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Corometrics™ 250cx Series Monitor

1. 30 Coincidence enabled This annotation prints N every 30 minutes along 15 10 26 AUG 00 FECG US mma HBC TOCO with the modes 100 E l 10 75 Simulated Heartbeat Coincidence Detection Trace Revision C 250cx Series Maternal Fetal Monitor 13 5 2036946 001 Heartbeat Coincidence Using the Heartbeat Coincidence Feature 13 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 14 Waveforms Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Waveforms For your notes 14 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Waveforms Waveform Area Waveform Area The waveform area displays approximately 4 seconds of waveform data from one of the following FECG MECG or MSpO The waveform chosen for display is independent of any of the numerics shown on the display For example MSpO can be chosen as the maternal pulse rate source numerics while the MECG waveform is selected for display in the waveform area CAUTION WAVEFORM INTERPRETATION Waveforms generated by the 250cx Series Monitor are not intended for true diagnostic interpretation Selecting the Waveform Waveform Speed ECG Size MECG Lead Select MECG Pacer Label Use the Waveform softkey on the normal operating screen to select FECG MECG MSpO2
2. Volume 5 Off High 35 120 120 Alarm Volume 5 OMAN ODA PWD o 100 250 oOAN OahWHN MHR P Setup Screen Source This field selects the MHR P source When Auto is selected the monitor checks for parameter availability and use in the following order MECG MSpO then NIBP If a source is not available the next available source is automatically selected IMPORTANT WAVEFORM The MHR P Source field is independent of the waveform selected on the normal operating screen For example you can select MECG as the MHR P source yet display the MSpO plethysmograph waveform Or you can select MSpO as the source and display MECG as the waveform 7 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Heart Pulse Rate Monitoring MHR P Setup Screen HR PR Trace Volume Alarms Alarm Volume MECG Lead This field enables or disables the printing of the MHR P trace on the strip chart paper m On The MHR P trend is printed in grey annotated with MECG or MSpO Pa whichever parameter is selected in the MHR P Source field MHR P data from NIBP is not trended since blood pressure determinations are static measurements m Off The MHR P trend is not printed This field sets the volume of the beep sounded with each detected valid heartbeat for MECG and MSpO only These fields adjust t
3. Annotation Explanation CARDIO INOP This annotation prints in place of any trend source if the respective connector FECG MECG US or US2 is unused UA INOP This annotation prints in place of the trend source if the UA receptacle is unused MSpO INOP This annotation prints if the trend is enabled and the Maternal SpO2 receptacle is unused Chart Speed The chart speed prints on the bottom annotation line 20 seconds after you turn Example 3 cm min on the monitor UA REF This message prints on the bottom line of the bottom strip chart paper grid during active uterine activity monitoring whenever m you press the UA Reference button or m whenever automatic re zeroing occurs during tocotransducer monitoring BASELINE PRESSURE OFFSCALE This annotation prints on the bottom line of the bottom strip chart paper grid during IUPC monitoring when the pressure falls below 0 mmHg for more than 20 seconds Maternal NIBP vital signs data For example NIBP 103 71 M 83 P 72 mmHg mode NIBP 13 7 9 5 M 11 1 P 72 kPa mode or 4 NIBP 103 71 M 83 P 72 mmHg mode NIBP 13 7 9 5 M 11 1 P 72 kPa mode Maternal NIBP vital signs data prints for each manual and automatic determination m identifies the 250cx Series as the source m identifies an external device as the source The diamond prints on the bottom two lines of the bottom grid of the strip chart paper and marks the time of the reading The vital signs da
4. Item Catalog Number REF Qwik Connect Plus Spiral Electrode 50 carton 7000AAO Leg Plate for Qwik Connect Plus Spiral Electrode 8 foot Cord round connector 1590AAO Leg Plate for Qwik Connect Plus Spiral Electrode 8 foot Cord rectangular connector 1591AAO Attachment Pads for Qwik Connect Plus Spiral Electrode Legplate 50 carton 2464AAO Tocotransducer Ordering Information Tocotransducer Supplies Item Catalog Number REF Loop Style Tocotransducer Nautilus 8 foot Cord 2264LAX Button Style Tocotransducer Nautilus 8 foot Cord 2264HAX Reusable Belt for Loop Style Transducer Mesh Style 10 carton 4425AAO Reusable Belt for Loop Style Transducer Velcro Style 10 carton 4425CAO Reusable Belt for Button Style Transducer Blue 10 carton 2015827 001 Reusable Belt for Button Style Transducer 1 pink and 1 blue pack 100 packs case 2015919 001 Semi Reusable Belt for Loop Style Transducer Velcro Style 4425FAO 2 pack 50 packs carton Single Patient Use Belt for Loop Style Transducer Foam Style with Velcro Closure 8024AAO IUPC Ordering Information IUPC Supplies and Accessories Item Catalog Number REF Saflex IUPC with Amnio Infusion Sampling Capabilities 10 carton 2076BAO Saflex Intermediate Cable 1336AA0 18 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Supplies amp Accessories MECG Ordering Information MECG Ordering Information Defibrillator protection requires the use of GE M
5. Display Example From the graphic below you can determine the following Blood pressure is not active as indicated by the absence of numerics Maternal pulse oximetry is active by presence of pulse amplitude indicator MECG is selected as the heart rates source as indicated by the MECG mode title softkey rather than Pulse m The MECG waveform is displayed at 25 mm sec at a size of 2x with lead II selected m Heartbeat coincidence is enabled as indicated by the HBC acronym in the primary labor parameters area m All alarms are enabled as indicated by JT HBC TOCO 165v 172 30 Y NIBP f MECG MSpo 87 Y 98 25 mm s I 2x 15 52 58 Freeze Alarms Setup VSHX Maternal Fetal Monitor Display Example Revision C 250cx Series Maternal Fetal Monitor 3 7 2036946 001 Controls Indicators and Connectors Primary Labor Parameters Primary Labor Parameters The primary labor parameters section displays FHR1 FHR2 and UA data FHR Display The FHR1 and FAR 2 areas are summarized in the following figure and table C 1656 A FHR Display FHR Display Description Up to three digits indicate the fetal heart rate in beats per minute This symbol provides information about the FHR audio alarm and the FHR high low alarm limit settings See Chapter 10 Alarms for more information LA All alarm settings are enabled X At least one fetal alarm is disable
6. Rate in FHR area of the display and the FHR trend on the strip chart paper do not correlate Monitor is set for 30 bpm cm vertical scale and 20 bpm cm vertical scale strip chart recorder paper is being used or vice versa Call Biomedical Engineering Department External Uterine Activity Troubleshooting External UA Troubleshooting Problem Probable Cause Possible Solution Tocotransducer not recording contractions m Transducer not properly connected to monitor m Transducer not properly placed m Transducer not secured to patient m Defective transducer cable assembly m No maternal contractions m UA Reference range exceeded m Ensure that transducer is securely attached to monitor m Reposition transducer m Secure or re apply transducer to patient m Replace transducer cable assembly m Wait m Loosen belts or remove transducer from patient Press UA Reference button while no pressure is applied to transducer button Re apply transducer Do not overtighten belt Press UA Reference button again between contractions See Out of Range Condition on page 6 4 for further information Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Troubleshooting Internal UA Troubleshooting External UA Troubleshooting Problem Probable Cause Possible Solution n Flashing sign mmHg gt 100 13 3 kPa Press the UA Refe
7. Controls Indicators and Connectors Front Panel Displays Front Panel Displays The monitor is divided into two main sections patient information the left side of the monitor and monitor functionality the right side of the monitor Refer to Monitor Front Panel on page 3 3 The keys are ordered for user efficiency The content and layout of the display can change depending on which functions are installed in the monitor and the modes of operation in use Primary Labor ipod Spon NIBP Parameters a Fetal Additional _ __ Parameters Maternal Maternal and Fetal Parameters Display Summary Display Section Item Mode Primary Labor Parameters upper portion of monitor Additional Parameters Available in Maternal Fetal Fetal Heart Rate 1 FHR1 US US2 FECG or INOP Fetal Heart Rate 2 FHR2 US US2 or INOP Uterine Activity UA Maternal Blood Pressure TOCO IUP or INOP NIBP Maternal Heart Pulse Rate MECG Pulse or INOP Monitor only Maternal SpO MSpO Waveform Fetal ECG Waveform Maternal ECG Waveform or FECG MECG MSpOz or Off Maternal SpO Pulsatile Waveform Time Current Time Label Frozen Message and Time of Activation Softkeys System Configuration Softkey Controls 3 6 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Controls Indicators and Connectors Front Panel Displays
8. m Reposition by twisting catheter m Replace catheter m Call Biomedical Engineering Department 16 6 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Troubleshooting MECG Troubleshooting MECG Troubleshooting MECG Troubleshooting Problem Probable Cause Possible Solution MECG erratic or not functioning properly m Cable not properly connected to monitor m Electrodes not properly placed m Clips not attached to electrodes properly m Electrode gel dried m Defective MECG cable m Selected lead providing inadequate signal m Service required m Ensure cable is securely attached to monitor m Re apply electrodes m Check clip attachments m Check electrodes and change if necessary m Replace cable m Change lead selection on MHR P Setup screen m Call Biomedical Engineering Department Dashes shown in MHR P area of display Monitor unable to make a determination due to insufficient signal Ensure patient is not asystolic Ensure electrodes are firmly secured to patient Blood Pressure Troubleshooting Blood Pressure Troubleshooting Problem Probable Cause Possible Solution High reading Measurement taken during uterine contraction m Annotate chart then take a manual reading in between contractions m f possible cancel reading during contraction m Enable the monitor s Smart BP feature CHE
9. 0 0cee eee eee 9 9 Response Time Nellcor NELL 3 Technology Only 00ee seas 9 9 Sensitivity Masimo Technology Only 0 00 c cece cece eee eee ee 9 9 Averaging Time Masimo Technology Only 0 00 cece eee eee eee 9 10 Print Int E E cess 9 10 Ve EL 9 10 ALANIS av c dade reatu ica uelit abus soe i N 9 10 Alarmi VOTE uoo utei ces atk Ge Aca dere at He eds 9 10 MSpO Methodology 0 eccec cece eee KK 9 10 MSpO Pulse Beat Audio 2 0 cece eee e eee nes 9 11 The MSpOz Waveform 2 cece eee eee e 9 11 Module and Probe Compatibility ccc cece cece ees 9 11 Modules and Sensors 9 12 No Implied License 9 12 Sensols Sh sist ee o e e EC NS 9 12 1 0 A co dete taa Ere etat incontri Qus 10 1 ni 000000 A dd 10 3 Alarm Selup oia id a ds aa 10 3 Master Alarm Setup Screen nunnurnar cece cent n enn eees 10 3 Revision C 250cx Series Maternal Fetal Monitor V 2036946 001 Alarms a gor mto A a a 10 3 Alarm Vol men E NE Gee a ee 10 4 Alarm Silence cu ia pube RE a ds 10 4 Alarm Setting Indicators 00 0 ccc cece eee e eee eee 10 5 Maternal Alarm Occurring During Setup 10 5 Alarm Behavior 0000 etarra riders 10 5 Fetal Heart Rate Alarms ooooooooccococcnnn n 10 6 FHR Patient Alarms i uos alar 10 6 Active Patient Alarm 0 0 cece eee eet eee ees 10 6 Resolved Patient Alarm 2 0 0 cece eee eee een eee ae 10 6 FHR Signal Quality Alarms 10 6 Active Si
10. 1 held down The Remote Marker is an accessory that can be connected to the 250cx Series Monitor The monitor can be configured to use this annotation or the one shown in the previous row of this table Refer to the 250 250cx Series Monitor Service Manual gt This annotation prints on the bottom two lines of the upper grid indicating that the Corometrics Model 146 Fetal Acoustic Stimulator is being used The music symbol prints each time a clinician presses the button on the stimulator Freestyle annotations For example Entries typed using a Corometrics Model 2116B Data Entry Clinical Notes Keyboard print in the annotation area The Model 2116B is an optional device PT NAME JANET STEVENS that can be connected to the 250cx Series Monitor PT ID 6535148 PT AGE 18 DR CARTER Adjustable Recorder Font Size The 250cx Series Monitor offers a choice of font sizes to print annotations Refer to Table Summary of Annotations on page 11 10 A larger font size fosters readability a smaller font size increases printing speed Set the font size on the password protected Install Options service screen Refer to the 250 250cx Series Monitor Service Manual for more information CAUTION FONT SIZE TIf the medium or large font size is selected there is the possibility that messages may be truncated during periods of multiple annotations Revision C 250cx Series Maternal Fetal Monitor 1
11. 5 Now rotate the Trim Knob to change the current setting as desired With each setting change an audio tone indicative of the alarm volume will be emitted from the speaker 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking A final audio tone indicative of the alarm volume is emitted from the speaker Now rotate the Trim Knob to select highlight the Exit item on the bottom menu Press the Trim Knob again to return to the main monitoring display screen co Y Rotate the Trim Knob to highlight the legend for MSpO This legend is located slightly above center on the right side of the display Once the MSpO legend is highlighted press the Trim Knob The display changes to show the MSpO Setup screen Now rotate the Trim Knob to select highlight the Alarm Volume setting which is located immediately to the right The setting is in the range of 1 to 9 Once the Alarm Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video and an audio tone indicative of the alarm volume is emitted from the speaker 5 Now rotate the Trim Knob to change the current setting as desired With each setting change an audio tone indicative of the alarm volume will be emitted from the speaker 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current valu
12. Alarms High Low Systolic 160 90 Diastolic 90 50 MAP 140 50 MHR P 50 MSpO2 100 95 Alarm Volume 5 Master Maternal Alarm Setup Screen Alarms These fields adjust the high and low alarm limits for NIBP MHR P and MSpO The available ranges are shown the Technical Specifications section The factory default setting are listed in Appendix A Factory Defaults Revision C 250cx Series Maternal Fetal Monitor 10 3 2036946 001 Alarms Alarm Setup Alarm Volume Alarm Silence The alarm limits for each modality are configured by a respective setup screen Refer to Chapter 4 Setup Procedures A Master Alarm Setup screen provides a summary of most alarm limit settings with the exception of the FHR1 and FHR2 limit settings which are set independently NOTE For each modality the available ranges of high and low alarm limits overlap however the monitor prevents the selection of overlapping alarm limits The alarm volume can be set on any individual setup screen or on the Master Alarm Setup screen This settings is used for all alarms CAUTION ALARM SETUP Prior to monitoring each patient it is recommended that you check the alarm limits to ensure they are appropriate for the patient The figure below is a sample of the ALARM SILENCE message on screen Press the Alarm Silence button to silence an individual maternal audio alarm or paper load error However for MECG and MS
13. Masimo s principle of operation is that arterio venous shunting is highly variable and that fluctuating absorbance by venous blood is a major component of noise during the pulse The Masimo product decomposes red and infrared pulsatile absorbance into an arterial signal plus a noise component and then calculates the ratio of the arterial signals minus the noise The practitioner can adjust high and low alarm limits to a desired value if required and then monitor the waveform pulse rate and Sp0 value on the display If an alarm limit is reached the information on the display helps to assess the condition of the patient and aids in determining if any intervention is required Due to a change in Nellcor technology the SpO parameter in the Corometrics 250cx Monitor is migrating from Nellcor 506 technology to Nellcor NELL 3 technology To determine which Nellcor technology your monitor contains refer to the Service Lock screen To display the Service Lock 1 Select the Setup softkey to display the General screen 2 Select the Service softkey from the General Setup screen 3 The Service Lock screen appears Service Lock Enter Access Code 0000 MSpO NELLCOR NELL 3 V1 9 0 1 12 9 03 NIBP Pri 1 25 Sec 1 1 KeyPd 1 1 CPU VX XX DSP XX XX Nellcor uses pulse oximetry to measure functional oxygen saturation in the blood Pulse oximetry works by applying an OxiMax sensor to a pulsating arteriolar vascular bed such as a
14. Revision C 250cx Series Maternal Fetal Monitor 15 5 2036946 001 Maintenance Maternal SpO Calibration SpO Sensors The user has the responsibility to validate any deviations from the recommended method of cleaning and disinfection For additional information on infection control procedures contact GE Medical Systems Information Technologies Technical Support Adhesive sensors are sterile and for single use only Reusable sensors should be cleaned before reuse with a 7096 alcohol solution If low level disinfection is required use a 1 10 bleach solution Do not use undiluted bleach 5 5 2596 sodium chlorite or any cleaning solution other than those recommended here because permanent damage to the sensor could occur Do not sterilize the sensor by irradiation steam or ethylene oxide If disposable sensors or their packaging are damaged they must be disposed of as advised in this appendix To clean or disinfect the sensor 1 Saturate a clean dry gauze pad with the cleaning solution Wipe all surfaces of the sensor and cable with this gauze pad 2 Saturate another clean dry gauze pad with sterile or distilled water Wipe all surfaces of the sensor and cable with this gauze pad 3 Dry the sensor and cable by wiping all surfaces with a clean dry gauze pad Maternal SpO Calibration The 250cx Series Monitor automatically calibrates the pulse oximetry parameter upon power up whenever a new sensor is attached and at
15. 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Spectra Alerts Each monitor in the 250cx Series can be upgraded to include Spectra Alerts Contact your Sales Representative for more information This feature analyzes heart rate and uterine activity data to detect certain abnormal trends and alert the clinician A Nurse Call Light Interface is also provided as part of the Spectra Alerts upgrade Revision C 250cx Series Maternal Fetal Monitor C 1 2036946 001 Spectra Alerts For your notes C 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Important Safety Information Important Safety Information IMPORTANT INSTRUCTIONS FOR USE It is mandatory that you read this chapter prior to operating a 250cx Series Monitor with the Spectra Alerts feature enabled Keep this manual available for future reference and for the orientation of new personnel The Spectra Alerts option is designed to assist the perinatal staff in assessing the status of a patient at the bedside by recognizing normal and abnormal FHR and UA pattern features The system does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider who will make diagnoses and decide on treatments or interventions The user should determine the status of the patient at regular intervals see Standards for Obstetric Gynecologic Services 7th edition Washingto
16. Annotations from a Central Information System o ooooooccccccc o 11 9 Multiple Annotations eaae ee e rra a ae a E a nent need 11 9 Summary of Annotations esses 11 10 Adjustable Recorder Font Size 0 cece cece eee eee eee eee 11 13 Chart Style Vital Signs Printing 0 c cece eee eee eee eee 11 14 Enabling Disabling Chart Style Printing 0 00 ccc eee eee eee 11 14 Examples of Printing Styles 0 cece cece e eee 11 15 Chart Style Printing Examples 000 c cece cece eee eens 11 15 Real Time Printing Example 0 0 eee e eens 11 15 Chart Style 7 Minute Exception for NIBP 0000 cece eee 11 15 Strip Chart Papel crine pene cele alu ncm lent sce x Ret nenne 11 16 Paper Low Paper Out and Paper LoadING Error Conditions 11 18 1 2 Maternal Vital Signs History 12 1 What is the Maternal Vital Signs History Screen ooooommoomom 12 3 Using the Maternal Vital Signs History Screen sese 12 4 Displaying the Screen 0 na 12 4 Selecting the HX Interval uaaa 12 4 Printing the Maternal Vital Signs History Screen 20 e cece eee 12 5 Printing the Entire Vital Signs History 000 cece eee eae 12 5 Printing a Page of the Vital Signs History 0 eee eee eee 12 5 Stopping the Printing of Maternal Vital Signs History 12 5 1 3 Heartbea
17. Refer to Paper Supplies Ordering Information on page 18 3 to order paper required for use with the 250cx Series Monitor AR scale of 30 240 bpm or HR scale of 50 210 bpm Refer to Chapter 11 Recorder Modes for more information about the different paper styles CAUTIONS LOADING PAPER The instructions for loading paper into the 250cx Series Monitor are different than the instructions for loading paper into other Corometrics monitors Improper loading can cause paper jams Follow the instructions carefully PAPER TYPE Do not use non Corometrics paper or paper designed for use with other Corometrics monitors Using incorrect paper may produce inferior print quality could result in permanent damage to the recorder s print head and may void your warranty Refer to Paper Supplies Ordering Information on page 18 3 for the correct monitor paper part number STORAGE TRANSPORT Paper should be installed in the monitor s strip chart recorder at all times This reduces particle build up on the printhead and facilitates opening the recorder door To install Corometrics chart paper in the 250cx Series Monitor follow these steps 1 Press down on the latch on the right side of the strip chart recorder door to open the recorder door Opening the Recorder Door Revision C 250cx Series Maternal Fetal Monitor 4 3 2036946 001 Setup Procedures Loading Strip Chart Recorder Paper 2 Fan the
18. 15 4 Maternal NIBP Cuffs and Hoses s esses 15 5 COMM 15 5 Materials ca oed e rto Pe e Eie eet e ea 15 5 Procedure so cette tr ebore e o P PR 15 5 SpO2 Sensols c iet E ere Lr eR Le RD RET EL 15 6 Maternal SpO Calibration ssseeseeeennnnnm e 15 6 NIBP Maintenance seen HH 15 6 Disposal of Product Waste ccecee eee e cece eect e 15 7 Patient Applied Parts iudi me toreen cece eee eee I 15 7 Packaging Material 20 0 0 cece cette eae 15 7 MONOT seres os Hasan tele thong wane Abele a pube Male rosa drea d 15 7 1 6 Troubleshooting ooooocoomnnnnr 16 1 General Troubleshooting sssssseeeennI eens 16 3 Ultrasound Troubleshooting enn 16 4 FECG Troubleshooting sees 16 5 External Uterine Activity Troubleshooting see 16 5 Internal UA Troubleshooting seen 16 6 MECG Troubleshooting Ke 16 7 Blood Pressure Troubleshooting leen nnn n 16 7 Maternal Pulse Oximetry Troubleshooting oooooococococcccc 16 8 1 Technical Specifications 17 1 General Monitor vomita ii emen m a ek ai 17 3 Operating Modes 0c ccce cece eee Kn 17 4 viii 250cx Series Maternal Fetal Monitor Revision C 2036946 001 18 Strip Chart Recorder cccccce eee e eee eee eee eee eee eens 17 11 Supplies amp Accessories Lseseee 18 1 General Add Ons Order
19. 21 Enabling Disabling UC Chime If the Spectra Alerts option is enabled the UA Setup screen contains a UC Chime field When enabled a low frequency chime sounds at the onset of a contraction a high frequency chime sounds at the conclusion This audio contraction indicator is useful to caregivers as well as patients Caregivers are made aware of contractions during internal exams or while making adjustments to internal sensors transducers without having to watch the monitor An anesthetized mother can use the indicator as a push signal if she is unable to feel contractions To enable disable the UC Chime 1 Access the UA setup screen by selecting the UA mode title TOCO or IUP 2 Set the UC Chime field to the desired setting On or Off Refer to the Figure UC Frequency Histogram Revision C 250cx Series Maternal Fetal Monitor C 15 2036946 001 Spectra Alerts Nurse Call Interface Nurse Call Interface The Spectra Alerts option includes a Nurse Call Interface rear panel connector as shown in the Figure below This connector attaches to a standard Nurse Call System The connector s maximum output is 50 Vdc at 100 mA the maximum on resistance is 0 5 O When connected to a Nurse Call System the monitor will activate the system each time a Spectra Alert is issued This interface simulates pressing the button on a bedside Nurse Call System allowing nurses to respond to patient needs quickly and efficiently Refer to
20. 70 non condensing 700 1060 mbar 525 795 mmHg 0 to 95 non condensing 700 1060 mbar 525 795 mmHg lt 80 F lt 26 5 C 45 to 65 non condensing 700 1060 mbar 525 795 mmHg Certification ANSI AAMI EC13 1992 UL 2601 1 CUL Complies with all areas except those listed below 3 1 2 1e Heart Rate Meter Accuracy and Response to Irregular Rhythm not tested 3 2 6 1 Range of QRS wave amplitude and duration 3 2 7 Range and accuracy of heart rate meter 4 2 7 f input rate of 300 bpm 3 2 8 1 Lower Alarm Limit The lowest alarm limit on the 250cx Series is 35 bpm 3 2 9 7a Output Display a Channel Width 3 2 9 8c Impulse Response 3 2 9 12 Pacemaker Pulse Display capability Classified to UL 2601 1 Medical electrical equipment classified by Underwriter s Laboratories Inc with respect to fire shock and mechanical hazards in accordance with UL 2601 1 Classified with respect to electric shock fire mechanical and other specified hazards only in accordance with CAN CSA C22 2 No 601 1 1 Paper operating environmental conditions are for a period of less than one month Paper storage environmental conditions are for extended storage Revision C 250cx Series Maternal Fetal Monitor 17 3 2036946 001 Technical Specifications Operating Modes Operating Modes Operating Mode Specifications CAUTION specifications in this table The monitor may produce incorrec
21. A blank line is printed after each message to improve readability m Each message can be a maximum of 40 characters in length m Thetime precedes each message m An outlined diamond marker 0 indicates the data is provided by one of the monitor s built in parameters m A filled diamond marker 9 indicates the data is provided by an external device interfaced to the monitor m The date is printed when the maternal only mode is first activated when the date time is changed and at midnight Changing Recorder Modes Use the Record button to select between on maternal only mode and off Turn the recorder on for continuous trending set the recorder to maternal only mode when you are interested in the maternal vital signs except MECG heart rate 11 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Functionality with a QS System CAUTION DATA STORAGE Stored maternal vital signs history data is erased when you turn the monitor off Therefore for intermittent monitoring it is recommended that you leave the monitor on but turn the recorder off Refer to Chapter 12 Maternal Vital Signs History for more information Changing Recorder Modes From To Button Off On Briefly press once or press and hold 3 seconds Off Maternal Only Briefly press twice On Maternal Only Briefly press once On Off Press and hold 3 seconds Maternal Only On Briefly press once M
22. FHR Static noise on ultrasound m Active fetus m Reposition transducer m Environmental noise m Keep sheets and gown off transducer Do not hold transducer with hand m Maternal movement m Use alternate monitoring mode m Defective transducer m Replace transducer Rate on FHR area of display and FHR Monitor is set for 30 bpm cm vertical scale Call Biomedical Engineering Department trend on strip chart paper do not correlate and 20 bpm cm vertical scale strip chart recorder paper is being used or vice versa 16 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Troubleshooting FECG Troubleshooting FECG Troubleshooting FECG Troubleshooting Problem Probable Cause Possible Solution Internal FECG erratic or not recording properly m Cable not properly connected to monitor m Attachment pad or legplate not securely attached to patient m Electrode wire not secure in legplate post m Paste is dried or incorrect paste is being used m Electrode not properly attached m No FECG signal m Defective electrode m Defective attachment pad m Service required m Ensure cable is securely attached to the monitor m Secure attachment pad or legplate to patient m Inspect legplate connection m Check ECG paste re apply if necessary m Replace electrode m Auscultate FHR m Replace electrode m Replace attachment pad m Call Biomedical Engineering Department
23. ISOLATION MONITOR TRANSIENTS Line isolation monitor transients may resemble actual cardiac waveforms and thus cause incorrect heart rate determinations and alarm activation or inhibition 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Safety Monitor Contraindications Warnings and Precautions WARNINGS MRI USE Do not use the electrodes during MRI scanning conducted current could potentially cause burns PATIENT CABLES AND LEADWIRES Do not use patient cables and electrode leads that permit direct connection to electrical sources Use only safety cables and leadwires Use of non safety patient cables and lead wires creates risk of inappropriate electrical connection which may cause patient shock or death PACEMAKER PATIENTS Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely entirely upon rate meter alarms Keep pacemaker patients under close surveillance Refer to Chapter 16 Troubleshooting for disclosure of the pacemaker pulse rejection capability of the 250cx Series Monitor RF INTERFACE Known RF sources such as cell phones radio or TV stations and two way radios may cause unexpected or adverse operation of this device SIMULTANEOUS DEVICES Do not simultaneously connect more than one device that uses electrodes to detect ECG and or respiration to the same patient Use of more than one device in this manner
24. Knob control Setup screens for FECG US US2 Maternal NIBP MHR P and MSpO are detailed in Chapter 5 Revision C 250cx Series Maternal Fetal Monitor 4 7 2036946 001 Setup Procedures Setup Screens Using the Trim Knob Control General instructions for using the Trim Knob control follow NOTE When any setup screen except 1 the General Setup screen is displayed the primary labor parameters remain displayed To display a parameter setup screen rotate the Trim Knob control until the bar cursor highlights the title of the parameter FECG US US2 NIBP MECG Pulse or MSpO To access the Master Alarm Setup screen or the General Setup screen rotate the Trim Knob control until the bar cursor highlights the Alarms softkey or the Setup softkey respectively on the bottom of the screen Press the Trim Knob control once to display the selected setup screen While the screen is displayed rotate the Trim Knob control until the desired field is highlighted Press the Trim Knob control again to activate the selected field The cursor flashes to indicate the field is active Rotate the Trim Knob control in either direction to cycle through the available choices for the field When the desired selection is made for the field press the Trim Knob control once to confirm the selection Repeat Steps 3 through 6 until all desired settings have been made Rotate the Trim Knob control until the bar cursor highlights the
25. Now rotate the Trim Knob to change the current setting Select a value between 140 bpm and 200 bpm or Off Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking Repeat 3 through 6 for the Low heart rate alarm setting The valid range is 60 bpm to 140 bpm or Off NOTE The software does not permit the alarm settings to overlap Now rotate the Trim Knob to select highlight the Exit item on the bottom menu Press the Trim Knob again to return to the main monitoring display screen NOTE When the monitor is powered off then on again the settings revert back to the factory default settings or can be saved if you choose Store Current to Hospital from the password protected Install Options screen PO Sco al o N co co Revision C 250cx Series Maternal Fetal Monitor D 3 2036946 001 Frequently Asked Questions Question How do change the alarm limits for Non Invasive Blood Pressure How do change the alarm limits for MHR P Maternal Heart Rate Pulse Answer 1 Rotate the Trim Knob to highlight the legend for NIBP This legend is slightly above center on the left side of the display 2 Once the NIBP legend is highlighted press the Trim Knob The display changes to show the NIBP Setup screen 3 Rotate the Trim Knob to highlight the Systolic High alarm limit setting 4 Once the Systolic High alarms limit setting is highlighted
26. Oximetry Monitor 6 foot Interface Cable to Nellcor Model N 200 N 400 1557AAO Pulse Oximetry Monitor 1 foot RS 232C Interface Cable to Quantitative Sentinel Perinatal System 1558AA0 18 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 A Factory Defaults Factory Defaults are found in the table that follows Factory defaults settings are dependent upon the model purchased Revision C 250cx Series Maternal Fetal Monitor 2036946 001 A 1 Factory Defaults For your notes A 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Factory Defaults Table of Defaults Table of Defaults Summary of Factory Defaults setup i ipti Factory Defaul Default Opti Hospital Pref Screen Field Description actory Default efault Options ospital Preference FECGor FHR Volume 5 0 9 US US2 E FHR Alarm Limits High Low 200 140 Off 160 120 bpm 60 140 Off Audio Alarms On On Off Volume 5 1 9 NIBP Initial Target Pressure 135 mmHg 100 250 mmHg 13 3 33 3 18 0 kPa kPa in increments of 5 mmHg 0 7 kPa Mode Manual Manual 1 2 3 4 5 10 15 20 30 40 45 60 90 120 min NIBP Done Vol 5 0 9 Alarm mmHg mode High Low High Low Systolic 160 90 mmHg 70 240 50 150 Diastolic 90 50 mmHg 70 130 30 120 MAP 140 50 mmHg 70 150 30 120 MHR P 120 50 bpm 100 250 35 120 Alarm kPa mode High Low High Low Systolic 21 3 12 0 kPa 9 3 32 0 6 7 20 0 Diastoli
27. Rear Panel Description 250cx Series Rear Panel Standard and Optional Features Name Description AC Voltage Selection This switch is intended for qualified service Switch personnel to select a voltage range for the AC input M m 120 Accepts an AC input in the range of 100 120 VAC m 240 Accepts an AC input in the range of 220 240 VAC Power Entry Module AC line power cord receptacle Refer to the rear N panel markings to verify line voltage and line frequency requirements CAUTION NON DESTRUCTIVE VOLTAGE The maximum non destructive voltage that may be applied to the rear panel connectors is O volts Do not attempt to connect cables to these connectors without contacting your Biomedical Engineering Department or GE Medical Systems Information Technologies Service Representative This is to ensure the connectors comply with leakage current requirements of one of the following applicable standards Underwriters Laboratories UL 2601 1 Canadian Standards Associations CSA 22 2 No 125 or International Electrotechnical Commission EN60601 1 250cx Series Maternal Fetal Monitor Revision C 2036946 001 4 Setup Procedures evision 250cx Series Maternal Fetal Monitor 2036946 001 Setup Procedures For your notes 4 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Setup Procedures Loading Strip Chart Recorder Paper Loading Strip Chart Recorder Paper
28. Resolved Alerts Resolved alerts function similar to the FHR alarms yet differently from the maternal alarms m Resolved Unsilenced Alert You must acknowledge an alert even if the condition has already been resolved The visual and audible indication remain present until you press the Alarm Silence button This ensures that a clinician is aware that an alert occurred You may hear this type of alert described as latching m Resolved Silenced Alert If you have already silenced an alert the visual indications disappear automatically Alert Suspension Feature When care provider is at the patient s bedside it may be desirable to suspend the audio component of alerts When you suspend alerts the audio indication is inhibited as well as the nurse call interface the visual indications remain active and data continues to be assessed Enabling Disabling the Alert Suspension Feature The alert suspension feature must be enabled disabled on the password protected Install Options service screen Refer to the 250cx Series Service Manual for more information The alert suspension feature has two settings m Off disabled users cannot activate the function m On enabled users can manually activate de activate the function Suspending Audio Alerts and the Nurse Call Interface To suspend alerts press and hold the Alarm Silence button for approximately 3 seconds you will hear two beeps as feedback While suspended m al
29. and Connectors 3 1 Front Panel Description cece eee eee eee eee eee eee eee eeeee 3 3 Front Panel Displays carcin cece a e cece Hn 3 6 Display Example 2 tre Das Ire a td ae ine 3 7 Primary Labor Parameters oooococccocccoccnr cs 3 8 FAR DISplay 3 eis wits A A Gee a Aa a 3 8 UA Display A A 3 9 Additional Parameters 0cceee eect teen eee eee eeeeeeneeee 3 10 Maternal NIBP cocida das 3 10 MEIRIP Aa cl 3 11 DEN YIN a da 3 12 WavetonmArea 5 oet a 3 12 Time and Waveform Message Area 3 12 Battery Backed RAM Status 0 0 2 0 eect eee eee 3 13 SOMKCYS ii aid 3 13 Mode Title Softkeys 0 0 00 cece cece nee e eens 3 13 Waveform SoftkeyS 00 escent eee e 3 13 Dedicated Softkey Area 0 cece cece een eee eens 3 14 Rear Panel Description sse 3 16 Setup Procedures sueeeeeeeees 4 1 Loading Strip Chart Recorder Paper ssseseeseeeeennnnnnn 4 3 POWER A A A A etis 4 6 Interruption of Power oooccooocccccccocr n eens 4 6 Self Test Routine eorr be RI I ar ERR EE PESE EIE 4 7 Setup Screens c occur Ri ce EPI aie e MuR dae eA al ere UR 4 7 Using the Trim Knob Control 4 8 General Setup Screen 0cc cece cece teen eee eee menn 4 9 Play Song ea ec ede bt RE ME 4 9 SONG Volume uir eec en er c Oe E HERE RE ted 4 9 Temp Done Volumen enr et ane Pno PEE II 4 9 A AA D EHE e AE EU Re YE HEU r 4 9 Paper Speed ecce dette tee ette ase e Da tato oe t
30. and holding this button for 1 second starts or stops a monitor self test routine Revision C 250cx Series Maternal Fetal Monitor 3 3 2036946 001 Controls Indicators and Connectors Front Panel Description Front Panel Name Description Mark Offset Button The Mark Offset button is a multi function button m Mark Pressing this button prints an event mark ton strip chart paper on the bottom two lines of the top grid m Offset When the Heart Rate Offset mode is enabled pressing and holding this button shifts the secondary FHR trend 20 bpm for visibility purposes Refer to Fetal Heart Rate Offset on page 5 11 UA Reference Button The UA Reference button sets a baseline for uterine activity pressure monitoring Refer to Chapter 6 Uterine Activity Monitoring Paper Advance Button Pressing this button advances chart paper at a rate of 40 cm min for as long as the button is held down Record Button The Record button selects one of three recorder states on maternal only mode or off Refer to Chapter 11 Recorder Modes Factory default is OFF Power Indicator The indicator lights green when the monitor is turned on Record Indicator Indicator Status Recorder Status on on off off three short flashes maternal only mode every 5 sec flashes on and off error condition Light Button Recorder Door Latch Illuminates the strip chart paper for night time
31. arrhythmia Move cuff to another limb REPAIR message display in NIBP area of display System error or self test failure Contact Biomedical Engineering Department WEAK SIGNAL message Monitor unable to make a determination due to insufficient signal Assess patient situation Maternal Pulse Oximetry Troubleshooting Maternal Pulse Oximetry Troubleshooting Problem Probable Cause Possible Solution Dashes shown in MSpO display area m Monitor unable to make a determination due to insufficient signal m Improperly applied sensor m Excessive maternal movement m Excessive ambient light m Damaged sensor m Check patient The patient may be experiencing shock hypotension severe vasoconstriction severe anemia hypothermia arterial occlusion proximal to the sensor or cardiac arrest m Ensure that the intermediate cable is firmly attached to the monitor and to the sensor assembly m Ensure sensor is not too tight Move sensor to another location m Restrict patient limb movement Restrain limb if necessary m Cover sensor with opaque material m Replace sensor REPAIR message shown in MSpO area of display System error or self test failure Contact Biomedical Engineering Department SENSOR message shown in MSpO area of display Nellcor only Wrong MSpO2 cable and or sensor connected to the monitor Check the type of MSpO te
32. available only as an Auto selection the Manual selection is disabled Values updated only when NIBP determinations are taken IMPORTANT MSpO AS AN MHR P SOURCE If MSpO is selected as the MHR P source an MHR P alarm only occurs if the pulse rate value derived from the MSpO sensor violates an MHR P alarm limit The MHR P values derived from the MECG and NIBP sections of the monitor are ignored The heart rate tone varies in pitch to reflect changes in the maternal oxygen saturation reading The pitch rises as the saturation values increase and lowers as the saturation values decrease The pulse rate trend is a grey line annotated by MSpO5P 1 If NIBP is selected as the MHR P Source there is no trending of the data since these are static measurements Revision C 250cx Series Maternal Fetal Monitor 2036946 001 7 3 Maternal Heart Pulse Rate Monitoring MHR P Setup Screen MHR P Setup Screen Select the mode title softkey MECG or Pulse to access the MHR P Setup screen Refer to the following figure NOTES The figure below provides an example of MECG selected as the MHR P source as indicated by the MECG mode title When either MSpO or NIBP are selected as the MHR P source the mode title changes to Pulse The Lead source and Pacer fields apply to MECG only Auto TOCO E 165v 172 y 30 MHR P Setup On Off fi MECG Source 89 Y MECG HR PR Trace Lead Il 1 H HI Pacer Off
33. available ranges are shown in the above figure the factory default settings are listed in Appendix A Factory Defaults NOTE The FHRI and FHR2 alarm limits are set independently of each other This field enables disables the audio alarm function for FHR when derived from FECG m On Visual and audible indications are provided during an FHR alarm condition m Off Only a visual indication is provided during an FHR alarm condition This field controls the alarm volume for all alarms Revision C 250cx Series Maternal Fetal Monitor 5 5 2036946 001 Fetal Heart Rate Monitoring Fetal Heart Rate Alarms Fetal Heart Rate Alarms FHR Threshold Alarms Latching Alarms A fetal heart rate threshold alarm occurs when any fetal heart rate falls outside of the pre defined alarm limits greater than the high limit setting or less than the low limit setting These alarm limits are configured via the user setup mode the alarm can be completely disabled as well NOTE The alarm enable disable setting controls all FHR alarms high low and signal quality A threshold alarm is indicated both visually and audibly Visual indications are provided by the Alarm indicator A and the respective heart rate numerics The audio alarm is described as alternating high low tones CAUTION Prior to monitoring each patient it is recommended that you check the alarm status and alarm limits to ensure they are appropriate for the patient
34. change a setting an audio tone indicative of the alarm volume will be emitted from the speaker 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking A final audio tone indicative of the alarm volume is emitted from the speaker 7 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen Revision C 250cx Series Maternal Fetal Monitor D 9 2036946 001 Frequently Asked Questions Question How do enable or change alarm volume settings for MHR P Maternal Pulse How do enable or change alarm volume settings for Maternal Blood Oxygen Saturation MSpO Answer 1 Rotate the Trim Knob to highlight the legend for MHR P This legend is located approximately in the center of the display and may indicate MECG Pulse or INOP depending on the settings that are currently enabled 2 Once the MHR P legend is highlighted press the Trim Knob The display changes to show the MHR P Setup screen 3 Now rotate the Trim Knob to select highlight the Alarm Volume setting located immediately to the right The setting is in the range of 1 to 9 4 Once the Alarm Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video and an audio tone indicative of the alarm volume is emitted from the speaker
35. compensation to provide 100 mmHg 13 3 kPa above the reference level Re zeroing should correct the problem m Ifa negative value is displayed pressure less than 0 mmHg 0 kPa the baseline should be re zeroed When a negative value occurs for more than 20 seconds the message BASELINE PRESSURE OFFSCALE is on the bottom grid on the strip chart paper Revision C 250cx Series Maternal Fetal Monitor 6 5 2036946 001 Uterine Activity Monitoring Internal Method Intrauterine Pressure IUP 6 6 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Maternal Heart Pulse Rate Monitoring evision 250cx Series Maternal Fetal Monitor 2036946 001 Maternal Heart Pulse Rate Monitoring For your notes 7 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Heart Pulse Rate Monitoring MHR P Source MHR P Source The MHR P can be determined by the MECG MSpO and NIBP sections of the monitor However the data from only one parameter is m referred to as the MHR P source m displayed in the MHR P area m used to evaluate an MHR P alarm condition and m used to generate the MHR P trace on the strip chart paper The source is selected via the MHR P Setup screen may be manually selected or automatically selected by the monitor according to the following priority order MECG values updated continuously MSpO values updated continuously NIBP NIBP is
36. data NOTE The monitor stores blood pressure and maternal pulse oximetry events from the monitor s built in parameters The monitor only stores external device data from the TAT 5000 external temperature probe See monitor service manual for proper communications settings to interface TAT 5000 The monitor stores the following maternal vital signs data Each manual and automatic blood pressure event is stored A blood pressure event includes the systolic pressure diastolic pressure mean arterial pressure and maternal pulse rate derived from the blood pressure cuff An event snapshot of MSpO is taken every minute An MSpO event includes the MSpO and the maternal pulse rate derived from the sensor An event snaphot of the MHR is taken every minute An MHR event is the MHR value derived from the MECG electrodes Manual temperature events initiated from the external TAT 5000 temperature probe Revision C 250cx Series Maternal Fetal Monitor 12 3 2036946 001 Maternal Vital Signs History Using the Maternal Vital Signs History Screen LA US A US2 TOCO 154v 135 17 Vital Signs History Date 24 Mar 24 Mar 24 Mar 24 Mar 24 Mar Time 12 00 12 10 12 20 12 30 12 40 NIBP SYS 120 125 DIA 85 95 MAP 94 105 P 74 81 MSpO2 02 98 100 P 76 81 MECG 75 81 HX Interval 10 min PrintAll NOTE NIBP values appear in kPa when in kPa mode Maternal Vital Signs History Screen Using the Maternal Vital Sign
37. data that falls outside the user defined normal range The monitor does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider who will make diagnoses and decide on treatments or interventions A provider should determine the status of the patient by visual assessment of the fetal monitor tracing at the bedside and evaluation of fetal and maternal vital signs and progress in labor The absence of an alarm does not indicate fetal or maternal well being Frequent assessment of the fetal monitor tracing is necessary to ensure recognition of unusual undefined or suspicious patterns that may or may not generate a threshold alarm Single Fetal Heart Rate Monitoring The Corometrics 250cx Series monitor offers three options to monitor a single fetal heart rate FHR US external US2 external FECG internal Please refer to the FHR Display and Trend Summary Table for FHR display and trend summary Dual Fetal Heart Rate Monitoring The Corometrics 250cx Series monitor is capable of monitoring two fetal heart rates The discussion in this section is limited to methods of monitoring dual fetal heart rates however it is important to note that MECG monitoring can continue during the monitoring of twins even when one twin is monitored using FECG Please refer to the FHR Display and Trend Summary Table for FHR display and trend summary There are three availab
38. decrease heart rate CAUTIONS Accuracy of NIBP measurement depends on using a cuff of the proper size It is essential to measure the circumference of the limb and choose the proper cuff size ACCURACY As with any non invasive oscillometric blood pressure monitor there are clinical conditions which can affect the accuracy of the measurements obtained For example do not use the monitor s NIBP feature on a patient experiencing convulsions or who is attached to a heart lung machine In addition disregard or stop automatic blood pressure determinations that coincide with maternal contractions Finally be aware that the accuracy of measurements can be affected if readings coincide with maternal uterine contractions Refer to Smart BP Feature on page 8 13 CALIBRATION Do not operate the monitor unless it has been properly calibrated Inaccurate blood pressure readings may result Refer to Chapter 15 Maintenance for details DISPLAY INTERVAL The time period in minutes that a blood pressure reading remains displayed before being automatically erased is selectable via the password protected Install Options Screen 2 The option can also be set to continuously display the reading until replaced by a new reading The display of old pressure values may cause confusion If a patient s condition changes during the time interval between determinations the monitor will not detect the change or indicate an alarm con
39. finger or toe The OxiMax sensor contains a dual light source and a photodetector Bone tissue pigmentation and venous vessels normally absorb a constant amount of light over time The arteriolar bed normally pulsates and absorbs variable amounts of light during the pulsations The ratio of light absorbed is translated into a measurement of functional oxygen saturation SpO Revision C 250cx Series Maternal Fetal Monitor 9 5 2036946 001 Maternal Pulse Oximetry Monitoring MSpO2 Technology Because a measurement of SpO is dependent upon light from the OxiMax sensor excessive ambient light can interfere with this measurement Select an appropriate OxiMax sensor apply it as directed and observe all warnings and cautions presented in the directions for use accompanying the OxiMax sensor Clean and remove any substances such as nail polish from the application site Periodically check to ensure that the OxiMax sensor remains properly positioned on the patient High ambient light sources such as surgical lights especially those with a xenon light source bilirubin lamps fluorescent lights infrared heating lamps and direct sunlight can interfere with the performance of an SpO OxiMax sensor To prevent interference from ambient light ensure that the OxiMax sensor is properly applied and cover the OxiMax sensor site with opaque material WARNING Failure to cover the OxiMax sensor site with opaque material in high a
40. for Belt Tension When adjusting the belt on the patient regardless of transducer type it is important to ensure a comfortable fit also ensure that the transducer is held securely in place GE Medical Systems Information Technologies recommends adjusting the belt tension so that between contractions the UA display shows approximately 25 mmHg 3 3 kPa above the initial baseline After the belt is adjusted it is important to establish a new baseline to prevent belt tension to be counted as uterine pressure also pressure readings could tend to go off the scale if belt pressure is not taken into account Again the UA Reference button should only be pressed between contractions More About Referencing Out of Range Condition After you press the UA Reference button if there is insufficient range to provide at least 100 mmHg 13 3 kPa above the reference level probably because the belt is too tight the UA display area flashes the message CHECK TOCO If this happens remove the tocotransducer from the patient re reference with no pressure applied to the button reapply the transducer adjusting the belt to approximately 25 mmHg 3 3 kPa above the baseline then re reference one more time If you still receive the CHECK TOCO message try a different tocotransducer or contact your GE Service Representative Manually Setting the Baseline at the Default Value Briefly pressing the UA Reference button sets the baseline at the default setti
41. invasive monitoring of maternal blood pressure NIBP This monitor is not intended for use in neonatal or pediatric blood pressure monitoring Revision C 250cx Series Maternal Fetal Monitor 2 3 2036946 001 Introduction Series Overview Pulse Oximetry The monitor is intended for use in the non invasive monitoring of the functional oxygen saturation of maternal arterial blood MSpO Heart Pulse Rate The monitor is intended for use in the non invasive monitoring of the maternal heart pulse rate MHR P NOTE The Corometrics 250cx Series provides both maternal heart rate and maternal pulse rate data the heart rate data is derived from the MECG section of the monitor while the pulse rate data is derived from the NIBP or MSpO sections of the monitor Series Overview The Corometrics 250cx Series monitor provides one solution for high risk and low risk labors and deliveries The monitor lets you start with a fetal or maternal fetal monitor and add the extended features later as your clinical needs increase and your budget allows The model of the monitor determines which parameters are in your monitor Fetal Heart Rate Twins US The 250cx Series Monitor Features The 250cx Series monitor offers the following features System Parameters 256cx and 259cx m The QVGA LCD display with circularly polarized filter removes glare its wide viewing angle provides sharp viewing at a distance m The large display ar
42. pack of Z fold paper on all sides to loosen any folds and to ensure proper feed of the paper through the recorder Fanning the Paper NOTE The black squares indicate the end of the recorder paper When the black squares appear the strip chart recorder has approximately 20 minutes of paper remaining when running at a speed of 3 cm min 3 Hold the package of paper so that the black squares are on the bottom of the pack and the Corometrics logo and page numbers are on the left side of the pack EL ped bie bbe he oe This side UP for 120 2120is and 170 Series 59 O cononarrnics MEDICAL SYSTEMS INC ii e e I A Orienting the Paper NOTE The paper is labeled This side up for the 120 2120is and 170 Series This paper is compatible with and required for the 250cx Series 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Setup Procedures Loading Strip Chart Recorder Paper 4 Unfold two sheets from the top of the package so that they extend toward you Creating Paper Leader Inserting the Paper Closing the Recorder Door Revision C 250cx Series Maternal Fetal Monitor 4 5 2036946 001 Setup Procedures Power Refer to Chapter 11 Recorder Modes for information about paper loading errors Power 1 Turn the monitor s power off The Power button is located in the lower right hand corner of the monitor 2 Connect the detachable line cord to the rear panel
43. periodic intervals during use The intensity of the sensor s LEDs are also automatically adjusted to compensate for differences in tissue density NIBP Maintenance A leak test of the NIBP parameter should be performed at least once a year or when there is doubt about the validity of the pressure readings CAUTION Refer calibration and leak testing to qualified service personnel Full calibration details are available in the Corometrics 250cx Series Monitor Service Manual available from GE Medical Systems Information Technologies 15 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maintenance Disposal of Product Waste Disposal of Product Waste Patient Applied Parts Packaging Material As you use the 250cx Series monitor you will accumulate solid wastes that require proper disposal or recycling These include patient applied parts and packaging material Certain patient applied parts such as those with adhesive disposable SpO sensors are intended for single use and should be disposed of properly as medical waste in accordance with regional body controlled guideline Other patient applied parts such as blood pressure cuffs should be cleaned according to instructions Inspect reusable applied parts for wear replace as necessary and dispose of used product as medical waste in accordance with regional body controlled guideline Retain original packaging materials for future use in
44. rather than parallel to the direction of paper travel Then the recorder halts and the yellow LED flashes intermittently to indicate MATERNAL ONLY mode is enabled 2 From the Off state The yellow LED above the recorder is off press the Record button twice quickly The recorder advances printing the date and time on the chart paper perpendicular rather than parallel to the direction of paper travel Then the recorder halts and the yellow LED flashes intermittently to indicate MATERNAL ONLY mode is enabled From the On or MATERNAL ONLY state The yellow LED above the recorder is illuminated or flashing intermittently press Record and hold for 2 seconds until the monitor emits a two tone audio beep which indicates that the recorder is off The yellow LED is now extinguished 250cx Series Maternal Fetal Monitor Revision C 2036946 001 World Headquarters European Representative Asian Headquarters GE Medical Systems GE Medical Systems GE Medical Systems Information Technologies Inc Information Technologies GmbH Information Technologies Asia GE China Co Ltd 8200 West Tower Avenue Munzinger Stra e 3 5 24th Floor Shanghai MAXDO Center Milwaukee WI 53223 USA D 79111 Freiburg 8 Xing Yi Road Hong Qiao Development Zone Tel 1 414 355 5000 Germany Shanghai 200336 P R China 1 800 558 5120 US only Tel 49 761 45 43 0 Tel 86 21 5257 4650 Fax 1 414 355 3790 Fax 49 761 45 43 233 Fax 86 21 5208 2008 GE Med
45. screen Revision C 250cx Series Maternal Fetal Monitor 2036946 001 3 15 Controls Indicators and Connectors Rear Panel Description Rear Panel Description 4 3109 3110 EU RS232C RS2300 RS232C LL 1 Monitor Rear Panel Connectors Standard and Optional IMPORTANT The Fetal Acoustic Stimulator and Remote Event Marker connectors are identical in size and shape Be sure you connect to the proper connector to ensure accurate information 250cx Series Rear Panel Standard and Optional Features Name Description A Vent Provides ventilation for the monitor s internal circuitry B J101 Telemetry Connector for Corometrics telemetry system Connector interface C J103 Data Entry Connector for data entry system interface Connector J104 Nurse Call Connector for standard Nurse Call System D Connector interface The connector s maximum output is 50 Vdc at 100 mA the maximum on resistance is 0 50 3 16 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors Rear Panel Description 250cx Series Rear Panel Standard and Optional Features Name Description J102 Central Systems Connector Connector for analog central station system interface J112 External VGA Connector for external VGA display Use of Connector recommended GE external display w
46. that is purchased separately How do enable and change the alarm volume settings for Fetal Heart Rate 1 Answer 1 Rotate the Trim Knob to highlight the legend for US This legend is top left on the display Note This feature applies only if ultrasound is the source 2 Once the US legend is highlighted press the Trim Knob The display changes to show the US Setup screen where US not US2 Setup is the current legend 3 Now rotate the Trim Knob to highlight the FM Detect setting This setting is On or Off 4 Once the FM Detect setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a value of On enabled or Off disabled 6 Once you set the desired value press the Trim Knob again to save the value The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen 1 Rotate the Trim Knob to highlight the legend for FHR1 This legend is top left on the display and it may read INOP FECG US or US2 2 Once the FHR1 legend is highlighted press the Trim Knob The display changes to show the MODE Setup screen where MODE is the current legend 3 Now rotate the Trim Knob to highlight the FHR1 Audio Alarms setting This is at the bottom of the flat panel displa
47. the limit the time to alarm is 30 seconds FHR bpm low alarm limit threshold alarm activates Time minutes Low FHR Alarm Example Revision C 250cx Series Maternal Fetal Monitor 5 7 2036946 001 Fetal Heart Rate Monitoring Fetal Heart Rate Alarms Sample Clinical Exceptions The figure below provides an example of FHR fluctuations above and below the high alarm limit setting high alarm limit threshold Time minutes Fluctuations Near High Alarm Limit Example Whether the pattern shown in the above figure generates an alarm depends on what percentage of the data violates the limit The monitor evaluates the data on an on going basis the methodology can be simplified as follows m An FHR threshold alarm occurs if the FHR violates the alarm limit setting for more time than it stays within the specified acceptable range m The time to alarm increases as a greater percentage of data stays within the specified acceptable range Signal Quality Alarms A fetal heart rate signal quality alarm occurs if the monitor is unable to detect an acceptable FHR signal Active Signal Quality Alarm Signal quality alarms are indicated both visually and audibly Dashes display in the affected fetal heart rate display The audio alarm is described as alternating high low tones Resolved Signal Quality Alarm As soon as an alarm condition is resolved both the visual and audible
48. the screen for review In addition a 6 second snapshot can be printed on the strip chart paper Continuous display printing of the maternal pulse rate trend can be enabled The MECG waveform can be optionally displayed and can be frozen on the screen for review In addition a 6 second snapshot can be printed on the strip chart paper Built in independent MECG monitoring is provided with selection of lead I II or III Selectable 3 lead maternal ECG with pacemaker detection and rejection generates maternal heart rate QRS waveform display and a 6 second snapshot printout when requested Twins and maternal monitoring can be accomplished simultaneously using dual ultrasound and MECG or by using ultrasound FECG and MECG Maternal alarm limits are user defined with preset defaults they are easily configured via setup screens Maternal alarm conditions have audible and visual indications and can be silenced for a user specified time Alarm silencing is controlled by a brightly colored easily recognizable front panel monitor button Adding Fetal Movement Detection and or Spectra Alerts The monitor can be upgraded to include Fetal Movement Detection and or Spectra Alerts Contact your local sales representative for upgrade information 2 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 3 Controls Indicators and Connectors evision 250cx Series Maternal Fetal Monitor 3 1 2036946 001 Co
49. versus cuff pressure are measured and finally systolic mean and diastolic pressure are determined and the screen is updated In any subsequent determination as few as four pressure steps may be necessary to complete the process When employing fewer pressure steps the system uses the stored information from the previous blood pressure determination to decide the best pressure steps to take The monitor measures the consistency of pulse size to tell if the oscillations taken at a step are good and if more steps are needed If the current blood pressure reading is similar to the previous reading the monitor may use some information from the previous blood pressure in the current determination The monitor constantly evaluates data during a measurement and tries to perform a blood pressure determination in the shortest possible time providing greater comfort to the patient Revision C 250cx Series Maternal Fetal Monitor 8 5 2036946 001 Maternal Non Invasive Blood Pressure Monitoring SuperSTAT NIBP Determination Accelerated Determination Systolic Search The monitor will try to make an accelerated determination of blood pressure if it has been 16 minutes or less since the last determination and the current blood pressure is similar to the previous reading If systolic pressure is not found the NIBP parameter can search at cuff pressures higher than the initial target pressure The parameter will inflate the cuff above the in
50. visibility Factory default is ON Opens the strip chart recorder door to add remove or adjust the paper Power Switch Moving the switch to the on position I turns the monitor on moving the switch to the off position O turns the monitor off Strip Chart Recorder MATERNAL NIBP Connector Annotations and trends are printed on the strip chart paper Two paper styles are available Refer to Chapter 4 Setup Procedures for instructions on loading strip chart paper into the recorder Refer to Chapter 11 Recorder Modes for additional information about trends and annotations Connect a pneumatic hose and blood pressure cuff assembly to this black twin lumen receptacle MATERNAL SpO Connector FECG MECG Connector Connect a 250cx Series MSpO intermediate cable to this royal blue receptacle Use only Nellcor Maternal Oxygen Saturation Sensors if Nellcor technology is installed in your monitor Masimo Sensors if Masimo technology is installed in your monitor or Ohmeda Sensors if Ohmeda technology is installed in the monitor Connect an FECG cable legplate or MECG cable plug to the FECG MECG receptacle Cables with rectangular plugs connect directly to the FECG MECG receptacle Cables with round plugs require an FECG MECG adapter Refer to MECG Ordering Information on page 18 5 for the adapter part number This adapter is used for dual ECG monitoring as well The adapter branches into two cables each
51. with a round receptacle at the end one branch is labeled MECG the other branch is labeled FECG 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors Front Panel Description Front Panel Name Description R UA Connector Connect a tocotransducer IUPC or strain gauge transducer plug to this white receptacle Contact your Sales Representative for information about compatibility S US2 Connector Connect the secondary ultrasound transducer plug to this light gray receptacle T US Connector Connect the primary ultrasound transducer plug to this light gray receptacle U FHR2 Volume Decrease Button The four Volume buttons raise and lower lt 7 the volume of sound emitted by the rear panel speaker The upper pair controls the volume for FHR1 The lower pair V FHR2 Volume Increase Button controls the volume for FHR2 Volume settings have no effect on the processing used W FHR1 Volume Decrease Button to determine heart rate The Volume buttons work in conjunction with the volume control settings on the US US2 Setup screen page 5 3 and on the FECG Setup X FHR1 Volume Increase Button screen page 5 5 Y Alarm Silence Button Pressing this button removes the audible indication of an individual alarm Refer to Re Alarm in the Alarms Section for more information Revision C 250cx Series Maternal Fetal Monitor 3 5 2036946 001
52. 1 13 2036946 001 Recorder Modes Chart Style Vital Signs Printing Summary of Font Settings Printing Description Font Setting 30 240 bpm Scale Paper 50 210 bpm Scale Paper Small m Eight annotation lines are available m Four annotation lines are available m Time date modes and annotations all print using m Time date modes and annotations all print using the small font size the small font size m See Figure on page 11 14 Medium m Four annotation lines are available m Two annotation lines are available m Time date and annotations print using the medium m Time date and annotations print using the medium font size font size Modes print using the small font size Modes print using the small font size m See Figure on page 11 14 Large m Three annotation lines are available m Annotation print using the large font size m Time date print using the medium font size Modes print using the small font size m See Figure on page 11 14 NBP 120 85 M 96 ANNOTATION LINE 2 ANNOTATION LINE 3 ANNOTATION LINE 4 ANNOTATION LINE 5 ANNOTATION LINE 6 A OTATION LINE 0 26 31 DEC 98 L FECG TO NBP 120 85 ANNOTATION LIN 4 NBP 120 85 M 96 P 68 ANNOTATION LINE 2 10 26 31 DEC 98 A FECG VV TOCO VV 3 CM MIN Chart Style Vital Signs Printing The monitor provides an option for chart style printing of blood pressure and MSpO values on standard clock qu
53. 120 6 7 Auto 120min 7 8 Alarm Volume 5 8 9 9 Maternal NIBP Setup Screen This field alternates between the manual and automatic monitoring modes for maternal blood pressure For auto mode this field also sets the interval time in minutes between automatic blood pressure determinations This interval time is measured from beginning to beginning of determinations The monitor is factory set with the optional 1 minute interval time enabled For information on disabling the 1 minute interval refer to the 250 250cx Series Monitor Service Manual NOTE As soon as the auto mode is selected on the setup screen the countdown timer begins to decrement The first automatic determination begins after expiration of one complete interval time period This option lets you choose the initial pressure for cuff inflation If the NIBP is taken while previous determination is still displayed and within 16 minutes of the previous determination the initial target pressures for subsequent determinations are based upon the systolic values of previous determination The default initial target pressure is 135 mmHg 18 0 kPa Adjust the pressure between 100 to 250 mmHg 13 3 to 33 3 kPa in increments of 5 mmHg 0 7 kPa NOTE Selecting a target pressure will clear old NIBP values in the vital signs area and cancel any determination in progress Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Mater
54. 210 bpm lt 10 pA at 120 240 VAC isolated by transducer Uterine Activity Mode Range Resolution Bandwidth Excitation Voltage Zero Set Temperature Drift Leakage Current Strain Gauge 0 100 mmHg 0 13 3 kPa 1 mmHg 0 13 kPa dc to 0 5 Hz 4 0 Vdc lt 0 1 mmHg C 0 013 kPa C excluding transducer lt 60 pA at 254 VAC electrically isolated dc to 0 5 Hz Tocotransducer 0 100 mmHg 0 13 3 kPa 1 mmHg 0 13 kPa The ranges shown here are typical ranges seen in a cl inical setting 17 4 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Technical Specifications Operating Modes Operating Mode Specifications Continued MECG Mode Technique Maternal ECG Electrode Type Leads Available Heart Rate Counting Range Heart Rate Resolution Heart Rate Update Rate Countable Input Signal Range Baseline Drift Tall T wave Rejection Heart Rate Meter Response Time 80 120 bpm Step Increase 80 40 bpm Step Decrease Alarm Time for Tachycardia 80 200 bpm Offset Voltage Tolerance Differential Maximum Common Mode Voltage Preamplifier Bandwidth Common Mode Rejection Balanced Unbalanced 5K RA or LA Input Equivalent Noise Input Impedance Differential Common Mode Mains Frequency Rejection Leakage Current Isolation Mains to Patient Leads Off Detection Alarms Audio Visual Limits Technical Tachycardia Respons
55. 4 contractions without a deceleration or 10 minutes without decelerations if no uterine contractions are present Artifac Arrhythmia Present No alert 5 of data in last minute may be PVCs other arrhythmias or artifact Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Spectra Alerts Alert Parameters Summary of Alert Parameters ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria UA Baseline Pressure mmHg kPa TOCO Uterine activity gt 40 mmHg 5 3 kPa for 5 minutes No alert UA BASELINE SET appears in Uterine Activity Display mmHg kPa IUP Hypertonus Uterine activity gt 25 mmHg 3 3 kPa for 5 minutes 7 minutes at start up No alert UA BASELINE SET appears in Uterine Activity Display Hypertonus UA Hypertonus UA Uterine activity gt 35 mmHg 4 7 kPa for 5 minutes Alert has not been silenced Alert silenced and question resolved The alert is deleted after uterine activity is 35 mmHg 4 7 kPa for 5 minutes UC Uterine con tractions in 10 min of uterine contractions Tachysyst Tachysyst Six uterine contractions completed in 10 minutes any size internal or external No alert If FHR Alert is present The alert is deleted if there are 6 uterine contractions in 10 minutes If 4 Z blank Start up No cont
56. 6 P 83 MSpO2 96 P 72 9 00 FECG US WM MHR 44 TOCO MSp02 3 CM MIN SpO Scale Annotations Five Trends Printing Simultaneously Two scale options are available for printing the MSpO trends The scale is printed on the paper along with the trend This option is located in the password protected Install Options screen m Aulo The trend plots on an expanded scale of 60 100 or 50 100 depending on the paper m 0 100976 This option configures the MSpO trend to always plot at a fixed scale of 0 100 Several standard annotations are printed by the monitor to help analyze the strip chart data and complete the patient record Most annotations print in the area between the top and bottom grids of the strip chart paper however some annotations print in either grid All annotations are listed and explained in the Summary of Annotations Table The MSpO trend is plotted over a range of 60 100 on paper with a HR scale ranging from 30 240 bpm The MSpO trend is plotted over a range of 50 100 on paper with a HR scale ranging from 50 210 bpm Revision C 250cx Series Maternal Fetal Monitor 11 7 2036946 001 Recorder Modes Annotations Standard Annotations The most common of the annotations which print on the bottom line are date time active modes heart rate coincidence enable status fetal heart rate alarm enable status recorder speed telemetry status Blood Pressure Annotations A bloo
57. 99 bpm m late decelerations m severe variable or sporadic decelerations m tachycardia with flat variability m mild sporadic decelerations with decreased variability m moderate variable decelerations with tachycardia or bradycardia or decreased variability m mixed decelerations m mild bradycardia and flat variability m mild late or mixed decelerations with decreased variability or mild tachycardia m mild variables and flat variability m mild variables and mild tachycardia and decreased variability m prolonged deceleration 80 119 bpm m bradycardia 90 bpm m prolonged deceleration 80 bpm m late variable or mixed decelerations with decreased variability and tachycardia or bradycardia m severe late or variable decelerations with tachycardia or bradycardia or decreased variability m moderate bradycardia and flat variability m any deceleration except mild variables and flat variability m late or severe variables with tetanic uterine contraction Revision C 250cx Series Maternal Fetal Monitor 2036946 001 C 5 Spectra Alerts Alert Indications Alert Indications Active Alerts When the system detects an alert condition visual and audible indications are provided There is no printed indication of the alert The alert level indicated by asterisks flashes and displays in inverse video between the FHR1 and FHR2 areas in addition the associated FHR numerics flash The audio indica
58. Adult Thigh 46 66 cm Range 5524AA0 Single Patient Use Dual Tube Locking Luer Cuff Small Adult 18 26 cm Range 10 carton 900373 003 Single Patient Use Dual Tube Locking Luer Cuff Adult 25 35 cm Range 10 carton 900373 002 Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Supplies amp Accessories MSpO Ordering Information NIBP Supplies and Accessories Item Catalog Number REF Single Patient Use Dual Tube Locking Luer Cuff Large Adult 33 47 cm Range 10 carton 900373 001 NIBP Cuff Hose Adapter 414876 001 MSpO Ordering Information MSpO Supplies and Accessories Item Catalog Number REF Ohmeda OxyTip Adult Adhesive Sensor 10 box OXY AP 10 Ohmeda OxyTip Adult Adhesive Sensor 25 box OXY AP 25 Ohmeda OxyTip Interconnect Finger Sensor OXY F UN Intermediate Cable for Nellcor Sensors 2025350 001 Intermediate Cable for Masimo LNOP Sensors 2017002 003 Intermediate Cable for Onmeda Sensors OXY ES3 Nellcor Durasensor Adult Reusable Finger Probe 407705 006 Masimo Sensor LNOP Adult Reusable Finger Probe E9008JC 2002800 001 Masimo Sensor LNCS Adult Adhesive 20 box 2027253 001 Masimo Sensor LNCS Adult Reusable Finger Probe 2027258 001 Intermediate Cable for Masimo LNCS Sensors 2027263 001 Peripheral Device Ordering Information Peripheral Device Supplies and Accessories Item Catalog Number REF Interface Cable to Nellcor Model N 200 M 400 1557BAO Pulse
59. CK CUFF message displayed in NIBP area of display m Improper cuff position m Loose cuff m Air pressure error m Maternal movement m Hose not properly connected to monitor m Neonatal cuff connected m Reposition cuff m Tighten cuff Contact Biomedical Engineering Department m Restrict patient limb movement m Ensure that hose is firmly attached to monitor m Ensure an adult cuff is connected OVERPRESSURE message displayed in NIBP area of display m Cuff pressure has exceeded the overpressure limit of 315 x 15 mmHg 42 0 2 0 kPa m Kinked hose m Blocked hose m Restrict patient limb movement If this is not the case contact Biomedical Engineering Department to perform pneumatic test m Check the external cuff for kinks Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Troubleshooting Maternal Pulse Oximetry Troubleshooting Blood Pressure Troubleshooting Problem Probable Cause Possible Solution COMM ERROR message displayed in NIBP area of display Communication error between the built in NIBP parameter and the remainder of the monitor circuitry Call Biomedical Engineering Department MOTION message displayed in NIBP area of display m Excessive maternal movement m Maximum reading determination time exceeded m Talk to patient about the importance of minimizing limb movement m Reposition cuff m Check patient for
60. Exit softkey on the bottom of the screen This returns the monitor to normal operation IMPORTANT EFFECTIVITY All changes take effect immediately after a selection is enacted in Step 6 Some changes take effect as the values are changed without having to press the Trim Knob 4 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Setup Procedures General Setup Screen General Setup Screen Off Happy Birthday Brahms Lullaby Rock A Bye Baby All General Setup Temp Done Volume Paper Speed Selection 1 2 or 3 cm min On Off Play Song Off Song Volume 5 Temp Done Volume 5 Brightness 5 Paper Speed 3 cm min Date 01 Jan 2007 Time 12 01 00 External Monitor Setups o o 00 PWN o Play Song Song Volume Temp Done Volume MSpO2 Print Interval 5 min FSpO2 Print Interval 5 min FSpO2 Trace Off Service Exit This field sets the volume of the song player 000 JO 0 kt WHY o OANA ON OFF 2 min 5 min 10 min 15 min 30 min 60 min Following is a sample General Setup screen Y ou can access this screen from the main screen by selecting Setup Using the Trim Knob to go to the field you wish to change and select it by pressing the knob Choose the desired setting General Setup Screen You can activate a song to be played from
61. FECG TOCO m TOCO m UP m UP m NIBP m MSpO m MECG Dual ultrasonic heart rate monitoring allows for non invasive monitoring of twins Independent volume controls facilitate easy transducer placement when monitoring twins m A 20 bpm heart rate offset option is provided for the secondary heart rate HR2 trend when using dual ultrasound or ultrasound and direct FECG to separate overlapping FHR trends for easy interpretation A heartbeat coincidence detection feature can be enabled to inform you when there is the possibility that you may be monitoring a duplicate signal m The FECG waveform can be optionally displayed and can be frozen on the screen for review In addition a 6 second snapshot can be printed on the strip chart paper m Fetal parameters are continuously displayed even during configuration of system setup options m The ultrasound mode provides clean accurate traces with few dropouts because of Corometrics patented autocorrelation processing m Fetal heart rate alarm limits are user defined with pre set defaults Signal quality has no user defined parameters Alarm limits are easily configured via setup screens Alarm silencing is controlled by a brightly colored easily recognizable front panel monitor button Revision C 250cx Series Maternal Fetal Monitor 2 5 2036946 001 Introduction Series Overview Alarm conditions have both audible and visual indications Only fetal aud
62. GE Healthcare Corometrics 250cx Series Monitor Operator s Manual Corometrics 250cx Series Monitor English 2036946 001 C paper O 2007 General Electric Company All Rights Reserved GE Healthcare Corometrics 250cx Series Monitor Operator s Manual Corometrics 250cx Series Monitor English 2036946 001 C paper O 2007 General Electric Company All Rights Reserved GUARANTEE All equipment sold by GE Medical Systems Information Technologies is fully guaranteed as to materials and workmanship for a period of 1 year GE Medical Systems Information Technologies reserves the right to perform guarantee service operations in its own factory at an authorized repair station or in the customer s installation Our obligation under this guarantee is limited to repairing or at our option replacing any defective parts of our equipment except fuses or batteries without charge if such defects occur in normal service Claims for damage in shipment should be filed promptly with the transportation company All correspondence covering the instrument should specify the model and serial numbers GE MEDICAL SYSTEMS Information Technologies A GE Healthcare Company GE Medical Systems Information Technologies will make available on request such circuit diagrams component diagrams component parts lists descriptions calibration instructions or other information which will assist the users or appropri
63. General Information 00 c ccc eee e eee eee nn 1 3 General USe sr users Sea ie a a 1 3 Responsibility of the Manufacturer 0 0 cece eee eae 1 3 Responsibility ofthe User 1 3 Definitions of Terminology cece cece eee eee eee eee eee eeeeeeaes 1 4 Monitor Contraindications Warnings and Precautions 1 5 Warnings anced ates ve ege ahve Sr ant ne an add aie 1 5 A RON 1 8 Electromagnetic Interference 0 0 cee cee 1 9 Equipment Symbols sss nne 1 10 2 Introduction s voy ve Pic e e e eee 2l About the Manual ssseeseeeennnn n nh 2 3 O o e adds 2 3 Intended Audience o aa A td id te 2 3 Istria O ca are 2 3 Fetal Monitoring Indications for Use 00 cee ee eee eee eee eeeeees 2 3 SUI M LC a dai 2 3 Maternal Monitoring Indications for Use sese 2 3 Blood PIossUre oct eR EC 2 3 Pulse Oximetty cays cor b nter e pH enin 24 Heart Pulse Rate 2 eee e ened 2 4 Series OVErVieW ui pi RI Mat EE IR Re st 2 4 The 250cx Series Monitor Features 0 0 cece cece eee eee ee 2 4 System Parameters 256cx and 259CX 0 c cece eee eee nee 2 4 Fetal Parameters 00 c cece eens 2 5 Maternal Parameters 259cx only 02 0 cece tee eee eee 2 6 Adding Fetal Movement Detection and or Spectra Alerts 2 6 Revision C 250cx Series Maternal Fetal Monitor i 2036946 001 Controls Indicators
64. MECG leads off Flashing dashes in place Alternating high low tones if of MHR P numeric and MECG audio enabled LEADS OFF message displays underneath MSpO MSPO limit high or low actively MSpO numeric flashes MSpO Alternating high low tones if being violated Issued after about 8 seconds Malfunction with MSpO circuitry MSpO intermediate cable disconnected from monitor sensor assembly disconnected from intermediate cable or sensor or cable has a broken wire value and pulse rate print on the strip chart COMM or REPAIR message displays in MSpO area Dashes in place of MSpO numeric audio enabled Alternating high low tones if audio enabled Alternating high low tones if audio enabled There is an MECG re alarm There is an MSpO re alarm 10 10 250cx Series Maternal Fetal Monitor 2036946 001 Revision C 11 Recorder Modes Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Recorder Modes For your notes 11 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Modes Modes Off Mode On Mode The 250cx Series Monitor has three recorder modes off on and maternal only Factory default is ON When the recorder is off the yellow Record indicator is off and nothing is automatically printed on the strip chart paper Even with the recorder turned off it is possible to manually pr
65. Maternal Fetal Monitor Revision C 2036946 001 Alarms Maternal Alarms Resolved Signal Quality Alarm Resolved signal quality alarms function like most other 250cx Series alarms As soon as an alarm condition is resolved both the visual and audible indications automatically disappear Silencing an FHR Audio Alarm Press the Alarm Silence button to cancel the audio however the visual indication remains until the condition is resolved Maternal Alarms Maternal Patient Alarms A maternal patient alarm occurs when a parameter value falls outside of the pre defined alarm limits greater than the high limit setting or less than the low limit setting m For MHR P the value used for analysis comes from the selected MHR P source For Ohmeda and Masimo MSpO the value must be out of range for 8 seconds For Nellcor MSpO the range depends upon the SatSeconds setting Refer to SatSeconds in the Maternal Pulse Oximetry Monitoring Section for more information Active Patient Alarm A patient alarm is indicated both visually and audibly The visual indication is provided by flashing the associated numeric The audio alarm consists of alternating high low tones For MSpO the MSpO2 value and accompanying pulse rate are printed on the strip chart paper Resolved Patient Alarm The visual and audible indications automatically disappear as soon as the condition is resolved Signal Quality Alarms If the monitor is unable to
66. Mode Title Softkeys Selects US US2 FECG NIBP MHR P or SpO Setup screens B ECG Scale Softkey Selects 0 25x 0 5x 1x 2x 4x or Auto MECG Lead Select Selects Lead 1 II or III C Softkey D VSHX Softkey Displays maternal Vital Signs History screen See illustration below E Setup Softkey Displays General Setup screen F Alarms Softkey Displays Master Alarm Setup screen 3 14 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors Softkeys Display Summary Name Description G Freeze Softkey Freezes waveform for analysis unfreezes waveform to return to real time display H Print Softkey Prints 6 second snapshot of frozen waveform real time waveform or maternal vital signs history I Waveform Softkey Selects FECG MECG MSpO or Off AUS 154v Date 24 Mar Time 12 00 NIBP A US2 TOCO 135 17 Vital Signs History 24 Mar 24 Mar 24 Mar 24 Mar 12 10 12 20 12 30 12 40 125 95 105 81 100 81 81 HX Interval 10 min PrintAll Maternal Vital Signs History Screen Softkeys Name Maternal Vital Signs History Screen Softkeys Description A Print Softkey Prints one page screen of the table B PrintAll Softkey Prints all pages screens View Softkey Scrolls through the data m Counterclockwise for newest data m Clockwise for oldest data D Exit Softkey Returns to the previous
67. ONS For continued and safe use of this equipment it is necessary to follow all listed instructions However the instructions provided in this manual in no way supersede established medical procedures concerning patient care The monitor does not replace observation and evaluation of the patient at regular intervals by a qualified care provider who will make diagnoses and decide on treatments and interventions INTERFACING OTHER EQUIPMENT Monitoring equipment must be interfaced with other types of medical equipment by qualified biomedical engineering personnel Be certain to consult manufacturers specifications to maintain safe operation LEAKAGE CURRENT TEST The interconnection of auxiliary equipment with this device may increase the total leakage current When interfacing with other equipment a test for leakage current must be performed by qualified biomedical engineering personnel before using with patients Serious injury or death could result if the leakage current exceeds applicable standards The use of accessory equipment not complying with the equivalent safety requirements of this equipment may lead to a reduced level of safety of the resulting system Consideration relating to the choice shall include use of the accessory in the patient vicinity and evidence that the safety certification of the accessory has been performed in accordance with the appropriate EN60601 1 and or EN60601 1 1 harmonized national standard LINE
68. R bpm 135 140 a FHR Variability The alert parameter information is Decelerations Absent available even if there is no alert Artifact Arrhythmia associated with this FHR UA Babbling Pressure 2 UC in 10 min 3 Duration of Last UC 60 Signal Quality Good Alert On Volume 5 Alert Parameters Example US is not associated with any alert Revision C 250cx Series Maternal Fetal Monitor C 11 2036946 001 Spectra Alerts Resetting Alerts Resetting Alerts If you do not agree with an alert see False Pattern Recognition and Mode Switching you can clear the data being used via the Alert field on the associated setup screen FECG or US US2 NOTEFHR data is collected over time for analysis Resetting an alert clears all data from the monitor s memory for both FHR1 and FHR2 To reset an alert 1 Access the setup screen associated with the alert indicated by the flashing FHR numerics Select the mode title softkey FECG or US US2 2 Highlight the Alert field Whenever you display the setup screen this field is set to On 3 Change the Alert field setting to Reset If you change the field to Reset by mistake and wish to change it back simply set it to On again 4 Once an alert is reset audio and visual indications are removed and the alert parameters information clears NOT Elt is possible that the Spectra Alerts feature may generate the same alert again False Patte
69. SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria Unknown external Baseline variability is determined to be 5 15 Average internal beats peak to peak Increased Alert pending Approximately 5 minutes of baseline variability which is gt 15 beats peak to peak Increased VARIABILITY Alert is issued if baseline variability remains increased for approximately 10 minutes and there are no other FHR alerts detected Increased VARIABILITY Alert silenced Decreased Alert pending Reflects the detection of baseline variability which is lt 4 5 beats FHR Variability peak to peak for approximately 10 minutes Decreased VARIABILITY Alert will be issued 20 40 minutes after decreased variability is detected The time to alert depends on whether or not any other alert parameters are outside the normal range Decreased VARIABILITY Alert silenced Flat Alert pending Absent variability detected for approximately 4 minutes Flat VARIABILITY Alert will be issued approximately 6 10 minutes after flat variability is detected Flat VARIABILITY Alert silenced Alert is deleted if approximately 5 minutes of better variability is detected Decelerations Absent May miss subtle decelerations Present Deceleration with or without a contraction is detected This indication may come and go prior to alert condition Once an alert condition is detected the word Present rema
70. SpO falls outside of the alarm limit is multiplied by the number of seconds that the SpO level remains outside that limit This can be stated as an equation Points x Seconds SatSeconds Where m Points SpO percentage points outside of the limit m Seconds number of seconds the SpOs remains at that point outside of the limit The alarm response time assuming a SatSeconds limit set at 50 and a lower alarm limit set at 90 is described and illustrated below In this example the SpO level drops to 88 2 points and remains there for a period of 2 seconds 2 points x 2 seconds 4 SatSeconds The SpO then drops to 86 for 3 seconds and then to 84 for 6 seconds The resulting SatSeconds are SpO Seconds SatSeconds 2X 2 4 4X 3 12 6X 6 36 Total SatSeconds 11 52 SatSeconds Calculation Revision C 250cx Series Maternal Fetal Monitor 9 7 2036946 001 Maternal Pulse Oximetry Monitoring MSpO2 Technology SpO After approximately 10 9 seconds the SatSeconds alarm would sound because 50 SatSeconds the assumed SatSeconds limit in this example had been exceeded 90 88 86 0123456789 10 11 SECONDS Alarm Response with SatSeconds Saturation levels may fluctuate rather than remain steady for a period of several seconds Often the SpO levels may fluctuate above and below the alarm limit re entering the non alarm range several times During such fluctuations the pulse oxim
71. The alarms are disabled if the Alarm Disable indicator X is lit they are enabled if the indicator is unlit Fetal heart rate threshold alarms are latching This means that a clinician must acknowledge the alarm using the monitor s Alarm Silence button in order to clear the alarm m Active Threshold Alarm Press the Alarm Silence button X to cancel the audio component of an active threshold alarm The visual indications remains present until the FHR value returns to within the defined acceptable range m Unsilenced Resolved Threshold Alarm If a threshold alarm condition resolves prior to being silenced clinical acknowledgment the visual and audible indications both remain present Press the Alarm Silence button KX to cancel both the audible and visual indications 5 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Heart Rate Monitoring Fetal Heart Rate Alarms FHR High Alarm The simplest example of a high FHR alarm occurs when the FHR value is continuously greater than the threshold high limit for 5 minutes When data consistently violates the limit the time to alarm is 5 minutes FHR bpm alarm activates ie oc P high alarm limit threshold Time minutes High FHR Alarm Example FHR Low Alarm The simplest example of a low FHR alarm occurs when the FHR value is continuously less than the threshold low limit for 30 seconds When data consistently violates
72. a Alerts Using the Spectra Alert Option Using the Spectra Alert Option Enabling Disabling Spectra Alerts Methodology CAUTION CIS The Spectra Alerts option provides bedside alerts only If you connect the 250cx Series Monitor to a Quantitative Sentinel or Spectra 400 Alert and Surveillance Central System you must disable the Spectra Alerts feature in the monitor The Spectra Alerts option when installed is enabled disabled from the Fetal Alert Alarm field on the password protected Install Options service screen FHR alarms and Spectra Alerts cannot be enabled at the same time You may select one or the other or you can disable them both To effect a change to the Fetal Alarms setting you must turn the monitor off then back on again When the Alerts option is enabled a solid bell icon A displays next to the FHR mode title s and prints on the strip chart paper prior to the active FHR mode annotation s Refer to the Figure Spectra Alert Enabled Annotation on page C 5 and the Figure Example of a Level One Decelerations Alert on page C 6 This icon indicates that the feature is enabled only it does not indicate the presence of an alert condition The Spectra Alerts feature is designed to assist the perinatal staff in assessing the status of monitored patients by recognizing normal and abnormal pattern features Medically researched pattern recognition techniques are utilized to detect when the pre set limit
73. able Spectra alerts can appear in this area NOTE Refer to the Maternal Fetal Monitoring Clinical Applications Manual for patient application information An ultrasound US US2 transducer placed on the maternal abdomen is used to direct an ultrasonic beam toward the fetal heart the transducer detects Doppler shifted frequency changes in echoes created by moving cardiac structures An autocorrelation process is used to determine the time interval between successive cardiac cycles The fetal heart rate is displayed in bpm and is continuously plotted on the strip chart paper if the recorder is on Refer to the US US2 Setup Screen figure below The heartbeat indicator flashes for each detected heartbeat Select the US or US2 softkey to access the US US2 Setup screen below The title of the screen US vs US2 is dependent on the mode selected when the screen is activated US2 420 120 20 US Setup FM Detect Off Alert Suspend Off Volume 5 Alert On Volume 5 Trend US US2 Setup Screen Volume This field adjusts the volume for the FHR derived from the selected mode US or US2 This field works in conjunction with the front panel Volume buttons Revision C 250cx Series Maternal Fetal Monitor 5 8 2036946 001 Fetal Heart Rate Monitoring FECG Internal Method Alert This field controls and shows Spectra Alerts Refer to Appendix C for more information Alarm Volum
74. ain to return to the main monitoring display screen D 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Frequently Asked Questions Question How do enable or change alarm volume settings for Fetal Heart Rate 2 How do enable or change alarm volume settings for Non Invasive Blood Pressure Answer 1 Rotate the Trim Knob to highlight the legend for FHR2 This legend is top left on the display and may display as INOP or US2 2 Once the FHR2 legend is highlighted press the Trim Knob The display changes to show the lt MODE gt Setup screen where mode is the current legend 3 Now rotate the Trim Knob to highlight the FHR2 Audio Alarms setting This is at the bottom of the flat panel display slightly above the menu bar on the left half of the screen The setting is either On or Off If the setting is Off you must enable it Proceed to Step 4 below If the setting is already On and you simply wish to change the Volume setting proceed to Step 7 below 4 Once the Audio Alarms setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting to On 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the Volume setting located immediately to the right The setting is in the
75. aper and for output to external devices such as a central station system The averaged MHR values are used for display and for alarm detection Pacemaker Safety Information The following safety information applies to patients with pacemakers WARNINGS ACCESSORIES Use only electrodes lead wires and cables recommended by GE Medical Systems Information Technologies Failure to use recommended accessories may result in inaccurate readings damage to equipment or loss of defibrillator protection FALSE ALARMS False low heart rate alarms or false asystole may result with certain pacemakers because of electrical overshoot FALSE COUNTING Be aware that a pacer spike could be falsely counted as a QRS complex during asystole INTERFERENCE Interference caused by electrosurgical or diathermy instruments will affect the proper operation of the MECG section of 250cx Series Monitors PACEMAKER SPIKE Do not diagnostically interpret the pacemaker spike size and shape the spike may be attenuated by the module in order to be displayed or printed PATIENT OBSERVATION Keep pacemaker patients under close observation Revision C 250cx Series Maternal Fetal Monitor 7 7 2036946 001 Maternal Heart Pulse Rate Monitoring Maternal ECG Monitoring MECG Waveform CAUTION FDA POSTMARKET SAFETY ALERT the United States FDA Center for Devices and Radiological Health issued a safety bulletin October 14 1998 Th
76. art rate derived from blood pressure readings is not used to detect heartbeat coincidence since blood pressure is a static measurement The following table summarizes the combinations of heart rate sources that are continuously compared for the possibility of coincidence Heartbeat Coincidence Comparisons Mode FECG US US2 MECG MSpO2 FECG Y Y Y Y US Y Y v v US2 Y Y Y v MECG Y Y Y MSpO Y Y v Using the Heartbeat Coincidence Feature Enabling Disabling Heartbeat Coincidence Detection Display Indicator This feature is enabled from the password protected Install Options service mode screen Refer to the 250 250cx Series Monitor Service Manual for detailed information about enabling disabling this feature When heartbeat coincidence detection is enabled the acronym HBC appears to the right of the FHR2 mode title See Heartbeat Coincidence Example below If the monitor detects two heartbeats that appear to be coinciding this may indicate that the two channels are picking up the same signal When this coincidence occurs the heart rate numerics for both heart rates display in inverse video as shown below Inverse video is a dark background with white numerics As soon as coincidence is resolved the numerics return to standard video Standard video is a white background with dark numerics Revision C 250cx Series Maternal Fetal Monitor 13 3 2036946 001 Heartbeat Coincidenc
77. arter half and whole hour marks Enabling Disabling Chart Style Printing The chart style feature is enabled disabled from the password protected Install Options service screen Refer to the Maternal Fetal Monitoring Clinical Applications Manual for more information 11 14 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Chart Style Vital Signs Printing Examples of Printing Styles Chart Style Printing Examples When chart style printing is enabled m The 15 minute interval prints on the quarter hour e g 9 00 9 15 9 30 9 45 etc m The 30 minute interval prints on the half hour e g 9 00 9 30 10 00 10 30 etc m The 60 minute interval prints on the hour e g 9 00 10 00 11 00 12 00 etc The following are examples of chart style printing m NIBP Example 1 The automatic blood pressure mode is activated at 9 03 with the interval time set to 15 minutes Whereas the first real time reading would occur at 9 18 the first chart style reading is taken at 9 15 Subsequent readings are taken and printed at 9 30 9 45 10 00 10 15 etc m NIBP Example 2 The automatic blood pressure mode is activated at 9 17 with the interval time set to 30 minutes Whereas the first real time reading would occur at 9 47 the first chart style reading is taken at 9 30 Subsequent readings are taken and printed at 10 00 10 30 11 00 11 30 etc m MSpO2 Example 1 The MSpO print interval time i
78. ate the source The user is encouraged to try to correct the interference by one or more of the following measures m Turn equipment in the vicinity off and on to isolate the offending equipment Reorient or relocate the other receiving device Increase the separation between the interfering equipment and this equipment m Ifassistance is required contact your GE Medical Systems Service Representative Revision C 250cx Series Maternal Fetal Monitor 1 9 2036946 001 Safety Equipment Symbols Equipment Symbols The following is a list of symbols used on products manufactured by GE Medical Systems Information Technologies Some symbols may not appear on your unit Equipment Symbols ATTENTION Consult accompanying documents WASTE OF ELECTRICAL AND ELECTRONIC EQUIPMENT WEEE This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately Please contact an authorized representative of the manufacturer for information concerning the decommissioning of your equipment TYPE B EQUIPMENT Type B equipment is suitable for intentional external and internal application to the patient excluding direct cardiac application gt A TYPE BF EQUIPMENT Type BF equipment is suitable for intentional external and internal application to the patient excluding direct cardiac application Type BF equipment has an F
79. ately qualified technical personnel to repair those parts of the equipment which are classified by GE Medical Systems Information Technologies as repairable Refer to the 250 250cx Series Service Manual for further information NOTE In addition to software version 4 50 the information in this manual also applies to previous software revisions of Corometrics 250cx Series Monitor There are no user apparent differences among these software versions Due to continuing product innovation specifications in this manual are subject to change without notice NOTE Fortechnical documentation purposes the abbreviation GE is used for the legal entity name GE Medical Systems Information Technologies Ohmeda Oximetry and other trademarks OxyTip PI TruSat TruSignal TruTrak SuperSTAT are the property of GE Medical Systems Information Technologies a division of General Electric Corporation All other product and company names are the property of their respective owners MASIMO SET is a trademark of Masimo Corporation Possession or purchase of this device does not convey any express or implied license to use the device with replacement parts which would alone or in combination with this device fall within the scope of one or more of the patents relating to the device NELLCOR OxiMax C LOCK and SatSeconds are trademarks of Nellcor Puritan Bennett TAT 5000 Exergen and TemporalScanner are trademarks of Exergen Corpo
80. aternal Only Off Press and hold 3 seconds 1 A confirmation tone sounds to indicate the recorder has been turned off Recorder Mode Audiovisual Indicator Status Recorder Mode Record Indicator Audio Indicator On continuously illuminated Maternal Only lights three short flashes every Off 5 seconds Off Off Functionality with a QS System Users of a Quantitative Sentinel QS System Software Version 4 0 3 0 or earlier should be aware of the following items when using the monitor s maternal only mode Paper Versus Electronic Strip Charts As described earlier the monitor s maternal only mode acts as a paper saver turning the strip chart recorder on and off as needed However the QS System overrides the maternal only mode by storing the entire patient record In other words the electronic strip chart is retained as if the monitor s recorder were left on Revision C 250cx Series Maternal Fetal Monitor 11 5 2036946 001 Recorder Modes Trends continuously with all data lines printing in the annotation area this may result in many blank pages in between maternal vital signs data In addition the FHR mode will list INOP Contact your Service Representative for clarification on your QS System s wiring Fetal Heart Rate Alarms Trends Multiple Trends The QS System is designed to alarm when there is no fetal heart rate signal so it is recommended that you unplug the ultrasound an
81. ation The ages ranged from 18 to 50 years old with variations of skin pigmentations Adult specifications are shown for OxiMax MAX A and MAX N sensors with the N 600 Saturation accuracy will vary by sensor type 7 Applicability OxiMax MAX A MAX AL MAX P MAX I and MAX N sensors Information of wavelength range can be especially useful to clinicians performing photodynamic therapy NOTE Because pulse oximeter equipment measurements are statistically distributed only about two thirds of pulse oximeter equipment measurements can be expected to fall within Arme of the value measured by a CO Oximeter NOTE Use of a functional SpO simulator to assess the accuracy of the Corometrics 250cx SpO parameter has not been demonstrated This device is covered under one or more ofthe following Patents US Patent No 4 802 486 4 869 254 4 928 692 4 934 372 4 960 126 5 078 136 5 485 847 5 743 263 5 865 736 6 035 223 6 298 252 6 463 310 6 591 123 6 675 031 6 708 049 6 801 797 Re 35 122 and foreign equivalents Maternal Vital Signs History Storage Recall 8 hours maximum 17 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Technical Specifications Strip Chart Recorder Strip Chart Recorder Strip Chart Recorder Technical Specifications Heart Rate Scale Domestic International Chart Width 7 cm 8 cm Scaling 30 bpm cm 20 bpm cm Range 30 240 bpm 50 210 bpm Resolut
82. bled via the password protected Install Options service screen Refer to the 250 250cx Series Monitor Service Manual for more information Methodology The Smart BP feature is functional with both TOCO and IUP monitoring when m the automatic blood pressure mode is selected and m the interval time is set to 5 minutes or greater NOTE Blood pressure readings cannot be postponed indefinitely The Smart BP feature ensures that a BP reading is completed even in the presence of frequent uterine contractions Uterine activity trends are continuously analyzed to recognize patterns of uterine contractions Once the onset of a contraction is identified m An active blood pressure reading automatically stops and the cuff deflates it will be re started following the contraction Wm A scheduled reading is delayed until after the contraction Revision C 250cx Series Maternal Fetal Monitor 8 13 2036946 001 Maternal Non Invasive Blood Pressure Monitoring Smart BP Feature 8 14 250cx Series Maternal Fetal Monitor 2036946 001 Revision C 9 Maternal Pulse Oximetry Monitoring evision 250cx Series Maternal Fetal Monitor 9 1 2036946 001 Maternal Pulse Oximetry Monitoring For your notes 9 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Pulse Oximetry Monitoring MSpO2 Technology MSpO Technology Pulse oximetry is a continuous and non invasive method of measuring the leve
83. c 12 0 6 7 kPa 9 3 17 3 4 0 16 0 MAP 18 7 6 7 kPa 9 3 20 0 4 0 16 MHR P 120 50 bpm 100 250 35 120 Volume 5 1 9 Revision C 250cx Series Maternal Fetal Monitor A 3 2036946 001 Factory Defaults Table of Defaults Summary of Factory Defaults Setup i ipti Factory Defaul Default Opti Hospital Pref Screen Field Description actory Default efault Options ospital Preference MSpO Response Time Fast Normal Fast Nellcor 506 Response Time Fast Fast Nellcor NELL 3 Averaging Time Masimo 8 seconds 2 4 8 10 12 14 16 seconds Sensitivity Masimo Normal Normal Maximum Print Interval 5 minutes Off 2 5 10 15 30 60 minutes 950 Trace Off On Off Alarms High Low High Low MSpO 100 95 85 100 80 99 MHR P 120 50 bpm 100 250 35 120 Volume 5 1 9 MHR P Source Auto Auto MECG MSpO NIBP MHR P Trace Off On Off Volume 0 0 9 Alarms High Low High Low 120 50 bpm 100 250 4 35 120 Alarm Volume 5 1 9 MECG Lead I 1 Ul Ill Pacer Off On Off Normal Waveform Display MECG FECG MECG MSpO Off Operation MECG Waveform Size 1X 1 mV cm 0 25X 0 5X 1X 2X 4X Auto A 4 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Factory Defaults Table of Defaults Summary of Factory Defaults Setup X a Screen Field Description Factory Default Default Options Hospital P
84. c 4 10 Date DE 4 10 Tis iuo n Re a be tao ates pue A Palas ses 4 10 MSpOz Print Interval 4 10 FSpO Print Interval orii anad aa aaa i E A AAA 4 10 FSpOTI C8 ci ob cete A Ras 4 10 SENICE PER A AAEE E NE TOE EN AA 4 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Preparing the Monitor for Patient Use lessen 4 11 5 Fetal Heart Rate Monitoring 5 1 Ultrasound External Method usse 5 8 Metliodology x5 x ias ete c in vede eee qp a 5 3 US US2 Setup Screen 0 cece need 5 3 Volume Sad otal cis oe hh teas e Ed ea 5 3 Alert i esc scc wave dee neve ve cel andy s neve vac ace sac 5 4 AMV UM 2 5 ces ECC CO VEL 54 FECG Internal Method 0ccc cece eee eee eee eee eens 5 4 Methodology nce pos c ane n e e ac 5 4 Artifact Elimiriatlont cce eet er t tup eR 5 4 FECG Setup Screen viii A pep ir ot 5 5 Volume eet e Set a anre ER Ace E cad adeb a A 5 5 AMO A d 5 5 AUG ALANIS 2c em te ad 5 5 Alami Volume aia seek deo tin sve te osa e AE Io shivers rea ati tas 5 5 Fetal Heart Rate Alarms eese 5 6 FHR Threshold Alarms a erii A E E AA t ee eeae 5 6 FHR AORAR omo a pA ete ets 5 7 Sample Clinical Exceptions 00 c cece 5 8 Active Signal Quality Alarm 0 00 0 cece cece eee eee 5 8 Resolved Signal Quality Alarm 20 cece eee 5 8 100 Sighal LOSS rer soca ia iN ea Owes Meas 5 9 Silencing an Audio Alarm 2 0 c cece eee eee
85. ch marks the time of the reading Module and Probe Compatibility Ohmeda Masimo and Nellcor pulse oximetry parameters are calibrated to display functional saturation Other manufacturer s pulse oximetry monitors may be calibrated to display fractional saturation m 250cx Series Monitors with Masimo Technology are compatible only with Masimo LNOP and LNCS sensors For additional information refer to Directions for Use supplied with sensor m 250cx Series Monitors with Ohmeda Technology are compatible only with Ohmeda OxiTip sensors For additional information refer to Directions for Use supplied with sensor m 250cx Series Monitors with Nellcor Technology are compatible only with Nellcor OxiMax sensors For additional information refer to Directions for Use supplied with sensor IMPORTANT Use only Masimo LNOP oximetry sensors with the Masimo Technology Ohmeda sensors with the Ohmeda Technology and Nellcor sensors with the Nellcor Technology Other sensors may result in unpredictable performance The MSpO cable should plug into the monitor s MSpO connector easily and securely Do not use excessive force to connect the cable If the MSpO cable does not easily fit into the MSpO connector on the monitor it is likely that you are using an incorrect cable IMPORTANT It is possible to connect the wrong MSpO cable and or sensor to the monitor If this happens the MSpO parameter will not work Ohmeda and Masimo or will cause a
86. chnology your monitor contains the label next to the lower right hand side of the display and use the corresponding cables and sensors for that technology 16 8 250cx Series Maternal Fetal Monitor 2036946 001 Revision C 17 Technical Specifications This section contains a detailed list of the technical specifications for the 250cx Series Monitor Revision C 250cx Series Maternal Fetal Monitor 17 1 2036946 001 Technical Specifications For your notes 17 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Technical Specifications General Monitor General Monitor General Monitor Technical Specifications Category Technical Specifications Power Requirements Nominal Line Voltage 100VAC 120 VAC 220 VAC 230 VAC 240 VAC Line Frequency 50 60 Hz 50 60 Hz 50 60 Hz 50 60 Hz 50 60 Hz Power Consumption maximum 100 W 100 W 0 4A 0 4A 0 4A Chassis Leakage 300 uA Physical Characteristics Height 6 7 in 17 0 cm Width 16 7 in 42 4 cm Depth 17 5 in 44 4 cm Weight 22 0 lbs 10 9 kg approx Environmental Conditions Operating Storage Monitor Ambient Temperature 50 F to 104 F 10 C to 40 C 14 F to 131 F 10 C to 55 C Relative Humidity Atmospheric Pressure Strip Chart Paper Ambient Temperature Relative Humidity Atmospheric Pressure 10 to 95 non condensing 700 1060 mbar 525 795 mmHg 50 F to 104 F 10 C to 40 C 30 to
87. choose the larger size cuff Precaution Accuracy depends on use of proper size cuff Inspect cuff for damage Replace cuff when aging tearing or weak closure is apparent Do not inflate cuff when unwrapped Precaution Do not use cuff if structural integrity is suspect Connect the cuff to the air hose Warning It is mandatory that the appropriate hose and cuff combination be used Inspect patient s limb prior to application Precaution Do not apply cuff to areas where skin is not intact or tissue is injured Palpate artery and place cuff so that patient s artery is aligned with cuff arrow marked artery Squeeze all air from cuff and confirm that connection is secure and unoccluded and that tubing is not kinked Wrap cuff snugly around the patient s limb Cuff index line must fall within range markings Ensure that hook and loop closures are properly engaged so that pressure is evenly distributed throughout cuff If upper arm is used place cuff as far proximally as possible Proper cuff wrapping should be snug but should still allow space for a finger between patient and cuff Cuff should not be so tight as to prevent venous return between determinations Warning Using a cuff that is too tight will cause venous congestion and discoloration of the limb but using a cuff that is too loose may result in no readings and or inaccurate readings Blood Pressure Methodology During a determination the instantaneous cuff pressure i
88. conds field resets when minutes change This field sets the time interval for printing MSpO values received from an external maternal pulse oximetry monitor This field sets the time interval for printing FSpO values received from an external fetal pulse oximetry monitor This field enables disables FSpO trend trace printing of data received from an external fetal pulse oximetry monitor By choosing this option you can view software revisions what type of SpO technology your 250cx Monitor contains i e Ohmeda Nellcor and Masimo etc and allows service personnel to enter the password protected Service Mode For example February of 1996 has a day range of 01 29 February of 1997 has a range of 01 28 August of 1997 has a day range of 01 31 4 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Setup Procedures Preparing the Monitor for Patient Use Preparing the Monitor for Patient Use The following procedures should be performed before use on each patient 1 Ensure an adequate supply of paper is in the recorder The recorder will automatically stop when paper runs out If the recorder requires paper refer to Loading Strip Chart Recorder Paper on page 4 3 2 Ensure the monitor power is on 3 Connect the appropriate transducers for monitoring Read the Maternal Fetal Monitoring Clinical Applications Manual for instructions on applying the transducers 4 Ensure
89. ctivated 4305CAO 4305CAO FHR 240 bpm ALARTE 3 TETTCEEETETEEETE TUTE Il ON S TTR TTT y A Example MECG Waveform Snapshot Recorder On If the recorder is on the waveform overlaps the MHR P trace if enabled with no interruption to other trending The recorder speed remains at the selected rate of 1 2 or 3 cm min Revision C 250cx Series Maternal Fetal Monitor 14 5 2036946 001 Waveforms Printing a Waveform Snapshot Recorder in Maternal Only Mode Recorder Off If the recorder is running in maternal only mode the waveform does not interrupt the printing of data and prints at a high speed mode of 12 cm min When finished the recorder returns to the maternal only mode If the recorder is off the waveform print using a high speed mode of 12 cm min after which the recorder turns off again NOTE You cannot switch between different types of waveforms without cancelling any printing that is in progress NOTE The monitor must collect 6 seconds of new data following completion of a print function before it can print again Stopping a Print Command The following actions interrupt waveform printing changing the recorder mode pressing the Test button opening the recorder door running out of paper turning off th
90. d An abbreviation indicates the monitoring mode in use FECG US US2 or INOP FECG only displays in the FHR1 area Select the mode softkey to access the respective setup screen See Connectors vs Display Modes Table below for FHR connection options Name A FHR Value FHR Alarm Setting Indicator B FHR Mode Title C D FHR Heartbeat Indicator Flashes with each detected valid heartbeat 3 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors UA Display UA Display Connectors vs Display Modes Active Connectors FHR1 Area FHR2 Area FECG FECG INOP FECG US FECG US FECG US2 FECG US2 US US INOP US US2 US US2 US2 US2 INOP INOP INOP FECG US US2 FECG US2 l Tf three FHR transducers are plugged in the FECG signal overrides the US signal The UA area is summarized by the following figure and table B TOCO 30 UA Display Name UA Display Description UA Value Up to three digits indicate the uterine activity value mmHg or kPa Internal UA monitoring is absolute and external monitoring Toco is relative The units are consistent in both cases and are user selectable mmHg or kPa UA Mode Title An abbreviation indicates the monitoring mode in use TOCO IUP or INOP Revision C 250cx Series Maternal Fetal Monitor 3 9 2036946 001 Control
91. d press the Trim Knob The current setting displays in blinking inverse video 3 Now rotate the Trim Knob to change the current setting to MECG Lead setting 1 II or Ill 4 Once you set the desired source parameter press the Trim Knob to confirm your selection The current value setting stops blinking and the waveform should reflect the selected lead 1 To change the waveform scale the current selected waveform must be MECG or scale on the display FECG The waveform scale cannot be altered when you view MSpO plethsysmograph waveforms which auto scale 2 Rotate the Trim Knob to highlight the scale factor setting for the waveform display This setting is slightly below vertical center on the right hand side of the display below the horizontal speed indication of 25 mm s The vertical scale indicates one of the following Auto 0 25x 0 5x 1x 2x or 4x 3 Once the MECG scale setting is highlighted press the Trim Knob The current setting displays in blinking inverse video 4 Now rotate the Trim Knob to change the current setting to Auto 0 25x 0 5x 1x 2x or 4x 5 Once you set the desired scale press the Trim Knob to confirm your selection The current value setting stops blinking and the waveform should reflect the selected lead Revision C 250cx Series Maternal Fetal Monitor D 7 2036946 001 Frequently Asked Questions Question How do disable enable Fetal Movement Detection FMD is an optional feature
92. d or FECG transducers from the monitor when not in use to eliminate false alarms Multiple trends can be simultaneously printed on the strip chart paper The Table below provides a summary of the different trend types Figure on page 11 7 provides an example of a strip chart with five traces printed simultaneously Up to three heart pulse rate trends can be printed in the top or left channel of the strip chart paper two FHR trends as well as the MHR P trend The primary FHR trend is printed in plain black The secondary FHR trend is printed in bold black The MHR P trend is printed in grey The UA External FSpO and MSpO trends are printed in the bottom or right grid of the strip chart paper The UA trend is printed in plain black The External FSpO trend is printed as a black beaded line The MSpO trend is printed in grey The FHR and UA trends are printed continuously The MHR P External FSpO and MSpO trends must all be enabled via the respective setup screen Summary of Strip Chart Trends Grid Source Type Trace Description Parameter Trend Source Top Fetal Plain Black FHR1 US or FECG Bold Black FHR2 US or US2 Maternal Grey MHR P MECG or MSpO P Bottom External Fetal Plain Black FSpO gt External FSpO Maternal Plain Black UA TOCO or IUP av Grey MSpO MSpO 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Annotations MSpO2 9
93. d pressure reading can print on any of the first three annotation lines depending on which printing line is available A diamond marks the time of the reading m An unfilled diamond indicates the reading was received from the monitor s built in blood pressure parameter The vital signs print below the diamond See Figure on page 11 8 9 An unfilled diamond with a slash indicates a blood pressure reading was cancelled delayed The 0 marks the time the reading was originally scheduled The annotation NIBP D prints below the marker See Figure on page 11 8 m 4 A filled diamond indicates the reading was received from an external blood pressure monitor connected to the 250cx Series Monitor The vital signs print below the diamond Contact your Service Representative for connectivity information If the top three printing lines are busy printing other data the diamond prints at the time of the reading however the vital signs data prints as soon as a line becomes available NBP D NBP 126 78 M 94 P 68 9 00 US 44US2 WA TOCO 3CM MIN NIBP Vital Signs Data Annotation from Built In Module 11 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Annotations Maternal Pulse Oximetry Annotations A maternal pulse oximetry reading prints according to the interval time set on the MSpO Setup screen for built in parameter or the General Setup screen for external device For the built i
94. detect an acceptable signal a signal quality alarm is provided Revision C 250cx Series Maternal Fetal Monitor 10 7 2036946 001 Alarms Maternal Alarms Active Signal Quality Alarm The following signal quality alarms are indicated both visually and audibly The audio alarm consists of alternating high low tones The visual indication varies according to the alarm Asystole Dashes display in place of the MHR P numeric MECG Leads Off Dashes display in place of the MHR P numeric The following message displays in the MHR P area MECG LEADS OFF During this type of alarm the MHR P source automatically switches to the next available parameter MSpO then NIBP As soon as the alarm condition is resolved and the MECG signal is detected and the monitor resumes using MECG as the MHR P source NIBP System Problem When there is a malfunction with the NIBP parameter cuff or air hoses the monitor will be unable to make a determination During this type of alarm one of the following messages displays in the NIBP area CHECK CUFF OVERPRESSURE COMM MOTION WEAK SIGNAL or REPAIR Refer to Chapter 16 Troubleshooting for more information on these messages MSpO System Problem When there is a malfunction with the monitor s built in MSpO parameter one of the following messages displays in the MSpO area COMM REPAIR or SENSOR Nellcor only Refer to Chapter 16 Troubleshooting for more informa
95. dition Blood pressure and pulse can fluctuate greatly between measurements the monitor does not alert the user through audio or visual means to changes in NIBP or NIBP derived pulse rate occurring between measurement cycles EXTERNAL PRESSURE Do not apply external pressure against the cuff while monitoring Doing so may cause inaccurate blood pressure values Revision C 250cx Series Maternal Fetal Monitor 8 3 2036946 001 Maternal Non Invasive Blood Pressure Monitoring Warnings CAUTIONS PULSE RATE COMPARISONS The pulse rate measured by the monitor s NIBP circuitry may differ from the heart rate measured by the monitor s MECG circuitry or another maternal ECG monitor because the monitor s blood pressure module measures peripheral pulses not electrical signals or contractions of the heart Occasionally the electrical signals at the heart do not produce a peripheral pulse Similarly if a patient s beat to beat pulse amplitude varies significantly blood pressure and pulse rate readings can be erratic and an alternate measuring method should be used for confirmation Warnings WARNINGS The NIBP parameter will not measure blood pressure effectively on patients who are experiencing seizures or tremors Arrhythmias will increase the time required by the NIBP parameter to determine a blood pressure and may extend the time beyond the capabilities of the parameter Use care when placing the cuff on an extrem
96. e APPLICATION This monitor is not designed for direct cardiac connection CONDUCTIVE CONNECTIONS Avoid making any conductive connections to applied parts patient connection which are likely to degrade safety CONDUCTIVE PARTS Ensure that the conductive parts of the lead electrodes and associated connectors do not contact other conductive parts including earth CONNECTIONS The correct way to connect a patient to the monitor is to plug the electrode leads into the patient cable which in turn connects to the monitor The monitor is connected to the wall socket by the power cord Do not plug the electrode leads into the power cord a wall socket or an extension cord DEFIBRILLATION During defibrillation all personnel must avoid contact with the patient and monitor to avoid a dangerous shock hazard In addition proper placement of the paddles in relation to the electrodes is required to minimize harm to the patient DEFIBRILLATION PROTECTION When used with the GE Medical Systems Information Technologies recommended accessories the monitor is protected against the effects of defibrillator discharge If monitoring is disrupted by the defibrillation the monitor will recover ELECTRICAL SHOCK To reduce the risk of electrical shock do not remove monitor cover Refer servicing to qualified personnel ELECTROMAGNETIC INTERFERENCE Be aware that strong electromagnetic fields may interfere with monitor operation Interf
97. e This field controls the alarm volume for all fetal alarms FECG Internal Method Methodology This method uses an electrode attached directly to the fetal presenting part The electrode is connected to the cable legplate secured to the mother The fetal heart rate is computed based upon the interval between successive R wave peaks of the fetal QRS complex The fetal heart rate is displayed in bpm and is continuously plotted on the strip chart recorder paper if the recorder is on Refer to US US2 Setup Screen on page 5 3 The heartbeat indicator flashes for each detected heartbeat Artifact Elimination An FECG artifact elimination option is available behind the password protected Service Lock screen on all 250cx Series Monitors 5 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Heart Rate Monitoring FECG Setup Screen FECG Setup Screen Select the FECG softkey to access the FECG Setup screen 165w 172 30 Volume 5 On Off FECG Setup High Low 140 200 Off Off 60 140 Audio Alarms On Volume 5 85 bpm oOAN OA FP WORD o ooo ono Volume Alarms Audio Alarms Alarm Volume Exit FECG Setup Screen With Fetal Alarms Enabled This field controls the volume for the FHR beeps derived from FECG This field works in conjunction with the front panel Volume buttons These fields adjust the high and low alarm limits The
98. e Using the Heartbeat Coincidence Feature NOTE Although an unlikely scenario if three channels are picking up the same signal the heart rate numerics for all three heart rates display in inverse video If you disconnect a transducer while coincidence is detected any value displayed in inverse video returns to standard video 12 32 27 Alarms Setup VSHX Heartbeat Coincidence Example 13 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Heartbeat Coincidence Using the Heartbeat Coincidence Feature Strip Chart Annotation When heartbeat coincidence detection is enabled the annotation HBC prints in the center margin of the strip chart paper following the active FHR modes Refer to Simulated Heartbeat Coincidence Detection Trace on page 13 5 As soon as heartbeat coincidence is detected two overlaid hearts q print in the upper portion of the top grid of the strip chart paper the hearts print every 4 5 cm for as long a coincidence is detected Once coincidence is resolved two side by side hearts print yy once If you disconnect a transducer while coincidence is detected the overlaid hearts e stop printing In addition the mode status line prints on the strip chart paper without the HBC annotation indicating the deactivated mode 10B iis 6952 Coincidence detected CY NEU Coincidence resolved 180 150 Simulated trends
99. e 250cx Series blood pressure parameter complies with the American National Standard for Electronic or Automated Sphygmomanometers AAMI ANSI SP10 1992 The GE monitor values are based on the oscillometric method of noninvasive blood pressure measurement and correspond to comparisons with intra aortic values within ANSI AAMI Standards for accuracy 4 754 761 4 638 810 and international equivalents USA patents pending This device is covered under one or more of the following US Patents 6 423 010 6 358 213 5 704 362 5 680 870 5 579 776 5 518 000 5 170 795 5 052 397 17 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Technical Specifications Operating Modes Operating Mode Specifications Continued Maternal Pulse Oximetry Mode Masimo Technique Sensor Accuracy Sensor Model Weight Range Saturation No Motion Accuracy Motion Pulse Rate No Motion Accuracy Motion Low Perfusion Saturation Accuracy Pulse Rate Measurement Range Saturation Range SpO Pulse Rate bpm Perfusion Accuracy and Motion Tolerance Saturation SpO During no motion conditions Adults During motion conditions Adults Low Perfusion Wavelengths Red Infrared Maximum Optical Output Power Radiant Power at 50 mA pulsed Pulse Rate bpm During no motion conditions Adults During motion conditions Adults Resolution Saturation SpO Pulse Rate bpm Low Perfusion Performance gt 0 02 Pu
100. e Time Peak detecting beat to beat cardiotachometer Medtronic 1700 003 or equivalent I II and IIl 30 240 bpm 1 bpm 1 update per second 0 5 mV to 5 mV peak to peak 0 5 mV RTI 0 8 x QRS amplitude 2 seconds 3 seconds lt 10 seconds high alarm limit at 100 bpm 300 mVdc maximum 20 V peak to peak 0 6 to 40 Hz gt 80 dB at mains frequency with patient cable gt 50 dB at mains frequency lt 30 u V peak to peak gt 2 5 MQ 10MO 40 dB lt 60 pA at 254 VAC with cable electrically isolated 4kVAC dc current lt 0 1 uA Alternating 1 5 second chimes Flashing heart rate numeric or message User selectable high and low maternal heart rate Leads off 8 seconds Pacemaker Detection Rejection Input Voltage Range 2 5 mV to 700mV Input Pulse Width 0 1 to 2 ms Pulse Rise Fall Time 10 of pulse width not greater than 100 us Overshoot Undershoot 2 mV CAUTION Excessive overshoot time of pacemaker pulse may cause false QRS detection Revision C 250cx Series Maternal Fetal Monitor 17 5 2036946 001 Technical Specifications Operating Modes Operating Mode Specifications Continued Maternal Blood Pressure Mode DINAMAP SuperSTAT Technique Blood Pressure Range Systolic Diastolic Visual Mean Arterial Pressure MAP Pulse Rate Range Blood Pressure Accuracy Pulse Rate Accuracy Cuff Inflation Inflation Pr
101. e center of the display and may indicate MECG Pulse or INOP according on the settings that are currently enabled 2 Once the MHR P legend is highlighted press the Trim Knob The display changes to show the MHR P Setup screen 3 Now rotate the Trim Knob to highlight the HR PR setting It should read Off 4 Once the HR PR setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a setting of On to enable MHR P trace or Off 6 Once you set the desired trace setting press the Trim Knob to confirm your selection The current setting stops blinking Now rotate the Trim Knob to select highlight the Exit item on the bottom menu Press the Trim Knob again to return to the main monitoring display screen co Y Rotate the Trim Knob to highlight the legend for MHR P This legend is located approximately in the center of the display and may indicate MECG Pulse or INOP according to the settings that are currently enabled Once the MHR P legend is highlighted press the Trim Knob The display changes to show the MHR P Setup screen Now rotate the Trim Knob to highlight the Source setting It will read Auto MSpO MECG Once the Source setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video Now rotate the Trim Knob to change the current setting S
102. e cuff While this procedure is adequate for cleaning disinfection it may not remove all stains Do not immerse hoses Do not immerse cuffs without prior application of cuff hose caps Materials Enzymatic detergent such as ENZOL enzymatic detergent US or Cidezyme enzymatic detergent UK Distilled water 10 solution of household bleach 5 25 sodium hypochlorite in distilled water Soft cloths and soft bristled brushes Spray bottles Procedure 1 Prepare the enzymatic detergent according to the manufacturer s instructions and the 10 bleach solution in separate spray bottles 2 Spray the detergent liberally on device If the material is dried on allow the cuff to sit for 1 minute For soil on the soft part of the closure or the cuff itself wipe the material off with a soft cloth For persistent contamination on the soft part of the closure use a soft bristled brush to loosen particles Rinse with copious amounts of distilled water Repeat until no visible contamination remains For soil on the hook part of the closure use a soft bristled brush to remove the material and rinse with copious amounts of distilled water Repeat until no visible contamination remains 3 Spray the 10 bleach solution on the affected area until the area is saturated Allow the cuff to sit for 5 minutes 4 Wipe away any excess solution and rinse the cuff again with distilled water Allow 2 hours for drying Trademarked
103. e eee eee eens 8 9 Hydrostatic Effect o panded A Ss BAN ee BE eS ERE TET 8 10 Manual Modes i soe eb eter teer t bor ie cep ey eacus 8 10 Automatic Mode i p ideas 8 10 Taking a Manual Reading Between Auto Determinations 8 11 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Venous Return in Auto Mode 0 0 ccc cece RI 8 11 Adjusting the Interval Time Between Automatic Determinations 8 11 NIBP Interval Button Shortcut 2 0 cece eee eens 8 12 Terminating a Determination in Progress 8 13 Smart BP Feature sis sees e eh ee is wee E 8 13 Enabling Disabling Smart BP 8 13 Methodology 25 eet ettet die es e twit ena et 8 13 9 Maternal Pulse Oximetry Monitoring 9 1 MSpO2 Technology 2 cir a ad a 9 3 Which Module is Installed ooooooccoocccocccocco 9 3 Theory of Operation o ita bic sad do ose eet Ede 9 4 Ohmeda TruSignal Oximetry 0 ccc eee eee 9 4 TruSignal Enhanced SpO2 aai 9 4 Signal processing me 9 4 Masimo SETQ uctor a lao anio 9 4 Signal Processing 9 4 Nellcor OxiMaxB cocoa 9 5 Automatic Calibration 0 0 cece cee 9 6 SatSeconds Yes chase peas EIE EA dein ioe gue Erde ely pd 9 6 SatSeconds Safety Net 0 cece eee eee 9 8 Using SatSeconds 0 cece cee eee 9 8 MSPO Setup Screen 00 c cece cece eee cence eee nnn 9 9 Response Time Nellcor 506 Technology Only
104. e monitor CAUTION DATA STORAGE Stored data for the maternal Vital Signs History screen is immediately lost when the monitor is turned off This ensures that stored data for one patient is not inadvertently transferred to a new patient Refer to Chapter 12 Maternal Vital Signs History for more information 14 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 15 Maintenance Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Maintenance For your notes 15 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maintenance Cleaning Cleaning General care and cleaning are required for the 250cx Series Monitor and its accessories If an accessory is not listed consult the manufacturer s instructions CAUTION Unplug the monitor from the AC power source and detach all accessories from the monitor Do not immerse accessories in any liquid Do not use abrasive cloth or cleaners on monitor or accessories Monitor Exterior 1 The exterior surfaces of the equipment may be cleaned with a dampened lint free cloth Use one of the following approved solutions Commercial diluted bleach solution Mild soap diluted Commercial diluted ammonia solution NOTE Always dilute cleaning solutions per manufacturers recommendations 2 Wipe off cleaning solutions with a clean dry cloth 3 Do not use a cleaning substance containing wax 4 Do not p
105. e of the following products then wring out until only slightly wet Sodium Hypochlorite 5 25 Bleach diluted 10 1 Cidex Sporicidin Soap and water 2 Rub soiled area until clean taking care not to excessively wet the tocotransducer diaphragm seal Rub around the seal 3 Dry with a soft dry cloth Leg Plates and MECG Cables CAUTIONS ABRASION Do not use abrasive cloth sharp objects or abrasive cleaners ALCOHOL Do not use Alcohol in cleaning solutions DISCONNECTION Detach the cables legplate from the monitor IMMERSION Do not immerse cables or hold under running water 1 Dampen a cloth or paper towel with one of the following products then wring out until only slightly wet Sodium Hypochlorite 5 25 Bleach diluted 10 1 Cidex Trademarked 15 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maintenance Cleaning Sporicidin Soap and water 2 Rub soiled area until clean 3 Dry with a soft dry cloth Maternal NIBP Cuffs and Hoses General The cuff must be thoroughly cleaned with the specified detergent before reuse The additional use of household bleach as described below provides at least intermediate level disinfection Apply cuff hose plugs before cleaning The following cleansing procedure was repeated 20 times on DURA CUF Blood Pressure Cuffs and once on SOFT CUF Blood Pressure Cuffs without affecting the performance of th
106. e setting stops blinking A final audio tone indicative of the alarm volume is emitted from the speaker 7 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen Po 99 A D 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Frequently Asked Questions Question Answer How do change the volume for FHR1 Option 1 audio or heart beat tones 1 Use the front panel Volume Up or Volume Down buttons left to control volume for FHR Channel 1 Option 2 1 Rotate the Trim Knob to highlight the legend for FHR1 This legend is top left on the display and it may read INOP FECG US or US2 However to be able to alter the volume with this method you must enable one FHR1 mode by inserting a transducer into the appropriate receptacle on the front of the monitor 2 Once the FHR1 legend is highlighted press the Trim Knob The display changes to show the MODE SETUP SCREEN where mode is the current legend 3 Now rotate the Trim Knob to highlight the FHR1 Volume setting which is located slightly above vertical center on the left next to the volume bar graph 4 Once the Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current volume setting Select a value between 0 and 9 As the setting is changes
107. e that the hose is not kinked or compressed Choose the appropriate blood pressure measurement site Because normative values are generally based on this site and as a matter of convenience the upper arm is preferred When upper arm size or shape or the patient s clinical condition or other factors prohibit use of the upper arm the clinician must plan patient care accordingly taking into account the patient s cardiovascular status 8 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Non Invasive Blood Pressure Monitoring NIBP Monitoring 10 11 and the effect of an alternative site on blood pressure values proper cuff size and comfort Warning Do not place the cuff on a limb being used for intravenous infusion or any area where circulation is compromised or has the potential to be compromised If patient is standing sitting or inclined ensure that cuffed limb is supported to maintain cuff at level of patient s heart If cuff is not at heart level the difference in systolic and diastolic values due to hydrostatic effect must be considered Add 1 80 mmHg 0 24 kPa to values for every inch 2 54 cm above heart level Subtract 1 80 mmHg 0 24 kPa from values for every inch 2 54 cm below heart level Choose appropriate cuff size Measure patient s limb and choose appropriately sized cuff according to size marked on cuff or cuff packaging When cuff sizes overlap for a specified limb circumference
108. ea provides simultaneous display of fetal parameters maternal parameters and maternal waveforms The Brightness softkey permits clear viewing in all lighting conditions Frequently used functions are controlled by your choice of front panel monitor buttons Volume UA Reference Alarm Silence Mark Offset Record and Paper Advance System setup options are easily accessed via a front panel Trim Knob control Automatic mode selection is provided simply by inserting the appropriate transducer plug into the front panel receptacle m Transducer connectors are easy to use color coded and durable 2 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Introduction Series Overview Fetal Parameters m Annotations from an optional Model 2116B Keyboard are printed on the strip chart recorder paper m The strip chart recorder is a quiet easy to load high resolution thermal array printer The recorder prints continuous trends and alphanumeric data on one strip chart m The Chart Light allows the room lights to be dimmed without sacrificing visibility of the strip chart recorder m The system is compatible with Centricity Perinatal Clinical Information Systems as well as with other information systems to streamline capture and archiving of patient data Following is a summary of the features Fetal Only Monitor 256cx Maternal Fetal Monitor 259cx m US m US m US2 m US2 m FECG m
109. ed in the countdown timer area they appear as follows 1 00 2 00 3 00 60 00 etc The monitor is factory set with the optional 1 minute interval time enabled For information on disabling the 1 minute interval refer to the 250 250cx Series Monitor Service Manual 4 When the desired interval is displayed release the NIBP Start Stop button 5 The timer reappears and begins to count down from the new value NIBP Interval Time replaces the countdown timer while NIBP Start Stop button is held NIBPO 15 00 A MECG A MSpO2 130 85 87 98 MAP 107 03 15 MECG 03 22 45 Print Freeze Alarms Setup VSHX NIBP Interval Time Shortcut 8 12 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Non Invasive Blood Pressure Monitoring Smart BP Feature Terminating a Determination in Progress A determination manual or automatic can be cancelled by pressing the NIBP Start Stop button m The selected mode Manual or Auto remains in effect m The next scheduled automatic determination takes place as planned Smart BP Feature The 250cx Series monitor has the patented Smart BP feature that prevents an automatic blood pressure determination from occurring during a uterine contraction This feature m reduces the chances for erroneous vital signs readings and m reduces patient discomfort during labor Enabling Disabling Smart BP The Smart BP feature is enabled disa
110. eda TruSignal Oximetry Masimo SET TruSignal Enhanced SpO Ohmeda s TruSignal Enhanced SpO offers fine performance especially during challenging conditions of clinical patient motion and low perfusion With ultra low noise technology TruSignal selects the appropriate clinically developed algorithm to correct weak signals and generate reliable saturation readings The waveform update rate is 48 Hz SpO and pulse rate are continuously calculated using a 12 second weighted moving average controlled by priority in the TruSignal algorithms Signal processing Ohmeda pulse oximetry uses a two wavelength pulsatile system red and infrared light to distinguish between oxyhemoglobin O5Hb and reduced hemoglobin HHb The light is emitted from the oximeter sensor which contains a light source and a photodetector m The light source consists of red and infrared light emitting diodes LEDs m The photodetector is an electronic device that produces an electrical current proportional to incident light intensity The two light wavelengths generated by the LEDs are transmitted through the tissue at the sensor site and are modulated by arterial blood pulsation The photodetector in the sensor converts the light intensity information into an electronic signal that is processed by the monitor Signal Processing The Masimo MS 11 technology uses a two wavelength pulsatile system to distinguish between oxygenated and deoxygenated blood Si
111. edical Systems Information Technologies recommended cables MECG Supplies and Accessories Item Catalog Number REF FECG MECG Y Adapter Cable 1442AAO0 FECG Socket Adapter accepts 1590AAO QuikConnect Plus Leg Plates 1442BA0 MECG Cable for use with detachable leadwires requires 1442AAO USA AHA 1553AAO MECG Cable for use with detachable leadwires requires 1442AAO Intl IEC 1553BAO Multi Link Snap Leadwires Set of 3 Grouped Detachable 31 inches 411203 001 Multi Link Snap Leadwires Set of 5 Individually Detachable 31 inches 411200 001 Multi Link Grabber Leadwires Set of 3 Grouped Detachable 31 inches 412682 001 Multi Link Grabber Leadwires Set of 5 Individually Detachable 31 inches 414556 001 Leadwire Adapter 3 Lead Multi Link to 3 Lead DIN 414371 001 Electrodes Round Foam Pouches of 30 Case of 300 9431 004 NIBP Ordering Information NIBP Supplies and Accessories Item Catalog Number REF Air Hose for Dual Tube Threaded Luer Cuff 12 foot Hose 9461 217 Reusable Single Tube Male Luer Cuff Small Adult 18 26 cm Range 5531CAO Reusable Dual Tube Threaded Luer Cuff Small Adult E27795 Reusable Single Tube Male Luer Cuff Adult 25 35 cm Range 5522CAO Reusable Single Tube Male Luer Cuff Large Adult 33 47 cm Range 5523CAO Reusable Dual Tube Threaded Luer Cuff Adult 25 35 cm Range 5522AAO Reusable Dual Tube Threaded Luer Cuff Large Adult 34 47 cm Range 5523AAO0 Reusable Dual Tube Threaded Luer Cuff
112. eee ees 5 9 SUMMARY sara odd Cogo Wnts Gade e Dee b Geese Gebel 5 10 Single Fetal Heart Rate Monitoring ccceeeee sence eee eens 5 10 Dual Fetal Heart Rate Monitoring eeeeeee eee e eee eeeeeeeeees 5 10 Heartbeat Coincidence 0 cece cece eee e teens 5 11 Fetal Heart Rate Offset 5 11 Activating the Fetal Heart Rate Offset Feature 5 11 De Activating the Fetal Heart Rate Offset Feature 5 12 6 Uterine Activity Monitoring 6 1 Tocotransducer External Method sseseseeeeeennennnnnnn 6 3 Methodology rere recte Lletres Le b LEES f 6 3 Establishing a Baseline 0 ooooocooccocccorcoorrr eae 6 3 Initial Referencing 0 cece eee nena 6 3 Accounting for Belt Tension 0 cee eee eee 6 4 More About Referencing 0 cece cece nena 6 4 Out of Range Condition 0 cece eee 6 4 Manually Setting the Baseline at the Default Value 6 4 Manually Overriding the Baseline Default Value 6 4 Revision C 250cx Series Maternal Fetal Monitor iii 2036946 001 Automatic Baseline Zeroing 0 0 0 cece eee eee eee 6 4 Internal Method Intrauterine Pressure IUP oooooocococooco 6 5 Methodology cocteles EXE OR EXecEedR AA 6 5 Why You Must Zero the System 6 5 Maternal Heart Pulse Rate Monitoring 7 1 MHR P SOUFCe oe cre ee e ell ta
113. elect from Auto MSpO MECG If you select Auto the pulse value parameter is automatically selected according to the parameters that are currently enabled with precedence highest to lowest in the following order MECG MSpO gt 6 Once you set the desired source parameter press the Trim Knob to confirm your selection The current value setting stops blinking Now rotate the Trim Knob to select highlight the Exit item on the bottom menu Press the Trim Knob again to return to the main monitoring display screen Po 99 A al co Y Rotate the Trim Knob to highlight the legend for MSpO This legend is located above the center on the right side of the display Once the MSpO legend is highlighted press the Trim Knob The display changes to show the MSpO Setup screen Now rotate the Trim Knob to highlight the 0 Trace setting It should read Off Once the 0 Trace setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a setting of On to enable MSpO trace or Off 6 Once you set the desired trace setting press the Trim Knob to confirm your selection The current setting stops blinking T Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen Po A 0 Revision C 250cx Serie
114. emote location if the central station has the capability to send that command See Figure on page 11 10 Sometimes annotations occur within seconds of each other Consider the following example shown in Figure on page 11 10 m an automatic NIBP reading occurs at 16 51 30 W three annotations are received from a central information system the entries are made between 16 51 40 and 16 52 00 m amanual NIBP reading occurs at 16 52 10 Revision C 250cx Series Maternal Fetal Monitor 11 9 2036946 001 Recorder Modes Summary of Annotations 5 P 70 NBP 120 85 TO LDR LEFT SIDE Multiple Annotations Example Summary of Annotations Summary of Annotations Annotation Explanation Time and Date Example 10 40 12 AUG 97 Time and date are both printed on the bottom annotation line 20 seconds after the recorder is turned on and when the date changes after midnight A time stamp automatically prints approximately every 10 minutes at the 10 minute mark For example 10 50 11 00 11 10 11 20 11 30 etc If the bottom annotation line is being used to print another annotation the time stamp is delayed For example 10 50 11 00 11 12 11 20 11 30 etc In this example the 11 10 date stamp was delayed until 11 12 The time and or date also prints whenever it is changed via the General Setup Screen SET TIME DATE TEST ARE ALL DOTS PRINTED This annotation prints across the width of the top strip c
115. erence prevents the clear reception of signals by the monitor If the hospital is close to a strong transmitter such as TV AM or FM radio police or fire stations a HAM radio operator an airport or cellular phone their signals could be picked up as monitor signals If you feel interference is affecting the monitor contact your Service Representative to check the monitor in your environment Refer to Electromagnetic Interference on page 1 9 for additional information Revision C 250cx Series Maternal Fetal Monitor 1 5 2036946 001 Safety Monitor Contraindications Warnings and Precautions WARNINGS ELECTROSURGERY The monitor is not designed for use with high frequency surgical devices In addition measurements may be affected in the presence of strong electromagnetic sources such as electrosurgery equipment EQUIPMENT USE The use of this equipment is restricted to one patient at a time EXPLOSION HAZARD Do not use this equipment in the presence of flammable anesthetics or inside an oxygen tent GROUNDING Do not defeat the three wire grounding feature of the power cord by means of adaptors plug modifications or other methods A dangerous shock hazard to both patient and operator may result INOPERABLE MECG The MECG trace is not visible during a MECG LEADS OFF condition or an overload saturation of the front end amplifier during differential input voltage of more than 300mV INSTRUCTI
116. erts are only indicated visually on the monitor s display screen m an alert suspension icon A displays next to the FHR mode title s m an alert suspension icon A prints on the strip chart paper along with the active FHR mode annotations s and m alert output to a nurse call system is inhibited Refer to the figures on this page Restoring Audio Alerts and the Nurse Call Interface To restore full alert functionality press and hold the Alarm Silence button for approximately 3 seconds you will hear two beeps as feedback Once restored the alert enable icon A displays next to the FHR mode title s and prints on the strip chart paper along with the active FHR mode annotation s Revision C 250cx Series Maternal Fetal Monitor C 7 2036946 001 Spectra Alerts Alert Indications WFECG 3 ATUS 15 1479 138 th Alert suspended del A NIBP fA MECG fA MSpO2 879 98 25 mm s Il 2x MECG 15 52 58 Print Freeze Alarms Setup VSHX Spectra Alert Suspended Icon Alert restored Alert suspended 9 00 US TOCO 3 CMIMIN f Spectra Alert Suspend Restore Annotations C 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Alert Parameters Summary Alert Parameters Summary The FHR setup screens FECG or US US2 include an Alert Parameters summary presenting an overview of the alert analysis results for FHR and UA Fields shown in inverse video are co
117. es 30 240 bpm International 50 210 bpm United States 30 240 bpm International 50 210 bpm Recorder Font Size Medium Small Medium Large FECG Artifact Elimination Off On Off Paper Chime Out Only Off Low out Out only Paper Chime Volume 5 1 9 HBC Heartbeat On On Off Coincidence Enable HR Offset 10 min Off On 10 min Applies to US or US2 whichever is FHR2 FM Fetal Movement On On Off Remote Marker SpO Scale 0 100 Auto 0 100 Does not change A 6 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Factory Defaults Table of Defaults Summary of Factory Defaults Sone i ipti Factory Defaul Default Opti Hospital Pref Screen Field Description actory Default efault Options ospital Preference Install Fetal Alert Alarm Off Off Alarms Alerts Options SH o Alert Suspend Off Off On Service Re Alarm 120 sec 120 300 seconds in MECG and SpO only 5 second intervals VS Vital Signs Print Real Time Real Time Chart Style Interval Default TOCO Reference 10 in mmHg mode or 1 3in 5 10 15 20 or 25 relative kPa modes units in mmHg mode or 0 7 1 3 2 0 2 7 or in 3 3 kPa mode Smart BP On On Off NIBP 1 min Interval On On Off NIBP Display On On 1 2 3 5 10 15 30 min Pressure Units mmHg mmHg kPa China kPa SatSeconds Nellcor 10 Off 10 25 50 100 Default Settings Factor
118. es Maternal Fetal Monitor Revision C 2036946 001 1 Safety Revision C 250cx Series Maternal Fetal Monitor 2036946 001 1 1 Safety For your notes 1 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Safety General Information General Information General Use If the monitor is cold to the touch or below ambient temperature allow it to stabilize before use To ensure patient safety use only parts and accessories manufactured or recommended by GE Medical Systems Information Technologies Parts and accessories used shall meet the requirements of EN60601 1 1 Disposable devices are intended for single use only They should not be reused Test all functions periodically and whenever the integrity of the monitor is in doubt Refer to the Maternal Fetal Monitoring Clinical Applications Manual for information concerning the limitations of internal and external fetal heart rate monitoring techniques Responsibility of the Manufacturer GE Medical Systems Information Technologies is responsible for the effects on safety reliability and performance if m assembly operations extensions readjustments modifications or repairs are carried out by persons authorized by GE Medical Systems Information Technologies m the electrical installation of the relevant room complies with the requirements of appropriate regulations and m the monitor is used in accordance with the instructions of
119. essure Range Cuff Deflation Safety Features Display Record Alarms Audio Visual Limits Technical Compliance Oscillometric Microprocessor software eliminates most ambient noise and motion artifact 30 290 mmHg 4 0 38 7 kPa 10 220 mmHg 1 3 29 3 kPa 20 260 mmHg 2 7 34 7 kPa 30 200 bpm 5 mmHg 0 7 kPa with a standard deviation no greater than 8 mmHg 1 1 kPa 2 bpm or 2 whichever is greater Initial inflation to 135 mmHg 18 0 kPa Subsequent inflation approximately 30 mmHg 4 0 kPa greater than the previous systolic pressure 100 250 mmHg in increments of 5 13 3 33 3 kPa in steps of 0 7 Automatic Automatic cuff deflation if cuff pressure exceeds the overpressure limit of 315 mmHg 15 mmHg 42 0 2 0 kPa or maximum reading determination time is exceeded not to exceed AAMI ANSI SP10 1992 limit of 180 s or safety timer detects microprocessor failure Auto mode minimum 30 second delay from the end of one determination to the beginning of another to allow for venous return Systolic diastolic and mean pressure pulse rate Alternating 1 5 second chimes Flashing pressure numeric or message User selectable high and low systolic diastolic and mean pressures User selectable high and low pulse rate Cuff errors connection errors insufficient signal excessive inflation or determination times overpressure hose errors excessive motion communication problem or self test failure Th
120. etection When fetal movement is detected a solid line is automatically marked on the bottom of the upper grid for the duration of the detected movement Refer to Figure Simulated Fetal Movement Detection Trace on page B 5 Using the FM Remote Marker to Complement the Patient Record The FM Remote Marker is an accessory that can be used to complement the patient record 1 Connect the Corometrics FM Remote Marker to the Remote Marker T connector on the rear panel of the 250cx Series Monitor 2 Instruct the mother to press the FM Remote Marker button whenever she feels fetal movement Ask her to hold down the button for the duration of the perceived fetal movement The annotation T or 1 with a horizontal bar prints on the strip chart for as long as the button is held down Refer to Figure Simulated Fetal Movement Detection Trace on page B 5 B 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Movement Detection Using Fetal Movement Detection While Monitoring The annotation resulting from the FM Remote Marker can be configured as one of the following m f commonly used to record a general event or 1 commonly used as an indication that the mother has perceived fetal movement This is the factory default setting LL 9 00US 2 v MSpO2P FMD TOCO Simulated Fetal Movement Detection Trace Revision C 250cx Series Maternal Fetal Monitor B 5 2036946 001 B 6
121. eter integrates the number of SpO points both positive and negative until either the SatSeconds limit SatSeconds time setting is reached or the SpO level returns to within a normal range and remains there SatSeconds Safety Net The SatSeconds Safety Net is for patients with saturation levels having frequent excursions below the limit but not staying below the limit long enough for the SatSeconds time setting to be reached Using SatSeconds The SatSeconds option is located in the Service Mode To activate SatSeconds your biomed sets the SatSeconds limit Off 10 25 50 or 100 that suits the clinical environment and patient condition To deactivate SatSeconds your biomed sets the SatSeconds limit to Off When it is set to Off the alarm sounds immediately without any delay The SatSeconds factory default setting is set at 10 SatSeconds To change this setting refer to your biomed or 250 250cx Series Service Manual IMPORTANT If you set SatSeconds to Off the monitor behavior will change Any brief desaturation event will cause the monitor to alarm 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Pulse Oximetry Monitoring MSpO Setup Screen MSpO Setup Screen Select the MSpO softkey to access the MSpO Setup screen See figure below TOCO 1659 172 30 MSpO Setup Response Time Fast A MSpO2 Print Interval 5 min 9 O2 Trace Off 7 o High 100 120 Ala
122. ftkey selects the waveform for display Moving gap This softkey selects the size for FECG or FECG MECG MSpO or Off MECG 0 25X 0 5X 1X 2X 4X or Auto Waveform Area on the Display Freezing Waveforms The waveform displayed in the waveform area can be frozen on the display for review the most recent data is displayed on the screen for analysis The message Frozen for any waveform along with the time of activation is displayed at the lower left of the waveform All numerics continue to be updated and the real time clock continues to be displayed Select the Freeze softkey to freeze a waveform select it again to return to real time display 14 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Waveforms Printing a Waveform Snapshot Printing a Waveform Snapshot Select the Print softkey to print a 6 second snapshot of the displayed waveform regardless of whether the waveform real time or frozen The following figure provides a sample MECG waveform snapshot on strip chart paper The waveform is printed on the lower portion of the top or left grid A vertical tick mark is printed at the start 3 second mark and end or 6 second mark for reference If the waveform is frozen 6 seconds of historical data are printed ending with the time the waveform was frozen on the display If the waveform is displayed in real time 6 seconds of historical data are printed ending with the time the Print softkey was a
123. g times 13 36 13 41 13 46 13 51 13 56 If the screen remains displayed for 1 minute the columns of data change to 13 37 13 42 13 47 13 52 18 57 Printing the Maternal Vital Signs History Screen NOTE Once the print function is You can select all or a portion of the maternal vital signs history for printing on the activated you may exit the history strip chart paper The information is printed in the upper portion of the top or left screen it need not remain displayed grid of the strip chart paper at a high speed mode If the recorder is on all other during printing trending is interrupted while the maternal vital signs history is printed If the recorder is in the maternal only mode the recorder interrupts any printing of data to print the vital signs history any pre empted data is printed at the end If the recorder is off it will turn on to print the vital signs history then turn off again Printing the Entire Vital Signs History Select the PrintAll softkey to print the entire vital signs history An audible tone provides confirmation Printing a Page of the Vital Signs History Use the View softkey to display a page then select the Print softkey to print the selected page An audible tone provides confirmation Stopping the Printing of Maternal Vital Signs History Printing automatically stops if W you open the recorder door W strip chart paper runs out W you press the Test button m you change the recorde
124. gement For continuous limit violations a high alarm activates after 5 minutes a low alarm activates after 30 seconds About Latching Alarms The FHR limit alarms are latching alarms which means that a clinician must acknowledge the alarm using the monitor s Alarm Silence button in order to clear the alarm Inadequate FHR signal quality A displays to the left of the FHR mode title FHR numeric flashes Flashing dashes E in place of FHR numeric Alternating high low tones if audio enabled Alternating high low tones if audio enabled NIBP Systolic diastolic or MAP pressure value high or low actively being violated Malfunction with NIBP circuitry cuff or air hoses NIBP numeric systolic diastolic or MAP flashes CHECK CUFF COMM MOTION WEAK SIGNAL or REPAIR message displays in NIBP area Alternating high low tones if audio enabled Alternating high low tones if audio enabled Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Alarms Alarms Summary Summary of 250cx Series Alarms Type Condition Display Message Audible Notification MHR Pa MHRYP limit high or low actively MHR P numeric flashes Alternating high low tones if being violated audio enabled The tachycardia response time is 8 seconds Asystole Flashing dashes in lace Alternating high low tones if of MHR P numeric audio enabled
125. gnal Quality Alarm 0 0 00 cece cece eee eens 10 6 Resolved Signal Quality Alarm 10 7 Silencing an FHR Audio Alarm 2 cece cena 10 7 Maternal Alar MS kerrain ea nME a la al Du eels 10 7 Maternal Patient AlarMS oooooccococcccccoccccc 10 7 Active Patient Alarm 0 0 cece eee eens 10 7 Resolved Patient Alarm 0 00 c cece eee eee eee eens 10 7 Signal Quality Alarms 00 nee ee 10 7 Active Signal Quality Alarm 2 0 0 0 0 ccc cece eee ees 10 8 Resolved Signal Quality Alarm 10 8 Silencing a Maternal Audio Alarm 10 2 0 c cece cee eee ae 10 8 Alarms SUMMALY A de 10 9 1 1 Recorder Modes oooooooooommocomocoo 11 1 Mods aa a i 11 3 Off Mode A 11 3 On Mode O 11 3 Maternal Only Mode sseeeeennnn e 11 3 What is the Maternal Only Mode ssssssssssesesenn 11 8 Printing Style sess ota a roS pde puis 11 3 Changing Recorder Modes ssssssseeeennnnn eee eee eens 11 4 Functionality with a QS System cece eee eee eee eee eee 11 5 Paper Versus Electronic Strip Charts 00 0 cece cece eee eee eee 11 5 Fetal Heart Rate Alarms lesse 11 6 A LE DE 11 6 Multiple TIS oe Eo 11 6 O uer erf e eaa 11 7 Annotations esac siete eine eae Reed eR ERU ERR REGERE MEE 11 7 Standard Annotations 11 8 Blood Pressure Annotations 11 8 Maternal Pulse Oximetry Annotations sese 11 9 vi 250cx Series Maternal Fetal Monitor Revision C 2036946 001
126. gnal data is obtained by passing red rd 663 nm wavelength and infrared ir 880 nm wavelength light through a capillary bed e g a fingertip a hand a foot and measuring changes in light absorption during the pulsatile cycle The Masimo sensor has red and infrared light emitting diodes LEDs that pass light through the site to a photodiode photodetector The photodetector receives the light converts it into an electronic signal and sends it via a patient cable to the MSpO parameter for calculation of the patient s functional oxygen saturation and pulse rate The MASIMO SET MS 11 pulse oximeter is based on three principles 1 Oxyhemoglobin and deoxyhemoglobin differ in their absorption of red and infrared light spectrophotometry 2 The volume of arterial blood in tissue and the light absorbed by the blood changes during the pulse plethysmography 3 Arterio venous shunting is highly variable and that fluctuating absorbance by venous blood is a major component of noise during the pulse 9 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Pulse Oximetry Monitoring MSpO2 Technology Nellcor OxiMax Traditional pulse oximetry assumes that all pulsations in the light absorbance signal are caused by oscillations in the arterial blood volume This assumes that the blood flow in the region of the sensor passes entirely through the capillary bed rather than through any arterio venous shunts
127. hart grid when you press If the monitor senses a clock circuit fault when the recorder is turned on this message replaces the normal time date stamp The message reprints every 10 minutes at the 10 minute mark until the clock is reset the Test button The message reminds you to check for a continuous unbroken line of recorder dots 4X This icons prints prior to the FHR trend source annotations if the FHR alarms are enabled The FHR alarm option is enabled disabled via the password protected Install Options service screen US or FECG av US or US2 An MECG or MSpOP A UA External F5pO The trend source prints on the bottom annotation line by the following rules m All trend sources print 20 seconds after the recorder is turned on including inoperative modes m All trend sources print every 30 minutes m f a mode change occurs only those trend sources belonging to the corresponding group print If any top grid trend source changes all top grid active trend sources are printed If the UA mode changes the active UA trend source is printed A mode change is defined as switching connectors connecting to a front panel receptacle disconnecting from a front panel receptacle or enabling disabling a trend on a setup menu 11 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Summary of Annotations Summary of Annotations Continued
128. he following figure and table C D s A MECG i 89v MHR P Display MHR P Display Name Description A MHR P Value Up to three digits indicate the MHR P in beats per minute MHR P Alarm Setting This symbol provides information about the MHR P B Indicator audio alarm and the MHR P high low alarm limit settings See Chapter 10 Alarms for more information Maternal alarms cannot be disabled MHR P Mode Title The mode title MECG indicates MECG is the MHR P source the mode title Pulse indicates C MSpO or NIBP is used as the source Select the mode title softkey to access the MHR P Setup Screen D Maternal Heartbeat Flashes with each detected valid heartbeat for Indicator MECG only Revision C 250cx Series Maternal Fetal Monitor 3 11 2036946 001 Controls Indicators and Connectors MSpO Area MSpO Area The MSpO area is summarized in the following figure and table C D A MSpo2 97 MSpO Display MSpO Display Name Description A MSpO Value Up to three digits indicate the percentage of oxygen in the mother s blood MSpO Alarm Setting This symbol provides information about the MSpO B Indicator audio alarm and the MSpO high low alarm limit settings See Chapter 10 Alarms for more information Maternal alarms cannot be disabled C MSpO Mode Title Select the mode title to access the MSpO Setup screen D MSpO gt Pulse Ampli
129. he high and low alarm limits for MHR P in increments of 5 bpm The selectable values are shown in the MHR P Setup screen The factory defaults are listed in Appendix A Factory Defaults This field controls alarm volume for all maternal alarms This field selects the ECG lead configuration The lead can also be selected from the MECG Lead Softkey on the normal operating screen m Lead refers to the potential between the left arm and the right arm m Leadllrefers to the potential between the right arm and left leg m Lead Ill refers to the potential between the left arm and the left leg Revision C 250cx Series Maternal Fetal Monitor 7 5 2036946 001 Maternal Heart Pulse Rate Monitoring MHR P Setup Screen The following figure illustrates which electrodes reference the ECG lead obtained WHITE RA BLACK LA BLACK LA RED R YELLOW L YELLOW L WHITE RA Il RED R ll Il RED LL Il RED LL GREEN F GREEN F NOTE AHA label is bolded IEC label is italicized MECG Lead Selection Guide MECG Pacer This field enables disables pacemaker pulse rejection circuitry m Off Use this setting for a patient without a pacemaker All ECG events are monitored all complexes including pacer spikes may be displayed and may be included in the heart rate calculation m On Use this setting for a patient who has a pacemaker The monitor rejects the pacer spike from the heart rate calculation and replaces
130. hted press the Trim Knob again The current setting in displayed in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a value between 140 bpm and 200 bpm or Off 6 Once you set the desired alarm value press the Trim Knob again to confirm your selection The current value setting stops blinking Repeat 3 through 6 for the Low heart rate alarm setting The valid range is 60 bpm to 140 bpm or Off NOTE The software does not permit the alarm settings to overlap Now rotate the Trim Knob to select highlight the Exit item on the bottom menu Press the Trim Knob again to return to the main monitoring display screen NOTE When the monitor is powered off then on again the settings revert back to the factory default settings or can be saved if you choose Store Current to Hospital from the password protected Install Options screen Y co co How do change the alarm limits for Fetal 1 Rotate the Trim Knob to highlight the legend for FHR2 This legend is at the top left Heart Rate 2 on the display and it may read INOP or US2 Once you highlight the FHR2 legend press the Trim Knob The display changes to show the MODE Setup screen where mode is the current legend Now rotate the Trim Knob to highlight the FHR2 High heart rate alarm limit setting Once the High heart rate alarms limit is highlighted press the Trim Knob again The current setting is displayed in blinking inverse video
131. iation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population NOTE Because pulse oximeter equipment measurements are statistically distributed only about two thirds of pulse oximeter equipment measurements can be expected to fall within Arme of the value measured by a CO Oximeter NOTE Use of a functional SpO simulator to assess the accuracy of the Corometrics 250cx SpO parameter has not been demonstrated This device is covered under one or more of the following US Patents 5 482 036 5 490 505 5 632 272 5 685 299 5 758 644 5 769 785 6 002 952 6 036 642 6 067 462 6 206 830 6 157 850 and international equivalents USA and international patents pending 17 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Technical Specifications Operating Modes Operating Mode Specifications Continued Maternal Pulse Oximetry Mode Ohmeda Technique Sensor Type Pulse Rate Accuracy Saturation Range Pulse Rate Range Saturation Accuracy Wavelengths Red Infrared Maximum Optical Output Power Alarms audio and visual Audio Visual Limits Technical Spectrophotometry and plethysmography OxiTip OXY AP and OxiTip OXY F 30 250 bpm 2 digits or 2 whichever is greater no motion 30 250 bpm 5 digits or 5 whichever is greater with motion 30 250 bpm 3 digits or 3 whichever is greater during low perfu
132. ible alarms can be disabled Fetal heart rate threshold and signal quality alarms can be cancelled Optional Spectra AlertsTM simultaneously analyzes FHR and UA information and notifies clinicians of deviations from the norm Maternal Parameters 259cx only Built in maternal vital signs monitoring eliminates the need for separate blood pressure and maternal pulse oximetry monitors Maternal vital signs storage provides an 8 hour history of the maternal vital signs in a spreadsheet format The data can be displayed or printed on demand A maternal only recording mode is specifically designed for postpartum monitoring of the mother The monitor can be interfaced to the most widely used non invasive blood pressure monitors and pulse oximeters Maternal non invasive blood pressure readings can be taken on demand or at pre programmed intervals The use of unique patented DINAMAP SuperSTAT blood pressure technology provides blood pressure accuracy and faster automated readings Smart BP option prevents blood pressure readings from occurring during contractions Continuous non invasive MSpO oxygen saturation and maternal pulse rate can be reliably monitored using well known user preferred pulse oximetry brands Masimo SET Nellcor OxiMax or Ohmeda TruSignal MSpO may be selected at the time of purchase or changed later as determined by hospital needs The MSpO pulsatile waveform can be optionally displayed and can be frozen on
133. ical Systems Information Technologies a General Electric Company going to market as GE Healthcare www gehealthcare com
134. idated for no motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies in the range of 70 100 SpO against a laboratory co oximeter and ECG monitor This variation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population The Masimo SET SpO parameter with LNOP Adt sensors has been validated for motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies while performing rubbing and tapping motions at 2 to 4 Hz at an amplitude of 1 to 2 cm and a non repetitive motion before 1 to 5 Hz at an amplitude of 2 to 3 cm in induced hypoxia studies in the range of 70 100 SpO against a laboratory co oximeter and ECG monitor This variation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population Masimo SET technology with LNOP and LNCS sensors have been validated with human blood studies on healthy adult volunteers with induced hypoxia studies The volunteer population composed of both men and women spanned a range of skin pigmentations from light to dark and ranged in age from 22 to 40 years old The Masimo SET SpO parameter has been validated for low perfusion accuracy in bench top testing against a Biotek Index 2 simulator and Masimo s simulator with signal strengths of greater than 0 02 and a transmission of greater than 5 for saturations ranging from 70 to 100 This var
135. ields indicate a prealert condition 8 UC 10 FECG Setup Alert Level Baseline HR bpm FHR Variabilitv ecelerations Artifact Arrhythmia vA Baseline Pressure UC in 10 min Duration of Last UC Signal Quality Alert Parameters 160 165 High c Hzpertonus chysystole Tetanic Present With UC Volume 5 Alert Parameters Example with Two Columns of Alert Information The following figure shows an example of alert parameters for a level one decelerations alert for FECG 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Alert Parameters Summary TOCO 147 v 138 v 12 FECG Setup Volume Alert Parameters Alert Level Baseline HR bpm 145 150 FHR Variability Average Decelerations Ea Artifact Arrhythmia Items listed in inverse video are UA Baseline Pressure 10 i i UC in 10 min 3 contributing factors to the alert Duration of ise UE s0 Other items may indicate an alert Signal Quality Good is pending Alert On Volume 5 Alert Parameters Example FECG is the FHR associated with the alert The next Figure shows an example of alert parameters for the US Setup screen when the FHR is not associated with any alert 147 v 138 v US Setup HR Offset off Volume Alert Parameters The alert level is blank indicating Alert Level there is no active alert for this FHR Baseline H
136. igher inflation pressure The instantaneous cuff pressure is displayed in place of the mean arterial pressure area and is indicated by the title Cuff WARNING The NIBP parameter should be set to determine blood pressures only as frequently as is clinically indicated to ensure adequate patient monitoring 8 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Non Invasive Blood Pressure Monitoring NIBP Monitoring Taking a Manual Reading Between Auto Determinations If the NIBP Start Stop button is pressed during the interval time between automatic readings a new determination is initiated IMPORTANT The countdown timer is not reset whenever a manual blood pressure reading is initiated the next scheduled automatic determination will take place as planned Venous Return in Auto Mode When in auto mode the monitor always waits at least 30 seconds from the end of one blood pressure determination to the beginning of the next This provides a minimum time that pressure around the patient s limb is relieved to allow for venous return At all settings except 1 minute if a determination ends with less than 30 seconds remaining until the next one that next determination will be cancelled NOTE The 250cx Series Monitor is factory set with the optional 1 minute interval time enabled For information on disabling the 1 minute interval refer to the 250 250cx Series Service Manual Exam
137. ighlight the Exit item on the bottom menu Revision C 250cx Series Maternal Fetal Monitor D 13 2036946 001 Frequently Asked Questions Question How do change the time How do enable the maternal only recorder mode How do turn off the recorder completely Answer 1 Rotate the Trim Knob to highlight the Setup legend at the bottom of the display below the menu bar 2 Once the Setup legend is highlighted press the Trim Knob 3 The display changes to the General Setup screen 4 In the General Setup screen rotate the Trim Knob to highlight one of the Time setting fields on the top left corner of the display These fields are for hours HH minutes MMM and seconds YYYY Note that the seconds field cannot be selected or set 5 After the desired field is highlighted selected press the Trim Knob The current setting displays in blinking inverse video 6 Now rotate the Trim Knob to change the current time parameter setting 7 Once you set the desired value press the Trim Knob again to save the value The current value setting stops blinking 8 Repeat Step 4 through Step 7 for any other date parameters that need to be set 9 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 1 From the On state The yellow LED above the recorder is illuminated press the Record button once quickly The recorder advances printing the date and time on the chart paper perpendicular
138. ill allow monitor front panel display video to be replicated remotely Speaker The rear panel speaker emits an audible tone for heart rates MSpO pulse with O2 dependent pitch and alarms It also provides the sound for the song player feature J109 J110 and J111 Three serial RJ 11 connectors are provided for RS 232C interfacing to peripheral equipment Contact your Communications GE Service Representative for more information Connectors ECG Out Connector External recorder receptacle for MECG signals The standard output level is 1 V mV Fetal Acoustic Stimulator Connector Receptacle for Corometrics Model 146 Fetal Acoustic Stimulator FAST A musical note symbol prints on the strip chart paper each time the Model 146 is used 2 Remote Event Marker Connector Receptacle for the Corometrics Remote Event Marker When activated one of the following marks prints on the strip chart paper m The event marker is commonly used to record an event f m The fetal movement marker default setting is commonly used as an indication that the mother has perceived fetal movement 1 Refer to the Coro 250 250cx Series Monitor Service Manual for more information Equipotential Lug A binding post terminal is directly connected to the chassis for use as an equipotentiality connection 2036946 001 250cx Series Maternal Fetal Monitor 3 17 Controls Indicators and Connectors
139. in tissue thickness the light intensity of the OxiMax sensor s LEDs is adjusted automatically SatSeconds False or nuisance alarms are a common concern in pulse oximetry monitoring They are often triggered by minor brief desaturation events that are clinically insignificant SatSeconds is a proprietary Nellcor alarm management technique that helps reduce false and nuisance alarms without risking patient safety 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Pulse Oximetry Monitoring MSpO2 Technology With traditional alarm management upper and lower alarm limits are set for monitoring oxygen saturation During monitoring as soon as an alarm limit is violated by as little as one percentage point an audible alarm immediately sounds When the SpO level fluctuates near an alarm limit the alarm sounds each time the limit is violated Such frequent alarms can be distracting With the SatSeconds technique upper and lower alarm limits are set in the same way as with traditional alarm management The clinician also sets a SatSeconds limit that allows the monitoring of SpO below the selected low alarm limit and SpO above the selected high alarm limit for a period of time before an audible alarm sounds The SatSeconds limit controls the time that the SpO level may fall outside the alarm before an audible alarm sounds The method of calculation is as follows The number of percentage points that the
140. indications automatically disappear unlatch 5 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Heart Rate Monitoring Fetal Heart Rate Alarms 100 Signal Loss In cases where there is a complete absence of signal the signal quality time to alarm is 1 25 minutes FHR bpm 100 signal loss Ao min alarm activated Time minutes 100 Signal Loss Example Intermittent Signal Loss In the clinical environment a partial loss of signal is seen more frequently than a complete loss of signal The time to alarm will vary related to the percentage of signal loss Figure below shows an example where there is 70 signal loss resulting in a signal quality alarm after 5 minutes 70 signal loss min end of good quality signal Time minutes 70 Signal Loss Example Silencing an Audio Alarm Press the Alarm Silence button KX to cancel the audio component of an alarm the visual indications remain until the alarm condition is resolved The silence function works on an alarm by alarm basis An audio alarm will sound if a new alarm condition occurs after the previous condition has been resolved Revision C 250cx Series Maternal Fetal Monitor 5 9 2036946 001 Fetal Heart Rate Monitoring Single Fetal Heart Rate Monitoring Summary The alarm algorithms are intended to assist the perinatal staff in assessing the status of a patient at bedside by recognizing vital signs
141. ing mother poking her abdomen in addition to emesis fetal hiccups or twins During fetal sleep or in the event of a fetal demise some of these detected movements may be confused with fetal movement Using Fetal Movement Detection While Monitoring Enabling Disabling Fetal Movement Detection The fetal movement detection is available for the US connector only FMD is not available for the US2 connector To enable disable fetal movement detection set the FM Detect field on the US Setup screen to On Refer to Figure below This field is only displayed for the US connector and if the option is installed in your monitor and if a transducer is plugged into the US connector Rotating the Trim Knob control alternates between On and Off The factory default setting is Off Revision C 250cx Series Maternal Fetal Monitor B 3 2036946 001 Fetal Movement Detection Using Fetal Movement Detection While Monitoring Display Indicator When fetal movement detection is enabled and a transducer is plugged in the annotation FMD appears in between the FHR1 and FHR2 mode titles Refer to Figure below 165 30 US Setup FM Detect On Volume 5 Volume 5 US Setup Screen Strip Chart Annotation When fetal movement detection is enabled the mode annotation FMD prints following the FHR modes The annotation provides an indication that the feature is enabled it does not indicate d
142. ing Information oooococococrcrnccnr 18 3 Paper Supplies Ordering Information sese 18 3 Ultrasound Ordering Information sseseeeeennnnnnn 18 3 FECG Ordering Information oocooccccccccnncnn nr 18 4 Tocotransducer Ordering Information oooooccccccccnccncro 18 4 IUPC Ordering Information sssseseeeennnnn eens 18 4 MECG Ordering Information sssleseeeeennnnn ees 18 5 NIBP Ordering Information sssseseeeennnnn eee ees 18 5 MSpO Ordering Information 0cc cee e eee eee eee eee ees 18 6 Peripheral Device Ordering Information s seen 18 6 I Factory Defaults ccc cece eee eee e eee A 1 Table of Defaults 0 cece eect e eee eee eee eeeeeeaes A 3 B Fetal Movement Detection 00oooooooo o B 1 Introduction iasi iris en se da ee se e ERI cd NEP eet B 3 Ayallability voca id inate aaa e m i ae B 3 Methodology n EL E enter ERE Wee REI B 3 Using Fetal Movement Detection While Monitoring B 3 Enabling Disabling Fetal Movement Detection 0oo ooooommo o B 3 Display Indicators e ii a e Ro eds a idl B 4 Strip Chart Annotation 60 00 cece nee e eee B 4 Using the FM Remote Marker to Complement the Patient Record B 4 C Spectra Alerts is aa C 1 Important Safety Information 0c cece cece eee eee eae C 3 Revision C 250cx Series Maternal Fetal Monito
143. ins until the alert condition is resolved C 18 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Alert Parameters Summary of Alert Parameters ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria Decelerations Present Present DECELERATIONS The analysis of deceleration characteristics has recognized features of either variable late mixed or prolonged decelerations or decelerations without uterine activity recorded The baseline FHR and variability impact the monitor s ability to analyze patterns as well as the severity of the pattern The monitor attempts to integrate the baseline features with the deceleration features onset size duration etc to determine when to alert The alert message is issued on the basis of 1 2 or 3 decelerations depending on the size shape onset duration etc and related baseline rate and variability Examples An alert occurs when Three out of 5 contractions have mild variable decelerations if baseline FHR is in normal range and variability is average Two out of 5 contractions have any decelerations except early if the variability decreased One severe variable deceleration that drops to 60 bpm for 60 seconds NOTE Alert occurs in approximately 2 minutes Alert silenced DECELERATIONS The alert is deleted when there are
144. int the displayed waveform or the maternal vital signs history Selecting the Print or PrintAll softkey places the recorder into a special high speed printing mode After the information is printed the recorder turns off again Refer to Chapter 12 Maternal Vital Signs History and Chapter 14 Waveforms for more information When the recorder is on the yellow Record indicator continuously illuminates and the recorder runs at the selected speed of 1 2 or 8 cm min Maternal Only Mode What is the Maternal Only Mode Printing Style The maternal only printing mode sets the recorder to a standby mode turning the recorder on and off as needed to print information such as m maternal non invasive blood pressure m maternal pulse oximetry and m notes from a Model 2116B Clinical Notes Data Entry System When the recorder is in the maternal only mode the yellow Record indicator flashes approximately every 5 seconds Information printed using the maternal only mode prints vertically across the page Figure on page 11 4 provides an example of a maternal only mode printout Revision C 250cx Series Maternal Fetal Monitor 11 3 2036946 001 Recorder Modes Changing Recorder Modes 46 y MSPO2 97 P 72 45 NIBP 113 64 M88 P 7 41 0 MSPO2 98 P 74 36 Q MSPO2 97 P 7D 1 Q MSPO 99 P 74 BO NIBP 115 62 M88 P 7 FEB 96 28 Maternal Only Mode Printout A summary of the printed information follows m
145. inued Annotation Explanation system For example E ZH EPIDURAL GIVEN AROM POS CHG LEFT SIDE Remote annotation from a central information This annotation represents notes received from a remote central information system The computer icon B prints in the bottom two lines of the top grid The icon marks the time of the annotation and also indicates that the information comes from a remote computer such as a QS Perinatal System The notes print on any lines except the first The first line is reserved from NIBP vital signs data HBC This annotation prints on the first annotation line following the active heart rate mode s indicating heartbeat coincidence is enabled This feature is enabled disabled via the password protected Install Options service screen The annotation represents only that the feature is enabled it does not indicate that heartbeat coincidence has been detected YY This annotation prints in the top two lines of the upper grid indicating that the monitor detects heartbeat coincidence This annotation prints in the top two lines of the upper grid indicating the cessation of heartbeat coincidence This annotation prints on the bottom two lines of the upper grid indicating that active telemetry signals are being received The annotation re prints every 30 minutes along with the modes A US 20 or US2 20 yy do This annotation prints on the bot
146. ion 1 bpm 1 bpm Uterine Activity Scale Strain Gauge Tocotransducer Chart Width 4 cm 4 cm Scaling 25 mmHg 3 3 kPa cm 25 mmHg 3 3 kPa cm Range 0 100 mmHg 0 13 3 kPa 0 100 mmHg 0 13 3 kPa Resolution 1 mmHg 0 13 kPa 1 mmHg 0 13 kPa Maternal Pulse Oximetry MSpO Scale Chart Width Scaling Range Resolution Domestic 4 cm 12 5 cm or 25 cm 60 100 or 0 100 1 International 4 cm 12 5 cm or 25 cm 50 100 or 0 100 1 Recorder Drive Speeds Speed Accuracy 1 2 and 3 cm min 1 NOTE Specifications are subject to change without notice Revision C 250cx Series Maternal Fetal Monitor 2036946 001 17 11 Technical Specifications Strip Chart Recorder 17 12 250cx Series Maternal Fetal Monitor Revision C 2036946 001 18 Supplies 4 Accessories This section provides an overall listing of supplies and accessories for use with 250cx Series Monitors To order any of the supplies and accessories listed in this manual Inside the United States Call 1 800 558 7044 Outside the United States Contact your local representative Revision C 250cx Series Maternal Fetal Monitor 18 1 2036946 001 Supplies amp Accessories For your notes 18 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Supplies amp Accessories General Add Ons Ordering Information General Add Ons Ordering Information General Supplies Item Remote E
147. is bulletin states that minute ventilation rate adaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment causing the pacemakers to pace at their maximum programmed rate The FDA further recommends precautions to take into consideration for patients with these types of pacemakers These precautions include disabling the rate responsive mode and enabling an alternate pace mode For more information contact Office of Surveillance and Biometrics CDRH FDA 1350 Piccard Drive Mail Stop HFZ 510 Rockville MD 20850 USA When MECG monitoring is employed the MECG waveform can be displayed and printed independent of the MHR P source Refer to Chapter 14 Waveforms 7 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 8 Maternal Non Invasive Blood Pressure Monitoring evision 250cx Series Maternal Fetal Monitor 2036946 001 Maternal Non Invasive Blood Pressure Monitoring For your notes 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Maternal Non Invasive Blood Pressure Monitoring Blood Pressure Safety Precautions Blood Pressure Safety Precautions NOTES This safety information applies to the non invasive blood pressure NIBP of the monitor A patient s vital signs may vary dramatically during the use of cardiovascular agents such as those that raise or lower blood pressure or those that increase or
148. isplay option 1 Access the UA setup screen by selecting the UA mode title TOCO or IUP 2 Setthe UA Display field to the desired setting UA or UA UCF Refer to the Figure UC Frequency Histogram on page C 15 UC Frequency in UA Display Area When enabled On the UC frequency per 10 minutes displays in the UA Display area the UA value displays in a smaller size in order to accommodate the additional information See figure below US2 TOCO 165 v 172 en UC Frequency option enabled NIBPO 02 15 A MECG N MSpo2 130 85 09 97 MAP 107 03 15 03 22 45 Freeze Alarms VSHX UC Frequency Option Enabled C 14 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Uterine Contraction Frequency UC Frequency Histogram If the Spectra Alerts option is enabled the UA Setup screen displays a UC Frequency Histogram as shown in the next Figure Each bar in the graph represents the number of contractions in a 10 minute segment The graph displays up to 10 bars or 100 minutes FECG US 59 48 153 X UC in 10 min gt 10 9 8 7 6 5 4 3 2 1 0 09 44 10 24 11 14 UA UA Display UA UCF UC Chime OFF On UA UCF Off D EH UC Frequency Histogram The following two messages may display above the UC Frequency Histogram RECORDING UA and UA BASELINE SET For more information refer to Table on pages C 17 through C
149. itial target pressure to get data in the systolic region The maximum pressure allowed in systolic search is limited by the normal range for cuff pressures In any operating mode if a patient s systolic pressure exceeds the inflation pressure the parameter will begin normal deflation sequence detect the absence of a systolic value stop deflation reinflate to a higher than initial inflation pressure and resume the normal deflation sequence WARNING Arrhythmias will increase the time required by the NIBP parameter to determine a blood pressure 8 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Non Invasive Blood Pressure Monitoring NIBP Setup Screen NIBP Setup Screen kPa mode High Low 9 3 32 0 6 7 20 0 9 3 17 3 4 0 16 0 9 3 20 0 4 0 16 0 100 250 35 120 mmHg mode High Low 70 240 50 150 70 130 30 120 70 150 30 120 100 250 35 120 Mode Target Select the NIBP softkey to access the NIBP Setup screen Manual TOCO Auto 1 min 165 172 3035 A f 100 250 uto 3 min NIBP Setup 5 mmHg Auto 4 min increments Auto 5 min LANIBP O 11 41 Mode Auto 10 min 0 Auto 15 min 1 30 85 Target 135 n uo MAP 107 NIBP Done Vol 5 1 A Auto da gt lanis High 2 3 Auto 40min Systolic 160 3 4 Auto 45 min Diastolic 90 4 5 Auto 60 min MAP 140 5 Auto 90 min MHR P
150. itor 9 9 2036946 001 Maternal Pulse Oximetry Monitoring MSpO Methodology Averaging Time Masimo Technology Only Print Interval 0 Trace Alarms Alarm Volume This menu option only appears when using Masimo Technology and sensor Choose a response time in order to compensate for different levels of patient activity 2 4 6 10 12 14 or 16 seconds For the 2 and 4 second averaging settings The actual averaging times may range from 2 to 4 and 4 to 6 seconds respectively m 10 12 14 or 16 seconds These averaging settings are least affected by patient movement m 8seconds This averaging selection is recommended in cases where the patient is relatively inactive m 2or 4 seconds These averaging selections are most affected by patient movement This setting determines the time interval for printing the MSpO values on the strip chart paper This setting enables or disables the printing of the MSpO trend on the bottom grid of the strip chart paper m On The MSpO trend prints in grey and is annotated with MSpO m Off The MSpO trend is not printed These fields adjust the high and low alarm limits for MSpO as well as for MHR P in increments of 1 or 5 bpm The selectable values are listed in Chapter 10 Alarms Refer to Appendix A Factory Defaults for additional information This field controls alarm volume for all maternal alarms Refer to Factory Defaults on page A 1 for information
151. ity scale is pre printed from 0 100 mmHg 0 0 13 3 kPa this same scale is used for relative units When SpO and monitoring is in progress the scale is printed on the paper by the recorder The Figures on pages 12 3 and 12 4 also call out the top grid bottom grid and the annotation area for each style paper 11 16 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Strip Chart Paper PAGES REMAINING Pre printed HR Scale Primary Annotation Area CED UA Scale Bottom Grid Strip Chart Paper with 30 240 bpm Heart Rate Scale Revision C 250cx Series Maternal Fetal Monitor 11 17 2036946 001 Recorder Modes Paper Low Paper Out and Paper LoadING Error Conditions 02377 vus REMAINING Top Grid 180 160 Pre printed HR Scale 140 60 Primary Annotation Area 1CM b 100 M 12 Pre printed UA Scale m 80 60 8 60 Bottom Grid 6 40 4 40 20 20 UA OmmHg 0 UA OmmHg Strip Chart Paper with a 50 210 bpm Heart Rate Scale PAPER LOW PAPER OUT and PAPER LOADING Error Conditions The 250cx Series Monitor alerts you when paper is running low or when the recorder is completely out of paper To protect against paper jams the recorder also contains a paper loading sensor which notifies you if the paper has been incorrectly loaded Refer to Loading Strip Chart Recorder Paper on page 4 3 and follow the instructions on loading pa
152. ity used to monitor other patient parameters The monitor is intended only for use in the non invasive monitoring of maternal blood pressure NIBP This monitor is not intended for use in neonatal or pediatric blood pressure monitoring Devices that exert pressure on tissue have been associated with purpura skin avulsion compartmental syndrome ischemia and or neuropathy To minimize these potential problems especially when monitoring at frequent intervals or over extended periods of time make sure the cuff is applied appropriately and examine the cuff site and the limb distal to the cuff regularly for signs of impeded blood flow 8 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Non Invasive Blood Pressure Monitoring NIBP Determination NIBP Determination SuperSTAT NIBP A patient s vital signs may vary dramatically during the use of cardiovascular agents such as those that raise or lower blood pressure or those that increase or decrease heart rate Because treatment protocol based on the patient s blood pressure may rely on specific values and differing measurement methods clinicians should note a possible variance from values obtained with this unit in planning patient care management The GE monitor values are based on the oscillometric method of noninvasive blood pressure measurement and correspond to comparisons with intra aortic values within ANSI AAMI Standards for accuracy Most auto
153. l of arterial oxygen saturation in blood The measurement is usually taken by placing a sensor on the adult patient s fingertip The sensor is connected to the monitor by a patient cable The sensor collects signal data from the patient and sends it to the monitor Pulse oximetry is governed by the following principles 1 Oxyhemoglobin oxygenated blood and deoxyhemoglobin non oxygenated blood differ in their absorption of red and infrared light spectrophotometry 2 The amount of arterial blood in tissue changes with your pulse photoplethysmography Therefore the amount of light absorbed by the varying quantities of arterial blood changes as well The 250cx Series Monitor measures the maternal oxygen saturation MSpO and pulse rate using the principles of spectrophotometry and plethysmography Which Module is Installed GE Medical Systems Information Technologies offers you the choice of one of the following MSpO options m Ohmeda Oximetry Technology m MASIMO SET Technology m Nellcor Technology You can identify which MSpO technology your monitor contains by referring to the front of the monitor The MSpO technology logo appears next to the lower right hand side of the display example shown below Onmeda AMi E Ohmeda Nellcor and Masimo Set Labels Revision C 250cx Series Maternal Fetal Monitor 9 3 2036946 001 Maternal Pulse Oximetry Monitoring MSpO2 Technology Theory of Operation Ohm
154. le options to monitor dual fetal heart rate FHR m US US2 dual external m FECG US internal external m FECG US2 internal external The 250cx Series monitor offers two advanced features to aid in monitoring twins m heartbeat coincidence m fetal heart rate offset 5 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Heart Rate Monitoring Dual Fetal Heart Rate Monitoring Heartbeat Coincidence FHR Display and Trend Summary ACTIVE DISPLAY MODE TREND ANNOTATION CONNECTORS FHR1 FHR2 FHR1 FHR2 US US US An US US2 US2 An FECG FECG FECG Ap US US US US2 US A US2 A FECG US FECG US FECG US Mm FECG US2 FECG US2 FECG US2 FECG US US2 FECG US2 FECG US2 NOTE In the event that three transducers are plugged into the monitor FECG overrides the primary ultrasound connector US When the heartbeat coincidence feature is enabled the monitor alerts you when there is the possibility that you may be monitoring a duplicate signal Refer to Chapter 13 Heartbeat Coincidence for more information Fetal Heart Rate Offset When monitoring dual fetal heart rates overlapping traces on the strip chart may be difficult to interpret The 250cx Series monitor provides a 20 bpm shift for the secondary FHR trend to alleviate this problem whether using dual ultrasound or ultrasound and FECG This field provides an alternative to using the fron
155. level Subtract 1 80 mmHg 0 24 kPa from values for every inch 2 54 cm below heart level In manual mode press the NIBP Start Stop button to begin a single determination The cuff will inflate to the target pressure If this initial inflation pressure is insufficient the unit retries with a higher inflation pressure 40 mmHg 5 3 kPa The instantaneous cuff pressure is displayed in place of the mean arterial pressure area and is indicated by the title Cuff If you have the 256 Monitor which does not have the NIBP parameter installed and press the NIBP Start Stop button the message NOT INSTALLED appears under the NIBP label on the monitor s screen In auto mode an indefinite series of determinations are made at defined time intervals Upon activation a clock icon D displays in the NIBP area indicating the time remaining until the next scheduled automatic determination NOTE The first automatic determination begins after the expiration of one complete interval time period Since the first automatic blood pressure reading will not occur until after a complete interval time you may wish to take an initial manual reading by pressing the NIBP Start Stop push button Automatic determinations inflate to the target pressure if no previous values are displayed If previous values are displayed the cuff inflation target pressure is based on the previous values If this initial inflation pressure is insufficient the unit retries with a h
156. light the Source setting It will read Auto MSpO MECG or NIBP 4 If the Source setting is not MECG press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting to MECG 6 Once you set the desired source parameter press the Trim Knob again to save the value The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the MECG Lead setting This setting is slightly above vertical center towards the right side of the screen and indicates Lead l Il or Ill 8 Now press the Trim Knob again The current setting displays in blinking inverse video 9 Now rotate the Trim Knob to change the current setting to the desired lead selection 10 Once you set the desired source parameter press the Trim Knob to confirm your selection The current value setting stops blinking 11 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 12 Press the Trim Knob again to return to the main monitoring display screen Option 2 1 If the MHR P Source setting is set to Auto and MECG is currently enabled plugged in OR MHR P Source is set to MECG then from the main monitor screen rotate the Trim Knob to highlight the selected Lead setting for MECG This setting is slightly below vertical center on the right hand side of the display It will indicate I or II 2 Once the MECG Lead setting legend is highlighte
157. lse Amplitude and Transmission gt 5 Alarms Visual Audio Spectrophotometry and plethysmography LNOP DC I LNOP Adt LNCS PC I and LNCS Adt gt 30 kg 2 3 3 bpm 5 bpm 2 3 bpm 1 100 25 240 beats min 0 02 20 70 100 2 digits 70 100 3 digits 70 100 2 digits 0 69 unspecified 663 nm nominal 880 nm nominal 0 13 mW minimum 0 79 mW maximum 25 to 240 bpm x 3 digits 25 to 240 bpm x 5 digits 196 1 Saturation SpO 2 digits Pulse Rate 3 digits Flashing SpO numerics or message Alternating 1 5 second chimes Interfering Substances Carboxyhemoglobin may erroneously increase readings The level of increase is approximately equal to the amount of carboxyhemoglobin present Dyes or any substance containing dyes that change usual arterial pigmentation may cause erroneous readings Revision C 250cx Series Maternal Fetal Monitor 17 7 2036946 001 Technical Specifications Operating Modes Operating Mode Specifications Continued Maternal Pulse Oximetry Mode Masimo continued 1 Accuracy specified when used with Masimo SET pulse oximetry modules using PC or LNC series patient cables Numbers represent x 1 standard deviation Plus or minus one standard deviation represents 68 of the population SpO accuracy from 70 to 100 Pulse Rate accuracy from 25 to 240 bpm The Masimo SET SpO parameter with LNOP Adt sensors has been val
158. lt m Access the General Setup screen and reset the time and date see Setup Section m Call Biomedical Engineering Department Battery Low Icon appears K No heartbeat or pulse sounds m Data Corruption m Battery needs service m Volume set too low m Transducer not connected or is loose m Cycle power Access setup screens and reset last used settings m Call GE Service to report m Press the Volume buttons or access the respective setup screen s FECG US or US2 to increase the volume m Ensure that each transducer is securely attached to monitor and applied to the patient Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Troubleshooting Ultrasound Troubleshooting Ultrasound Troubleshooting Ultrasound Troubleshooting Problem Probable Cause Possible Solution Ultrasound not functioning properly m Transducer not properly connected to m Ensure that transducer is securely monitor attached to monitor m Transducer placement m Wait before moving transducer FHR often returns Reposition transducer m Too little gel applied to transducer m Apply more gel m Defective transducer m Replace transducer m Active fetus or mother Fetal arrhythmia or m Use alternate technique hiccups Extreme maternal obesity m No signal m Auscultate FHR m Service required m Call Biomedical Engineering Department m Check maternal pulse to ensure monitoring of
159. matic non invasive blood pressure monitoring uses the oscillometric method of measurement To understand how this method works it is compared to the auscultatory method Auscultatory With the auscultatory method the clinician listens to the blood flow and determines the systolic and diastolic pressures The mean pressure is then calculated with reference to these pressures as long as the arterial pressure curve is normal Oscillometric The oscillometric method measures cuff pressure oscillations Oscillations are small changes in cuff pressure caused by artery motion against the cuff During a determination the monitor stores oscillations along with cuff pressures At the end of a determination these stored data are used to determine systolic mean and diastolic pressures Due to the difference in these methods one cannot be used to check the accuracy of the other Determination The oscillometric method of determining SuperS TAT NIBP is accomplished by a sensitive transducer which measures cuff pressure and minute pressure oscillations within the cuff The first determination initially pumps up to an initial target cuff pressure of about 135 mmHg 18 0 kPa or to the user selected initial target pressure To allow for rapid setting of cuff pressure the monitor will momentarily inflate to a higher pressure then immediately deflate to the target pressure After inflating the cuff the monitor begins to deflate the oscillations
160. may cause improper operation of one or more of the devices STRANGULATION Make sure all patient cables leadwires and tubing are positioned away from the patient s head to minimize the risk of accidental strangulation WATER BIRTHS Do not use the monitor to directly monitor patients during water births in whirlpool or submersion water baths during showers or in any other situation where the mother is immersed in water Doing so may result in electrical shock hazard EXTERNAL VGA CONNECTIONS Connect only to GE recommended display ONLY remove cover plate if external display is used TELEMETRY CONNECTIONS Connect only to GE recommended telemetry systems Contact your GE service representative for more information Revision C 250cx Series Maternal Fetal Monitor 1 7 2036946 001 Safety Monitor Contraindications Warnings and Precautions Cautions WARNINGS COLOR DISPLAY Certain colors may have limited visibility at a distance Color blind individuals may experience this more often EXERGEN TAT 5000 Cable assembly 2036641 001 cannot be field serviced Do NOT attempt any repairs to this assembly This assembly must be returned to the factory for any repairs This assembly as shipped is important to patient safety DISPOSAL This product consists of devices that may contain mercury which must be recycled or disposed of in accordance with local state or country laws Within this system
161. mbient light conditions may result in inaccurate measurements The Nellcor Technology determines SpO by passing red and infrared light into an arteriolar bed and measuring changes in light absorption during the pulsatile cycle Red and infrared low voltage light emitting diodes LED in the oximetry OxiMax sensor serve as light sources a photo diode serves as the photodetector To identify the oxygen saturation of arterial hemoglobin the monitor uses the pulsatile nature of arterial flow During systole a new pulse of arterial blood enters the vascular bed and blood volume and light absorption increase During diastole blood volume and light absorption reach their lowest point The pulse oximeter bases its SpO measurements on the difference between maximum and minimum absorption measurements at systole and diastole By doing so it focuses on light absorption by pulsatile arterial blood eliminating the effects of nonpulsatile absorbers such as tissue bone and venous blood Automatic Calibration Because light absorption by hemoglobin is wavelength dependent and because the mean wavelength of LEDs varies an oximeter must know the mean wavelength of the OxiMax sensor s red LED to accurately measure SpO During monitoring the software selects coefficients that are appropriate for the wavelength of that individual OxiMax sensor s red LED these coefficients are then used to determine SpO Additionally to compensate for differences
162. ms only MECG and MSpO alarms FHR values are not configurable A patient alarm is indicated both visually and audibly The visual indication is provided by flashing the affected FHR numeric The audio alarm consists of alternating high low tones Resolved FHR alarms function differently than other alarms with a 250cx Series Monitor m Resolved Unsilenced FHR Patient Alarm You must acknowledge an FHR patient alarm even if the condition has already been resolved The visual and audible indications remain present until you press the Alarm Silence button This ensures that a clinician is aware that an alarm occurred You may hear this type of alarm described as latching m Resolved Silenced FHR Patient Alarm If you have already silenced an FHR patient alarm the visual indications disappear automatically By comparison the visual and audible indications for a maternal patient alarm automatically disappear as soon as the condition is resolved whether or not you have acknowledged the alarm FHR Signal Quality Alarms A fetal heart rate signal quality alarm occurs if the monitor is unable to detect an acceptable FHR signal Active Signal Quality Alarm A signal quality alarm is indicated both visually and audibly The visual indication is provided by flashing the FHR numeric if available or flashing dashes in place of the FHR numeric The audio alarm consists of alternating high low tones 10 6 250cx Series
163. n D C ACOG 1989 by visual assessment of the fetal monitor tracing at the bedside and evaluation of maternal vital signs and progress in labor The absence of an alert does not indicate fetal or maternal well being The alert message and priority level are only a means to direct the staff s attention to the patient since more than one parameter may be contributing to the alert condition Visual assessment of the strip chart combined with knowledge of patient history and risk factors are necessary to manage the situation appropriately The alert system will not detect every possible abnormality and cannot detect abnormalities that have not been clinically recognized and described in the literature Frequent assessment of the fetal monitor tracing is necessary to ensure recognition of unusual undefined or suspicious patterns The care provider should only make the diagnosis of abnormal fetal heart rate patterns by personal assessment of the fetal monitor tracing from the bedside fetal monitor not the alert message The monitor requires data of a consistently good quality to recognize abnormalities Artifact will limit its ability to recognize abnormalities Increased variability long and frequent accelerations baseline changes half counting or double counting and poor or absent uterine activity are examples of factors which may limit detection capabilities Revision C 250cx Series Maternal Fetal Monitor C 3 2036946 001 Spectr
164. n error Nellcor error SENSOR Be sure to check the type of MSpO technology your monitor contains the label next to the lower right hand side of the display and use the corresponding cables and sensors for that technology Revision C 250cx Series Maternal Fetal Monitor 9 11 2036946 001 Maternal Pulse Oximetry Monitoring Module and Probe Compatibility Modules and Sensors No Implied License The Masimo Ohmeda and Nellcor parameters are used to measure the amount of oxygenated hemoglobin and pulse rate non invasively The absorption of selected wavelengths of light is measured with sensors Although these parameters process the MSpO measurements differently the function and appearance of MSpO on your monitor is the same Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized replacement parts which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device Sensors Before use carefully read the manufacturer s sensor directions for use CAUTIONS TISSUE DAMAGE Tissue damage can be caused by incorrect application or use of a MSpO sensor for example by wrapping the sensor too tightly Inspect the sensor site as directed in the sensor s directions for use to ensure skin integrity and correct positioning and adhesion of the sensor 9 Do not use damaged sensors 9 Do not use a se
165. n parameter a reading also prints for each alarm generated The reading can print on any of the first three annotation lines depending on which printing line is available A diamond marks the time of the reading m An unfilled diamond indicates the reading was received from the monitor s built in maternal pulse oximetry parameter The vital signs print below the diamond m 4A filled diamond indicates the reading was received from an external maternal pulse oximeter connected to the 250cx Series Monitor The vital signs print below the diamond Contact your Service Representative for connectivity information Tf the top three printing lines are busy printing other data the diamond prints at the time of the reading however the vital signs data prints as soon as a line becomes available The pulse rate value determined by MSpO always prints along with MSpOo Annotations from a Central Information System Multiple Annotations The 250cx Series Monitor has three built in RS 232C ports which can be used to connect to a central information system which supports Hewlett Packard s Digital Series Protocol Contact your Service Representative for more information The 250cx Series Monitor can also be configured via a communications service screen to print annotations received from a central information system A computer marker i prints on the bottom two lines of the heart rate grid marking the time the annotation was made from a r
166. n power cycle the monitor If message still prints call GE Service to report Softkeys Mode Title Softkeys Waveform Softkeys A softkey is an area on the screen that can be selected with the Trim Knob control When the softkey is activated by pressing the Trim Knob control it may cycle through available settings or it may display a setup screen Most of the mode titles in the display are also softkeys which give access to corresponding setup screens US US2 FECG NIBP MECG Pulse and MSpO The waveform title is a softkey used to select the waveform for display or to disable the area The ECG Scaling and MECG lead labels are softkeys used to configure the waveform currently displayed Revision C 250cx Series Maternal Fetal Monitor 3 13 2036946 001 Controls Indicators and Connectors Softkeys Dedicated Softkey Area Cen Softkeys are located at the bottom of each screen as shown in Maternal Fetal Monitor Display Summary on page 3 14 Although there are many possible softkeys which may appear in this area a maximum of five are shown at a time US2 HBC TOCO 16591729 30 NIBPO 02 15 A MECG A MSpo2 130 85 899 97 MAP 107 03 15 25 mm s Il Auto 09 21 41 Frozen 09 22 06 T Freeze Alarms Setup VSHX H F D G E Maternal Fetal Monitor Display Summary Display Summary Name Description A
167. nal Non Invasive Blood Pressure Monitoring NIBP Monitoring NIBP Done Volume Alarms Alarm Volume NIBP Monitoring Checklist Patient Preparation This field sets the volume of the sound emitted at the completion of each blood pressure determination As you adjust the volume a sample tone sounds These fields adjust the high and low alarm limits for maternal systolic diastolic and mean arterial pressures as well as for MHR P in increments of 5 mmHg 0 7 kPa or 5 bpm The selectable values are listed in Maternal NIBP Setup Screen on page 8 7 The factory default settings are listed in Appendix A Factory Defaults This field controls alarm volume for all maternal alarms duc d The NIBP hose is securely inserted into the NIBP connector on the monitor A cuff appropriate for the limb size has been selected Cuff is properly placed on patient and connected to the NIBP hose Tubes between the cuff and the monitor are not kinked or blocked Cuff selection and application are important Inappropriate selection or improper application of the cuff will result in erroneous measurements WARNING The system is designed for use only with dual hose cuffs and tubing Do not place the cuff on a limb being used for A V fistulas intravenous infusion or on any area where circulation is compromised or has the potential to be compromised Connect the air hose to the NIBP port on the front of the monitor Make sur
168. nd the countdown timer shows 4 minutes until the next reading in other words 6 minutes have elapsed If you change the interval time to 15 minutes the countdown timer will wait another 15 minutes until the next reading Therefore a total of 21 minutes will elapse between readings Revision C 250cx Series Maternal Fetal Monitor 8 11 2036946 001 Maternal Non Invasive Blood Pressure Monitoring NIBP Monitoring Example 2 The interval time is set at 15 minutes and the countdown timer shows 2 minutes until the next reading in other words 13 minutes have elapsed If you change the interval time to 10 minutes the countdown timer will wait another 10 minutes until the next reading Therefore a total of 23 minutes will elapse between readings NIBP Interval Button Shortcut You can set the interval time from the NIBP Setup screen or from the normal operating screen using a front panel button shortcut 1 While the normal operating screen is displayed press and hold the NIBP Start Stop button on the front panel 2 After holding for approximately 2 seconds the interval field display in place of the countdown timer Refer to NIBP Interval Time Shortcut on page 8 12 3 Continuous pressure on the NIBP Start Stop button cycles through the available intervals 1 2 3 4 5 10 15 20 30 40 45 60 90 and 120 minutes and Off Off appears as a blank in the interval field display NOTES Since the intervals are display
169. ng the default is configured on the password protected Install Options service screen The monitor is shipped from the factory with either a default setting of 10 in mmHg mode or 1 3 in kPa mode Qualified personnel can access the password protected Install Options service screen to set the baseline default to 5 10 15 20 or 25 relative units in mmHg mode or 0 7 1 3 2 0 2 7 or 3 3 in kPa mode Refer to the 250 250cx Series Monitor Service Manual for more information Manually Overriding the Baseline Default Value Pressing and holding the UA Reference button for more than 2 seconds causes the UA reference level and display to override the default setting and cycle through all available selections 5 10 15 20 or 25 relative units in mmHg mode or 0 7 1 8 2 0 2 7 or in 3 3 kPa mode starting at the default setting until the button is released Once the button is released the UA trace and UA value take on this new value as a baseline for reference Briefly pressing the UA Reference button reverts back to using the default setting configured via the password protected Install Options service screen Automatic Baseline Zeroing If pressure falls below 0 mmHg 0 kPa probably because the belt has loosened automatic UA referencing occurs and a new baseline reference is set at O relative units 6 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Uterine Activity Monitoring Internal Method Intrauterine P
170. nsor with exposed optical components Do not re sterilize single patient use sensors For reusable sensors refer to the manufacturer s instructions for cleaning and sterilization Do not immerse the patient cable in water solvents or cleaning solutions the patient cable connectors are not waterproof 9 Do not re sterilize the patient cable by irradiation steam or ethylene oxide 250cx Series Maternal Fetal Monitor Revision C 2036946 001 10 Alarms Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Alarms For your notes 10 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Alarms Introduction Introduction Alarm Setup This chapter provides a summary of alarms for all modalities in the 250cx Series monitor The monitor provides patient alarms alarm limit threshold violations for FHRI FHR2 NIBP systolic diastolic and mean arterial pressures MHR P for the selected source MSpO In addition the monitor provides signal quality alarms NOTE The audio portion of an alarm takes priority to override the song player if activated Master Alarm Setup Screen The figure below is a sample Master Alarm Setup screen Although each of the fields on this screen can be accessed under the individual parameter setup screens the Master Alarm Setup screen provides an overall summary of the maternal alarm setup information TOCO 165v 172 30 Master Alarm Setup
171. ntributing factors to an alert Some fields contain a second column to provide qualifying information The Table Summary of Alert Parameters provides a list of possible results which can appear in the Alert Parameters summary NOT EParameters displayed in inverse video are contributing to an active alert Items displayed in normal video may indicate an alert is pending Summary of Alert Parameters Alert Analysis Result Possibilities Parameter Label Column 1 Column 2 Alert Level Baseline HR bpm High Range Low For example 145 150 Brady Tachy FHR Variability Unknown Average Increased Decreased Flat Increased Decreased Flat Decelerations Absent Present Present Artifac Arrhythmia Present UA Baseline Pressure pressure in relative units or mmHg Hypertonus kPa when selected Hypertonus UC in 10 min Tachysyst of UCs Tachysyst Revision C 250cx Series Maternal Fetal Monitor C 9 2036946 001 Spectra Alerts Alert Parameters Summary Summary of Alert Parameters Alert Analysis Result Possibilities Parameter Label Column 1 Column 2 Duration of Last UC Tetanic of seconds gt Tetanic Signal Quality Good Moderate Poor Unknown The next Figure provides an example of an alert with two columns of information Inverse video indicates the feature is contributing to an alert Some fields are informational Some f
172. ntrols Indicators and Connectors For your notes 3 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors Front Panel Description Front Panel Description A B C D E F G H el Y J D VEEE TL FECG T1U52Z TOCO mr M ol y A pa 250 Sed O 1165 172 3 coooo Z zu NIBPO 15 00 MEC MSpO2 w A 130 85 87v 987 VU mas NE V y sE f L o Ta ELLA 9 V E M O P T S R Q N Monitor Front Panel Front Panel Name Description A Display The monitor s display is divided into several sections The content and layout of the display can change depending on which functions are installed in the monitor and the modes of operation in use B Trim Knob Control Operation of the monitor is controlled by using the front panel buttons in conjunction with the Trim Knob control This control selects softkeys on the display and positions a cursor within a setup screen Rotate the Trim Knob control left or right to highlight items on the screen with a bar cursor After highlighting the desired item press the Trim Knob control to make the selection In summary rotate to move cursor press to select an item C NIBP Start Stop Button This button starts and stops both manual and automatic blood pressure determinations It also provides a shortcut for changing the auto interval time see 8 12 D Test Button Pressing
173. on factory defaults and setting options MSpO Methodology The maternal oxygen saturation is indicated by up to three digits representing the percentage of oxygen saturation The pulse amplitude indicator is a vertical bar that visually indicates each pulse When MSpO monitoring is employed the MSpO pulsatile plethysmograph waveform can be displayed and printed Refer to Chapter 14 Waveforms for more information 9 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Pulse Oximetry Monitoring Module and Probe Compatibility MSpO Pulse Beat Audio If MSpO is selected as the MHR P source each pulse beat is indicated with a beep the pitch of the beep will vary according to the saturation value the pitch rises as the saturation value increases the pitch lowers as the saturation value decreases If MECG is selected as the MHR P source the MECG audio plink is used instead it will not vary in pitch NIBP cannot be chosen as the MHR P source Refer to Chapter 7 Maternal Heart Pulse Rate Monitoring for more information The MSpO Waveform When MSpO monitoring is employed the MSpO pulsatile plethysmograph waveform can be displayed and printed Refer to Chapter 14 Waveforms for more information When enabled the MSpO trend prints in the bottom grid as a grey trace annotated by MSpO 44 Values are printed on the annotation area preceded by an outlined diamond Q whi
174. onitor Revision C 2036946 001 12 Maternal Vital Signs History evision 250cx Series Maternal Fetal Monitor 2036946 001 Maternal Vital Signs History For your notes 12 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Vital Signs History What is the Maternal Vital Signs History Screen What is the Maternal Vital Signs History Screen This feature displays prints maternal vital signs data in a spreadsheet format called Vital Signs History An example of the maternal Vital Signs Screen is shown on page 12 4 A printout example is shown on page 12 6 CAUTION DATA STORAGE Stored data for history is immediately lost when the monitor is turned off This ensures that stored data for one patient is not inadvertently transferred to a new patient It should be noted that the maternal Vital Signs History feature is most beneficial when a patient is being continuously monitored If a patient is being monitored intermittently all history data is erased each time the monitor is turned off If a significant amount of history data has been collected and the monitor must be turned off you may wish to print the data prior to powering off the monitor in order to retain a hard copy for your files The monitor stores up to 8 hours of data on a first in first out basis available for review and printing at any time After 8 hours of data storage the oldest data begins to be replaced by new
175. or Off Refer to Figure on page 14 4 All waveforms are displayed at a rate of 25mm sec This speed is not adjustable The speed is displayed at the top right of the waveform The size is printed in the upper right above the waveform This label is also a softkey which can be used to change the setting Select from the following 0 25x 4 mV cm 0 5x 2 0 mV cm 1x 1 0 mV cm 2x 0 5 mV cm 4x 0 25 mV cm or Auto The selected lead is displayed in the upper right above the waveform This label is also a softkey which can be used to change the setting Select from the following Il or Ill NOTE The MECG lead can also be changed from the MHR P Setup screen When the MECG Pacer option is enabled On the letter P is displayed prior to the waveform speed See Figure on page 7 6 Revision C 250cx Series Maternal Fetal Monitor 14 3 2036946 001 Waveforms Waveform Area Moving Gap For all waveforms a moving gap a blank gap separating the line in a waveform scrolls along the screen The gap can be thought of as a pen drawing the waveform on the screen and erasing old data along the way The most recent data is displayed to the left of the bar the oldest data is displayed to the right of the bar HBC TOCO 165v 172 30 ANIBPO 0215 f MECG N MSpo2 130 85 89 V 9796 Frea eco MAP 107 only I Il or III 03 15 Scale represents 1 mv MECG 09 21 41 09 22 06 Pri Freeze Alarms VSHX This so
176. our or spray water or any cleaning solution on the equipment or permit fluids to run behind switches into the connectors into the recorder or into any ventilation openings in the equipment 5 Do not use the following cleaning agents Abrasive cleaners or solvents of any kind Acetone Ketone Alcohol based cleaning agents or 999 Betadine CAUTION Failure to follow these rules may melt distort or dull the finish of the case blur lettering on the labels or cause equipment failures Cleaning products known to cause the types of problems mentioned above include but are not limited to Sani Cloth Wipes Sani Wipes and Ascepti Wipes These should be avoided Products containing active ingredients and solutions similar to these products should also be avoided Revision C 250cx Series Maternal Fetal Monitor 15 8 2036946 001 Maintenance Cleaning Display To clean the display screen use a soft clean cloth dampened with a glass cleaner Do not spray the glass cleaner directly onto the display Do not use alcohol or hospital disinfectants like Cidex or Betadine Tocotransducer and Ultrasound Transducer CAUTIONS ABRASION Do not use abrasive cloth sharp objects or abrasive cleaners ALCOHOL Do not use Alcohol in cleaning solutions DISCONNECTION Detach the transducers from the monitor NOTE Only Nautilus transducers are immersible 1 Dampen a cloth or paper towel with on
177. ower switch is placed in the On I position m Monitor is not connected to an AC line receptacle m The AC power cord is defective m The AC outlet is defective m The power cord is not connected to the monitor m Blown fuses m Power selector software has the wrong setting m Connect the power cord to an AC line receptacle m Replace the power cord m Use a different outlet m Connect the power cord to the monitor m Call Biomedical Engineering Department m Recorder does not function and the Record indicator is off m Recorder does not function and the Record indicator flickers three short flashes every 5 seconds m Recorder functions however Record indicator flashes on and off every second m Recorder does not function the Record indicator is off the message PAPER INCORRECTLY LOADED RELOAD WITH BLACK SQUARES DOWN is shown in maternal waveform area m Recorder does not function and the Record indicator is on m Recorder is off out of paper or paper is incorrectly loaded m Recorder is in maternal only mode m Paper supply is low m Paper loaded backwards m Service required m Press Record button or install re install paper see 4 3 then press Record button m Press Record button to turn on m Install paper see 4 3 m Re install paper see 4 3 m Call Biomedical Engineering Department Incorrect time and date m Time incorrectly set m Clock circuit or battery fau
178. pO monitoring and during a paper load error condition an alarm will be reissued if the alarm state continues after a specified amount of time Once alarm silence is activated an ALARM SILENCE message box appears on screen with a timer that counts down the remaining time to re alarm 10 34 01 Freeze Alarms VSHX Alarm Silence Message On Screen 10 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Alarms Alarm Setup Alarm Setting Indicators An alarm setting indicator displays for FHR1 FHR2 NIBP MHR P and MSpO The following table provides a summary of the two possible states for this indicator NOTE The FHR alarms may be completely disabled from the password protected Install Options service screen When disabled the alarm setting indicator is not displayed Alarm Setting Indicators Mode jac I All of the following are true At least one of the following is true m The FHR audio alarm is on m The FHR audio alarm is off FHR m Each of the FHR high low limits is set to a value m The FHR high limit is off m The FHR low limit is off NIBP m The NIBP audio alarm is on m Maternal alarms cannot be turned off m Each of the NIBP high low limits is set to a value MHR P m The MHR P audio alarm is on m Maternal alarms cannot be turned off m Each of the MHR P high low limits is set to a value MSDO m The MSpO audio alarm is on Maternal alarms cannot be turned off pu m Each of
179. per into a 250cx Series Monitor 11 18 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Paper Low Paper Out and Paper LoadING Error Conditions The alarms are summarized by the following Table The volume of the alarm tone for all three conditions is configured on the password protected Install Options Screen 1 screen Recorder Error Conditions Paper Error s Recorder 4 Alarm Silence Condition Record Indicator Status Behavior Audio Status Button Behavior PAPER LOW Flashes on and off once every Continues to Two short tones every 30 Cancels the alarm Low Out second print until paper seconds runs out PAPER OUT Off Automatically Three short tones every Cancels the alarm Out Only stops printing 30 seconds PAPER Flashes on and off once every Does not print Three short tones every 3 Temporarily silences alarm INCORRECTLY second The message PAPER seconds The alarm is re issued if the LOADED INCORRECTLY LOADED RELOAD condition continues after WITH BLACK SQUARES DOWN displays in the waveform area of the display the re alarm time specified on the Install Options Screen 2 The paper chime audio is enabled on the password protected Install Options Screen 1 Revision C 250cx Series Maternal Fetal Monitor 2036946 001 11 19 Recorder Modes Paper Low Paper Out and Paper LoadING Error Conditions 11 20 250cx Series Maternal Fetal M
180. ple 1 The auto mode is selected with a time interval of 2 minutes A determination begins at 12 00 00 Due to excessive patient movement the determination ends at 12 01 35 This leaves only 25 seconds until the next automatic reading scheduled at 12 02 00 The 12 02 00 determination is cancelled and the following reading will resume at 12 04 00 The optional 1 minute interval is an exception When 1 minute is selected if a determination ends with less than 30 seconds until the next one the reading will be delayed to guarantee 30 seconds between determinations During the delay Wait appears in the Auto mode timer Example 2 The auto mode is selected with a time interval of 1 minute An automatic determination begins at 11 59 00 with the next reading therefore scheduled for 12 00 00 The 11 59 00 determination ends at 11 59 35 This leaves only 25 seconds until the next scheduled automatic reading Instead of being cancelled the next reading is reset to start in 30 seconds at 12 00 05 The additional 5 seconds displays as Wait Adjusting the Interval Time Between Automatic Determinations You can adjust the interval time in between determinations by going back into the maternal NIBP Setup screen Regardless of whether you are increasing or decreasing the interval time the countdown timer resets to the new value The next automatic reading will occur after the expiration of the new interval Example 1 The interval time is set at 10 minutes a
181. power connector plug the other end into a hospital grade grounded wall outlet of appropriate voltage If you are unsure about the voltage contact your hospital Biomedical Engineering Department or GE Service Representative Attaching the Power Cord 3 Turn the monitor s power on The green indicator light located near the upper left hand corner of the Light button illuminates and a series of tones are heard indicating that the monitor has been turned on Interruption of Power When the supply main to the monitor is interrupted for more than 30 seconds the following behaviors occur m Configuration Settings The configuration settings are restored to the current user selected default setting Factory or Hospital Patient Data The stored patient data including vital signs history are erased NIBP The NIBP parameter reverts to Manual Mode 4 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Setup Procedures Self Test Routine Self Test Routine The 250cx Series Monitor contains a self test routine which checks the calibration and internal circuitry of the monitor Initiate the self test routine at the beginning of each monitoring session to print the results on the patient s strip chart NOTE To stop a self test routine that 1 Ensure that strip chart is loaded is in progress press the Test button or open the recorder door 2 Press the Test button 3 Referto the table below and ensure
182. press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a value between 70 mmHg and 240 mmHg 9 3 kPa and 32 0 kPa 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Repeat 3 through 6 for the m Systolic Low select a value between 50 mmHg and 150 mmHg 6 7 kPa and 20 0 kPa mDiastolic High select a value between 70 mmHg and 130 mmHg 9 3 kPa and 32 0 kPa mDiastolic Low select a value between 30 mmHg and 120 mmHg 4 0 kPa and 16 0 kPa m MAP Mean Arterial Pressure High select a value between 70 mmHg and 150 mmHg 9 3 kPa and 20 0 kPa m MAP Low select a value between 30 mmHg and 120 mmHg 4 0 kPa and 16 0 kPa mYou may optionally change the MHR P Maternal Heart Rate Pulse High select a value between 100 bpm and 250 bpm Note The MHR P alarm settings are also available through the Pulse legend or the MSpO legend on the main monitoring screen mYou may optionally change the MHR P Low select a value between 35 bpm and 120 bpm Note The MHR P alarm settings are also available via the Pulse legend or the MSpO legend on the main monitoring screen 8 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 9 Press the Trim Knob again to return to the main monitoring display screen 1 Rotate the Trim Knob to highlight the legend fo
183. quency clinical rubbing motion with hand in supine position OxyTip sensors are validated during low perfusion conditions Low perfusion was achieved by having the room chilled to 60 68 F keeping the left side of the subject warm and the right side cooled to a perfusion index level lt 0 1 Saturation readings were compared against a reference system that was compared to arterial blood draws NOTE Because pulse oximeter equipment measurements are statistically distributed only about two thirds of pulse oximeter equipment measurements can be expected to fall within Ar of the value measured by a CO Oximeter NOTE Use of a functional SpO simulator to assess the accuracy of the Corometrics 250cx SpO parameter has not been demonstrated This device is covered under one or more of the following US Patents 5 503 148 5 766 127 5 934 277 6 381 479 6 385 471 6 397 092 6 408 198 6 415 166 6 434 408 6 505 060 6 505 133 6 510 329 6 650 918 6 707 257 6 714 803 Revision C 250cx Series Maternal Fetal Monitor 2036946 001 17 9 Technical Specifications Operating Modes Operating Mode Specifications Continued Maternal Pulse Oximetry Mode Nellcor Technique Sensor Type and Accuracy OxiMax Sensor Models MAX A DS 100A Saturation Range Pulse Rate Range Accuracy Saturation SpO Adults Low Perfusion Spectrophotometry and plethysmography SpO Range 70 100 2 digi
184. r MHR P This legend is located approximately in the center of the display and may indicate MECG Pulse or INOP depending on the settings that are currently enabled 2 Once the MHR P legend is highlighted press the Trim Knob The display changes to the MHR P Setup screen 3 Now rotate the Trim Knob to highlight the MHR High alarm limit setting 4 Once the MHR High alarm limit setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a value between 100 bpm and 250 bpm 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting tops blinking 7 Repeat 3 through 6 for the MHR Low alarm limit setting Select a value between 35 bpm and 120 bpm 8 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 9 Press the Trim Knob again to return to the main monitoring display screen D 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Frequently Asked Questions Question How do enable the MHR P Maternal Heart Rate Pulse trend recorder tracing How do change the source parameter for MHR P Maternal Heart Rate Pulse How do enable the MSpOs Maternal Blood Oxygen Saturation trend recorder tracing Answer 1 Rotate the Trim Knob to highlight the legend for MHR P This legend is located approximately in th
185. r ix 2036946 001 Using the Spectra Alert Option ooococcccococccnnnnn eee eee C 4 Enabling Disabling Spectra Alerts 0 cece cece eee eee C 4 Methodology me ccoitarddaisda is hanes vet eds da C4 Alert Indications sisse HHHnnn C 6 Active Alerts citer cose tp gt o ebbe peer e Slane ate a deh os pun C 6 Silencing Alerts miras breve ER t EP tl eee C 6 Resolved Alerts oos iio er ic Ee XI n e Ros E WEG ERE e LP T C 7 Alert Suspension Feature 2 2 0 cece cece ete e C 7 Enabling Disabling the Alert Suspension Feature C 7 Suspending Audio Alerts and the Nurse Call Interface C 7 Restoring Audio Alerts and the Nurse Call Interface C 7 Alert Parameters Summary 0 0c cece eee eee nnn C 9 Resetting Alerts coria ii bee mene C 12 False Pattern Recognition 0 ccc e cece ae C 12 Mode Switching oie A aaa ae C 12 Trend Screen ii A a eels C 13 Uterine Contraction Frequency 0 cceee eee eee Ke C 13 Enabling Disabling UC Frequency Display sss C 14 UC Frequency in UA Display Area 2 een I C 14 UC Frequency Histogram isssssssssssse m C 15 Enabling Disabling UC Chime sssssssseeee I C 15 Nurse Call Interface 0 0 0 ccc cece cece e eee eee eee eee A i C 16 Alert Parameters coo ct nne Itt n e a Reis dn C 17 Frequently Asked Questions D 1 FAQS c occu i rte AE CAE diae Pa A ED prance D 3 250cx Seri
186. r mode CAUTION Do not turn monitor off during printing or your data will be lost Revision C 250cx Series Maternal Fetal Monitor 12 5 2036946 001 Maternal Vital Signs History Using the Maternal Vital Signs History Screen VITAL SIGNS STORY DATE 24 MAR 24 MAR 24 MAR 24 MAR 24 MAR TIME 22 49 22 50 22 51 22 82 29 53 NBP SYS 129 PR MSpO2 O2 99 97 98 PR 75 70 71 MHR 65 69 72 70 71 Vital Signs History Print Example 12 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 13 Heartbeat Coincidence evision 250cx Series Maternal Fetal Monitor 2036946 001 Heartbeat Coincidence For your notes 13 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Heartbeat Coincidence Heartbeat Coincidence Theory Heartbeat Coincidence Theory The heartbeat coincidence feature alerts you when there is the possibility that you may be monitoring a duplicate signal Heartbeat coincidence is indicated when any two heartbeats have a consistent phase relationship for equal to or greater than 60 of the detected beats for about 60 seconds the cessation of coincidence is indicated when the phase relationship is inconsistent for greater than 40 of the detected beats for about 7 seconds Heartbeat coincidence detection is most useful when monitoring twins but can also detect when an elevated maternal heart rate is mistaken for a fetal heart rate NOTE The maternal he
187. race automatically reverts to normal after 10 minutes The trend returns to the unshifted position A left arrow lt and a vertical dashed line print to draw attention to the change Setting the FHR trend to the normal unshifted mode does not disable the HR Offset function it deactivates it To disable the mode refer to the 250cx Series Service Manual did o eo 7 58103 Sa 58104 a pem WV ees ys gt L c 4 f i i i 7 gt A ii N 1 A 1 V L gt Le e Fetal Heart Rate Offset Example 5 12 250cx Series Maternal Fetal Monitor Revision C 2036946 001 6 Uterine Activity Monitoring evision 250cx Series Maternal Fetal Monitor 2036946 001 Uterine Activity Monitoring For your notes 6 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Uterine Activity Monitoring Tocotransducer External Method Tocotransducer External Method NOTE Refer to the Maternal Fetal Monitoring Clinical Applications Manual for patient application information Methodology A tocotransducer applied to the maternal abdomen records relative changes in abdominal tension caused by uterine contractions The mode TOCO and value are shown in the UA area of the display During normal operation the UA value displays from 0 100in mmHg mode and 0 0 13 3 in kPa mode Uterine activity is continuously plotted on the bottom or righ
188. ractions detected for 10 minutes Continuous Monitoring No contractions detected for 30 minutes RECORDING UA appears in Uterine Activity Display Duration of Last UC seconds Tetanic UA Tetanic UA Alert has not been silenced One uterine contraction with amplitude 50 mmHg above baseline for 60 seconds Alert silenced The alert is deleted after one normal uterine contraction 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Spectra Alerts Alert Parameters Summary of Alert Parameters ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria Good Alert pending Moderate Alert has not been silenced Signal Quality Poor Unknown appears when UC is the only active parameter Poor Poor SIGNAL QUALITY Three minutes of unsatisfactory data FECG Five minutes of unsatisfactory data ultrasound SIGNAL QUALITY Alert silenced The alert is deleted after 3 minutes of satisfactory data Poor Poor Poor With UC Data unsatisfactory with uterine contractions present With UC SIGNAL QUALITY Alert has not been silenced Data between uterine contractions is acceptable data during contractions is either poor quality or absent Alert occurs after 1 2 or 3 uterine contractions depending on what events preceded it With UC SIGNAL QUALITY Alert silenced The ale
189. range of 1 to 9 8 Once the Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video and an audio tone indicative of the alarm volume will be emitted from the speaker 9 Now rotate the Trim Knob to change the current setting as desired With each setting change an audio tone indicative of the alarm volume will be emitted from the speaker 10 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking A final audio tone indicative of the alarm volume is emitted from the speaker 11 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 12 Press the Trim Knob again to return to the main monitoring display screen 1 Rotate the Trim Knob to highlight the legend for NIBP This legend is slightly above center on the left side of the display 2 Once the NIBP legend is highlighted press the Trim Knob The display changes to show the NIBP Setup screen 3 Now rotate the Trim Knob to select highlight the Volume setting which is located immediately to the right The setting is in the range of 1 to 9 4 Once the Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video and an audio tone indicative of the alarm volume is emitted from the speaker 5 Now rotate the Trim Knob to change the current setting as desired Each time you
190. ration CAUTION In the United States of America Federal Law restricts this device to sale AN by or on the order of a physician Corometrics and Marquette are registered trademarks of GE Medical Systems Information Technologies GE is a registered trademark of General Electric Company All other product and brand names are trademarks or registered trademarks of their respective companies 2005 2006 2007 GE Medical Systems Information Technologies All rights reserved No part of this manual may be reproduced without the permission of GE Medical Systems Information Technologies T 2 Corometrics 250cx Series Monitor Revision C 2036946 001 16 Sept 2007 CE Marking Information CE Marking Information 0086 Compliance A GE brand Corometrics 250cx Series Monitor bears CE mark CE 0086 indicating its conformity with the provisions of the Council Directive 93 42 EEC concerning medical devices and fulfills the essential requirements of Annex of this directive The device is manufactured in India the CE mark is applied under the authority of Notified Body BSI 0086 The country of manufacture and appropriate Notified Body can be found on the equipment labeling The product complies with the requirements of standard EN 60601 1 2 Electromagnetic Compatibility Medical Electrical Equipment and standard EN 60601 1 General Requirements for Safety Components of the Certified Systems The IEC electromagne
191. recorder on the front panel of the 250cx Series Monitor for 2 seconds You will hear a short two tone audio beep from the monitor when offset is activated 2 To end the HR offset period press and hold the Mark Offset button over the recorder again for 2 seconds You will hear a short two tone audio beep from the monitor when HR offset is Off Heart Beat Coincidence HBC indicates that two HR channels may be monitoring the same signal by placing both heart rates in inverse video on the front panel display AND by placing a symbol of two overlapping hearts on the trend recorder 1 Rotate the Trim Knob to highlight the Setup legend at the bottom of the display below the menu bar 2 Once the Setup legend is highlighted press the Trim Knob 3 The display will change to the General Setup screen 4 In the General Setup screen rotate the Trim Knob to highlight one of the Date setting fields on the top right corner of the display These fields are for day DD month MMM and year YYYY 5 After the desired field is highlighted selected press the Trim Knob The current setting displays in blinking inverse video 6 Now rotate the Trim Knob to change the current date parameter setting 7 Once you set the desired value press the Trim Knob again to save the value The current value setting stops blinking 8 Repeat Step 4 through Step 7 for any other date parameters that need to be set 9 Now rotate the Trim Knob to select h
192. reference Master Alarm Limits mmHg High Low High Low Alarm Systolic 160 90mmHg 70 240 50 150 Setup Diastolic 90 50 mmHg 70 130 30 120 MAP 140 50 mmHg 70 150 30 120 MHR P 120 50 bpm 100 25 35 120 MSpO 100 95 85 100 80 99 Alarm kPa mode High Low High Low Systolic 21 3 12 0 kPa 9 3 32 0 6 7 20 0 Diastolic 12 0 6 7 kPa 9 3 17 3 4 0 16 0 MAP 18 7 6 7 kPa 9 3 20 0 4 0 16 MHR P 120 50 bpm 100 250 35 120 Volume 5 1 9 General Play Song Off Off Happy Birthday Setup Brahms Lullaby Rock a Bye Baby All Song Volume 5 0 9 Temp Done Volume 5 0 9 Brightness 9 0 9 nine brightest Paper Speed United States 3 cm min 1 3 cm min International 1 cm min Date Set to current local date Set to current local date Time Set to current local time Set to current local time Must manually change to EST EDT MSpO Print Interval 5 min Off 2 5 10 15 30 60 min External Monitor FSpO Print Interval 5 min Off 2 5 10 15 30 60 min External Monitor FSpO Trace Off Off On Vital Signs HX Interval Event 1 5 10 15 30 60 Event History Revision C 250cx Series Maternal Fetal Monitor A 5 2036946 001 Summary of Factory Defaults asd Field Description Factory Default Default Options Hospital Preference Install Language Set according to shipping Set according to shipping Options destination destination Screen 1 Service Line Frequency United States 60 Hz 50 Hz 60 Hz International 50 Hz Scaling United Stat
193. rence button between contractions CHECK TOCO message is shown in UA area of the display area when the UA Reference button is pressed m UA Reference button pressed before UA circuits stabilized m UA Reference range exceeded due to over tightening belt m Transducer defective m Service required m You must wait 10 seconds following powering on the monitor and or connecting to the UA connector m Loosen belts or remove transducer from patient Press UA Reference button while no pressure is applied to transducer button Re apply transducer Do not overtighten belt Press UA Reference button again between contractions See Out of Range Condition on page 6 4 for further information m Replace transducer m Call Biomedical Engineering Department Internal UA Troubleshooting Internal UA Troubleshooting Problem Probable Cause Possible Solution Internal pressure not measuring correctly m Cable not properly connected to monitor m Catheter has fallen out of place m Catheter zeroed m Service required m Ensure cable is securely attached to monitor m Replace catheter m Calibrate catheter m Call Biomedical Engineering Department CHECK IUP message displayed in UA area of the display m Blockage or kinked catheter m Fetus pressing directly on catheter m Defective catheter m Service required m Flush catheter Re zero Replace catheter if necessary
194. ressure IUP Internal Method Intrauterine Pressure UP Methodology NOTE To secure a strain gauge post for IUP monitoring refer to the strain gauge manufacturer s instructions An intrauterine pressure catheter IUPC inserted transcervically into the uterine cavity measures intrauterine pressure You can monitor using either a fluid filled catheter or a transducer tipped catheter The mode IUP and value are shown in the UA area of the display The UA value displays from 0 100in mmHg mode and 0 0 13 3 in kPa mode during normal operation Uterine activity is continuously plotted on the bottom or right grid of the strip chart paper as a plain black line Pressure exceeding 100 mmHg 13 3 kPa is printed as a straight line at 100 mmHg 13 3 kPa Why You Must Zero the System When you zero the system you are referencing the pressure to 0 mmHg 0 kPa while the system is open to air to ensure an absolute pressure measurement Refer to the Maternal Fetal Monitoring Clinical Applications Manual for more information m f you disconnect the patient from the monitor all zeroing information is lost If you re connect the patient to the monitor you must re zero regardless of whether you connect to the same monitor or a different monitor m If the mother s position has changed the baseline may have been altered If this 1s the case re zero m Ifthe message CHECK IUP flashes in the UA display area there is insufficient
195. ressures How do activate and terminate Heart Rate Offset How do know when the monitor detects Heart Beat Coincidence How do change the date Answer 1 Rotate the Trim Knob to highlight the legend for NIBP This legend is slightly above center on the left side of the display 2 Once the NIBP legend is highlighted press the Trim Knob The display changes to show the NIBP Setup screen 3 Now rotate the Trim Knob to highlight the Mode setting which is below the NIBP Setup title The current setting is one of the following Manual Auto 1 min Auto 2 min Auto 3 min Auto 4 min Auto 5 min Auto 10 min Auto 20 min Auto 30 min Auto 40 min Auto 45 min Auto 60 min Auto 90 min or Auto 120 min 4 Once the MODE setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting Select a value from one of the following Manual Auto 1 min Auto 2 min Auto 3 min Auto 4 min Auto 5 min Auto 10 min Auto 20 min Auto 30 min Auto 40 min Auto 45 min Auto 60 min Auto 90 min or Auto 120 min 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring screen 1 Press and hold the Mark Offset button over the
196. rm Volume 5 Nellcor MSpO Setup Screen NOTES A Masimo MSpO Setup Screen differs slightly from the Nellcor Setup Screen The Response Time field is absent and it is replaced by a Sensitivity field followed by an Averaging Time field AnOhmeda MSpO Setup Screen also differs from the above example as the Response Time field is absent Response Time Nellcor 506 Technology Only Before you begin confirm which Nellcor Technology your monitor contains Refer to Nellcor OxiMax on page 9 5 for instructions Choose a response time mode in order to compensate for different levels of patient activity m Normal Useful when patient is unavoidably active least affected by patient motion m Fast Factory default setting Useful in most clinical situations for relatively inactive patients Response Time Nellcor NELL 3 Technology Only Before you begin confirm which Nellcor Technology your monitor contains Refer to Nellcor OxiMax on page 9 5 for instructions If your monitor contains NELL 3 Fastis the only available setting Sensitivity Masimo Technology Only This menu option appears only when using Masimo Technology and sensor m Normal Use the Normal Sensitivity setting for normal patient monitoring purposes m Maximum Use the Maximum Sensitivity setting for improved low perfusion performance and for faster tracking of rapid MSpO saturation changes Revision C 250cx Series Maternal Fetal Mon
197. rn Recognition Mode Switching The system may recognize accelerations as baseline During dual FHR monitoring the system may confuse the FHRs following mode switches after delivery of the presenting twin To guard against mode changes prior to delivery of the presenting twin Use US for the presenting twin and US2 for the second twin When switching to FECG for the presenting twin disconnect the US connector which is no longer in use If an alert is generated following delivery of the presenting twin evaluate the tracing to determine if there are any clinical factors contributing to the alert If you feel the alert was generated in error change the Alert field on the associated setup screen to Reset Consider the following m Ifyou continue monitoring the second twin with US2 and you disconnect the FECG transducer which is no longer in use the US2 fetal heart rate now moves to the primary display and the FHR trend which was bold now prints using a normal print density m f you later switch to internal monitoring for the second twin and you disconnect the US2 transducer which is no longer in use the fetal heart rate for the second twin displays as FECG in the primary heart rate area and the FHR trend continues to print using a normal print density 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Trend Screen Trend Screen Select the Trend softkey from the FHR Setup screen to display
198. rt is deleted following two uterine contractions with satisfactory data or 10 minutes of good data no data Message appears if there is a problem with REPAIR the monitor or the Spectra Alerts option Contact Biomedical Department or Service Representative Revision C 250cx Series Maternal Fetal Monitor C 21 2036946 001 Spectra Alerts Alert Parameters 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Frequently Asked Questions Frequently Asked Questions Revision C 250cx Series Maternal Fetal Monitor 2036946 001 D 1 Frequently Asked Questions D 2 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Frequently Asked Questions FAQs Question Answer NOTE When the monitor is powered off then on again the settings revert back to the factory default settings or can be saved if you choose Store Current to Hospital in the password protected Install Options screen How do change the alarm limits for Fetal 1 Rotate the Trim Knob to highlight the legend for FHR1 This legend is at the top left Heart Rate 1 on the display and it may read INOP FECG US or US2 2 Once you highlight the FHR1 legend press the Trim Knob The display changes to show the MODE Setup screen where mode is the current legend 3 Now rotate the Trim Knob to highlight the FHR1 High heart rate alarm limit setting 4 Once the High heart rate alarms limit is highlig
199. s Indicators and Connectors Additional Parameters Additional Parameters The additional parameters area displays NIBP MHR P and MSpO data Maternal NIBP The maternal NIBP section is summarized in the following figure and table e A NIBP 11 41 lt 130 85 MAP 107 03 15 NIBP Display NIBP Display Name Description NIBP Time Stamp The time in 24 hour format of the last blood pressure measurement NIBP Values The systolic diastolic and mean arterial pressures MAP are each indicated by up to three digits displayed as XXX mmHg or XX X kPa All kPa readings are displayed to 1 10 kPa During a determination the instantaneous cuff pressure displays in place of the mean arterial pressure and is denoted by the title Cuff NIBP Alarm Setting Indicator This symbol provides information about the NIBP audio alarm and the NIBP high low alarm limit settings See Chapter 10 Alarms for more information Maternal alarms cannot be disabled NIBP Mode Title Select the mode title to access the NIBP Setup screen NIBP Countdown Timer The clock symbol represents activation of the auto mode The countdown timer indicates the minutes and seconds until the next automatic reading 3 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors MHR P Area MHR P Area The MHR P area is summarized by t
200. s have been exceeded When abnormal features are recognized by the system these features are displayed on an Alert Parameters area on the FECG US or US2 Setup screen whichever is affected When the abnormal feature s meet the preset criteria for an alert the monitor provides an audible and visual indication of that alert When an alert condition is detected the system categorizes the alert into one of three levels with level three being the most severe Refer to the Possible Alert Conditions Table limits are not user selectable C 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Using the Spectra Alert Option 9 00 US 4 TOCO 3 CM MIN Spectra Alert Enabled Annotation Possible Alert Conditions Level One Alert Level Two Alert kk Level Three Alert kkk m decreased variability m flat variability m bradycardia 100 119 bpm m tachycardia 161 180 bpm m mild moderate variable decelerations m mild moderate sporadic decelerations m mild variable decelerations with decreased variability or mild tachycardia or mild bradycardia m tachycardia 161 180 bpm with decreased variability m undefined decelerations m mild bradycardia and decreased variability m prolonged deceleration 2120 bpm m increased variability m uterine hypertonus m tetanic uterine contraction gt 60 sec m signal quality m tachycardia 2180 bpm m bradycardia 90
201. s History Screen Displaying the Screen 1 Select the VSHX softkey to display the Vital Signs History screen 2 Select the VIEW softkey to scroll through the data Scroll right roll towards the oldest data scroll left towards the most recent data 3 Press the Trim Knob control to de activate the VIEW gt softkey 4 Select the Exit softkey to return to the main screen Selecting the HX Interval The maternal Vital Signs History screen can be configured to display different columns of data by adjusting the HX Interval field The interval choices are Event to display all events and 1 5 10 15 30 and 60 minutes The factory default setting is Event The history interval has no effect on the data being stored You can change the interval setting at any time and all data for the most recent 8 hours is available for display 12 4 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Vital Signs History Using the Maternal Vital Signs History Screen When the screen is called up for display the previous minute in time is listed at the far right of the screen the preceding values to be displayed are counted backwards from the previous minute in time based on the intervals you have selected m Example The HX Intervalis set at 5 minutes and the maternal Vital Signs History screen is displayed when the current time is 13 57 When the screen is displayed there will be five columns of data for the followin
202. s Maternal Fetal Monitor D 5 2036946 001 Frequently Asked Questions Question Answer How do I change the alarm limits for Rotate the Trim Knob to highlight the legend for MSpO This legend is slightly MSpO Maternal Blood Oxygen above center on the right side of the display Saturation Once the MSpO legend is highlighted press the Trim Knob The display changes to show the MSpO Setup screen Now rotate the Trim Knob to highlight the current High saturation percentage 9 alarm limit setting Once the High saturation percentage 96 alarm limit setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video Now rotate the Trim Knob to change the current setting Select from 100 to 85 Repeat 3 through 6 for the High saturation percentage 9 alarm limit setting Select a value between 99 and 80 mYou may optionally change the MHR P Maternal Heart Rate Pulse High select a value between 100 bpm and 250 bpm The MHR P alarm settings are also available through the Pulse legend or the NIBP legend on the main monitoring screen mYou may optionally change the MHR P Low select a value between 35 bpm and 120 bpm The MHR P alarm settings are also available via the Pulse legend or the NIBP legend on the main monitoring screen Once the desired source parameter is set press the Trim Knob to confirm your selection The current value setting stops blinking 8 Now rotate
203. s indicated by a numeric value displayed beside the title Cuff This information is displayed in place of the mean arterial pressure When a determination is successful the monitor emits two short tones high low and displays the three pressure readings and the maternal pulse if NIBP is enabled as the MHR P source Refer to Chapter 7 Maternal Heart Pulse Rate Monitoring for information Regardless of the mode auto or manual the values remain displayed according to the time period specified in the display timer field Revision C 250cx Series Maternal Fetal Monitor 8 9 2036946 001 Maternal Non Invasive Blood Pressure Monitoring NIBP Monitoring Hydrostatic Effect Manual Mode Automatic Mode The systolic and diastolic pressures are each indicated with two or three digits and separated by a slash The mean arterial pressure is indicated with two or three digits and enclosed in parentheses All pressure values are displayed in mmHg or kPa Systolic diastolic MAP and pulse rate values are printed on the strip chart paper annotated by an outlined diamond 0 which marks the time of the reading If patient is standing sitting or inclined ensure that cuffed limb is supported to maintain cuff at level of patient s heart If cuff is not at heart level the difference in systolic and diastolic values due to hydrostatic effect must be considered Add 1 80 mmHg 0 24 kPa to values for every inch 2 54 cm above heart
204. s set to 30 minutes and the sensor is connected at 9 24 a m Whereas the first real time printing would occur at 9 54 the first chart style printing is done at 9 30 Subsequent values are printed at 10 00 10 30 11 00 11 30 etc m MSpO2 Example 2 The MSpO print interval time is set to 60 minutes and the sensor is connected at 9 42 a m Whereas the first real time printing would occur at 10 42 the first chart style printing is done at 10 00 Subsequent values are printed at 11 00 12 00 1 00 2 00 etc Real Time Printing Example When chart style printing is disabled standard real time printing occurs m NIBP Example The automatic blood pressure mode is activated at 9 03 with the interval time set to 15 minutes The first reading occurs at 9 18 Subsequent readings are taken at 9 33 9 48 10 03 etc m MSpO Example The print interval is set to 15 minutes and the first acceptable pulse signal is detected at 9 05 a m The first printing occurs at 9 05 Subsequent MSpO values are printed at 9 20 9 35 9 50 10 05 etc Chart Style 7 Minute Exception for NIBP If you take a manual blood pressure reading within 7 minutes of a chart style interval 15 30 or 60 minutes and then activate automatic blood pressure readings using a chart style interval the first automatic reading will be skipped This rule only applies to the first reading when chart style vital signs printing is enabled on the password protected Install Options
205. service screen m Example You take a manual blood pressure reading at 7 10 At 7 13 you then activate automatic blood pressure readings using a 15 minute time interval The 7 15 chart style reading is skipped since a manual reading occurred 5 minutes earlier The first automatic reading is taken at 7 30 Since the rule applies only to the first reading if you take another manual reading at 7 40 the 7 45 automatic reading occurs as scheduled Revision C 250cx Series Maternal Fetal Monitor 11 15 2036946 001 Recorder Modes Strip Chart Paper Strip Chart Paper Instructions for loading the strip chart paper are provided in Chapter 4 Setup Procedures Two kinds of strip chart paper are available from GE m Z Fold Chart Paper with Pre Printed 30 240 bpm Heart Rate Scale Refer to Figure on Page 11 17 m Z Fold Chart Paper with Pre Printed 50 210 bpm Heart Rate Scale Refer to Figure on Page 11 18 In the United States of America the most common grid is the 30 240 bpm scale with the recorder speed set at 3 cm min As shown in Figure on Page 11 17 a dark line is printed every 3 cm which represents 1 minute in time at a speed of 3 cm min In other countries the most common grid may be the 50 210 bpm scale with the recorder speed set at 1 cm min As shown in Figure on Page 11 18 every other vertical line measures 1 cm or 1 minute in time at a speed of 1 cm min Regardless of the heart rate scale the uterine activ
206. sion 0 100 30 250 bpm Accuracy Arms root mean square of paired values previously represented by 1 standard deviation 70 100 2 digits without motion 70 100 3 digits during clinical motion 70 100 2 digits during clinical low perfusion Below 70 unspecified 650 670 nm 930 950 nm 10 5 mW Alternating 1 5 second chimes Flashing SpO numeric or message User selectable high and low SpO and high and low pulse rate Sensor errors connection errors insufficient signal excessive motion communication problem internal calibration error or self test failure 1 Applicability OxyTip Adult Pediatric Accuracy of Oxy F sensors has not been validated under clinical motion conditions Ohmeda sensor accuracy tests were done with 13 healthy adult subjects The volunteer population was composed of 3 females and 10 males The ages ranged from 19 to 35 years old The weights ranged from 120 to 185 Ib with a mean weight of 158 Ib The skin tones were as follows 2 African American and Jamaican subjects with dark pigmentation 1 Asian subject with light yellow pigmentation 1 Hispanic subject and 1 Mexican subject with medium pigmentation and 8 Caucasian subjects with light to medium pigmentation OxyTip OXY AP sensor has been validated under motion condition Three types of motion artifacts were evaluated mechanically induced tapping at 3 Hz random frequency clinical rubbing motion with hand in prone position and random fre
207. storing or shipping the monitor and accessories This recommendation includes corrugated shippers and inserts Whenever possible recycle the packaging of accessories and patient applied parts Monitor At the end of its service life the product described in this manual as well as its accessories must be disposed of in compliance with the guidelines regulating the disposal of such products If you have questions concerning disposal of the product please contact GE Medical Systems Information Technologies or its representatives Revision C 250cx Series Maternal Fetal Monitor 15 7 2036946 001 Maintenance Disposal of Product Waste 15 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 16 Troubleshooting This section of the manual provides a troubleshooting guide for the most basic 250cx Series Monitor operational problems If the response to a specific question is not found contact Technical Support Inside the United States 1 800 558 7044 Outside the United States Contact your local representative Revision C 250cx Series Maternal Fetal Monitor 16 1 2036946 001 Troubleshooting For your notes 16 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Troubleshooting General Troubleshooting General Troubleshooting General Troubleshooting Problem Probable Cause Possible Solution No monitoring functions and green Power indicator does not illuminate when P
208. t grid of the strip chart paper as a plain black line IMPORTANT FOR TRIMLINE TOCOTRANSDUCERS ONLY You must wait at least 10 seconds from the time you power the monitor on or connect a tocotransducer before pressing the UA Reference button Establishing a Baseline Monitoring uterine activity using a tocotransducer provides relative pressure measurements compared to a baseline or UA reference The quality of measurements depends on the following m position of the tocotransducer m belt tension W size of the patient and established baseline All 250cx Series Monitors provide a UA Reference button that sets the baseline When a baseline is established all pressure measurements are relative to that baseline The baseline can be set manually by two different methods or automatically when necessary Whenever the baseline is set the bottom line of the bottom strip chart grid is annotated with UA REF Initial Referencing The initial reference occurs automatically After you plug in a transducer verify that the display reads less than 30 mmHg 4 kPa Make a note of the reading The purpose of establishing a baseline at this point is necessary for consistency when applying and tightening the belt You will have to set the baseline again after tightening the belt Revision C 250cx Series Maternal Fetal Monitor 6 3 2036946 001 Uterine Activity Monitoring Tocotransducer External Method Accounting
209. t Coincidence oooooomcoommmoo 13 1 Heartbeat Coincidence Theory 0 sceceee scene eee eee n 13 3 Using the Heartbeat Coincidence Feature ccceeeeeeee eee eeeees 13 3 Enabling Disabling Heartbeat Coincidence Detection 13 3 Display Indicators Aa 13 3 Strip Chart Annotation bensa 344 ron dada es 4 13 5 1 4 Waveforms c verses ye x sea ERE Rede tees 14 1 Waveform Area cece e cece cece mnn 14 3 Selecting the Waveform 2 0 cece cece teen tenet e tees 14 3 Waveform Speed civic ai c tt c pr re Pe e GU dr ee ies 14 8 ECG SZG ie A ERES RUE REMIS 14 3 MECG Lead Select cer dra e ertet bx ehe dp eee e 14 3 MECG Pacer Label 0 0 cece cece ene e 14 3 Movitig Cit a pr Der teen Baan hee gaged ed 14 4 Freezing Waveforms 0 6 cece eee eene 14 4 Revision C 250cx Series Maternal Fetal Monitor vii 2036946 001 Printing a Waveform Snapshot sssssseeeeennmI 14 5 Recorder Of Lic ssec E REP CE keds hie EE edad 14 5 Recorder in Maternal Only Mode ssssssssssseeeen n eee 14 6 Recorder Off id vedi eec RP REY EE T e LE NE EE Tama es 14 6 Stopping a Print Command 0 cece eee eens 14 6 1 5 Maintenance viii ta amp 15 1 Cleaning A Beet ahaa a eir 15 3 Monitor EXteHIOE cei reto cr e oc e c EE E 15 3 Bar Em 15 4 Tocotransducer and Ultrasound Transducer esses 15 4 Leg Plates and MECG Cables 0 cece cece eee eee
210. t panel Mark Offset button Refer to the service manual for information on enabling disabling fetal HR offset Activating the Fetal Heart Rate Offset Feature To shift the secondary FHR trend 20BPM 1 2 Ensure the recorder is on and two HR channels are activated Press and hold the Mark Offset button for 3 seconds Or use the US US2 Setup screen When you use dual ultrasound or US2 and FECG the US2 trace is shifted 20 bpm and the US2 20 4 5 cm When you use US and FECG the US trace is shifted 20 bpm and the symbol prints on the upper portion of the top grid every US 20 symbol prints on the upper portion of the top grid every 4 5 cm Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Fetal Heart Rate Monitoring Dual Fetal Heart Rate Monitoring m A right arrow gt and a vertical dashed line print to draw attention to the start of the shifted trend Refer to Fetal Heart Rate Offset Example on page 5 12 for an example of a shifted trend De Activating the Fetal Heart Rate Offset Feature After the FHR patterns have been assessed set the secondary FHR trend back to the normal unshifted position 1 Ensure the recorder is on NOTE If the auto revert 10 min 2 Press and hold the Mark Offset button for 3 seconds Or use the US US2 Setup setting is selected on the password screen protected Install Options screen the shifted heart rate t
211. t results if operated outside the minimum specified parameter FECG Mode Technique Heart Rate Counting Range Heart Rate Resolution Artifact Elimination Countable Input Signal Range Offset Voltage Tolerance Differential Maximum Common Mode Voltage Preamplifier Bandwidth Common Mode Rejection Balanced Unbalanced 5kQ RA or LA Input Equivalent Noise Input Impedance Differential Common Mode Mains Frequency Rejection Leakage Current Isolation Mains to Patient Peak detecting beat to beat cardiotachometer 30 240 bpm 1 bpm Selectable 25 bpm artifact rejection 15 uV to 2 mV peak to peak 300 mVdc maximum 20 V peak to peak 1 90 Hz 120 dB at mains frequency with patient cable 110 dB at mains frequency lt 10 uV peak to peak 10MO 20MO 40 dB lt 60 pA at 254 VAC electrically isolated 4 kVAC Ultrasound Mode Technique Transducer Type Pulse Repetition Frequency Single Ultrasound Mode Dual Ultrasound Mode Pulse Duration Transmitter Frequency Spatial Peak Temporal Average Intensity Focal 20 dB Beam Area Peak Instantaneous Intensity Peak Negative Acoustic Pressure Heart Rate Counting Range Leakage Current Spatial Average Temporal Average Intensity Pulsed Doppler with autocorrelation processing 9 crystal 4 kHz 2 kHz 92 us 1 151 MHz Ispta 10 mW cm Isata lt 5 mW cm 16 6 cm ata range 7 cm 1 8 mW cm p lt 10 0 kPa 50
212. t the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking T Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen Revision C 250cx Series Maternal Fetal Monitor D 11 2036946 001 Frequently Asked Questions Question How do change the volume for MHR Pulse tones How do change the volume for NIBP completion indication Answer 1 Rotate the Trim Knob to highlight the legend for MHR P This legend is located near the center of the display and may indicate MECG Pulse or INOP depending on the settings that are currently enabled 2 Once the MHR P legend is highlighted press the Trim Knob The display changes to show the MHR P Setup screen 3 In the MHR P Setup screen rotate the Trim Knob to highlight Volume setting This setting is at the vertical center in the left half of the display next to the Volume bar graph 4 Once the Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current volume setting Select a value between 0 and 9 As the setting changes the bar graph changes to reflect the current setting 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Now rota
213. ta prints in one of the top three lines of the annotation area as soon as a printing line is available The printed pulse rate value is derived from the blood pressure parameter and is independent of the MHR P source selected on the MHR P Setup screen NIBP D Indicates an NIBP determination was cancelled or delayed due to the occurrence of a uterine contraction MSpO vital signs data For example y MSpO 97 P 66 or 4 MSpO 98 P 70 MSpO vital signs data is printed at selected intervals according to the MSpO Setup screen built in parameter or the General Setup screen external device In addition for the built in parameter only vital signs data is printed when a MSpO2 alarm occurs however only one alarm related print occurs within a 5 minute period m identifies the 250cx Series as the source m 4 identifies an external device as the source The diamond prints on the bottom two lines of the bottom grid of the strip chart paper and marks the time of the reading The vital signs data prints in one of the top three lines of the annotation area as soon as a printing line is available The printed pulse rate value is derived from the pulse oximetry parameter monitor and is independent of the MHR P source selected on the maternal MHR P Setup screen Revision C 250cx Series Maternal Fetal Monitor 11 11 2036946 001 Recorder Modes Summary of Annotations Summary of Annotations Cont
214. te i e MEL ede a 7 3 MHR P Setup Screen ooococcccccococccncr In 7 4 nd cl EE 7 4 HR PH Taca 2 52 ate ir ee A vod ur vant dont extet 7 5 Vol me otra AE 7 5 A A 7 5 Alarm Volume secre vetu ERE EAS etbeithtenkbetisetibestia 7 5 MECO dias ea in 7 5 MECG PACET aret eine dente sb eran raul ies qu RITU 7 6 Maternal ECG Monitoring sess Kee 7 7 Theory and Methodology 0 cece vnnt U varine nee nee eee 7 7 Pacemaker Safety Information 0 0 e cect essen 7 7 MECG WavelOlm ieus dot rettet P rb ver ore Pelee d 7 8 Maternal Non Invasive Blood Pressure Monitoring 8 1 Blood Pressure Safety Precautions 00cceeee eee e eee eee eee eeas 8 3 Warnings 4 certes Me pe LE eL a nga ot 84 NIBP Determination 0 cece cece reece eee eee eee eee eee eeeeeaes 8 5 SuperSTAT NIBP Determination 0ceee cece eee eee n 8 5 Accelerated Determination 000 c cece eee eens 8 6 Systolic Search i nior pr avre os ee meer rex spe eee teh EU ces 8 6 NIBP Setup Screen ccc eee eee e eee eee Inn 8 7 Mod isis ect ee es dale Ta oed e e o rg oY 8 7 Iri DEM 8 7 NIBP Done Volume sssssessssseeen IH 8 8 AMS ends era PC Ree esr e pd eso ee RO pu 8 8 Alarm Volume i eee ia eae eng a Beth eds da 8 8 NIBP Monitoring sls 8 8 Checklist usn nur esu ae ad pate VEU dd ln 8 8 Patient Preparation 0 ccc cece eee eee rr 8 8 Blood Pressure Methodology 00 e cece ee
215. te the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen 1 Rotate the Trim Knob to highlight the legend for NIBP This legend is slightly above center on the left side of the display 2 Once the NIBP legend is highlighted press the Trim Knob The display changes to show the NIBP Setup screen 3 In the NIBP Setup screen rotate the Trim Knob to highlight the NIBP Done Vol setting This setting is slightly above vertical center in the right half of the display next to the NIBP Done Vol bar graph 4 Once the NIBP Done Vol setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current volume setting Select a value between 0 and 9 As the setting changes the bar graph changes to reflect the current setting With each change an audio tone that reflects the selected audio level is heard 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Frequently Asked Questions Question How do change the interval time for taking Non Invasive Blood P
216. the 250cx Series Service Manual for more information NOTETf the Spectra Alerts are suspended see Alert Suspension Feature on page C 7 the Nurse Call output is inhibited during the suspension time Nurse Call Interface 250cx Series Rear Panel Communications Connectors 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Alert Parameters Alert Parameters Summary of Alert Parameters ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria A message Alert has not been silenced Alert Level e message Alert has been silenced High Alert pending FHR 160 bpm for 5 minutes Tachy BASELINE Alert has not been silenced Reflects the detection of baseline FHR 160 bpm for 10 minutes Tachy BASELINE Alert silenced Low Alert pending FHR 120 bpm for 5 Baseline HR Average rate over minutes bpm past 10 minutes Brady BASELINE Alert has not been silenced Reflects the detection of baseline FHR 120 bpm for a pre determined period of time The alert occurs in 2 10 minutes depending on how low the rate goes Brady BASELINE Alert silenced Alert is deleted when baseline FHR is within the normal range for 10 minutes Revision C 250cx Series Maternal Fetal Monitor C 17 2036946 001 Spectra Alerts Alert Parameters Summary of Alert Parameters ALERT PARAMETERS SUMMARY ON FHR
217. the FHR UA trend screen For dual fetal heart rate monitoring you can access it from either mode s setup screen The Trend screen displays m the alert level and message if present m the most recent 10 minutes of FHR and UA trend data reflecting the paper scale and chart speed settings and m the current time The following Figure shows a sample Trend screen with dual FHR monitoring in progress and a level one decelerations alert FECG 30 Alert level and message X Decelerations 210 The Trend screen displays the most recent 10 minutes of FHR and uterine activity data For dual heart rate monitoring the same trend screen displays regardless of which FHR setup screen FECG or US US2 you use to access the Trend screen The current time Trend Screen Example Uterine Contraction Frequency The Spectra Alerts option includes a uterine contraction UC frequency display When enabled the UA screen m provides the setup field for the UA display W provides a uterine contraction audio indicator and m provides a UC frequency histogram which graphs the contractions per 10 minutes over the most recent 100 minutes Revision C 250cx Series Maternal Fetal Monitor C 13 2036946 001 Spectra Alerts Uterine Contraction Frequency Enabling Disabling UC Frequency Display A UA Setup screen is automatically activated when the Spectra Alerts option is installed and enabled To enable disable the UC D
218. the MSpOz high low limits is set to a value Maternal Alarm Occurring During Setup Alarm Behavior If the visual indication of a maternal alarm is inhibited by a setup screen only an audio alarm if enabled is issued As soon as you exit the setup screen the visual alarm indication displays m Example If the NIBP Setup screen is displayed the primary labor parameters continue to be displayed as well as the maternal NIBP area of the screen Under an alarm condition that affects NIBP both a visual and audible alarm is issued Under an alarm condition that affects MSpO or MECG only an audio alarm if enabled is issued while the NIBP Setup screen remains displayed Once the setup screen is exited the visual alarm indication for MSpO or MECG displays Revision C 250cx Series Maternal Fetal Monitor 10 5 2036946 001 Alarms Fetal Heart Rate Alarms Fetal Heart Rate Alarms FHR Patient Alarms Active Patient Alarm Resolved Patient Alarm A fetal heart rate patient alarm occurs when any fetal heart rate falls outside of the pre defined alarm limits greater than the high limit setting or less than the low limit setting The FHR alarm function can be completely disabled from the password protected Install Options service screen For this change to take effect you must cycle power Refer to the 250 250cx Series Monitor Service Manual for more information NOTE The re alarm time does not apply to FHR alar
219. the Trim Knob to select highlight the Exit item on the bottom menu 9 Press the Trim Knob again to return to the main monitoring display screen Po 99 A oun N How do I change the waveform parameter 1 Rotate the Trim Knob to highlight the waveform selection item This legend is being displayed slightly above the bottom menu bar to the far left of the display and should indicate one of the following Off MECG MSpOz or FECG 2 Once the waveform selection item is highlighted press the Trim Knob again The current setting displays in blinking inverse video 3 Now rotate the Trim Knob to change the setting to Off MECG MSpO or FECG 4 Once you set the desired source parameter press the Trim Knob to confirm your selection The current value setting stops blinking 5 The selected waveform parameter displays on the main monitoring screen D 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Frequently Asked Questions Question How do change the Maternal ECG lead waveform being displayed How do change the waveform vertical Answer Option 1 1 Rotate the Trim Knob to highlight the legend for MHR P This legend is in the approximate center of the display and reads MECG Pulse or INOP according to the settings that are currently enabled 2 Once the MECG legend is highlighted press the Trim Knob The display changes to show the MHR P Setup screen 3 Now rotate the Trim Knob to high
220. the actual pacer spike with a pacer event mark in addition the letter P is displayed prior to the waveform speed Following is an example of an MECG waveform with the MECG pacer On l Auto MECG 09 21 41 Frozen 09 22 06 Print EINE Alarms VSHX The bracket situated to the left of the ECG waveform denotes 1 mv If the ECG waveform size is set to Auto the bracket will auto adjust to maximize the QRS display depending on signal amplitude MECG Waveform with Pacer Enabled If the MECG waveform is enabled for display 7 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Maternal Heart Pulse Rate Monitoring Maternal ECG Monitoring Maternal ECG Monitoring Theory and Methodology The maternal heart rate MHR is measured via electrodes placed on the maternal chest When MECG is employed the maternal heart rate is computed on a beat to beat basis using the R to R time interval on the maternal QRS complex When MECG is selected as the MHR P source the MAR is displayed on the front panel display in beats per minutes bpm denoted by MECG The heartbeat indicator y flashes for each detected heartbeat The rear panel speaker emits an audible tone for each detected heartbeat The maternal heart rate trend when enabled is continuously plotted in the top or left grid of the strip chart paper The MHR trace is a grey line annotated by MECG a The beat to beat MHR signal is used for trending on the strip chart p
221. the backlight lamps in the monitor display contain mercury CAUTIONS STATIC ELECTRICITY This assembly is extremely static sensitive and should be handled using electrostatic discharge precautions ANNUAL SERVICING For continued safety and performance of the monitor it is recommended that the calibration accuracy and electrical safety of the monitor be verified on an annual basis by a GE Medical Systems Information Technologies Service Representative DAILY TESTING It is essential that the monitor and accessories be inspected every day It is recommended practice to initiate the monitor s self test feature at the beginning of each monitoring session follow the instructions in Chapter 4 Setup Procedures ENVIRONMENT The performance of the monitor has not been tested in certain areas such as x ray and imaging suites The monitor is not recommended for use in these environments EQUIPMENT CONFIGURATION The equipment or system should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the equipment or system should be tested to verify normal operation in the configuration in which it is being used PERFORMANCE Report all problems experienced with the monitor If the monitor is not working properly contact your Service Representative for service The monitor should not be used if it is not working properly 250cx Series Maternal Fetal Monitor Re
222. the bar graph changes to reflect the current setting 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 8 Press the Trim Knob again to return to the main monitoring display screen How do change the volume for FHR2 Option 1 audio or heart beat tones 1 Use the front panel Volume Up or Volume Down buttons right to control volume for FHR Channel 2 Option 2 1 Rotate the Trim Knob to highlight the legend for FHR2 This legend is top left on the display and it may read INOP or US2 However to be able to alter the volume using this method you must enable one FHR2 mode by inserting a transducer into the appropriate receptacle on the front of the monitor 2 Once the FHR2 legend is highlighted press the Trim Knob The display changes to show the MODE SETUP SCREEN where mode represents the current legend 3 Now rotate the Trim Knob to highlight the FHR2 Volume setting which is located slightly above vertical center on the left next to the volume bar graph 4 Once the Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current volume setting Select a value between 0 and 9 As the setting changes the bar graph changes to reflect the current setting 6 Once you se
223. the monitor s speaker to celebrate each This field adjusts the temperature completion volume This field is only available when the Exergen protocol is configured Brightness This field allows you to adjust the brightness of the backlight of the display The settings range from 1to 9 with 9 being the brightest setting Revision C 250cx Series Maternal Fetal Monitor 4 9 2036946 001 Setup Procedures General Setup Screen Paper Speed Date Time MSpO Print Interval FSpO Print Interval FSpoO Trace Service The monitor offers a choice of paper speeds of the strip chart recorder m 1 cm min paper saving m 2cmf min a compromise between the 1 cm min and 3 cm min m 3cm min recommended for greater diagnostic capability It is very important to set the date on your monitor prior to initial use The month field has a range from 01 12 the range for the day field varies according to the selection for month and year the year field has a range of 00 99 A long lasting battery maintains the date even when the monitor is unplugged from AC power It is also very important to set the monitor s clock prior to initial operation and during daylight saving time changes A long lasting battery maintains the set time even when the monitor is unplugged from AC power The time is represented by a 24 hour clock in hours minutes and seconds The hour field has a range of 00 23 the minutes field has a range of 00 59 the se
224. the setup menus are configured appropriately for use on this patient Refer to Setup Screens on page 4 7 5 Turn the recorder on Refer to Chapter 11 Recorder Modes for more information CAUTION PAPER MOVEMENT Alvways ensure that the chart paper is moving properly from the front of the recorder drawer when the Record indicator light is on 6 Press the Paper Advance button to create a paper leader 7 Press the Test button to run the monitor s self test routines Refer to Self Test Routine on page 4 7 8 Check the time and date printed on the strip chart paper Refer to General Setup Screen on page 4 9 if you need to change the time date setting 9 Annotate the patient name and ID using the optional Corometrics Model 2116B Data Entry Clinical Notes Keyboard if available PT NAME MARY SMITH PT ID 48576 4 PT AGE 32 DR CARTER Annotating Patient Information Revision C 250cx Series Maternal Fetal Monitor 4 11 2036946 001 Setup Procedures Preparing the Monitor for Patient Use 4 12 250cx Series Maternal Fetal Monitor 2036946 001 Revision C 9 Fetal Heart Rate Monitoring evision 250cx Series Maternal Fetal Monitor 2036946 001 Fetal Heart Rate Monitoring For your notes 5 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Heart Rate Monitoring Ultrasound External Method Ultrasound External Method Methodology US US2 Setup Screen Applic
225. the test results are produced as expected At the successful completion of the self test routine the monitor is ready for use Monitor Self Test Routines Test Routine Description Display Test All display pixels extinguish for one second and then illuminate for one second A green horizontal line moves down on a red background followed by a blue vertical line moving from left to right Lamp Test The yellow Record indicator illuminates Recorder Test The message TEST ARE ALL DOTS PRINTED prints followed by two vertical lines and four horizontal lines The two vertical lines should appear continuous and indicate a fully functional printhead The four horizontal lines align with the heart rate and uterine activity scales i e 30 and 240 BPM or 50 and 210 BPM and 0 and 100 mmHg 0 0 and 13 3 kPa Counting Test After the recorder test the display returns to the main screen The software generates a 120 bpm rate in the FHR1 area a 180 bpm rate in the FHR2 area and both mode titles display Test Uterine Activity The monitor sets UA value to 50 mmHg and displays in the UA display area the mode title displays Test Setup Screens The 250cx Series Monitor provides a variety of options that are selected using the setup screens shown on the display The illustrations in this section are representative of all possible features Your monitor screens may vary All functions are performed easily using the front panel Trim
226. tic compatibility EN standards require individual equipment components and accessories to be configured as a system for evaluation For systems that include a number of different equipments that perform a number of functions one of each type of equipment shall be included in the evaluation The equipment listed below is representative of all possible combinations For individual equipment certification refer to the appropriate declarations of conformity Component Description 250cx Series Maternal Fetal Monitor Model 146 Fetal Acoustic Stimulator Intrauterine Pressure Transducer TOCO Transducer FECG Cable Legplate Ultrasound Transducers x2 Blood Pressure Hose and Cuff MSpO Interconnect Cable and Sensor MECG Cable FECG MECG Adapter Cable Remote Event Marker RS 232C Interconnect Cables x3 Central Nurses Station Interconnect Cable Model 2116B Keyboard and Interconnect Cable Model 1563AAO Telemetry Cable Exergen TemporalScanner TAT 5000 Assembly 2036641 001 Revision C 250cx Series Maternal Fetal Monitor CE 1 2036946 001 CE Marking Information Exceptions The Monitor System EMC Immunity Performance None Be aware that adding accessories or components or modifying the medical device or system may degrade the EMI performance Consult with qualified personnel regarding changes to the system configuration CE 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Contents 1 A A RI
227. tion MSpO Disconnect An MSpO disconnect alarm occurs if the MSpO intermediate cable is disconnected from the monitor the sensor assembly is disconnected from the intermediate cable or the sensor or cable have a broken wire Dashes display in place of the MSpO numeric Resolved Signal Quality Alarm Resolved signal quality alarms behave like most other 250cx Series alarms As soon as an alarm condition is resolved the visual and audible indications automatically disappear Silencing a Maternal Audio Alarm Press the Alarm Silence button to cancel the audio however the visual indication remains until the condition is resolved For MECG and MSpO you can only temporarily silence the audio portion of the alarm If the alarm condition remains after expiration of the re alarm time configured on the Master Alarm Setup screen the audio alarm is re issued 10 8 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Alarms Alarms Summary Alarms Summary Summary of 250cx Series Alarms Type Condition Display Message Audible Notification FHR An alarm setting audio or high low limit is turned off Alarm Defaults Audio on Volume 5 Limits High 160 bpm Low 120 bpm FHR limit high or low actively being violated or Unsilenced resolved FHR limit violation the limit was violated but the FHR has since returned to the normal range before clinical acknowled
228. tion is a pattern of beeps representing the alert level Level 1 Beep Beep Beep Level2 BeepBeep___ BeepBeep___ BeepBeep Level 3 BeepBeepBeep BeepBeepBeep BeepBeepBeep Beep represents audio tone sets and is the pause between sets The following figure provides an example of an active alert level one decelerations Alert enabled icon For an active alert the FHR numerics E 3j flash indicating which FHR is associated FECG TOCO with the alert For a silenced alert the numerics continue to flash until the condition is resolved 144701384 1 For an active unsilenced alert the alert level flashes and displays in inverse A NIBP A MECG A MSpO2 video After the alert is silenced the alert 87 Y 98 level stops flashing and displays in normal video until the alert is reset or the condition is resolved Silencing Alerts 25 mm s Il 2x MECG 15 52 58 Print Freeze Alarms Setup VSHX Example of a Level One Decelerations Alert Press the Alarm Silence button to cancel the audio The alert level stops flashing and displays in normal video however the associated FHR numerics continue to flash For an active silenced alert the visual indications remain present until the condition is resolved or the alert is reset Refer to Resetting Alerts on page C 12 C 6 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Spectra Alerts Alert Indications
229. to specific features of the monitor When grouped warnings and cautions are listed alphabetically and do not imply any order of importance Definitions of Terminology Danger A DANGER notice indicates an imminently hazardous situation which if not avoided will result in death or serious injury Warning A WARNING indicates a potentially hazardous situation which if not avoided could result in death or serious injury Caution A CAUTION indicates a potentially hazardous situation which if not avoided may result in minor or moderate injury Cautions are also used to avoid damage to equipment Contraindication A CONTRAINDICATION describes any special symptom or circumstance that renders the use of a remedy or the carrying out of a procedure inadvisable usually because of a risk Important An IMPORTANT notice indicates an emphasized note It is something you should be particularly aware of something not readily apparent Note A NOTE indicates a particular point of information something on which to focus your attention 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Safety Monitor Contraindications Warnings and Precautions Monitor Contraindications Warnings and Precautions Warnings WARNINGS ACCIDENTAL SPILLS In the event that fluids are accidentally spilled onto the monitor remove the monitor from operation and inspect for damag
230. tom two lines of the upper grid indicating that telemetry signals are no longer being received This annotation can only be seen when dual heart rate monitoring is in progress The offset annotation US 20 or US2 20 prints at the top of the upper grid indicating that the secondary fetal heart rate trend is shifted 20 bpm The right left arrows gt and vertical dashed lines bracketing the heart rate grid indicate the start end of the fetal heart rate offset mode respectively This annotation prints on the bottom two lines of the upper grid indicating an event Generate the mark by one of the following m Briefly press the monitor s Mark Offset button m Press the FM Remote Marker button The Remote Marker is an accessory that can be connected to the 250cx Series Monitor The monitor can be configured to use this arrow annotation or the one shown in the next row of this table Refer to the 250 250cx Series Monitor Service Manual 11 12 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Recorder Modes Adjustable Recorder Font Size Summary of Annotations Continued Annotation Explanation This annotation prints on the bottom two lines of the upper grid indicating that the mother perceives fetal movement The arrow prints each time the mother presses the FM Remote Marker button Note A horizontal bar prints as a tail on the arrow for as long as the button is
231. ts 3 digits 1 100 30 250 bpm 70 100 2 digits 70 100 2 digits 0 69 unspecified Pulse Rate bpm Adults 20 to 250 bpm 3 digits Wavelengths Red 660 nm nominal Infrared 890 nm nominal Maximum Optical Output Power 15mW Response Time Fast Alarms audible and visual Alternating 1 5 second chimes Audio Flashing SpO numeric or message Visual User selectable high and low SpO User selectable high and Limits low pulse rate Sensor errors connection errors insufficient signal communication Technical problem internal calibration error or self test failure 1 Accuracy specifications are based on controlled hypoxia studies with healthy non smoking adult volunteers over the specified saturation SpO range Pulse oximeter SpO readings were compared to SaO values of drawn blood samples measured by hemoximetry All accuracies are expressed as X digits This variation equals one standard deviation 1 SD which encompasses 68 of the population Oxygen saturation accuracy can be affected by certain environmental and patient physiological conditions as discussed in the operator s manual for the monitor Use Nellcor sensors only with 250cx Series Monitors containing Nellcor oximetry Consult individual manufacturers for accuracy specifications and compatibility information of particular instruments and Nellcor sensor models The volunteer population was composed of healthy men and women recruited from the local popul
232. tude This vertical bar qualitatively indicates pulse Indicator amplitude Waveform Area The waveform area displays approximately 4 seconds of waveform data for FECG MECG or MSpO gt Refer to Chapter 14 Waveforms for more information Time and Waveform Message Area The current time in 24 hour format always displays on the far right When a waveform is frozen the message Frozen displays on the far left bottom corner along with the time of activation 3 12 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Controls Indicators and Connectors Softkeys Battery Backed RAM Status Whenever you turn off a 250cx Series Monitor a battery provides power to the RAM random access memory that stores information such as time date default settings etc Low Battery Icon The icon shown above will appear in the upper right hand section of the monitor under the following circumstances Battery Backed RAM Status Icon Appearance Reason Solution Icon appears and then disappears after power cycle Data corruption Your monitor has reverted to factory settings Access setup screens and configure last used settings Icon appears after multiple power cycles Battery requires service Call GE Service to report SET TIME DATE message prints on the strip chart paper Failure of the battery backed RAM to retain time and date Reset the time and date the
233. type applied part DEFIBRILLATOR PROOF TYPE BF EQUIPMENT RI Type BF equipment is suitable for intentional external and internal application to the patient excluding direct cardiac application Type BF equipment is type B equipment with an F type isolated floating part The paddles indicate the equipment is defibrillator proof suitable for intentional external and internal application to the patient including direct cardiac application Type CF equipment is F type applied part that provides a higher degree of protection against electric shock than that provided by Type BF applied parts TYPE CF EQUIPMENT Type CF equipment is La DR ALTERNATING CURRENT AC o EQUIPOTENTIALITY 1 10 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Safety Equipment Symbols Equipment Symbols O POWER OFF disconnection from the mains POWER ON connection to the mains IJ VGA connection Revision C 250cx Series Maternal Fetal Monitor 2036946 001 Safety Equipment Symbols 250cx Series Maternal Fetal Monitor 2036946 001 Revision C 2 Introduction Revision C 250cx Series Maternal Fetal Monitor 2036946 001 2 1 Introduction For your notes 2 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Introduction About the Manual About the Manual Purpose This manual documents all possible parameters so that when yo
234. ur equipment is upgraded new documentation will not be required Also the manual provides an opportunity to read about features you may not have to assist you with your upgrade decisions Some sections will not apply to your unit s monitoring capabilities Intended Audience This manual is intended for physicians nurses and midwives Clinical professionals are expected to know the medical procedures practices and terminology required to monitor obstetrical patients Illustrations All illustrations are provided as examples only Your monitor may not be equipped with the specific feature shown In addition unless explicitly stated the display examples do not represent your equipment setup or displayed data Fetal Monitoring Indications for Use A Corometrics 250cx Series Fetal Monitor is used for fetal surveillance Surveillance A Corometrics 250cx Series monitor can be used for routine non invasive and invasive fetal monitoring throughout labor and delivery Maternal Monitoring Indications for Use A Corometrics 250cx Series Maternal Fetal Monitor is intended for monitoring maternal vital signs to help assess maternal well being The vital signs which can be measured are summarized below NOTE Maternal vital signs provided by the monitor should only be used as an adjunct to patient assessment and must be used in conjunction with clinical signs and symptoms Blood Pressure The monitor is intended for use only in the non
235. use Responsibility of the User This device is intended for use by clinical professionals who are expected to know the medical procedures practices and terminology required to monitor obstetrical patients This manual documents all possible parameters available in the 250cx Series monitor It is the responsibility of each hospital to ensure that the Labor and Delivery staff is trained in all aspects of the selected model The 250cx Series monitor is only one clinical indicator of fetal status during labor The monitor is designed to assist the perinatal staff in assessing the status of a patient The monitor does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider who will make diagnoses and decide on treatments or interventions Visual assessment of the monitor display and strip chart must be combined with knowledge of patient history and risk factors to properly care for the mother and fetus Revision C 250cx Series Maternal Fetal Monitor 1 3 2036946 001 Safety Definitions of Terminology Definitions of Terminology Six types of special notices are used throughout this manual They are Danger Warning Caution Contraindication Important and Note The warnings and cautions in this Safety section relate to the equipment in general and apply to all aspects of the monitor Be sure to read the other chapters because there are additional warnings and cautions which relate
236. vent Marker Model 2116B Clinical Notes Data Entry System Model 146 Fetal Acoustic Stimulator Exergen TemporalScanner TAT 5000 Assembly Catalog Number REF 3919BAO 2116BAX 0146AAY 2036641 001 Paper Supplies Ordering Information Paper Supplies Item Catalog Number REF Z Fold Chart Paper Pack 30 240 bpm Heart Rate Scale 40 carton 4305CAO Z Fold Chart Paper Pack 50 210 bpm Heart Rate Scale 40 carton 4305DAO Ultrasound Ordering Information Ultrasound Supplies Item Catalog Number REF Loop Style Ultrasound Transducer Nautilus 8 foot Cord 5700LAX Button Style Ultrasound Transducer Nautilus 8 foot Cord 5700HAX Ultrasound Coupling Gel Bottle 250 ml 12 carton 2434AAO Reusable Belt for Loop Style Transducer Mesh Style 10 carton 4425AAO Reusable Belt for Loop Style Transducer Velcro Style 10 carton 4425CAO Reusable Belt for Button Style Transducer Blue 10 carton 2015827 001 Reusable Belt for Button Style Transducer 1 pink and 1 blue pack 100 packs case 2015919 001 Semi Reusable Belt for Loop Style Transducer Velcro Style 1pink and 1 blue pack 50 packs carton 4425FAO Single Patient Use Belt for Loop Style Transducer Foam Style with Velcro Closure 8024AAO 250cx Series Maternal Fetal Monitor 2036946 001 Revision C Supplies amp Accessories FECG Ordering Information FECG Ordering Information FECG Supplies
237. vision C 2036946 001 Safety Monitor Contraindications Warnings and Precautions Electromagnetic Interference This device has been tested and found to comply with the Medical Electrical Equipment General Requirements for Safety Collateral Standard Electromagnetic Compatibility EN60601 1 2 2001 Medical Device Directive 93 42 EEC These limits are designed to provide reasonable protection against harmful interference in a typical medical installation However because of the proliferation of radio frequency transmitting equipment and other sources of electrical noise in the health care and home environments e g cellular phones mobile two way radios electrical appliances it is possible that high levels of such interference due to proximity or strength of a source may result in disruption of performance of this device Refer to the Electromagnetic Immunity information in this product s service manual for EN 60601 1 2 2001 compliance information and safety information for this product This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with these instructions may cause harmful interference with other devices in the vicinity Disruption or interference may be evidenced by erratic readings cessation of operation or incorrect functioning If this occurs the use site should be surveyed to determine the source of this disruption and actions should be taken to elimin
238. y slightly above the menu bar on the left half of the screen The setting is either On or Off If the setting is Off it needs to be enabled Proceed to Step 4 below If it is already On and you simply wish to change the Volume setting proceed to Step 7 below 4 Once the Audio Alarms setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video 5 Now rotate the Trim Knob to change the current setting to On 6 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking 7 Now rotate the Trim Knob to select highlight the Volume setting which is located immediately to the right The setting is in the range of 1 to 9 8 Once the Volume setting is highlighted press the Trim Knob again The current setting displays in blinking inverse video and an audio tone indicative of the alarm volume is emitted from the speaker 9 Now rotate the Trim Knob to change the current setting as desired Each time you change a setting you will hear an audio tone indicative of the alarm volume emitted from the speaker 10 Once you set the desired alarm value press the Trim Knob to confirm your selection The current value setting stops blinking A final audio tone indicative of the alarm volume is emitted from the speaker 11 Now rotate the Trim Knob to select highlight the Exit item on the bottom menu 12 Press the Trim Knob ag
239. y Factory Hospital Revision C 250cx Series Maternal Fetal Monitor A 7 2036946 001 Factory Defaults Table of Defaults A 8 250cx Series Maternal Fetal Monitor 2036946 001 Revision C B Fetal Movement Detection Each monitor in the 250cx Series can be upgraded to include fetal movement detection This feature is designed to detect gross fetal body movements and body movements with associated limb movement Revision C 250cx Series Maternal Fetal Monitor B 1 2036946 001 Fetal Movement Detection For your notes B 2 250cx Series Maternal Fetal Monitor Revision C 2036946 001 Fetal Movement Detection Introduction Introduction Availability Methodology Fetal movement detection is an option which can be installed in your 250cx Series Monitor to function with the US channel Contact your Sales Representative for information Fetal movement detection FMD is designed to detect gross fetal body movements and body movements with associated limb movement Corometrics defines gross fetal body movement as the extension flexion or rolling over of the fetal trunk about the longitudinal axis of the body and associated limb movements Movements of the extremities alone may not be detected Eye movements will not be detected CAUTION FALSE DETECTION The following may be automatically detected as fetal movement transducer movement and maternal movement such as coughing laughing reposition

Corometrics™ 250cx Series Monitor

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Corometrics&trade; 250cx Series Monitor

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Corometrics™ 250cx Series Monitor