP displays on a split screen central monitor appear in a format slightly different from that of bedside or full screen central monitors.

í˘ł

í˘ľ

í˘ą

í˘´

(120) 165/ 97 mmHg

LAST BP = 10:45 09/01

BED 01 DAVIS, J.

í˘˛

N I B P

í˘˛ 08:30 am 128/67 (80)

09:45 am 138/73 (88)

08:45 am 132/67 (83)

10:00 am 140/73 (90)

09:00 am 134/69 (85)

10:15 am 142/76 (92)

09:15 am 140/72 (89)

10:30 am 144/77 (95)

09:30 am 141/72 (91)

10:45 am 165/97 (120)

í˘ˇ

Split Screen Central Monitor

INTERVAL q 15 min LAST BP = 10:45 09/01

í˘ą

N I B P

í˘ł

í˘´

165 97

í˘ľ

(120) m 150 m S 100 H D* 100 g 60

í˘ś

Bedside Monitor Figure 15-1: Displays

í˘ą time and date of the last reading (10:45, 09/01 in the example above) í˘˛ NIBP parameter key í˘ł last systolic and diastolic readings (165/97) í˘´ alarm limits: split screen central monitors display a bell symbol when alarms are turned ON; bedside monitors display the alarm limits (systolic high 150/low 100, diastolic high 100/low 60, asterisk indicates alarms active for mean pressure)

í˘ľ mean reading (120) í˘ś current interval for automatic readings (q 15 min). qâ&#x20AC;&#x2122; in place of q indicates that the reduced delay of 5 seconds between readings is active (refer to Setting Automatic Measurements on page 15-6)

í˘ˇ NIBP table 15-4

NIBP

Bedside monitors show an NIBP table displaying a chronological listing of NIBP readings. The oldest value is at the top of the left column. Each reading contains the time of the measurement and the pressure values for systolic, diastolic, and mean. As new measurements are taken, the oldest reading moves off the screen.

•

If you remove one NIBP module and insert another without purging data (via ADMIT/DISCHARGE), the NIBP table may display data for two patients.

Central monitors display the last NIBP reading only.

Setting or Adjusting Alarm Limits To set or adjust alarms: 1 2 3 4 5 6

Touch NIBP. Touch ALARM LIMITS. Select SYS, DIA, or MEAN. Select ALARM ON. Select HI= or LO=. Use arrow keys to adjust.

You can define alarm limits for systolic, diastolic and mean values. The factory default setting for NIBP alarms is OFF. The default alarm limits settings for both the adult and the neonate modes are listed in Table 1: Alarm Limits. Table 1: Alarm Limits HIGH Neonatal

Adult

LOW

Systolic

85 mmHg

(11.5 kPa)

55 mmHg

(7.5 kPa)

Diastolic

75 mmHg

(10.0 kPa)

45 mmHg

(6.0 kPa)

Mean

80 mmHg

(10.5 kPa)

50 mmHg

(6.5 kPa)

Systolic

150 mmHg

(20.0 kPa)

100 mmHg

(13.5 kPa)

Diastolic

100 mmHg

(13.5 kPa)

60 mmHg

(8.0 kPa)

Mean

110 mmHg

(14.5 kPa)

90 mmHg

(12.0 kPa)

Selecting Adult or Neonatal Mode To select the patient type: 1 2 3

Touch NIBP. Touch CHANGE CONFIG. Select ADULT or NEONATAL.

In modules that offer both adult and neonatal modes, you can determine the current mode by observing which key is highlighted or by reading the menu prompt in the NIBP menu. The factory default setting is adult. The following events occur with each change of mode: • • •

The monitor erases current NIBP readings from the display but retains them in memory. Previous NIBP readings appear immediately if present in memory. If not, readings appear as the measurements are taken. Alarm limits and state (ON/OFF) are automatically changed for the new mode (adult or neonatal).

15-5

Ultraview Care Network

•

Active NIBP alarms reset; alarms in violation terminate and suspended alarms end. WARNING: • The mode (adult or neonatal) selected must correlate with the hose connected to the module and the patient type.

Displaying Heart (Pulse) Rate Data To display heart rate on NIBP table: 1 2 3

Touch NIBP. Touch CHANGE CONFIG. Select DISPLAY PR ON.

Non-invasive pressure measurements may be displayed with or without a pulse rate. If you choose to display pulse rate, only five measurements may be displayed in the NIBP table. Otherwise, ten measurements may be displayed as shown in Figure 15-1: Displays. Pulse rate is obtained from ECG, arterial pressure (ART), SpO2, and NIBP (in that order), depending on the availability of these parameters.

Initiating a Manual Measurement To start an immediate measurement: 1 2

Touch NIBP. Touch STAT BP.

You can start a measurement at any time by touching STAT BP. If an initial measurement attempt is not successful, a single retry will be initiated after a 5- or 30-second interval.

•

New measurements cannot be initiated if another measurement is already in progress.

Setting Automatic Measurements To determine automatic measurement intervals: 1 2 3 4

Touch NIBP. Touch TIME INTRVL. Select AUTO ON. Use arrow keys to adjust interval.

The NIBP module always powers ON with automatic measurements set to OFF. The current time interval for automatic measurements is displayed on the message line above the arrow keys. The factory default setting for automatic time interval is 15 minutes. For automatic time intervals of less than five minutes, the module makes special allowances for a rapid succession of readings. For the first 15 minutes after you set up a reading (turn AUTO mode ON or select a new time interval), the minimum delay between readings is only five seconds. When this five-second delay is active, the interval message will appear with an apostrophe, after the q (q’). After the 15-minute period, the minimum delay between readings becomes 30 seconds. WARNING: • During blood pressure readings the inflated cuff reduces blood flow to the limb to which it is applied. Consider this when selecting short time intervals.

15-6

NIBP

Measurement Intervals Adult and neonatal measurement intervals are as follows: •

between 1- and 10-minutes in 1-minute increments,

•

between 10- and 60-minutes in 5-minute increments, or

•

1-, 2-, 4-, or 8-hours.

Automatic Reading Times Turning automatic mode ON or changing the interval, initiates a new measurement schedule. When the selected interval is a multiple of five minutes, automatic readings will always begin at the next five-minute division. Selecting AUTO ON shortly before the desired five-minute division can be used to synchronize measurements to exact clock times. For example, if at 8:03 you select a time interval of 15 minutes, automatic readings will occur at 8:05 and 8:20. If at 8:22 the interval is changed to seven minutes, the next automatic readings will occur at 8:29 and 8:36.

•

Touching STAT BP will take an immediate reading without affecting scheduled reading times.

Stopping a Measurement in Progress To stop an NIBP measurement currently in progress, press the red Deflate or Stop button on the front of the module. The next automatic reading will begin on schedule.

Displaying New or Previous Readings To view readings not currently on the screen: 1 2

You can change the current display in groups of five. Use PREV 5 READINGS or NEXT 5 READINGS to step through the stored readings.

Touch NIBP. Select PREV 5 READINGS or NEXT 5 READINGS.

Recording BP Readings To print out the current NIBP display: 1 2

You can choose to print out either the complete NIBP display or only the numeric values of the last reading.

Touch NIBP. Touch PRINT.

15-7

Ultraview Care Network

Restoring User-Defined Settings To restore user-defined settings: 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

•

RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

Status Messages To print out the most recent reading (no table): 1 2

Touch RECORD (monitor key). Touch NIBP.

At the beginning of a blood pressure measurement: •

The mean value of the previous reading disappears.

•

The message READING IN PROGRESS replaces the diastolic value.

•

A bleed step replaces the previously displayed systolic pressure.

If the system fails to complete an initial measurement reading, the message SECOND READING REQUIRED will be displayed along with a description of the cause of the failure. A second measurement automatically begins either 5- or 30- seconds later, depending on whether the short-term automatic mode is active. If the second attempt fails: •

The message NO READING is displayed.

•

An alarm sounds (if alarms are turned ON).

•

One of the following messages is displayed: INFLATE ERROR HW ERROR NO DATA

If the Deflate or Stop button on the front of the module is pressed during a reading, the reading will end and the messages NO READING and CUFF DEFLATE will be displayed. If the system detects unstable beat-to-beat blood pressures during measurements, one of two messages will be displayed: •

In the neonatal mode, MOTION is displayed.

•

In the adult mode, ARTIFACT is displayed.

If an error status message is displayed and the system is unable to proceed with its current operation, you must correct the fault before the system can continue. If you are unable to correct the fault, contact a qualified service person. If NIBP SYSTEM FAILURE ERROR NUMBER = XX (bedside only), or HW ERROR (bedside and remote) is displayed, this indicates that a hardware problem has caused the NIBP portion of the module to be inoperable. The module must be serviced by a qualified service person before NIBP measurements can be taken. If the error message CUFF CAN NOT BE DEFLATED REMOVE CUFF FROM LIMB is displayed, this indicates that the deflate hardware is blocked and the cuff cannot be deflated. Remove the cuff from the limb immediately and have the module serviced. The module must be serviced by a qualified service person before NIBP measurements can be taken.

15-8

NIBP

If either of the above messages are displayed, a RESET NIBP key will be present in the Change Config menu. Touch the RESET NIBP key to re-enable noninvasive blood pressure monitoring.

â&#x20AC;˘

If these messages occur repeatedly, discontinue NIBP monitoring and contact a qualified service person.

15-9

NIBP Troubleshooting Guide Clinical Situation No NIBP screen key is displayed No NIBP readings can be obtained

Possible Cause ■ Module not inserted correctly.

■ Remove and re-insert the module.

■ Incorrect or inoperative cuff in use.

■ Replace with the cuff known to be operative.

■ Cuff tubing is attached to an adult outlet, but monitor is configured in the neonatal mode (or vice versa).

■ Tubing is kinked. ■ Some arrhythmias (for example, atrial fibrillation and frequent ventricular ectopy) may cause a single or repeated failure to obtain a reading (may be due to true beat-to-beat variations in pressure).

Correlate monitor mode, cuff and patient type.

■ Locate kink and straighten tubing. ■ Document arrhythmia if present, verify pressure with another method, then follow hospital procedure for care of this type of patient.

■ Ensure that patient is quiet with mini-

contractions associated with shivering or severe pain.

mal movement during NIBP readings. Minimize the patient’s shivering.

ment range.

Apparent incorrect value

■ Connect tubing to the correct outlet.

■ Excessive patient motion or muscle ■ Blood pressure outside of measureIntermittent or complete failure to operate

Solution

■ Module error.

■ Verify extremely high or low pressures with another method.

■ Remove the module from service and call a qualified service person.

■ Wrong size cuff for patient.

■ Measure patient’s limbs at the midpoint. Match limb measurement to the range specified on the cuff (undersizing the cuff results in the greatest degree of error).

■ Cuff is damaged. ■ Excessive patient motion, shivering or severe pain.

■ False high readings may be the

■ Replace with a good cuff. ■ Ensure the patient is quiet with minimal movement during NIBP readings. Minimize the patient’s shivering.

■ Reduce the frequency of the readings.

result of venous congestion caused by frequent readings.

■ Cuff too loose or positioned incorrectly. Variable readings occur

■ Some arrhythmias may cause beatto-beat pressure and NIBP readings.

■ Larger than normal influence of respiratory phases on blood pressure (inspiratory fall in blood pressure; expiratory rise).

■ Tighten the cuff or reposition it appropriately.

■ Document the arrhythmia, if present. Verify the pressure using another method, then follow hospital procedure for care of this type of patient.

■ NIBP software usually compensates for normal variation.

Clinical Situation No NIBP readings or questionable values in the presence of shock

Possible Cause

Solution

â&#x2013; Peripheral vascular changes experi-

â&#x2013; Consider invasive pressure measure-

enced during shock may reduce the reliability of blood pressure readings obtained with any indirect method. Peripheral pulses may be diminished or absent.

ments in patients with symptoms of shock or in any patient who rapidly becomes unstable for unknown reasons.

Pressure

Directory of Keys The pressure label you select will appear here

PRESSURE MAIN MENU ALARM SIZE SETUP LIMITS

SELECT LABEL

SCALES

ZERO This key becomes SAVE PCWP with PA

PRESSURE SCALES Menu SCALES FREEZE SCALE 0-180 ON OFF ON OFF

SAVE SYS

SAVE DIA

CURSOR = 95

SAVE MEAN

ZERO

PRESSURE Label Select Menu ART

CVP

RAP

PRESSURE Setup Menu SWEEP SPEED FILTER 25 mm/sec. 12 Hz

LAP

ART REJ ON OFF

ICP

PRS

NUMERIC SIZE

PRESSURE Numeric Size Menu SYS/DIA MEAN ALL LARGE LARGE LARGE

FILTER 12 HZ

PRESSURE Sweep Speed Menu 50 25 12.5 6.25 mm/sec. mm/sec. mm/sec. mm/sec.

SAME AS ECG

The scale is now 0 - 180. Enter the new scale setting: 0 0

ENTER

PRESSURE Waveform Size Menu

PRESSURE Alarm Limits Menu ALARM SYS SYS LO=90 ON OFF HI=150

•

DIA HI=150

DIA LO=90

MEAN HI=OFF

MEAN LO=OFF

ALL OFF

Based on features purchased, more or fewer keys may appear here than on your menu screens.

16-1

Pressure

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Zeroing the Pressure Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Selecting Numeric Display Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Displaying Waveforms with Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Freezing the Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Changing the Waveform Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Selecting the Waveform Measurement Value. . . . . . . . . . . . . . . . . . . . . . . . . . .6 Storing Values for Trending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Recording Pressure Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Setting Artifact Rejection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Selecting a Filter Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Factory Default Pressure Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Invasive Pressure Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Overview A pressure key and waveform will automatically be displayed as soon as you connect a transducer to the module. Immediately after connection, you can relabel the catheter site or zero the system. Pressure labels may be pre-defined (refer to Selecting Alarm Attributes on page 7-6) or you can select from the following:

Pressure Label

Description

ART

arterial pressure

CVP

central venous pressure

ICP

intracranial pressure

LAP PA

left atrial pressure pulmonary artery pressure

RAP

right atrial pressure

PRS

generic pressure

umbilical artery pressure

umbilical vein pressure

Disconnecting the pressure cable or the transducer will cause the pressure key and waveform to disappear from the display.

16-2

Pressure

Systolic, diastolic, and mean pressure values are displayed for arterial, pulmonary artery, umbilical artery, umbilical vein and generic pressures. Only the mean value is displayed for other pressure types. Refer to the Display Detail on page 16-4 for a sample arterial pressure and intracranial pressure display on the bedside monitor. WARNING: • Systolic and diastolic pressures displayed numerically for patients being treated with an Intra-Aortic Balloon Pump (IABP) therapy may not be accurate. Display the waveform with scales to verify or determine pressures for these patients.

•

With the Module Configuration Manager feature, you can define your own default settings for such characteristics as alarm limits and display configuration. Refer to the Module Configuration Manager on page 7-1 for further details.

Setting Up Pressure Monitoring Connect the cable end of either a reusable or disposable transducer to the pressure connector located on the front of the module using a Spacelabs Medical pressure cable. When setting up an invasive pressure system, take all measures to maintain system sterility and to prevent the introduction of air into the system. Air bubbles are the most common cause of inaccurate pressure readings. The transducer, stopcocks, connectors and tubing must be completely free of air to ensure maximum performance.

•

Refer to the catheter, tubing, or transducer manufacturer’s instructions or your hospital’s protocol for specific instructions on removing air from the system.

•

Invasive pressure systems specified by Spacelabs Medical are compatible with high-frequency electrosurgical and defibrillation equipment. No special precautions are required.

Zeroing the Pressure Transducer To zero the pressure transducer: 1 2 3 4 5

Touch the desired pressure parameter key. Open stopcock to air/close to patient (at phlebostatic axis). Touch ZERO. Close stopcock to air/open to patient. Begin monitoring after the pressure values appear.

Before you can begin monitoring you must zero the system. Zeroing has two purposes: 1) to establish atmospheric pressure as zero, and 2) to compensate for the hydrostatic effect of fluid in the catheter-tubing system.

•

If after you have followed the instructions to zero the pressure transducer and a ZERO REJECTED message appears, you may have a transducer problem. Follow the transducer manufacturer's directions to correct this problem before you continue.

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Ultraview Care Network

Display Detail A pressure display appears once you select a pressure label and zero the transducer. Figure 16-1: Bedside Monitor Pressure Display shows an example of the display for ART and ICP. The system identifies the specific pressure type in the parameter key and menu title (PA, CVP, LAP, etc.).

í˘ł

í˘´

CHECK CATHETER

A R T

ě?&#x2C6;

í˘ą

í˘˛

133 mm 70 H g

I C P

CPP= 86

m m H g

(92) S150 120 D120 60

í˘¸ 15 M 5

Figure 16-1: Bedside Monitor Pressure Display

í˘ą pressure waveforms í˘˛ pressure parameter keys í˘ł systolic pressure í˘´ mean pressure í˘ľ systolic pressure alarm limits í˘ś diastolic pressure alarm limits í˘ˇ diastolic pressure í˘¸ cerebral perfusion pressure í˘š mean pressure alarm limits ě?&#x2026; mean pressure ě?&#x2C6; CHECK CATHETER key (for UA pressures only)

Setting and Adjusting Alarms 1 2 3 4 5

16-4

Touch the desired pressure parameter key. Touch ALARM LIMITS. Select desired alarm. Select ALARM ON. Use arrow keys to adjust a limit value.

í˘ś í˘ˇ

ě?&#x2026;

To set or adjust alarm limits:

í˘ľ

Pressure alarm limits can be defined for systolic, diastolic, and mean values for ART, PA, UA, UV, and PRS. Alarm limits can only be set for the mean value for all other pressures. The Alarm Limits menu for ICP provides a cerebral perfusion pressure key (CPP) used to set CPP alarm limits. CPP is computed as mean arterial pressure minus intracranial pressure (MAP-ICP). The value CPP=xxx displays at the top of the digital zone above the ICP value if ICP and at least one peripheral invasive arterial

í˘š

Pressure

pressure are being monitored. If the system cannot compute a pressure (for example, no mean arterial pressure is available), then the message CPP=??? displays. Alarms can be independently set for each pressure channel. The CHECK CATHETER alarm may be set when umbilical artery pressure is being monitored. This alarm will sound whenever the pulse rate drops below 60 BPM or the pressure approaches 0 mmHg. Touching the CHECK CATHETER key will silence the alarm.

Adjusting Waveform Size To change the waveform size: 1 2 3

Touch the desired pressure parameter key. Touch SIZE. Select SIZE ↑ or SIZE ↓.

You can increase or decrease the size of the pressure waveform display. This only changes the displayed size and does not affect the signal gain. The waveform size may not be adjusted while the scales are displayed.

Selecting Numeric Display Size To change the numeric display size: 1 2 3 4

Touch the desired pressure parameter key. Touch SETUP. Touch NUMERIC SIZE. Select a display size.

You can select from three different display formats for pressure numerics.

133 70

m m H g

133 m

(92)

92 70

SYSTOLIC/ DIASTOLIC LARGE

m H g

MEAN LARGE

133 m 92 70 Hg ALL LARGE

Figure 16-2: Display Formats In each of the three display formats, mean pressure is 92, systolic pressure is 133 and diastolic pressure is 70. This feature is available for ART, PA, PRS, UA and UV only.

•

Specific alarm limits are not displayed in the All Large display format.

Adjusting Sweep Speed To select a pressure waveform sweep speed: 1 2 3 4

Touch the desired pressure parameter key. Touch SETUP. Touch SWEEP SPEED. Select a sweep speed.

The sweep speed determines the rate at which the pressure waveform moves across the screen. Sweep speed selections are: 50-, 25-, 12.5-, or 6.25- mm/second. The sweep speed may also be set at the same sweep speed as ECG.

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Ultraview Care Network

Displaying Waveforms with Scales To configure the display of pressure waveforms with a vertical scale:

You can superimpose a vertical reference scale over pressure waveforms. Up to four pressures can be scaled at one time.

Touching a parameter key and then the SCALES key adds scales when the pressure parameter key is activated. Selecting SCALES ON maintains the selected pressure display in scaled format until SCALES OFF is selected.

Touch the desired pressure parameter key. Touch SCALES. Select SCALES ON if the pressure is to remain in scales.

2 3

Freezing the Scaled Display To freeze the pressure display: 1 2 3

Touch the desired pressure parameter key. Touch SCALES. Select FREEZE ON.

You can freeze a pressure waveform display to stabilize the waveform for obtaining measurements. To unfreeze the waveform display, select FREEZE OFF or exit the pressure menu by touching either the PREVIOUS MENU or NORMAL SCREEN keys.

Changing the Waveform Scale To change the pressure waveform scale: 1 2 3 4 5

Touch the desired pressure parameter key. Touch SCALES. Select SCALE 0-xxx. Type a new scale. Touch ENTER.

To obtain a pulmonary capillary wedge pressure (PCWP): 1 2 3 4 5 6 7

16-6

Touch PA. Touch SCALES. Inflate PA catheter balloon. Touch FREEZE ON. Deflate PA catheter balloon. Use arrow keys to position cursor. Touch SAVE PCWP.

You can increase or decrease the pressure waveform scale. The bottom of the scale will always be 0 (zero). You may set the top of the scale to be any value from 10 to 500 mmHg by typing in the desired value and touching ENTER.

Selecting the Waveform Measurement Value You can obtain a measurement at any part of the pressure waveform by using the horizontal cursor. The measurement value displays as CURSOR = xx in the message line above the Pressure menu. The most common use of this function is to obtain a pulmonary capillary wedge pressure (PCWP) value from the pulmonary artery catheter.

Pressure

Storing Values for Trending To store values in memory: 1 2 3

Touch the desired pressure parameter key. Touch SCALES. Use arrow keys to position cursor.

You can store values into memory for pressure trend displays for use in clinical calculations.

For ART, PRS, UA and UV 4

Select SAVE SYS, SAVE DIA or SAVE MEAN.

For CVP, RAP, LAP or ICP 5

Touch SAVE MEAN.

For PA 6

Touch SAVE PCWP.

Recording Pressure Waveforms To print pressure waveforms: 1 2

Touch RECORD. Touch flashing pressure parameter key.

You can print pressure waveforms and values from a printer module, a bedside recorder, or a system printer. Refer to Printing on page 4-1 for additional information.

â&#x20AC;˘

The pressure scales should not be changed during a recording. This may lead to an annotation on the recorded strip that does not match the actual scale of the recording.

Setting Artifact Rejection To activate respiration artifact rejection: 1 2 3

Touch the desired pressure parameter key. Touch SETUP. Select ART REJ ON.

Variations in intrathoracic pressures during the respiratory cycle can influence invasive pressures; especially PA, PCWP and CVP. The respiratory artifact rejection feature minimizes the impact of such variations by automatically selecting data from waveform peaks that have little change in amplitude from peak to peak. End-expiration is typically the time with the least variation. The artifact rejection feature works equally well in both mechanically-ventilated and spontaneously-breathing patients. In patients with chronic obstructive pulmonary disease, intrathoracic pressures during respiration are different than those in patients with normal lung function. Disable artifact rejection when monitoring these patients. The factory default for artifact rejection is ON for PA pressure only, and OFF for all other pressures.

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Ultraview Care Network

Selecting a Filter Frequency To adjust the filter frequency: 1

Touch the desired pressure parameter key. Touch SETUP. Touch FILTER. Touch the arrow keys to choose the desired setting.

2 3 4

When noise and other interference appears on the pressure waveform, you can adjust the filter frequency to minimize its effect. A higher filter frequency shows greater detail, but can also produce more artifact. A lower filter frequency smooths the waveform and may help diagnose transducer or catheter problems such as under damping or ringing. The filter frequency may be set within the range of 3 to 40 Hz.

Restoring User-Defined Settings To restore user-defined settings: (Configurations with ECG) 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

To restore user-defined settings: (Configurations without ECG): 1 2 3

Touch TEMP. Touch RESTORE SETTINGS. Select YES.

16-8

â&#x20AC;˘

RESTORE SETTINGS changes the user-configurable settings for all parameters.

â&#x20AC;˘

Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.

Pressure

Factory Default Pressure Alarm Settings Arterial (ART), Generic Pressure (PRS), Umbilical Artery and Vein (UA and UV), Cerebral Perfusion (CPP-mean only)

Systolic * mmHg

High

Diastolic

Mean Low

mmHg

High

mmHg

Low

High

Low

-50 to 79

+30

-05

-50 to 69

+30

-05

-50 to 69

+30

-05

80 to 109

+30

-10

70 to 79

+30

-10

70 to 79

+20

-10

110 to 119

+30

-15

80 to 99

+30

-15

80 to 89

+20

-15

120 to 129

+25

-20

100 to 109

+30

-20

90 to 99

+15

-15

130 to 139

+20

-20

110 to 119

+30

-25

100 to 109

+10

-20

140 to 149

+15

-20

120 to 129

+25

-30

110 to 119

+05

-25

150 to 159

+10

-20

130 to 139

+20

-30

120 to 300

+05

-30

160 to 169

+10

-25

140 to 149

+15

-30

170 to 179

+10

-30

150 to 179

+10

-30

180 to 189

+10

-35

180 to 300

+10

-35

190 to 300

+10

-40

Systolic * kPa

High

* Example: If systolic is between 80 and 109 mmHg, then HI alarm defaults to 30 mmHg above actual value; LO alarm defaults to 10 mmHg below actual value.

Diastolic

Mean Low

kPa

High

kPa

Low

High

Low

-6.7 - 10.5

+4.0

-0.7

-6.7 - 9.2

+4.0

-0.7

-6.7 - 9.2

+4.0

-0.7

10.6 - 14.5

+4.0

-1.3

9.3 - 10.5

+4.0

-1.3

9.3 - 10.6

+2.7

-1.3

14.6 - 15.9

+4.0

-2.0

10.6 - 13.2

+4.0

-2.00

10.7 - 11.8

+2.7

-1.9

16.0 - 17.2

+3.3

-2.7

13.3 - 14.5

+4.0

-2.7

11.9 - 13.2

+2.00

-1.9

17.3 - 18.5

+2.7

-2.7

14.6 - 15.8

+4.0

-3.3

13.3 - 14.5

+1.3

-2.7

18.6 - 19.9

+2.0

-2.7

15.9 - 17.2

+3.33

-4.0

14.6 - 15.8

+0.7

-3.3

20.0 - 21.2

+1.3

-2.7

17.3 - 18.5

+2.7

-4.0

15.9 - 40.0

+0.7

-4.0

21.3 - 22.5

+1.3

-3.3

18.6 - 19.8

+2.00

-4.0

22.6 - 23.8

+1.3

-4.0

19.9 - 23.8

+1.3

-4.0

23.9 - 25.1

+1.3

-4.7

23.9 - 40.0

+1.3

-4.7

25.2 - 40.0

+1.3

-5.3

Pulmonary Artery (PA), Right Atrial (RAP), Central Venous (CVP), Left Atrial (LAP), and Intracranial (ICP-mean only)

Systolic, Diastolic, and Mean mmHg

High

Low

kPa

High

Low

-50 to 25

+05

-05

-6.7 - 3.3

+0.67

-0.67

26 to 300

+20%

-20%

3.4 to 40.0

+20%

-20%

16-9

Invasive Pressure Troubleshooting Guide Clinical Situation Intermittent or no operation

No pressure key appears

Numeric display does not settle

Pressure display disappears

Possible Cause

Solution

■ Module error.

■ Call a qualified service person.

■ Module not inserted correctly.

■ Reinsert the module.

■ Transducer not connected.

■ Reconnect the transducer.

■ Respiration artifact too high.

■ Select ART REJ ON.

■ Cable disconnected from the module.

■ Reconnect cable.

■ Cable disconnected from the trans-

■ Reconnect cable.

ducer.

Pressure shows NOT ZEROED

Shows constant pressure

ZERO REJECTED message appears

■ Pressure has not been zeroed.

■ Zero pressure with the ZERO key after opening transducer to air.

■ Stopcock(s) are positioned incorrectly.

■ Still unable to zero.

■ Reposition stopcock(s) to connect the patient to the transducer (a waveform will appear on the screen).

■ Reposition stopcock(s) to open the transducer to air. Zero pressure with the zero key.

■ Follow transducer manufacturer’s instructions to correct the problem.

CHECK CATHETER key appears on the monitor

■ Stopcock(s) are positioned incorrectly.

■ UA catheter has become dislodged

■ Reposition stopcock(s) to connect the patient to the transducer (a waveform will appear on the screen).

■ Check UA catheter.

or occluded.

■ Upon completion of the above, touch the CHECK CATHETER key to silence the alarm.

Cardiac Output

Directory of Keys CO - MENU C O

HEIGHT/ WEIGHT

CARDIAC OUTPUT

CC = .550

CALCS

Enter computational constant 0.5

ENTER

BSA = ?.? Must enter patient height and weight for calculations HEIGHT = 170 CM

CO#1

BAD CURVE

WEIGHT = 70 KG

ENTER

Select a curve by pressing the corresponding key

CO#3

CO#2

5.8

5.8 Inject when ready

CO#4

5.8

STOP CURVE

TB XX.XoC TI X.XoC

Only seen during CO measurement

Inject when ready (if auto) Touch START then INJECT (if manual) AVERAGE ALL

CLEAR

YES

CANCEL

YES

Press YES to confirm CLEAR YES

STORE

CALCS

AUTO MANUAL

CO CO/CI

START

Press YES to confirm STORE

CALCULATIONS

Press YES to confirm AVERAGE ALL

HEIGHT/ WEIGHT

VITAL SIGNS

SCROLL UP

SCROLL DOWN

VR INDEX ON OFF

SW INDEX ON OFF

VITAL SIGNS - Adjust vital signs, then touch ENTER HR = xxx

Select a row of data by pressing the key corresponding to the day/time desired

DAY/TIME

•

MAP = xxx mmHg CO

CVP = xx mmHg

MPA = xx mmHg

SVI

PCWP = xx mmHg

ENTER

SVRI

PVRI

LVSWI

RVSWI

MAP

CVP

MPA

PCWP

26/02:25p

5.1

2.9

70.8

40.4

1629

235

54.9

10.4

110

27/09:30p

4.9

2.8

65.3

37.8

1712

211

51.4

9.2

112

28/10:15p

4.5

2.5

56.2

32.1

1917

213

44.5

7.8

115

29/07:30a

4.0

2.2

47.0

26.8

2237

219

38.2

6.5

120

30/08:30a

4.0

2.2

47.0

26.8

2237

219

38.2

6.5

120

Based on features purchased, more or fewer keys may appear here than on your menu screens.

17-1

Cardiac Output

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setup Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Entering the Computational Constant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Entering Patient Height/Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Measuring Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Averaging Cardiac Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Clearing Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Storing Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Stopping Curve Drawing and Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Selecting Index Normalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Displaying Cardiac Index and Cardiac Output Values . . . . . . . . . . . . . . . . . . . .7 Displaying Calculations Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Editing Vital Sign Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 View Additional Table Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Recording Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Error Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Cables and Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Cardiac Output Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Overview Cardiac output (CO) monitoring enables you to evaluate the patientâ&#x20AC;&#x2122;s fluid status and the pumping ability of the heart, as well as calculate and display various hemodynamic values. Cardiac output is calculated by the thermodilution technique using a variation of the Stewart-Hamilton formula. Thermodilution involves injecting a cooled fluid (injectate) through a flow-through housing into an intravascular catheter. The catheter delivers the injectate directly to the right atrium and monitors the temperature downstream from the delivery site at the pulmonary artery. Cardiac output is determined by measuring the change in blood temperature downstream from the delivery site with respect to time. The change in temperature is inversely proportional to the flow of blood through the right heart. If the flow is large, the volume of blood that the injectate mixes with is large as well, so the monitor detects a small change in temperature. When a smaller flow of blood is diluted by the same volume of injectate, the change in temperature is larger. The injectate has a larger influence on the temperature as measured in the pulmonary artery. The system displays cardiac output by plotting a curve for each injection. The vertical axis of the curve represents temperature and the horizontal axis represents time. Spacelabs Medicalâ&#x20AC;&#x2122;s cardiac output monitoring automatically captures vital sign values at the moment each CO curve is completed. This data is used to produce hemodynamic calculations.

17-2

Cardiac Output

Setup Procedure To set up the system for monitoring cardiac output: 1 2

Insert the cardiac output cable into the module. Attach the thermodilution catheter to the cardiac output cable. Connect either an in-line injectate temperature probe or a reference solution injectate probe to the cardiac output cable.

The setup procedure that follows assumes that the pulmonary artery catheter has been placed. Follow your standard hospital procedure to properly place the pulmonary artery catheter in the patient. Figure 17-1: Cardiac Output Monitoring Setup illustrates the components used for CO monitoring. When using a reference solution injectate temperature probe, it should be inserted into the cardiac output cable in place of the in-line injectate temperature probe. When you connect the thermistor connector port of the catheter to the cardiac output cable, the system monitors patient blood temperature (TB) and displays the value on the screen. When you connect the injectate temperature probe, the system detects the temperature of the injectate (TI) and displays it on the screen, but does not trend the data. The system displays a message instructing you to connect the probe or catheter, or to enter the computational constant (CC). If you connect the cardiac output cable only to the catheter or only to the injectate probe, you can enter or adjust the computational constant but you cannot monitor cardiac output. Injectate

Connect to module

Thermodilution catheter

Cardiac output cable

Thermistor connector

In-line injectate temperature probe

Figure 17-1: Cardiac Output Monitoring Setup

17-3

Ultraview Care Network

Display Detail The CO key is displayed once you connect the CO cable to the module. To display the CO main menu, touch the CO key and curves will appear as the system detects the flow for each injection. The message INJECT WHEN READY is displayed when the system is ready to plot a new output curve. Figure 17-2: Cardiac Output Display illustrates the cardiac output display when curves are being acquired, on a bedside monitor.

í˘ł CO#1

CO#2

5.8

CO#3

5.8

6.0

í˘¸ í˘ą

í˘˛

TB 36.5 oC TI 0.2 oC

í˘´ CO#1

CO CI

5.8 3.7

í˘ľ

í˘ś

5.8

STOP CURVE

CI = 3.7 01:07 P 01/09

í˘š

ě?&#x2026;

í˘ˇ

Figure 17-2: Cardiac Output Display

í˘ą Cardiac output curve í˘˛ Cardiac output (liters/minute) í˘ł Curve ID number í˘´ Blood temperature í˘ľ Injectate temperature í˘ś Cardiac output (average) í˘ˇ Time and date of averaging í˘¸ Stop curve key (during curve drawing) í˘š Cardiac index value ě?&#x2026; Cardiac index value (average)

To enter the computational constant: 1 2 3

Touch CO. Touch CC =. Touch the appropriate keys (tenths, hundredths, and then thousandths) and use arrow keys to adjust. Touch ENTER.

17-4

Entering the Computational Constant To generate calculations, you must first enter the computational constant (CC) and verify that the system is correctly configured. The temperature of the injectate changes due to contact with the catheter wall and the surrounding blood. To account for this interaction, the system includes a correction factor in the equation. The correction factor (K or CT) is a function of catheter and flow-through housing dimension, internal volume, and injectate temperature; and differs among catheter models and manufacturers.

Cardiac Output

Refer to your thermodilution catheter package insert for current constants. Once you enter a value for the computational constant, the value is displayed on the CC = key and remains in system memory. Until you enter the computational constant, the message CC REQUIRED appears in the first curve window and ENTER COMPUTATIONAL CONSTANT is displayed on the message line, after the CC = key is selected.

Entering Patient Height/Weight To enter patient height and weight: 1 2 3 4 5

Touch CO. Touch HEIGHT/WEIGHT. Select HEIGHT = and/or WEIGHT =. Use arrow keys to adjust. Touch ENTER.

To perform indexed hemodynamic calculations, you must enter the patient’s height and weight before you generate CO curves. The valid range for height is 10 to 85 in (25 to 215 cm). The valid range for weight is 2 to 400 pounds (1 to 180 kg). After you enter both height and weight values, the system automatically calculates and displays the patient’s body surface area (BSA). If you entered the patient’s height and weight during the admit function, those values carry over to the CO function.

Measuring Cardiac Output To obtain CO measurements: 1 2 3 4a

Touch CO. Touch CARDIAC OUTPUT. Select AUTO or MANUAL. Wait for the INJECT WHEN READY or the TOUCH START THEN INJECT message to display. or 4b If in manual mode, touch START. 5 Inject the prepared injectate into the proximal lumen of the thermodilution catheter.

To maintain the accuracy of the readings, you must allow the catheter to warm up between injections. When in AUTO mode, wait until the INJECT WHEN READY message appears between injections. When in MANUAL mode, wait until the TOUCH START THEN INJECT message appears. Five curves can be displayed at one time. Some curves may automatically be classified as “bad,” in which case they are then labeled BAD CURVE and are automatically excluded from averaging. CO curves are numbered consecutively from 1 to 99.

•

To obtain all hemodynamic calculations remember to enter height and weight, and to store a PCWP prior to initiating measurement of CO.

A 15-minute timer begins after acquisition of the first good curve. After 15 minutes, the AUTO/MANUAL and START keys become invalid (dotted), and the messages MUST SELECT CURVES, AVERAGE, STORE, or CLEAR CO appear. Cardiac output injections are disabled until you perform one of these actions. Injections may resume as soon as the INJECT WHEN READY or TOUCH START, THEN INJECT message appears.

Averaging Cardiac Output To average all cardiac output curves: 1 2 3 4

Touch CO. Touch CARDIAC OUTPUT. Touch AVERAGE ALL. Touch YES.

This function computes the average of all acceptable, displayed curves. You can perform cardiac output averaging as soon as the system has measured and displayed at least two acceptable cardiac output curves. The cardiac output numeric zone displays the average cardiac output value in large numerics. The average cardiac index, if available, in medium numerics and the time and date of the last curve. The curves used in the average remain on the screen. The system does not include curves it labels as “bad” in the average value. Averaging uses the data from all good, displayed curves, up to a maximum of five.

17-5

Ultraview Care Network

Clearing Cardiac Output Curves To clear or store all curves: 1 2 3 4

Touch CO. Touch CARDIAC OUTPUT. Select CLEAR or STORE. Touch YES.

Occasionally, you may wish to delete a curve prior to averaging. You can clear all curves or selected individual curves. When you select to average or store curves, the system will automatically clear curves labeled “bad.” When you clear an individual CO curve or all CO curves, the INJECT WHEN READY message is displayed in the first available curve window. If a “bad” curve was on the display at the time you selected to clear another displayed individual curve, the “bad” curve will be cleared as well. The curves that display on the screen may or may not appear in numerical order, depending on which curves have been cleared.

Storing Cardiac Output Curves To clear or store selected curves: 1 2 3

4 5

Touch CO. Touch CARDIAC OUTPUT. Touch the CO# keys adjacent to the curves (up to 5) that you wish to clear or store. Select CLEAR or STORE. Touch YES.

To stop a curve in progress: 1

Touch STOP CURVE.

This feature enables you to store all of the acceptable, displayed curves at once or individually. The system stores the vital signs and cardiac output value it acquired at the end of curve acquisition, along with the time it displayed each curve. The curves clear from the screen as they are stored. The system does not store “bad” curves. After you store the acceptable curves, the system clears all curves from the screen.

Stopping Curve Drawing and Acquisition This feature enables you to stop the curve drawing and data acquisition of a cardiac output curve in progress. The STOP CURVE key only appears during curve drawing. Touching this key will invalidate all curve data for that injection. Once the blood temperature is again stable, the INJECT WHEN READY message will appear if in AUTO mode. The TOUCH START THEN INJECT message will appear if in MANUAL mode.

Selecting Index Normalization To select indexing: 1 2 3 4

Touch CO. Touch CARDIAC OUTPUT. Touch CALCS. Select VR INDEX ON or SW INDEX ON.

17-6

To individualize the values to the patient, the system calculates them with the BSA. Cardiac Index (CI) and Stroke Volume Index (SVI) are automatically displayed. You can select to display either the Systemic Vascular Resistance (SVR) and the Pulmonary Vascular Resistance (PVR) or their indexed values (SVRI and PVRI), but not both simultaneously. Similarly, you can select to display the Left Ventricular Stroke Work (LVSW) and the Right Ventricular Stroke Work (RVSW) or their indexed values (LVSWI and RVSWI), but not both simultaneously.

Cardiac Output

Displaying Cardiac Index and Cardiac Output Values To display both cardiac output and cardiac index values: 1

Touch CO|CO/CI.

The cardiac output or both cardiac output/index values can be displayed with the curves. If the CO portion of the CO|CO/CI key is highlighted, only the cardiac output value will be displayed. To activate the display for the cardiac output and cardiac index values, touch the CO|CO/CI key (the CO/CI portion of the key is highlighted). If the cardiac index value is available, then it is displayed when the CO parameter is inactive.

Displaying Calculations Table To display the calculations table: 1 2

Touch CO. Touch CALCS. Hemodynamic Equations

After the system completes one CO average or store, you can view hemodynamic calculations. The table includes only those calculations that have been stored or averaged. The sample calculations table below is an example of the hemodynamic calculations table displayed when you touch the CALCS key. The system defaults to VR INDEX OFF and SW INDEX OFF. Each horizontal row is one complete set of data. Each new value appears at the bottom of the table.

BSA

= Ht 0.725 x Wt 0.425 x 0.007184

= CO/BSA

= (CO/HR) x 1000

SVI

= SV/BSA

DAY/TIME

SVI

SVR

PVR

LVSW

RVSW

MAP

CVP

MPA

PCWP

SVR

= 79.9 x [(MAP-CVP)/CO]

26/02:25p

5.1

2.9

70.8

40.4

1629

235

54.9

10.4

110

SVRI

= 79.9 x [(MAP-CVP)/CI] = 79.9 x [(MAP-CVP)]/[CO/BSA] = 79.9 x [(MAP-CVP)]/[CO x 1/BSA] = 79.9 x [(MAP-CVP)/CO] x BSA = SVR x BSA

27/09:30p

4.9

2.8

65.3

37.8

1712

211

51.4

9.2

112

28/10:15p

4.5

2.5

56.2

32.1

1917

213

44.5

7.8

115

29/07:30a

4.0

2.2

47.0

26.8

2237

219

38.2

6.5

120

PVR

= 79.9 x [(MPA-PCWP)/CO]

30/08:30a

4.0

2.2

47.0

26.8

2237

219

38.2

6.5

120

PVRI

= 79.9 x [(MPA-PCWP)/CI] = 79.9 x [(MPA-PCWP)]/[CO/BSA] = 79.9 x [(MPA-PCWP)]/[CO x 1/BSA] = 79.9 x [(MPA-PCWP)/CO] x BSA = PVR x BSA

LVSW

= 0.0136 x SV x (MAP - PCWP)

RVSW

= 0.0136 x SV x (MPA - CVP)

LVSWI

= LVSW / BSA

RVSWI

= RVSW / BSA

Assumes pressures are measured in mmHg

Table 1: Sample Calculations

â&#x20AC;˘

The vital sign values shown in Table 1: Sample Calculations are typical if your monitor's UNITS OF MEASURE key is set to mmHg. Consult your system administrator if your display is different from that shown here.

The system automatically calculates and enters CO and CI values in the table. Values in the columns SV, SVI, SVR, PVR, LVSW, and RVSW are automatically calculated from the vital sign values entered in the columns HR, MAP, CVP, MPA, and PCWP. The values under the columns HR, MAP, CVP, MPA, and PCWP are parameter values obtained from other channels in the bedside monitor at the time a CO value is calculated or those values you have entered manually. To enter values in these columns refer to Editing Vital Sign Values on page 17-8. If you do not enter height and weight values prior to generating CO curves, the monitor displays any value that uses BSA (e.g. CI, SVI, LVSWI and RVSWI) as ?.?. If a calculated value is out of the displayable range, the monitor displays the value as ++++. If any of the vital signs in the hemodynamics table are negative, the system uses the value 0 (zero) in the calculations. Terms used in the hemodynamics table are defined in the table to the left.

17-7

Ultraview Care Network

Editing Vital Sign Values To edit vital sign values: 1 2 3 4 5 6 7 8

Touch CO. Touch CARDIAC OUTPUT. Touch CALCS. Touch DAY/TIME in the row you wish to select. Touch VITAL SIGNS. Select the vital sign you wish to edit. Use arrow keys to edit the displayed value. Press ENTER.

Select a row of data in the hemodynamic calculations table to turn the vital signs keys ON. Table 2: Hemodynamic and Vital Signs Values Label

Name

Units

Default Value

Valid Range

Heart Rate

beats/min

0 - 300

MAP

Mean Arterial Pressure

mmHg kPa

80 10.7

0 - 300 0.0 - 40.0

CVP

Central Venous Pressure

mmHg kPa

10 1.3

0 - 99 0.0 - 13.2

MPA

Mean Pulmonary Artery Pressure

mmHg kPa

15 2.0

0 - 99 0.0 - 13.2

PCWP

Pulmonary Capillary Wedge Pressure

mmHg kPa

10 1.3

0 - 99 0.0 - 13.2

Default values are supplied if you touch the VITAL SIGNS key and no prior value is available. When you edit a value, the system recalculates the hemodynamic calculation values using the new vital sign value. A CVP value is used in calculations if it is available. If only a RAP value is available, then the RAP value is used in place of CVP. If neither CVP nor RAP pressure is available, the system cannot automatically calculate SVR, SVRI, RVSW, or RVSWI. A CVP or RAP value can be manually added using this edit process.

â&#x20AC;˘

To ensure that a RAP/CVP value can be registered, immediately reopen the stopcock to the patient after you inject the bolus so that flow is reinstated.

A PCWP value is used in calculations if the last stored PCWP value is less than 15 minutes old. If no such PCWP value is present, an LAP value is substituted. If neither PCWP nor LAP values are available, the system cannot automatically calculate PVR, PVRI, LVSW, nor LVSWI and the monitor displays the message NO PCWP VALUE AVAILABLE WITHIN THE LAST 15 MINUTES. You can add a PCWP value manually using this edit process.

17-8

Cardiac Output

View Additional Table Data To view additional sets of data: 1 2 3

Touch CO. Touch CALCS. Touch SCROLL UP to scroll the data up one row, touch SCROLL DOWN to scroll the data down one row.

Five sets of values display at any one time. You have access to additional sets of values by scrolling through the data. Thirty sets of values are saved in the monitor’s hemodynamic calculations table so you can remove and re-insert the module without losing hemodynamic values. You can erase these values by discharging a patient or by powering the monitor OFF.

Recording Cardiac Output Curves To record thermodilution curves: 1 2 3

Touch CO. Touch CARDIAC OUTPUT. Touch PRINT.

If a bedside or system printer is installed, you can record all curves in the CO display area. You can also record the calculations table when it is displayed on the screen.

Error Messages Catheter Fault There is a problem with the thermodilution catheter. Connect or replace the catheter.

TB Out Of Range The blood temperature (TB) is unacceptable. The temperature must be between 27° and 43°C.

Probe Fault There is a problem with the probe. Connect or replace the probe.

TI Too Warm The injectate temperature (TI) is greater than 25.5°C. Cool down injectate.

Bad Curve There are a number of different possible causes: unsteady baseline, irregular curve from shunts or poor injection, delayed curve, catheter or probe fault during curve recording. Delete the bad curves as necessary to perform additional cardiac output determination.

Injectate Temperature Error The temperature difference between the injectate and body is less than 8°C. Cool the injectate down.

17-9

Ultraview Care Network

Cables and Probes Refer to Spacelabs Medical Supplies Products catalog for part numbers and specifications for cables, probes, and injectate systems.

Computation Constants/Catheter Compatibility Nominal resistance @ 37°C

14,004 Ω + 15%

Refer to the instructions provided with your catheter for the computation constants for your specific catheter, setup injectate temperature, and injectate volume. Contact your local thermodilution catheter sales representative for further information.

•

Cardiac output function is compatible with the Baxter Edwards Critical-Care REF™ and REF-Ox™ catheters for cardiac output measurement, but cannot perform the REF function.

WARNING: • For 3 cc injectate volumes, the 0° - 5°C injectate temperature is required for consistent results.

Refer to Calculations on page 20-1 for hemodynamic and vital sign value tables.

17-10

Cardiac Output Troubleshooting Guide Clinical Situation Invalid pressure reading

Possible Cause ■ Stopcock of the CVP or RAP line may not have been turned OFF quickly enough after injection was made.

Erroneous CO values using room temperature injectate

■ Injectate too warm.

Solution ■ Turn the stopcock off immediately after making the injection to provide the module with the correct pressure value at the time it obtains the curve.

■ Injectate temperature is above 25.5° C.

■ Injection rate too slow.

■ Administer bolus smoothly at a rate of < 10 cc/4 seconds.

Unable to obtain indexed values for calcs

■ Did not enter height and/or weight prior to averaging curves.

■ Enter the height/weight and reinject the curves.

■ If the Calcs option is installed, enter the height/weight in hemocalcs to obtain index values without reinjecting curves.

Value of calcs variable displays as +++

Spontaneous CO curves drawn while in AUTO mode

■ Measured value is out of range.

■ Check computation constant (CC) values for validity.

■ Infusion of IV drips or medications

■ Turn off the IV solutions temporarily.

through proximal port.

■ Mechanically ventilated patient

■ Use the Manual mode.

causing shifts in PA temperature.

■ Cardiac arrhythmias causing blood flow variance.

Substantial variance in CO values/irregular curves

■ Varied temperature in bolus. ■ Injection delivered at varying points in the respiratory cycle.

■ Use the Manual mode and time the injection during stable ECG rhythm.

■ Standardize the temperature of bolus.

■ Use the Manual mode and time the injection at end expiration, if desired.

■ Movement.

■ Standardize the patient position during procedure.

■ Physiological problems.

■ Any of the following conditions can affect accurate readings: ventricular arrhythmias, low stroke volume, and/or valve insufficiency.

■ Injectate rate too slow.

■ Administer the bolus smoothly at a consistent rate.

No curve drawn after bolus injected

■ Insufficient time has elapsed between injections to allow blood temperature stabilization.

■ Wait 60-90 seconds between injections.

SpO2

Directory of Keys S P O 2

SPO2 MENU ALARM LIMITS

SETUP

IABP YES

PULSE RATE ON

OFF

SPO2 - SETUP WAVEFORM

SIZE

AVERAGING

TONE

SPO2 - DATA AVERAGING TIME XXs

SPO2 - WAVEFORM SIZE SIZE

OFF

SIZE

SPO2 - TONE TONE ON

OFF

VOLUME

SPO2 - ALARM LIMITS ALARMS ON

HI = 100

OFF

LO = 85

ALM DELAY 15s

MSG ALARM DELAY 30s MSG ALARM KEY is displayed only when its value is other than 20 seconds.

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

18-1

SpO2

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Ensuring Accurate Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Setting or Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Selecting Data Averaging Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Using SpO2 with Intra-Aortic Balloon Pumps . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Adjusting Tone Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Modifying Waveform Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Viewing Pulse Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Using the Sensorwatch Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Error Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 SpO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Overview Pulse oximetry allows continuous noninvasive monitoring of a patient’s hemoglobin oxygen saturation. The oximetry sensor contains two light emitting diodes (LEDs) that transmit specific wavelengths (typically 660 and 940 nanometers) of light that are received by a photo detector. Oxygen saturated blood absorbs light differently compared to unsaturated blood. The amount of light absorbed by the blood can be used to calculate the ratio of oxygenated hemoglobin to total hemoglobin in arterial blood. The monitor displays this ratio as percent SpO2. Normal values range from 95 to 100%. WARNING: • A pulse oximeter should NOT be used as an apnea monitor.

! 18-2

•

A pulse oximeter should be considered an early warning device. If a trend towards patient deoxygenation is indicated, blood samples should be analyzed by a laboratory co-oximeter to completely understand the patient's condition.

•

When used according to the manufacturers’ instructions, sensors have no adverse effect on tissues.

•

Pulse oximetry may interfere with magnetic resonance imaging (MRI) procedures. Refer to your hospital’s protocols for specific instructions.

•

You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-5 for further information.

SpO2

Setting Up SpO2 Monitoring To set up SpO2 monitoring: 1 2

Connect the adapter cable to the module. Attach the sensor to the patient and connect the sensor cable to the adapter cable. Touch SPO2.

When you connect the adapter cable to the module the SPO2 key will be displayed. Attach the sensor to the patient and then to the adapter cable. CAUTION: • Use only patient sensors specified by Spacelabs Medical. If you use sensors other than those specified, it may degrade performance and could damage the monitor during defibrillation. •

Spacelabs Medical recommends the use of sensors repaired or remanufactured by the original manufacturer only.

•

Check the sensor site frequently. Do not allow the sensor to remain on one site for a prolonged period of time, especially when monitoring neonates. Refer to the sensor manufacturer's instructions.

•

Never attach an SpO2 sensor on a limb being monitored with a blood pressure cuff or a limb with restricted blood flow.

•

A poorly applied sensor may give incorrect saturation values. The Sensorwatch signal strength indicator is used to identify a poorly applied sensor or a poorly chosen site. Re-apply the sensor. Refer to Using the Sensorwatch Feature on page 18-6 for further details.

•

Choose a site with sufficient perfusion to ensure accurate oximetry values.

An adapter cable is required between the sensor and the module. Do not discard the adapter cable when you have finished using a disposable oximetry sensor. Disconnect the sensor cable from the adapter cable before discarding the sensor.

Dual SpO2 Monitoring Some modules support real-time monitoring of dual SpO2 sites. To employ this option, insert a second Spacelabs Medical SpO2 module into an available slot in the monitor. The new parameter will be displayed below the first SpO2 channel. Affix a label to the monitor’s bezel to indicate the sensor site location (for example, right hand, left foot) for each SpO2 parameter displayed on the monitor.

18-3

Ultraview Care Network

Display Detail These figures illustrate a typical SpO2 display. You can view oximetry values from any Ultraview Care Network bedside or central monitor on a network.

í˘ľ

í˘´

SPO2=99% PULSE RATE = 109 bpm

í˘ą

í˘ˇ

S P O 2

S P O 2 í˘˛

í˘ą

Figure 18-1: Split Screen Central Monitor

í˘˛

109 bpm

99 í˘ł í˘´

100

% 85

í˘ľ

í˘ś

Figure 18-2: Bedside Monitor

í˘ą Pulse plethysmographic waveform í˘˛ SPO2 key í˘ł Sensorwatch signal strength indicator; horizontal line denotes minimum signal level; bar shades from bottom to top

í˘´ SpO2 pulse rate (asterisk flashes when pulse is detected - on bedside monitors only)

í˘ľ Current SpO2 value (percent) í˘ś High and low SpO2 alarm limits í˘ˇ The bell indicates that alarms are enabled (on split screen central only)

18-4

SpO2

Ensuring Accurate Monitoring While each sensor requires site specific application procedures, the following general points aid in ensuring oximetry monitoring success. • • • • •

Choose a site that provides proper alignment of the LEDs and receiving photodetector. Reduce light interference when monitoring a neonate under bright light by using a diaper or other light block over the sensor. Select a site that has unrestricted blood flow and can remain as immobile as possible to reduce or eliminate movement artifact. Do not restrict blood flow when securing a sensor with tape. Do not select a site near potential electrical interference (electrical cords, for example).

Setting or Adjusting Alarm Limits To set or adjust alarms: 1 2 3 4

Touch SPO2. Touch ALARM LIMITS. Select ALARMS ON. Select HI=, LO=, ALM DELAY, or MSG ALARM DELAY (if present). Use arrow keys to adjust.

Pulse oximetry alarm limits and delays are based either on factory default limits or user-defined limits. The factory default settings for alarm limits are 100% for high and 85% for low. For alarm delays, the factory default settings are 15-seconds for alarm limit delay and 20-seconds for message alarm delay. Refer to Alarms on page 2-1 for further information concerning Ultraview Care Network alarm operations.

Selecting Data Averaging Period To specify a data averaging period: 1 2 3 4

Touch SPO2. Touch SETUP. Touch AVERAGING. Use arrow keys to adjust.

Use this feature to smooth the oximetry saturation value by averaging patient input values over 4-, 8-, or 16-seconds. The default value is 8-seconds. The data averaging period is given in the menu prompt line of the AVERAGING menu.

Using SpO2 with Intra-Aortic Balloon Pumps To use with balloon pump: 1 2

Touch SPO2. Select IABP YES.

Use this feature whenever an intra-aortic balloon pump (IABP) is in use or for patients with irregular cardiac rhythms.

•

When the IABP feature is enabled, the pulse rate obtained from SpO2 may not match the heart rate obtained from ECG.

18-5

Ultraview Care Network

Adjusting Tone Volume To adjust tone volume: 1 2 3 4 5

Touch SPO2. Touch SETUP. Touch TONE. Select TONE ON. Use arrow keys to adjust.

Use this function to turn the pulse tone ON or OFF. The pitch varies according to the SpO2 value. The higher the oxygen saturation, the higher the pitch. The default setting for the pulse tone is OFF.

Modifying Waveform Display To modify display of the waveform:

Use this function to turn the plethysmographic waveform display ON or OFF. The default setting is ON.

1 2 3 4 5

Use the SIZE key to change the height of the displayed waveform as necessary for clarity. This changes the displayed size only and does not affect the signal gain.

Touch SPO2. Touch SETUP. Verify WAVEFORM ON. Touch SIZE. Touch SIZE↑ or SIZE↓ to adjust.

•

Amplitude of the displayed waveform is not proportional to the pulse amplitude.

Viewing Pulse Rate To modify the pulse rate display: 1 2

Touch SPO2. Select PULSE RATE ON/OFF.

You can obtain and view a pulse rate derived from the saturation data. The pulse rate is displayed within the range of 30 to 250 beats per minute ±3 beats per minute. The default setting for the pulse rate display is ON.

Using the Sensorwatch Feature The Sensorwatch feature is a graphical presentation of the amplitude of the signal received from the sensor. It can be used to determine the best sensor site and application. Changes in the displayed shaded level signify the changes in the patient’s perfusion or changes in the application of the sensor. The horizontal line near the bottom fourth of the graphic represents the minimum signal level that results in accurate saturation values. When the shading is just below this point, the message LOW SIGNAL STRENGTH - REPOSITION OR REPLACE SENSOR is displayed and SENSORWATCH flashes. When the shading is below the line: • • • •

18-6

Reposition the sensor to a different site to provide better perfusion. Reposition the sensor so that better contact is made with the skin and the LEDs and photodetector are aligned better. Replace a defective sensor. Wait for the patient to warm and the perfusion to increase.

SpO2

Restoring User-Defined Settings To restore user-defined settings: Configurations with ECG 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

•

RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

•

Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.

To restore user-defined settings: Configurations without ECG 1 2 3

Touch TEMP. Touch RESTORE SETTINGS. Select YES.

Error Messages Error messages indicate a problem or condition which may affect accurate monitoring values. Do not ignore these messages. Correct any fault before continuing. When the following messages are displayed, the saturation value and pulse rate are immediately changed to ??? and an alarm is triggered (if your module has been configured with an alarm for that message). ADAPTER DISCONNECTED - CHECK CONNECTION AT MODULE • • • •

The module does not detect an adapter cable connected to the front panel. Check proper adapter cable connection. If the message persists and the adapter cable is secure, replace the adapter cable. The channel will drop and the alarm will stop after approximately 10 seconds. On remote view, there may be no audible alarm on the remote monitor before the channel drops.

SENSOR DISCONNECTED - CHECK CONNECTION AT ADAPTER CABLE • •

The module does not detect a sensor. Check the proper connection of the sensor with adapter cable. If the message persists, replace the sensor and/or the adapter cable.

SENSOR OFF PATIENT - CHECK CONNECTION AT PATIENT • •

The module does not detect a valid sensor input signal. Check the patient for proper sensor placement. The tissue between the LED and photodiode is too transmissive. If the sensor placement seems correct and the message persists, try a sensor site with a thicker tissue bed.

18-7

Ultraview Care Network

FAULTY SENSOR - REPLACE SENSOR •

The LED and/or photodiode have failed. Replace the sensor.

AMBIENT LIGHT INTERFERENCE - COVER SENSOR AREA • • •

The sensor is receiving external light interference from a bright light source near the sensor. Shield the sensor from the external light source. The sensor photodiode and LEDs are misaligned on flexible sensors thereby allowing light to enter. Realign the sensor photodiode with LEDs. If the message persists, replace the sensor.

INSUFFICIENT SIGNAL - REPOSITION OR REPLACE SENSOR • • •

Insufficient signal for proper operation as evidenced by a low deflection on Sensorwatch signal strength bar. Poor sensor application or site. Correctly re-apply or reposition to a better perfused site or massage site. If the message persists, replace the sensor.

NOISY SIGNAL • • •

Sensor signal disturbed by motion or other interference. Eliminate sensor movement. Message disappears when the value is obtained. Sensor placement adjacent to power cords or other electrically noisy devices. Move the noisy device or move the sensor to another site. If the message persists, replace the sensor.

LOW SIGNAL STRENGTH - REPOSITION OR REPLACE SENSOR When this message appears the saturation and pulse rate continue to be displayed; however, the Sensorwatch flashes as a indication of a possible error condition. • • • •

Insufficient blood flow between the sensor light emitter and detector. Move the sensor to an area of higher perfusion. Poor sensor application. Reposition to place active components closer to skin or locate to a better perfused site. Sensor site is below the blood pressure cuff. Move to another site. If the message persists, replace the sensor.

Sensors For further information about biocompatibility or sensor disposal, refer to the Spacelabs Medical Product Specification sheets and to the manufacturer's instructions enclosed with each sensor.

18-8

SpO2 Troubleshooting Guide Clinical Situation No SpO2 parameter key is displayed

Possible Cause

Solution

■ Module not inserted correctly.

■ Remove and reinsert the module.

■ Adapter cable not connected to

■ Correctly connect the adapter cable.

module properly.

■ Sensor not connected to adapter

■ Correctly connect the sensor.

cable.

SpO2 value displays ???

■ Sensor not connected to patient.

■ Reattach the sensor.

■ Excessive patient motion.

■ Urge patient to remain still while reading is in progress.

■ Module is in the initialization phase (the first 15 seconds after sensor application).

Low signal strength

■ Sensor placement not optimum.

■ Wait until the initialization is complete.

■ Move the sensor to a site which has better perfusion.

■ Align the LED with the sensor photo detector.

■ Sensor is placed below blood pres-

■ Move the sensor to an alternate limb.

sure cuff. Intermittent or complete failure to operate

Factors which cause significant variances in sensor accuracy

■ Module error.

■ Call a qualified service person.

■ Presence of dysfunctional hemoglo-

■ Follow hospital procedure for deter-

bins (COHb, MetHb).

■ Presence of intravascular dyes (indocyamine green, methylene blue) depending on their concentration in the blood stream.

mining oxygenation in these patients.

■ Follow hospital procedure for determining oxygenation in these patients.

■ High ambient light level.

■ Reduce light levels near the patient.

■ Electrosurgical interference.

■ Follow hospital procedure for determining oxygenation in these patients.

■ Patient is significantly anemic (Hb less than 5g/dl) or patient has received large amounts of IV solutions.

■ Follow hospital procedure for determining oxygenation in these patients.

SvO2

Directory of Keys S V O 2

SVO2 MENU ALARM LIMITS

TIMEBASE 2 HOURS

INTENSITY DISPLAY

STORE READ

CALIBRATE

STORE

YES

IN VIVO

YES

SCALES

SVO2 TREND

CALC RESULTS

CALCS

READ

PREINSERTION

LIGHT INTENSITY

YES

ENTER

ALARMS ON OFF

1 HOUR

2 HOUR

HI = 80

LO = 80

4 HOUR

PvO2 =

•

CO =

16 HOUR

LIGHT INT ON OFF

11:55 av DO2 = 4.61 Ca = 19.80 Cv = 15.20 ml/dl PaO2 =

8 HOUR

SaO2 =

O2AV = 990 VO2 = 250 ml/min SvO2 =

Hgb =

ENTER

Based on features purchased, more or fewer keys may appear here than on your menu screens.

19-1

SvO2

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Preparing the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Performing Pre-insertion (in vitro) Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Inserting the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Performing Light Intensity Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Performing In Vivo Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Displaying Intensity Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Setting the Light Intensity Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Adjusting Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Obtaining Oximetry Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Printing Oximetry Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Storing or Reading Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Correcting Out-of-Range Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Correcting Insufficient Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Correcting Calibration Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Correcting Optical Module Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Correcting SvO2 Display Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Ensuring Catheter Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 SvO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Overview Measurements of venous oxygen saturation (SvO2) provide a status indicator of the oxygen transport system in the critically ill patient. Low or rapidly decreasing saturation values indicate an imbalance between oxygen consumption and oxygen delivery. Normal values reflect a balance of the oxygen transport system or the patient’s ability to successfully compensate for alterations in oxygen supply or demand. Continuous SvO2 monitoring can reduce the frequency of additional invasive measurements and enhance the timeliness of intervention in the critically ill patient. This system utilizes three-wavelength reflectance spectrophotometry to sense the amount of light absorbed by the blood. The use of three wavelengths compensates for changes in light reflectance from red blood cell surfaces, blood vessel walls, and for variations in hematocrit values. Digital filtering reduces vessel-wall artifacts. Data acquisition begins when an Abbott Opticath® catheter is positioned at a site within the pulmonary artery. The catheter connects to an Abbott Oximetrix® optical module which contains three LEDs emitting red and infrared wavelengths of light. The catheter returns reflected light through a second optical fiber to the optical module. Here the light is converted to an electrical signal which the SvO2 module recognizes and displays as a saturated venous oximetry value (percent SvO2).

19-2

SvO2

CAUTION: • The Spacelabs Medical SvO2 module will not correctly operate with any other catheter for SvO2 monitoring.

Setting Up SvO2 Monitoring To set up SvO2 monitoring: 1

Place the catheter’s optical connector into the optical module on the connecting cable. Insert the connecting cable into the SvO2 module.

In addition to the Spacelabs Medical module, venous oximetry monitoring requires an Abbott Oximetrix 3 optical module with connecting cable and an Abbott Opticath catheter. You must correctly connect all necessary cables, prepare the catheter and patient for this invasive procedure, and calibrate the catheter to begin monitoring. The system provides two calibration methods. The patient’s current status determines the proper calibration method. You may calibrate the catheter: • •

while in its sterile package, or after it has been placed within the pulmonary artery, and you can verify adequate light intensity during monitoring.

Refer to Preparing the Catheter on page 19-4 and Performing Pre-insertion (in vitro) Calibration on page 19-6 for more details.

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Ultraview Care Network

Display Detail Refer to Figure 19-1: Typical Venous Oximetry Display, which provides a trend of oximetry values and the current light intensity value.

Figure 19-1: Typical Venous Oximetry Display

í˘ą Current time base â&#x20AC;&#x201D; 1HR í˘˛ Venous oximetry trend graph í˘ł Event marks â&#x20AC;&#x201D; I (in vivo calibration initiated), C (in vivo calibration complete) í˘´ Light intensity display marks (vertical lines) superimposed over trend graph í˘ľ Light intensity bar graph (light meter) í˘ś Real time intensity signal level (two vertical lines) í˘ˇ Markers for normal intensity levels (two horizontal lines) í˘¸ SvO2 parameter key í˘š Current venous oximetry value â&#x20AC;&#x201D; 76% ě?&#x2026; Status or error message area ě?&#x2C6; Current alarm limits â&#x20AC;&#x201D; high 80, low 60

Preparing the Catheter Each Abbott Opticath catheter is packaged in a sterile, disposable tray which includes a disposable optical reference. Inspect the catheter tray carefully. If you suspect damage to the tray DO NOT USE THE CATHETER. Perform the catheter setup according to the instructions included with the catheter. Setup instructions are included here as a convenience.

19-4

Peel back the outer wrap. Do not break the seal of the inner wrap.

Peel back the lift tab to uncover the optical connector at the end of the tray.

Pull the optical connector slightly away from the tray. Place the optical module in the recess at the open end of the catheter tray.

SvO2

Open the end of the optical module by pulling straight out in the direction of the arrow (refer to Figure 19-2: Placing the Optical Module into the Catheter Tray). The monitor will display an INSUFFICIENT LIGHT message.

Figure 19-2: Placing the Optical Module into the Catheter Tray 5.

Place the optical connector into the optical module with the word TOP facing up. Close the module (refer to Figure 19-3: Placing the Optical Connector into the Optical Module).

Figure 19-3: Placing the Optical Connector into the Optical Module 6.

With the inner wrap still in place, press down on the black optical reference at the point labeled PUSH. Listen for a click.

The catheter is now ready for pre-insertion calibration. After you complete the calibration, prepare the patient for catheter insertion.

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Ultraview Care Network

Performing Pre-insertion (in vitro) Calibration To initiate pre-insertion calibration: 1 2 3 4

Touch SVO2. Touch CALIBRATE. Touch PRE-INSERTION. Touch YES.

This calibration procedure tales up to 72 seconds. When calibration is successful, the message PRE-INS CAL COMPLETE displays and the event mark P displays on the oximetry trend. If the catheter fails calibration, verify the following: • • • •

A secure cable connection exists between the optical and SvO2 modules. The catheter tip is inserted properly within the optical connector. You have pressed the optical reference with enough force to hear the click, indicating a secure connection. You tested the catheter by replacing it with a known good catheter to ensure proper catheter function.

Repeated calibration failure with a known good catheter may indicate a defective optical module. Replace the optical module if necessary.

Inserting the Catheter Follow standard hospital procedure to prepare the patient for catheter insertion. 1.

Using sterile procedures, peel back the remaining inner wrap from the catheter tray. Pull the retainer (white tab) to release the catheter.

Grasp the catheter at approximately the 5 cm mark and gently pull it straight out from the optical reference. CAUTION: • The optical fibers can be damaged if you do not draw the catheter out carefully.

Prepare the catheter and insert it into the patient according to hospital procedure. Oxygen saturation readings will immediately display on the bedside monitor.

When the catheter is positioned properly, verify the light intensity signal is within the correct operating range (i.e., the bars on the graph extend at least two vertical dots within the high and low range markers).

Perform a light intensity calibration.

! 6.

19-6

•

Do not begin a light intensity calibration if the signal is out of range. If this occurs, refer to Correcting Out-of-Range Light Intensity on page 19-10.

Begin continuous mixed venous oxygen saturation monitoring.

SvO2

Performing Light Intensity Calibration To initiate light intensity calibration: 1 2 3 4

Touch SVO2. Touch CALIBRATE. Touch LIGHT INTENSITY. Touch YES.

This procedure adjusts the optical module’s light intensity reference level to match the light intensity returned through the catheter from the patient’s blood. The SvO2 module stores this value and signals an alarm if the detected light differs significantly from the stored light levels. Perform a light intensity calibration only when the catheter is in the proper position in the patient.

Performing In Vivo Calibration To initiate in vivo calibration: 1 2 3 4 5

Touch SVO2. Touch CALIBRATE. Touch IN VIVO. Touch YES. Draw blood from the distal lumen when the message DRAW BLOOD is displayed and send to lab for analysis. Use arrow keys to adjust value if displayed value differs from lab value by more than four saturation units.

In vivo calibration compares a drawn (measured) blood gas value with the value displaying on the monitor. The catheter manufacturer recommends that the oxygenation value be checked periodically. Several conditions may necessitate in vivo calibration. • • •

•

Catheter was placed without pre-insertion calibration. Catheter has been in place for an extended period of time. Decaying light intensity values indicate possible damage to the fiber optics (in this case, the catheter manufacturer recommends checking the oxygenation value every 12 hours). You believe the saturation reading is incorrect.

•

Use only measured oxyhemoglobin saturation values from a cooximeter. Do not use values calculated from a laboratory blood gas analyzer. Oxyhemoglobin values calculated on the basis of PO2, pH, and temperature have been shown to be inaccurate.

Perform an in vivo calibration only when the patient’s oxygen saturation is relatively stable and the intensity signal is within normal limits. When calibration begins, the optical module stores the preceding five seconds of oxygen saturation data.

Displaying Intensity Data To display a history of light intensity values: 1 2

Touch SVO2. Touch INTENSITY DISPLAY.

You can display a history of light intensity values superimposed over the saturation trend graph. This combined display can be valuable for troubleshooting because the quality of light passing the catheter tip directly affects the accuracy of the saturation value. Successful monitoring ensures light intensity values remain within the limits of the bar graph display. Real time maximum and minimum intensity values display as vertical bars to each side of a vertical row of dots. This display updates every six seconds. Horizontal lines represent the recommended operating limits for light intensity. Removing display of the intensity data does not affect storage of the data in monitor memory, and the current intensity continues to display in the intensity bar.

19-7

Ultraview Care Network

Setting Alarm Limits To set or adjust alarm limits: 1 2 3 4 5

Touch SVO2. Touch ALARM LIMITS. Select ALARMS ON. Select HI= or LO=. Use arrow keys to adjust.

The current limits for venous oximetry display to the right of the parameter key. You can set high or low saturation limits. The alarm default is OFF. When you turn alarms ON: • • •

they default to a high of 80% and low of 60%. the exceeded limit key flashes. the limit value is displayed in the message area of the screen.

Setting the Light Intensity Alarm To set the light intensity alarm: 1 2 3

Touch SVO2. Touch ALARM LIMITS. Select LIGHT IN - ON or OFF.

If the light intensity alarm is turned ON, a second-level alarm will sound in the event of an intensity alert.

Adjusting Trend Display The most recent minute of mixed venous oxygen saturation data is displayed as a point on the right side of the trend graph. As the module acquires new data, the older data points move left to create a record of data.

Select Timebase To select a timebase: 1 2 3

Touch SVO2. Touch TIMEBASE x HOURS. Select hours.

The SvO2 module stores the most recent 18-hours of saturation trend data. You can view this data graphically in 1-, 2-, 4-, 8-, or 16-hour time bases. Data is displayed in 1-minute increments on 1- to 4-hour graphs, in 2-minute increments on the 8-hour graph, and in4-minute increments on the 16-hour graph.

Select Scale To change trend graph size: 1 2 3

Touch SVO2. Touch SCALES. Use arrows to adjust.

You can select one of three sizes for the trend graph: • • •

30% to 70% 40% to 80% 50% to 90% (default)

Event Marks The system automatically displays event marks along the top of the trend graph to note the point when any of the following events occur: P — pre-insertion calibration initiated I — in vivo calibration initiated C — in vivo calibration complete L — light intensity calibration complete F — calibration failure R — light intensity range error

19-8

SvO2

Obtaining Oximetry Calculations To obtain oxygenation calculations: 1 2 3 4 5

Touch SVO2. Touch CALCS. Select a manually entered value(s) for PaO2, PvO2, Hgb. Use arrow keys to adjust. Touch ENTER.

You can use the calculations feature to obtain specific values for the oximetry measurements listed below. Arterial oxygen content — Ca CaO2 = (1.34 x Hgb x SaO2/100) + (0.0031 x PaO2) Venous oxygen content — Cv CvO2 = (1.34 x Hgb x SvO2/100) + (0.0031 x PvO2) Arterial-venous oxygen content difference avDO2 = CaO2 - CvO2 Oxygen availability or oxygen delivery O2AV = CaO2 x CO x 10 Oxygen consumption VO2 = avDO2 x CO x 10 Values for cardiac output (CO), pulse oximetry (SpO2), and venous oxygen saturation (SvO2) are automatically displayed when data is available in the Ultraview Care Network system. You must manually enter laboratory values for PaO2, PvO2, and hemoglobin (Hgb) to obtain calculations.

•

If an SaO2 value is available, it may be used in place of the SpO2 value.

Printing Oximetry Data To print saturation data: 1 2 3

Touch SVO2. Touch PRINT. Select SvO2 TREND or CALC RESULTS.

To read or store data in the optical module: 1 2 3 4

Touch SVO2. Touch STORE READ. Select STORE or READ. Touch YES.

You can print venous oximetry data in two formats: the current trend or the results of the most recent set of oxygenation calculations. Refer to Printing on page 4-1 for more details on system and bedside printers.

Storing or Reading Data The last 15 minutes of data gathered by the SvO2 module may be stored in the optical module’s memory before disconnection. That data can be read back into the SvO2 module. The stored data includes the year, month, hour, and minute of collection.

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Ultraview Care Network

Correcting Out-of-Range Light Intensity Each time you perform a light intensity calibration, the oximetry module stores the intensity value and signals an alarm or error message if the current light level differs significantly from the stored level. Light intensity error messages serve as a reference to determine if the light at the catheter tip is adequate for accurate monitoring. Do not ignore these messages. The module alerts you to this condition when: • •

an INTENSITY ALERT or SVO2 DATA OUT OF RANGE message is displayed or a second level alarm begins.

When the monitor displays the SVO2 DATA OUT OF RANGE or INTENSITY ALERT message, select the intensity display feature to view a history of light intensity values. Refer to Figure 19-4: Abnormal Intensities to identify the type of abnormal intensity. Refer to the following list of possible causes and solutions. • •

High — check the position of the catheter as the tip may lie against the vessel wall. Reposition the catheter according to your hospital protocol. Low, dampened, or erratic — check the blood flow past the catheter as a clot may have formed over the catheter tip.

Figure 19-4: Abnormal Intensities Take the following actions: •

•

• •

19-10

If a Spacelabs Medical invasive pressure module is being used, examine the pulmonary artery (PA) pressure waveform for spontaneous wedge indicating the catheter tip may lie against the vessel wall. If this occurs, reposition the catheter. If a Spacelabs Medical invasive pressure module is being used for pulmonary artery pressure monitoring, examine the pressure waveform for dampening, indicating clotting over the tip of the catheter. If this occurs, follow hospital procedure to flush the distal lumen. Reposition the catheter if necessary. Abnormal resistance when you push the catheter through the distal lumen indicates damage to catheter fiber optics. Reposition the catheter and replace if necessary. If connections between the catheter optical connector and the optical module appear loose, tighten the connections. If the catheter contains obvious kinks, the optical fibers may be damaged. Replace the catheter.

SvO2

Correcting Insufficient Light Intensity The message INSUFFICIENT LIGHT displays when an unusually small amount of light is being received during monitoring or during pre-insertion calibration. Take the following actions: •

• •

•

If this message displays while the catheter is exposed to room light during pre-insertion calibration, take no action. It disappears when the catheter is placed in the patient. If this message displays during pre-insertion calibration while the catheter is connected to the optical module, verify proper connection to the module. Check that the tip is fully inserted into the optical reference and firmly press PUSH on the optical reference until you hear a click. Do not use the catheter if the tip is pulled out of the optical reference when you receive the catheter tray. Disconnect the optical module from the catheter, close the optical module lid, and place the optical module in an area out of direct light. If the message disappears, replace the catheter. If the message remains, contact your system administrator. Examine the catheter for kinking. If optical fibers are damaged, replace the catheter.

Correcting Calibration Errors The message CALIBRATION REJECTED displays when pre-insertion or in vivo calibration is not successful. Take the following action as indicated: • •

•

Check for secure catheter connection to the optical module. Reconnect the catheter if necessary. Check the status message on the monitor screen to verify sufficient, stable light intensity. If the INSUFFICIENT LIGHT message displays, refer to the previous section which describes steps to correct this condition. Allow the optical module to warm up for one more minute, then retry.

The message NOT CALIBRATED displays and an alert sounds (if alarms are ON) if you begin monitoring before you calibrate the system. The message disappears after you complete a successful calibration.

Correcting Optical Module Errors The SvO2 module performs constant memory checks to ensure data is not lost or changed erroneously. When the OPTICAL MODULE MEMORY ERROR message displays, replace the optical module with a known good unit. Expect the NO OPTICAL MODULE message whenever you disconnect the optical module from the SvO2 module because this suspends SvO2 monitoring. If this message appears when the optical module is not disconnected, replace the module or contact a qualified service person.

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Ultraview Care Network

Correcting SvO2 Display Error If the oxygen saturation value is out of the display range, the display changes from a percentage to ???. Take the following action as indicated: • • •

Verify proper function of the optical module; no error messages display. Replace with a known good module if necessary. Display light intensity history to verify proper catheter function (refer to Correcting Insufficient Light Intensity on page 19-11). Perform in vivo calibration.

Ensuring Catheter Function The catheter fiber optics are sensitive to damage. Avoid kinking, excessive manipulation, or grasping with forceps or a hemostat. Damage to the fiber optics reduces transmission of light to and from the blood which significantly compromises oxygen saturation accuracy. Damage is indicated by one or more of the following: • • • •

19-12

Low intensity display. Intensity error message displays. Intensity alarms begin if alarms are ON. Oxygen saturating values are inaccurate.

SvO2 Troubleshooting Guide Clinical Situation INTENSITY ALERT or SVO2 DATA OUT OF RANGE message is displayed

Possible Cause ■ Faulty catheter position within vessel.

Solution ■ Check for spontaneous wedge or balloon inflation; if present reposition the catheter.

■ Clot over catheter tip.

■ Flush distal lumen.

■ Loose connections between

■ Tighten the connections.

catheter optical connector and optical module.

■ Kinked or damaged fiber optics in

■ Replace the catheter.

catheter.

INSUFFICIENT LIGHT message is displayed

■ Catheter exposed to room light during pre-insertion calibration.

??? is displayed in place of SvO2 value

only.

■ Catheter is kinked.

■ Check the catheter.

■ Faulty connection between catheter

■ Fully insert the tip into the optical

and optical module.

CALIBRATION REJECTED message is displayed

■ No action required; status message

■ Faulty connection between catheter

reference.

■ Reconnect.

and optical module.

■ Optical module not warmed up.

■ Wait one minute and retry.

■ Value out of range.

■ If optical module error message also is displayed, replace optical module.

■ Poor light intensity.

■ Display light intensity history to verify.

■ Pre-insertion calibration insufficient.

•

■ Perform in vivo calibration.

Catheters should be handled according to your hospital’s protocol.

Calculations

Directory of Keys - Ultraview Portable/1500/1600 Monitors Oxygenation Example SPECIAL FUNCTIONS LOCAL TRENDS/CALCS

REMOTE TRENDS/CALCS

TABULAR TRENDS

CALCS

DRUG CALCS

HEMO CALCS

RESP CALCS

OXY CALCS

RENAL CALCS

NEW ENTRY

EDIT INPUTS

EDIT DAY/TIME

STORE ENTRY

DELETE ENTRY

PAGE SCROLL

FIO2 %

PaO2 mmHg

SpO2 %

PaCO2 mmHg

PvO2 mmHg

SvO2 %

BED 1

BED 2

BED 3

BED 4

BED 5

UPDATE DATA

Hgb g/dl

PB mmHg

BSA m2

CO l/min

Drug Dosage Directory

DRUG A

(Neonate Only) EDIT INPUTS

STORE ENTRY

MIX TITRATE

TITRATION TABLE

UPDATE DATA

Displays Titrate Tables UNITS

AMT

VOL

CONC

WEIGHT

DOSE

RATE

mcg

DOSE/MIN mcg/min

DOSE/HR mg/hr

TOTAL DOSE

TOTAL VOL

Displays pop-up keypad

Displays pop-up keypad AMOUNT DOSE

DUR

mEq

DOSE/WT/MIN mcg/kg/min

units

k units

m units

DOSE/WT/HR mcg/kg/hr

Displays pop-up keypad VARY RATE DOSE

DOSE/MIN mcg/min

•

DOSE TYPE

PAGE SCROLL

DOSE/HR mcg/hr

DOSE/WT/MIN mcg/kg/min

DOSE/WT/HR mcg/kg/hr

Based on features purchased, more or fewer keys may appear here than on your menu screens.

20-1

Calculations

Directory of Keys - UCW and Ultraview 1700

This key is dithered in central mode

This key is dithered when the remote option is not installed

REMOTE BED

LOCAL BED

Select a bed

CLINICAL CALCS for Bed XXX HEMO CALCS

RESP CALCS

OXY CALCS

RENAL CALCS

NEW ENTRY

EDIT INPUTS

EDIT DAY/TIME

STORE ENTRY

Example (oxy calcs)

FiO2 %

PaO2 mmHg

SpO2 %

UPDATE DATA

DELETE ENTRY

PaCO2 mmHg

SvO2 %

PvO2 mmHg

YES

Drug Calcs Directory

RESIZE WINDOW

Hgb g/dl

PB mmHg

DEFAULT SIZE

HEIGHT WEIGHT in lb

CO l/min

MINIMUM SIZE

REDUCE SIZE

ENLARGE SIZE

DRUG A (Neonate Only) EDIT INPUTS

STORE ENTRY

MIX TITRATE

TITRATION TABLE

RESIZE WINDOW

UPDATE DATA

RATE

DUR

Displays Titrate Tables UNITS

AMT

VOL

CONC

WEIGHT

DOSE

DOSE/MIN

mcg

DOSE/HR

TOTAL VOL

Displays pop-up keypad

Displays pop-up keypad AMOUNT

TOTAL DOSE

mEq

DOSE/WT/MIN

units

k units

m units

DEFAULT SIZE

DOSE/WT/HR

MINIMUM SIZE

REDUCE SIZE

ENLARGE SIZE

Displays pop-up keypad VARY RATE DOSE

DOSE/MIN

20-2

DOSE TYPE

SCROLL ←

DOSE/HR

SCROLL →

DOSE/WT/MIN

PAGE ←

PAGE →

DOSE/WT/HR

Calculations

Contents Directory of Keys - Ultraview Portable/1500/1600 Monitors . . . . . . . . . . . . . . . 1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Setting Up Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Setting Up Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Hemodynamic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Respiration Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Oxygenation Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Renal Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Using the Drug Name List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Overview The Clinical Calculations feature can be divided into two types: (1) Physiologic and (2) Drug Dosage. Physiologic calculations include hemodynamic, respiration, oxygenation, and renal. These calculations use input values entered manually or collected automatically by the system to produce a set of output values. Drug Dosage calculations enable you to determine infusion rates for drugs based on drug concentration, desired dose, patient weight, and type (adult or neonate).

Setting Up Physiologic Calculations Values are entered into the system in several ways. You can take a snapshot of currently monitored inputs by selecting the NEW ENTRY key (refer to Creating a New Entry on page 20-6). You may also specify a day and time to gather input data from the past, although this function is generally limited to the past 24 hours. The system displays a combined total of 200 entries into the four physiologic calculations tables. Each table has an Edit Inputs menu that is used to edit input data. You can also create a record of both input and output data by printing the displayed table.

20-3

Ultraview Care Network

Setting Up Drug Dosage Calculations The Drug Dosage calculation feature enables you to edit the inputs and to store up to four (UCW and Ultraview 1700) or six (Ultraview Portable,1500, and 1600) drug records. Titration tables are displayed for each drug record entered. Drug dosage calculations operate similarly to physiologic calculations except that weight is handled differently, and that you must select an ADULT or NEONATE patient type. Refer to Selecting Patient Type and Gender on page 3-8 for details on adult/neonate selection. WARNING: â&#x20AC;˘ If the system is turned OFF, all clinical calculations data will be lost.

Accessing Calculation Data To access local or remote calcs (Ultraview Portable, 1500, 1600 monitors): 1 Touch SPECIAL FUNCTIONS. 2a Select LOCAL or REMOTE TRENDS/CALCS. 2b If you selected REMOTE TRENDS/CALCS, select a bed. 3 Touch CALCS. 4 Select a calcs key (HEMO, RESP, OXY, RENAL). To access local or remote calcs (for UCW and Ultraview 1700 monitors): 1 Touch SPECIAL FUNCTIONS. 2 Touch CALCS. 3a Select LOCAL BED (bedside only) or REMOTE BED. 3b If you selected REMOTE BED, select a bed. 4 Select a calcs key (HEMO, RESP, OXY, RENAL).

20-4

Calculations can be accessed via the local bedside monitor or from a remote monitor on the network depending upon the options purchased. Contact your system administrator for details if you are unable to access this function. The data displayed in the Calculations table is from the local bedside or the specified remote monitor as selected.

Updating Data Between Monitors The UPDATE DATA key is used to synchronize calculation data between multiple monitors. For example, if lab data for calculations were entered at the central monitor and stored in the bedside monitor database, using the UPDATE DATA key would provide those values for calculations performed at the bedside.

Calculations

Display Detail Tables for Physiologic calculations occupy the four display zones (six on the UCW and Ultraview 1700) above the message line, allowing display of waveforms on the remaining display zones of the screen. The Drug Dosage calculations table has a different format, but occupies the same four lower display zones.

í˘ą í˘˛

í˘ł

í˘´ í˘ľ Figure 20-1: Clinical Calculations Table (on UCW or Ultraview 1700)

í˘ą The top line of the table shows the type of calculations performed, the bed name, and the patient name.

í˘˛ A day/time key is displayed at the top of each data column. Each day/time key indicates the day, hour, and minute. The hours can be in either 12-hour or 24-hour format, depending on the system setup. When you use the 12-hour format, A or P are displayed to indicate either a.m. or p.m.

í˘ł Calculation inputs are listed on the top of the table. Output from the calculations are listed under the dividing line at the bottom of the table. Eight columns of data can display on the screen at once, each column appears under the key which corresponds to the day and time at which the data was collected. New data values are entered to the right of existing ones. If the table is full, older entries are shifted left one column. Data columns that do not display remain in memory. A highlighted key indicates a selected column.

í˘´ This menu is displayed for all physiologic calculations tables. All keys appear dithered or dotted (disabled) except for NEW ENTRY and PRINT until at least one record (data column) is displayed in the table.

í˘ľ The RESIZE WINDOW key (UCW and Ultraview 1700 only) changes the window size from 1 to 8 columns for Physiologic calculations and from 1 to 4 columns for Drug Dose calculations.

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Ultraview Care Network

Scrolling and Paging To view calcs data: 1 Touch CALCS. 2 Select a calcs key. 3a Toggle the PAGE/SCROLL key to SCROLL. 3b Use the → or ← keys to move data by one column. or 4a Toggle the PAGE/SCROLL key to PAGE. 4b Use the → or ← keys to move data by eight columns. or 5 Touch the scroll bar and slide either direction to review older or newer data (UCW and Ultraview 1700 only). To create a new entry: 1 2 3

4 5 6 7 8

Access Local or Remote Calcs. Touch NEW ENTRY. Touch EDIT INPUTS to input new data not available in the system. Select an input key. Use the pop-up keypad to input the value. Touch ENTER on the pop-up keypad. Touch PREVIOUS MENU. Touch STORE ENTRY to retain entry in Calcs table.

Toggle the PAGE/SCROLL key to SCROLL and use the left or right arrows to move the Calculations table over one column in the desired direction. Newer records display to the right, older records to the left. Toggle the PAGE/SCROLL key to PAGE and use the left or right arrows to move the calculations table over 8 columns, or one whole page, in the desired direction. Touch the right arrow key to display the next newer page (8 columns) of record. This key does not function when the newest record is displayed in the table. Touch the left arrow key to display the next oldest page (8 columns) of records. The scrolling stops when the oldest record is displayed on the table. The UCW and Ultraview 1700 use a windows scroll bar to display data. Use the bar to move data left or right as desired. The viewed data can also be changed by touching the arrow at the end of the scroll bar.

Creating a New Entry Touch the NEW ENTRY key to create a new record for the current day and time and to add the record to the Calculations table. The new record is positioned immediately to the right of existing records. If all the columns on the screen are filled, the display shifts to the left and the new record is displayed in the far right column. The new record’s DAY/TIME key is highlighted and contains the current day and time. The available input values are displayed in the input column and calculated results appear in the output column. Any unavailable inputs or outputs are displayed as question marks. NEW ENTRY does not function when a total of 200 records exist in all the Physiologic calculations tables for the selected system. If you want to make further entries, you must first delete some of the existing entries from one or more of the calculations tables.

•

Touch NEW ENTRY, then touch STORE ENTRY to store the entry in the database. Entries that have not been stored remain in the table until you select a different bed or patient, then they disappear.

Editing Inputs To edit a record: 1 2 3 4 5 6

Access Local or Remote Calcs. Touch EDIT INPUTS. Select an input value to edit. Use the pop-up keypad to change the input value. Touch ENTER on the pop-up keypad. Touch PREVIOUS MENU, then STORE ENTRY to retain entry in Calcs table.

Each type of calculation displays its own Edit Inputs menu containing the inputs listed in the upper part of the Calcs table. The name of the input and units of measure appear on each EDIT INPUTS key for the Physiologic calculations. Once an input has been edited, the letter e is displayed immediately after the edited value in the table.

•

The displayed units for pressure values, height, and weight may vary based on your monitor's configuration. Contact your system administrator for details.

When you select an input key, the pop-up keypad appears. Refer to Using the Keyboard on page 3-4 for pop-up keypad operating instructions.

20-6

Calculations

If you enter a height and weight in the BSA menu, the system automatically computes a BSA. However, changing the BSA directly invalidates any height or weight previously entered.

â&#x20AC;˘

Changing the height and weight in the BSA menu does not affect the height and weight in the Admit/Discharge menu.

Refer to Table 1: BSA, Height, and Weight Calculations for adult and neonatal BSA, height and weight values for hemodynamics, oxygenation, and renal calculations. Table 1: BSA, Height, and Weight Calculations

Label

Name

Units

Default Value Adult Neonatal

Valid Range

BSA

Body Surface Area

1.81

0.11

0.03 - 3.69

Height

cm in

170 66.9

35 13.8

20 - 215 7.9 - 84.6

Weight

kg lb

70.000 154.324

1.500 3.307

0.2 - 250.0 0.441551.156

Editing Day and Time To create a record for a past time: 1 2 3 4 5 6 7 8

Access Local or Remote Drug Calcs. Touch NEW ENTRY. Highlight the DAY/TIME key on a new or prior entry. Touch EDIT DAY/TIME. Select DAY, HOURS, or MINUTES. Use the pop-up keypad to change. Touch ENTER on the pop-up keypad. Touch PREVIOUS MENU, then STORE ENTRY to retain entry in Calcs table.

To create a Calculations record for a specified day and time, create a new entry and highlight the DAY/TIME key. Then touch EDIT DAY/TIME and enter the day and time for the record you want to create. Touch the DAY, HOUR, or MINUTE keys to highlight that key and display the popup keypad. The selected parameter and value appear in the pop-up keypad. The hour can appear in either 12-hour or 24-hour format. If the system is set for 12-hour format, use the AM/PM key to select a.m. and p.m. on the DAY/TIME key. When editing minutes and hours, you cannot change the value to a future time. When you have entered the day, hour, and minute via the pop-up keypad, the input values and output calculations reflect data available from the system at the entered time. An e appears under any edited DAY/TIME key.

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Ultraview Care Network

Storing an Entry To store an entry: 1 2 3

Access Local or Remote Calcs. Highlight DAY/TIME key of the entry to be stored. Touch STORE ENTRY.

Touching the STORE ENTRY key after touching the DAY/TIME key stores the record of input values and output calculations in the selected monitorâ&#x20AC;&#x2122;s database. Up to 100 stored records may be saved in each system. The letter s is displayed under the DAY/TIME key to indicate that the record has been stored. If you edit a record after it has been stored, the letter s is removed because the newly edited changes have not been stored. Storing a record overwrites the data already stored.

â&#x20AC;˘

Stored records are saved until the system is powered down or until patient data is purged via the Admit/Discharge function.

Deleting an Entry To delete an entry: 1 2 3 4

Access Local or Remote Drug Calcs. Highlight DAY/TIME of the entry to be deleted. Touch DELETE ENTRY. Touch YES.

After selecting a DAY/TIME key, you may delete a record by touching the DELETE ENTRY key. A menu is displayed to confirm the deletion. A record previously stored in the database via the STORE ENTRY key will be deleted from the database, as well as from the table. Automatically displayed records, such as cardiac output data, remain in the database. These records reappear, even if deleted, when you leave and then return to a patient or bed.

Printing To print calcs data: 1 2

Access Local or Remote Drug Calcs. Touch PRINT.

20-8

Touch the PRINT key to print the currently displayed page of the Calculations table. The complete table (4 zones) will print on a 4-channel recorder. On a 2-channel recorder, the top half of the table prints first followed by the bottom half.

Calculations

Hemodynamic Calculations To view current hemodynamic calcs:

Hemodynamic calculations provide significant data describing cardiovascular system performance.

1 2

Cardiac output values from a Cardiac Output (CO) module automatically create records in the Hemodynamic Calculation table.

Touch CALCS. Touch HEMO CALCS.

Table 2: Hemodynamic Inputs

Label

Name

Units

Default Value

Valid Range

Heart Rate

beats/min

0 - 300

MAP

Mean Arterial Pressure

mmHg kPa

80 10.7

-50 - 300 -6.7 - 40.0

CVP

Central Venous Pressure

mmHg kPa

10 1.3

-50 - 99 -6.7 - 15.0

MPA

Mean Pulmonary Artery Pressure

mmHg kPa

15 2.0

-50 - 99 -6.7 - 15.0

PCWP

Pulmonary Capillary Wedge Pressure

mmHg kPa

10 1.3

-50 - 99 -6.7 - 15.0

Cardiac Output

I/min

5.0

0 - 40.0

When you create a new entry, any current values for HR, MAP, CVP, MPA, and PCWP are displayed in the table. The system will enter the current body surface value into the table, if available. The most recent CO value (if less than 15 minutes old) is also put into the table. If the system locates a CO value, then values for MAP, CVP, MPA, or PCWP not currently available are put into the table from the CO record. Any inputs which remain unavailable display question marks. The DAY/TIME key displays the current time. Hemodynamic Calculations require several specific pressure values, including CVP, MAP, and PCWP. CVP and MAP are monitored continuously; PCWP is an episodic value. A data substitution may occur if any of these pressure values are not available when you touch NEW ENTRY. When a substitution occurs, one of the error messages listed here displays on the message line. •

Warning...RAP has been substituted for CVP. A continuous RAP value is used instead of the continuous CVP value if CVP is not available.

•

Warning...NIBP has been substituted for MAP. An episodic mean NIBP value which is less than 15 minutes old is used instead of MAP if the continuous MAP value is not available.

•

Warning...LAP has been substituted for PCWP. A continuous LAP value is used instead of the episodic PCWP value if the PCWP value is not available or is more than 15 minutes old.

20-9

Ultraview Care Network

Table 3: Hemodynamic Output Label

Name

Units

Cardiac Index

L/min/m2

Stroke Volume

ml/beat

SVI

Stroke Volume Index

ml/beat/m2

SVR

Systemic Vascular Resistance

dynes x sec/cm5

SVRI

Systemic Vascular Resistance Index

(dynes x sec/cm5) x m2

PVR

Pulmonary Vascular Resistance

dynes x sec/cm5

PVRI

Pulmonary Vascular Resistance Index

(dynes x sec/cm5) x m2

LVSW

Left Ventricular Stroke Work

g x min/beat

RVSW

Right Ventricular Stroke Work

g x min/beat

LVSWI

Left Ventricular Stroke Work Index

g x min/beat/m2

RVSWI

Right Ventricular Stroke Work Index

g x min/beat/m2

Table 4: Hemodynamic Equations BSA

= Ht 0.725 x Wt 0.425 x 0.007184

= CO/BSA

= (CO/HR) x 1000

SVI

= SV/BSA

SVR

= 79.9 x [(MAP-CVP)/CO]

SVRI

= 79.9 x [(MAP-CVP)/CI] = 79.9 x [(MAP-CVP)]/[CO/BSA] = 79.9 x [(MAP-CVP)]/[CO x 1/BSA] = 79.9 x [(MAP-CVP)/CO] x BSA = SVR x BSA

PVR

= 79.9 x [(MPA-PCWP)/CO]

PVRI

= 79.9 x [(MPA-PCWP)/CI] = 79.9 x [(MPA-PCWP)]/[CO/BSA] = 79.9 x [(MPA-PCWP)]/[CO x 1/BSA] = 79.9 x [(MPA-PCWP)/CO] x BSA = PVR x BSA

LVSW

= 0.0136 x SV x (MAP - PCWP)

RVSW

= 0.0136 x SV x (MPA - CVP)

LVSWI

= LVSW / BSA

RVSWI

= RVSW / BSA

Assumes pressures are measured in mmHg

20-10

Calculations

Respiration Calculations To view current respiration calcs 1 2

Touch CALCS. Touch RESP CALCS.

Respiration calculations describe the performance of the lungs in the ventilation process. Unless you have a ventilator Flexport interface, most input values for Respiration calculations must be manually entered. Table 5: Respiration Inputs

Label

Name

Default Value

Valid Range

Respiration Rate

breaths/ min

0-200

PaCO2

Partial Pressure of Arterial Carbon Dioxide

mmHg kPa

40 5.3

0-150 0-20.0

Tidal Volume

ml/breath

500

0-3000

PIP

Peak Inspiratory Pressure

cmH2O

0-200

PLT

Plateau Pressure

cmH2O

0-200

PEEP

Positive End Expiratory Pressure

cmH2O

0-50

PECO2

Partial Pressure of Expired Carbon Dioxide

mmHg kPa

35 4.7

0-150 0-20.0

Table 6: Respiration Equations

Label

Units

Value

Table 7: Respiration Output

Label

Name

Units

VMIN

= VT x RR/1000

VMIN

Minute Volume

l/min

Cst

= VT/(PLT-PEEP)

Cst

Static Compliance

ml/cmH2O

Cdyn

= VT/(PIP-PEEP)

Cdyn

Dynamic Compliance

ml/cmH2O

= (PaCO2 - PECO2) x (VT/PaCO2)

Dead Space Volume

VD/VT

= VD/VT

VD/VT

Ratio

= (VT - VD) x RR

Dead Space to Tidal Volume Ratio

Alveolar Ventilation

ml/min

20-11

Ultraview Care Network

Oxygenation Calculations To view current oxygenation calcs: 1 2

Touch CALCS. Touch OXY CALCS.

Oxygenation calculations provide specific data describing the efficiency with which the body acquires, circulates, and utilizes oxygen in the cardiopulmonary system. Input values for Oxygenation calculations are automatically obtained from SpO2, SvO2, cardiac output modules, or Flexport interfaces. You must manually enter inputs for laboratory blood analysis values. Table 8: Oxygenation Inputs

Label

20-12

Name

Units

Default Value

Valid Range

FiO2

Fractional Inspired Oxygen

0 - 100

PaO2

Partial Pressure of Arterial Oxygen

mmHg kPa

100 13.3

0 - 500 0 - 70.0

SpO2

Arterial Oxygen Saturation

0 - 100

PaCO2

Partial Pressure of Arterial Carbon Dioxide

mmHg kPa

40 5.3

0 - 150 0 - 20.0

PvO2

Partial Pressure of Mixed Venous Oxygen

mmHg kPa

38 5.1

0 - 99 0 - 15.0

SvO2

Mixed Venous Oxygen Saturation

0 - 99

Hgb

Hemoglobin

g/dl

15.0

0 - 50

Barometric Pressure

mmHg kPa

760 101.3

0 - 1000 0 - 130.0

Cardiac Output

l/min

5.0

0 - 40.0

Calculations

Calculating O2AV, O2AVI, VO2, and VO2I requires a CO value to complete the calculations. The most recent CO value (less than 15 minutes old) is used for these calculations if it is available. Table 9: Oxygenation Output Label

Name

Units

CTaO2

Arterial Oxygen Content

ml/dl

CTvO2

Venous Oxygen Content

ml/dl

avDO2

Arteriovenous Oxygen Content difference

ml/dl

O2AV

Oxygen Availability

ml/min

O2AVI

Oxygen Availability Index

ml/min/m2

VO2

Oxygen Consumption

ml/min

VO2I

Oxygen Consumption Index

ml/min/m2

O2ER

Oxygen Extraction Ratio

None

PAO2

Partial Pressure of Alveolar Oxygen

mmHg kPa

Qs/Qt

Pulmonary Venous Admixture Shunt

P/F

PaO2/FiO2 ratio

None

Table 10: Oxygenation Equations Label

Value

CTaO2

= (1.34 x Hgb x SpO2/100) + (0.0031 x PaO2)

CTvO2

= (1.34 x Hgb x SvO2/100) + (0.0031 x PvO2)

avDO2

= CTaO2 - CTvO2

O2AV

= CTaO2 x CO x 10

O2AVI

= O2AV/BSA

VO2

= avDO2 x CO x 10

VO2I

= VO2/BSA

O2ER

= (CTaO2 - CTvO2)/CTaO2

PAO2

= [(FiO2/100) x (PB*-47)] - PaCO2 /0.8

Qs/Qt

= 100 x [(1.34 x Hgb) + (0.0031 x PAO2) - CTaO2] [(1.34 x Hgb) + (0.0031 x PAO2) - CTvO2]

* PB = Barometric Pressure

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Ultraview Care Network

Renal Calculations To view current renal calcs: 1 2

Touch CALCS. Touch RENAL CALCS.

Renal calculations provide data related to kidney function. Inputs for Renal calculations, other than a previously entered BSA, must be manually entered. The system automatically computes BSA when you enter a height and weight into this menu. Table 11: Renal Inputs

Label

Table 13: Renal Equations Label

Value

Name

Default Value

Units

Valid Range

URK

Urine Potassium

mEq/l

0 - 300

PLOSM

Plasma Osmolality

mOsm/L

290

0 - 999

UROSM

Urine Osmolality

mOsm/L

575

0 - 9999

SerNa

Serum Sodium

mEq/l

140

0 - 999

Serum Creatinine

mg/dl

1.10

0 - 9.99

URNaEX

= URNa x URINE/1000

UCR

Urine Creatinine

mg/dl

50.0

0 - 999.9

URKEX

= URK x URINE/1000

BUN

Blood Urea Nitrogen

mg/dl

0 - 999

Na/K

= URNa/URK

URNa

Urine Sodium

mEq/L

0 - 999

COSM

= (UROSM/PLOSM) x URINE

URINE

Urine Volume

ml/day

2000

0 - 9999

CH2O

= URINE - COSM

U/POSM

= UROSM/PLOSM

FENa

= (URNa/SerNa) x (CR/UCR) x 100

Table 12: Renal Output Label

Name

Units

URNaEX

Urine Sodium Excretion

mEq/day

URKEX

Urine Potassium Excretion

mEq/day

CRCL

= (UCR/CR) x (URINE/1440) x 1.73/BSA

Na/K

Urine Sodium: Potassium Ratio

Ratio

NSLOSS

= URINE - (URINE x UrNa/ SerNa)

COSM

Osmolal Clearance

ml/day

BUN/CR

= BUN/CR

CH2O

Water Clearance

ml/day

U/CR

= UCR/CR

U/POSM

Urine: Plasma Osmolality Ratio

Ratio

FENa

Fractional Sodium Excretion

CRCL

Creatinine Clearance

ml/min/m2

NSLOSS

Non-Saline Loss

ml/day

BUN/CR

BUN: Creatinine Ratio

Ratio

U/CR

Urine: Serum Creatinine Ratio

Ratio

20-14

Calculations

Drug Dosage Calculations Drug Dosage Equations CONC

= Amount/Volume

RATE

= Dose/Conc

DOSE

= Rate x Conc

TOTAL VOL

= Rate x Duration

TOTAL DOSE

= Dose x Duration

When you select Drug Dosage Calculations, Table 14: Adult/Neonatal Drug Calculations Display is displayed along with the Drug Dosage Calculations menu. Select the DRUG A - D keys (A - F keys for Ultraview Portable, 1500, and 1600 monitors), as you selected the DAY/TIME keys in other Calculations tables. When you begin Drug Dosage Calculations, the patient’s currently stored weight (automatically converted to kilograms) appears in the table. Thereafter, selecting a drug key allows you to edit the data in the column below it. The DRUG A - D keys (A - F keys for Ultraview Portable, 1500, and 1600 monitors) do not display actual drug names. However each column’s default values are derived from common admixtures of frequently used drugs. Table 14: Adult/Neonatal Drug Calculations Display

ADULT DRUG CALCS DRUG A

Bed Name: 00001 DRUG B

Patient Name: Doe, Jane DRUG C

DRUG D

AMOUNT

400.00 mg

2.00 g

16.00 mg

50.00 mg

VOLUME

250 ml

CONC

1.60 mg/ml

8.00 mg/ml

64.00 mcg/ml

200.00 mcg/ml

WEIGHT

70.000 kg

DOSE/MIN

500.00 mcg/min

2.00 mg/min

10.00 mcg/min

200.00 mcg/min

DOSE/HR

30.00 mg/hr

120.00 mg/hr

600.00 mcg/hr

12.00 mg/hr

DOSE/WT/MIN

7.14 mcg/kg/min

28.57 mcg/kg/min

0.14 mcg/kg/min

2.86 mcg/kg/min

DOSE/WT/HR

428.57 mcg/kg/hr

1.71 mg/kg/hr

8.57 mcg/kg/hr

171.43 mcg/kg/hr

RATE

18.75 ml/hr

15.00 ml/hr

9.38 ml/hr

60.00 ml/hr

DURATION

1.00 hr

TOTAL DOSE

30.00 mg

120.00 mg

600.00 mcg

12.00 mg

TOTAL VOL

18.75 ml

15.00 ml

9.38 ml

60.00 ml

NEONATAL DRUG CALCS DRUG A MIX

Bed Name: 00002 DRUG B MIX

Patient Name: Doe, Baby DRUG C MIX

DRUG D MIX

AMOUNT

10.00 mg

1.00 mg

2.50 g

3.00 mg

VOLUME

100 ml

CONC

100.00 mcg/ml

10.00 mcg/ml

25.00 mg/ml

30.00 mcg/ml

WEIGHT

1.500 kg

DOSE/MIN

7.50 mcg/min

0.75 mcg/min

83.33 mcg/min

0.75 mcg/min

DOSE/HR

450.00 mcg/hr

45.00 mcg/hr

5.00 mg/hr

45.00 mcg/hr

DOSE/WT/MIN

5.00 mcg/kg/min

0.50 mcg/kg/min

55.56 mcg/kg/min

0.50 mcg/kg/min

DOSE/WT/HR

300.00 mcg/kg/hr

30.00 mcg/kg/hr

3.33 mg/kg/hr

30.00 mcg/kg/hr

RATE

4.50 ml/hr

0.20 ml/hr

1.50 ml/hr

DURATION

1.00 hr

TOTAL DOSE

450.00 mcg

45.00 mcg

5.00 mg

45.00 mcg

TOTAL VOL

4.50 ml

0.20 ml

1.50 ml

20-15

Ultraview Care Network

Entering Drug Dosage Values To access local or remote calcs and drug calcs (Ultraview portable, 1500, and 1600 monitors): 1 Touch SPECIAL FUNCTIONS. 2a Select LOCAL or REMOTE TRENDS/CALCS. 2b If you selected REMOTE TRENDS/CALCS, select a bed. 3 Touch CALCS. 4 Touch DRUG CALCS (Ultraview Portable and 1500 only). 5 Select DRUG A, B, C, or D.

From the Drug Dosage menu you may edit the inputs, store up to 4 drug records, display two titration tables for each of these drug records, and print any of the displayed information. You may enter drug values for adults or neonates, depending on the current patient type selection (refer to Selecting Patient Type and Gender on page 3-8 for more information). If NEONATE was selected the MIX/TITRATE key is displayed. The MIX/TITRATE key toggles to highlight either MIX or TITRATE and affects how calculations are performed when the DOSE is edited. While WEIGHT is the only drug dosage input automatically entered by the system, default values are present when you first display the table. You can edit any value by manually entering a new value. Weight must be entered in kilograms. Table 15: Drug Dosage Calculations

To access local or remote drug calcs (UCW and Ultraview 1700 monitors): 1 Touch SPECIAL FUNCTIONS. 2 Touch DRUG CALCS. 3a Select LOCAL BED (bedside only) or REMOTE BED. 3b If you selected REMOTE BED, select a bed. 4 Select DRUG A, B, C, or D. To enter a drug dose value: 1 2 3 4 5

Access Local or Remote Drug Calcs. Touch EDIT INPUTS. Select the desired key. Use pop-up keypad to change value. Touch ENTER on the pop-up keypad.

To store a drug calcs entry: 1 2 3

Access Local or Remote Drug Calcs. Highlight DRUG X key. Touch STORE ENTRY.

Label

Name

Valid Range

Possible Units of Measure

AMT

Amount

0.019999.99

mcg, mg, g, mEq, units, k units, m units

VOL

Volume

1-9999

CONC

Concentration

0.019999.99

mcg/ml, mg/ml, g/ml, mEq/ml, units/ml, k units/ml, m units/ml

WEIGHT

Weight

0.2-250.0

DOSE/MIN & DOSE/HR

Dose/Time

0.019999.99

* mcg/xx, mg/xx, g/xx, mEq/xx, units/xx, k units/xx, m units/xx

DOSE/WT/MIN & DOSE/WT/HR

Dose/Weight/ Time

0.019999.99

* mcg/kg/xx, mg/kg/xx, g/kg/xx, mEq/kg/xx, units/kg/xx, k units/kg/xx, m units/kg/xx

RATE

Flow Rates

0.1-999.99

ml/hr

DUR

Duration

0.1-999.99

TOTAL DOSE

Total Dose

0.01-9999.9

mcg, mg, g, mEq, units, k units, m units

TOTAL VOL

Total Volume

0.1-9999.99

* where xx is minutes or hours To begin editing input values, touch a DRUG key (A through D for Ultraview 1700 and UCW, A through F for Ultraview Portable, 1500, and 1600 monitors). Touch EDIT INPUTS to display the Edit Inputs menu. Touch any input key on the Edit Inputs menu, except UNITS and DOSE (described later), to display the pop-up keypad. During editing, the menu prompt shows the minimum and maximum values you can enter. Touch ENTER in the pop-up keypad to update the Drug Dosage table.

20-16

Calculations

Changing Units of Measure To change drug units: 1 2 3 4

Access Local or Remote Drug Calcs. Touch EDIT INPUTS. Touch UNITS. Select units to change.

Units of measurement are displayed on the table to the right of the data values. Changing the selected units for AMOUNT may also change the displayed units for CONC. Changing the selected units for DOSE may also change the displayed units for DOSE/WT and TOTAL DOSE. If the values for CONC, DOSE/HR, DOSE/WT/HR, and TOTAL DOSE exceed the range of their currently selected units, that value is divided by 1000 and the units change accordingly. For example, if the value for TOTAL DOSE is 123,456 mg, it will be displayed as 123.46 g. This value is rounded because only two digits can be displayed to the right of the decimal point. WEIGHT is displayed in kilograms (kg), regardless of the systemâ&#x20AC;&#x2122;s setting for weight. Weights in pounds automatically convert to kilograms prior to being displayed. Units Submenu This menu allows you to choose one of three types of units (grams, mEq, and units) for AMOUNT or DOSE. Changing the units for AMOUNT may change the units for CONC. Changing the unit type for AMOUNT changes the unit type for DOSE. Either may scale the values and units for CONC, DOSE, DOSE/WT, and TOTAL DOSE up or down for values less than 0.01 or greater than 9999.99. Changing the units for DOSE may change the units for DOSE/WT and TOTAL DOSE. As a result, both the minute and hour values for DOSE and DOSE/WT may change. Dose Submenu When you select DOSE in the Edit Inputs menu, 4 dose type keys are displayed. Select any of these keys to edit the corresponding value shown in the Drug Dosage Calculations table. The system automatically calculates and displays the changes for the other 3 dose types in the Drug Dosage Calculations table. The dose type selected for a specific drug defines the dose unit used for that drugâ&#x20AC;&#x2122;s titration tables. When you store a Drug Calculation record, the dose type is also stored.

20-17

Ultraview Care Network

Storing a Record To store a drug dose entry: 1 2

Access Local or Remote Drug Calcs. Touch STORE ENTRY.

Touch STORE ENTRY to store the record and to display the letter s under the associated DRUG key. You can store 4 records, one for each DRUG key. If you edit a record that has been stored, the system removes the letter s because the newly edited changes have not been stored.

Displaying Titration Tables To display titration tables: 1 2

Access Local or Remote Drug Calcs. Touch TITRATION TABLE.

To vary based on rate/dose: 1 2 3

Access Local or Remote Drug Calcs. Touch TITRATION TABLE. Touch VARY RATE/DOSE.

The VARY RATE/DOSE toggle key and DOSE TYPE keys are displayed when you touch TITRATION TABLE. VARY RATE varies the rate (holding the concentration constant) and calculates (titrates) the corresponding dose using the selected dose unit type. VARY DOSE varies the dose (holding the drug concentration constant) and calculates (titrates) the corresponding delivery rate in ml/hr. The DOSE TYPE key displays the DOSE TYPE menu where the dose values are displayed and the Titration table is updated with the selected dose type. This key is disabled whenever VARY RATE is selected, and enabled when VARY DOSE is selected. In the titration tables, flow rate and dose are calculated using the equations below.

FLOW RATE in ml/hr

DOSE x 60 min/1 hr AMOUNT/VOLUME

DOSE in xx/min

FLOW RATE x AMOUNT x 1hr/60 min VOLUME

Figure 20-2: Titration Table (UCW or Ultraview 1700) displays a sample Vary Rate Titration table. The amount and volume is displayed at the top of the table along with the dose and rate units. The units for amount and dose are the same units used in the Drug Dosage table. The drug (A, B, C, or F) and patient weight are displayed at the top of the table. Dosages can vary between 0.01 and 9999.99 mg/min, and rates can vary between 0.1 and 999.99 ml/hr. The patient type (ADULT or NEONATE) is displayed in the upper left corner of the table.

CAUTION: â&#x20AC;˘ If any value in the Drug Calculation table is over its designated range, ++++.++ will be displayed for values of AMOUNT, CONC or DOSE, or RATE and the Titration Table becomes inaccessible.

20-18

Calculations

Adjusting the Table Range Use the SCROLL and PAGE keys in the Titration Table menu to select the range of data displayed in the titration table. The default range is 1-100.

Figure 20-2: Titration Table (UCW or Ultraview 1700)

Printing the Drug Dosage Table o print the drug dosage table: Access Local or Remote Drug Calcs. Touch PRINT.

You can print the currently displayed Drug Dosage table. The complete table (4 zones) prints on a 4-channel recorder. On a 2-channel recorder, the upper 2 zones print first followed by the lower 2 zones.

20-19

Ultraview Care Network

Recalculations You can recalculate all Drug Dosage inputs except for the amount/hour entries shown for DOSE and DOSE/WT. In most cases, changing one parameter automatically recalculates and redisplays other parameters under that DRUG key. The table below shows adult patient recalculations rules, except where noted in AMOUNT and VOLUME. When TITRATE on the MIX/TITRATE key is selected, DOSE, DOSE/WEIGHT, and FLOW RATE results are the same for Adult and Neonatal. Edit AMOUNT

VOLUME

Holds VOLUME constant

Results Calculates CONC

Holds DOSE (dose/min) constant

Calculates FLOW RATE (ADULT only)

Holds DUR constant

Calculates TOTAL VOL (ADULT only)

Holds DOSE constant

Calculates FLOW RATE

Holds DUR constant

Calculates TOTAL DOSE (NEONATAL only)

Holds AMOUNT constant

Calculates CONC

Holds DOSE/MIN constant

Calculates FLOW RATE (ADULT only)

Holds DUR constant

Calculates TOTAL VOL (ADULT only)

Holds DOSE constant

Calculates FLOW RATE

Holds DUR constant

Calculates TOTAL DOSE and VOL (NEONATAL)

Holds VOLUME constant

Calculates AMOUNT

Holds DOSE/MIN constant

Calculates FLOW RATE

Holds DUR constant

Calculates TOTAL VOL

Holds DOSE/MIN constant

Calculates DOSE/WEIGHT/MIN

Holds DOSE/HR constant

Calculates DOSE/WEIGHT/HR

DOSE or

Holds WEIGHT constant

Calculates other 3 DOSE and DOSE/WEIGHTS

DOSE/WEIGHT

Holds CONC constant

Calculates FLOW RATE

(TITRATE)

Holds DUR constant

Calculates TOTAL DOSE and TOTAL VOL

DOSE or

Holds WEIGHT constant

Calculates other 3 DOSE and DOSE/WEIGHTS

DOSE/WEIGHT

Holds FLOW RATE constant

Calculates CONC

(MIX)

Holds VOLUME constant

Calculates AMOUNT

Holds DUR constant

Calculates TOTAL DOSE

FLOW RATE

Holds CONC constant

Calculates DOSE/MIN and DOSE/HR

Holds WEIGHT constant

Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR

Holds DUR constant

Calculates TOTAL VOL

CONC

WEIGHT

(TITRATE)

FLOW RATE

Holds DOSE/HR constant

Calculates CONC

(MIX)

Holds VOLUME constant

Calculates AMOUNT

Holds DUR constant

Calculates TOTAL DOSE and TOTAL VOL

DUR

Holds DOSE/MIN constant

Calculates TOTAL DOSE

Holds FLOW RATE constant

Calculates TOTAL VOL

TOTAL DOSE

Holds CONC constant

Calculates FLOW RATE

TOTAL VOL

20-20

Constants

Holds DUR constant

Calculates DOSE/MIN, DOSE/HR, and TOTAL VOL

Holds WEIGHT constant

Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR

Holds DUR constant

Calculates FLOW RATE

Holds CONC constant

Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR

Holds WEIGHT constant

Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR

Calculations

Using the Drug Name List To use the list of drug names: 1.

Touch the DRUG key in the Drug Calcs Edit Inputs menu.

Figure 20-3: Edit Inputs Menu The DRUG NAME LIST dialog box appears, enabling you to choose from the master drug list.

Figure 20-4: Drug Name List Dialog Box 2.

Select the appropriate drug name and then touch ACCEPT. The drug name and stored default values are transferred into the currently selected drug (A, B, C, or D). Select CANCEL to remove the selection dialog box without changing the current settings for the drug. Drug calcs will display the selected drug name.

20-21

Ultraview Care Network

Figure 20-5: Drug Calcs Display

20-22

â&#x20AC;˘

The drug default values for drugs A, B, C, and D can be overwritten and not affect the master drug list entry. However, selecting another drug name for drug A, B, C, or D will override all previously-edited values and will insert the master default settings. Ensure that the changes are effected after selecting the drug name (and not before).

Table 16: Hemodynamic Calculations Variable

Table 18: Oxygenation Calculations

Calculation

Normal Range*

Cardiac Index (CI)

CO BSA

2.5 - 4.0 liters/min/m2

Stroke Volume (SV)

CO x 1000 HR

60 - 130 ml/beat

Stroke Volume Index (SVI)

SV BSA

30 - 65 ml/beat/m2

Systemic Vascular Resistance (SVR)

MAP - CVP x 79.9 CO

900 - 1400 dynes x sec/cm5

Systemic Vascular Resistance Index (SVRI)

MAP - CVP x 79.9 CI

1760 - 2600 (dynes x sec/cm5) x m2

(Converts to SVR x BSA)

Variable

Normal Range*

Calculation

Arterial Oxygen Saturation (SaO2)

Laboratory Measurement (SaO2) or Pulse Oximetry (SpO2)

95 - 100%

Partial Pressure of Arterial Oxygen (PaO2)

Laboratory Measurement

80 - 100 mmHg

Mixed Venous Oxygen Saturation (SvO2)

Laboratory Measurement or Monitored Value

60 - 80%

Partial Pressure of Mixed Venous Oxygen (PvO2)

Laboratory Measurement

35 - 45 mmHg

Oxygen Availability (O2AV)

CTaO2 x CO x 10

900 - 1100 ml/min

Pulmonary Vascular Resistance (PVR)

MPA - PCWP x 79.9 CO

20 - 130 dynes x sec/cm5

Oxygen Availability Index (O2AVI)

O2AV/BSA

497 - 608 ml/min/m2

Pulmonary Vascular Resistance Index (PVRI)

MPA - PCWP x 79.9 CI

36 - 235 (dynes x sec/cm5) x m2

Arterial Oxygen Content (CTaO2)

(1.34 x Hgb x SaO2/100) + (PaO2 x 0.0031)

18 - 20 ml/dl

Mixed Venous Oxygen Content (CTvO2)

(1.34 x Hgb x SvO2/100) + (PvO2 x 0.0031)

14 - 16 ml/dl

Arterial/Venous Oxygen Difference (avDO2)

CTaO2 - CTvO2

3 - 5.5 ml/dl

Oxygen Consumption (VO2)

avDO2 x CO x 10

200 - 300 ml/min

Oxygen Consumption Index (VO2I)

VO2/BSA

110 - 166 ml/min/m2

Oxygen Extraction Ratio (O2ER)

VO2/O2AV (Simplifies to avDO2/CTaO2)

1/4 or 0.25

Partial Pressure of Alveolar Oxygen (PAO2)

[(FiO2/100) x (PB - 47)] - PaCO2/0.8

100 mm Hg

Pulmonary Venous Admixture Shunt (Qs/Qt)

100 x[ (1.34 x Hgb) + (0.0031 x PAO2) - CTaO2)]

Variable, depending on FiO2

PaO2/FiO2 Ratio (P/F)

PaO2/FiO2

(Converts to PVR x BSA) Left Ventricular Stroke Work (LVSW)

(MAP - PCWP) x SV x 0.0136

Left Ventricular Stroke Work Index (LVSWI)

(MAP - PCWP) x SVI x 0.0136

Right Ventricular Stroke Work (RSVW)

(MPA - CVP) x SV x 0.0136

Right Ventricular Stroke Work Index (RVSWI))

(MPA - CVP) x SVI x 0.0136

(Converts to LVSW/BSA)

(Converts to RVSW/BSA)

45 - 75 g x min/m2/beat

4-8gx min/m2/beat

(HR = Heart Rate; BSA = Body Surface Area; MAP = Mean Arterial Pulse; CVP = Central Venous Pressure; MPA = Mean Pulmonary Artery Pressure; PCWP = Pulmonary Capillary Wedge Pressure)

Table 17: Renal Calculations Variable Urine Potassium (URK)

Acquisition Method or Calculation Laboratory Measurement

(1.34 x Hgb) + (0.0031 x PAO2) - CTvO2

Units Variable, depending on FiO2

mEq/L

Plasma Osmolality (PLOSM)

Laboratory Measurement

mOsm/L

Urine Osmolality (UROSM)

Laboratory Measurement

mOsm/L

Serum Sodium (SerNa)

Laboratory Measurement

mEq/L

Serum Creatinine (CR)

Laboratory Measurement

mg/dl

Urine Creatinine (UCR)

Laboratory Measurement

mg/dl

(Hgb = Hemoglobin; PB = Barometric Pressure)

Table 19: Respiration Calculations Variable

Calculation

Units

Blood Urea Nitrogen (BUN)

Laboratory Measurement

mg/dl

Respiratory Rate (RR)

Monitored Value or Ventilator

breaths/min

Urine Sodium (URNa)

Laboratory Measurement

mEq/L

Laboratory Measurement

mmHg

Urine Volume (URINE)

Data Entry

ml/day

Partial Pressure of Arterial Carbon Dioxide (PaCO2)

Urine Sodium Excretion (URNaEX)

URNa x URINE/1000

mEq/day

Tidal Volume (VT)

Ventilator

ml/breath

Peak Inspiratory Pressure (PIP)

Ventilator

cmH2O

Plateau Pressure (PLT)

Ventilator

cmH2O

Urine Potassium Excretion (URKEX)

URK x URINE/1000

mEq/day

Urine Sodium to Urine Potassium Ratio (Na/K)

URNa/URK

(ratio)

Osmolar Clearance (COSM)

(UROSM/PLOSM) x URINE

ml/day

Water Clearance (CH2O)

URINE - COSM

ml/day

Urine Osmolality to Plasma Osmolality Ratio (U/POSM)

UROSM/PLOSM

(ratio)

Fractional Sodium Excretion (FENa)

(URNa/SerNa) x (CR/UCR) x 100

Creatinine Clearance (CRCL)

(UCR/CR) x URINE/1440) x 1.73/BSA

Non-Saline Loss (NSLOSS)

URINE - (URINE x URNa/SerNa)

Positive End Expiratory Pressure (PEEP)

Ventilator

cmH2O

Partial Pressure of Expired Carbon Dioxide (PECO2)

Data Entry

mmHg

Minute Volume (VMIN)

VT x RR/1000

L/min

Static Compliance (Cst)

VT/(PLT - PEEP)

ml/cmH2O

Dynamic Compliance (Cdyn)

VT/(PIP - PEEP)

ml/cmH2O

ml/min/m2

Dead Space Volume (VD)

(PaCO2 - PECO2) x (VT/PaCO2)

ml/day

Dead Space to Tidal Volume Ratio (VD/VT)

VD/VT

(ratio)

Alveolar Ventilation (VA)

(VT - VD) x RR

ml/min

BUN to Creatinine Ratio (BUN/CR)

BUN/CR

(ratio)

Urine Creatinine to Serum Creatinine Ratio (U/CR)

UCR/CR

(ratio)

Note: The values listed here represent commonly published ranges for adults and are for reference purposes only.

Note: Acceptable values for individual patients should be determined by hospital protocol and the attending physician.

Trends

Directory of Keys Ultraview Portable/1500/1600 Monitors SPECIAL FUNCTIONS

SPECIAL FUNCTIONS REMOTE VIEW

ALARM WATCH

RV/AW OFF

LOCAL TRENDS/CALCS

REMOTE TRENDS/CALCS

REMOTE TRENDS Select Bed MORE

These keys are not displayed when Trends option is not installed.

GRAPHIC TRENDS

TABULAR TRENDS

This key is not displayed when the Calculations option is not installed.

CALCS

TABULAR TRENDS for local bed X TIME INTERVAL

PAGE SCROLL

GRAPHIC TRENDS

1.5 HR

3 HR

CHANGE TIME INTERVAL 1 MIN

5 MIN

10 MIN

15 MIN

30 MIN

1 HR

GRAPHIC TRENDS TIME BASE

SIZE

TOP GRAPH

BOTTOM GRAPH

CURSOR

RESP RR

TABULAR TRENDS

Refer to Printing the Trend Display in this chapter

TREND PARAMETERS ECG HR

EXPAND ON OFF

ART

TEMP

Note: Keys are labeled according to parameters currently being trended CHANGE SIZE RESP RR

ECG HR

ECG ABN

Note: Keys are labeled according to parameters currently being trended CHANGE TIME BASE 2 HRS

6 HRS

•

12 HRS

24 HRS

Based on features purchased, more or fewer keys may appear here than on your menu screens.

21-1

Trends

Directory of Keys - UCW and Ultraview 1700

LOCAL BED

This key is dithered in central mode

This key is dithered when the remote option is not installed

REMOTE BED

Select a bed

Graphic Trends Remote Bed Selection

NICU

ICU

BED01 BED01

BED02

MICU

BED03

CCU

BED04

BED05

BED06

BED07

GRAPHIC TRENDS TIME BASE

TOP GRAPH

SIZE

BOTTOM GRAPH

CURSOR

EXPAND ON OFF

TABULAR TRENDS

TREND PARAMETERS ECG HR

RESP RR

ART

Note: Keys are labeled according to parameters currently being trended

TEMP

Refer to Printing the Trend Display in this chapter

CHANGE SIZE RESP RR

ECG HR

ECG ABN

Note: Keys are labeled according to parameters currently being trended CHANGE TIME BASE 2 HRS

! 21-2

6 HRS

â&#x20AC;˘

12 HRS

24 HRS

Based on features purchased, more or fewer keys may appear here than on your menu screens.

Tabular Trends

Directory of Keys - UCW and Ultraview 1700

This key is dithered in central mode

LOCAL BED

REMOTE BED

This key is dithered when the remote option is not installed

Select a bed

Tabular Trends Remote Bed Selection

NICU

ICU

BED01 BED01

BED02

MICU

BED03

CCU

BED04

BED05

BED06

BED07

TABULAR TRENDS TIME INTERVAL

PAGE SCROLL

GRAPHIC TRENDS

RESIZE WINDOW

Refer to Printing the Trend Display in this chapter

RESIZE WINDOW - Select a menu key to adjust table size DEFAULT SIZE

MINIMUM SIZE

1.5 HR

3 HR

REDUCE SIZE

ENLARGE SIZE

CHANGE TIME INTERVAL 1 MIN

5 MIN

•

10 MIN

15 MIN

30 MIN

1 HR

Based on features purchased, more or fewer keys may appear here than on your menu screens.

21-3

Trends

Overview To display a trend: 1 Touch SPECIAL FUNCTIONS. 2a Select LOCAL TRENDS/ CALCS or REMOTE TRENDS/ CALCS. 2b If you touched REMOTE TRENDS/CALCS, select a bed. 3a Touch GRAPHIC TRENDS. or 3b Touch TABULAR TRENDS. (Follow these three steps to start each quickstart in this chapter for Ultraview Portable, 1500, and 1600 operation.) To display a trend (for UCW and Ultraview 1700 monitors): 1 Touch SPECIAL FUNCTIONS. 2a Touch GRAPHIC TRENDS. or 2b Touch TABULAR TRENDS. 3a Select LOCAL BED or REMOTE BED. 3b If you touched REMOTE BED, select a bed. (Follow these three steps to start each quickstart in this chapter for UCW and Ultraview 1700 operation.)

21-4

Trends are a convenient way of displaying numeric data that has been collected for a patient over the last 24 hours. Your monitor can display a graphic trend or tabular trend (depending on the option purchased) of collected numeric data for every parameter except delta temperature and EEG. This data appears in a table format similar to common flowsheets or spreadsheets. Graphic trends can appear in three formats. • •

•

Continuous trends represent parameters with continuous monitoring. A solid line connects trend points. Episodic trends represent parameters that produce individual events. Episodic values are displayed as an x, +, or 0. A dotted line connects each episode. Histogram trends are displayed as vertical bars starting at a base of zero.

The system collects trend values every minute and episodic trend values as they become available. Up to the last 24 hours of collected data in memory is displayed and the system saves trend values for as long as memory limitations allow. In most cases, an episodic trend contains at least 30 values.

•

When you suspend alarms with the TONE RESET/ALM SUSPEND key the system may not collect trend data. Contact your system administrator to enable this function.

Trends

Display Detail Graphic Trend Display í˘˛

í˘ł

í˘´

Bed: S114 Patient: Smith, A.

Date: 01 Sep 2001

300

í˘ľ Values at

Time: 08:27

í˘ą

m k p m H a g

Left axis: ART (mmHg) SYS = 136 MEAN = (96) DIA = 74

-6

-5

-4

-3

-2

-1

í˘ś

0 hr

200

í˘ˇ í˘¸

ě?&#x2026; 0

8:30a

9:30a

10:30a

11:30a

12:30a

0 1:30p

Left axis: ECG HR = 128 Right axis: ABN = 10

í˘š

Figure 21-1: Graphic Trends Display

í˘ą trend unit of measure (unit labels are not displayed for parameters with one acknowledged unit of measure for example, ECG, RESP, and CO.)

í˘˛ scale value - use SIZE key to select í˘ł bed and patient identification í˘´ cursor í˘ľ data values for top graph* í˘ś upper trend time axis í˘ˇ right axis for bottom graph í˘¸ data values for bottom graph* í˘š lower trend time axis ě?&#x2026; left axis for bottom graph * When the cursor is displayed, data values reflect those at the cursor location, and the Values at label is displayed. When the cursor is not displayed, data values reflect current values, and the Current Values label is displayed. The system maintains settings for trend displays (time base, parameters, size, etc.) until you change them or display a new patientâ&#x20AC;&#x2122;s trend. The messages â&#x20AC;&#x153;No trends available for this bedâ&#x20AC;? or â&#x20AC;&#x153;Trend data not availableâ&#x20AC;? appear when trend data has yet to be accumulated for the selected bed.

21-5

Ultraview Care Network

Tabular Trends Display You can view a tabular trend of continuous patient data and episodic patient data acquired within the last 24 hours by touching the TABULAR TRENDS key.

í˘ą Bed: 220 Time HR(ECG) ABN RR(RESP ART/s MAP ART/d

í˘ˇ

í˘˛ Patient: b/min b/min br/min mmHg mmHg mmHg

SMITH, 05:30 70 0 8 165 136 108

í˘ś

í˘ł JOHN 06:00 75 0 14 137 136 80

06:30 82 0 9 165 136 108

07:00 67 0 9 165 136 108

í˘´ 07:30 76 0 8 165 136 108

Date: 18 SEP 2000 08:00 08:30 85 72 0 0 8 14 165 137 136 108 108 80

CURRENT 09:00 77 0 14 138 109 81

í˘ľ Figure 21-2: Tabular Trends Display

í˘ą bed identification í˘˛ patient name í˘ł times that data was collected í˘´ date of tabular trend í˘ľ trended data í˘ś unit of measure for each parameter í˘ˇ list of parameters Parameters always appear in descending order of priority. Data that is monitored on a continuous basis always precedes episodic data. Episodic values are presented according to the sequence in which they were originally stored. Data older than 24 hours is not displayed. Calculations data does not appear in tabular trends.

Printing the Trend Display To print the trend display: 1 2

21-6

Adjust trend display as desired. Touch PRINT.

You can print a copy of the displayed graphic trend or tabular trend at any time.

â&#x20AC;˘

When using a 2-channel printer, the top and bottom half of the trend display print consecutively.

Trends

Graphic Trends Features Selecting Trend Parameters To select a parameter for the top or bottom graph: 1 2

Select TOP GRAPH or BOTTOM GRAPH. Select desired parameter.

The first time you display a patient’s graphic trend, the highest priority parameter is displayed on the bottom trend graph and the next highest priority parameter is displayed on the top graph. You can view other trends by selecting them from the Trend Parameter menu.

Using the Cursor To move the cursor: 1

Touch cursor keys as needed.

The graphic trends cursor is a solid, vertical line that moves across the entire trend graph (refer to Figure 21-1: Graphic Trends Display). The home position of the cursor is at the extreme right end of the graph. Once the cursor moves from its home position, the CURRENT VALUES label changes to reflect the cursor’s current position. The CURRENT VALUES label now displays VALUES at and the time. These values represent the data acquired from the patient.

•

The trend graph continues to update EXCEPT when the cursor is moved from its home position. It updates again when the cursor returns to its home position.

•

When switching between Graphic Trends and Tabular Trends, the cursor remains in the same position. For example, if the cursor is placed on data two hours previous to the current time in Graphic Trends, when moving directly to Tabular Trends, the screen will display the same time frame, and the corresponding data column will be highlighted.

Selecting a Time Base To set a trend graph time base: 1 2

Touch TIME BASE. Select 2, 6, 12, or 24 HRS.

The time base for each trend graph can be set for 2-, 6-, 12-, or 24-hours. The displayed resolution for each time base is: 2 hours

= 1 minute

6 hours

= 1 minute

12 hours

= 2 minutes

24 hours

= 4 minutes

Selecting a Scale Size To adjust the scale size: 1 2 3

Touch SIZE. Select desired parameter key. Use arrow keys to adjust.

You can adjust the scale for each parameter. Initially, the system selects a scale that includes all monitored values for the displayed parameter. You may adjust the scales using the arrow keys.

21-7

Ultraview Care Network

Expanding the Trend Display To expand the trend display: 1

Touch either CURSOR key to move the cursor to the desired location. Select EXPAND ON.

You may expand the trend display to include only an hour’s worth of information. With EXPAND ON, the TIME BASE key does not operate and updating of the trend graph is suspended on the graph as it is currently displayed. When EXPAND is OFF, the trend graph returns to its original display. Moving the cursor while EXPAND is ON does not change the cursor’s position in the OFF mode.

Tabular Trends Features Setting a Time Interval To set a time interval 1 2

Touch TIME INTERVAL. Select the desired time interval.

You can display acquired data at various time intervals: 1-, 5-, 10-, 15-, and 30-minutes; and 1-, 1.5-, and 3-hours. For continuous data, the value displayed in the tabular trend table is the value taken at the displayed time. It is not an average of all readings taken during that time period. When more than one episodic reading occurs in the same time interval, only the most recent value is displayed. Asterisks to the right of the episodic value indicates that more data entries are available for that time interval. The trend table automatically updates at the end of each time interval. This shifts all data columns to the left to include the new interval.

•

Updating is suspended when you review data while paging or scrolling.

Viewing Off-Screen Information To view additional parameters and data (for Tabular Trends): 1 2

Select PAGE or SCROLL. Use the ↑ and ↓ arrow keys to move parameter rows up or down.

To view additional parameters and data (from a different time): 1

21-8

Use the PAGE and SCROLL up and down arrow keys to move parameter rows vertically. or Use the PAGE and SCROLL left and right keys to move data columns horizontally.

You can view up to 22 rows and 8 columns (7 columns on Ultraview Portable, 1500, and 1600 monitors) of parameter data on a single screen in a tabular trend. You can view additional parameters by moving rows up or down. When you select PAGE, the arrow keys move the entire page up or down. When you select SCROLL, the arrow keys move the display up or down one parameter row at a time. You can view data collected at other times by moving columns left or right. When you select PAGE, the arrow keys move the display to show an entirely new set of columns. When you select SCROLL, the arrow keys move the display left or right by one column.

Trends Troubleshooting Guide Clinical Situation Current patient data not being added to trends

Possible Cause

Solution

■ If alarms are suspended data may not

■ Turn ON alarms or have your system

be trended at the bedside monitor.

■ EXPAND key ON (trend data will not be lost).

■ Cursor not in home position (trend data will not be lost). PCWP trend not available

Incorrect unit of measure displayed

CALCS data not trending

NO TRENDS AVAILABLE FOR THIS BED message is displayed

Numerous entries with ??? instead of vital signs

administrator enable your system to trend while alarms are suspended.

■ Change EXPAND to OFF. Resume ECG processing.

■ Move the cursor to the extreme right position.

■ PCWP values not saved.

■ Save the PCWP values.

■ Incorrect unit of measure configured

■ Contact your system administrator.

for system.

■ Trends cannot trend CALCS.

■ Use the CALCS menu to display this data.

■ No trend data has yet accumulated for the selected parameter.

■ Alarm Suspend was selected frequently.

■ ECG/Resp processing suspended.

■ Allow sufficient time for data to accumulate.

■ Contact your system administrator to collect data during Alarm Suspend periods.

■ Do not suspend ECG processing unless the patient is off the system.

■ Ensure that ECG/Resp amplitude and signal quality are sufficient.

Remote Keypad

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP TONES

ADMIT/ DISCHARGE

MONITOR CONFIGURATION

PRIVILEGED ACCESS

CLINICAL ACCESS (user name is CLINICAL)

CLINICAL LEVEL: Select Parameter TIME/ DATE

SCALED DISPLAY

RECORDER CONFIGURATION

PRESELECTED RECORDINGS

UNITS OF MEASURE

USER ACCESS ENABLE

ALARM SETUP

CLINICAL Level: Select Parameter REMOTE KEYPAD STATION ADDRESS

CHANGE CLINICAL PASSWORD

RESET MONITOR

SECURED MODE ON

•

OFF

Based on features purchased, more or fewer keys may appear here than on your menu screens.

22-1

Remote Keypad

Contents Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up the Remote Keypad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Selecting a Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Operating Menu Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Recording a Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Programming Access Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Remote Keypad Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Overview The remote keypad system allows you to operate your monitor from up to 20 feet away. Some system functions can be remotely selected, allowing you to suspend or adjust alarms, access graphic trends, adjust waveform size, make recordings, etc. The zoom function enlarges menu keys on the monitor making them easy to read from across the room.

•

Since the UCW and the Ultraview 1700 come equipped with an internal receiver, remote keypad operation is automatically enabled.

Before operating your remote keypad: • • •

ensure that a fresh battery is installed in the remote keypad initialize the system if necessary use the correct access code

Setting Up the Remote Keypad The remote keypad is a cordless, hand-held transmitter powered by an internal battery. It sends your instructions via infrared signals to the monitor’s receiver. The maximum operating range is 20 feet at an angle of up to 45 degrees on either side of the receiver.

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Remote Keypad

The remote keypad provides all of the functions you need to operate your monitor remotely.

HELP MONITOR SETUP SPECIAL FUNCTIONS

Press to move cursor up, down, right, or left within an application

Press to enlarge keys for ease of viewing at a distance Press to change focus among multiple applications, or to place cursor on first menu key (or icon)

Press as necessary to enter a numeric value or to position cursor

Press to delete a previous entry

TONE RESET ALM SUSPEND

ZOOM MENU

ENTER

RECORD

WAVEFORM

PREVIOUS MENU

DEL

NORMAL SCREEN

Press to activate the key highlighted with the cursor or to enter the security code in access mode

Press to place cursor on first parameter key

ACCESS CODE

Figure 22-1: Remote Keypad

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Ultraview Care Network

Selecting a Waveform To select a waveform: 1

Point the remote keypad at the monitor’s receiver. 2 Press WAVEFORM for waveform number 1. 3a Press up or down arrow keys to desired parameter. or 3b Press the number of the desired waveform. 4 Press ENTER.

The remote keypad cursor remains on the screen for approximately one minute following the last keypad activity or until you touch the touchscreen itself. The waveform keys display vertically near the right side of the screen, with waveform number one at the top (except on a split screen central display).

Operating Menu Keys To operate menu keys: 1

Point the remote keypad at the monitor’s receiver. 2 Select a parameter key. 3 Press MENU. 4a Press left or right arrow key to desired position. or 4b Press the number of the desired menu key.

The menu keys display horizontally across the bottom of the screen with menu key number one at the far left. Press the ZOOM key once to activate the zoom feature, making each key easier to see. Press the ZOOM key again to turn OFF the zoom feature.

Recording a Waveform To print data from a waveform zone: 1

Point remote keypad at the monitor’s receiver. 2a Press up or down arrow keys to desired parameter. or 2b Press the number of the desired waveform. 3 Press RECORD. 4 Press ENTER.

22-4

After you activate the RECORD key, you have two seconds to highlight a waveform parameter key. To ensure enough time in making a selection, place the cursor on the waveform key and press the cursor for an additional two seconds, before you press the remote keypad’s RECORD key.

•

When printing several parameters at the same time or when trying to print an event such as a single abnormal beat, it is easier to use keys on the monitor rather than on the remote keypad to direct the recording.

Remote Keypad

Programming Access Codes To select the unsecured mode (UCW and Ultraview 1700): 1 2 3 4 5 6

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch MORE. Touch REMOTE KEYPAD STATION ADDRESS. Select SECURED MODE OFF.

To verify a remote keypad’s current access code: 1 2 3

Point the remote keypad at the monitor’s receiver. Touch ACCESS CODE. Touch ENTER.

To set a remote keypad’s access code: 1 2 3 4 5

Point the remote keypad at the monitor’s receiver. Touch ACCESS CODE. Select first digit. Select second digit. Touch ENTER.

Access codes ensure that the receiver responds only to a remote keypad with a matching code number. If a keypad’s access code differs from the receiver’s, the command is ignored. This prevents interference from other remote keypads. The programmed access code (numbered from 1 to 32) is displayed for approximately 10 seconds on the UCW or Ultraview 1700. This code is stored in system memory and retained whenever the system is reset or powered OFF.

•

Remote keypad systems can be operated in an unsecured mode without access codes so that the receiver accepts commands from any remote keypad. When in the unsecured mode, the word All appears on the monitor's display.

When programming a system’s access code, the keypad’s access code must initially match the receiver’s. The new system access code is programmed simultaneously with the keypad’s. The monitor temporarily displays the remote keypad’s access code, then returns to displaying its own code.

•

To prevent inadvertently changing other access codes, unplug all other monitors during the programming process (or move the remote keypad directly in front of the monitor to be programmed) and place your finger over the remote keypad's infrared window during programming (sufficient signal transmits through your finger to program the receiver).

To set the monitor’s access code (UCW and Ultraview 1700 only): 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch MORE. Touch REMOTE KEYPAD STATION ADDRESS. Select SECURED MODE ON. Use the arrow keys to select the number.

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Remote Keypad Troubleshooting Guide Clinical Situation Monitor accepts commands from any keypad

During programming, another receiver was inadvertently changed

Monitor does not respond

Possible Cause ■ System operating in an unsecured mode.

■ Remote keypad placed too close to another monitor’s receiver.

Solution ■ Select an access code and program both the receiver and the keypad to that code.

■ Move the keypad directly in front of the receiver to be programmed and place your finger over the keypad window during programming.

■ Monitor not initialized.

■ Initialize monitor.

■ Monitor may not support remote

■ Contact your system administrator.

keypad.

Remote Display

Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UCW-ID Rear Panel Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Up the Secondary Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copying Stored Values of the Primary Monitor . . . . . . . . . . . . . . . . . . . . . . . . . Restoring a Stored Value. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Copying Primary Attributes to the Secondary . . . . . . . . . . . . . . . . . . . . . . . . . . Resetting Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tracking or Locking Displays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Adjusting Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 2 2 4 4 4 4 5 6

Overview The UCW and Ultraview 1700 provide an optional output to a remote-configurable secondary display. This secondary display, the 90386 UCW-Independent Display (UCW-ID) with option 1DE, enables you to view selected parameters from the primary display. There is no user interface with the 90386 in this configuration. The primary monitor is used to control the configuration and waveform display characteristics of the secondary remote display. The secondary display has no touchscreen surface or functional keys.

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Ultraview Care Network

UCW-ID Rear Panel Detail The UCW-ID consists of a CPU assembly, an input/output assembly and a power supply. The UCW-ID communicates with a specified monitor on an Ethernet communications network.

red

green

external alarm

blue

RS232

video composite out sync

SCSI

RS422

SDLC

mouse

keyboard IR receiver

Ethernet

power connector with cord retainer

power ON/OFF switch

Figure 23-1: UCW-ID Rear View

Setting Up the Secondary Display To set up the remote display: 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch SECONDARY CONFIGURATION. Touch PARAMETER CONFIGURATION. Select a parameter. Select the destination priority. Select a color. Select the parameter key to be colored (the key and waveform will appear in the chosen color). Touch STORE to store local color and priority settings.

23-2

The Configuration menu for the secondary display appears on the primary monitor. The menu functions identically to the primary monitorâ&#x20AC;&#x2122;s menu although it has three additional keys.

Selecting Colors and Priorities Each parameter has a specific default color and priority. You can change the colors or priority levels of the parameters to customize the monitor to your specific needs. After making any configuration change, touch STORE to make the secondary display changes permanent. If you do not touch STORE, the system disregards your changes.

Remote Display

Figure 23-2: Parameter Configuration Screen

â&#x20AC;˘

Your display may not be configured to allow changes to parameter priorities or colors. Contact your hospital system administrator for details.

The Parameter Configuration screen allows you to change the system default priorities and colors. The current parameter priority and color default is visible from the DISPLAY PRIORITIES toggle key. The LOCAL key displays the current active parameters and the ALL key displays all possible parameters. Each parameter is assigned a display priority, with the highest priority appearing at the top of the screen. Blank parameter keys allow you to force a space above, between, or below other parameters. Blanks can be inserted into any priority template by selecting the blank and putting it into the desired location. This causes a blank zone to be inserted into the corresponding display area and all active parameters with a lower priority to be pushed down. The STORE key stores the current local priority and color settings into non-volatile memory. The RESTORE key restores the last stored local priorities and color settings from memory. The FACTORY DEFAULTS key restores the factory default priority and color settings.

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Ultraview Care Network

Copying Stored Values of the Primary Monitor o copy the stored values of the rimary: Touch MONITOR SETUP. Touch SECONDARY CONFIGURATION. Touch PARAMETER CONFIGURATION. Touch COPY PRIMARY PRIO/COLOR. Touch STORE.

Touch COPY PRIMARY PRIO/COLOR to duplicate the primary display’s stored settings for priorities and colors on the secondary display. Touch STORE to put these changes into effect. You can use the Copy Primary Prio/Color function to remove blank zones resulting from parameters that were deleted while the secondary display was in Lock mode.

Restoring a Stored Value To restore the last stored configuration: 1 2 3 4

Touch MONITOR SETUP. Touch SECONDARY CONFIGURATION. Touch PARAMETER CONFIGURATION. Touch RESTORE.

Touch RESTORE to reset the secondary display’s configuration screen to its last stored changes. Restoring the screen also stops the Copy Primary function (if STORE has not yet been touched).

Copying Primary Attributes to the Secondary To copy the primary monitors configuration: 1 2 3 4

Touch MONITOR SETUP. Touch SECONDARY CONFIGURATION. Touch PARAMETER CONFIGURATION. Touch COPY PRIMARY PARAM ATTR.

Touch COPY PRIMARY PARAM ATTR to copy the primary's current parameter attributes or settings to the secondary display. Parameter colors and priorities are not copied. Use this key to: • • •

remove any blank zones caused by deleting a parameter while the secondary was locked, insert any new parameters added while the secondary was locked, change sizes, sweep speeds, full scales ON/OFF, etc., to match the primary monitor’s configuration.

Resetting Default Values To set factory default values of secondary display: 1 2 3 4 5

23-4

Touch MONITOR SETUP. Touch SECONDARY CONFIGURATION. Touch PARAMETER CONFIGURATION. Touch FACTORY DEFAULTS. Touch STORE.

Touching FACTORY DEFAULTS resets the secondary display to its factory values. Touch STORE to make these changes permanent. Options that can be reset include: • •

Relative priorities and colors to factory default configuration of primary Blanks caused by deleting a parameter while in Lock mode

Pressing this key does not insert any new parameters added while the secondary display was in Lock mode.

Remote Display

Tracking or Locking Displays To lock the secondary display: 1

2 3 4 5

Adjust parameter attributes on primary to reflect how you want the secondary to appear. Touch MONITOR SETUP. Touch SECONDARY CONFIGURATION. Touch PARAMETER CONFIGURATION. Touch LOCK.

In addition to parameter color and priority, you may configure other attributes of the secondary display to be different from the primary monitor. To make additional adjustments to each display separately, select LOCK after you configure the secondary display. This allows the secondary display to remain largely unchanged when you adjust the primary display. If you need the secondary display to duplicate changes to the primary, set the secondary display to TRACK. Refer to the following table (where X = yes) for the effect of Track and Lock on each display characteristic. To make additional changes to the secondary screen after you select LOCK, return to the Secondary Configuration menu and touch TRACK. Table 1: Remote Display Track and Lock Chart

Always independent of primary Colors/priorities

Track mode copies primary

Lock mode copies primary

Lock mode does not copy primary

Waveform size

Sweep speed

Full scales ON/OFF

Screen/waveform attributes

Addition of parameter on primary

Deletion of parameter on primary

Pressure/ECG key labels

Zone size of certain displayed parameters

Full scales 4/6 zones

# of minor graticules

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Ultraview Care Network

Adjusting Scaled Display To adjust the scaled display: 1 2 3 4 5

6 7 8

23-6

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter user name “Clinical” and password. Touch SCALED DISPLAY. Touch PRIMARY/ SECONDARY key to choose display to change. Select MINOR GRATICULE ON. Use arrow keys to adjust. Touch FULL SCALE SIZE to select 4 or 6 zones.

The display of parameters in scales for the secondary display is independent of the primary monitor. Scales are adjusted using the same menu as the primary except when a secondary display is enabled, the PRIMARY/SECONDARY key appears in the menu. This key allows you to choose which display you want to change.

TE Mode

Directory of Keys - UCW and Ultraview 1700 To set up Terminal Emulation (TE) Mode

MONITOR SETUP ADMIT/ DISCHARGE

TONES

PRIVILEGED ACCESS

MONITOR CONFIGURATION

Enter biomed login and password

BIOMED Level - Select Parameter NETWORK CONFIGURATION

TELEMETRY CONFIGURATION

SERIAL PORT CONFIGURATION

MONITOR CALIBRATION

CHANGE BIOMED PASSWORD

CLINICAL MENU

BIOMED Level - Serial Port Configuration ASSIGNMENT

SETTINGS

BIOMED Level - Serial Port - Settings: Changes committed on exit DATA BITS 8

PARITY NONE

STOP BITS 1

ECHO NONE

CR/LF NONE

XON/OFF DISABLE

BAUD RATE 9600

BIOMED Level - Serial Port - Assignment: Changes committed on exit DIAGNOSTICS

TE MODE

DATA LOGGER

To access TE Mode

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

24-1

TE Mode

Overview To set up TE Mode (must have System Administrator menu access): 1 2 3 4 5 6 7

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter biomed login and password. Touch SERIAL PORT CONFIGURATION. Touch ASSIGNMENT. Touch TE MODE. Touch PREVIOUS MENU.

To set serial settings: 8 Touch SETTINGS. 9 Select desired serial settings. 10 Touch NORMAL SCREEN.

24-2

Terminal Emulation (TE) Mode enables bedside and central monitors to be used as remote terminals to other computers, while continuing to display patient information. Your system administrator must first set up communication between the monitor and the external device by assigning a serial port. The TE mode option can be used with any system offering RS232 serial terminal access.

â&#x20AC;˘

Ensure that any cables or other computer or communications equipment connected to the bedside monitor comply with applicable medical standards.

TE Mode

Display Detail Terminal Settings When the serial session is active, press [Alt+S] on the keyboard to activate the Terminal Setting menu. From this menu you may change any settings by typing the option number or letter of the setting and changing its state.

Figure 24-1: Terminal Settings Screen •

• • • • • • • • • • • •

ECHO Mode - Active echo mode. Local echo: Echoes terminal (keyboard) input to the display. Remote echo retransmits computer input back to the sending application. CR/LF Input/Output - Enables Carriage Return/Line Feed Mode on input or output. Column Mode - 80 or 132 columns. Note: 132-column mode is only supported for small font. XOn/XOff - Enables XOn/XOff RS232 communications. Press [Cntrl+S] to stop input scrolling and [Cntrl+Q] to resume input. 7/8 Bit Mode - Emulation type selection (VT100/7 bit, VT220/7 bit, or VT220/8bit). Reverse Video Mode - Reverse video mode (black background or colored background). ANSI/VT52 Mode - ANSI or VT52 mode for VT110 communications. Auto Wrap Mode - Enable auto character wrap mode on end of line. Line Mode - Enable line mode. A carriage return is required for character transmissions. Font Mode - Select Font (small, medium, or large). Number of Rows - 24 or 36 rows of data. (36 mode is only supported for small font). Color Select - Select color (gray, blue, yellow, red, green, purple, white). Keyboard Mapping - Map keyboard sequences to single keys.

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Ultraview Care Network

Keyboard Mapping (VT220) To use keyboard mapping for VT220: 1 2 3 4

Type k from Terminal Settings screen. Touch the key to be remapped. Type the new mapping sequence. Press ENTER on keyboard.

Figure 24-2: VT220 Keymap Application Screen • • • •

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QUIT - Exits the keyboard mapping application. Unsaved changes will be lost. SAVE - Saves the strings associated with all the keys. CANCEL - Cancels the changes not saved and reverts to the previously saved strings. CLEAR - Clears all the strings.

Digital Telemetry

Directory of Keys E C G

ECG - MENU - (Single-Lead) with Arrythmia ON - used with 90339 transmitter type ALARM LIMITS

SIZE

SETUP

LEAD SELECT

SUSPEND PROCESSING

RELEARN

REVIEW

LEAD LABEL

III

BLANK LABEL

MCL6

MCL1

ECG MENU - (Multi-lead) (MultiView™ II option with Arrhythmia and Review On - used with 90340-10/90341 transmitter type) ALARM LIMITS

SETUP

SIZE

LEAD SELECT

CHANNEL FORMAT

SUSPEND PROCESSING

RELEARN

ECG - RELEARN CLEAR MEMORY

ECG - CHANNEL FORMAT 2nd LEAD OFF ON

1st LEAD xx

AUTO LEAD SWITCH

2nd LEAD xx

ECG - SETUP SWEEP SPEED

QRS TONE

MONITOR EXTENDED

PACED YES NO

SAVE MEMORY

SINGLE LEAD ALARM ON

OFF

CONFIG

OFF Bedside monitors only RATE SOURCE

RESTORE SETTINGS

PT RECORD YES NO

•

Select primary heart rate source ECG

ART

SPO2

TM SETUP

Bedside only

ECG - TM SETUP

ECG - CONFIG ARR ADULT ON OFF INFANT

REVIEW

LO BAT ON OFF

SET TM CHAN

Enable alternate rate source(s) ECG ON OFF

ART ON OFF

UA ON OFF

SPO2 ON OFF

Based on features purchased, more or fewer keys may appear here than on your menu screens.

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Digital Telemetry

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Setting Up ECG Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Monitoring Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Selecting Options for Lead Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Assigning a Telemetry Channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Tuning a Receiver Module for a Bedside . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Entering Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Changing the Display Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Acknowledging Signal Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Setting Battery Status Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Controlling Patient-Initiated Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Digital Telemetry Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 ECG Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Overview The digital telemetry receiver module (Model 90478) provides continuous monitoring of electrocardiographic signals to detect abnormal cardiac rhythms, including life-threatening arrhythmias such as asystole, ventricular fibrillation, and ventricular tachycardia. The Model 90478 should be used in conjunction with a Spacelabs Medical telemetry transmitter, an Ultraview Care Network monitor, and a modular receiver housing (Model 90479).

Transmitter The transmitter is a small battery-powered device carried by the patient to continually monitor ECG activity and transmit the information to the telemetry receiver module. • • •

The 90339 transmits a single lead of ECG and requires only three lead wires. The 90341 transmits two leads of ECG and uses up to five lead wires. The 90340-10 transmits four leads of ECG and uses up to five lead wires. However, only two leads may be displayed simultaneously.

Each telemetry channel requires its own transmitter operating at a unique radio frequency. Channel receivers are tuned from the touchscreen on the monitor to receive the available transmitter frequencies.

! 25-2

•

Operation of this equipment may be subject to licensing requirements by your local telecommunications authority. Please check with your Spacelabs Medical customer service representative.

Digital Telemetry

•

Spacelabs telemetry equipment complies with part 15 of the FCC Rules, and with RSS of Industry and Science Canada. Operation of this equipment is subject to: (1) it may not cause harmful interference and (2) it must accept any interference received, including interference that may cause undesired operation.

•

Medical telemetry equipment is only for installation and use in hospitals and health care facilities. It is not permitted for use in vehicles that operate outside of the medical facility premises. The user of this equipment is not authorized to make any changes or alterations that could compromise the national certifications.

•

Unlicensed low power operation of biomedical telemetry is on a no-protection and no-interference basis. Biomedical Telemetry operations are listed as secondary allocations to VHF/UHF television broadcast services. Additionally, some frequency bands may be shared with amateur radio operations and other unlicensed low power devices.

•

Channel operating frequencies may have to be changed to avoid new broadcast services or other interference problems that may be encountered during the life of this equipment. Contact your Customer Service Representative or the Spacelabs Service Department at 1-800-522-7025.

Up to five standard disposable silver/silver chloride chest electrodes are connected to the patient and the transmitter. A patient-operated RECORD button initiates an ECG strip at the system printer if this feature is enabled at the central or bedside. CAUTION: • This device has a limited bandwidth from .05 to 30 Hz, which may adversely affect the recording of high frequency components in the ECG signal, especially when the morphology of the ECG changes rapidly.

•

This device has a limited dynamic range of ± 4 mV, which may render the device vulnerable to saturation by ECG signals with amplitudes higher than 4 mV.

•

To clean the transmitter case, use only the following solutions per the manufacturer’s recommendations: Isopropyl Alcohol (70%), Hydrogen Peroxide, Cidex, Betadine, and Clorox. Use of cleaning solutions other than those listed will VOID the warranty of the Digital Telemetry transmitter cases.

•

Clean the transmitter after each use. The transmitter does not require any preventative maintenance other than cleaning.

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Ultraview Care Network

Digital Telemetry Receiver Module The telemetry receiver module plugs into a bedside, central, or transport monitor, and a digital telemetry module housing. The receiver module receives patient ECG waveform data from the transmitter. This data is reconstructed by the receiver module, displayed on the monitor, and analyzed. Refer to ECG on page 8-1, Arrhythmia on page 9-1, and ST Analysis on page 10-1 for detailed analysis information. WARNING: â&#x20AC;˘ Telemetry systems may be more susceptible to interference than hardwired systems, which may impact patient safety. â&#x20AC;˘

Operation of hand-held, wireless telephone equipment (for example, cordless telephones, cellular telephones, etc.) near telemetry systems may cause interference and should be discouraged.

â&#x20AC;˘

Do not install a telemetry receiver module into a bedside which is currently equipped with any other ECG module (hardwired or telemetry). Doing so may result in inaccurate patient waveform displays at remote monitors.

Digital Telemetry Module Housing The telemetry module housing can hold up to eight separate telemetry receiver modules. Except for the ON/OFF switches, there are no operator controls on the module housing. For normal operation with AC mains power applied, the AC mains indicator light on the front panel of the housing must be illuminated. Operation of the system without AC mains power is limited to ten minutes of battery backup time.

25-4

Digital Telemetry

Diversity Antenna System NOTE: The UCW bedside connects to the UCW module housing, and the UCW central connects to the digital telemetry module housing.

E C G

VI ST=0.00 A=3

HELP: Besturingselementen voor toegang behorende bij de ECG ECG MENU ALARM LIMITS

SIZE

SETUP

LEAD SELECT

CHANNEL FORMAT

SUSPEND PROCESSING

Ultraview Portable UCW Module Housing UCW Bedside or Central

SDLC

90478 Receiver Module

SDLC

90479 Digital Telemetry Module Housing 90340-10/90341

90339

Digital Transmitters

Figure 25-1: UCN Digital Telemetry System

25-5

Ultraview Care Network

Setting Up ECG Monitoring To initiate ECG monitoring: 1 2 3 4 5 6 7

Select a transmitter. Note its channel number. Attach lead wires to transmitter. Attach lead wires to electrodes. Apply electrodes to patient. Install a transmitter battery. Close the transmitter case.

Each lead wire must be plugged into the transmitter, connected to an electrode, and then attached to the patient. Match the lead wire color to the color-coded connectors on the top of the transmitter case. Refer to Patient Preparation and Electrode Application on page 8-5 for details regarding electrode application. Telemetry patients are commonly ambulatory and require optimal skin preparation and lead application to minimize motion artifact. After the electrodes and lead wires have been attached, it is important to tape a loop of lead wire close to the electrode to minimize stress or pulling on the electrode itself — a process called stress-looping. ECG monitoring begins when the telemetry receiver module detects a signal sent by a telemetry transmitter. The telemetry transmitter sends a signal as soon as a battery is installed. ECG telemetry reception requires the following minimum conditions: •

• • •

The telemetry receiver module must be connected to a UCN monitor, either directly or through a module housing, with the power ON and a Spacelabs Medical diversity antenna connected. ECG electrodes must be properly attached to the patient, and lead wires to the transmitter. The transmitter battery must be functional. The telemetry receiver module must be tuned to the telemetry transmitter’s frequency (channel number).

•

All system connections must be made by Spacelabs Medical personnel only.

•

Leakage currents are not affected by the high level output. The patient is electrically isolated from the monitor by the RF link.

WARNING: • Operation of television receivers or other CRT displays near the transmitter (within 2 to 3 feet), or operation of some pacemaker programmers may suppress the ECG waveform, preventing QRS detection and rate counting. An erroneous Asystole Alarm may result. •

Signals resulting from devices such as Automatic Implantable Cardiac Defibrillators (AICD) may momentarily blank the ECG trace rather than display an out-of-range signal. In such cases, it may not be apparent that the AICD has fired and the condition of the patient should be checked. In all instances of AICD firing, the bedside or central will redisplay the ECG waveform within 5 seconds.

Transmitter Batteries The Duracell 9 V alkaline battery (Spacelabs Medical P/N 146-0033-00) is recommended for use in the digital telemetry transmitter.

25-6

Digital Telemetry

Always observe the battery position and polarity as illustrated on the bottom of the battery compartment. After battery installation, close and latch the compartment cover. The transmitter will begin transmitting as soon as the battery is in place.

•

When the transmitter is not in use, the battery should be removed. Insert a battery only when the transmitter is actually being used with a patient.

•

The LOW BATTERY message appears and an alarm tone sounds (if LO BAT is set to ON) when the transmitter battery voltage falls below 7.0 volts. When this message appears, the transmitter has up to 24 hours of operating time left, depending on the type of battery used.

Electrodes Use silver/silver-chloride electrodes or their equivalent. Always connect all electrodes required for a particular lead. Missing electrodes may result in the loss of ECG tracing. Refer to Patient Preparation and Electrode Application on page 85 for information on placing the electrodes.

•

Use only Spacelabs Medical recommended electrodes. Some electrodes may be subject to large offset potentials due to polarization. Recovery time after application of defibrillator pulses may be especially compromised. Squeeze bulb electrodes commonly used for diagnostic ECG recording may be particularly vulnerable to this effect.

CAUTION: • Visually inspect each lead wire for obvious damage and replace as needed. •

Only use patient cables and lead wires specified by Spacelabs Medical. Other cables and lead wires may degrade performance and may damage the monitor during defibrillation or high frequency electrosurgery. NonSpacelabs Medical cables and lead wires may also change the required input impedance and D.C. offset voltage, affecting monitor performance.

•

Do not use stainless steel electrodes.

•

Do not allow conductive parts of electrodes and connectors, including the reference electrode, to contact other conductive parts, including the ground.

•

Poor cable dress or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit heart rate alarms. Refer to Patient Preparation and Electrode Application on page 8-5 for details on proper electrode preparation and application.

25-7

Ultraview Care Network

Display Detail Signal detection is indicated on your monitor when an ECG signal appears next to the ECG parameter key in the zone assigned to receive the transmitted telemetry channel. The transmitterâ&#x20AC;&#x2122;s channel number is always identified above the waveform, to the left of the ECG key.

í˘ą

í˘˛

í˘ł

í˘´

í˘ľ

í˘ś

í˘ˇ í˘¸*

HR=70 A=3

CHAN 347

VI CHAN 347

E C G

MON PACED

ST=0.00 A=3

BED 01 DANIELS,R

í˘š** ě?&#x2026;* ě?&#x2C6; ě?&#x2030;*

A/M 10 ROW 4 120 40

E C G

ě&#x201D;&#x2C6;

VI ST=0.08

ě&#x201D;&#x2030;

BED 01 DANIELS,R

Split Screen Central

Full Screen Central/Bedside

ě&#x201D;&#x2039;

ě&#x201D;&#x160;**

í˘ą ECG trace for first lead í˘˛ telemetry channel number í˘ł ECG key for first lead í˘´ QRS indicator (flashes once per detected beat) í˘ľ ECG lead designator í˘ś display resolution (monitor or extended) í˘ˇ paced operation indication (pacemaker detection is enabled) í˘¸ abnormals per minute alarm limit * í˘š ST segment level for first lead ** ě?&#x2026; abnormals in a row alarm limit * ě?&#x2C6; ECG rate alarm limits; split screen centrals display a bell symbol when alarms are enabled; bedsides display the rate alarm limits (120/40)

ě?&#x2030; abnormals per minute counter * ě&#x201D;&#x2C6; current heart rate ě&#x201D;&#x2030; ECG lead designator for second lead ě&#x201D;&#x160; ST segment level for second lead** ě&#x201D;&#x2039; ECG key for second lead (90341,90340-10 only)

25-8

Only appears with the MultiView I or II option in the adult mode with Arrhythmia detection enabled.

Only appears in adult mode with the ST segment analysis option.

Digital Telemetry

Monitoring Paced Patients To monitor paced patients: 1 2 3

Touch ECG. Touch SETUP. Select PACED YES.

When monitoring pacemaker patients, use the Paced feature to automatically enhance pacemaker spikes for display and eliminate them from the heart rate counter. The last setting you select is retained as the default. If the interval between the pacemaker pulse and the QRS complex is greater than 150 milliseconds, the beat is considered to have originated in the atria and is not classified as a paced beat. To prevent pacemaker pulses from being counted as actual beats, specialized circuitry removes the pacemaker pulses from the ECG signal and replaces them with pacemaker flags.

•

The optimal leads for monitoring paced patients may vary. In telemetry monitoring, pacemaker spikes are detected on lead II. If pacemaker spikes are not detected, change the electrode position.

•

Use the pacemaker manufacturer’s performance analyzer as the primary means of evaluating pacemaker operation.

25-9

Ultraview Care Network

Selecting Options for Lead Display To select ECG leads: 1 2 3 4

Touch ECG. Touch LEAD SELECT. Touch 1ST or 2ND LEAD. Select the desired lead.

One Operational Mode One operational mode is available with the 90340-10 multi-lead transmitter. When all electrodes are connected to the patient, leads I, II, III, AVR, AVL, AVF, and V16 are available. When no chest lead is applied, leads I, II, III, AVR, AVL, and AVF are available using the remaining connected electrodes.

To discharge a patient: 1 2 3 4 5

Table 1: One Operational Mode

Disconnect the transmitter from the patient. Remove battery. Select YES to confirm signal loss permanent. Select YES to discharge. Select YES to purge data.

Connected Electrodes (X) RL

V1-6, I, II, III, AVR, AVL, AVF

X X

II III

I, II, III, AVR, AVL, AVF

25-10

X X

90340-10 Valid Lead Vectors

â&#x20AC;˘

III

III X

All combinations of leads not shown above result in no valid lead vectors. In general, for at least one valid vector, either RL or C and two limb leads must be connected.

Digital Telemetry

Two Operational Modes Two operational modes are available with the 90341 dual-lead transmitter: • •

the standard mode that offers a choice of one V lead (V1-6), plus lead II; or the limb lead mode that offers choices of the leads I, II, III, AVR, AVL, or AVF.

The standard mode is available if the chest lead is applied. The limb lead mode is available when there is no chest lead applied. Loss of the chest electrode changes the ECG - Lead Select menu to the limb lead mode if the left arm, left leg, and right arm electrodes are intact. Refer to ECG on page 8-1 for lead placement illustrations. •

With dual-lead transmitters, both modes work correctly with or without the right leg electrode attached. However, for optimum performance, the right leg electrode should always be used.

Table 2: Two Operational Modes Connected Electrodes (X) C

90341 Valid Lead Vectors

RA X

V1-6 and II (standard mode)

I (standard mode)

III (standard mode) total lead failure (standard mode)

X X

II (standard mode)

None (lead failure)

None (lead failure) X X

None (lead failure) None (lead failure)

X X

•

III (limb lead mode) X

I (limb lead mode)

II (limb lead mode)

I, II, III, AVR, AVL, AVF (limb lead mode)

With dual-lead transmitters, if one of the leads fails, a lead fault message will be displayed in the upper left corner of the waveform zone. If there is no valid lead vector, the message LEADS OFF is displayed and an alarm tone is generated.

25-11

Ultraview Care Network

There is only one operational mode available with the 90339 single lead transmitter. In single lead mode, the lead vector is “unlabeled” and is a function of the electrode position. You may select a lead label after positioning the electrode labels for leads I, II, MCL1, MCL6, and Blank Label. If a lead label is selected, it will be displayed on the bedside or central and will print on all recordings.

Assigning a Telemetry Channel To set up the central for ECG (if bed name not remembered): 1

Touch the key label that matches transmitter’s frequency. Select bed/room number for transmitter channel.

Telemetry transmitters are preassigned with channel frequencies. This channel number is identified on the back of the case and cannot be changed. To receive this telemetry channel, one of the receivers in the telemetry receiver module must be tuned to its assigned frequency.

•

Tuning telemetry receiver modules to transmitter channels at the central must be done by a qualified service person.

•

Your central can be configured to remember beds that are assigned to individual telemetry channels using the Module Configuration Manager feature. These beds are permanently assigned until you de-assign or re-assign them.

To set up the central for ECG (PC1 only): 1 2 3 4 5

Touch MONITOR SETUP. Touch SCREEN FORMAT. Select zone desired. Select bed/room number. Select ECG ON.

To tune a receiver module at bedside: 1 2 3 4 5

6 7

Touch ECG. Touch SETUP. Touch TM SETUP. Touch SET TM CHANNEL. Select the digit to change. Use the ↑ ↓ keys to select the value for that digit. Repeat for all digits as necessary. Touch STORE.

Tuning a Receiver Module for a Bedside The central must be tuned by a qualified service person, but the bedside may be tuned using the ECG TM Setup menu. You may use this menu to tune the receiver module to the pre-assigned channel frequencies on the telemetry transmitter.

•

The module default is set for North America - UHF band operation. If operating in another country or frequency band, you must select the appropriate frequency band using the Module Configuration Manager feature.

To admit a patient:

Entering Patient Information

1 2 3

The ADMIT/DISCHARGE menu enables you to enter a patient identification (ID) number, name, height, weight, and body surface area (BSA).

4 5 6 7 8 9

Touch MONITOR SETUP SETUP. Touch ADMIT/DISCH. ADMIT/DISCH Select bed/room number for channel channel. Touch ADMIT. ADMIT Select YES. YES Select ID, NAME, HEIGHT, WEIGHT, or BSA. BSA Enter data using pop-up keypad or keyboard. keyboard Touch ENTER. ENTER Repeat steps 6 - 8 until data has been entered entered.

25-12

•

Admitting a new patient purges data from the previous patient on that telemetry channel.

Digital Telemetry

Changing the Display Resolution To change the display resolution: 1 2 3

Touch ECG. Touch SETUP. Select MONITOR or EXTENDEND.

The MONITOR/EXTENDED key determines the display resolution of the two ECG traces, whether or not both traces are currently displayed on the monitor. Key

â&#x20AC;˘

Display Resolution

Monitor

(0.5 - 30 Hz)

Extended

(0.05 - 30 Hz)

Changing the display resolution does not change the waveform bandwidth used to analyze the ECG signal for arrhythmia and ST segment level.

The factory default setting for display resolution is Monitor Mode.

Acknowledging Signal Loss When a telemetry signal is lost because the transmitter is out of range or the battery is removed, the receiver initiates a squelch condition. This condition is indicated when a triangular waveform replaces the normal ECG waveform. The notation SQUELCH is included in the edge print for any strip chart recording. The ECG trace automatically begins again if the lost signal returns. After eight seconds of loss, the IS SIGNAL LOSS PERMANENT? message appears. Selecting NO suspends alarm tones. Selecting YES displays the message DISCHARGE THE PATIENT? Selecting YES again, provides you with the message PURGES DATA-ARE YOU SURE? Selecting YES a third time, discharges the patient from the system and purges all data for that patient. Selecting NO at any point in this sequence returns you to the previous option.

Setting Battery Status Alarms To control low battery alarms: 1 2 3 4

Touch ECG. Touch SETUP. Touch TM SETUP. Select LO BAT ON or OFF.

The telemetry battery alarm tone alerts you to a low battery condition in the transmitter. A LOW BATTERY message also appears in the ECG zone involved. You may select to disable the low battery alarm tone, if your bedside or central is configured to do so. The factory default setting for low battery alarm is ON.

Controlling Patient-Initiated Recordings To control transmitterâ&#x20AC;&#x2122;s Patient Record function: 1 2 3 4

Touch ECG. Touch SETUP. Touch TM SETUP. Select PT RECORD YES or NO.

If the Patient Record function is activated (PT RECORD is YES) in the ECG TM SETUP menu, the patient may initiate a recording by pressing the RECORD button on the front of the transmitter.

25-13

Ultraview Care Network

Restoring Default Settings To restore default settings: 1 2 3 4

Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

With the Module Configuration Manager feature, you can restore all default settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-5.

•

RESTORE SETTINGS changes the user-configurable options for all parameters in the module.

Digital Telemetry Problem Solving Refer to ECG Problem Solving on page 8-16 for additional conditions. ASYSTOLE An ASYSTOLE message means it has been five seconds or more since a QRS complex has been detected. Check the patient, then check the following: • • • •

Check that the lead wires are inserted into the proper receptacle. Use the continuity tester to check for damage to the lead wires. The amplitude may be poor. Check the appropriate lead with a 12-lead ECG. Check that the transmitter is not too near (within two to three feet) a television receiver or other CRT display.

ECG VOLTAGE TOO LOW The ECG amplitude may have dropped below the R-wave detector threshold level. Reposition the electrodes to obtain a QRS amplitude of at least 0.20mV (adult) and 0.15mV (neonate). LOSS OF SIGNAL This message indicates that the patient may be out of antenna range, or that the battery is dead. • •

Return the patient into antenna range. Check that the battery is functioning properly.

LOW BATTERY The battery is weak. After this message appears, the battery has from a few hours to 24 hours of charge remaining (depending on the type of battery used). NOISY SIGNAL The patient may be moving excessively. Secure the lead wires to the patient. • •

25-14

Check electrodes for good skin adhesion. Check lead wires at the transmitter for good contact.

ECG Troubleshooting Guide Clinical Situation Noisy signal

Possible Cause

■ ECG frequency response set to

Solution

■ Select Monitor Mode.

extended mode.

■ Electrodes dry or poor skin adhesion.

Baseline wanders

■ Patient moving excessively.

■ Repeat skin preparation and apply new, moist electrodes.

■ Secure lead wires by stress-looping to the patient.

■ Respiration artifact.

■ Re-position the electrodes.

■ Electrodes dry or poor skin adhe-

■ Repeat skin preparation and apply

sion.

Low amplitude ECG

new, moist electrodes.

■ Skin improperly prepared.

■ Abrade skin and reapply electrodes.

■ Lead selected not providing QRS

■ Select another lead for monitoring.

complex with greatest amplitude.

■ Electrodes could be positioned over

■ Re-position the electrodes.

bone or muscle mass.

ECG won’t learn

■ ECG signal too noisy.

■ Check lead wires and electrodes, then relearn patient rhythm.

■ ECG voltage not within threshold. ECG VOLTAGE TOO LOW message may be displayed.

LOW BATTERY message

Excessive alarms

■ Select a different lead or adjust electrode location.

■ Transmitter battery is running low.

■ Install a new battery.

■ Electrodes dry or poor skin adhe-

■ Repeat skin preparation and apply

sion.

■ Alarm limits set too close to patient’s

new, moist electrodes.

■ Readjust the alarm limit.

normal heart rate.

■ Excessive patient movement or muscle tremor.

■ Reposition electrodes and secure electrodes with tape if necessary.

Refer to Digital Telemetry Problem Solving on page 25-14 and ECG Problem Solving on page 8-16 for further monitoring tips.

Patient Data Logger

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP MONITOR CONFIGURATION

ADMIT/ DISCHARGE

TONES

RECORDER CONFIG

PRIVILEGED ACCESS Enter system administrator login and password

Ultraview portable and 1500 monitors

NETWORK SETUP

RECORDER SETUP

SERIAL PORTS

PRESELECTED RECORDINGS

UCW/ Ultraview 1700 monitors

ALARM SETUP

USER ACCESS

UNITS OF MEASURE

BIOMED LEVEL - Select Parameter NETWORK CONFIGURATION

TELEMETRY CONFIGURATION

SERIAL PORT CONFIGURATION

MONITOR CALIBRATION

CHANGE BIOMED PASSWORD

CLINICAL MENU

BIOMED LEVEL - Serial Port Configuration SETTINGS

ASSIGNMENT

BIOMED LEVEL - Serial Port - Settings: Changes committed on exit DATA BITS 8

PARITY NONE

STOP BITS 1

ECHO NONE

CR/LF NONE

XON/OFF DISABLE

BAUD RATE 9600

BIOMED LEVEL- Serial Port - Assignment: Changes committed on exit DIAGNOSTICS

TE MODE

DATA LOGGER

UCW and Ultraview 1700 only

Patient Data Logger PATIENT DATA LOGGER ON

OFF

SETUP Patient Data Logger - SETUP: Change the settings ALARM LOGGING ON

•

OFF

CHECKSUMS ON

OFF

SAMPLE RATE 15 sec

Based on features purchased, more or fewer keys may appear here than on your menu screens.

26-1

Patient Data Logger

Contents Directory of Keys - UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Data Printouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Patient Data Logger Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Overview The Patient Data Logger option automatically sends patient vital signs from the monitor to an external device, such as a printer or a terminal. Episodic patient data is also sampled and transmitted. The output is in the form of ASCII text byte strings, and is printed using standard RS232 serial communications via the monitorâ&#x20AC;&#x2122;s serial port. Refer to the Display Detail on page 26-4 for further information. This option continues to send data whether the external device is on-line or offline. Data transmission can be stopped by reassigning the data port or disabling the Patient Data Logger. Your system administrator (or other designated personnel) must first set up communication between the monitor and the external device by assigning the serial port to Patient Data Logger, and then adjusting the serial port settings. The various serial settings can be adjusted to suit the device attached to the serial port. Refer to the appropriate service manual for more details.

26-2

Patient Data Logger

To set up Patient Data Logger (the user must have System Administrator access): 1 2 3

7 8 9

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter biomed login and password (UCW and Ultraview 1700). Enter privileged access password (Ultraview Portable, 1500, and 1600 monitors). Touch SERIAL PORT CONFIGURATION (UCW and Ultraview 1700). or Touch SERIAL PORTS and select a port (Ultraview Portable, 1500, and 1600 monitors). Touch ASSIGNMENT. Touch DATALOGGER. Touch PREVIOUS MENU.

The sample rate refers to the frequency of data sampling and can be set to time intervals ranging from 5-seconds to 60-minutes. The new sample rate takes effect at once.

•

The option is only available on bedside monitors.

•

Ensure that any cables or other computer or communications equipment connected to the bedside monitor comply with applicable medical standards.

•

The combination of PDL baud rate and sample rate must be selected carefully. Slow baud rates, in combination with frequent data transmissions, may cause loss of data. This is especially true if a large amount of patient vital sign data is being monitored. However, some devices cannot accept data at high baud rates. This may limit the range of sample rates at which your device can accept data readings from the monitors.

The data logger output requires a serial cable that swaps pins (refer to Table 1: Serial Cable Pinout). The serial cable must be properly connected at both ends and the data logger output enabled. Table 1: Serial Cable Pinout Input

To set serial settings: 10 Touch SETTINGS. 11 Touch the desired setting key(s) display desired settings. 12 Touch NORMAL SCREEN to effect changes.

Output

26-3

Ultraview Care Network

Display Detail The Patient Data Logger report is automatically sent to an external device, such as a printer or terminal, once the serial port is assigned and toggled ON. The data fields that appear on this report (ECG, RESP, ART, SpO2, and EtCO2) will vary depending on the parameter modules installed on the system.

SPACELABS MEDICAL PATIENT DATA LOGGER PATIENT NAME DOE, JOHN

Bed # 01

ECG

DATE 08 MAY 2001

RESP

ART

mmHg

SPO2

TIME

ABN

LEAD

LEAD2

ST1

ST2

RATE

SYS/DIA

MEAN

RESP

ETCO2 %

AGENT

14:55:49

212

2,08

-2,00

138/81

109

0,1

HAL

0,0

14:55:54

158

2,08

-2,00

138.81

109

0,1

HAL

0,0

14:55:59

146

2,08

-2,00

138/81

110

0,1

HAL

0,0

14:56:04

146

2,08

-2,00

138/81

110

0,1

HAL

0,0

14:56:10

212

2,08

-2,00

138/81

109

0,1

HAL

0,0

14:56:15

200

2,08

-2,00

138/81

110

5,2

HAL

0,1

14:56:20

146

2,08

-2,00

138/81

110

5,2

HAL

0,1

14:56:25

146

1,84

-2,56

138/81

109

5,2

HAL

0,1

14:56:30

211

1,84

-2,56

138/81

110

5,2

HAL

0,1

14:56:35

212

1,84

-2,56

138/81

110

5,2

HAL

0,1

14:56:45

146

1,84

-2,56

138/81

110

5,2

HAL

0,1

14:56:52

200

1,84

-2,56

138/81

109

5,2

HAL

0,1

Figure 26-1: Patient Data Logger Report Sample

26-4

•

All lines on this report are terminated by a line-feed, carriagereturn combination.

•

Lines may wrap if the line length exceeds the display or printer width.

•

The report prints a maximum of 132 characters per line and 2 lines per entry.

•

The report prints data from a maximum of 11 parameter groups (for example, ECG, RESP, ART, etc.). (Fewer parameters are printed if the line length limit is reached.)

Patient Data Logger

Data Printouts Each line of the data printout may contain up to 132 characters and is terminated with line feed and carriage return characters.

•

If you are monitoring a large number of parameters and have an 80-column printer, the data from one reading may require more than one line. If your printer has a wrap-around feature, this will be handled automatically. If you prefer that each data reading fit onto one line, condense the printer’s type or use a widecarriage (132 column) printer.

The PDL transmits two types of information: page headers and data lines. The page header appears at the top of each page and contains the patient’s name, the bed number, and the current date. A new page is generated when any the following situations occur: • • • •

The end of a page is reached (that is, 50 data lines have been transmitted). The monitored vital signs parameters change. The patient name or bed number changes. The current date changes.

Data lines are transmitted at the interval specified at configuration. Each data line contains the time that the data was collected, as well as the data collected for each vital sign parameter being monitored.

26-5

Patient Data Logger Troubleshooting Guide Problem Data is displayed with improper spacing or double spacing

No data is displayed or printed on the external device

Possible Causes

■ The PDL interface sends a carriage return/line feed sequence at each end-of-line. The external device may not be set up properly.

■ There is a power problem or the cables are faulty. The device may not be set up properly.

Solution

■ Set the external device for “0” line feed.

■ Check the power and cables. Ensure that the device is in the online mode and that RS-232 port requirements are satisfied.

■ Check for RS-232 compatibility at the monitor and at the external device.

■ Check the monitor port assignments and port connections.

Data is lost or garbled

■ The cable is faulty.

■ Check the cables.

■ The parity is set incorrectly.

■ Verify the baud rates and parity settings.

■ Baud rate settings may be inappropriate.

DNA

Directory of Keys - UCW and Ultraview 1700 MONITOR SETUP ADMIT/ DISCHARGE

TONES

MONITOR CONFIGURATION

PRIVILEGED ACCESS

Enter system administrator login and password

BIOMED (SYSTEM ADMINISTRATOR) Level: Select Parameter NETWORK CONFIGURATION

TELEMETRY CONFIGURATION

SERIAL PORT CONFIGURATION

MONITOR CALIBRATION

CHANGE BIOMED PASSWORD

CLINICAL MENU

BIOMED (SYSTEM ADMINISTRATOR) Level: Select Parameter TONE CONFIGURATION

DNA CONFIGURATION

SECONDARY DISPLAY ENABLE DISABLE

CENTRAL BEDSIDE

DATACOMM WATCH

6 TRACE MODE ON OFF

RESET MONITOR

To access DNA

•

Based on features purchased, more or fewer keys may appear here than on your menu screens.

27-1

DNA

Overview To set up DNA (must have System Administrator menu access):

The Dynamic Network Access (DNA) feature allows you to view and control a remote application via X-windows, VT220, or 3270 functionality.

1 2 3

Your hospital system administrator (or other designated personnel) must first set up communication between the UCW and Ultraview 1700 and the external computer(s) before DNA can be accessed. Refer to the UCW Service Manual for more details.

4 5 6 7 8

Touch MONITOR SETUP. Touch PRIVILEGED ACCESS. Enter biomed login and password. Touch MORE. Touch DNA CONFIGURATION. Enter desired configuration using the keyboard. Touch OK. Touch RESET MONITOR.

â&#x20AC;˘

Ensure that any computer or communications equipment connected to the network comply with applicable medical standards.

3270 Mode To access DNA: 1 2 3

27-2

Touch SPECIAL FUNCTIONS. Touch DNA. Touch the desired application icon.

The 3270 mode provides IBM 3270 terminal emulation via telnet (TCP/IP) communications. Additionally, 3270 features the capability for customized keyboard mapping, light pen emulation support, an on-line keypad, and pop-up menu. Refer to the UCW Service Manual for details on setting up the 3270 mode.

DNA

Keyboard Mapping (3270) To use keyboard mapping for 3270: 1 2 3 4

Select Keyboard Mapping from Terminal Settings menu. Touch the key to be remapped. Press new mapping key(s) on keyboard. Press ENTER on keyboard.

Figure 27-1: Keyboard Mapping Screen • • • •

27-3

BIS

Directory of Keys B I S

BIS - MAIN MENU

ALARM LIMITS

TEST ELECT

SETUP

START PROCED

CLEAR DATA?

EXIT ELECT

YES

ALARM LIMITS MENU

ALARMS ON OFF

HI= XX

↑

LO= YY

↓

CAUTION ON OFF

BIS SETUP MENU

DISPLAY FORMAT

PLOT SCALES

TIME SCALES

40-100

20-80

0-60

DISPLAY FORMAT MENU

1 ZONE

ADV SETUP

SIZE MENU

PLOT SCALES MENU

0-100

SWEEP SPEED

SIZE

SWEEP SPEED MENU

3 ZONE

AUTO ZONE

15 mm/sec

30 mm/sec

50 mm/sec

TIME SCALES MENU

1 HR

2 HR

4 HR

8 HR

12 HR

24 HR

ADVANCED SETUP MENU

LOW FREQ

HIGH FREQ

LINE FREQ

SAVE SETTINGS

RESTORE SETTINGS

LINE FREQ MENU

50 HZ LOW FREQ MENU

0.25 HZ

HIGH FREQ MENU

1.0 HZ

•

60 HZ

2.0 HZ

30 HZ

50 HZ

70 HZ

NONE

Based on features purchased, more or fewer keys may appear here than on your menu screens.

28-1

BIS

Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Initialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Normal Bedside Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Remote View Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Split Screen Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Numeric Key Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 BIS Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 BIS Alarm Limits Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 BIS Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Display Format Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Plot Scales Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Time Scale Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Size Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Sweep Speed Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Advanced Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Low Frequency Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 High Frequency Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Line Frequency Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Start/Stop Procedure Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Prompt Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Recording and Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Help Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Overview The Spacelabs Medical 90482 Bispectral Index® (BIS®) Analysis module acquires and processes real-time EEG data into a BIS number between 0 and 100. The EEG data is also displayed as:

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•

BIS

•

Spectral Edge Frequency (SEF)

•

Median Power (MF)

•

EMGL (EMG energy in the 70–110 Hz band)

•

Signal Quality Index (SQI)

•

Suppression Ratio (SR)

BIS

The BIS module may be used in any of the Spacelabs Medical monitors listed in Table 1, with or without other Spacelabs Medical modules. Table 1: BIS Compatibility

Model

Description

Minimum Version of Software Required For Compatibility

90305/15/16

PC2

3.67.04 EN

90363

Ultraview 1500

1.01.10

90364

Ultraview 1600

1.03.08

90369

Ultraview 1050

1.01.10

90367

Ultraview 1030

1.01.12

90385/6

UCW/RDI

1.04.33

90385/7

UCW/Ultraview 1700

1.05.56

The BIS module uses disposable BIS sensors from Aspect Medical, Inc., and it includes the Digital Signal Converter (DSC) and the patient interface cable. CAUTION: â&#x20AC;˘ Place the sensors as far away from the electrosurgery site as possible because considerable high frequency current may flow into the electrodes. This can cause patient burns, especially if a defect is present in the neutral cable of the electrosurgical unit. Placing electrodes too close to the electrosurgery site can also cause a noisy EEG trace. â&#x20AC;˘

Do not allow conductive parts of sensors or connectors, including the neutral electrode, to contact other conductive parts, including the ground.

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Ultraview Care Network

BIS module

Digital Signal Converter

Patient Interface Cable

BIS sensor

Figure 28-1: Module, DSC, PIC, and Sensor CAUTION: â&#x20AC;˘ Detach all connectors and cables by grasping the connectors and pulling them straight out. Do not detach connectors and cables by pulling on the cables themselves.

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BIS

Digital Signal Converter The Digital Signal Converter (DSC) receives the EEG input from the patient and converts it to analog information that is processed by the module. top view

side view

bottom view

end view

Figure 28-2: Digital Signal Converter The DSC plugs into the front of the module as shown in Figure 28-1: Module, DSC, PIC, and Sensor. Patient Interface Cable The patient interface cable (PIC) is attached to the DSC’s three-foot cable and connects to the BIS sensor as shown in Figure 28-1: Module, DSC, PIC, and Sensor.

•

The PIC is not a disposable cable. Do not dispose of it when you dispose of the attached BIS Sensor.

•

A cable tie is provided with the PIC to secure it to the DSC cable to prevent accidental disposal of the PIC.

To attach the PIC to the BIS sensor: 1.

Remove the BIS Sensor from its packaging.

Locate the small, raised arrows on both the light-blue end of the PIC connector and the BIS Sensor connector.

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Plug the BIS Sensor into the PIC so that the arrows are on the same side and point toward each other. You may attach the BIS sensor to the PIC cable either before or after the sensor is placed on the patient.

Patient Preparation To prepare the patient for monitoring: 1.

Make sure that the skin surface is clean and dry.

Position circle #1 and #2 high on the center of the patient’s forehead approximately 1.5 inches above the bridge of the nose.

Apply circle #3 on either temple between the corner of the patient’s eye and hairline. CAUTION: • The BIS sensor will only work if it is placed on the patient’s forehead. Accordingly, it should not be used with any surgical procedure that precludes such placement.

Insert the tab into the patient interface cable until it is fully engaged (if you prefer, you may do this step before applying the sensor to the patient).

Using your finger, trace around the adhesive areas of the sensor, including the space between circles #1 and #2 to assure good adhesion and to prevent any bridging between the sensor elements.

Press each circle firmly and hold for five seconds to assure adequate prepping and to maximize sensor performance. CAUTION: • Do not expose the BIS sensor to surgical skin preparation solutions. This may result in harm to the patient’s skin.

Initialization Before processing data, the BIS sensor must be applied on the patient. When the sensor is applied and the PIC and DSC are connected to the module, you are ready to begin BIS monitoring. Touch BIS. Touch START PROCED. The module will ask if you wish to clear previous data. Touch YES and the module will automatically perform an impedance test.

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•

You do not need to test electrode placement because this is done automatically when you touch START PROCED.

BIS

If the impedance test passes, a message stating that will appear. Impedance Test Failed Passed

Figure 28-3: Impedance Test Passed Message If the test fails, a message stating that will appear. Impedance Test Failed

Figure 28-4: Impedance Test Failed Message

Impedance Values If the impedance value is too high, it could indicate that the BIS Sensor is no longer making good contact and needs to be examined. Usually artifacts will signal this fact. During the selection of the TEST ELECT key, additional feedback is given to the user by flashing the impedance value when the value exceeds the threshold. The Pass/Fail thresholds for the terminals are: •

Ground < 100 Kohms

•

Center < 7.5 Kohms

•

Left/Right < 7.5 Kohms

•

In normal use, the typical impedance value for the ground is less than or equal to 6 Kohms, while the values for the center and left/right terminals are between 0.5 and 1.5 Kohms.

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Ultraview Care Network

During impedance testing, the number will continue to flash until the impedance value drops to an acceptable range.

•

The user cannot control the impedance thresholds.

Normal Bedside Display Format Monitor Software

•

Some monitors do not support BIS modules. (Refer to Table 1: BIS Compatibility.)

The full bedside view requires three waveform zones. The example in Figure 285: BIS Bedside Display (3 Zones) displays the BIS plot and EMGL trends.

Figure 28-5: BIS Bedside Display (3 Zones)

Analog Waveform A single waveform is displayed in a box that is 300 pixels wide by 60 pixels high. With this display, roughly 8 seconds of waveform data can be displayed at a sweep speed of 15 mm/sec, 4 seconds at 30 mm/sec, and 2.4 seconds at 50 mm/sec.

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•

This module is not supported by the PC-1, Scout, or Ranger monitors.

BIS

Numeric Zone The numeric zone is to the right of the plot and the moving waveform on the monitor and is usually updated every 2 seconds. Some items, such as sweep speed, are only updated when the selection is changed. Display Fonts • • •

The BIS value is displayed in a large font. The units of measure are displayed in a small font. The remaining text is displayed in a small font.

BIS Value Alarm Limits

BIS 60 45 SR=0% SQI=100% EMGL=20dB SEF=30Hz MF=30Hz

Suppression Ratio Value Signal Quality Index Value EMGL Value Spectral Edge Frequency Value Median Power Frequency Value Figure 28-6: Plot Area Numerics

Alarm Display When the alarms are turned ON, the high and low alarm limit values are displayed. When the alarms are turned OFF, BIS ALM OFF is displayed. When the alarms are temporarily suspended, BIS ALM SUSP is displayed. The alarm display consists of a block of reverse video text containing either BIS ALM OFF or BIS ALM SUSP. They are mutually exclusive, and only one will be displayed in the numeric area. Turn the alarms OFF by setting the ALARM OFF key in the Alarms menu, or temporarily suspend the alarms by pressing the ALARM SUSPEND key on the monitor.

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Top Line Annotation The top of the plot area contains two labels: • •

the primary trend label (BIS); and the secondary trend label (EMGL)

Figure 28-7: BIS Primary and Secondary Trends

Waveform Annotation Waveform annotations are placed to the right of the moving EEG waveform (refer to Figure 28-8: Waveform Zone Annotations).

+ 50µV L/R - CTR 15 mm/s -50µV

waveform upper size scale BIS sensor labels sweep speed waveform lower size scale

Figure 28-8: Waveform Zone Annotations The analog scale size can be set at ±2, ±5, ±10, ±20, ±50, ±100, or ±200 µV. The analog scale limits are displayed with ± and µV in the label.

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BIS

Impedance Montage If, during BIS monitoring, you wish to test impedance without losing your trended data, you may perform an impedance test. An impedance test is automatically checked (or tested) every 10 minutes. The Impedance Montage is a temporary display that appears when the BIS Sensor is connected to a patient and when you press the TEST ELECTRODES key. The montage is placed on the right side of the screen to the right of the second wave zone area from the top.

•

All processing is on hold until you stop the impedance test by touching EXIT.

Figure 28-9: Impedance Test Display

Remote View Display Format The “Remote View” software option on Ultraview monitors allows you to view the BIS parameter from a remote monitor. This display shows the BIS plot in a single display zone format—no analog waveforms are available in this mode.

Figure 28-10: Remote Display Remote monitors permit one display zone to be used to display remote channels from other monitors, regardless of the type and the number of zones that are in use at the bedside monitor. When viewing the BIS from another monitor, the lower part of the BIS trend will not be visible due to the patient’s name being there.

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In the one zone or remote view mode, all numeric text must be compacted into one display zone height. In the remote view only, the BIS plot can have variable scaling and only the BIS value can be plotted. The scaling options for remote view are shown in Table 2: BIS Variable Scaling. Table 2: BIS Variable Scaling Parameter BIS

Value for the Labels

Scaling 0-100

0, 50, 100

40-100

40, 70, 100

20-80

20, 50, 80

0-60

0, 30, 60

Split Screen Display Format

â&#x20AC;˘

A split screen display is available only on central monitors.

The split screen display for the 90482 is shown in Figure 28-11: Split Screen Display.

5 2 12 /R=9.9

20% 0%

Figure 28-11: Split Screen Display

Numeric Key Format The numeric parameter key is labeled with the combined Bispectral Index value. You may choose to have your BIS parameter displayed as an icon on the bottom of the monitor screen. This allows other parameters to be displayed in the waveform zone. The full BIS display is restored whenever this icon is touched.

BIS=50

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Bispectral Index value

BIS

BIS Main Menu The Main menu is the initial menu that is displayed when you press the BIS key.

Alarm Limits Key The ALARM LIMITS key sets the upper and lower BIS alarm limits and turns the Caution alarm ON or OFF. Pressing this key brings up the Alarm Limits menu.

Setup Key The SETUP key enables you to set the display parameters to be used during the procedure. Pressing this key brings up the BIS Setup menu.

Test Elect Key The TEST ELECT key initiates a continuous impedance check of all electrodes. Pressing this key brings up the Impedance Montage display and changes the label to EXIT ELECT. When you press EXIT ELECT, the Impedance Montage display disappears and the labeling becomes TEST ELECT again.

Print Key The PRINT key prints a bit-mapped display of the BIS and EMGL trends. The analog waveform is not printed using this key. Press RECORD and BIS to print the analog waveform.

Start Procedure Key The START PROCED key indicates the beginning of the procedure to be recorded. If prior data has been stored, the user is given the option of saving or erasing this data. This key becomes labeled STOP PROCED.

â&#x20AC;˘

In the remote view, only the ALARM LIMITS, SETUP, and PRINT keys are active. All other keys are disabled (dotted).

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Ultraview Care Network

BIS Alarm Limits Menu

The BIS Alarm Limits menu enables you to set and adjust alarm limits for the BIS parameter and the Caution alarm. The Alarms may be turned ON or OFF with the ALARMS key. Turning the alarms OFF disables the remaining keys. When the alarms are OFF, no alarm bell is displayed on the plot area of the screen. The user raises or lowers each alarm limit setting by first pressing the HI or LO key then the up or down arrow keys. Each press of the arrow key raises or lowers the alarm limit by 5 units. There are separate values for the low limit and the high limit.

•

The alarm limits appear in the HI and LO keys as they are changed.

Enabling the Caution Alarm will allow you to be warned when the BIS value is within 5 units of either alarm limit.

Alarm Settings The only alarms for this parameter deal with the BIS value exceeding user defined limits. The user can set an upper limit and a lower limit. No other parameters are monitored for alarms. In the Alarms menu, the user has several choices of alarm behavior: • •

determine whether the alarm is enabled. determine whether a caution alarm is enabled.

Alarms Disabled When the alarms are disabled, the display replaces the bell symbol with a reverse video box containing BIS ALM OFF in small text. In this situation, no alarms will be tested, and all displays will appear normal. The settings for the caution alarm and audible alarm are ignored.

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BIS

Figure 28-12: BIS Alarms Disabled

â&#x20AC;˘

In the split screen display format, the alarm limits are replaced with a bell icon. When the alarms are enabled, the bell will be displayed. When alarms are disabled, the bell will be removed.

Alarms Enabled When the alarms are enabled the upper right corner of each of the display formats contains the alarm limits.

65 45

Figure 28-13: BIS Alarms Enabled When an alarm condition exists, the BIS number flashes, and the alarm limit value flashes to indicate which limit was exceeded, and a tone is sounded. In the split screen display, the small bell symbol is displayed when the alarms are enabled. During an alarm violation the bell symbol flashes.

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Caution Alarm When the Caution alarm is enabled, additional testing is done to determine if the BIS value is within 5 units of either of the alarm limits, i.e., if the BIS value is 5 units below the upper limit or 5 units above the lower limit. When the Caution alarm is enabled and the BIS number is within the caution zone, the BIS number flashes.

•

No tone is emitted for the caution alarm.

Alarm Suspended The ALARM SUSPENDED key is used to temporarily turn off the audible alarm for 3 minutes. When this key is pressed, the text BIS ALM SUSP replaces the alarm limits. The BIS number continues to flash if the limit is exceeded. When the temporary time has elapsed, the display returns to normal behavior. If the audible alarm is enabled, the alarm tone will again be sounded, and limit number will flash. In the split screen display the bell symbol is displayed in reverse video when the alarms are enabled, but suspended. During an alarm violation, the bell symbol flashes in reverse video.

Equipment Alarms If any of the following conditions occur, a brief message will display in the BIS message zone topline of graphical display. •

digital signal converter becomes disconnected

•

patient sensor is not making good connection

•

BIS Sensor impedance check fails

•

digital signal converter has a power fault

These errors are detected by the BIS engine board and passed to the module in the status message.

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•

Equipment alarms do not sound any tones.

BIS

BIS Setup Menu

Display Format Key The DISPLAY key selects the type of display format.

Plot Scales Key The PLOT SCALES key selects the vertical display scale range options for the BIS Trend. Selecting this key brings up one of the Plot Scale menus.

Time Scales Key The TIME SCALES key selects the time base for the BIS and EMGL trend plots. Selecting this key brings up the Time Scales menu.

Size Key The SIZE key selects the waveform size. Selecting this key brings up the Size menu.

Sweep Speed Key The SWEEP SPEED key selects the sweep speed for the analog waveform. Selecting this key brings up the Sweep Speed menu.

Advanced Setup Key The ADVANCED SETUP key enables you to control a variety of functions. Selecting this key brings up the Advanced Setup menu. In this menu, only the BIS SCALES key is available on a remote display.

â&#x20AC;˘

Some of the above modes may be disabled (dotted) because of other selections.

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Ultraview Care Network

Display Format Menu DISLAY FORMAT MENU 1 ZONE

3 ZONE

AUTO ZONE

In the Display Format menu, you can set the type of display that you will use. In the 1-Zone format, the display will be the single waveform zone type shown in Figure 28-14: 1-Zone Display. In the three-zone format, the display will be the full bedside view type shown is Figure 28-15: 3-Zone Display. In Auto Zone mode, the display will be the full bedside view when the BIS parameter key is selected. When the BIS parameter key is not selected, the display will be the 1 Zone display.

Figure 28-14: 1-Zone Display

Figure 28-15: 3-Zone Display

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BIS

Plot Scales Menu

This menu is used to select the scale for the vertical scale for graphical BIS trend display in the one-zone or remote view format only. The selections are from 0–100, 40–100, 20–80, or 0–60.

•

The selected scale key is highlighted.

Time Scale Menu

This menu is used to select the time scale for the BIS plot area. Available time base options are 1, 2, 4, 8, 12, and 24 hours. This indicates the total number of hours represented by the x-axis of the BIS plot display.

•

The selected scale key is highlighted.

Size Menu

From this menu, you can modify the amplitude scale of the analog waveforms. The available amplitude scales (full scale) can be set at ±2, ±5, ±10, ±20, ±50, ±100, and ±200 µV. The default setting is ±50. Pressing the ↑ or ↓ key changes the scale to the next value up or down. The upper and lower vertical axis labels on the analog waveform(s) also change to reflect the new size setting. If either the maximum or the minimum scale has been reached, the following message appears on the menu prompt line: MAXIMUM WAVEFORM SIZE HAS BEEN ATTAINED or MINIMUM WAVEFORM SIZE HAS BEEN ATTAINED The appropriate arrow key becomes dotted.

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Sweep Speed Menu

From this menu you can modify the sweep speed of the analog waveform(s). You can select 15, 30, or 50 mm/sec as the sweep speed.

Advanced Setup Menu

Low Frequency Key The LOW FREQUENCY key determines the lowest frequency that is displayed and processed. Selecting this key brings up the Low Frequency menu.

High Frequency Key The HIGH FREQUENCY FILTER key determines the highest frequency that is displayed and processed. Selecting this key brings up the High Frequency menu.

Line Frequency Key The LINE FREQUENCY key is used to select either 50 Hz or 60 Hz line frequency. Selecting this key brings up the Line Frequency menu.

Save Settings Key Selecting the SAVE SETTINGS key causes the current selections to be stored in memory for later recall.

Restore Settings Key Selecting Restore Settings causes the stored settings to be recalled from memory and resets all the current settings. The display may change with this operation. The default settings are contained in Section 34, Setup Summary

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BIS

Low Frequency Menu

The Low Frequency options are 0.25 Hz, 1.0 Hz, and 2.0 Hz.

•

The selected scale key is highlighted.

High Frequency Menu

The High Frequency options are 30 Hz, 50 Hz, and 70 Hz.

•

The selected scale key is highlighted.

Selecting NONE disables any high frequency filtering.

Line Frequency Menu

Select the appropriate line filter for the appropriate country. The selected key is highlighted.

Print This key will allow user to print the current bit-map of the screen.

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Start/Stop Procedure Menu

The START PROCED key is used to denote the beginning of a case. You will have the option of retaining archived data or clearing it. If archived data is retained on same patient (NO), the new data will be appended to the existing data. Selecting YES causes trend memory to be erased and clears the trend display. After the START PROCED key is pushed, its function and name changes to STOP PROCED. If the STOP PROCED Key is pressed, the name changes to START PROCED again, and the same Clear Data menu is displayed.

Status Messages Status messages are displayed on one medium font line in the waveform zone starting at the upper right corner of the BIS plot. The text will be flashing to indicate that there is a problem. Processing may be suspended when any of these messages are displayed. The numeric data may be displayed as question marks. The EEG waveform may have artifacts. The status message will continue to display until all faults are corrected. Message

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User action

Impedance Test In Progress

The impedance test is in progress; this should normally last 10 to 15 seconds.

Re-prep Ground Electrode

The impedance test has failed; check to see that all the electrodes are connected properly. The module will not collect data until the test passes.

DSC Test in Progress

The system is performing a hardware self test of the DSC cable.

DSC Not Connected

Check that the PIC cable is connected to the DSC and at the front of the module. If connected, and the DSC doesnâ&#x20AC;&#x2122;t work, the DSC or module may require service.

DSC Shut Down Restart Module

Too many fatal errors (overcurrent, voltage regulation) have occurred with this DSC, and the module has stopped communicating. Remove the module and reinsert it. If this problem persists, the DSC and/or module may require service.

Illegal DSC ID: DSC Turned Off

An unrecognized DSC has been connected to the module. Connect correct DSC. If error persists, the DSC and/or the module may require service.

Illegal PIC ID

An unrecognized Patient Interface Cable has been connected to the DSC. The PIC may be defective. Replace the PIC.

BIS

Message

User action

Check the Sensor

The BIS Sensor has an impedance which is too high. Check the cable connections and correct as necessary. If the message persists, check the impedance of the Sensor. Check or replace Sensor as necessary.

PIC Not Connected

The Patient Interface Cable may be disconnected from the DSC. Check the cable connections. The PIC may be defective. Replace the PIC.

Last Impedance Test Not Completed

At least one BIS element failed during the last impedance test and the test was ended by pressing the STOP PROCED key. Repress the element that failed. Re-test the impedance. This message will also appear if the test was ended prematurely by pressing STOP PROCED.

Poor Signal Quality

The Signal Quality Index is poor and the numeric display blinks. Check BIS Sensor. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.

Bad Signal Quality

The Signal Quality Index is unacceptable, therefore, the Primary Trend variable cannot be calculated. Check BIS Sensor. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.

Iso-electric EEG Detected

No discernible EEG activity is detected for several minutes, SR = 100. Check the patient. Check the BIS Sensor for proper connection.

Check BIS Sensor (GND Element)

The ground element on the patient has an impedance that is too high. Check the Sensor and cable connections, and correct as necessary. If the message persists, check the impedances of the BIS Sensor. Reprep the patientâ&#x20AC;&#x2122;s scalp if necessary.

Hardware Error, Service Required

Major problems in the DSC, BIS engine or module. Requires servicing.

Prompt Messages The text of the prompt message is displayed on the prompt line of the bedside monitor as one line of small font characters. This is normally used for messages that affect the keys that have been pressed. Message

Reason

Maximum Waveform Size has Been Attained

The waveform was increased to a value setting beyond the limits.

Minimum Waveform Size has Been Attained

The waveform was decreased to a value setting beyond the limits.

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Recording and Printing Touching RECORD (the hard key on right-hand-side of the monitor), followed by BIS will select the analog EEG waveform for recording and printing. To print the BIS and EMGL trended data, select the PRINT key in the BIS menu. This produces a bit-mapped image of the trend area on the screen.

•

The PRINT key prints a bit-mapped display of the BIS and EMGL trends. The analog waveform is not printed using this key. Press RECORD and BIS to print the analog waveform.

Help Messages BIS Key BIS

HELP: BIS — Accesses controls that pertain to BIS

BIS Main Menu ALARM LIMITS

HELP: ALARM LIMITS — Permits setting or changing of BIS alarm limits

SETUP

HELP: SETUP — Displays the Setup menu

TEST ELECT

HELP: TEST ELECT — Starts the electrode test sequence

HELP: PRINT — Prints the contents of the display zone

START PROCED

HELP: START PROCED — Starts the procedure

BIS Setup Menu

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DISPLAY FORMAT

HELP: ZONES — Accesses the Display Format menu

PLOT SCALES

HELP: BIS SCALES — Accesses the Plot Scales menu

TIME SCALE

HELP: TIME SCALE — Accesses the Time Scale menu

SIZE

HELP: SIZE — Accesses the analog waveform Size menu

SWEEP SPEED

HELP: SWEEP SPEED — Accesses the analog waveform Sweep Speed menu

ADV SETUP

HELP: ADV SETUP — Accesses the Advanced Setup menu

BIS

Plot Scales Menu (BIS) 0 - 100

HELP: 0 - 100 — Selects the plot scale for the BIS trend as 0 - 100%

40 - 100

HELP: 0 - 100 — Selects the plot scale for the BIS trend as 40 - 100%

20 - 80

HELP: 20 - 80 — Selects the plot scale for the BIS trend as 20 - 80%

0 - 60

HELP: 0 - 60 — Selects the plot scale for the BIS trend as 0 - 60%

Time Scale Menu 1 HOUR

HELP: 1 HOUR — Selects 1 hour as the time scale for the plot

2 HOUR

HELP: 2 HOUR — Selects 2 hours as the time scale for the plot

4 HOUR

HELP: 4 HOUR — Selects 4 hours as the time scale for the plot

8 HOUR

HELP: 8 HOUR — Selects 8 hours as the time scale for the plot

12 HOUR

HELP: 12 HOUR — Selects 12 hours as the time scale for the plot

24 HOUR

HELP: 24 HOUR — Selects 24 hours as the time scale for the plot

Size Menu ↑

HELP: ↑ — Increases the size of the analog waveform

↓

HELP: ↓ — Decreases the size of the analog waveform

Sweep Speed Menu 15 mm/sec

HELP: 15 mm/sec — Sets the analog waveform sweep speed to 15 mm/sec

30 mm/sec

HELP: 30 mm/sec — Sets the analog waveform sweep speed to 30 mm/sec

50 mm/sec

HELP: 50 mm/sec — Sets the analog waveform sweep speed to 50 mm/sec

Advanced Setup Menu LOW FREQ

HELP: LOW FREQ — Accesses the Low Frequency setup menu

HIGH FREQ

HELP: HIGH FREQ — Accesses the High Frequency setup menu

28-25

Ultraview Care Network

LINE FREQ

HELP: LINE FREQ — Accesses the Line Frequency setup menu

SAVE SETTINGS

HELP: SAVE SETTINGS — Saves the setup information

RESTORE SETTINGS HELP: RESTORE SETTINGS — Restores the saved setup information

Low Frequency Filter Menu 0.25 Hz

HELP: 0.25 Hz — Selects 0.25 Hz as the low frequency filter

1.0 Hz

HELP: 1.0 Hz — Selects 1.0 Hz as the low frequency filter

2.0 Hz

HELP: 2.0 Hz — Selects 2.0 Hz as the low frequency filter

High Frequency Filter Menu 30 Hz

HELP: 30 Hz — Selects 30 Hz as the high frequency filter

50 Hz

HELP: 50 Hz — Selects 50 Hz as the high frequency filter

70 Hz

HELP: 70 Hz — Selects 70 Hz as the high frequency filter

NONE

HELP: NONE — Disables the high frequency filter

Line Frequency Filter Menu 50 Hz

HELP: 50 Hz — Selects 50 Hz as the line filter

60 Hz

HELP: 60 Hz — Selects 60 Hz as the line filter

BIS Alarm Limits Menu ALARMS

HELP: ALARMS — Enables or disables the BIS alarm

HI =

HELP: HI =?? — Permits changing of the high limit

LO =

HELP: LO=?? — Permits changing of the low limit

↑

HELP: ↑— Increases the BIS alarm limit by 5

↓

HELP: ↓ — Decreases the BIS alarm limit by 5

CAUTION

HELP: CAUTION — Enables or disables the alarm caution alerts

Start/Stop Procedure Menu

28-26

YES

HELP: YES - Review data will be erased before continuing

HELP: NO - Review data will not be erased before continuing

BIS

Definitions BIS — Bispectral Index Analysis. A mathematical calculation derived from the frequency, power, and phase throughout the entire frequency range of the EEG. The Index is a number between 0 and 100. DSC — The Digital Signal Converter. The DSC contains the input connector, amplifiers, and digitizer for the 90482 one channel EEG. The DSC is configured for referential montage monitoring. EEG — Electroencephalogram. Real-time electrical activity of the brain. The EEG waveform can be further separated (digitized) into elements. The signal can be processed in time, frequency, and Fourier analysis. EMG — Electromyogram. Electrical activity of the muscles. Processed as the absolute power in the frequency (Hz) range. This product calculates EMGL, which is over a fixed 70 to 110 Hz frequency range. EMGL — EMG Low. Refer to EMG. Epoch — The time during which the bispectral index is calculated. MF — Median Power Frequency measured in Hz. The frequency at which 50% of the total power lies equally on either side. The frequency range is between 0.5 and 30 Hz. Montage — A pattern of linking electrodes together over the scalp to generate a display of EEG channels in a particular way. Montages can be bipolar or referential. PIC — The Patient Interface Cable. Used by the BIS module. This cable is configured to tell the DSC and module to automatically use a single channel montage for the BIS Sensor. The BIS Sensor is normally placed on the left or right side of the forehead. SEF — Spectral Edge Frequency. The frequency (measured in Hz) at which 95% of the total EEG power lies below it and 5% lies above it. Frequency range is between 0.5 and 30 Hz. SQI — Signal Quality Index. The percentage of good epochs in the last 60 seconds that are used to calculate the Bispectal Index and spectral variables. Not affected by the suppression ratio. Percentage values range between 1 and 100. SR — Suppression Ratio. The percentage of time in the last 63 seconds in which the EEG signal is considered suppressed. Percentage values range from 0.0 to 100.

28-27

Ultraview Care Network

Troubleshooting

•

For additional troubleshooting guidance refer to the 90482 BIS Service Manual (P/N 070-0708-xx).

Use Table 3: Error Messages and Recommended Response to interpret and respond to error messages. Table 3: Error Messages and Recommended Response Message

28-28

Recommended Response

DSC Not Connected

Check that the DSC is connected to the front panel of the monitor. If connected, and the DSC doesn’t work, the DSC or monitor may require service.

DSC Overcurrent

The run-time diagnostics tries up to three times to clear this error condition. If it doesn’t work, the DSC or module may require service.

DSC Power Regulation

The run-time diagnostics checks three times for this error condition. This indicates that the DSC may require service.

DSC Communications Fault

Messages between the DSC and the module are garbled or missing. This may occur during the use of electrocautery devices. If the message persists, the module or DSC may require service.

DSC Not Interrupting

The DSC is not sending messages to the module. This indicates that either the DSC or the module may require service.

DSC Busy Error

The DSC had not finished processing the last command when the next command was received from the module. This may indicate that the DSC or monitor requires service.

DSC Framing Error

The message packet from the DSC is garbled. This may occur during the use of eletrocautery devices. If the message persists, the module or DSC may require service.

DSC Not Responding to Command

The expected change in DSC status did not occur when a DSC command was issued. The DSC or the module may require service.

DSC Shut Down

Too many fatal errors (overcurrent, voltage regulation) have occurred with this DSC and the module has stopped trying to get it to work. Turn the monitor off, then on to try again. If this problem persists, the DSC and/or monitor require service.

Illegal DSC ID: DSC Turned Off

An unrecognized DSC has been connected to the module. Connect correct DSC. If error persists, the DSC and/or the module may require service.

DSC Failed SelfTest

The DSC has failed either the noise test or gain test performed at startup. The DSC and/or the module may require service.

Illegal PIC ID

An unrecognized Patient Interface Cable has been connected to the DSC. The PIC may be defective. Replace the PIC.

BIS

Message

Recommended Response

Re-prep Sensor

The sensor has an impedance that is too high. Check the cable connections and correct as necessary. If the message persists, check the impedance of the sensor. Re-prep or replace sensor as necessary.

Re-prep Electrodes, L

The electrode has an impedance that is too high. Check the cable connections and correct as necessary. If the message persists, check the impedance of the electrode. Re-prep or replace electrode as necessary.

Re-prep Electrodes, R

PIC Not Connected

PIC is not connected. If PIC is connected, it may be defective. Replace PIC.

Re-prep Electrode (Ground)

Last Impedance Test Not Completed

At least one electrode failed during the last impedance test and the test was ended by pressing [EXIT] or [EXIT] was pressed prematurely. Replace the failed electrode, if any, and retest.

Illegal Command

The IPU rejected a command from the CPU. The module requires service.

IPU Not Responding

The IPU is not acknowledging commands from the CPU. Restart the module. If the error persists, the module requires service.

IPU Checksum Error

The IPU has detected a checksum failure on five straight attempts of the CPU to send a command. The module requires service.

IPU Interrupt Error

The IPU interrupt has been late or missing five times in the last 1/4 of a second. If the error persists, the module requires service.

Left side SQI Bad

(2-channel monitoring only.)

Right side SQI Bad

(2-channel monitoring only.)

Poor Signal Quality

The Signal Quality Index is poor. Note: the numeric display changes from a solid to an outlined number. Check Sensor/leads. May occur as a result of artifact such as those generated from motion or the presence of electrocautery devices.

Bad Signal Quality

The Signal Quality Index is unacceptable therefore the Trend variable cannot be calculated. Check Sensor. This may occur as a result of artifact such as those generated from motion or the presence of electrocautery devices.

Isoelectric EEG Detected

No discernible EEG activity is detected for several minutes, SR = 100. Check the patient. Check the leads for proper connection.

28-29

Ultraview Care Network

Message

Recommended Response

Review Data Lost

The contents of the data memory were lost and have been re-initialized. If the error persists, the monitor requires service.

Operating on Battery Backup

The AC power has been lost and the monitor is running on the battery. The battery keeps the monitor operating for approximately 20 minutes.

Serial Port 1 Buffer Error

The software attempted to place a message in the serial data queue, but the queue is full. If the error persists, the monitor requires service.

C-Scape Function Error

Indicates a user interface software problem. The monitor requires service.

Replacing a PIC To replace a faulty or damaged PIC: 1.

Remove and discard the unusable cable.

Locate the end with a yellow dot on the PIC connector.

Engage the PIC connector and the DSC cable connector with the yellow dots oriented the same way, ensuring that they are fully seated.

Care and Maintenance Cleaning BIS Module and Host Monitor Cleaning To clean monitor screens and covers, modules, processors, and printers use a cloth or swab that has been slightly dampened in a solution of warm water and a mild detergent. Avoid solvents that may damage the product cases. Follow your hospital protocol. CAUTION: â&#x20AC;˘ Using cleaning agents other than those listed may cause degradation to the productâ&#x20AC;&#x2122;s plastic enclosure and labels. Refer to Cleaning and Sterilization on page 32-1 for questions or concerns regarding cleaning. Digital Signal Converter Cleaning Clean all visible blood, liquids, and soil as soon as possible from the Digital Signal Converter (DSC), cabling, and connectors. Use a lint-free, absorbent towel that has been moistened (damp, but not dripping) with a solution of mild detergent and

28-30

BIS

lukewarm, clean water. Using light pressure, thoroughly clean all surfaces. Dilute and handle detergents and disinfectants according to their instructions. Dispose of the towels properly. CAUTION: • When cleaning the connectors (or other small features of the DSC), do not let dirt, moisture, or lint get trapped in the cracks or cavities of the receptacle or pin ends. •

Do not autoclave any of the components of the BIS monitoring system. Autoclaving will seriously damage the components.

Before cleaning, wipe thoroughly. Apply an approved disinfectant for the DSC with a germicidal, disposable wipe, such as the SANI-CLOTH. Active ingredients in the approved wipe are: n-Alkyl dimethyl benzyl ammonium choride (0.1%), and nAlkyl dimethyl ethylbenzyl ammonium chloride (0.1%). Be sure the disinfectant is not dripping from the wipe. Using light pressure, wipe the surface of the DSC, its cabling, and connectors as indicated by manufacturer’s instructions. Dispose of the wipes properly. BIS Sensor Disposal The BIS Sensor is a patient connected, single-use sensor that must be disposed of after each use. Dispose of the sensor per your applicable hospital practice.

Bispectral Index (BIS) is a trademark of Aspect Medical Systems, Inc.

28-31

Capnography

Directory of Keys G A S

GAS - MAIN MENU ALARM LIMITS

FREEZE ON OFF

SETUP

COMP

VIEW ALARMS

CAL

GAS - CAL MENU O2 CAL

CO2 CHECK

ADAPTER CAL

GAS - CAL MENU - ADAPTER CAL

GAS - CAL MENU - O2 CAL ROOM O2 SPAN

ZERO

100% O2 SPAN

START

CANCEL

GAS - CAL MENU - CO2 CHECK

GAS - COMP O2 AUTO MAN

N2O ON OFF

O2 ON

CO2 = XX.X

BarPres = XXX

OFF

NEXT READING

GAS - SETUP MENU SWEEP SPEED

SIZE

LARGE TXT SMALL TXT

RESP TONE

PERCENT mmHg (kPa)

CAPNO O2 ONLY

RESTORE SETTINGS

GAS - SETUP MENU - RESP TONE RESP TONE ON OFF

VOLUME

YES

GAS - SETUP MENU - SWEEP SPEED 25 mm/sec

12.5 mm/sec

6.25 mm/sec

3.12 mm/sec

1.56 mm/sec

GAS - SETUP MENU - SIZE WAVEFORM ON OFF

0-80 mmHg

0-60 mmHg

0-40 mmHg

0-10.7 kPa

0-8.0 kPa

0-5.3 kPa

GAS - ALARM LIMITS MENU APNEA

ETCO2

MINCO2

GAS - ALARM LIMITS MENU - APNEA APNEA ON OFF

APNEA = OFF

GAS - ALARM LIMITS MENU - RR RR HI = LO = OFF OFF ON OFF

•

APNEA RR

Based on features purchased, more or fewer keys may appear here than on your menu screens.

29-1

Capnography

Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Alarm Status and Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Adjusting the Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Turning the Waveform Display Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Selecting a Sweep Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Adjusting the Tone Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Turning the Tone Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Freezing the Waveform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Freezing the Waveform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Calibrating O2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Calibrating the Airway Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Calibrating the CO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Performing a 100% O2 Span . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Selecting Gas Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Capnography Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Overview The 90516 Ultraview Capnograph module is a mainstream gas analyzer, designed to measure the concentration of carbon dioxide in a gas mixture to aid in determining the patientâ&#x20AC;&#x2122;s ventilatory, circulatory, and metabolic status. The capnograph module has a small, lightweight sensor that continuously measures the end-tidal and minimum CO2 levels in the patientâ&#x20AC;&#x2122;s airway. Respiration can be monitored via airway and endotracheal or tracheostomy tubes. Both adults and neonates can be monitored with this type of capnograph (using separate adult and neonatal airway adapters). The sensor head contains a small infrared transducer that accurately measures the CO2 in the airway. The sensor is connected to the airway by an airway adapter. These adapters may either be disposable or reusable and are available in adult and neonatal sizes.

29-2

Capnography

The capnograph automatically compensates for the ambient barometric pressure to ensure accurate readings. A connector is included to allow measurement of O2 in the airway using a fuel cell type O2 sensor. A full calibration menu is provided to easily calibrate and use the O2 sensor. A separate adapter is used for O2 monitoring. CAUTION: • Although the 90516 capnograph module detects and reports apnea conditions, it is not intended to be a primary diagnostic apnea monitor and/or apnea recording device.

•

Use only Spacelabs Medical sensors with this monitor. Other sensors may plug in, but will not operate.

•

Use only Spacelabs Medical airway adapters with Spacelabs Medical sensors. The monitor may not function if other airway adapters are used, and sensor damage may result.

•

If the patient’s airway is configured with a closed suctioning system, make sure the airway adapter is placed close to the suctioning system (on the ventilator side). This will help ensure that the sampling adapter is not impaired during and after suctioning.

•

U.S. Federal law restricts this device to sale by or on the order of a physician.

If your module is equipped with the Module Configuration Manager feature, you can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-1 for further details.

29-3

Ultraview Care Network

To start capnography monitoring: Plug the module into the monitor. 2 Plug the sensor connector into the monitor. 3 Perform sensor calibration, if necessary. 4 Prepare the patient according to hospital procedures. 5 Select appropriate airway adapter (neonate or adult). 6 Verify that windows are clean and dry. 7 Place sensor head over the airway adapter and perform an adapter calibration, if necessary. 8 Remove the airway adapter from the sensor head. 9 Insert the airway adapter into the ventilator circuit and Ballard style tracheal suction system (if present) as shown in Figure 291: Ballard Setups. 10 Attach the sensor head to airway adapter. 11 Ensure that the sensor head is always positioned above the ventilator circuit so that moisture will not enter the adapter.

Patient Connection

Respiration can be monitored via an endotracheal or tracheostomy tube. Mainstream capnography is a highly accurate method of measuring respiratory gas values and there are several variations of closed circuit tracheal suction systems that can be used with Spacelabs Medical capnography units. Spacelabs Medical recommends the Ballard style tracheal suction system.

Ballard Style Tracheal Suction System The Ballard style tracheal suction system is used to extend the life of the trach tube and associated tubing by enabling the trach tube to be periodically suctioned out without having to detach it from the ventilator circuit. When using the closed circuit tracheal suction system with Spacelabs Medical capnography units, the Ballard Model #221 elbow closed tracheal suction system, or similar system, is recommended (refer to the lower right of Figure 29-1: Ballard Setups). This setup allows the Spacelabs Medical airway adapter to be placed outside the tube through which fluids are being suctioned, reducing the chance of occluding the airway adapter. In the traditional setup, using the Ballard Model 2205 style, the airway adapter is in-line with the endotracheal tube (refer to the figure on the lower left). This is not recommended. However, if you prefer this setup, use the Ballard Model 112 adapter that will move the airway adapter away from the suction catheter. Figure 29-1: Ballard Setups show examples of the recommended Ballard setups. Similar closed systems, such as Concord Portex (not shown), must be placed in the ventilator circuit in the same positions as shown in Figure 29-1: Ballard Setups.

suction catheter

suction catheter Ballard Adapter #112 sensor head

ventilator circuit

sensor head

ventilator circuit

mainstream airway adapter

endotracheal tube endotracheal tube

Ballard Closed Tracheal Suction System with Adapter (Model 2205/Adapter #112)

Ballard Elbow Closed Tracheal Suction System (Model 221) Figure 29-1: Ballard Setups

29-4

Capnography

When you first power on the module, the vertical GAS parameter key is displayed adjacent to a flat baseline.

•

Capnography is not monitored during unit warm-up.

•

The typical initial warm-up period is 2 to 5 minutes. This time period is dependent on the temperature of the sensor (5 minutes is the maximum warm-up time).

•

The capnograph module is protected against the affects of a cardiac defibrillation discharge, and it is safe to use on patients with a cardiac pacemaker or other electrical stimulation.

•

When you operate the capnograph on patients that emit excessive mucous, the airway adapter may require regular cleaning or replacement.

29-5

Ultraview Care Network

Display Detail When you connect the capnography device to a monitor, the waveform area is displayed in one of four formats, the large and small text formats in normal or view alarms modes. Instructions for choosing a format are detailed later in this manual. The full screen, large text format is the default display for bedside monitors. The full screen, small text format in VIEW ALARMS is the only display format for the full screen remote view monitors. The split screen central format is available only for central monitors operating in split screen mode. The screen displays are shown below.

쐃

G A S

쐇

ETCO2= 30 mmHg O2= 20% MINCO2= 0 mmHg RR= 6 BPM

쐋 쐏 쐂

bedside screen in small text (waveform on)

쐄 O2 COMP ON N2O COMP ON

쐃

쐂

6 0

30 20

G A S

BPM MINCO2

쐇

mmHg

쐄

쐋

ETCO2 mmHg O2

쐏

bedside screen in large text (waveform off)

쐂 O2 COMP ON N2O COMP ON

ETCO2 O2

45 APNEA 0 RR 80 15 MINCO2

쐄

30 30 1 5

G A S

쐇

쐃

30 20

ETCO2 mmHg O2 %

bedside screen in large text during view alarms (waveform off)

29-6

쐏

쐋

Capnography

쐃 O2 COMP ON N2O COMP ON

ETCO2 O2

45 0 80 15

APNEA RR MINCO2

G A S

30 30 1 5

쐇

ETCO2= 40 mmHg O2= 18% MINCO2= 2 mmHg RR= 12 BPM

ETCO2 = 3.2 MINCO2= 0.5

쐏

split screen

쐄

쐇

쐃

G A S

쐏

쐂

full remote view (waveform off)

ETCO2= 40 mmHg O2= 18% APNEA= 30 s RR= 12 BPM MINCO2= 32 mmHg

쐋

O2= 21 RR= 23

numeric key

쐄

쐃 Gas screen key 쐇 End tidal carbon dioxide data 쐋 Oxygen data 쐏 Alarms ON bell (refer to table below) 쐄 Minimum inspired carbon dioxide data 쐂 Respiratory rate

Alarm Status and Display Alarm Status

Bell Display

At least one alarm ON

Present

At least one alarm ON & violated

Flashing

All alarms OFF

Replaced with GAS ALM OFF in reverse video

At least one alarm on and alarms temporarily suspended by monitor

Replaced with GAS ALM SUSP in reverse video

At least one alarm ON and violated, and alarms temporarily suspended by monitor

Replaced with flashing GAS ALM SUSP in reverse video

Figure 29-2: Alarm Status and Display

29-7

Ultraview Care Network

Setting Alarm Limits To set gas alarm limits: 1 2 3 4 5 6

Touch GAS. Touch ALARM LIMITS. Select the parameter for which you wish to set alarm limits. Touch ON for the parameter selected in step 3. Select the HI=, LO=, or APNEA= alarm. Use the arrow keys to set the high and/or low alarm limits or the apnea alarm delay time. Touch PREVIOUS MENU to select another parameter for setting alarm limits. Repeat steps 3 through 7 until all limits are set. Monitored Parameter

You may set high and low alarm limits for respiratory rate, ETCO2, and O2, only high limit for minimum CO2, and the apnea alarm delay time. You may modify limits for any of the monitored parameters. Factory-set default values appear for alarm limits when you initially power up the unit. Factory default settings and ranges for alarm limits are shown on the table below. Refer to Alarms on page 2-1 for additional information on alarms. The VIEW ALARMS format with small text selected is the default display for all full screen remote. In this format, all text is cleared from the waveform zone and the labels and alarm limits of respiratory rate, ETCO2, O2, minimum CO2, and apnea are displayed. The VIEW ALARMS screen is the only format that displays the alarm limits.

Low alarm minimum

Low alarm maximum

Low alarm default

High alarm minimum

High alarm maximum

High alarm default

Minimum separation

Resolution

0.0

9.9†

0.1

10.0†

0.1

0.0

9.9

0.1

10.0

0.1

RR BPM

145

150

1 for 1 - 30 5 when > 30

APNEA sec

—

MINCO2%

—

0.1

9.9

1.0

—

0.1

MINCO2 mmHg

—

MINCO2kPa

—

0.1

9.9

1.0

—

0.1

100

1 for 1 - 30 5 when > 30

ETCO2% ETCO2 mmHg ETCO2 kPa

O 2%

Figure 29-3: Alarm Limit Ranges * High alarm defaults are +15% of their displayed value; low alarm defaults are -15% of their displayed value. ** Respiration defaults: RR < 12 RR > 12 RR < 20 RR > 20

29-8

LO = 1BPM LO = RR x 0.5 (Truncated to the next lower resolution) HI = 30BPM HI = RR x 1.5 (Rounded to the next higher resolution)

Capnography

† When the units of measure key is set to %, the maximum high and low alarm limits for EtCO2 depend on the current barometric pressure.

•

If the EtCO2 reading is 0 when you first turn on alarms and the units are set to mmHg, the low limit is 0 and the high limit is 1. If the units are set to percent or kPa, the low limit is 0.0 and the high limit is 0.1.

•

If your module is equipped with the Module Configuration Manager feature you can define your own alarm defaults.

Adjusting the Waveform Size To adjust the waveform scale size: 1 2 3 4

Touch GAS. Touch SETUP. Touch SIZE. Select 0-80 mmHg (0-10.7 kPa), 0-60 mmHg (0-8.0 kPa), or 0-40 mmHg (0-5.3 kPa).

The capnography waveform can appear on your monitor in three scale sizes: 0 to 40 mmHg (0 to 5.3 kPa), 0 to 60 mmHg (0 to 8.0 kPa), or 0 to 80 mmHg (0 to 10.7 kPa).

Turning the Waveform Display Off To turn the waveform display OFF: 1 2 3 4

You can turn the capnography waveform OFF.

Touch GAS. Touch SETUP. Touch SIZE. Select WAVEFORM OFF.

Selecting a Unit of Measure To select a measurement unit: 1 2 3

Touch GAS. Touch SETUP. Select PERCENT or mmHg (kPa).

You can monitor capnography values as a percentage or in millimeters of mercury (mmHg).

Selecting a Sweep Speed To select a sweep speed: 1 2 3 4

Touch GAS. Touch SETUP. Touch SWEEP SPEED. Select desired sweep speed.

You can view capnography waveforms at any of the following sweep speeds: 25, 12.5, 6.25, 3.12, or 1.56 mm/second.

29-9

Ultraview Care Network

Adjusting the Tone Volume To adjust the tone volume: 1 2 3 4 5

Touch GAS. Touch SETUP. Touch RESP TONE. Select RESP TONE ON. Use arrow keys to adjust the volume.

You can adjust the volume of the respiration cycle tone that sounds at the peak of the respiration cycle.

Turning the Tone Off To turn tone OFF: 1 2 3 4

You can turn the respiration cycle tone OFF.

Touch GAS. Touch SETUP. Touch RESP TONE. Select RESP TONE OFF.

Selecting a Text Format To switch text formats: 1 2 3

Touch GAS. Touch SETUP. Select LARGE TXT or SMALL TXT.

You can change display formats for capnography by switching between large and small text (refer to Display Detail on page 29-6).

Freezing the Waveform To freeze the gas waveform: 1 2

Touch GAS. Select FREEZE ON.

You can freeze the gas waveform display at any time. The waveform stays frozen until you press the FREEZE ON/OFF key again or until you press the NORMAL SCREEN key.

Calibrating O2 To calibrate O2: 1 2 3 4

Touch GAS. Touch CAL. Touch O2 CAL. Disconnect O2 cell and press ZERO. 5 Reconnect O2 cell. 6 Ensure that O2 cell is in room air. 7 Touch ROOM O2 SPAN. 8 If >60% O2 is being delivered, perform 100% O2 span. 9 Flow 100% O2 through the O2 airway adapter and wait for O2 readings to stabilize. 10 Touch 100% O2 SPAN.

29-10

A ZERO calibration establishes baseline values for the oxygen channel. A message will appear prompting you to perform a ZERO calibration if it is required.

â&#x20AC;˘

To minimize patient disruptions perform O2 zero and span procedures prior to placing the adapter in the ventilator circuit.

A room O2 span calibration uses room air to do a span calibration of the oxygen channel. If more than 60% O2 is being delivered to the patient, perform 100% span. This ensures accuracy at the higher levels of O2. Authorized service personnel use the 100% O2 span calibration to calibrate the response of the oxygen channel to 100% O2.

Capnography

Calibrating the Airway Adapter To calibrate the airway adapter: 1 2 3 4 5 6 7

Touch GAS. Touch CAL. Select appropriate airway adapter (neonate or adult). Place sensor head over the airway adapter. Place the sensor and adapter away from all sources of CO2. Touch ADAPTER CAL. Touch START.

Adapter calibration compensates for the optical differences between the adult and neonatal airway adapters. Adapter calibration needs to be performed each time you switch from an adult airway adapter to a neonatal airway adapter.

•

During calibration, keep the sensor and airway adapter away from all sources of CO2 (including the patient’s and your own exhaled breath, and ventilator exhaust valves).

Calibrating the CO2 Sensor To calibrate the CO2 sensor: 1

2 3

Remove the airway adapter from the sensor head (if present). Place the sensor on the zero cell. When the message ZERO CAL COMPLETE appears, remove the sensor from the zero cell and place it on the reference cell. When the message CALIBRATION VERIFIED appears, remove the sensor from the reference cell (An airway adapter cal may be required). Sensor is ready for use.

The CO2 sensor does not require calibration at each power up. Calibration is only necessary the first time the sensor is connected, or when the monitor requests it, (when a CAL REQUIRED message is displayed). Once calibrated, the sensor can be unplugged and reconnected without having to recalibrate. However, if a second sensor is connected in place of the original, the new sensor must be calibrated. If the original sensor is reconnected, it too will have to be recalibrated.

•

To maintain optimum performance of the sensor and capnograph, you should perform a calibration verification of the sensor at least once a week.

To verify the sensor calibration: 1

2 3

Remove the airway adapter from the sensor head (if present). Place the sensor on the reference cell. When the message CALIBRATION VERIFIED appears, remove the sensor from the reference cell (An airway adapter cal may be required). Sensor is ready for use.

29-11

Ultraview Care Network

Performing a 100% O2 Span To perform a 100% O2 span 1 2 3 4

Touch GAS. Touch CAL. Touch O2 CAL. Flow 100% O2 through the O2 airway adapter and wait for O2 readings to stabilize. Touch 100% O2 SPAN.

The O2 span function sets the level for oxygen so that the display reads 100% when pure oxygen is input to the unit. For improved accuracy, perform a 100% O2 span if the O2 being monitored is greater than 60%.

Selecting Gas Compensation To select gas compensation: 1 2 3 4

5 6

Touch GAS. Touch COMP. Select N2O ON, if N2O is greater than 50%. Touch O2 AUTO to automatically select COMP, if O2 cell is present. Select O2 MAN, if no O2 cell is present. Select O2 ON, if O2 is greater than 60%.

The measurement of CO2 by infrared analysis is affected by the presence of oxygen and nitrous oxide. The module must be set up with the appropriate compensations turned on in order to obtain accurate end-tidal CO2 readings when increased levels of O2 (greater than 60%), or N2O (greater than 50%) are present in the airway.

•

High concentrations of O2 will cause a lower than expected CO2 reading while a high N2O level will cause a higher than expected CO2 reading.

Restoring Default Settings To restore default settings: 1 2 3 4

Touch GAS. Touch SETUP. Touch RESTORE SETTINGS. Select YES.

29-12

With the Module Configuration Manager feature, you can restore all default settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-5.

•

Module Configuration Manager is an optional feature for some modules. Your module may not contain this option.

•

RESTORE SETTINGS changes the user-configurable options for all parameters in the module.

Capnography Troubleshooting Guide The capnography module displays error messages in the gas waveform zone. Many of these messages also trigger an alarm. If the menu line is available, the monitor displays messages there as well. The table below provides the text, meaning and suggested response to these messages.

Problem or Message SERVICE REQUIRED Send for repair

Probable Cause(s)

Suggested Response

Alarm Sounds

■ Incompatible or faulty sensor. ■ Barometric pressure reading

■ Return to factory for repair or ■ use compatable sensor.

■ Yes

■ Remove the excessive heat

■ Yes

error.

■ Module self-test failure. SENSOR OVER TEMPERATURE

WARMING UP

■ Sensor is exposed to extreme heat.

■ Module or sensor was just plugged in.

PLACE ADAPTER IN RM AIR

ADAPTER CAL IN PROGRESS

ADAPTER CAL ERROR Perform adapter cal

NOT CALIBRATED Place adapter in room air

ADAPTER ERROR Check airway adapter

■ The adapter calibration menu is accessed.

■ An airway adapter calibration sequence is in progress.

■ An error was found during the airway adapter calibration.

■ An airway adapter calibration was started, but either the sensor is not ready, or the sensor is on the zero or reference cell, or some CO2 or a breath has been detected in the last 20 seconds.

■ Airway adapter is removed from the sensor head.

■ Optical blockage on airway adapter windows.

■ Adapter calibration was not performed.

source from the sensor. If problem persists, return to factory for repairs.

■ Allow two to five minutes to

■ No

warm up

■ Either place the sensor head

■ No

and the airway adapter in room air and start an airway adapter calibration, or leave the adapter calibration menu.

■ Wait until adapter calibration

■ No

is completed and message goes away.

■ Place the sensor head and

■ Yes

the airway adapter in room air and away from any source of CO2 and perform an airway adapter calibration. If the problem persists, return to factory for repairs

■ Place the sensor head and

■ Yes

the airway adapter in room air and away from any source of CO2 and perform an airway adapter calibration. If problem persists, return to factory for repairs.

■ Snap airway adapter back into the sensor head.

■ Clean or replace the airway adapter.

■ Perform an airway adapter calibration.

■ Yes

Problem or Message CO2 CAL IN PROGRESS

Probable Cause(s) ■ A zero calibration of the CO2 sensor is in progress.

ZERO CAL COMPLETE Place sensor on REF cell

CO2 ZERO CAL ERROR Perform zero calibration, or

SENSOR ERROR CO2 zero cal required

■ An error was found during the sensor zero calibration

■ A drift of the source current is detected since the last time that the sensor was either plugged in or zeroed

tion of the CO2 sensor is in progress.

CALIBRATION VERIFIED Remove sensor from cell

sensor is completed successfully.

■ A span or reference calibra-

CHECKING CALIBRATION

•

■ A zero calibration of the CO2

■ A reference calibration of the CO2 sensor is completed successfully.

Suggested Response ■ Wait for the message ZERO

Alarm Sounds ■ No

CAL COMPLETE to appear.

■ Remove the sensor head from

■ No

the zero cell and place it over the reference cell.

■ Perform a zero and a refer-

■ Yes

ence calibration. If the problem persists, return sensor to factory for repairs

■ Perform a zero and a refer-

■ Yes

ence calibration. If the problem persists, return sensor to factory for repairs

■ Wait for the CALIBRATION

■ No

VERIFIED message to appear.

■ Remove the sensor head from

■ No

the reference cell and place it over the airway adapter.

The unit does not analyze patient data while the monitor displays the above messages.

Problem or Message Low or high CO2 values are observed

ADAPTER CAL ABORTED

Probable Cause(s) ■ An airway adapter and/or sensor calibration is needed.

■ The airway adapter calibration was aborted by the user.

O2 ZERO COMPLETE

■ The zero calibration of the O2 sensor is completed successfully.

O2 ZERO REJECTED Zero value too high

21% O2 SPAN COMPLETE

O2 SPAN REJECTED Span value out of range

■ O2 cell was connected during zero.

■ The span calibration of the O2 sensor in room air is completed successfully.

Suggested Response ■ Perform a zero and a refer-

■ No

ence calibration, make sure an appropriate airway adapter is selected, and perform an airway adapter calibration. If problem persists, return to factory for repairs

■ Wait for the message to go

■ No

away.

■ Wait for the message to go

■ No

away.

■ Disconnect O2 cell and repeat

■ No

the O2 zero

■ Wait for the message to go

■ No

away.

■ O2 cell was not functioning

■ Replace O2 cell perform room

during the room O2 span.

O2 span. If problem persists, return to factory for repairs

■ O2 cell was not in room air

Alarm Sounds

■ No

■ Place the O2 sensor in room air and away from any source of higher level oxygen and perform room O2 span. If problem persists, return to factory for repairs

100% O2 SPAN COMPLETE

100% O2 SPAN FAILED O2 cell bad or 100% O2 not present

■ The span calibration of the O2 sensor using 100% oxygen is completed successfully.

■ O2 cell is wearing out

■ Wait for the message to go

■ Replace O2 cell and perform 100% O2 span. If problem persists, return to factory for repairs

■ 100% oxygen was not present in the O2 sensor airway adapter

■ No

away.

■ Make sure 100% O2 is present in the O2 sensor airway adapter and perform 100% O2 span. If problem persists, return to factory for repairs

■ No

Problem or Message O2 SPAN REQUIRED Perform a ROOM O2 SPAN

Probable Cause(s) ■ O2 cell requires new span when initially plugged in.

■ A drift in the O2 cell output voltage level was detected.

Suggested Response ■ Place the sensor in room air and away from any source of oxygen and perform room O2 span. If problem persists, return to factory for repairs

■ Place the sensor in room air and away from any source of oxygen and perform room O2 span. If problem persists, return to factory for repairs

Alarm Sounds ■ No

Multigas

Directory of Keys G A S

GAS - MAIN MENU ALARM LIMITS

SETUP

SELECT AGENT

FREEZE ON OFF

VIEW ALARMS

CAL

SUSPEND SAMPLING

GAS - SELECT AGENT MENU - AGENT TYPE DETECTED: XXX AUTO ID

HAL

ISO

ENF

SEV

DES

GAS - CAL MENU CHECK O2 SENSOR

BAR. PRESS. XXX mmHg

SERVICE CAL MODE

100% O2 SPAN

See your System Administrator for access to this key

PERCENT kPa

GAS - SETUP MENU SWEEP SPEED

SIZE

LARGE TEXT SMALL TEXT

PERCENT mmHg

PUMP SPEED

GAS - SETUP MENU - PUMP SPEED 50 ml/min

75 ml/min

100 ml/min

125 ml/min

150 ml/min

175 ml/min

200 ml/min

GAS - SETUP MENU - SWEEP SPEED 25 mm/sec

12.5 mm/sec

6.25 mm/sec

3.12 mm/sec

1.56 mm/sec

GAS - SETUP MENU - SIZE WAVEFORM ON OFF

0-80 mmHg

0-60 mmHg

0-40 mmHg

0-10.0 kPa

0-7.5 kPa

0-5.0 kPa

GAS - ALARM LIMITS MENU APNEA

ETCO2

I CO2

FiO2

FeO2

I N2O

E N2O

I AGNT

E AGNT

GAS - ALARM LIMITS MENU - APNEA APNEA ON OFF

APNEA RR

HI = OFF

GAS - ALARM LIMITS MENU - RR RR ON OFF

HI = OFF

•

LO = OFF

APNEA RR

Based on features purchased, more or fewer keys may appear here than on your menu screens.

30-1

Multigas

Contents Directory of Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Multigas Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Turning the Waveform Display Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Selecting a Sweep Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Selecting an Agent ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Selecting Stand By Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Selecting a Pump Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Freezing the Waveform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Replacing the Water Trap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Replacing the Gas Analyzer Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Initiating a Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Suspending Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Multigas Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Overview WARNING: • Always test the sampling line adapter for a tight connection and proper operation before attaching to a patient.

30-2

•

To protect the patient’s safety, do not silence, suspend, or disable audible alarms without providing continuous, direct observation of the patient.

•

Connect the sample gas outlet on the monitor’s rear panel to the scavenging system to prevent pollution of the room air.

•

Always unplug the monitor before cleaning to protect against electrical shock.

•

If any halogenated anesthetic agent other than halothane, enflurane, isoflurane, sevoflurane or desflurane is present, it will be misidentified and/or will interfere with the reported anesthetic agent concentrations.

Multigas

CAUTION: • When administering anesthetic agents, incorrect agent identification may occur when a mixture of sevoflurane and enflurane occur in the sample circuit.

•

When administering anesthetic agents, always verify your anesthetic vaporizer setting.

•

Use only original Spacelabs Medical sampling lines and accessories; other sampling lines may cause inaccurate readings and malfunctions.

•

The diameter of the scavenging system line must be two to three times larger than the sample line tubing to avoid changes in the operating pressure of the monitor, and consequential inaccurate readings or internal damage.

•

Route the scavenger hose so that it does not kink during operation of the monitor. A kinked or partially kinked scavenger hose can impair performance of the monitor.

•

Check the water trap container regularly during monitoring. The water trap is disposable.

•

Replace the sampling line and check the water trap container between each patient.

•

The Spacelabs Medical sampling lines are for single-patient use only. Cleaning deteriorates the properties of the sampling line, resulting in slower response time and more frequent occlusions.

The Spacelabs Medical Multigas Analyzer simultaneously monitors gas concentrations and alerts clinical personnel when the concentration of anesthetic agents, oxygen, carbon dioxide, or nitrous oxide falls outside of defined limits. The anesthetic agent being administered is automatically identified. The analyzer is for use primarily in the operating room, but can be used with any Ultraview Care Network or PCMS monitor. Although the analyzer sounds an alarm when the duration between monitored breaths exceeds user-defined limits, it is not intended to be a primary diagnostic apnea monitor and/or recordingdevice. WARNING: • To avoid explosion hazards, flammable anesthetic agents such as ether and cyclopropane must not be used in the analyzer. Only halothane (HAL), enflurane (ENF), isoflurane (ISO), sevoflurane (SEV), and desflurane (DES) are suitable for use with the analyzer. •

The use of antistatic or electrically conductive breathing tubes when using high-frequency electrosurgery equipment may increase the risk of burns and is, therefore, not recommended in any application of this anesthetic monitor.

•

The analyzer is not intended for use in an MRI environment.

30-3

Ultraview Care Network

CAUTION: • If the patient’s airway is configured with a closed suctioning system, the airway adapter must be placed near the suctioning system (on the ventilator side). This helps to ensure that the sampling adapter is not impaired during and after suctioning.

•

Do not use cellular phones or other wireless communications equipment near the analyzer.

•

U.S. Federal law restricts this device to sale by or on the order of a physician.

•

Before you administer nebulized drugs to a patient that is connected to the multigas analyzer, you must disconnect the sample line from the patient or stop the pump by using the SUSPEND SAMPLING key.

•

To facilitate disconnecting and reconnecting the sample line, use a T-connector in the patient airway circuit and keep the sampling suspended, until all nebulized drugs have cleared from the patient’s airway.

Multigas Analyzer

POWER ON OCCLUSION WATER TRAP FULL STAND BY

Gas analyzer filter access door Sample line

Water trap

Stand by switch

Product Orientation Up

Figure 30-1: Analyzer Front Panel Controls and Indicators

30-4

Multigas

Scavenger port SDLC connector

SDLC Pb J2

! J3

Power switch

MAINS J4

CAUTION

! 50/60 Hz 1A/100-240V~ T1.0A/250V

AC power input receptacle

Fan filter

Fuse block USE SPECIFIED FUSES

Figure 30-2: Analyzer Rear Panel Controls and Indicators

Multigas Setup To connect the multigas analyzer: 1

2 3

Verify that the power cord is connected as required by local standards. Assemble the cables necessary for the desired configuration. Connect the T cable between the multigas analyzer and the monitor. Connect the SDLC terminator to the T cable.

Before you put the unit into service, it must be unpacked and the exterior inspected for visible damage. A biomedical technician or an authorized Spacelabs Medical customer service representative should inspect the interior and exterior of the analyzer for signs of visible damage. Instructions for these procedures are in the 90518 Multigas Analyzer Service Manual P/N 070-0643-xx. Multigas Analyzer

monitor SDLC connector .... .....

T cable

SDLC terminator included with the analyzer

Figure 30-3: Monitor Connection

30-5

Ultraview Care Network

Patient Connection To start multigas monitoring when the unit is OFF: 1

5 6

8 9

Plug the device power cord into an AC power outlet and assure that the unit is connected to a monitor. If not present, insert the gas analyzer filter above the water trap and close the lid. If not present, insert the water trap cartridge with the patient connector on the right-hand side. Check to make certain that the Stand By switch is OFF (in the â&#x20AC;&#x153;outâ&#x20AC;? position). Turn power for the unit and monitor ON. Prepare the patient according to hospital procedures. Allow the analyzer to warm up for a minimum of 2 minutes. After thirty minutes, you will have full accuracy. Connect one end of the gas sample line to the gas sampling tee or breathing circuit and connect the other end to the water trap luer connection. Check for a good seal at the water trap cartridge top. During the use of anesthetic agents, ensure that the scavenge line connects to the scavenger port on the multigas analyzer's rear panel.

Respiration can be monitored via a nasal cannula, an oxygen mask, or an airway and endotracheal or tracheostomy tube. There are several variations of closed circuit tracheal suction systems that can be used with Spacelabs Medical multigas units. elbow

ventilator circuit

gas sampling tee

endotracheal tube

Figure 30-4: Example of Sidestream Multigas Setup for an Adult Prior to connecting to the patient airway, verify that there are no leaks in the sample line, water trap, and gas analyzer filter by sealing the end of the sample line with your thumb. After approximately 15 seconds, the Occlusion LED lights and an occlusion message appears on the monitor. If this does not occur within 30 seconds, check for an air leak by removing and carefully reinstalling the water trap, the gas analyzer filter, and the sample line. Repeat the test. WARNING: â&#x20AC;˘ Always test the sampling line adapter for a tight connection and proper operation before attaching to a patient.

Ballard Style Tracheal Suction System The Ballard style system is used to extend the life of the trach tube and associated tubing by enabling the trach tube to be periodically suctioned without having to detach it from the ventilator circuit. When using the Ballard closed circuit tracheal suction system with Spacelabs Medical multigas units, the Ballard Model #221 Elbow Closed Tracheal Suction System or other similar system is recommended. This setup allows the Spacelabs Medical gas sampling tee to be placed outside the tube through which fluids are being suctioned, which reduces the chance of occluding the gas sampling tee. In the traditional setup, using the Ballard Model 2205, the gas sampling tee is inline with the endotracheal tube. This setup is not recommended. If you prefer this setup, use the Ballard Model 112 adapter which moves the airway adapter away from the suction catheter. The following illustrations show examples of the recommended Ballard setups. Similar closed systems, such as Concord Portex (not shown), must be placed in the ventilator circuit in the same position as the Ballard setup illustrates.

30-6

Multigas

suction catheter

ventilator circuit ventilator circuit

gas sampling tee

Ballard adapter #112

gas sampling tee

endotracheal tube

Ballard Elbow Closed Tracheal Suction System (Model 221)

Ballard Closed Tracheal Suction System with Adapter (Model 2205/Adapter #112) Figure 30-5: Ballard Setups

CAUTION: • Use only original Spacelabs Medical sampling lines and accessories. Other sampling lines may cause inaccurate readings and malfunctions. The analyzer must use a sample line that is fabricated from a special material. Use of other sample lines results in erroneous readings. This sample line is color-coded as blue and is available from Spacelabs Medical. •

If you use the multigas analyzer with setups that do not include the Spacelabs Medical approved gas analyzer filters, and service inspection determines that patient fluids have contaminated the unit, your warranty will be nullified.

•

The diameter of the scavenging system line must be 2–3 times larger than the sample-out tubing to avoid changes in the operating pressure of the monitor, and consequential inaccurate readings or internal damage.

•

Route the scavenger hose so that it does not kink during operation of the monitor. A kinked or partially kinked scavenger hose can impair performance of the monitor.

30-7

Ultraview Care Network

Operation CO2, N2O, and anesthetic agents are measured by drawing a sample gas stream into the measuring chamber. The absorption of different infrared light wavelengths is measured here. A microprocessor compares these measurements to a zero concentration light-level to calculate the different gas concentrations. WARNING: • If any halogenated anesthetic agent other than halothane, enflurane, isoflurane, sevoflurane, or desflurane is present, it will be misidentified and/or will interfere with the reported anesthetic agent concentrations. CAUTION: • When administering anesthetic agents, incorrect agent identification may occur when a mixture of sevoflurane and enflurane occur in the sample circuit. •

When administering anesthetic agents, always verify your anesthetic vaporizer setting.

Oxygen concentration is measured using the micro-fuel cell sensing technology. During the sensing process, the oxygen molecules in the sampled gas diffuse through the sensing membrane and become reduced at the sensing electrode, creating a current signal. The current signal is proportional to the oxygen partial pressure in the sampled gas. The fast response of the oxygen measurement is achieved by combining a unique design of the pneumatic sampling system, fast sensing membrane, and state-of-the-art signal processing electronics. Because this method of measurement has a fast response time, inspired and expired values of O2 can be reported. The analyzer uses a side-stream sampling technique to acquire respiratory gases from an endotracheal tube, nasal cannula, or mask. A constant-flow vacuum system maintains the flow rate through the sample line. The analyzer is equipped with an external water trap to prevent humidity, water drops, and patient secretions from contaminating the unit or affecting the accuracy of the gas measurements. The water trap collects water drops that condense in the sample line. A “Water Trap Full” indicator warns you that the water trap should be replaced. The analyzer is also equipped with a filter as a second line of defense in case the water trap overflows or nebulized drugs are accidently drawn into the sample line. After the gas sample passes through the water trap and filter, it passes through a Nafion tube that is inside the analyzer. This helps to equalize the humidity of the gas sample so that it is close to the humidity of ambient air. CAUTION: • The analyzer cannot be operated without a water trap and a gas analyzer filter installed. •

30-8

Replace the water trap and gas analyzer filter as needed. Verify the water trap is not broken as a result of connecting the sample line fitting too tightly or by tugging on the sample line. A broken water trap results in low values due to room air entrainment. If a span calibration is performed with a broken water trap, patient values will be unusually high. Refer to Replacing the Water Trap on page 30-17 and Replacing the Gas Analyzer Filter on page 30-17 for details.

Multigas

•

Check the water trap container regularly during monitoring. The water trap is disposable.

•

Replace the sampling line and check the water trap container between each patient.

The analyzer automatically compensates for the ambient barometric pressure to ensure accurate readings. Both CO2 values may appear in partial pressure (in mmHg or kPa) or in percent. % Gas =

•

PARTIAL PRESSURE Gas X 100 BAROMETRIC PRESSURE

Respiration rate and alarm limit accuracies are not specified above 100 breaths per minute.

Powering ON the Unit Before powering the analyzer unit ON, assure that the unit is attached to a monitor and check to make certain that the Stand By switch is OFF (in the “out” position). Press POWER ON/OFF located on the rear panel. When you first power ON a properly installed multigas device, the green power-on LED lights within five seconds. Within 30 seconds the patient monitor displays the vertical GAS parameter key adjacent to a flat waveform. If this does not occur, verify that the POWER ON/OFF button is pressed and appears green, and that the front panel STAND BY button is not pressed. The analyzer must be connected to an AC power outlet. Verify that the appropriate SDLC cable and terminator are connected from the unit to the monitor. If the monitor or the module housing has a SDLC switch, check that the switch is in correct position (refer to the operations manual for the monitor or module housing). If the unit does not display on the monitor, turn the power to the analyzer off, then turn the power to the monitor off. Power on the monitor again, and then power on the analyzer again.

•

The analyzer is protected against the effects of a cardiac defibrillation discharge, and it is safe to use on patients with a cardiac pacemaker or other electrical stimulation.

•

When you operate the analyzer on patients that emit excessive mucous, use the filtered gas sampling tee to prevent patient fluids from clogging the sample line.

No multigas analyzer data appears during the warm-up period following power-on. Data first appears during the stabilization period. CAUTION: • The warm-up period is less than two minutes with full accuracy after 30 minutes. You may use it prior to full warm up but be aware of possible inaccuracies in gas analysis.

30-9

Ultraview Care Network

Display Detail When you connect the multigas device to a bedside Ultraview or PCMS monitor, the waveform area is displayed in one of four formats, depending on whether large or small text is selected and whether or not the VIEW ALARMS display is active. The full screen, large text format is the default display for the bedside monitors. For REVIEW ALARMS, refer to Setting Alarm Limits on page 30-12 and Figure 30-7: Multigas Full Screen Small Text with View Alarms. The small text format with VIEW ALARMS display activated is the only available display for the full screen remote view monitors. The split screen central format is available only on central monitors operating in the split screen mode.

Agent Parameter Label View When in AUTO ID mode, the inspired and expired agent labels are displayed in normal video, and in the MANUAL mode, the labels are displayed in reverse video. In MANUAL mode, full-screen large text view, the mixed condition is reported by displaying MIX under the parameter label area next to the units of measure. In the full-screen small text view, the parameter labels alternate between the mix label and agent type label. In AUTO ID mode, the agent labels are replaced by “I MIX” and “E MIX”. In all views, when a conflict is detected the agent label areas flash. In small text and split screen central displays, the agent numeric values also flash.

30-10

Multigas

ě?&#x192;

í˘˛

6 5

í˘ł

2.5 1.7

I N2O % E N2O %

ě?&#x2026;

I AGNT

í˘´ FiO2

21 17

% E AGNT

ě?&#x2030; RR bpm

FeO2

G A S

í˘¸

í˘š

0.5 5.2

í˘ˇ

I CO2 % ETCO2 %

í˘ś

í˘ľ

Full Screen Large Text

í˘ˇ G A S

E N2O

15 I AGNT 4.5 0.0 5 15 E AGNT 3.0 0 0.0

FiO2

40 20

FeO2 25 15

30 10

I CO2 2.0

APNEA 30

ETCO2 7.5 2.5

G A S

í˘ˇ

0.5 5.2

Numeric Key Display

ETCO2=5.2% FiO2= 21% RR=20BPM I N2O=6%

í˘ą

I CO2 % ETCO2

í˘ľ

í˘ś

Full Screen Large Text with VIEW ALARMS

ě?&#x2C6;

í˘ľ í˘˛

ě?&#x2030;

Full Screen Small Text I N2O

í˘ś í˘´ í˘ł

ETCO2=5.2% RR=20BPM FiO2=21% I AGNT=2.5% I N2O=6%

ě?&#x2030;

I CO2=0.5% RR=20BPM FiO2= 21% Split Screen Central I AGNT=2.5% I N2O=6%

ETCO2=5.2% APNEA=30s FeO2=17% E AGNT=1.7% E N2O=5%

G A S

BED1 DANIELS, R

ě&#x201D;&#x2C6; Figure 30-6: Display Screens

í˘ą Inspired nitrous oxide data

í˘¸ Fractional expired O2

í˘˛ Inspired agent

í˘š Expired agent

í˘ł Fractional inspired O2

ě?&#x2026; Expired nitrous oxide data

í˘´ Respiration rate in breaths/minute

ě?&#x2C6; Inspired carbon dioxide data

í˘ľ Alarms ON bell (refer to Table 1: Alarm

ě?&#x2030; Apnea alarm setting (the delay value)

Status and Display)

í˘ś End tidal carbon dioxide data

ě&#x201D;&#x2C6; Bed ID and patient name (remote displays only)

í˘ˇ Gas screen key

30-11

Ultraview Care Network

CAUTION: • If you see I AGNT or E AGNT next to numerics on the display, wait until HAL, DES, SEV, ISO, or ENF appear on the screen to indicate that the multigas analyzer recognizes the agent you are using. The displayed value is based on the coefficient factors of the last detected or selected agent type.

No Breath Mode View Normal mode of operation is in effect as long as breathing is detected. Twenty seconds after the last breath is detected, the analyzer switches to “no breath mode” automatically and the ETCO2, Resp rate, expired agent, FeO2, and expired N2O numeric values are shown as ???. The momentary data is displayed in place of the inspired numeric values.

Setting Alarm Limits To set gas alarm limits: 1 2 3 4 5

You may set alarm limits for the following:

Touch GAS. Touch ALARM LIMITS. Select the parameter for which you wish to set alarm limits. Touch ON for the parameter selected in step 3. Use the arrow keys to set the high and low alarm limit or the apnea alarm delay time. Touch PREVIOUS MENU to select another parameter for setting alarm limits. Repeat steps 3 through 6 until all limits are set.

• • • • • • • •

Apnea (delay is measured in seconds) - high limit RR (respiratory rate) - high and low limits ETCO2 - high and low limits I CO2 - high limit FiO2 - high and low limits FeO2 - high and low limits Inspired and Expired N2O - high and low limits Inspired and Expired Agent - high and low limits

Factory-set default values appear for alarm limits when you initially power up the multigas unit. You may modify limits for any of the monitored parameters. Default settings and ranges for alarm limits are shown in Table 2: Alarm Limit Ranges. Refer to Alarms on page 2-1 for additional information on alarms. The VIEW ALARMS display format is the default for all full screen remote and central monitors. In this format, all text is cleared from the waveform zone and ten sets of parameter labels and their alarm limits are displayed. This is the only mode that displays all alarm limits.

I N2O E N2O

15 I AGNT 4.5 0.0 5 15 E AGNT 3.0 0 0.0

FiO2

40 20

FeO2 25 15

30 10

I CO2 2.0

APNEA 30

ETCO2 7.5 2.5

G A S

ETCO2=5.2% RR=20BPM FiO2=21% I AGNT=2.5% I N2O=6%

Figure 30-7: Multigas Full Screen Small Text with VIEW ALARMS

30-12

Multigas

â&#x20AC;˘

The large alarm bell on full-sized screens operates as follows:

Table 1: Alarm Status and Display Alarm Status

Bell Display

At least one alarm is ON

Present

At least one alarm is ON & violated

Flashing

All alarms are OFF

Replaced with GAS ALM OFF in reverse video

At least one alarm is ON and alarms are temporarily suspended by monitor

Replaced with GAS ALM SUSP in reverse video

At least one alarm is ON and violated, and alarms are temporarily suspended by monitor

Replaced with flashing GAS ALM SUSP in reverse video

Table 2: Alarm Limit Ranges Low alarm minimum

Low alarm maximum

0.0

9.9

ETCO2 mmHg

ETCO2 kPa

0.0

9.9

0.1

10.0

0.1

I N2O%

E N2O%

RR BPM

170

175

1 for 1 - 30 5 when > 30

APNEA sec

I CO2%

0.1

9.9

1.0

0.1

I CO2 mmHg

I CO2 kPa

0.1

9.9

1.0

0.1

O2 Inspired (FiO2)

100

5 when > 30 Otherwise 1

O2 Expired (FeO2)

100

5 when > 30 Otherwise 1

Inspired Agent% HAL, ISO, ENF, DES, SEV

0.0

19.9

0.1

3.0

0.1

Expired Agent% HAL, ISO, ENF, DES, SEV

0.0

19.9

0.1

3.0

0.1

Monitored parameter ETCO2 %

Low alarm default *

High High alarm alarm minimum maximum 0.1

10.0

High alarm default *

Minimum separation 0.1

Resolution 0.1

30-13

Ultraview Care Network

* ETCO2 Learned Limits The factory default setting for ETCO2 limits is LEARNED. The limits are calculated when they are first turned on and are based on the following formulas: High limit = (1.15 x Current ETCO2 reading) rounded Low limit = (0.85 x Current ETCO2 reading) truncated If the current ETCO2 reading is 0 when the alarms are first turned on, special ETCO2 limits are defined. If mmHg is selected, the low and high limits are set to 0 and 1, respectively. If percent or kPa is selected, the low and high limits are set to 0.0 and 0.1, respectively. ** Resp Rate Learned Limits The factory default setting for Resp Rate limits is LEARNED. The limits will be calculated when they are first turned on and are based on the following formulas: High limit = (1.5 x Current Resp Rate) rounded Low limit = (0.5 x Current Resp Rate) truncated The learned high limit is set to 30 for Resp Rates of â&#x2030;¤20, and the learned low limit is set to 1 for Resp Rates of â&#x2030;¤12. The rounding and truncations are based on the resolution of the limit level and will always be whole numbers.

Adjusting Waveform Size To adjust the waveform scale size: 1 2 3 4

Touch GAS. Touch SETUP. Touch SIZE. Select 0-80 mmHg, 0-60 mmHg or 0-40 mmHg; or 0-10.0 kPa, 0-7.5 kPa, or 0-5.0 kPa.

The multigas waveform can appear on your monitor in any of three scale sizes: 0 to 80 mmHg, 0 to 60 mmHg or 0 to 40 mmHg (0 to 10.0 kPa, 0 to 7.5 kPa, or 0 to 5.0 kPa). You can also turn the multigas waveform OFF.

Turning the Waveform Display Off To turn the waveform display OFF: 1 2 3 4

Touch GAS. Touch SETUP. Touch SIZE. Select WAVEFORM OFF.

To reduce display clutter, the capnography waveform can be turned off while leaving the numerics visible. When the waveform is off, the size adjustment, sweep speed, and freeze keys are disabled.

Selecting a Unit of Measure To select a measurement unit: 1 2 3

Touch GAS. Touch SETUP. Select PERCENT of mmHg or PERCENT of kPa.

30-14

You can monitor CO2 values as a percentage (%), as millimeters of mercury (mmHg) or kiloPascal (kPa). If you want to use % as the measurement, press the PERCENT/mmHg (kPa) key until PERCENT is highlighted. If you want to measure in mmHg (kPa), press the PERCENT/mmHg (kPa) key until mmHg (kPa) is highlighted.

Multigas

Selecting a Sweep Speed To select a sweep speed: 1 2 3 4

Touch GAS. Touch SETUP. Touch SWEEP SPEED. Select desired sweep speed.

You can view multigas waveforms at any of the following sweep speeds: 25, 12.5, 6.25, 3.12, or 1.56 mm/second.

Selecting an Agent ID To select an Auto Agent ID: 1 2 3

Touch GAS. Touch SELECT AGENT. Touch AUTO ID.

You can manually choose an agent type by touching the SELECT AGENT key in the main menu which opens the agent selection sub-menu. The prompt line above the sub-menu identifies the detected agent: DES, SEV, ISO, HAL, ENF. MIX is displayed if more than one agent is detected, and NONE if the agent type is not identified.

To select Agent ID manually: 1 2 3

WARNING: • In the event an agent is selected manually, but not administered, the analyzer will detect the difference and begin flashing the detected agent’s label. This is to alert the clinician to possible errors.

Touch GAS. Touch SELECT AGENT. Select HAL, ENF, ISO, SEV, DES.

Touching the AUTO ID key sets the analyzer to automatically use the agent type detected. The five agent keys are the manual agent selection keys. Selecting one of the agent keys forces the analyzer to use and report the concentration levels based upon coefficient factors of the manually selected agent. In AUTO ID mode, if nonzero concentration levels are reported for more than two minutes and the agent type is not detected, the AUTO ID key flashes. If in manual mode and the selected agent type is different from the detected agent type, the key that is labeled with the detected agent flashes. The agent parameter label areas are flashed on all screens when a conflict is detected. A conflict is confirmed and the flashing stops when either a key is touched in the Select Agent menu or the Select Agent menu is exited. Conflict detection is restarted if: • •

the agent concentration level goes to zero for more than two minutes. an agent type is selected that is not the type currently selected and not the first agent type in conflict.

30-15

Ultraview Care Network

Selecting Stand By Mode To start multigas monitoring from Stand By mode: 1 2

5 6

Press Stand By to deactivate Stand By mode (switch is out). If not present, insert the gas analyzer filter above the water trap and close the lid. If not present, insert the water trap cartridge with the patient connector on the right-hand side. Connect the gas sample line to the gas sampling tee or breathing circuit and to the water trap at the luer connection. Check for a good seal at the water trap cartridge top. During the use of anesthetic agents, ensure that the scavenge line connects to the scavenger port on the multigas analyzerâ&#x20AC;&#x2122;s rear panel. When multigas monitoring is no longer needed, press Stand By (switch is in). Do not disconnect power to the analyzer or the monitor.

For fastest warm-up, use the STAND BY button on the front of the device between patient-monitoring intervals, instead of powering the unit off. This allows the analyzer to remain warm and calibrated. Press the front panel STAND BY button to initiate the Stand By mode. The analyzer display disappears from the monitor screen and the STAND BY light illuminates. Press STAND BY again to return the analyzer to its normal operating mode when multigas monitoring is needed again.

â&#x20AC;˘

Stand By mode should not be used for long periods of time (i.e. overnight).

Selecting a Pump Speed To select a pump speed: 1 2 3 4

Touch GAS. Touch SETUP. Touch PUMP SPEED. Select desired pump speed.

To switch text formats: 1 2 3

Touch GAS. Touch SETUP. Select LARGE TEXT or SMALL TEXT.

You may select any of the following volumes of air that are drawn for use in measuring gas values: 50, 75, 100, 125, 150, 175, or 200 ml/min or you may suspend sampling (pumps off).

Selecting a Text Format You can change display formats for multigas by switching between large and small text (refer to Display Detail on page 30-10).

Freezing the Waveform To freeze the gas waveform: 1 2

Touch GAS. Select FREEZE ON.

30-16

You can freeze the gas waveform display at any time. The waveform stays frozen until you press the FREEZE ON/OFF key again or until you press the NORMAL SCREEN key. When the waveform is frozen, the SIZE key in the SETUP menu is disabled.

Multigas

Replacing the Water Trap The water trap must be disposed of when full. To remove the water trap, grasp the water trap firmly and pull it down from underneath, then lower it from the assembly. To install a new water trap, grasp it from the bottom and insert it up and into the assembly.

Replacing the Gas Analyzer Filter The gas analyzer filter must be disposed of when occluded. To remove the gas analyzer filter, lift the filter door, grasp the filter tab, lift up, and remove. To install the filter, open the filter door, hold the filter by the tab (with the gasket down) and place it into the recess. Close the door after insertion. WARNING: â&#x20AC;˘ The used water trap and gas analyzer filter may contain hazardous fluids and should be disposed of in accordance with hospital procedures.

Initiating a Calibration To check O2 sensor: 1 2 3 4 5

Allow unit to stabilize (4 minutes). Touch GAS. Touch CAL. Touch CHECK O2 SENSOR. At completion of test, normal monitoring will resume.

Check O2 Sensor Test The oxygen channel may drift slightly over time, therefore a check O2 sensor test should be performed daily. This test uses room air to check for aging of the oxygen sensor and may be performed at any time (except during the first 4 minutes of operation). The check does not require special equipment or additional gases. If drift or aging of the sensor is detected, the 100% O2 SPAN REQUIRED message will be displayed and a 100% O2 span must then be performed to calibrate the sensor. CAUTION: â&#x20AC;˘ If the message ??? appears in the numerics of FiO2 and FeO2 at any time you are monitoring a patient, you must perform a check O2 sensor test.

30-17

Ultraview Care Network

To span calibrate O2 sensor with 100% O2: 1

Allow unit to stabilize for 30 minutes. 2 Touch GAS. 3 Touch CAL. 4 Disconnect the sample line from patient. 5 Connect the sample line to 100% oxygen supply through a T-adapter. 6 Adjust the oxygen supply to flow through the T-adapter at a rate of approximately 500 ml/min. 7 Wait for O2 value to stabilize. 8 Touch 100% O2 SPAN. 9 Select YES. 10 At completion of test, normal monitoring will resume.

100% O2 Span Calibration The check O2 sensor test displays a message when a 100% O2 span is necessary to calibrate the sensor. Spacelabs Medical service personnel or your hospital biomed uses the 100% O2 Span calibration to calibrate the response of the oxygen channel to 100% O2. This function sets the level for oxygen so the screen displays “100%” when pure oxygen is input to the unit. Perform this calibration as needed. Refer to the 90518 Multigas Analyzer Service Manual P/N 070-0643-xx for details. CAUTION: • Performing a 100% O2 span calibration without using the proper concentration and flow of oxygen will result in failure of the gas analyzer.

Autozero Calibration To guarantee accurate readings, the zero reference of the multigas analyzer is automatically calibrated on a regular basis. The interval between automatic calibrations depends upon the amount of time the unit operates (either in normal or stand by mode). After the unit has been ON for at least 30 minutes, and has become thermally stable, autozero occurs in normal mode at approximately 10 minute intervals.

Pump Calibration This function is used by service personnel to adjust the pump flow rate. Refer to the 90518 Multigas Analyzer Service Manual P/N 070-0643-xx for details.

Gas Span Calibration A gas span calibration is recommended whenever gas values appear to be too low or too high. However, always perform a leak test first to verify that the erroneous values are not the result of a leak (poor connection, cracked water trap, etc.). The gas calibration (SPAN) procedure is used to recalibrate the gas channels for CO2, N2O, and anesthetic agents. It is recommended that it be done every 30-90 days. Equipment required for this calibration includes a gas mixture for the calibration, calibration adapter kit, gas pressure regulator, and flow meter. This equipment can be purchased from Spacelabs Medical Supplies Products. WARNING: • Perform a leak test before performing a gas span calibration. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details. Performing a gas span calibration without the calibrated gas mixture connected adversely affects the accuracy of the analyzer. •

30-18

Gas span calibrations should be performed by trained personnel only.

Multigas

Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details on calibrating the analyzer.

•

The waveform display and the numeric values may disappear during calibration.

Suspending Sampling To suspend sampling:

Sampling may be suspended by touching the SUSPEND SAMPLING key when

1 2 3

• • •

Touch GAS. Touch SUSPEND SAMPLING. Touch RESUME SAMPLING when finished.

suctioning a patient. use (by the patient) is temporarily discontinued. nebulized drugs are being used.

This stops the sampling pump and keeps the system free of debris. Touch the RESUME SAMPLING key to resume sampling. CAUTION: • The suspension of sampling must be disabled to resume proper monitoring of respiratory gases.

When sampling is suspended, the CAL key is disabled. Refer to Patient Connection on page 30-6 for examples of recommended suction system setups.

Cleaning and Sterilization Disposable patient accessories are available for use with the analyzer. Some disposable accessories are for single-patient use only. Do not sterilize or clean any disposable patient accessory for reuse on another patient. Refer to the instructions provided with the accessory.

•

The Spacelabs Medical sampling lines are for single-patient use only. Cleaning deteriorates the properties of the sampling line, resulting in slower response time and more frequent occlusions.

The accessory instructions also contain any applicable warnings regarding the use of the accessory. Read the instructions carefully before using the accessory.

Fan Filter The analyzer has a fan filter located on the rear panel. It must be kept free from dust and other contaminants.

30-19

Ultraview Care Network

Batteries The analyzer contains two lead-acid batteries used to provide short-term operation during a power failure. The analyzer retains the operating configuration for up to 5 minutes during an AC power interruption. The batteries should be replaced every year.

All batteries should be disposed of properly to protect the environment. Lithium batteries should be fully discharged before disposal. Batteries such as lead-acid (Pb) and nickelcadmium (Ni-Cd) must be recycled. Please follow your internal procedures and/or local (provincial) laws regarding disposal or recycling.

CO2 Scrubber The analyzer contains an internal CO2 scrubber which must be replaced every year. Refer to the 90518 Multigas Analyzer Service Manual P/N 070-0643-xx for details on replacing the CO2 scrubber, and cleaning and sterilization procedures.

30-20

Multigas Troubleshooting Guide The analyzer displays error messages in the gas waveform zone. Many of these messages also trigger an alarm. If the prompt line is available, the monitor displays messages there as well.

Clinical Situation FILTER DOOR OPEN Close filter access door OCCLUSION Check T-adapter, sample line

Possible Cause ■ The gas analyzer filter door is ajar.

■ The sample line is blocked. ■ The gas analyzer filter is

Solution ■ Close the door by pressing it

Alarm Sounds ■ Yes

downward.

■ Check the sample line for block-

■ Yes

age or crimps, and replace as necessary. Replace the gas analyzer filter cartridge.

plugged. SPAN IN PROGRESS

■ One of the span calibration procedures is in progress.

■ The unit is self testing or

WARMING UP

warming up. WATER TRAP ABSENT -Install water trap WATER TRAP FULL Replace or empty

•

■ There is no water trap installed

■ Wait until span calibration is

■ No

completed and message goes away.

■ Wait until warm up completes

■ No

before operating.

■ Install a water trap.

■ Yes

■ Replace the water trap.

■ Yes

in the holder.

■ The water trap is full.

The unit does not analyze patient data while the monitor displays the above messages.

Clinical Situation 100% O2 SPAN FAILED - Check 100% O2 gas supply, Check for leaks

Possible Cause ■ Sampled gas supply does not

Solution ■ Verify the O2 supply. Allow the

have 100% O2 present when compared to room air O2.

analyzer to warm up for at least 30 minutes before attempting a 100% O2 span.

■ Air leak in external sample cir-

■ Check water trap, water trap filter,

cuit.

■ Air leak in internal sample circuit.

■ External/internal pressures may be out of operating range or measurement of the pressures has failed.

■ O2 cell linearity error.

Alarm Sounds ■ Yes

and sample lines for air leaks. Replace all leaking components.

■ Perform a unit leak test. Service may be required.

■ Check that the cell pressure in SERVICE CAL MODE is between 525-825 mmHg. If the cell pressure is greater than the barometric pressure, external sample circuit is over pressured, adjust circuit.

■ Contact your Biomed or your Spacelabs Medical service representative.

100% O2 SPAN FAILED O2 cell replacement required 100% O2 SPAN REQUIRED

■ O2 cell output is below acceptable ■ Contact your Biomed or your levels, O2 values are disabled.

■ Initial 100% O2 CAL required.

■ Yes

Spacelabs Medical service representative.

■ Perform 100% O2 SPAN.

■ Yes

■ CHECK O2 SENSOR determined ■ Perform 100% O2 SPAN. need for 100% O2 span to restore specified O2 accuracy. CAL GAS SPAN FAILED Check span gas supply O2 CELL REPLACEMENT REQUIRED O2 INSTALLATION FAILED - O2 install cal requires new O2 cell

O2 SPAN FAILED Check exhaust port

■ The unit could not calibrate the gas channel.

■ Previous O2 span determined that O2 cell has aged to the point of needing replacement.

■ Repeat the span. Contact a quali- ■ Yes fied service person if the span fails again.

■ Contact your Biomed or your

■ Install cal detected an O2 cell out- ■ Contact your Biomed or your put above or below the allowable threshold for a new O2 cell.

■ Exhaust port is blocked.

■ Yes

Spacelabs Medical service representative.

■ Yes

Spacelabs Medical service representative.

■ Remove exhaust port blockage and repeat the SPAN. If the SPAN fails again, contact a qualified service person.

■ Yes

Clinical Situation

Possible Cause

Solution

■ O2 sensor assembly output is

■ After checking exhaust port, if

very negative.

RAW = 0 in SERVICE CAL MODE, service is required. Replacement of the O2 sensor electronics assembly is indicated.

■ O2 concentration may be more

■ Check the room air around the

than 23% or less than 19% in vicinity of the analyzer.

Alarm Sounds

analyzer for high O2 concentrations. Successful completion of O2 span is not possible under this condition.

•

The unit does not analyze patient data while the monitor displays the above messages.

•

For the above messages, while the gas channel menu is displayed, you can touch the NORMAL SCREEN key to remove the message from the waveform zone and stop the alarm tone. However, the message will continue to display on the monitor’s prompt line. Whenever a span failure occurs, the previous calibration factors are not lost. The analyzer continues to function and report the gas values, but the full accuracy of the values are not guaranteed.

Clinical Situation HIGH VALUES OBSERVED

LOW VALUES OBSERVED

Minimum waveform deflection and very low or zero numeric values when breathing normally through a new or unused sample line

Possible Cause ■ A span calibration was performed while there was a leak in the sample circuit.

■ A leak exists at the sample line connection, a water trap is broken at the luer connection, or a water trap filter is leaking.

■ Clogged or missing gas analyzer filter.

Solution ■ Check connections and check for a

Alarm Sounds ■ No

broken water trap. Perform leak test; refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.

■ Check connections and check for a

■ No

broken water trap. Perform leak test; refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.

■ Replace or install gas analyzer filter underneath the door above the water trap.

■ No

Clinical Situation MIX

Possible Cause ■ Agent mixture detected.

Solution ■ The analyzer is not designed to

Alarm Sounds ■ No

simultaneously measure multiple anesthetic agents. Erroneous numeric concentration values may be displayed when two or more agents are mixed.

NOTE: This message appears in agent numerics area.

■ The displayed value of the mixed condition is based on the combined value of agents using the coefficient factors of the last detected or selected agent type.

■ When the analyzer detects an agent mixture:

■ In Auto ID Mode — The mixed condition is reported by displaying I MIX and E MIX as the agent lables on all screens.

■ In Manual ID Mode — In large text screen, the mixed condition is reported by displaying the word MIX under the parameter label area next to the units of measure. In the small text screen or the split screen central, the parameter lables will alternate between the mix labels in normal video and the selected agent-type labels in reverse video.

■ The display zones will continue with the above displays, until the mix of the agents has flushed from the patient and delivery system and a single agent identity has been detected.

■ Depending on the agents used, the residue in the patient, and the breathing or delivery system, mixed conditions can last for more than an hour.

■ If the message persists, contact a qualified service person. Zeros or ??? are displayed for one or more of the inspired gases (I N2O, I AGNT, FiO2, or I CO2)

■ No gas is being adminis■ ■ ■

tered. Sample line is not connected. A leak in the system or failure in one of the internal electronics parts.

■ Administer gas. ■ Check sample line connections, the ■

water trap cartridge, and the filter above the water trap cartridge. Perform a leak test; refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for more details. Cycle the power to the analyzer. If the problems persist, contact a qualified service person.

Ultraview Care Network Product Specifications 31

Contents System Safety Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Equipment Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Equipment Maintenance Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ultraview Care Network Module Compatibility. . . . . . . . . . . . . . . . . . . . . . . . . .

1 3 4 4

System Safety Specifications System Introduction and Network Basics on page 1-1 includes information concerning the interconnection of equipment within the Ultraview Care Network. Initial connection of auxiliary line-operated equipment to a monitor must be performed by a hospital biomedical engineer or a Spacelabs Medical Customer Service Representative. For further information or instructions regarding interconnection of units, contact a qualified service person or your local Spacelabs Medical representative. After installation and/or interconnection with other units, the equipment leakage current shall not exceed the local (provincial) acceptable values. Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC standards (that is, IEC 950 for data processing equipment and IEC 601-1 for medical equipment). All configurations shall comply with the system standard IEC 601-1-1+A1. Everyone who connects additional equipment to the signal input part or signal output part configures a medical system, and is, therefore, responsible to ensure that the system complies with the requirements of the system standard IEC 601-1-1+A1. If in doubt, consult the technical service department or your local customer service representative. All Spacelabs Medical equipment is intended for use with a fixed mains socketoutlet. If a system is configured using multiple portable socket-outlets, this system must be reviewed for compliance with IEC 601-1-1+A1, including the maximum load and enclosure leakage currents requirements. The multiple portable socket outlet cannot be placed on the floor. If the leakage limit is exceeded, a second Protective Earth, fixed at both ends with a tool, may be necessary. This second Protective Earth must be tested to the requirements of clause 18 of IEC 601-1. Equipment weighing more than 20 kg is not portable. To lift heavy equipment, support under corners and lift according to hospital procedures. Use of patient cables, transducers, sensors and supplies other than those specified by Spacelabs Medical may degrade equipment performance, including defibrillation protection.

31-1

Ultraview Care Network

Input leakage current for all patient input channels is less than 10 µA making ECG units suitable for direct cardiac application. The maximum non-destructive voltage that can be applied to any input or output connector on the monitors, modules or printers is +5 V. All signal inputs or outputs are for exclusive connection to equipment specified by Spacelabs Medical. Disposal of these devices and all accessories must be in accordance with local and federal laws. Table 1: Ultraview Care Network Products Power Rating Product

Frequency

Electrical Rating

Fuse Rating

90367/90369

50/60 Hz

100-240VAC 2.0-1.0A

N/A

90385/90363

50/60 Hz

2.5A/100-120V 1.3A/220-240V

2-T3A/250V 2-T3.15A/250V

90386

50/60 Hz

1.35A/100-120V 0.8A/220-240V

2T2A/250V 2-T1.25A/250V

90479-A

50/60 Hz

2A/115V 1A/230-240V

2-T2.5A/250V (Slow) 2-T1.6A/250V

90364/90387/90491/ 90499/94000

50/60 Hz

100-240V 2.0-1.0A

N/A

WARNING: • To protect against electrical shock, proper grounding is essential. •

If a monitor is in battery mode during defibrillation, the monitor must be properly grounded using the ground terminal provided on the rear panel or by using the protective ground in the power cord.

•

If the integrity of the external protective earth conductor is in doubt, the equipment must be operated from its internal power source (if applicable).

When interconnecting equipment, avoid using optional battery operation. If such operation cannot be avoided, the battery-operated instrument must be grounded using the ground terminal on the rear panel or the protective ground (earth) in the power cord. Power Cord: • •

3-wire, 18-gauge, hospital grade or 3-wire, 0.75mm2, European harmonized

Plug: •

3-terminal polarized, with protective ground WARNING: • Do not use a 3-to-2 plug adapter. •

31-2

Ground terminal of the plug is connected directly to the frame of the instrument. Any interruption of the grounding connector can create an electric shock hazard.

Ultraview Care Network Product Specifications

Equipment Classification All of the products listed below are classified as â&#x20AC;&#x153;Class 1- ordinary equipment (not protected against harmful ingress of liquids or flammable anesthetic mixtures), continuous operation.â&#x20AC;? In addition, the 90367, 90369, and 94000 are internally powered. Table 2: Equipment Classification Product

Type*

Product

Type*

90367/90369

Depends on module used BF-Defibrillator-proof with O2/CO2 option*

94000

B-FHR (Ultrasound) BF-UA CF-FECG Depends on module used

90478

90424

CF-Defibrillator-proof

90385/90363

Depends on module used

90482

90386

Depends on module used

90496

CF-Defibrillator-proof

90387/90364

Depends on module used

90491

Depends on module used

90426/29/30

BF-Defibrillator-proof

90513/14

BF-Defibrillator-proof

90449/69

90515/16

BF-Defibrillator-proof

90479

Depends on module used

90499

Depends on module used

* Refer to Symbols on page 34-1 for type definitions.

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Ultraview Care Network

Equipment Maintenance Requirements Corrective or maintenance procedures must be performed by qualified personnel. Periodic maintenance procedures are required every 12 months to verify that: • • •

the equipment is physically sound. resistance between the chassis ground connector on the rear panel and the protective ground of the mains input is not greater than 0.1 ohm. isolation resistance between ground and mains is greater than 2 meg-ohm.

While the equipment is operating normally verify that: • •

chassis leakage current is less than 100 µA. patient leakage current is less than 10 µA (Type CF), 100 µA (Types B and BF).

While the equipment is operating in single fault condition verify that: • •

chassis leakage current is less than 300 µA (100-120 V), 500 µA (220-240 V); patient leakage current is less than 50 µA (Type CF), 500 µA (Types B and BF).

Under non-optimal environmental conditions or periods of intense use, more frequent checks are recommended. If the equipment has been dropped, abused or damaged in any way (if the monitor or module becomes wet, for example), a qualified service person must verify that the unit is working correctly and that all safety features are intact. Visually inspect all patient cables each time the unit is used. Check for worn or damaged plastic covering, frayed or broken wires, cracked connections or any other signs of damage. Do not use cables which exhibit obvious damage.

Ultraview Care Network Module Compatibility If any function (NIBP, ECG, SpO2, etc.) on your system does not contain a feature described in this manual: •

•

Your product may contain an earlier version of software. Contact your customer service representative and refer to the original documentation that accompanied your system. Your system configuration may be different from that described in this manual. Refer to notes in this manual describing features where system configuration is likely to impact the available features.

Before moving a Ultraview Care Network module from one network to another, be certain that the module software version is compatible with that required by the second network. If in doubt, have a qualified service person verify compatibility between the module and the network.

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Cleaning and Sterilization 32

Contents Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tru-Cuff Noninvasive Blood Pressure Cuffs . . . . . . . . . . . . . . . . . . . . . . . . . . . Capnography Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cables and Lead Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ultrasound Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 1 2 2 3 4 4

Monitors To clean Ultraview Care Network monitor screens and covers, modules, processors, and printers use a cloth or swab that has been slightly dampened in a solution of warm water and a mild detergent. Avoid solvents which may damage the product cases. Follow your hospital protocol. CAUTION: • Use of cleaning agents other than those listed may cause degradation to the product’s plastic enclosure and labels. Questions or concerns regarding cleaning issues should be directed to Spacelabs Medical Technical Support.

Touchscreen Cleaning There is not a separate shield over the face of the screen on the UCW or Ultraview 1500. Clean the screen with a soft cloth moistened with either 70% alcohol OR soapy water.

•

Follow your hospital protocol for the handling of blood and body fluids.

•

Do not allow liquid to enter the monitor.

Accessories • •

Where provided, follow the manufacturers' instructions concerning disposable and reusable supplies. As applicable, follow your hospital protocol concerning cleaning, disinfection and/or sterilization of reusable supplies.

Use of patient cables, transducers, sensors or supplies other than those specified by Spacelabs Medical may degrade module performance.

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Ultraview Care Network

Tru-Cuff Noninvasive Blood Pressure Cuffs Tru-Cuff® Disposable Cuff The disposable cuff wrap is designed for single patient use. It is packaged nonsterile and cannot be soaked, rinsed or sterilized.

Tru-Cuff Reusable Cuff The reusable cuff is packaged non-sterile. It may be cleaned and disinfected with an enzymatic detergent and 10% solution of household bleach (5.25% sodium hypochlorite).

Cuff Cleaning and Disinfection Materials •

Enzymatic detergent such as ENZOL (US) or CEDEZYME (UK)

•

10% solution of household bleach (5.25% sodium hypochlorite) in distilled water

•

Soft cloths or bristle brushes

•

Spray bottles

Procedure 1.

Prepare the enzymatic detergent and bleach solutions in separate bottles per the manufacturer’s instructions.

Spray detergent liberally on cuff, allow to sit for one minute.

Remove detergent with a soft cloth. For persistent contamination, scrub with a soft bristled brush.

Rinse cuff thoroughly with distilled water.

Spray bleach solution on the affected area until saturated. Allow the cuff to sit for five minutes.

Remove any excess solution with a soft cloth and rinse again with distilled water. Allow two hours for air drying at ambient temperature.

Capnography Sensors Cleaning The capnography sensor and cable should be cleaned routinely, especially between patient uses. Before cleaning, make sure the sensor is disconnected from the module and/or monitor. Sensors and cable assemblies may be wiped using a cloth or swab dampened in alcohol or 10% bleach solutions. Mild

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Cleaning and Sterilization

detergents may also be used initially to remove any residual buildup. Sensor should be wiped immediately following cleaning with distilled water and then dried to remove any cleaning residue. CAUTION: • Under no circumstances should sensors be immersed in a solution of any type.

•

Do not autoclave the sensor.

•

Never use solvents, acetone, or abrasive cleaning agents.

•

Do not force the sensor onto the airway adapter.

•

Avoid undue stress on the sensor head and cable.

•

After unpacking, keep the sensor container. When not in use, disconnect the sensor from the module and/or monitor, clean, and place it into the container for safe keeping.

•

Sensor exposure to cleaning agents should be limited to a maximum of 15- to 20-minutes. Longer intervals of exposure could produce a slight dulling of the original surface finish.

Visually inspect the sensor, cable, and the airway adapters for any sign of physical damage. Verify that the plugs and connectors are in good working condition and that the pins and prongs are not bent. Use a cotton swab dampened with alcohol, or a mild soap, to carefully clean the windows of the sensor head and the calibration cells. Always remove any damaged or questionable sensor or airway adapter from service.

Cables and Lead Wires Cleaning Tru-Link cables and lead wires may be cleaned with the following agents: •

Mild soap and water solution

•

U.S. Pharmacopeia (USP) green soap

•

Sodium hypochlorite solution (1:10 dilution of household bleach in water)

•

Phenolic germicidal detergent solutions (1% aqueous solutions)

•

Isopropyl alcohol solution (70%)

To clean product: 1.

Prepare cleaning agent according to manufacturer’s instructions.

Saturate a clean cloth with designated cleaning agent.

Wipe off exposed surfaces of product.

Re-wipe product with clean water.

Wipe dry.

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Ultraview Care Network

Tape adhesive may be removed with Spacelabs Medical’s adhesive tape remover pads (P/N 392196-001).

•

The compatibility of Tru-Link products with chemical agents other than the type identified is unknown.

•

The effective use of any cleaning or disinfecting procedure is subject to the proper preparation of each agent per the manufacturer’s instructions.

CAUTION: • Do not immerse connector ends or cables in liquid.

Sterilization Tru-Link cable and lead wires are provided non-sterile. Following use they may be ethylene oxide (EO) sterilized. Follow standard hospital protocol for processing. CAUTION: • Do not steam autoclave.

•

Product is compatible with sterilization process. Actual product sterility is dependent on a qualified sterilization cycle and procedure.

Pulse Oximetry Sensors For cleaning information see the manufacturer’s instructions enclosed with each sensor.

Ultrasound Transducers Basic cleaning should be performed regularly to ensure continued reliability.

32-4

Keep accessories clean.

Wipe transducers with a soft cloth moistened with a germicidal solution after each use.

Wipe off any ultrasound gel on the ultrasound transducers or the monitor as soon as possible.

Diagnostic Messages

Message MONITOR SUPPORTS xx PARAMETERS. ADDITIONAL PARAMETERS MAY OVERLOAD IT

Cause/Action Data for more than xx parameters is being input to the monitor. System performance may decline. Unplug modules to improve performance.

UNABLE TO SUPPORT A NEW MODULE AT THIS There is not enough system memory to support a new module. TIME Unplug modules to free memory. UNABLE TO SUPPORT A NEW CHANNEL AT THIS TIME

There is not enough system memory available to support a new channel. Detach channels to free memory.

DIAGNOSTIC ERROR ENCOUNTERED LOADING Checksum error detected loading module. Module is unsupported. MODULE DIAGNOSTIC ERROR ENCOUNTERED LOADING Checksum error detected loading channel. Channel is unsupported. CHANNEL OUT OF MEMORY - DELETING HEMO ENTRY

There is not enough system memory available to the application to complete the requested operation. Try again later.

OUT OF MEMORY - DELETING RESP ENTRY

There is not enough system memory available to the application to complete the requested operation. Try again later.

OUT OF MEMORY - DELETING OXY ENTRY

There is not enough system memory available to the application to complete the requested operation. Try again later.

OUT OF MEMORY - DELETING RENAL ENTRY

There is not enough system memory available to the application to complete the requested operation. Try again later.

CREATE NEW ENTRY FAILURE - MAXIMUM NUM The maximum number of Calcs entries are in use. Delete existing ENTRIES EXCEEDED entries to create new ones. REMOTE MONITOR NOT RESPONDING

Calcs timeout expired waiting for remote GDS response. Verify remote monitor is on network, and try again.

ERROR READING DATA

Bad return code from GDS on data read. GDS is possibly corrupt. Reboot monitor.

ERROR STORING DATA

Bad return code from GDS on data store. GDS is possibly corrupt. Reboot monitor.

ERROR DELETING STORED DATA

Bad return code from GDS on data delete. GDS is possibly corrupt. Reboot monitor.

NO TRENDS AVAILABLE FOR THIS BED

There is no trend data in GDS. Wait one minute and try again.

NO OTHER BED ON THE NETWORK HAS ACTIVE This message is in response to a remote request. Monitor Setup PARAMETERS has determined that there are no beds on the network with active parameters so remote operations are not possible at this time. THERE ARE NO PARAMETERS ACTIVE ON THIS The selected bed has no active parameters. In order to remotely BED work with the monitor at the selected bed, it must have active parameters. PARAMETER IS NOT AVAILABLE TO MONITOR

Failed attempt to attach to channel. Try again.

COMMUNICATIONS WITH REMOTE MONITOR INTERRUPTED

Lost connection to remote monitor. Verify that the remote monitor is on the network and retry remote operation.

THIS OPERATION WILL CAUSE THE MONITOR TO RESET

The requested operation will reboot the monitor. If you do not want this to occur, touch PREVIOUS MENU or NORMAL SCREEN.

THIS INSERTION WILL CAUSE PRIOR ASSIGNMENT TO BE LOST

The requested zone assignment will cause a previously assigned zone to be lost. Touch PREVIOUS MENU or NORMAL SCREEN to abort the operation.

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Ultraview Care Network

Message

Cause/Action

REMOTE BED SELECT FEATURE IS IN USE BY ANOTHER APPLICATION

The Remote Bed Select window is in use by another application. Only one application may use this window at one time. Touch the application which is using the Remote Bed Select feature and touch PREVOUS MENU or NORMAL SCREEN to abort the selection. The window will now be available for use.

UNABLE TO RECORD THE REQUESTED ALARM CHANNEL(S)

Unable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.

UNABLE TO RECORD THE REQUESTED CHANNEL(S)

Unable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.

PARAMETERS NOT AVAILABLE FOR RECORDING

Unable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.

CAUTION - MONITOR SETTINGS MAY HAVE CHANGED

Non-volatile battery has failed. Memory (that is, CMOS) resets the monitor to the default settings and the default settings may not match hospital preferences. Contact your hospital biomed to check Biomed and Clinical Menu settings and Alarm Watch setup.

PAPER OUT

There is no paper in the fetal chart recorder. Load paper.

RECORDER OFF

Indication that the fetal chart recorder is powered OFF. Power ON fetal chart recorder.

“CHECK CABLE” “NO CONNECTION”

Invalid CIM address. Verify that the CIM cable is properly connected to the monitor and the wall outlet.

“CHECK CABLE” then “OLD XXX NEWXXX” then “ID CHANGE!” ALTERNATELY

The CIM ID has changed unexpectedly during operation. Verify that the CIM cable is properly connected to the monitor and the wall outlet.

ADMIT PATIENT

No patient name has been entered. Enter patient name into BirthNet or standalone monitor.

33-2

Symbols 34

The following list of international and safety symbols describes all symbols used on Spacelabs Medical products. No one product contains every symbol.

Symbol

Description

Symbol

Description

UCW or Ultraview 1700 HELP Key

UCW or Ultraview 1700 MONITOR SETUP Key

UCW or Ultraview 1700 SPECIAL FUNCTIONS Key

UCW or Ultraview 1700 ALARMS Key TOnE RESET ALM SUSPEND

UCW or Ultraview 1700 RECORD Key

UCW or Ultraview 1700 PREVIOUS MENU Key

UCW or Ultraview 1700 NORMAL SCREEN Key

UCW or Ultraview 1700 REMOTE VIEW Key

UCW or Ultraview 1700 ALARM WATCH Key

UCW or Ultraview 1700 GRAPHIC TRENDS Key

UCW or Ultraview 1700 TABULAR TRENDS Key

UCW or Ultraview 1700 CALCS Key

UCW or Ultraview 1700 DRUG CALCS Key

UCW or Ultraview 1700 TE MODE Key

UCW or Ultraview 1700 DATA LOGGER Key

UCW or Ultraview 1700 DNA Key

UCW or Ultraview 1700 CLOCK Key

UCW or Ultraview 1700 mouse connection

UCW or Ultraview 1700 Keyboard Connection

ON — Power Connection to Mains

OFF — Power Disconnection from Mains

On Position for Push button Power Switch

Off Position for Push button Power Switch

STOP or CANCEL Key

RECORD

34-1

Ultraview Care Network

Symbol

34-2

Description

Symbol

Description

CONTINUE Key

START/STOP Key

START/STOP

START (NIBP) Key

On Direction

ON/OFF

Television, Video Display

Recycle

Protective Earth Ground

Functional Earth Ground

ON — Part of the Instrument Only

OFF — Part of the Instrument Only

Partial ON/OFF

STAND-BY Key

All batteries should be disposed of properly to protect the environment. Lithium batteries should be fully discharged before disposal. Batteries such as lead-acid (Pb) and nickelcadmium (Ni-Cd) must be recycled. Please follow your internal procedures and or local (provincial) laws regarding disposal or recycling.

Caution - hazardous voltages. To reduce risk of electric shock, do not remove the cover or back. Refer servicing to a qualified service personnel (U.S.A.).

PAUSE or INTERRUPT

Slow Run

Replace Fuse Only as Marked

Fuse

Power supply jack polarity. (+ / - Signs May be Reversed)

Equipotentiality Terminal

Battery Replace only with the appropriate battery.

Replace only with the appropriate battery. (+ / - Signs May be Reversed)

DANGER - High Voltage (International)

Symbols

Symbol

Description

Symbol

Alternating Current

Direct Current

Both Direct and Alternating Current

AC/DC Input

Amperes

Hertz

Hz Volts

1 2 3

Description

Watts

W Temporary Shut Off of Alarm Tone or Screen Indicators

Alarm

ENTER Key

PRINT REPORT Key

Attention - Consult Operations or Service Manual for Description

Risk of Explosion if Used in the Presence of Flammable Anesthetics

Indicator — Remote control

Indicator — Local Control

Return Unit to Monitor Mode

Indicator — Out of Paper

Activate Recorder for Graphics

Recorder Paper

Indoor Use Only

Auto Mode (NIBP)

Output (Not Terminated)

No Output (Terminated)

Data Input/Output

HELP (Explain Prior Screen) Key

34-3

Ultraview Care Network

Symbol

Description Clock/Time Setting Key

Monitor Setup Select Program Options

1 2 3

Input/Output

1 2 3

Set Initial Conditions Menu A

Access Special Function Menu

1 2 3

Description

Normal Screen

TREND/TIMER Key 1 2 3

34-4

1 2 3

Return to Prior Menu

Gas Exhaust

Electrocardiograph or Defibrillator Synchronization

Arterial Pulse

IEC 601-1 Type BF equipment. The unit displaying this symbol contains an Ftype isolated (floating) patient-applied part providing an adequate degree of protection against electric shock.

IEC 601-1 Type BF equipment which is defibrillator-proof. The unit displaying this symbol contains an F-type isolated (floating) patient-applied part which contains an adequate degree of protection against electric shock, and is defibrillator-proof.

IEC 601-1 Type CF equipment. The unit displaying this symbol contains an Ftype isolated (floating) patient-applied part providing a high degree of protection against electric shock.

IEC 601-1 Type CF equipment. The unit displaying this symbol contains an Ftype isolated (floating) patient-applied part providing a high degree of protection against electric shock, and is defibrillator-proof.

ETL Laboratory Approved

ď&#x203A;&#x161;

IEC 601-1 Type B equipment. The unit displaying this symbol contains an adequate degree of protection against electric shock.

Canadian Standards Association Approved

Keypad

Enlarge, Zoom

Symbols

Symbol

Description

Symbol

Menu Keys

Description Delete

Waveform/Parameter Keys

PCMCIA Card

Keep Dry

Fragile, handle with care

Foot Switch

This Way Up

Environmental Shipping/Storage Temperature Limitations

Environmental Shipping/Storage Humidity Limitations

Open Padlock

Closed Padlock

Down Arrow

Up Arrow

Event

Temperature TEMP temp

Antenna

220 hPa

Environmental Shipping/Storage Altitude Limitations

1052 hPa Network Connection

Audio Output, Speaker

34-5

Ultraview Care Network

Symbol

Description

Symbol

Description

Remote Alarm, Nurse Alert

Nurse Call

Serial Port 1

Serial Port 2

2 External marker push button connection

SDLC Port

SDLC

Microphone

Mermaid Connector

Note

Video Output

Warning About Potential Danger to Human Beings

Caution About Potential Danger to Equipment

Non-Invasive Blood Pressure (NIBP), Neonate

Fetal Monitor Connection (Analog)

Fetal Monitor Connection RS232 (Digital)

Physiological Monitor Connection RS232 (Digital)

Abbreviations used as symbols are shown below.

34-6

Symbols

Symbol 1 - 32

ANT 1 ANT 2

CH ch

Description Access Codes 1 Through 32

Diversity Antenna System 1 Diversity Antenna System 2

EEG, EMG, or ECG Channel EEG Channels - CH1, CH2, CH3, CH4 EMG Channel - CH5 Controlled Mechanical Ventilation

CMV

DIA dia

EEG eeg

ESIS

Diastolic

Electroencephalogram

Electrosurgical Interference Suppression

Fetal Electrocardiogram FECG

GND gnd

Patient Isolated Ground

Symbol Air AIR

Arr1 ArrNet2

NIBP nibp

Centimeters of Water

C.O. CO co ECG ecg

EMG emg

Cardiac Output

Electrocardiogram

Electromyogram

External EXT

FHR1 FHR2

HLO hlo

Fetal Heart Rate, Channel 1 Fetal Heart Rate, Channel 2

High-Level Output

Multi-Lead Electrocardiogram MULTIVIEW

Nitrous Oxide

Non-Invasive Blood Pressure N2O Oxygen

O2 PRESS press PRS

Arrhythmia Net 1 Arrhythmia Net 2

cmH2O

Inspiration Expiration Ratio I:E

Description

Positive End Expiratory Pressure PEEP

Pressure

Minimum Inspiratory Pressure Pmin

34-7

Ultraview Care Network

Symbol

Description Peak Inspiratory Pressure

Ppeak

Synchronous Data Link Control SDLC

SVO2 SvO2 SvO2 T1 T2 T3 T4

Mixed Venous Oxygen Saturation

Temperature 1 Temperature 2 Temperature 3 Temperature 4

Symbol RESP resp SPO2 SpO2 SpO2 SaO2 SYS sys

Description Respiration

Arterial Oxygen Saturation as Measured by Pulse Oximetry

Systolic

Uterine Activity or Umbilical Artery UA

Vacuum connection VAC

BirthNet, Caremaster, Chartmaster, CVScan, FT1000, FT3000, Flexchart, Flexform, Flexport, Flextable, Flextool, Flexview, Global Participant Index, Intesys, Multiview, Neochart, Neoscan, SensorWatch, Tru-Cap, Tru-Cuff, Tru-Link, UCW, Varitrend, Vita-Stat, and WinDNA are trademarks of Spacelabs Medical, Inc. Other brands and product names are trademarks of their respective owners.

34-8