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Acuity and Mobile Acuity LT Central Monitoring Systems

1. to page the display forward or backward To select and adjust the CO waveform and the trend graphs 1 Under Wave check up to three boxes to display the corresponding wave or trend graphs 2 Click Scales and then make a selection To locate and display alarm information 1 Click a red alarm area along a trend graph or wave The blue cursor bar shows vital sign values along each trend graph or wave 2 Click or to jump to the next or previous alarm Directions for use Chapter 6 Review or print patient data 115 Print and review printouts The Acuity System includes six types of printouts e Snapshot printouts e Review printouts e Alarm printouts e Patient List printouts e 12 Lead printouts e Hemodynamic Report printouts Snapshot printouts Snapshot printouts provide an instant snapshot of a currently monitored patient s data and waveforms Information in a Snapshot printout e Data from fourteen seconds before and seven seconds after the Snapshot button is clicked e The same waveforms that are selected for display in the Virtual Monitor Snapshot printouts Snapshot printouts are printed from these places e A Waveform Window or Virtual Monitor e Some patient monitors For more information see the directions for use of the monitors in question Automatic snapshot printouts e fyou are interested in setting automatic intervals for snapshot printouts to occur see Adjust preferences for a pa
2. If necessary contact qualified service personnel regarding printer status or to redirect print jobs to an alternate printer Low level alert Acuity System network Check Network There is a problem with a area or Acuity Central networked Acuity System Networked Acuity Station area or the Welch Allyn System Problem connectivity server WACS is unavailable or Contact qualified service Connectivity Server personnel Unavailable Low level alert Acuity System network None Represents a networked area Acuity System that is Unrecognized unknown to your Acuity Networked Acuity System System Software versions do not match Contact qualified service personnel Low level alert Acuity Central Station Call Service Some services associated Some Connectivity Services Unavailable Too Many Wireless Monitors Low level alert area Acuity Central Station area Too Many Monitors Also shown in hallway message panels with the Welch Allyn connectivity server WACS are unavailable Contact qualified service personnel Disconnect a wireless monitor 148 Chapter 9 Status icons Welch Allyn Acuity Central Monitoring System Table 9 Icons and messages that represent the status of Acuity System components Acuity System component icon Icon display Icon location on map priority Messages attop Recommended action of Acuity Central Station screen No Devices Running Clinician Notifier are Reachable
3. The Edit Patient Information window appears 3 Position the cursor after the information that you want to change and press the Backspace key until the incorrect information is gone Type the new information 4 Click Confirm The information is stored 80 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Edit a patient ID number add an amended revised patient ID Once a patient ID number is confirmed it cannot be changed However if your Acuity System includes the amended ID feature you can revise an original patient ID number by adding an amended ID If necessary you can change this amended ID again later If you re monitoring a patient with a Propag LT monitor you can edit this information at the monitor instead Both IDs appear on printouts To add an amended revised patient ID 1 Ina patient s Virtual Monitor click Setup Patient ID The Patient ID Setup window appears e TMG olearlly centim Surdo 2 Type or scan the number on the Amended ID line 3 Carefully review your entries for accuracy 4 Click Confirm The information is stored Directions for use Chapter 4 Adjust monitoring settings and patient information 81 Add or remove a note in a patient s Waveform Window If you would like to attach a note or reminder to a patient s Waveform Window such as when the patient temporarily moves to another location you can enter t
4. If you do not know the patient s room number highlight Select room at Central and then touch Select If you do not see the patient s ID name in the patient list highlight Select patient at Central and then touch Select Along the top of the Propag CS monitor screen verify that the patient mode matches the patient s age Adult Pediatric or Neonate If the patient mode does not match touch SETUP MORE CHANGE and then touch the appropriate mode If you did not enter a patient ID name and room number take these steps a Write down the patient s name ID room number and the last four digits of the serial number that is under the handle of the Propaq CS monitor b Ensure that the information is delivered to the Acuity Central Station for patient confirmation At the central station the patient map icon remains in the yellow ID or RM unconfirmed state until the ID and room are confirmed Optional Customize alarm limits using patient monitor keys or the Alarms Setup window at the Acuity Central Station See Adjust a patient s alarm limits on page 46 A WARNING When a patient is connected to a monitor ensure that the default alarm limits are appropriate for the patient The system uses Acuity System Presets values for Arrhythmia Analysis and ST Analysis limits and monitor default values for all other limits if the monitor can save default values Before you set customized alarm limits for a patient confirm th
5. Set at least one upper and lower limits pair per active vital sign Directions for use Chapter 9 Status icons Table 8 Icons and messages that represent patient and monitor status Patient monitor status icon Too Many Hardwired Monitors Monitor Cannot Communicate Icon display priority Takes priority over low level alerts Take priority over low level alerts Icon location on map Location representing the extra monitor Locations representing monitors that cannot communicate with Acuity System Messages in hallway message panels and at top of Acuity Central Station screen room Equipment room Equipment 141 Recommended action Audible alert tone continues until you disconnect a monitor Disconnect a monitor not in use or wait until another port becomes available to connect the extra monitor Close the alert window and turn off or disconnect the monitor Contact qualified service personnel Monitor Problem Take priority over low level alerts Locations representing problem monitors room Equipment or more specific message At Acuity Central Station 1 Check yellow Virtual Monitor for specific alert message 2 If there is an audible tone click Suspend 3 If present press one of these buttons e DISMISS or CONFIRM to dismiss the alert message e RESET to reset the monitor 4 Correct the problem If the problem persists
6. Welch Allyn Acuity Central Monitoring System Begin patient monitor communication with the system For information about patient monitors that are part of your Acuity System but are not shown in this chapter consult the patient monitor manufacturer s literature Connect a hardwired monitor to the system To connect the monitor to the system 1 Connect the Acuity System network cable a im Propag CS monitor Connect the cable to the Acuity System network connector on the bedside monitor Propaq Encore monitor b Connect the other end of the cable to the bedside network connector z For Propaq CS and Propag Encore monitors x 2 connect the network cable to the bedside connector labeled with this symbol D Welch Allyn 1500 Patient Monitor For a Welch Allyn 1500 Patient Monitor connect the network cable to the bedside connector labeled with this symbol ES The cable clicks into place when it is properly attached Ensure that the cable is neither damaged nor broken A WARNING Ensure that you connect the proper monitor network cable to the proper wall jack Using the wrong network cable or the wrong wall jack connector could damage the monitor or not send data to the Acuity System Ensure that the monitor is properly connected to the network before you start monitoring the patient 2 If the monitor is on take one of these steps If it was not monitoring this patient turn it off and on again
7. indication for HR 67 86 156 159 22 181 182 181 182 NIBP reduces size 22 not showing 159 Welch Allyn Acuity Central Monitoring System O Other Patients button 12 97 121 Overview Acuity System 9 OxyCRG printouts 49 Review window 113 Review window specifications 199 P Pacemaker 44 arrhythmia settings for patients with 62 NonCapture definition 57 set Analyze Pacers for patients 44 62 system detection of 178 turn on or off display 44 Pacer Display box 62 Patient admit duplicate not allowed 25 data review or print 97 discharge 136 in networked Acuity Systems 12 97 121 move from wireless monitor 129 move to different monitor 131 move with hardwired monitor 127 new Clear trends and alarm limits 37 pacemaker 44 readmit after discharge 27 review data 97 search for 97 start hardwired monitoring 28 start wireless monitoring 31 status icon 22 137 stop monitoring 133 Patient ID edit 80 enter or confirm 40 number unique 29 scanning 40 Setup window 40 Patient List button 12 19 97 121 printouts 121 search 97 specifications 188 summary information 98 Patient List Review PLR system 11 176 Patient mode incorrect 37 Patient note 22 81 Pause definition 57 Pl indicator 17 23 100 105 114 PLR Patient List Review system 11 176 Power Acuity System up or down 170 Directions for use outages 170 supply uninterruptible 3 Preadmit patient 25 Presets button 46 60 74 Print Next button
8. 1 Press v repeatedly until SERVICE MENU is highlighted and then press X The Service menu appears In this sequence and not too rapidly press and hold these keys v a and L An ARE YOU SURE prompt appears Press Y to highlight YES and then press L A Network Name menu appears Press a or Y to highlight the desired network name Carefully confirm that the highlighted name matches the appropriate Acuity System network name Press na The Micropaq monitor turns off and on again and then it attempts to connect to the Acuity System network Directions for use Identify or change a Propag LT monitor network name ae Chapter 10 Troubleshooting and maintenance 167 Dits Sle aoe Whe mnei To identify a Propaq LT monitor network name and prepare to change it if desired 1 2 Highlight SpO2 and then press C Highlight Setup and then press OJ The Setup menu appears Highlight Service and then press e The Service menu appears Highlight Radio and then press The Radio menu appears and Show Info is highlighted Take one of these steps If you want to change the network name Continue below to To proceed to change a Propag LT monitor network name If you do not want to change the network name a Press e The current network name is shown b Highlight Exit and then press You have completed the network name identification process To proceed to change a Propaq L
9. A Hallway message panel B Welch Allyn 1500 Patient Monitor C Propag Encore monitor D Propaq CS monitor E Micropaq monitor F Propag LT monitor G Wireless access point H Acuity Central Station Laser printer J Welch Allyn Connectivity Server WACS K Hospital network L Mobile device running Clinician Notifier software Welch Allyn Acuity Central Monitoring System Optional panels located throughout a unit visually indicate alarms and some alerts Hardwired full featured monitors with 12 lead ECG analysis and large displays Hardwired portable full featured vital sign monitors Wireless or hardwired full featured vital sign monitors with large displays Small wireless monitors that measure ECG and SpOz These monitors are useful for ambulatory patients Small wireless monitors that measure ECG Resp Sp0 and NIBP These monitors are capable of displaying large numerics Connects wireless monitors and the Acuity Central Station Monitors all connected patients stores patient information and displays alarms and alerts Optional laser printers give you printouts of various types of patient information An option to the Acuity System WACS is a server platform on which software options are installed Carries information to the Acuity System and carries patient data to the hospital information system HIS CIS AcuityLink is a WACS option that delivers Acuity System patient informatio
10. lead for display 2 ECG1 LEAD Monitors using 5 lead ECG cables Leads Il Ill aVR aVL ECG2 LEAD aVF and V Note If a Virtual Monitor represents a Propaq Encore Propaq CS or Welch Allyn 1500 Patient Monitor the leads that you select for ECG 1 and ECG 2 are used also for arrhythmia analysis For details regarding leads used for arrhythmia and ST segment analyses for all types of patient monitors see Table 35 on page 191 and Table 36 on page 193 Lead indicators Indicators are shown in ECG waveform areas of each patient s Virtual Monitor and Waveform Window and in the Wave Select status window If you want to review waveforms from all leads view the patient s Waveforms Review window For instructions see page 104 Propag Encore and Propag CS monitors changing leads when they are using two lead vectors If you change the ECG Lead from a V lead to a limb lead the ECG2 Lead changes to a V lead If you change the ECG1 Lead from a limb lead to a V Lead the ECG2 Lead changes to Lead Il Welch Allyn 1500 Patient Monitor Propag LT monitor leads shown at Acuity System and patient monitor Select the same leads at both places to view ECG information from the same leads in both places A lead failure for Propag LT monitor patients can result in lead selections that are different at the Acuity Central Station WARNING Ensure these things to minimize false HR Arrhythmia Analysis and ST Analysis alarms a
11. on page 92 Directions for use Chapter 4 Adjust monitoring settings and patient information 65 To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses The relearn operation cannot be undone 1 Inthe patient s Virtual Monitor click Setup Arrhythmia Alarms The Arrhythmia Alarms Setup window appears If your window appears abbreviated your system includes the Lethal Arrhythmia Analysis option lethal arrhythmia detection only _ Setup Arrhythmia Alarms Alarm Limit Level m y rl vj E fe ee AA Print on Alarm Alarm Arrhythmia Level Pause Irregular NonCapture Options Pause Limit Irregular Limit Single ECG Pacer Display Analyze Pacers YS ees Shelly F Phelps Print on Alarm Undo Close Carefully evaluate the patient s current rhythm to ensure that you want the Acuity A RELEARN alert occurs at the patient s Virtual Monitor and Waveform Window The 2 System to establish it as the patient s normal ECG rhythm 3 Click ST Arr Relearn or RELEARN alert remains until relearn is finished 4 Carefully evaluate the new ECG rhythm and ST segment to ensure that the Acuity System has learned an appropriate rhythm For instructions see Respond to a RELEARN alert on page 91 66 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Important considerations Arrhythmia An
12. yellow Message window At top of Acuity Central Station screen Specific message matches hallway message panel message panels are optional Vv Map icon at patient location matches Virtual Monitor and Waveform Window icon Map icon at Acuity Central Station location Orange Line on map When you bring your pointer into a Virtual Monitor or Waveform Window an orange line in the map shows the shortest route to your patient s bedside from the Acuity Central Station except for patients with map Icons in the wireless areas of the map Virtual Monitor icon border color change border message Waveform Window icon border color change border message these match the Virtual Monitor Utility windows Associated with Virtual Monitors Border color change matches corresponding Virtual Monitor and Waveform Window a Any review windows opened via the Patient List window have a blue border If an alarm or alert occurs for that patient the border remains blue but the patient s Virtual Monitor and Waveform Window borders turn yellow or red as usual Directions for use Chapter 11 Specifications Table 27 Alarm and alert indications at the Acuity System Virtual Monitor 181 Alarms Monitor equipment alerts System wide Patient red yellow equipment information alerts alerts yellow yellow Display Priority Virtual Monitors in alarm Virtual Monitors in alert state
13. 25 3 Admit and begin monitoring Preadmit a patient to Acuity System monitoring If you know a patient s ID number before the patient is admitted you can save time that would be spent later by preadmitting the patient at the Acuity Central Station When a preadmitted patient arrives If the patient is connected to a wireless monitor at the patient monitor you can simply confirm the patient ID and add a room number If the patient is connected to a hardwired monitor you can go to the Acuity Central Station and confirm the patient by entering only the ID number If a patient is already monitored by a networked Acuity System a duplicate entry is not allowed because patient information could be lost To preadmit a patient to Acuity System monitoring 1 In the lower left corner of the Acuity Central Station screen click oe The Patient List window appears Click Admit The Admit Patient window appears Specify a location e f you know the patient s room number click the number e f you do not know the patient s room number click UNASSIGNED You can enter the room number later via the Patient List or the Virtual Monitor Type or scan other patient information Carefully review your entries for accuracy Click Confirm The information is stored 26 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System To assign a room number for a preadmitted patient via the Patient List ON i 1
14. A run of premature ventricular beats that exceeds the PVC run alarm limit and that meets or exceeds the patient s VIach alarm limit Note The American Heart Association describes sustained and nonsustained ventricular tachycardia as follows Ventricular tachycardia can be referred to as sustained or nonsustained Sustained refers to an episode that lasts at least 30 seconds and generally requires termination by antiarrhythmia drugs antitachycardia pacing techniques or electrical cardioversion Nonsustained ventricular tachycardia suggests that the episodes are short three beats or longer and terminate spontaneously a Alarming for lethal arrhythmias cannot be turned off b VFib is detected within 6 seconds if the waveform fulfills these conditions Absence of fast slew rate activity ORS like activity Wave rate higher than 130 bpm Average peak to peak wave amplitude higher than 200 pV Wave period variance higher than a specific threshold 56 Full Arrhythmia Analysis option additional events detected Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Table 5 Full Arrhythmia Analysis option events detected in addition to lethal events Arrhythmia event and definition PVC run ventricular run A run of three to six consecutive premature ventricular beats that meets or exceeds the patient s VTach alarm limit Waveform example VRhythm ventricular
15. Click or to scroll forward or backward Click A or fj to page forward or backward 106 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System To locate and display alarm and event information Cursor bar 1306A aveforms Louls Dawid EI naa AEJ vow NDA NAJ Jrd 200 mm min 100 mm min 50 mm min y Y t Rn i 1 7 T 1 i 1 g 1 J i 12 00 Wt Wiko 5 s fue mmja Vio Print Close Resp 2x 1 Along the top of the waveforms click an event marker e Wevent markers show Relearn Learning Done or Snapshot Print events e YW event markers show that an arrhythmia alarm was recorded e WY event markers show that an arrhythmia event was detected but no alarm occurred because alarming for this arrhythmia type was turned off in the Arrhythmia Alarms Setup window The blue cursor bar identifies event types along each waveform 2 Jump to the next or previous alarm or arrhythmia event e Click amp or 4 to jump to the next or previous alarm e Click w gt or to jump to the next or previous arrhythmia event 3 Jump to the next or previous event of the same type that is currently displayed e Click ae or gt a to jump to the next or previous alarm of the same type e Click or to jump to the next or previous arrhythmia event of the same type The blue cursor bar identifies the event If you do not see some of these buttons in t
16. MORE Monitor and Waveform Window 3 STATSCALE Turn on or turn off the No Arrhythmia Analysis pacer display option 1 ECG or ECG RESP 2 MORE MORE MORE 3 NEXT 4 CHANGE Arrhythmia Analysis option 1 Setup 2 Arrhythmia Alarms 3 Pacer Display Also set Analyze Pacer for arrhythmia monitoring For instructions please see page 62 G aera ee The pacer display is shown as a dashed line in the waveform areas of the Virtual Monitor Waveform Window and Waveforms Review window WARNING Keep all pacemaker patients under close A observation Rate meters might continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely solely upon rate meter alarms WARNING Always turn on Analyze Pacers for paced patients and always turn off Analyze Pacers for non paced patients The Acuity System analyzes arrhythmias based on whether the Analyze Pacers setting is on or off The Analyze Pacers setting is Off by default A Directions for use Chapter 4 Adjust monitoring settings and patient information 45 Table 2 Typical monitoring functions at the Virtual Monitor Lead selection ECG and respiration Task Clicks at Virtual Monitor Notes Change the RESP lead 1 ECG RESP Lead indicators are shown in the respiration waveform areas 2 MORE of the Virtual Monitor and Waveform Window 3 RESP LEAD Select or change ECG 1 ECG or ECG RESP Available leads
17. Make adjustments periodically according to your facility s policy to maintain time accuracy You can adjust time forward or backwards up to 20 minutes Adjustments are made gradually to all Acuity Systems on a network and all patient monitors connected to the network To adjust Acuity System time 1 Inthe lower left corner of the Acuity screen click f o 2 Type your system administrator password The Administration window appears 3 Click Adjust Time The Adjust Time window appears If the window informs you that your server is synchronized to an NTP server close the window You do not need to manually adjust system time Adjust Time Current Central Station Time Adjust Central Station Time to 13 54 21 Must Confirm zizi Adjustment will be completed at 14 3715 0 Confirm 4 Click the up or down arrow button until you see the desired time 5 Click Confirm The system time adjustment is made gradually 6 Click Close Directions for use Chapter 10 Troubleshooting and maintenance 165 Identify or change a monitor s network name ESSID This section describes how to identify or change the extended service set identifier ESSID for each type of wireless patient monitor that can connect to an Acuity System wireless local area network WLAN This information is useful if you want to do these things e Set up a Mobile Acuity LT System network e Move a patient monitor from one Acuity System network to
18. all events in the time span are listed in bold Directions for use Chapter 6 Review or print patient data 103 Adjust the waveform display Beat labels Normal and ventricular V Review Tabular Treade Evers a anir gp e Male ie FAN Sia aa ic m eh et m TASS ED EW ON ETN a 0 Pj gt D a gt Tine Event Duration IHR PR IRR ER List type Tabular Ewn Baty Fua ee i5 sims Jt min t min interval gt tue 3 timit m 212 etd isin gt 0 a Sain Tue 14 39 16 Limit WR 38 136 a A iue 14 49 01 Linit HR i37 jei ma _ Tue 15 00 00 1 90 tho Blue 15204212 Livit Wk s1350 4h tue 15 12 55 Lipit HR 259 li Tue 15 15 00 1 Blue 15 16 34 Linit HR im le j Tue 15 16 48 APNEA 21 i iue 15 16 48 Linit RR 124 ea Tue 10 4510 ovr Tue 19 00 00 90 or Tue 19215 000 ea on Tue 19 30 00 so on I ERcueeeEeeE Tos 19745 200 so OFF Tue 20700 00 eo or Tue 20 35 00 so one l en phe EN m soam wa jor ce ET eo ao lY ao odd aaoo 24 aa 72 Dorta Euvwt Scales Print Clase To display waveform s that correspond to a trend or event in the tabular list 1 2 In the list locate a trend or event in which you are interested Click the trend or event The corresponding waveform s appear in the waveform pane Scroll the waveform Click or to scroll forward or backward Click D gt or Aj to page forward or bac
19. and a list of medications the patient may be taking A comment field is also available C Interpretation information This field displays the information generated by the Welch Allyn 1500 Patient Monitor regarding the analysis of the 12 lead report 124 Chapter6 Review or print patient data Hemodynamic Report printouts Welch Allyn Acuity Central Monitoring System Hemodynamic Reports are a collection of calculations derived from the cardiac output feature of the Welch Allyn 1500 Patient Monitor Print a Hemodynamic Report To print a Hemodynamic Report 1 Runa cardiac output measurement at the Welch Allyn 1500 Patient Monitor 2 Select Hemodynamic Calculations at the monitor 3 Select Transfer Data The monitor sends the Hemodynamic Report to the central station printer 4 Ifa re print of the Hemodynamic Report is needed place the cursor under printer icon at the Waveform Review Window or the Graphical Trends Review Window Click Print and select Print Report A printout occurs at the Acuity System printer Review a Hemodynamic Report WelchAllyn Wednesday 7 September 2011 16 01 21 A John Doe 123 45 6789 TestUnit 1302A Name Patient ID Amended ID Location Hemodynamic Calculations Acquired from WA 1500 PM v 1 3 0 517 SN KA340E5C HR 80 bpm ARTs 86 mmHg co 8 00 imin cl 4 44 Uminim ARTd 54 mmHg SV 100 0 m SVI 55 6 mim ARTm 65 mmHg SVR 510 DSem SVRI 918 DSm cm PAs 38 nnii PVR 80 Ds
20. m mi a Turn off the monitor 4s The trend information for this patient is erased from the monitor Oo On a Welch Allyn 1500 Patient Monitor JE a Press the Standby key and select Discontinue Monitoring b Turn off the monitor or c At Acuity select END TELE Note Turning off the monitor is optional and not required when selecting END TELE In either case the trend information for this patient is erased from the monitor 4 Connect the patient to a new monitor and connect the monitor to the Acuity System At the central station the patient s yellow icon appears in an unconfirmed state on the map in the new location Enter or confirm the patient information For instructions see Enter and confirm a patient s ID or room at the central station on page 40 Move a patient from a wireless monitor to a different monitor To move a patient from a Micropaq monitor to a different monitor 1 On the Micropag monitor press yw to highlight ACUITY and then press vw to select it N Select END TELE P The monitor disconnects from the Acuity System Remove the battery from the Micropag monitor Connect the patient to a new monitor and connect the monitor to the Acuity System At the central station the patient s yellow icon appears in an unconfirmed state on the map 132 Chapter 7 Move a monitored patient Welch Allyn Acuity Central Monitoring System Enter or confirm the patient information For instr
21. the monitor initiates measurements at the selected auto interval even when the cuff is not on the patient 1 At the patient monitor Acknowledge the alert 2 Press NIBP MANUAL to change the NIBP setting to Manual 3 Save the current settings to ensure that the problem doesn t persist after you turn off the monitor For instructions refer to the monitor directions for use Alarm limits Table 13 Troubleshooting alarm limits Problem set specialized alarm limits before the patient ID was confirmed and the limits changed after confirmation Explanation WARNING Before you set customized alarm limits for a patient A confirm the patient s ID and room number Otherwise customized limits might be lost After disconnected a patient for transport changed the patient s alarm limits at the patient monitor When reconnected the monitor to the Acuity System the alarm limits changed from what had set WARNING Always check alarm limits when a monitor reestablishes communication with the Acuity System If you change limits at a monitor while it is not communicating with the Acuity System for example during transport or signal dropout when you reestablish communication with the system the limits might change to Acuity System Presets values A When adjust arrhythmia alarm limits sometimes heart rate limits change too WARNING If you set the bradycardia alarm limit higher than the HR lower limit
22. x OFF i Pause Limit z page 156 dor 4 OFF 4 Single ECG Fi OFF 4 Pacer Display _ Always turn off Analyze OFF E Analyze Pacers oe non paced a al hjg S Alarms Set ST Arr Relearn Undo Close Adjust preferences for alarming e Alarm Level To specify the alarming priority for an arrhythmia type click the arrow next to the arrhythmia and then select an alarm level If an alarm level is set to off and an event of that type occurs y appears in the patient s review windows For a description of alarm levels see Table 6 on page 95 A WARNING Turning off alarming for arrhythmia types and ST Analysis disables both audio and visual alarm indicators Although alarming for lethal arrhythmias cannot be turned off patients susceptible to arrhythmias must be kept under close physical surveillance if their alarming has been turned off for any arrhythmia types A WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move e Pause Limit under Options To adjust the number of seconds that a Pause event must occur before the Acuity System alarms click an arrow to specify seconds and then check the Pause Lim
23. 19 20 97 121 145 176 opening Central Station windows 145 overview 9 secondary recommended 3 set language 165 specifications 175 status icons 20 troubleshooting 151 turn off 170 turn on 171 AcuityLink option 10 148 Admit button 25 Admit patient 25 readmit 27 Alarm limits Auto Set 46 changing during transport 37 47 125 155 clear for new patient 28 35 off for ST 71 set patient 46 Stat Set 46 Alarm printouts 119 Alarm Set button 46 60 Alarms and alerts Acuity Central Station indications 179 Arrhythmia or ST 90 Arrhythmia Setup window 58 can go unnoticed 3 CHECK HR PR 89 CHECK LEADS 93 color and icons 24 disabling 47 157 DROPOUT 88 false arrhythmia 156 indications 22 latched 87 levels 95 new during SUSPEND 85 154 158 NOISE 94 printouts 119 priority 95 RELEARN 91 respond to 83 resume tones 22 23 43 specifications 179 suspend temporarily 43 suspend tones 22 23 84 tones defined for levels 95 tones won t stop 87 troubleshooting 156 window borders 22 24 Alarms Setup window 46 Alarms Setup window specifications 190 All Alarms On button 46 Amended ID 80 Analyze Pacers button 62 Arrhythmia alarm during Relearn 91 alarming preferences set 60 61 alarming turn off 59 Alarms Off button 65 73 74 76 Alarms Setup window 58 Alarms Setup window specifications 191 alarms false 156 Analysis options two types 54 asystole not detected 161 atrial not detected 54 66 delete event marker 111 dismiss
24. 50 Print On Alarm arrhythmia 62 74 printout 119 Printer enable or disable parallel 165 optional laser 10 paper size set system 165 set ISO encoding 169 view status of 50 Printing Alarm printouts 62 74 119 coordinate jobs 50 delete selection 50 Patient List 121 print next 50 print on alarm setup 49 Review printouts 117 review prints 104 Setup window 49 Setup window specifications 194 Snapshot 22 specifications 188 Vital Signs Summary 120 Propaq monitor CS 10 CS connection to Acuity System 35 Encore 10 LT 10 LT leads independent 45 LT connection to Acuity System 33 PVC run definition 56 PVC definition of 52 PVC min definition 56 R Readmit a discharged patient 27 Recycling of equipment 173 Reference beat ST Analysis 70 Relearn after change Analyze Pacers 44 62 Alarm during Relearn 91 alert respond to 91 definition of 53 initiate Arr ST 63 ST Analysis 76 Remote Acuity System Patient List Review 11 Remote Acuity System PLR 176 Remote monitoring Index 207 close and open Waveform Windows 12 not a substitute for primary monitoring 4 remote Patient List Review system 11 specifications 176 within FlexNet 9 RESET button 88 RESP leads see Leads Response time C02 44 Sp02 44 Restarts caused by altered cabling 3 Review printouts 117 Review windows Arrhythmia Events 107 Graphical Trends 99 113 117 open for networked or remote patients 97 open from Patient List 97 opening 23 OxyCRG 112 specif
25. Bradycardia Show Deleted Lethal and High Arr Alarms All Arr Alarms All Arr Events ROR RORD Priority Time Duration Comments DAY HH MM SS MM SS Bigeminy Couplet Couplet Asystole Trigeminy Pause Irregular Bradycardia Irregular VTach VTach VEib Asystole Bigeminy Trigeminy Bigeminy Off Thu 12 23 11 Lethal Thu 12 23 12 Off Thu 12 23 52 Off Thu 12 24 51 Off Thu 12 25 03 Lethal Thu 12 25 24 Med Thu 12 25 49 Med Thu 12 26 26 Med Thu 12 26 29 High Thu 12 26 56 Med Thu 12 27 55 Lethal Thu 12 39 57 Lethal Thu 12 45 30 Lethal Thu 12 45 33 Lethal Thu 12 46 30 High Thu 12 47 09 Med Thu 12 47 38 High Thu 12 48 04 The title of the review printout Number of arrhythmia events that were deleted in the Arrhythmia Events Review window during the printed time span This event was deleted in the Arrhythmia Events Review window All events checked in the Arrhythmia Events Review window and checked above are listed in this printout Directions for use Chapter 6 Review or print patient data 119 Alarm printouts If Print on Alarm is set for a patient s parameter and the parameter alarms an alarm print occurs at the central station Information in an alarm printout e Fourteen seconds before an alarm and seven seconds after an alarm e The same waveforms that
26. Group 1 The Acuity System uses RF energy only for its internal CISPR 11 function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions Class A The Acuity System is suitable for use in all establishments CISPR 11 other than domestic establishments and those directly connected to the public low voltage power supply network Harmonic emissions Class A that supplies buildings used for domestic purposes IEC 61000 3 2 Voltage fluctuations flicker Complies emissions IEC 61000 3 3 Directions for use Chapter 11 Specifications 185 Guidance and Manufacturer s Declaration Electromagnetic Immunity The Acuity System is intended for use in the electromagnetic environment specified below The customer or the user of the Acuity System should assure that it is used in such an environment Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Guidance Electrostatic discharge 6 kV contact 6 kV contact Floors should be wood concrete or ceramic ESD 8 KV air 8 kV air tile If floors are covered with synthetic IEC 61000 4 2 material the relative humidity should be at least 30 Electrical fast 2 kV for power supply 2 kV for power Mains power quality should be that of a transient burst lines supply lines typical commercial or hospital environment IEC 61000 4 4 1 kV for input output 1 kV for input output lines l
27. In the lower left corner of the Acuity Central Station screen click I The Patient List window appears 2 Select the patient s name 3 Click Transfer The Transfer Patient window appears 4 Click a unit name in the list 5 Click a room 6 Click Confirm The information is stored Directions for use Chapter 3 Admit and begin monitoring 27 Readmit a discharged patient You can readmit a patient to the Acuity System if the patient s name still remains in the Patient List If a patient has been discharged from the Acuity System but the system still holds the patient s data the patient remains in the list The Acuity System stores patient data for 24 to 96 hours after monitoring stops To readmit a discharged patient 1 In the lower left corner of the Acuity Central Station screen click The Patient List window appears Select the patient s name If the patient s name does not appear in the patient list see Preadmit a patient to Acuity System monitoring on page 25 to admit the patient Click Readmit The location becomes UNASSIGNED If you do not know the patient s room number you can enter it later via the Patient List or Virtual Monitor If you know the patient s room number take these steps a Click Transfer The Transfer Patient window opens b Click a unit name in the list c Click a room Click Confirm The information is stored 28 Chapter 3 Admit and begin monitoring
28. Low level alert Acuity Central Station area Notifier Fault System includes a Welch Allyn connectivity server WACS with the AcuityLink option Mobile devices that are running Clinician Notifier software are no reachable All devices are logged off turned off or out of range or the AcuityLink network is unavailable Contact a clinical administrator and qualified service personnel 149 Troubleshooting and maintenance Contact information If you are unable to find the answer to a question or if you encounter a problem that cannot be corrected by ordinary operating procedures described in this manual please contact Welch Allyn Technical Services Phone within the U S A 1 800 289 2501 Phone worldwide 1 503 530 7500 ask for Technical Service Fax 1 503 526 4970 e mail solutions welchallyn com Internet http www welchallyn com support default htm Note Welch Allyn provides a 3 year support program for the Acuity Central Station After 3 years Welch Allyn will only provide phone support for the central station unless you purchase a service contract or purchase an upgrade 150 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Contents Troubleshooting Central Statiom displays esri secite ek woe eee cls ee eR ee ee ee 151 Connection patient room and patient ID 2 ees 152 EQUIDMENtGIEMS 5440 004 Sea e al orna a aed adeeb aeeae be Yeas 154 Alara I
29. Recommended action status icon Icon display priority Icon location on map Messages in hallway message panels and at top of Acuity Central Station screen Alarm Tone Suspended with No Violation Beneath alerts and alarms Locations representing None monitors with audible alarm tones suspended when no alarm or alert violation has occurred At the patient monitor press the Silence Reset key when ready Or At the central station click Resume in the patient s Virtual Monitor when ready color reflects current status of monitor Wireless When the View Wireless None button is pressed in the lower left corner of the Acuity Central Station screen this icon appears in map locations where wireless monitors are actively communicating with Acuity System Unconfirmed Patient ID Unconfirmed Room Number Some Alarm Limits Off Low level alert Low level alert Low level alert Locations representing None monitors with unconfirmed patient IDs Wireless monitor map None areas representing patients with unassigned or unconfirmed room numbers Locations representing None monitors with alarming for some vital signs set to off In the patient s Virtual Monitor click Setup Patient ID Confirm or enter ID information In the patient s Virtual Monitor click Setup Patient ID Confirm or enter a room number In the patient s Virtual Monitor click Setup Alarms
30. SETUP MORE NEXT to highlight the selected source and then CHANGE to highlight Sp0z WARNING All heart rate alarms are valid even if the HR value at A the central station differs from that at the monitor If your system includes an Arrhythmia Analysis option the Acuity System heart rates for adult and pediatric patients are a result of system software analysis The HR PR numeric changes to in the Virtual Monitor Waveform Window review windows and system printouts when the system detects ventricular fibrillation or asystole However an apparently valid heart rate numeric might show in the patient monitor Directions for use Chapter 10 Troubleshooting and maintenance 157 Table 14 Troubleshooting patient alarm indications Problem Explanation A false alarm occurred for Heart rate ECG ST analysis or arrhythmia analysis Alarms are not occurring for some alarm limit violations A WARNING Ensure these things to minimize false HR Arrhythmia Analysis and ST Analysis alarms and to achieve optimal event detection and analysis e ECG cable lead wires and electrodes are undamaged Patient s skin is properly prepared e Electrodes are placed using standard good practices e5 wire ECG cable is used A 3 wire cable limits arrhythmia and ST segment analyses to a single lead and ST analysis is disabled when a lead failure occurs eLL electrode is connected Otherwise only one ECG lead is available and a
31. ST segment deviation values iL 2 3 In the patient s Virtual Monitor click Setup ST Analysis The ST Analysis Setup window appears ST Analysis fon ort Measurement Offset ms 60 80 Auto Print on Alarm On Off 7 lead Il 7 lead Alarm Limits mm Alarm Level Lower 2 0 lt Upper 2 0 lt HIGH MED LOW OFF Ala alse Presets _ST RELEARN Undo Close Beneath the waveforms click the arrows to select the leads used for one or both lead displays View current ST segment deviation values in the Deviation column Alarm values are red Graphical trend values are shown in the Graphical Trends Review window For instructions on how to view ST trends see Review graphical trends on page 99 Directions for use Chapter 4 Adjust monitoring settings and patient information 73 Set analysis preferences for a patient s ST analysis To set analysis preferences for ST analysis 1 Inthe patient s Virtual Monitor click Setup ST Analysis The ST Analysis Setup window appears J points green ST Analysis fon off Measurement Offset ms 60 80 Auto Print on Alarm On Off Lead tl Alarm Limits mm Alarm Level Lower 2 0 Upper 2 0 lt HIGH MED LOW OFF aa aly Presets _ST RELEARN 2 Leads In the Lead column check leads to be used for ST Analysis Depending on the patient monitor some of these choices cannot be deselec
32. Set alarming indications e Print on Alarm Click On or Off to specify whether central station alarm printouts occur for ST Analysis alarms e Alarm Level Click to set the alarming level priority for ST alarms For a description of alarm levels see Table 6 on page 95 If you set Alarm Level to OFF the system continues ST Analysis for checked leads but it generates no ST alarms Directions for use Chapter 4 Adjust monitoring settings and patient information 75 Initiate a relearn of a patient s reference beats for ST analysis Description of the Relearn function Arrhythmia and ST relearn is an Arrhythmia Analysis function that causes the Acuity system to relearn a patient s normal ECG rhythm The Acuity System uses the relearned rhythm as a guideline to identify arrhythmia events arrhythmia relearn and to analyze deviation of the ECG ST segment offset ST relearn If you want to establish a new ST reference beat without changing the normal ECG rhythm used for arrhythmia analysis initiate relearn in the ST Analysis Setup window When ST relearn occurs for a patient e Only ST reference beat learning occurs when ST RELEARN is clicked in the ST Analysis Setup window e ST relearn also occurs along with Arrhythmia relearn when certain buttons are clicked in the Arrhythmia Alarms Setup window For details see Initiate relearn of a patient s ECG rhythm on page 63 What occurs in a patient s windows during and after ST RELEARN
33. Specifications 199 Table 43 Review window OxyCRG Features Factory default HR PR and SpOy trend data Trend data transferred from the patient s monitor CO and respiration data Graphed as lines connecting each successive data point PR from NIBP source graphed as single values Graphed as very small squares Displays as waveforms Time span CO or RESP selected Cursor bar position HR PR and CO labels to the right of the Graphical Trend display Presets values Blue cursor bar shows Two minutes If CO readings were taken in last 24 hours CO is selected if no CO readings taken but RESP readings were taken RESP is selected At right edge of most recent period monitored or if another review window was viewed first the period is centered around the cursor bar position in the first viewed review window Reflects label selected at the monitor during the current time position of the cursor bar Trend scales similar to monitor factory Trend Graphs values For further information see the monitor directions for use CO range 0 mmHg to 60 mmHg RESP scale 2x Vital sign numerics 24 hour or up to 96 hour time line indicates patient and equipment state Time line color matches icon color at all points in time Printouts Graph 200 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System 201 Warranty LIMITED WARRANTY ACUITY CENTRAL MONITORING SYSTEM AN
34. Station display is determined by Acuity System Arrhythmia Analysis software and patient monitor display is determined by patient monitor Patient monitor HR can be different from Central HR If a patient monitor alarms for HR and Central does not alarm Acuity Central Stations with software versions 6 31 can receive a Check HR PR equipment alert The time delay for this alert is configurable by the system administrator Acuity System Arrhythmia Analysis software calculation The beat to beat heart rate HR value is calculated as follows HR 60000 actual RR bpm Actual RR time between last detected ORS complex and previously detected ORS complex ms The average heart rate is calculated on the basis of the mean RR interval of the last 16 beats unless the heart rate calculated using the last four beats is less than or equal to 48 then this rate is used Acuity System without Arrhythmia Analysis option Acuity Central Station and patient monitor displays are determined by the patient monitor Time delay between patient monitor HR alarm and Acuity Central Station display of alarm 10 s default configurable Propag LT and Micropag monitors calculation determined by monitor Propaq CS and Encore monitors calculation Heart rate 60 latest average interval in seconds For higher heart rates latest average interval 7 8 of previous average interval 1 8 of latest interval For lower heart rates latest average inte
35. Station screen Recommended action E Locations representing None When you are ready begin unused ports available monitoring from this Port Icon for monitoring Acuity location System patients Locations representing None Wait until communication monitors establishing is established before you communication with open the Virtual Monitor Acuity System or Waveform Window Locations representing None If you have pressed the monitors disconnecting NET OFF key unplug from Acuity System monitor from Acuity System within 15 seconds or Acuity System reconnects Locations representing None If communication between monitors from which the patient and Acuity Patient Intentionally patients have been System is reestablished Disconnected intentionally the CONFIRM PATIENT disconnected prompt appears This icon also appears Click YES to reconnect the during Manual NIBP Only original patient to Acuity monitoring and spot System Sp02 monitoring but does not affect alarming at Acuity E Beneath alerts Locations representing None and alarms patients monitors that Patient Monitoring OK are not in an alarm or alert state Beneath alerts Locations representing None Auto NIBP Only Monitoring and alarms monitors that are only monitoring NIBP automatically 140 Chapter 9 Status icons Welch Allyn Acuity Central Monitoring System Table 8 Icons and messages that represent patient and monitor status Patient monitor
36. Window is an abbreviated Virtual Monitor E ECG lead F Note G Patient mode alarm and alert messages A Alarm Reed Erlandson te Adult limits To Radiology D Patient monitor status C Snapshot printing area B Vital sign values icon A Alarm limits Alarm limit settings B Vital sign values C Snapshot printing area D Patient monitor status icon E ECG lead F Note G Patient mode alarm and alert messages Vital signs in alarm are shown by numbers in a red field Click in this area to suspend or resume an audible alarm tone An NIBP numeric reduces in size after 16 minutes Click in the waveform area to print a snapshot print at the central printer Click the Patient Equipment status icon to open the Virtual Monitor For details about all status icons see Status icons on page 137 The adjacent waveform is derived from this ECG lead From the Patient ID Setup window you can type a temporary note to appear here For details see Add or remove a note in a patient s Waveform Window on page 81 Alarm and alert messages replace the patient mode indicator Color indicates status red alarm yellow alert green patient vital signs within limits and normal equipment operation and blue intentional disconnection To open a patient s Waveform Window A patient s map icon e On the Acuity Central Station screen map click the patient s map icon Note f you are viewing from a Pati
37. alarm 90 event definitions 54 Events Review window 107 Events Review window specifications 198 204 Index false alarms 159 Full or Lethal Only options 54 learning period during 64 78 91 162 171 lethal definition of 52 95 pacemaker patients and 62 physiologic differences 66 Print On Alarm 62 74 remove a latched alarm 87 terms 52 troubleshooting 161 types detected 66 Artifact definition of 52 Asystole definition 55 not detected 161 Auto prints setting up 49 Auto Set button 46 B Barcode scanner 40 Bigeminy definition 56 Border Virtual Monitor color 83 Buttons system 19 C Cable check network 172 network 38 Cabling altered causes system restarts 3 Central Station Acuity System 10 Printer window 50 screen overview 16 windows 145 CHECK HR PR alert 89 CHECK LEADS alert 93 Clinician Notifier 10 148 C02 indicator 23 OxyCRG print setup 49 response time 44 trouble changing units 160 Colors status icons 137 window border 22 24 Communication Alert message 154 Compatibility Acuity System and monitors 175 Compliance with safety standards 184 Compliance with safety standards 7 Components Acuity System don t change 3 Welch Allyn Acuity Central Monitoring System inspect 172 overview of 10 Confirm patient ID or room 40 Connecting hardwired monitors to Acuity System 28 troubleshooting 151 wireless monitors to Acuity System 31 Connectivity server 1 Couplet definition 56 D Data re
38. alerts 24 border color 83 monitor status icon 23 numeric display 181 open from map 21 opening 12 24 98 patient status icon 23 select waveforms display 51 specifications 189 VRhythm definition 56 VTach definition 55 Directions for use W WACS 1 10 Warnings and cautions arrhythmia analysis 66 connecting monitor to Acuity System 37 ST Analysis 69 suspending alarm alert tones 85 Waveform Window Acuity Central Station screen 16 add patient note in 81 border colors 22 close on Acuity System screen 51 close on PLR Acuity System screen 12 numeric display 182 open from a PLR station 12 open from map 21 open from the map 22 patient note in 22 print a Snapshot 22 resume alarm tones from 22 Setup window 51 Setup window specifications 194 STATSCALE button 44 suspend alarm tones from 22 Waveforms optimize display 44 Review window 104 Review window specifications 197 select for display 51 set sweep speed 44 view from all leads 24 Welch Allyn Connectivity Server 1 10 Technical Service 149 Window border Virtual Monitor 24 Waveform Window 22 Wireless be sure communicating 37 intermittent signal dropout 5 159 map icons 21 monitoring devices 21 patients 19 reconnect icon disappears 152 starting monitoring 31 view all wireless patients 19 Index 209 210 Index Welch Allyn Acuity Central Monitoring System
39. are selected for display in the Virtual Monitor Types of alarm printouts e Vital sign e OxyCRG e Arrhythmia event e ST segment deviation Set printing on alarm To learn how to set Print on Alarm for various parameters and events see these pages e For vital sign and OxyCRG alarm printing see Adjust preferences for a patient s central station printouts on page 49 e For arrhythmia event alarm printing see Adjust preferences for a patient s arrhythmia alarming on page 61 e For ST segment deviation alarm printing see Set alarm preferences for ST Analysis on page 74 120 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Review an alarm printout Bun Keat Heng 7663123555 K__YCCuU West 1324A Patient ID Location mC 4 May 2000 14 51 03 Portland Westside Medical Clinic WelchAllyn ALARM 25 mm sec Adult Pediatric Q 4 51 10 Vital Signs Summary Comments Time S D M h min mmHg NIBP A Patient name appears if patient is confirmed in the Acuity System Y indicates that this patient is monitored by a wireless monitor C The type of printout D A three second interval mark E An arrhythmia event marker was deleted for this waveform in the Arrhythmia Events Review window F Waveforms shown in a left shaded area are shown also in the preceding band s right shaded area G The printout was initiated at
40. arrhythmia alarm limit An appropriate numeric threshold for an arrhythmia type arrhythmia type A specific arrhythmia category artifact A disturbance or movement of the patient or sensors that adds errors to measured parameters Caused by muscle movement or shivering electrical interference or vibration event The occurrence of an arrhythmia event arrhythmia or ST segment relearn event learning done event or snapshot printout event event marker A notation that indicates the time when an event occurred Event markers appear in most review windows and in some printouts Event notations are Y for arrhythmia alarms Y for arrhythmia events and W for relearn and snapshot events lethal arrhythmia The Acuity System defines VFib ventricular fibrillation asystole and VTach ventricular tachycardia as lethal arrhythmias In the Arrhythmia Alarms Setup window the alarm level for these arrhythmia types is permanently set to LETHAL and alarming cannot be turned off PVC Premature ventricular contraction Directions for use Chapter 4 Adjust monitoring settings and patient information 53 relearn An Arrhythmia Analysis function that causes the Acuity system to relearn a patient s normal ECG rhythm The Acuity System uses the relearned rhythm as a guideline to identify arrhythmia events arrhythmia relearn and to analyze deviation of the ECG ST segment offset ST relearn When relearn occurs for a patient Both arrhythmia and S
41. is clicked e ST Analysis Setup window The waveform slice displays NO VALID BEATS and the Acuity System can take up to 30 seconds to update the waveform e Most review windows and some printouts Relearn and Learning Done event markers V appear 76 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System To initiate a relearn of a patient s reference beats for ST segment analysis The relearn operation cannot be undone 1 2 In the patient s Virtual Monitor click Setup ST Analysis The ST Analysis Setup window appears ST Analysis fon ort Measurement Offset ms 60 80 Auto Print on Alarm On Off Lead tl Y leadv Alarm Limits mm Alarm Level Lower 2 0 Upper 2 0 lt HIGH MED LOW OFF Aa ale Presets ST RELEARN Undo Close Carefully evaluate the patient s current ST segment for all active leads to ensure that you want the Acuity System to establish the beat as the patient s reference beat for ST Analysis Click ST RELEARN The waveform area displays NO VALID BEATS for up to 30 seconds The current beat for each ECG lead becomes the reference beat and the deviation value for each current beat becomes zero Closely examine the current ST segment for all active leads to ensure that the Acuity System has defined an appropriate ST analysis reference beat Directions for use Chapter 4 Adjust monitoring settings an
42. level alert Acuity Central Station Equipmen Contact qualified service pm area personnel Central Component s Also various Problem messages in hallway message panels Low level alert Acuity Central Station Check Panel Contact qualified service area personnel Hallway Message Panel Problem Low level alert Acuity Central Station Swap Space Low The system will reboot area Contact qualified service Swap Space Low personnel Low level Acuity Central Station Check Network Contact qualified service alert but in area personnel Acuity System certain Network Problem circumstances no other alarms or alerts can occur during this alert Directions for use Chapter 9 Statusicons 147 Table 9 Icons and messages that represent the status of Acuity System components Acuity System component icon Icon display priority Icon location on map Messages at top of Acuity Central Station screen Recommended action Central Printer Problem Central Printers OK Low level alert Yellow icon appears at Acuity Central Station area and in the Central Station Printer window if printer has a problem Blue icon appears only in the Central Station Printer window Indicates that the printer is normal Yellow icon Check Laser Printer 0 Printing Disabled Click the yellow icon to open the Central Station Printer window and click al to open the Printers View Determine the problem Check all printers
43. monitor If you would like to add a note to a patient s Waveform Window regarding a move you can do so in the Patient ID Setup window For instructions see Add or remove a note in a patient s Waveform Window on page 81 A WARNING Always check alarm limits when a monitor reestablishes communication with the Acuity System If you change limits at a monitor while it is not communicating with the Acuity System for example during transport or signal dropout when you reestablish communication with the system the limits might change to Acuity System Presets values 126 Chapter7 Move a monitored patient Welch Allyn Acuity Central Monitoring System Arrange a patient move from the Acuity Central Station If you want to arrange a patient transfer to another unit you must do so in the unit from which the patient is transferring To arrange a patient move from the Acuity Central Station 1 In the lower left corner of the Acuity Central Station screen click g The Patient List window opens Click the patient name Click Transfer The Transfer Patient window appears Click the unit name in the list even if the patient will stay in the same unit Take one of these steps e f you know the room number click the new room e f you do not know the room number click UNASSIGNED You can enter the room number later via the Patient List or the Virtual Monitor Click Confirm If the patient is currently connected to a hardwired patient mo
44. n e Beh eee eeu ised yoke ae bean er da Mile Rial e 1 COMVEMUOMS a asas tar ts Tad Meee el tte da bk dese lett J3 os Bese Aad ca thn beet tated Mba og 2 General warnings and Cautions 2 2 0 eens 3 Acuity System compliance with safety standards 0000 7 Related documents ac Ms eae ecole owen a pita A aa eel See ee 8 2 Acuity System OvervieW 0 cc eee eee 9 Systemi COMIGUrATIONS sanae a E a AE Bates Se Dees a AA estate yeah 9 C nttalstation SCreSN enmen se aaae Ste ats na i Bee ake RARS 16 3 Admit and begin monitoring 0 0c eee es 25 Preadmit a patient to Acuity System monitoring 00005 25 Readmit a discharged patient 0 0 0 0 0000 eee ee 27 Begin patient monitor communication with the system 004 28 Enter and confirm a patient s ID or room at the central station 40 4 Adjust monitoring settings and patient information 43 Set up typical monitoring at the Virtual Monitor 02000 43 Adjust a patient s alarm limits 0 onnaa aana aaa 46 Adjust general printing Settings 00 eee 48 Adjust a patient s waveform displayS 0 0 0 00 e cee eee 51 Arrhythmia Analysis option 2 20 00 00 eee 52 STAnayS S ODIO 0s eae adevg the aa aw E a e eects sg T een ae ee 69 EditipatientintOrmatlon three et a Ie Bea Al a eg Mea EU 79 5 Respond to alarms and alerts 000 c cece eee eens 83 Overview of central station
45. pacer pulse detection range with or without AAMI EC13 2002 tails of 4 8 15 25 50 75 or 100 ms decay time constant whose tail amplitudes meet either EC13 s method A or method B specifications whether ventricular only or A V sequential pulses 150 and 250 ms separation all per AAMI tests 4 1 4 1 and 4 1 4 2 a Rejects method B overshoots for pulse width x pulse amplitude lt 3 x 104 V sec Directions for use Chapter 11 Specifications 179 Acuity System alarm and alert indications Table 25 General Acuity System alarm and alert indications Feature Numeric update time after Acuity System receives alarm indication from a patient s monitor Specification Within 1 s Acuity Central Station tone volume Audible alarm or alert tone delay time to patient s monitor Installation choice hourly settings 10 s configurable up to four minutes 15 seconds Audible alarm or alert tone suspension time and activation 90 s activated individually for each patient Note frequency range and pause length for different types of tones Latched alarms Monitor equipment alerts 1 A 440 0 Hz pause 2 45 s Low level alarms 3 Es 660 0 Hz 1 s apart pause 1 25 s Medium level alarms 1 A 880 0 Hz coupled with 1 C 5 554 0 Hz pause 0 5 s High level alarms 3 A 880 0 Hz pause 5 6 s Lethal alarms 4 A 880 0 Hz with harmonics pause 0 8 s Visual latching When feature enabled the
46. rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move 64 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System A WARNING In Acuity Systems that include an Arrhythmia option a relearn function causes the system to learn a patient s normal ECG rhythm If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as a normal Thereafter rhythms of this type might not trigger an alarm A relearn event can be initiated by a user or by the system System relearns are in response to these circumstances e Patient connection e Lead change or failure e System restart During an arrhythmia relearn event the system posts a RELEARN alert in the patient s Virtual Monitor and Waveform Window Carefully observe a patient during an Acuity System learning period During learning the system detects only VFib and asystole arrhythmias After a relearn event Relearn and Learning Done event markers W appear in most of the patient s review windows and some printouts After relearn carefully evaluate the new ECG rhythm and the current ST segment for all active leads to ensure that the system learned an appropriate rhythm For evaluation instructions see To respond to a RELEARN alert
47. segment deviation values 1 Inthe patient s Virtual Monitor click Setup ST Analysis The ST Analysis Setup window appears ST Analysis beviation fon off Measurement Offset ms 60 80 Auto Print on Alarm On Off Y lead Il Alarm Limits mm Alarm Level Lower 2 0 lt Upper 2 0 HIGH MED LOW OFF Ala ale Presets _ST RELEARN Undo Close 2 Beneath the waveforms click the arrows to select the leads used for one or both lead displays 3 View current ST segment deviation values in the Deviation column Alarm values are red Graphical trend values are shown in the Graphical Trends Review window For instructions on how to view ST trends see Review graphical trends on page 99 Directions for use Chapter 6 Review or print patient data 113 Review OxyCRG information Full Disclosure option In the OxyCRG review window you can review and print oxygen cardiorespirogram information in these ways Scroll respiration and CO waveforms and graphical trend data for HR PR and SpO5 Locate red alarm periods along the trend graphs Click graphs to see vital sign values Jump to the next or previous alarm Open an OxyCRG Review window To open an OxyCRG Review window 1 Optional In the upper left corner of the Acuity Central Station screen click or to change the screen view to see a larger review window Open the window for one of these types of patients Curren
48. that the some Virtual Monitors have changed software is not performing at desired levels it restarts auto reboots in a color or disappeared controlled sequence to return the software to normal operation Paired Acuity Systems include a second high availability HA CPU for back up monitoring in the case of monitoring interruption If one CPU of an HA pair ceases operation the other CPU assumes control of the Acuity Central Station display s A yellow indicator on a display shows that an HA CPU switchover has occurred and the display is receiving input from the HA CPU for details see page 13 In both cases on the Acuity Central Station display s typically some virtual patient monitors re appear quickly and the rest appear one by one over the next one to three minutes Some Virtual Monitors may take approximately five minutes to re appear To respond to an HA CPU switchover 1 Ifa Virtual Monitor appears in a new yellow alert state take these steps to return it to the green state a Read the message to confirm the patient identity b Click the appropriate button WARNING If normal central processing unit CPU operation is A interrupted for example during CPU maintenance scheduled and unscheduled reboots power loss or a high availability HA CPU switchover period central station monitoring and analysis temporarily stop The Acuity System cannot collect patient review data during the interruption period Tha
49. this time H The vital signs summary appears when three or less waveforms per strip are chosen for printouts The box remains empty when no NIBP measurements have been taken within the last eight hours Directions for use Chapter 6 Review or print patient data 121 Patient List printouts You can print lists of patients in your unit If your system is part of an Acuity System network you can print lists of patients in any units within the network Types of Patient List printouts Preadmitted patients Patients pre admitted to the Acuity System within the last 24 to 96 hours Current patients Discharged or non monitored patients Patients who have been monitored by the Acuity System in the last 24 to 96 hours depending upon your system configuration Patients listed in Patient List printouts To print a Patient List printout 1 In the lower left corner of the Acuity Central Station screen click S The patients shown in the Patient List window are those assigned to your Acuity System unit Take one of these steps e To print the current list proceed to Step 4 e To list patients in another networked Acuity System unit click Other Patients The Other Patients List appears Click Unit and then select the unit name from the box on the right Patients are listed by unit Click a column heading to sort the list by name location or ID Actively monitored patients are listed at the top Click Print List A pr
50. 2 d AN Arr Alaras Sigh Fri 15 46 26 ANI Arr Events High fr 15 47 15 ae Stl 00 00 r 08 00 Ja 48 72 96 Delete ARR Events Event in events list section To display waveform s that correspond to an event 1 In the events list section click an event The corresponding waveform s appear in the waveform pane and the blue cursor bar indicates the event Scroll the waveform Click or to scroll forward or backward Click A gt or 4 to page forward or backward Click V gt or to jump to the next or previous arrhythmia event Click e or to jump to the next or previous arrhythmia event of the same type that is currently indicated by the cursor bar To select and adjust the waveform s 1 Check boxes under Waves to display waveforms from different ECG lead sources Up to seven waveforms can fit in the window If you see less than seven waveforms and you prefer more click in the upper left corner of the Acuity System screen to change to the full screen view Click Scales and then make a selection Directions for use Chapter 6 Review or print patient data 111 Delete or undelete an arrhythmia event marker from review windows and printouts Advanced Arrhythmia Analysis option aana AAA AAAI AAAAAAAAMAAAAAAAA AN tomy yy DDI DD DDD ID DID DDIM E a pesesse 12 AN Arr Alares 12 All Arr Events as Delete ARR Events Scales r Print Close Event cou
51. 3 100 12 12 23 For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where Pis the maximum output power rating of the transmitter in watts w according to the transmitter manufacturer Note 1 At 80 MHz and 800 MHz the separation distance for the higher frequency range applies Note 2 These guidelines might not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 188 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Acuity System customizable defaults and factory defaults Acuity System default settings appear in Acuity System windows upon patient monitor connection when a patient s window is first opened There are two types of Acuity System default settings e Customizable default settings Settings that can be customized to match your clinical workflow model at the point of installation e Factory default settings Settings that are shipped from the factory These settings cannot be changed Hardware specifications for Acuity System components are listed in the manufacturers manuals Specifications published in this manual are subject to change Central Station windows Table 30 Acuity Central Station Printer window Features Printing order of print requ
52. ARNING Turning off alarming for arrhythmia types and ST Analysis disables both audio and visual alarm indicators Although alarming for lethal arrhythmias cannot be turned off patients susceptible to arrhythmias must be kept under close physical surveillance if their alarming has been turned off for any arrhythmia types gt WARNING If a patient s ST analysis is turned off the patient s ECG is not analyzed for ST segment deviations ST alerts or alarms are not generated and ST information is not stored as graphical trends The Acuity System can be configured to set ST analysis to Off as a default setting For further information see your system administrator gt 162 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Problem Explanation A A WARNING In Acuity Systems that include an Arrhythmia option a relearn function causes the system to learn a patient s normal ECG rhythm If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm A relearn event can be initiated by a user or by the system System relearns are in response to these circumstances e Patient connection eLead change or failure e System restart During an arrhythmia relearn event the system posts a RELEARN alert in the patient s Virtual Monitor and Waveform Window Carefully observe a pa
53. ATS and the Acuity System can take up to 30 seconds to update the waveform e Most review windows and some printouts Relearn and Learning Done event markers W appear 54 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Arrhythmia event definitions The Acuity System Arrhythmia Analysis module is not an atrial arrhythmia analysis package Depending upon which arrhythmia analysis option that your Acuity System includes your system detects one of these groups of arrhythmia types e Lethal Arrhythmia Analysis option The system detects only lethal arrhythmias VFib asystole and VTach e Full Arrhythmia Analysis option The system detects lethal arrhythmias VFib asystole and VTach and all of the arrhythmia types shown in Table 5 on page 56 Normal sinus rhythm Table 3 Normal sinus rhythm QRS Normal sinus rhythm example P R interval R O T interval ORS duration Directions for use Chapter 4 Adjust monitoring settings and patient information 55 Lethal Arrhythmia Analysis option events detected Table 4 Definitions of lethal arrhythmia events Arrhythmia event and definition Waveform example VFib ventricular fibrillation Chaotic quivering of the ventricles accompanied by rapid irregular waves but no formed ORS complexes WAV Verein fn Asystole Absence of any detected beat for 4 or more seconds VTach ventricular tachycardia
54. Acuity and Mobile Acuity LT Central Monitoring Systems Directions for use Software version 8 2x WelchAllyn Advancing Frontline Care ii Welch Allyn Acuity Central Monitoring System 2013 Welch Allyn All rights are reserved To support the intended use of the product described in this publication the purchaser of the product is permitted to copy this publication for internal distribution only from the media provided by Welch Allyn No other use reproduction or distribution of this publication or any part of it is permitted without written permission from Welch Allyn Welch Allyn FOSS This product may contain software known as free or open source software FOSS Welch Allyn uses and supports the use of FOSS We believe that FOSS makes our products more robust and secure and gives us and our customers greater flexibility To learn more about FOSS that may be used in this product please visit our FOSS website at www welchallyn com opensource Welch Allyn assumes no responsibility for any injury to anyone or for any illegal or improper use of the product that might result from failure to use this product in accordance with the instructions cautions warnings or statement of intended use published in this manual Welch Allyn Acuity AcuityLink Propag Micropaq Flexible Monitoring and FlexNet are registered trademarks of Welch Allyn ParamSet is a trademark of Welch Allyn For patent information please vis
55. Class A a When the equipment is operated in a commercial environment Class A limits provide reasonable protection against harmful interference The equipment generates uses and can radiate radio frequency energy if it is not used in accordance with this reference guide or if it is modified from original installation it might cause harmful interference to radio communications Operation of this equipment in a residential area is likely to cause harmful interference in which case the user is required to correct the interference at his own expense 7 8 Chapter 1 General information Welch Allyn Acuity Central Monitoring System Related documents Acuity and Mobile Acuity LT Central Monitoring Systems Directions for use Acuity and Mobile Acuity LT Central Monitoring Systems directions for use and in service guide CD ROM multilanguage Acuity and Mobile Acuity LT Central Monitoring Systems directions for use Acuity Central Monitoring System in service guide English Mobile Acuity LT installation guide printed Mobile Acuity LT System installation guide En Fr Ger Sp It Pol Quick card Acuity System Icons English printed Welch Allyn Connectivity Server WACS Welch Allyn Connectivity Server WACS CD ROM English Welch Allyn Connectivity Server directions for use Welch Allyn Connectivity Server programmer s guide AcuityLink Clinician Notifier directions for use AcuityLink Clinician Notifier Software Acui
56. D ACCESSORIES This product is sold by Welch Allyn under the warranties set forth in the following paragraphs These warranties are extended only to the end user with respect to the purchase of this product directly from Welch Allyn or Welch Allyn s authorized distributors as new merchandise For a period of 12 months 1 year from the date of original delivery to the buyer the Acuity Central Monitoring System is warranted to be free from functional defects in materials and workmanship and to conform in all material respects to the description of the product contained in the directions for use and accompanying labels and or inserts For a period of 90 days this same warranty is made for accessories provided by Welch Allyn Warranty of accessories purchased separately from listed suppliers will be the responsibility of the listed suppliers This warranty is valid only if a the Acuity Central Station processing unit and monitor and the terminal servers are used with a continuous power source b all network equipment and cabling are approved for use with the Acuity System by Welch Allyn c the product is properly operated under conditions of normal use in accordance with applicable safety and regulatory requirements d replacements and repairs are made in accordance with the instructions provided by Welch Allyn e only the Acuity System or other software authorized by Welch Allyn is used on the workstation f the product has not been config
57. ID assigned C Acuity Central Station D Patient monitor status icon E Inactive Acuity System location C Acuity Central Station A Networked Acuity Systems These status icons represent networked Acuity Systems and they indicate the state of communications with the networked systems B No ID assigned No patient ID number has been assigned to the patient connected to this monitor C Acuity Central Station Icon indicates the Acuity Central Station status Click to open the Acuity Central Station Printers window Directions for use D Patient monitor status icon E Inactive Acuity System location Wireless Monitor F Room assigned G No room assigned Chapter 2 Acuity System overview 21 Icons appear at locations with active monitors Click a map icon once to open the patient s Waveform Window or twice to open the Virtual Monitor For details about all map icons see Patient monitor status icons on page 138 No hardwired monitor is connected to this Acuity System port or no wireless monitor has been assigned to this location A room number has been assigned to this patient connected to a wireless monitor No room number has been assigned to this patient connected to a wireless monitor The number is the device ID number and it is replaced by the room number after the room number is assigned 22 Chapter 2 Acuity System overview Waveform Window Welch Allyn Acuity Central Monitoring System A Waveform
58. MS 2 52 aren Rte e A BL Aa ek Gs ate ed aoe Boas ites 155 Patient alarm indications 0 eee eee eee 156 Heart rate and ECG displays 5 566464 nd ed odo Ra ke eA tekita kre eikit 159 CO SpOo IPI and NIBP displays 0 0 0 maaa a aa eee 160 Arrhythmia Analysis and ST Analysis 0 0 0 0 0000 cece eae 161 PRIMING ss ogee amp cae E E EE EEE EE T EEE des Aten dee BA aac 163 Maintenance Adjust Acuity System time ares sest eae i a a aa E e eee 164 Identify or change a monitor s network name ESSID 165 Mobile Acuity LT Systems Adjust localization parameters 169 POWE routage inca ote nodes nats walt T nee Sahay aoe se eng aes 170 Periodically check equipment for safety 00 0 e ee eee 172 EQUIPMENT disposal giie cone eo tence heeded wench ware ae Rue te Side heb et 173 Directions for use Chapter 10 Troubleshooting and maintenance 151 Troubleshooting WARNING Replace central station hardware within the the lesser of 3 years or the original equipment manufacturer s specification Failure to perform preventative maintenance can impact system performance and availability Central station displays Table 10 Troubleshooting the central station display Problem Explanation One or more of the Acuity Central As a preventative measure the Acuity Central Station monitors its central Station screens are blank or frozen or processing unit CPU software performance levels If it detects
59. NGE WARNING Always check patient mode in the border of the Waveform Window or Virtual Monitor Incorrect patient mode can result in unsuitable alarm settings inaccurate heart rate readings and inappropriate arrhythmia and ST segment analyses Temporarily suppress the 1 SUSPEND Although any alerts for this patient are displayed SUSPEND potential for audible 2 When ready to return to suppresses alert tones for 90 seconds alarm tones normal monitoring RESUME Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Table 2 Typical monitoring functions at the Virtual Monitor Response time Sp0 and CO Task Clicks at Virtual Monitor Notes Propaq Encore and CS monitors Set Sp07 response time Propaq Encore and CS monitors Set C03 response time 1 Sp02 or Sp02 C02 2 Sp02 3 MORE 4 RESPONSE p02 C02 c02 MORE RESPONSE ae Can be changed also at the patient monitor Can be changed also at the patient monitor Waveforms and pacer display Adjust sweep speed of 1 MAIN MENU Waveform sweep speed changes in the Virtual Monitor and all waveforms except 2 MORE Waveform Window CO and RESP 3 MORE 4 NEXT You can adjust RESP sweep speed separately in this window 5 CHANGE and CO sweep speed changes with it Optimize all waveform 1 MAIN MENU Waveforms are adjusted for best display in the Virtual scales except C03 2
60. No displays in Virtual Monitors in bump those not in alarm are not automatically Virtual Monitor alert state are not when necessary displayed automatically displayed Indications Violating vital sign s numeric Equipment Alert status No indications in Specific message is highlighted means window appears in Virtual Virtual Monitor in border measured values fall above Monitor the monitor s range Status icon means they fall below and For most a specific message 227 means they could not be appears in border measured Status icon Specific message appears in border Status icon Message Displays highest level lf more than one monitor No messages in Alarms and Priority message for each patient equipment alert occurs for Virtual Monitor monitor one monitor at once a Multiple message appears in border equipment alerts take priority over low level alerts 182 Chapter11 Specifications Welch Allyn Acuity Central Monitoring System Table 28 Alarm and alert indications at the Waveform Window Alarms Monitor equipment System wide Patient red alerts equipment information yellow alerts alerts yellow yellow Display Priority Acuity System automatically displays Waveform Windows in No displays in Waveform Waveform Windows in alarm state in alert state are not Waveform Windows in all views containing Waveform automatically displayed Window alert state Windows are not automatically Wave
61. PATIENT HR PR alert A patient monitor uses a single lead to calculate heart rate and an Acuity System with an Arrhythmia Analysis option uses more sophisticated arrhythmia analysis algorithms Thus the patient monitor and Acuity Central Station heart rate readings for the same patient can differ Differences mostly occur in response to these conditions e Rare ECG morphologies such as tall T waves e Certain paced rhythms e Noise or artifact If the patient monitor displays a higher heart rate it can present a heart rate alarm that the Acuity Central Station does not present If this condition occurs for a defined period the patient s Acuity System Virtual Monitor might display a silent equipment alert as defined by your system administrator to inform you of the monitor alarm If the heart rate alarm stops at the patient monitor the Acuity System dismisses this message Note You can attempt to reduce erroneous or nuisance heart rate alarms if the patient monitor is a Propag LT CS or Encore For instructions see Table 14 on page 156 To dismiss a CHECK PATIENT HR PR alert CHECK PATIENT HR PR DISMISS allt RENU Review T Suspend Snapshot Close e Click DISMISS The patient s Virtual Monitor and Waveform Window return to the green patient monitoring OK state 90 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System Dismiss an arrhythmia or ST alarm me
62. ST Analysis The ST Analysis Setup window appears ST Analysis on off Measurement Offset ms 60 80 Auto Print on Alarm On Off 5 lead il I Measurement J J points A Current beat white offset x Deviation mm rae JA B Deviation from 35 reference beat dell ai 0 6 2 3 09 C Measurement leads T lead D Isoelectric reference Alarm Limits mm Lower 2 0 lt Upper 2 0 lt alg Al de Presets Alarm Level baseline green HIGH MED LOW ORK H Setup window buttons G Display leads F Undo button To examine the ST Analysis Setup window A Current beat white B Deviation from reference beat C Measurement leads D Isoelectric reference baseline green E Reference beat green F Undo button G Display leads H Setup window buttons The current beat is shown for one or two leads Deviation mm or mV of the current ST segment offset from the reference ST segment offset for each lead Red numbers indicate alarm values Analysis is performed on the selected leads Horizontal line marks the isoelectric reference baseline for the ECG waveform The reference beat is learned when the Acuity System learning or relearn function occurs Undoes what has been done since the window was opened except ST RELEARN and measurement Lead choices One or two active leads can be displayed Open Alarms Printouts Waveform Window Arrhy
63. ST Arr Relearn Print on Alarm Alarm Arrhythmia Level Pause Irregular NonCapture Options Pause Limit Irregular Limit Single ECG Pacer Display Analyze Pacers 2 Click Alarms Set Arrhythmia Off Shelly F Phelps Printon Alarm Undo Close In the patient s review windows arrhythmia event markers appear as Y However lethal arrhythmia events still appear as Yy 60 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Adjust a patient s arrhythmia alarm limits A WARNING f you set the bradycardia alarm limit higher than the HR lower limit the Acuity System adjusts the HR lower limit to the new bradycardia limit If you set the tachycardia limit lower than the HR upper limit the Acuity System sets the HR upper limit to the new tachycardia limit In either case a message appears in the upper border of the Arrhythmia Alarms Setup window telling you HR alarm limits have changed A WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move To adjust a patient s arrhythmia alarm limits 1 Inthe patient s Virtual Monitor click Setup Arrhyth
64. Setup window Type of beats for which Non ventricular beats analysis is performed Offset to measurement Auto ms ms or mV The Auto setting allows the Acuity System to select the offset based on the heart rate If the sustained heart rate is greater than 120 beats per minute Acuity System chooses 60 ms at 120 beats per minute or less Acuity System chooses 80 ms Print on alarm Off Alarm limits 1 0 mm Alarm level Low ST alarms have a priority below arrhythmia alarms set to the same level Arrhythmia alarms are displayed before ST alarms Selected leads for ST Micropag and Propaq LT monitors analysis e 5 wire ECG cable all seven leads e 3 wire ECG cable The lead selected for ECG1 displays in the Virtual Monitor Maximum of one active lead at one time Propaq Encore and Propag CS monitors e 5 wire ECG cable The leads selected for ECG1 and ECG2 display in the Virtual Monitor e 3 wire ECG cable The lead selected for ECG1 displays in the Virtual Monitor Welch Allyn 1500 Patient Monitor e 10 wire ECG cable The leads selected for ECG1 and ECG2 display in the Virtual Monitor e 5 wire ECG cable The leads selected for ECG1 and ECG2 display in the Virtual Monitor e 3 wire ECG cable The lead selected for ECG1 displays in the Virtual Monitor Depending upon the monitor some of these leads cannot be deselected Trending ST segment shifts are recorded in continuous trend data every second The user
65. Source HR PR source at the patient No Continuous Heart Pulse Rate Source receive continuous heart pulse rate signals If monitoring began without an HR PR source the icon remains blue monitor Silence or suspend the audible alarm tone 143 144 Chapter 9 Status icons Welch Allyn Acuity Central Monitoring System Table 8 Icons and messages that represent patient and monitor status Patient monitor status icon Alarm Tone Suspended Icon display priority Only lethal events interrupt the suspension period All other newly occurring alarms are indicated only visually and the icon image remains the same Newly occurring alerts are not indicated Icon location on map Locations representing monitors for which audible patient alarm tones have been suspended and the alarm state is still active Messages in hallway message panels and at top of Acuity Central Station screen room VT ASYS VF APNEA Limit vital sign Recommended action Attend to the problem and then click the Silence Reset key at the patient monitor or Resume at the central station Directions for use Chapter 9 Status icons 145 System component status icons Acuity System component icons do these things e Show component status e Open Central Station windows some icons Locations of system component icons These icons appear in two places on the Acuity System map e At the Acuity Central
66. Station area e f your Acuity System is part of a network at the Acuity System network area Acuity System network area Acuity Central Station area Acuity Central Station area Opening windows associated with system components If you click some Central Station component icons on the map the Central Station Printers window opens 146 Chapter 9 Status icons Welch Allyn Acuity Central Monitoring System System component status icons and recommended action This table illustrates these things about system component status icons e Display priority e Location on the central station map e Messages at the top of the Acuity Central Station screen e Corresponding messages in message panels when present e Recommended action Table 9 Icons and messages that represent the status of Acuity System components Acuity System icon display Icon location on map Messages attop Recommended action component icon priority of Acuity Central Station screen Beneath alerts Acuity Central Station None Click this icon to open the and alarms area Central Station Printers Acuity Central Station window Components OK EE Beneath alerts Acuity System network None and alarms area if your system is Networked Acuity part of an Acuity network System OK Beneath alerts Optionally at Acuity None and alarms Central Station area if Connectivity Server your system includes a WACS OK Welch Allyn connectivity server WACS Low
67. System should be familiar with its operation as described in this manual and they should understand all warnings and cautions in the manual Conventions A WARNING Indicates conditions or practices that could lead to illness injury or death A Caution Indicates conditions or practices that could damage the equipment or other property pa On the product means Consult the accompanying documentation Directions for use Chapter 1 General information 3 General warnings and cautions Warnings Related to system components and configuration A WARNING Use only accessories approved by Welch Allyn The use of any other accessories can result in inaccurate patient data can damage the equipment and can void your product warranty See the accessory list or visit www welchallyn com A WARNING Always use accessories according to the standards of your facility and according to the manufacturer s directions A WARNING Welch Allyn has verified that Welch Allyn specified network requirements for this Acuity System have been met Altering the cabling or connecting the Acuity System to another type of power source could damage the equipment cause system restarts or hazardous conditions on the network or result in inaccurate patient information at the Acuity Central Station A WARNING Do not change Acuity System components or configuration such as removing or adding a printer or substituting hardware without approval by Welch Allyn Suc
68. T monitor network name 1 2 3 Highlight NetName and press Highlight the new network name Carefully confirm that the highlighted name matches the appropriate Acuity System network name Simultaneously press and gt and hold for one second The Propaq LT monitor turns off and on again and then it attempts to connect to the Acuity System network 168 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Identify or change a Wireless Propag CS network name m To identify a wireless Propaq CS monitor network name and prepare to change it if desired 1 Touch fa SETUP MORE MORE SERVICE YES MORE MORE RADIO The Network Status screen opens and the NET NAME is listed 2 Take one of these steps e f you want to change the network name continue below to To proceed to change a wireless Propag CS monitor network name e If you do not want to change the network name touch BA to return to the main menu To proceed to change a wireless Propaq CS monitor network name 1 Touch CHANGE NET NAME The Change Net Name screen appears N Touch NEXT repeatedly until the new network name is highlighted w Carefully confirm that the highlighted name matches the appropriate Acuity System network name 4 Touch SELECT An ARE YOU SURE confirmation screen appears 5 Respond to the confirmation prompt If you touch YES the Propag CS monitor turns off and on ag
69. T relearn events occur after these things e ST Arr Relearn is clicked in the Arrhythmia Alarms Setup window e Single ECG is clicked in the Arrhythmia Alarms Setup window e Patient connection some lead changes or lead failures system restart Only an arrhythmia relearn event occurs after these things e RELEARN is clicked in the Arrhythmia Alarms Setup window A RELEARN button instead of an ST Arr Relearn button indicates that the system does not include the ST Analysis option e Analyze Pacers is clicked in the Arrhythmia Alarms Setup window ST Analysis is disabled when Analyze Pacers is enabled Only an ST relearn event occurs after this e ST RELEARN is clicked in the ST Analysis Setup window A WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move What occurs in a patient s windows during and after a relearn event e Virtual Monitor and Waveform Window In all instances except clicking ST RELEARN a visual RELEARN alert occurs HR is taken from the patient monitor instead of from the arrhythmia software and real time waveforms display as usual e ST Analysis Setup window The waveform slice displays NO VALID BE
70. To ensure that all displays in a paired CPU system receive input from the same CPU Yellow indicator input received from the Acuity System HA CPU No yellow indicator input received from the Acuity System CPU Acuity System CPU Acuity System HA CPU During normal operating conditions 1 Ensure that none of the displays shows a yellow indicator in the top right corner If none shows a yellow indicator the system is receiving input properly If any display shows a yellow indicator proceed to the next step 2 On any display with a yellow indicator press the video input button generally located on the front of the display All displays now receive input from the Acuity System CPU and alarms and alerts appear on all of them No displays show a yellow indicator During interruption of Acuity System CPU operation 1 Ensure that all displays show a yellow indicator in their top right corners If any display does not show a yellow indicator proceed to the next step 2 On any display without a yellow indicator press the video input button generally located on the front of the display All displays now receive input from the Acuity System HA CPU and they all show a yellow indicator If one or more of the displays is blank or if all Virtual Monitors do not reappear with their original border colors in approximately five minutes see Table 10 on page 151 A WARNING Whenever an interruption in Acuity System CP
71. U operation occurs please contact Welch Allyn Technical Service soon to ensure that your entire system has returned to normal operating condition and that it does not require further service 16 Chapter 2 Acuity System overview Welch Allyn Acuity Central Monitoring System Central station screen Note Depending upon the default screen color scheme of your Acuity Central Station black on white or color on black your screen colors may not match those shown in this manual Depending upon the selected screen view the Acuity Central Station screen can include these areas e Map area e Virtual Monitor e Utility space e Waveform Windows area E Virtual Monitor F Screen view buttons G Message window E fdabwtddulrdda del MM oe some a A Utility space B E ae NN rea Tae Rene he ase E Wwe I0 H it AAA AS KY ESA WEE 12000 LYSE crated yey Ly vN it a T ot tir Lok 9A War nee ay UV u UN SIATS SIEFERD HiK ASA sep T aiee T B Waveform Windows IA ars PN Cee A D System buttons A Utility space B Waveform Windows C Acuity System map D System buttons E Virtual Monitor C Acuity System map Displays a patient s Setup windows Review windows Patient List window and Central Station Printer windows Abbreviated Virtual Monitors Shows the location and status of patients and it displays status icons for system equipment You open a patient s Waveform Window or Virtual Monito
72. a PLR station first locate the patient via the Patient List and then open the patient s Waveform Window 1 In the lower left corner of the Acuity Central Station screen click e The Patient List window appears 2 Scroll the patient list e If the patient is listed proceed to Step 4 e If the patient is not listed click Other Patients to view networked Acuity System units The Other Patients Lists window appears 3 List patients by one of these criteria e Click Unit and then select the unit name from the list in the box on the right e Click Last Name or First Name and then click the first letter of the name 4 Click a column heading to sort the list by name location or ID Actively monitored patients are listed at the top 5 Locate the patient name in the list and then click the name 6 Click E The patient s Waveform Window appears on the PLR station screen To close a Waveform Window on a PLR station screen aa BEKR ee 1 Drag the corresponding map icon to lt The Waveform Window and map icon close Directions for use Chapter 2 Acuity System overview 13 Flexible patient access FPA using virtual network computing VNC Note The FPA using VNC configuration is a licensable feature To order this feature contact your Welch Allyn sales representative See page ii The flexible patient access option allows you to connect to a Patient List Remote using a VNC connection Each pu
73. abels appear for waveforms displayed at sweep speeds between 6 25 mm s and 50 mm s Time line color matches icon color at all points in time Waveforms Custom All Leads 198 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Table 42 Review window Arrhythmia Events Features Factory default Waveform display 1 Arrhythmia 2 ECG waveforms used at the time of arrhythmia analysis one visible in Half Screen view more visible in Full Screen view depending on space and monitor type Period displayed 25 mm s period depends on sweep speed The most recent seconds monitored appear at the right side of the window or if another review window was viewed first the period is centered around the cursor bar position in he first viewed review window Presets values Blue cursor bar shows ECG beat labels ECG scale 1 mV Sweep speed 25 mm s Event types Event markers are arrhythmia types Arrhythmia Relearn and ST Relearn or Learning Done and snapshot print ormal and ventricular V 24 hour or up to 96 hour time line indicates patient and equipment state Time line color matches icon color at all points in time Number of deleted arrhythmias allowed before the Delete Selected button becomes disabled Acuity System screen views that support this window 1000 per patient Full screen and half screen views Printouts Waveforms Events Directions for use Chapter 11
74. ain and then it attempts to connect to the Acuity System network Directions for use Chapter 10 Troubleshooting and maintenance 169 Mobile Acuity LT Systems Adjust localization parameters If your Acuity System is a mobile laptop computer system you can adjust these system parameters Time zone Acuity System language Amended ID Micropaq monitor language Printout paper size EN1060 compliance Temperature units Enable or disable the optional parallel printer Set facility name appears on printouts Set unit name appears in upper right corner of Acuity system display Set printer ISO encoding Set barcode variables Set ECG filter To adjust Mobile Acuity LT localization parameters pl De Gl ee Hold down the A key on your keyboard move the cursor to the upper right corner of the screen and press the right mouse button Click Quit Application and then click Confirm Wait for the login screen to appear The screen appears within one to two minutes Type iupdate and then press Enter Follow the prompts to make the desired changes Press q to quit Take one of these steps If the system prompts you to reboot take these steps a Choose 2 to quit b Reboot the system The system reboots and starts the Acuity application If the system prompts you to quit take these steps a Choose 1 to quit Wait for the login prompt b Type acuity and then press Enter You are logged in to the Acuity applicati
75. alarm and alert indications 83 Suspend an audible alarm or alert tone for 90 seconds 84 Remove a latched arrhythmia alarm nannaa ee 87 Respond to specific alarms and alerts 0 0 0 0 00 02 ee eee 88 Summary of Acuity System alarm and alert levels n nnana anaana auaa 95 6 Review or print patient data ces 97 Review patientdata atA Paes ste tess a ald Sass gee PEN Oot en add NS 97 Print and review printouts 00000 ccc ee 115 iv Contents Welch Allyn Acuity Central Monitoring System 7 Move a monitored patient 000 cee eee eee 125 Move the patient and monitor to a new location 0 0 0 eee 125 Move the patient to a different monitor 0 0002 131 8 Discontinue Acuity System monitoring 000e eee 133 Stop monitoring a patient 0 eee 133 Discharge a patient from Acuity System monitoring 0 136 9 Status ICONS neeaae ew ete ewe ae ok eee a eats Oka 137 Status COMSCOlORS ea dees ese e ucin cereal a E E Gh E N E wee 137 Patient monitor StatuS ICONS e ees 138 System component status ICONS asasan aaaea cee 145 10 Troubleshooting and maintenance 0 0 000 eee 149 C nta t information a 2 xcs Bice PA eek eek Aker be eked Qe Ph dee 149 COMIC MLS es Ae e taht a ec tee ga ek iy at ace at A aA oa eae es a 150 TROUBIESNOOUNG is cts ak ise ee aces OSA acon od baie ares ad 151 MaintenanC s 282
76. alysis Related to Arrhythmia Analysis options patient populations and patient surveillance A WARNING The Acuity System Arrhythmia Analysis options are not atrial arrhythmia analysis packages they are ventricular analysis packages An Acuity System with the Full Arrhythmia Analysis option detects these arrhythmia types ventricular fibrillation asystole ventricular tachycardia PVC run ventricular run VRhythm ventricular rhythm couplet PVC per minute ventricular beats per minute bigeminy trigeminy tachycardia bradycardia irregular irregular rhythm pause and noncapture pacemaker noncapture WARNING In some clinical environments and due to some physiologic differences among patients the Acuity System might not alarm for occurrences of ventricular tachycardia ventricular fibrillation or asystole For instance asystole is defined as an absence of any detected beat for four or more seconds Patient pathologies where indications of electrical activity continue to exist without adequate cardiac function might not be recognized as asystole WARNING Do not use the Arrhythmia Analysis or ST Analysis feature on neonates The Arrhythmia Analysis and ST Analysis options are not intended for use with neonatal patients WARNING It is important that clinicians understand and communicate to all staff using the Acuity Central Station that any arrhythmia analysis software program is an effective tool to assist in patient care but arrh
77. and maintenance 161 Arrhythmia Analysis and ST Analysis Table 17 Troubleshooting arrhythmia and ST segment analyses Problem Explanation Arrhythmia analysis or ST analysis does not seem to be optimal WARNING Ensure these things to minimize false HR Arrhythmia Analysis and ST A Analysis alarms and to achieve optimal event detection and analysis e ECG cable lead wires and electrodes are undamaged Patient s skin is properly prepared e Electrodes are placed using standard good practices e5 wire ECG cable is used A 3 wire cable limits arrhythmia and ST segment analyses to a single lead and ST analysis is disabled when a lead failure occurs LL electrode is connected Otherwise only one ECG lead is available and arrhythmia and ST segment analyses are effected e Patient monitor and Virtual Monitor display these things HR numeric and ECG waveform Non noisy signal If signal is noisy reduce patient movement and increase distance from other electrical devices Correct patient mode for the patient eVirtual Monitor ECG 1 and ECG 2 display these things ECG waveform Waveform amplitude at least 160 uV peak to peak ORS complex amplitude at least twice the P or T wave amplitude WARNING If your system includes arrhythmia analysis and if you connect change or A move an electrode ensure that a RELEARN alert occurs at the patient monitor and the virtual monitor Moving or changing an electrode can change the beat morphol
78. and room number have not been confirmed You can scan or type missing patient information and confirm the information at the central station in the Patient ID Setup window Once the information is confirmed the patient s window borders and icons change to the green patient monitoring OK state If the borders and icons do not turn green another alert or patient alarm is occurring To enter patient information At the Acuity Central Station screen hardwired monitors are identified by room number and wireless monitors are identified by their serial numbers Note The Acuity System does not accept these scanned items Double quotation marks middle names one middle initial is accepted and spaces and periods 1 Click the patient s RM or ID icon in the patient s Waveform Window or on the map The Patient ID Setup windows appear Patient Identification ID 1234567890 Already Confirmed Amended ID Last Joe Room Number BEDO1 First Don Signal MT LCX 01 Serial Number 79100007 Patient Note a Next Page _Clear All Confiem Undo Close Patient ID window 1 2 Scan or type the patient s ID number in the ID field 3 Press the Tab or Enter key on your keyboard to advance a line If you are prompted this patient ID was pre entered via the hospital central information system the Acuity Patient List window a wireless monitor or a mobile device running AcuityLink Clinician Notifier softwa
79. anel 10 recommended for safety 3 Heart rate indication 67 86 156 159 Check HR PR alert 89 differing values at monitor 86 158 numerics not showing 159 OxyCRG print setup 49 reduce alarming 156 system calculation 177 values differ at monitor 67 86 156 159 Hospital information system 10 Icons Central Station component status 145 color indicates status 137 different priorities of 95 kicked out of room 152 map and status 20 map icons and networked Acuity Systems 20 145 146 147 map disappear 152 opening Central Station 145 patient monitor status 138 Index 205 table of Central Station component status 146 table of patient monitor status 139 ID amended 80 edit 80 enter or confirm patient 40 Information system hospital 10 Intended Use 1 Interconnection standards 3 Irregular Limit box 61 162 Irregular rhythm definition 57 Irregular rhythm duration setting 61 162 L Language set system 165 Latched alarm definition 87 remove indication 87 Leads automatic switch if disconnected 38 159 changing 45 Check Leads alert 93 default 189 191 193 for ST Analysis 73 indicators shown 45 label ECG V 45 RESP 45 select or change ECG RESP 45 view waveforms from all 24 Learning period arrhythmias during 64 78 91 162 171 Lethal arrhythmia alarm level 85 154 158 definition of 52 M Mainstream C02 indicator 23 Maintenance 164 Map Acuity Central Station screen 16 expand 18 icons 20 Masimo PI and SIQ in
80. another e Add a patient monitor to an Acuity System network e Especially among networked Acuity Systems verify a monitor s ESSID An Acuity System s network name appears on a label in these places e Fora Mobile Acuity LT System on the system case e Foran Acuity System on the CPU Note Changing a monitor s network name causes the monitor to restart erase all patient data and restore the monitor settings to default settings A WARNING Do not attempt to change a monitor s network name unless you are a qualified biomedical service engineer or technician Confirm that the network name that you select matches the network name of the appropriate Acuity System When you select a new ESSID the patient monitor seeks a connection with any nearby Acuity System network with that same ESSID If you select a wrong network name patient alarms and data for any patient connected to the monitor would occur at an unexpected Acuity Central Station 166 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Identify or change a Micropaq monitor network name N 8 To identify a Micropaq monitor network name 1 3 4 Press v to highlight SYSTEM INFORMATION and then press x The System Information menu appears Press wy to highlight NETWORK STATUS and then press x The Network Status screen appears Locate the Network Name in the list Press xX to exit To change a Micropaq monitor network name
81. arge gray menus with only a password entry line enabled they appear along the left side of the Acuity System screen These menus are meant for use only by trained authorized Welch Allyn service personnel Unauthorized use of these menus can result in unsafe alteration of the Acuity System including shut down of the system If you inadvertently open a menu that you do not understand and that is not explained in this manual please disregard the menu and clear it from the screen by pointing anywhere outside the menu and clicking on the left mouse or trackball key Connection patient room and patient ID Table 11 Troubleshooting connection patient room and patient ID Problem Explanation jo When connected a wireless monitor After your patient s icon was successfully assigned to a room a patient the Acuity System its map icon went connected to a hardwired monitor was assigned the same room so your into the room that had assigned it But patient was kicked out now it isn t in the room anymore and it a RM icon meaning the patient hasn t Assign another room to your patient been assigned a room What happened an When connect a monitor to the Acuity Ensure that you make a proper connection with the bedside network System connector does not appear on the Acuity Central If it takes more than a few seconds for the Monitor Connecting icon to appear Station screen disconnect the Acuity S
82. arned rhythm as a normal Thereafter rhythms of this type might not trigger an alarm A relearn event can be initiated by a user or by the system System relearns are in response to these circumstances e Patient connection e Lead change or failure e System restart During an arrhythmia relearn event the system posts a RELEARN alert in the patient s Virtual Monitor and Waveform Window Carefully observe a patient during an Acuity System learning period During learning the system detects only VFib and asystole arrhythmias After a relearn event Relearn and Learning Done event markers W appear in most of the patient s review windows and some printouts After relearn carefully evaluate the new ECG rhythm and the current ST segment for all active leads to ensure that the system learned an appropriate rhythm For evaluation instructions see To respond to a RELEARN alert on page 92 WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move 172 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Periodically check equipment for safety The Acuity System network cable R
83. as It win Yain Blue 14 26 13 Linit HK 12 jetata lv j Tus 14 30 00 0 8 y A P Tue 14 39 16 Limit HR 4 p A iue 14 49 01 Linit He 1 AN OR EI Tue 15 00 00 jc iwe 15 04 12 Livit mK tue 15 12 55 Lait HR _ Tue 15 15 00 Blue 15 16 34 Lisit WR Toe 15 16 48 APNEA Blue 15 16 48 Linit KR Tue 10 45 00 Tue 19 00 00 Tue 19115100 Tue 19730 00 Toe 19 45 00 PILIVIWGgecsessysey ee 24 aa 72 a6 Titty Event Scales Print Clase Time line To adjust the time period covered in the tabular list 1 Click a number under the time line to adjust the line s scope in hours 2 On the time line click an area in which you are interested events are red The blue box moves The box indicates the time span covered in the list 3 Under Time Span click to specify the number of hours spanned in the list The listings change To specify the format of the tabular list 1 Next to List Type click one of these buttons e Click Tabular to list tabular data only e Click Events to list events only e Click Both to list tabular data and events 2 Check vital sign boxes to list corresponding data and events The number of events that occurred in the time span appears beside each box 3 Under Tabular Interval click to specify the frequency interval at which data are listed For example 75 min means that readings are listed four times during each hour e g 12 00 12 15 12 45 and 1 00 However
84. ast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the Acuity System is used exceeds the applicable RF compliance level above the Acuity System should be observed to verify normal operation If abnormal performance is observed additional measures might be necessary such as reorienting or relocating the Acuity System b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m Directions for use Chapter 11 Specifications 187 Recommended Separation Distances Between Portable and Mobile RF Communications Equipment and the Acuity System The Acuity System is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the Acuity System can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the Acuity System as recommended below according to the maximum output power of the communications equipment Rated Maximum Output Separation Distance According to Frequency of Transmitter Power of Transmitter m 7 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz d 1 2 JP d 1 2 JP d 2 3 JP 0 01 0 12 0 12 0 23 0 1 0 38 0 38 0 73 1 1 2 1 2 2 3 10 3 8 3 8 7
85. ath0 assign e En oe wlth nero cedar e Sone oe Pele ae 164 T Specifications cir utes feet eee Be oe eee ae 175 Monitor Acuity System compatibility 0 0 00 00s 175 General system monitoring capabilities 0 2 20 0000000 175 Acuity Syst m heart ratent do edn bo ha da o eaa Side e u pe atalen due geeks 177 Acuity System pacemaker detection naana n anaana reanna ee 178 Acuity System alarm and alert indications n sanaaa naana naaa aeaa 179 Electromagnetic standards compliance assas aa aeae cece eee 184 Acuity System customizable defaults and factory defaults 188 Warranty creient Oo og a eee tee AAA A AE A aE 201 1 General information Indications for use The Acuity Central Monitoring Station is intended to be used by clinicians for the central monitoring of neonatal pediatric and adult patients in health care facilities In addition to the central monitoring of patient data waveforms alarms and alerts the Acuity software can include operational modules to provide extended recording of patient data Full Disclosure arrhythmia monitoring and ST analysis e Full disclosure stores patient data for up to 96 hours e Arrhythmia monitoring module provides real time monitoring and alarms for specific changes in cardiac rhythms The clinician is responsible for determining the clinical significance of each detected arrhythmia event or alarm The arrhythmia module is not intended for use with neonatal
86. can inspect trend data in Graphical Trends Review window and trend printouts to see the duration and elevation or depression for each episode for any period recorded The operator also can inspect a summary of ST segment shift data within tabular trend prints 194 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Table 36 Setup window ST Analysis Features Customizable default Factory default Presets values Alarm limits 1 0 mm Alarm level Low Measurement Offset Auto Print on Alarm Off Clicking the ST RELEARN button System relearns a patient s normal ECG rhythm and uses the relearned rhythm as a guideline to analyze deviation of the ECG ST segment offset Establishes a new ST reference beat without changing the normal ECG rhythm used for arrhythmia analysis In ST Analysis Setup window The waveform slice displays NO VALID BEATS and the Acuity System can take up to 30 seconds to update the waveform Relearn and Learning Done event markers W appear in most review windows and some printouts Table 37 Setup window Printouts Features Customizable default Factory default Vital signs that initiate central alarm print HR Central auto print time interval Off Vital signs that initiate Central OxyCRG alarm print Off Priority of vital signs alarming simultaneously for alarm Order listed in window prints Table 38 Setup window Waveform Window Featu
87. cate equipment problems or low level patient information alerts by showing yellow window borders and icons Some alerts are associated with audible tones When conditions are corrected the green patient monitoring OK state is restored Figure 1 Acuity Central Station screen showing a patient in alarm A Alarm and alert messages t 44 Ne el diihi Ahy nal ul dad CL West 19528 Leo Jerr ined sa T 1 we le eect Gh Susu AA B Border color changes A J Aak K es Ey Mate Pa ana g aden we VAL is eros EN Wwe 12000 Fie ka agia HPS OT Gk WES 12090 LYSE veeta KES Saad SIH LAET VA Pari Rees jes pelte t E Select job to Delete or Frint Nest C Matching alarm and alert LA icons D Shortest route to the patient A Alarm and alert messages Alarm and alert messages are displayed in the message window B Border color changes Borders of Virtual Monitors and Waveform Windows in alarm change color and display specific messages C Matching alarm and alert icons Matching alarm or alert icons appear D Shortest route to the patient Shortest route from the Acuity Central Station to the patient s bedside 84 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System Suspend an audible alarm or alert tone for 90 seconds All patient alarms and some alerts are associated with tones for details see Table 6 on page 95 You can silence tones temporarily from these places e Ac
88. central station 130 Chapter 7 Move a monitored patient Welch Allyn Acuity Central Monitoring System To arrange a patient move from a wireless Propaq CS monitor 1 2 From the main menu touch SETUP ACUITY PATIENT Take one of these steps Select NEW ROOM to move the patient to a new room within the unit and then select the new room The patient is confirmed with the new room Select TRANSFER to transfer the patient to a different unit select the new unit and then select the new room The patient is confirmed and the patient s map icon appears at the new central station Optional Switch a wireless Propag CS monitor to a ee aN omy hardwired connection wW a Connect the Acuity System network cable to the Acuity System network connector on the bedside monitor Connect the other end of the cable to the bedside network connector The patient is confirmed and the patient s map icon appears in the new location Directions for use Chapter 7 Move a monitored patient 131 Move the patient to a different monitor You can move patients who are connected to hardwired or wireless monitors to different monitors within the same Acuity System network Move a patient from a hardwired monitor to a different monitor 1 3 On a Propag CS monitor Press NET OFF in the top left corner of a the screen z ja y On a Propaq Encore monitor Press NET OFF on the top right corner of the casing
89. change or move an electrode ensure that a RELEARN alert occurs at the patient monitor and the virtual monitor Moving or changing an electrode can change the beat morphology If the system does not learn the new morphology it might not alarm or it might cause false alarms The relearn process establishes the new morphology as the normal ECG rhythm for arrhythmia and ST segment analyses e fa RELEARN alert occurs after changing or moving an electrode carefully evaluate the new ECG rhythm and the current ST segment for all active leads to make sure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 e fa RELEARN alert does not occur after changing or moving an electrode initiate a relearn event For instructions see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses on page 65 WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move Directions for use Chapter 8 Discontinue Acuity System monitoring 135 Permanently stop monitoring To permanently stop monitoring a patient 1 From the monitor s Main Men
90. contact qualified service personnel At patient monitor 1 Check for specific alert message 2 If present press one of these buttons e Acknowledge to acknowledge the alert e RESET to reset the monitor e DISABLE to disable the alert 3 Correct the problem 142 Chapter 9 Status icons Welch Allyn Acuity Central Monitoring System Table 8 Icons and messages that represent patient and monitor status Patient monitor status icon Monitor Communication Lost Alert Tone Suspended Icon display priority Take priority over low level alerts During suspension period newly occurring alerts are indicated only after original alert is corrected Acuity System only visually indicates newly occurring alarms by changing the Alert Tone Suspended icon from yellow to red Icon location on map Locations representing problem monitors Locations representing monitors with suspended audible alert tones Messages in hallway message panels and at top of Acuity Central Station screen room Loss of Comms room Equipment or more specific message Recommended action If the disconnect is intentional click Confirm and then close the alert window Otherwise reestablish communications between the patient monitor and the Acuity System Attend to problem Then click the Silence Reset key at the patient monitor or Resume at the central station Virtual Monitor Directions f
91. correct click YES At the central station the patient is confirmed with the new location e If the information in the CONFIRM PATIENT prompt is incorrect click NO and see To respond to the CONFIRM PATIENT prompt on page 29 128 Chapter7 Move a monitored patient Welch Allyn Acuity Central Monitoring System To switch a hardwired Propaq CS monitor to a wireless connection A WARNING When a hardwired Propag CS monitor is disconnected from an Acuity System if the monitor has wireless capability it attempts to connect wirelessly to an Acuity System After connection go to the Acuity Central Station where you want the monitor to have connected Ensure that the patient monitor s icon appears on the central station map If it does not contact your Biomedical Engineering department If you are a biomedical engineer see Identify or change a monitor s network name ESSID on page 165 Throughout this procedure leave the monitor turned on 1 Inthe upper left corner of the Propag CS monitor display touch NET OFF pn N O I T 2 Within 15 seconds remove the Acuity System network cable i from the Propaq monitor The CONFIRM PATIENT prompt appears when the monitor connects with an Acuity System 3 Take one of these steps If the information in the CONFIRM PATIENT prompt is correct click YES At the central station the patient remains confirmed If the patient is moving see To arrange a pati
92. crease the frequency of occurrence Related to hardwired monitoring A WARNING Ensure that you connect the proper monitor network cable to the proper wall jack Using the wrong network cable or the wrong wall jack connector could damage the monitor or not send data to the Acuity System Ensure that the monitor is properly connected to the network before you start monitoring the patient Related to trends and alarm limits A A WARNING Before you use a monitor on a new patient always turn off the monitor for a few seconds and then turn it on again This clears the prior patient s trends and alarm limits WARNING Always check alarm limits when a monitor reestablishes communication with the Acuity System If you change limits at a monitor while it is not communicating with the Acuity System for example during transport or signal dropout when you reestablish communication with the system the limits might change to Acuity System Presets values 38 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System Related to leads cables and the ECG display A A A A WARNING Ensure that the Acuity System network cable is neither damaged nor broken An Acuity System cable is the sole link between a hardwired monitor and an Acuity System WARNING Always replace disconnected lead wires immediately If a lead wire becomes disconnected and a second lead is not available the Virtual Monitor might show the same
93. ctual alarm situation WARNING Central station alarms and other events can go unnoticed if clinical personnel are not present at the central station or if interruptions occur in power or system operations WARNING The leading cause of patient death or serious injury reported with the use of patient monitoring equipment is failure to respond to alarms notifying the user of an adverse change in patient condition If you are relying on visual alarm notifications maintain a clear line of sight and remain within 4 meters of the central station If you are relying on audio alarm notifications make sure that you can hear audio alarms from where you are Set the volume as needed considering the environment and ambient noise levels Verify that the alarm is audible to a clinician working at the maximum distance from the central station 48 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Adjust general printing settings This section presents information about these tasks Setting preferences for a patient s Acuity Central Station vital signs printouts Coordinating printers and print jobs for the entire Acuity System If you want to set these preferences instead see these pages For arrhythmia event alarm printing see Adjust preferences for a patient s arrhythmia alarming on page 61 For ST segment deviation alarm printing see Set alarm preferences for ST Analysis on pa
94. cuity System pacemaker detection vs monitor pacemaker detection 192 Chapter 11 Specifications Table 35 Setup window Arrhythmia Alarms Welch Allyn Acuity Central Monitoring System Features Customizable default Factory default Clicking Arr ST Relearn or RELEARN System relearns the patient s normal ECG rhythm and uses the relearned Clicking Analyze Pacers rhythm as a guideline to identify arrhythmia events arrhythmia relearn Clicking Single ECG and to analyze deviation of the ECG ST segment offset ST relearn Note A RELEARN button instead of an Arr ST Relearn button indicates In Virtual Monitor and Waveform hat the system does not include ST Window A visual RELEARN alert Analysis or the ST Analysis Setup window occurs HR is taken from the patient monitor instead of from the arrhythmia software and real time waveforms display as usual In ST Analysis Setup window The waveform slice displays NO VALID BEATS and the Acuity System can take up to 30 seconds to update the waveform Relearn and Learning Done event markers W appear in most review windows and some printouts Directions for use Table 36 Setup window ST Analysis Chapter 11 Specifications 193 Features Customizable default Factory default ST Analysis On ST analysis is disabled e Patient monitors in the Neonate mode for these monitors e Virtual Monitors with Analyze Pacers on in the Arrhythmia Alarms
95. d patient information 77 Important considerations ST Analysis A A WARNING Before you set customized alarm limits for a patient confirm the patient s ID and room number Otherwise customized limits might be lost WARNING Do not use the Arrhythmia Analysis or ST Analysis feature on neonates The Arrhythmia Analysis and ST Analysis options are not intended for use with neonatal patients WARNING The ST algorithm has been tested for accuracy of segment data As with all computerized ST analysis systems the Acuity System cannot replace skilled care and proper surveillance by a clinician A clinician must review all data obtained from the Acuity System including the significance of ST segment changes before implementing therapy based on this data WARNING Ensure these things to minimize false HR Arrhythmia Analysis and ST Analysis alarms and to achieve optimal event detection and analysis e ECG cable lead wires and electrodes are undamaged e Patient s skin is properly prepared e Electrodes are placed using standard good practices e 5 wire ECG cable is used A 3 wire cable limits arrhythmia and ST segment analyses to a single lead and ST analysis is disabled when a lead failure occurs e LL electrode is connected Otherwise only one ECG lead is available and arrhythmia and ST segment analyses are effected e Patient monitor and Virtual Monitor display these things HR numeric and ECG waveform Non noisy signal If signal
96. d system printouts when the system detects ventricular fibrillation or asystole However an apparently valid heart rate numeric might show in the patient monitor Related to electrodes leads and ECG display A WARNING f your system includes arrhythmia analysis and if you connect change or move an electrode ensure that a RELEARN alert occurs at the patient monitor and the virtual monitor Moving or changing an electrode can change the beat morphology If the system does not learn the new morphology it might not alarm or it might cause false alarms The relearn process establishes the new morphology as the normal ECG rhythm for arrhythmia and ST segment analyses e fa RELEARN alert occurs after changing or moving an electrode carefully evaluate the new ECG rhythm and the current ST segment for all active leads to make sure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 e fa RELEARN alert does not occur after changing or moving an electrode initiate a relearn event For instructions see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses on page 65 WARNING Ensure these things to minimize false HR Arrhythmia Analysis and ST Analysis alarms and to achieve optimal event detection and analysis e ECG cable lead wires and electrodes are undamaged e Patient s skin is properly prepared e Electrodes are
97. dicators 17 23 100 105 114 Message panel hallway 10 indications defined 137 Message window Acuity Central Station screen 17 Message window Acuity Central Station screen 83 Micropag monitor 10 connection to Acuity System 31 set language 165 Mobile device running Clinician Notifier 10 Mode patient 22 23 206 Index incorrect 37 Monitor clearing trends and alarm limits 28 35 compatibility with Acuity System 175 connection to Acuity System 28 35 model and serial number 40 not connecting 152 saving trends and alarm limits 28 35 Monitor status icons 138 Monitoring begin 25 networked patients 9 19 176 set up typical 43 starting hardwired 28 stop 133 Move patient and hardwired monitor 127 patient from wireless monitor 129 patient to different monitor 131 N Neonatal patients do not use arrhythmia feature with 5 NET OFF fault 154 Network cable check 172 Network Fault message 154 Network name identifying or changing a 165 Networked Acuity System Close and open Waveform Windows for 12 map Icons for 145 open review windows for 97 Patient List Review 11 search for patients in 12 97 specifications 176 within FlexNet 9 Networked Acuity Systems print a patient list for 121 NIBP no alarm suspended status 86 158 numeric reduces in size 22 suspect readings 86 troubleshooting 160 NO VALID BEATS message 53 63 75 192 194 NOISE alert 94 NonCapture definition 57 Note patient 22 81 Numeric display 23 181 182
98. duct as unsorted municipal waste Prepare this product for reuse or separate For more specific disposal information see www welchallyn com weee or contact Welch Allyn Customer Service at 44 207 365 6780 174 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System 175 11 Specifications Monitor Acuity System compatibility Table 19 Patient monitor Acuity System compatibility Patient monitor Acuity System Micropaq monitor 1 3 software or higher Acuity System software version 8 2x Propaq CS monitor 3 0 software or higher Propaq LT monitor 1 00 01 software or higher Propaq Encore monitor 1 2 software or higher Welch Allyn 1500 Patient Monitor 1 1x or 1 4 software General system monitoring capabilities Table 20 General Acuity System monitoring capabilities Feature Specification Maximum number of patients for which data is First Acuity System screen and Mobile Acuity LT Systems 12 displayed simultaneously Acuity Systems with multiple screens 16 each additional screen maximum of three additional screens Chapter 11 Specifications Table 21 Networked Acuity System capabilities Welch Allyn Acuity Central Monitoring System Function Primary Acuity System Direct connection between patient s monitor and Acuity System Auto Open Secondary AOS Acuity Central Station Duplicate Acuity Central Station that derives information from the primary Acuity Syste
99. e it the job is corrupted due to a system configuration problem a Click the job b Click Delete and then click Delete Selection c Contact Welch Allyn Technical Services if necessary 5 If appears in the lower left corner of the window click al to open the Printers View 6 Check for a printer with a problem message and fix the problem Printers with a stop sign icon have been disabled 7 If the printer was disabled click the printer name and then click Enable If an alarm is suspended and the Acuity System generates an alarm print and then a new alarm occurs for the patient during the suspension period a new alarm print does not occur An alarm is suspended and an alarm print occurs Then another vital sign alarm occurs for the patient but no an alarm print occurs 164 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Maintenance Adjust Acuity System time If your facility had an internet server available at the time of Acuity System installation Welch Allyn encouraged you to synchronize the Acuity System clock to a network time protocol NTP server Welch Allyn recommends that you synchronize the Acuity System to an NTP server after Acuity System installation in these circumstances e f an internet connection is lost e f internet service becomes available If your facility does not have an available internet server manually adjust Acuity System time
100. e patient s ID and room number Otherwise customized limits might be lost Directions for use Chapter 3 Admit and begin monitoring 37 Important considerations connecting a monitor to the Acuity System Related to specific patient populations A WARNING Always check patient mode in the border of the Waveform Window or Virtual Monitor Incorrect patient mode can result in unsuitable alarm settings inaccurate heart rate readings and inappropriate arrhythmia and ST segment analyses Related to wireless monitoring A A A WARNING Use wireless monitors only on patients who can tolerate intermittent monitoring interruptions All wireless systems are prone to intermittent signal dropout During signal dropout periods arrhythmia and ST segment analyses cannot be performed and the Acuity System does not show alarms or alerts WARNING Check fora light above the monitor screen or a wireless icon Y on the screen to ensure that communication is established between the monitor and the Acuity System xX means communication is not established If you cannot establish communication use another monitor and contact qualified service personnel WARNING Auto reboots occur and wireless connection is occasionally disrupted During this period the bedside monitors continue to provide their primary alarming functions Auto reboots occur infrequently due to poor environmental conditions Failure to perform preventative maintenance can in
101. e the factory default alarm limits of the patient monitor based on patient mode For further information see monitor directions for use Acuity Systems execute the Propaq Encore monitor STAT SET function For further information see Propaq Encore directions for use Acuity Systems execute the Propaq Encore monitor STAT SET function For further information see Propaq Encore directions for use Directions for use Chapter 11 Specifications 191 Table 35 Setup window Arrhythmia Alarms Features Customizable default Factory default Medium for Pause off for all Lethal for VFib asystole V Tach other arrhythmia types except VFib asystole and V Tach Alarm level Arrhythmia alarm limits Presets values V Tach 125 PVC run 6 PVC min 30 Tachycardia 180 Bradycardia 45 Irregular Limit 45 Presets values Print on alarm Off for all Options Irregular Limit Off Single ECG active with 5 wire cable Off only Pacer Display Off Analyze Pacers Off PaceMaker NonCapture Disabled Leads used for arrhythmia analysis Welch Allyn 1500 Patient Monitor Micropagq and Propag LT monitor 5 wire cables e Arrhythmia channel 0 uses lead II e Arrhythmia channel 1 uses lead V e Arrhythmia channel 2 uses lead Ill Propaq Encore Propaq CS The leads that the user selects for ECG1 and ECG2 are used for arrhythmia analysis Arrhythmia alarms for paced patients Arrhythmia alarms depend on A
102. ea P AR Ail Serene IEA Wess VAIA Setare 9 Heir eile 15 28 raskar bagea Renit bees ee ESTRET EN WES 19590 L184 Crota LAs VAM rarely tere 3 ATST J EIFI EEE AHR ma Apai anapa i ios Corresponding patient patient monitor status icons Opening patient windows by clicking patient monitor status icons You can open a patient s Waveform Window or Virtual Monitor by clicking patient monitor status icons To open a patient s Waveform Window and Virtual Monitor 1 Click a patient s map icon to open the patient s Waveform Window 2 Click one of these icons to open the patient s Virtual Monitor e The patient monitor status icon in the patient s Waveform Window e The patient s map icon Note f you are viewing from a Patient List Review PLR station see To open a Waveform Window ona PLR station screen on page 12 for instructions Directions for use Chapter 9 Status icons Patient monitor status icons and recommended action This table illustrates these things about patient monitor status icons Display priority Location on the central station map Messages at the top of the Acuity Central Station screen Messages in message panels when present Recommended action Table 8 Icons and messages that represent patient and monitor status 139 Patient monitor status icon Icon display priority Icon location on map Messages in hallway message panels and at top of Acuity Central
103. egularly inspect network cables and replace them once every 12 months Discard all cables that have been in use for a year or longer To inspect Acuity System network cables Inspect for damaged connectors and intact connector securing clips If a cable s connector does not click into place when you connect it to a patient monitor and to the bedside network connector replace the cable with a new one System components Perform these inspections and tests at least every 24 months To inspect and test Acuity System components Verify that acoustic and visual alarms and alerts are functioning properly Ensure that the redundant protective earth connections green wires are in place for Acuity System components Inspect fuses located near the AC input on the back of Acuity Central Station components verify compliance with the current specifications indicated on labels near the fuses Inspect all Acuity System equipment for mechanical and functional damage Vacuum the intake vent and behind the computer inspect equipment for dust accumulation Directions for use Chapter 10 Troubleshooting and maintenance 173 Equipment disposal Acuity Central Monitoring System collection as specified by Directive 2002 96 EC of the European Parliament and the Council of the European Union on Waste Electronic and Electrical Equipment WEEE If this product is contaminated this directive does not apply K Do not dispose of this pro
104. en change the Acuity System screen view after it has not been changed for several hours a Monitor Communication Lost alert occurs briefly for one or more monitors and then Unconfirmed Patient ID status follows An NIBP equipment alert is suspended and then an NIBP measurement is taken The audible alert tone recurs after 90 seconds Acknowledge or Disable the alert If you wait a few seconds after selecting NET OFF and then remove the Acuity System cable from the patient monitor you can prevent this alert If there is an audible tone click Suspend to suspend the alarm tone Click whichever of these buttons is present CONFIRM to dismiss the alert message for a number of hours RESET to dismiss the alert and put the monitor in the blue patient intentionally disconnected state Bring the wireless monitor within range of a wireless access point 4 If the problem persists contact qualified service personnel e oe N gt w Each message panel might be programmed differently or a panel has lost network communication and it is displaying a message that was displayed at the time of the loss Contact qualified service personnel After the monitors reconnect click YES in the CONFIRM PATIENT prompt to confirm the patient s identification Go to the patient to investigate the cause of any NIBP equipment alert Acknowledge the alert and then correct the problem An equipment problem occurred during a patient ala
105. end graphs 1 2 Under Trends check boxes to display associated trend graphs Click Seales and then make a selection To locate and display alarm and event information 1 Click any of these things for details e Clicka red alarm area along a trend graph e Along the top of the window click an event marker indicates Relearn Learning Done or Snapshot Print events indicates that an arrhythmia alarm was recorded Y indicates that an arrhythmia event was detected but no alarm occurred because alarming for this arrhythmia type was turned off in the Arrhythmia Alarms Setup window The blue cursor bar identifies event types and shows numeric values along each trend graph Click 4 or to jump to the next or previous alarm Directions for use Chapter 6 Review or print patient data 101 Review tabular trends and events In the Tabular Trends and Events Review window you can review and print trends in these ways View vital sign values and alarm events in a tabular format at various intervals Click events in the list to view up to two corresponding waveforms Arrhythmia option View normal and ventricular ECG beat labels along the waves In the waveforms jump to the next or previous alarm Open a Tabular Trends Events window To open a Tabular Trends Events Review window 1 Open the window for one of these types of patients Current patient in local unit In the patient s Virtual Monitor c
106. ent monitor e f the indicated patient is incorrect press NO The MONITOR SETTINGS prompt appears 2 If yousee the MONITOR SETTINGS prompt click one of these buttons MONITOR SETTINGS CLR TREND CLEAR MONITOR TRENDS PRESETS USE CENTRAL SETTINGS mmHg _CLRTREND _ PRESETS BOTH _ NEITHER Setup Review V _Suspend Snapshot _Close CLR TREND PRESETS BOTH NEITHER 4 4 e Clears current trend e Keeps current trend e Clears current trend e Keeps current trend values values values values e Keeps current alarm e Uses Acuity System e Uses Acuity System e Keeps current alarm limits and displays Presets default alarm Presets default alarm limits and displays limits and displays limits and displays 30 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System At the central station the patient map icon remains in the yellow ID or RM unconfirmed state until the ID and room are confirmed To enter patient information 1 Verify that the patient mode matches the monitored patient s age Adult Pediatric or Neonate For a Propag CS monitor If the mode shown at the top of the screen is incorrect touch SETUP MORE CHANGE and then touch the appropriate mode For a Propag Encore monitor Press SETUP MORE and check the patient mode If the mode is incorrect press NEXT to highlight the mode and then press CHANGE
107. ent List Review PLR station see To open a Waveform Window on a PLR station screen on page 12 Directions for use Chapter 2 Acuity System overview 23 Virtual Monitor An Acuity System Virtual Monitor represents a patient monitor and the information obtained from the monitor The appearance and button sequences can differ from the actual patient monitor Options or monitor functions that are not available are shown in faint gray type H ECG lead I Color indicates status A CO IPI B Bells G Waveforms C Numerics D Buttons F Patient NIBP ECG INV PRS SpO2 C02 monitor status icon Setup F Review T Suspend Snapshot E Patient L cn mode messages A CO IPI MCO indicates mainstream CO SCO indicates sidestream CO2 IPI indicates Integrated Pulmonary Index and displays when the IPI feature is enabled on the Welch Allyn 1500 Patient Monitor B Bells Bells appear in larger numeric zones e Solid bell indicates that all of this vital sign s alarm limits are set e Half shaded bell indicates that some of this vital sign s alarm limits are set e Bell missing from larger numeric zone indicates that none of this vital sign s alarm limits are set C Numerics Up to eight labeled numeric displays D Buttons Buttons are visible when the pointer is within the window Options or monitor functions that are not available or active are shown in faint gray type e Setup Opens setup wi
108. ent move from a wireless Propaq CS monitor on page 130 If the information in the CONFIRM PATIENT prompt is incorrect click NO and see To respond to the CONFIRM PATIENT prompt on page 29 Directions for use Chapter 7 Move a monitored patient 129 Move patients and their wireless monitors Micropag monitor Propaq LT monitor Propag CS monitor Arrange a patient move from the patient monitor To arrange a patient move from a Micropaq monitor a N 1 Press to highlight ACUITY and then press na to select it Se 2 Take one of these steps e Select NEW ROOM to move the patient to a new room within the unit and then select a new room The patient is confirmed with the new room e Select TRANSFER to transfer the patient to a different unit select the new unit and then select the new room The patient is confirmed and the patient s map icon appears at the new central station To arrange a patient move from a Propaq LT monitor i SNK 1 Press the arrow keys to underline Y at the top of the screen and TE then press e to select it 2 Select Acuity menu 3 Take one of these steps e Select NEW ROOM to move the patient to a new room within the unit and then select the new room The patient is confirmed with the new room e Select TRANSFER to transfer the patient to a different unit select the new unit and then select the new room The patient is confirmed and the patient s map icon appears at the new
109. ent s trends and alarm limits keep it turned on If the monitor is off turn on the monitor If you see a low battery indicator on the top of the Propag CS monitor screen connect the monitor to AC power to charge it or use another monitor Verify that ON NETWORK flashes in the upper left corner of the Propag CS monitor screen This could take a few minutes If ON NETWORK does not appear use another monitor and contact qualified service personnel To connect the patient 1 2 Attach the lead wires to the electrodes Apply the electrodes to the patient Attach the cables to the monitor last to optimize waveform interpretation during the initial Acuity System learning phase 36 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System To enter patient information 1 If you see the CONFIRM PATIENT prompt follow the prompts For instructions see To respond to the CONFIRM PATIENT prompt on page 29 If the monitor displays a choice of units scroll to highlight the unit in which the patient will be monitored and then touch Select A patient list appears Scroll the patient list and take one of these steps If you see the patient s ID name in the patient list take these steps a Highlight the patient and then touch Select A room list appears b If you know the patient s room number highlight the number and then touch Select The patient is confirmed at the Acuity Central Station
110. es to the monitor last to optimize waveform interpretation during the initial Acuity System learning phase 32 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System To enter patient information 1 If prompted press W to highlight the unit in which the patient will be monitored and then press Vy to select it If the keys are locked simultaneously hold down x and W to release the menus 2 Scroll the patient list and take one of these steps If you see the patient s ID name select it and then select the patient s room number The patient is confirmed at the Acuity Central Station If you do not know the patient s room number choose Select room at Central If you do not see the patient s ID name choose Select patient at Central 3 If you did not enter a patient ID name and room number take these steps a Write down the patient name ID room number and the four digit serial number that is in the upper right corner of the Micropaq monitor screen Ensure that the information is delivered to the Acuity Central Station for patient confirmation At the central station the patient map icon remains in the yellow ID or RM unconfirmed state until the ID and room are confirmed 4 Optional Customize alarm limits using patient monitor keys or the Alarms Setup window at the Acuity Central Station See Adjust a patient s alarm limits on page 46 A WARNING When a patient is connected t
111. ests Customizable default Factory default 1 Print Next 2 Alarm Prints 3 All other printout requests in the order received Maximum allowable number of print requests in a print queue Printout deletion order Table 31 Patient List window Features 40 Factory default When the number of print requests in the queue exceeds the default the deletion order from the queue is 1st deletes the oldest print requests other than alarm or Print Next in a group of printout requests for a patient Then deletes the oldest alarm prints ina group of printing requests for a patient Then deletes the oldest Print Next requests in a group of printing requests for a patient Sort order Length of time review information remains accessible ID currently monitored patients at top 24 to 96 hours after patient discharge from Acuity System monitoring depending on Full Disclosure option Directions for use Chapter 11 Specifications 189 Virtual Monitor and Waveform Window Table 32 Virtual Monitor Features Customizable default Factory default Virtual Monitor auto open In map view and full screen review view e Upon patient s monitor connection to Acuity System if empty window e Upon alarm if open space is available OR replaces a non alarming Virtual Monitor Patient mode Micropag monitor adult listed in patient monitor Setup status window Propaq LT CS and Encore monitors Adult pedia
112. et to adult or pediatric mode e Not all parameters used to calculate IPI are active Make sure that etC0 Respiration Rate SpOz and Pulse Rate are are being monitored An NIBP reading seems inaccurate 27 27 27 is shown to indicate the time of an NIBP measurement When NIBP measurements are taken while a monitor is temporarily disconnected from an Acuity System the NIBP values are not transferred to the Acuity System review windows WARNING If a noninvasive blood pressure reading is suspect repeat the measurement watching a manometer if the monitor has one to verify the reading If you are still uncertain about the reading use another method This occurs under either of these circumstances e The monitor was connected to the Acuity System during NIBP measurement and the monitor was then disconnected from and reconnected to the Acuity System e The monitor was not connected to the Acuity System during NIBP measurement and then the monitor was connected to the Acuity System Open the NIBP status window at the patient monitor to read the time of the NIBP value If an NIBP measurement is taken within two minutes before connection to an Acuity System or two minutes following disconnection from an Acuity System the reading might not transfer to the Acuity System Take NIBP measurements after the monitor is connected to the Acuity System to ensure NIBP trending Directions for use Chapter 10 Troubleshooting
113. ferring historical patient data to most customer specified EMR systems through the Welch Allyn Connectivity Server WACS However the transferred patient data is not a substitute for the patient data collected by the primary monitoring system Related to close physical surveillance and specific patient populations A WARNING It is important that clinicians understand and communicate to all staff using the Acuity Central Station that any arrhythmia analysis software program is an effective tool to assist in patient care but arrhythmia analysis packages are unable to achieve 100 percent accuracy for all morphologies and occurrences of ORS and PVC detection Thus close physical surveillance and clinical interpretation of cardiac data must still be an integral part of every patient s care Clinicians must review all data obtained from the Acuity System before implementing therapy based on the data WARNING Ensure that Acuity System patients are kept under close surveillance especially patients prone to arrhythmia events Use the Acuity System only in conjunction with close surveillance by trained clinicians Directions for use gt gt Chapter 1 General information 5 WARNING Do not use the Arrhythmia Analysis or ST Analysis feature on neonates The Arrhythmia Analysis and ST Analysis options are not intended for use with neonatal patients WARNING Keep all pacemaker patients under close observation Rate meters might continue t
114. form Windows in alarm displayed bump those not in alarm when necessary Indications Violating vital sign s numeric is For most specific No messages Specific highlighted means measured message appears in in Waveform message values fall above the monitor s range border Window appears in means they fall below and border means they could not be measured Status icon Status icon Specific message appears in border Status icon If visual latched alarm capability is enabled lethal and high level arrhythmia alarms and medium level arrhythmia alarms if so configured persist in Waveform Windows until cleared at Central Message Priority Displays highest priority message for If more than one monitor No messages Alarms and each patient equipment alert occurs in Waveform monitor for one monitor at once Window equipment a Multiple message alerts take appears in border priority over low level alerts Directions for use Chapter 11 Specifications 183 Table 29 Alarm and alert indications at optional hallway message panels and in message window at the top of the Acuity Central Station screen Alarms Monitor equipment red alerts yellow System wide equipment alerts yellow Patient information alerts yellow Message RM number followed by Specific messages for specific alerts alarm type and violating vital sign Priority Only highest priority me
115. ge 74 Directions for use Chapter 4 Adjust monitoring settings and patient information 49 Adjust preferences for a patient s central station printouts This section presents the Printouts Setup window in which you can specify details regarding automatic central station printouts To adjust preferences for a patient s printouts 1 In the patient s Virtual Monitor click Setup Printouts The Printouts Setup window appears Prints a Snapshot printout at the Acuity Central Station These open the Alarms Printouts Waveform Window and Arrhythmia Alarms and ST Analysis Setup windows 2 Set preferences in these areas of the window Note Central Alarm Print Check a vital sign box to set automatic printing of an alarm print if an alarm occurs for that vital sign Print on Alarm Delay Move the slider to set the time delay in seconds between an alarm and the onset of an alarm printout If the duration of an alarm is shorter than this delay period no alarm print is generated Central Auto Print Click an interval for automatic snapshot printouts Auto Prints to occur Central OxyCRG Alarm Print Check a vital sign box to set automatic printing of an OxyCRG print if an alarm occurs for that vital sign OxyCRG printouts combine HR PR CO RR BR and SpO vital signs if active On some monitors RR BR is labeled RRECG RRCO2 RR and RRECG are respiration rates derived from ECG while BR and RRCO2 are respiration
116. h changes could degrade system performance and affect patient monitoring A WARNING Devices connected to the Acuity System must be certified for overall system compliance according to the European Norm 60601 1 and 60950 safety standards The interconnection of any device with an Acuity System must comply with IEC 60601 1 1 Devices listed in the Acuity System installation planning guide comply with these standards If in doubt about network connectors or devices please consult your facility s Biomedical Engineering department or Welch Allyn Technical Support A WARNING It is strongly recommended that Acuity Systems be installed with continuous power sources and redundant means of operator surveillance such as secondary central stations and hallway message panels Acuity System alarms alerts or other events can go unnoticed if clinical personnel are not present at the Acuity Central Station or if interruptions occur in power or system operations You are responsible to provide percent reliable power to the central station The central station will only work with reliable AC power A WARNING Ensure that no headphones or headphone adapters are connected to the headphone input of your computer A connection in the headphone jack of a computer will cancel speaker output for any audible alarms associated with the Acuity System 4 Chapter 1 General information Welch Allyn Acuity Central Monitoring System A A WARNING Ensure that the volume level
117. hat the Acuity System defined an appropriate ST analysis reference beat 4 Ifthe new ECG rhythm or ST segment is not appropriate wait until the patient s ECG rhythm is suitable to be learned as a normal ECG rhythm and then initiate a relearn For instructions see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses on page 65 Directions for use Chapter 5 Respond to alarms and alerts 93 Respond to a CHECK LEADS alert The visual CHECK LEADS alert appears when the number of PVCs exceeds the normal ranges of PVC activity The alert remains for a brief period To respond to a CHECK LEADS alert CHECK LEADS POSSIBLE MISLABELING DETECTED Mca igen Review F Suspend Snapshot Close 1 Verify that the patient s lead wires and electrodes are in good condition 2 Verify that the electrodes were placed using standard good practices 3 Click Review Waveforms The Waveforms Review window appears 4 Review the patient s waveforms for accurate beat labeling A normal beat is indicated by a dot 5 If it is necessary to initiate Relearn to establish the patient s normal ECG rhythm see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses on page 65 94 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System Respond to an arrhythmia NOISE alert The visual NOISE alert occurs when the Acuity System can t anal
118. he information in the Patient ID Setup window The note remains in the Waveform Window until you remove it even during wireless dropout Always remove a patient note when it is no longer relevant to ensure that proper patient care is delivered To add or remove a note in a patient s Waveform Window 1 Click the patient s map icon or Waveform Window icon The patient s Virtual Monitor appears 2 Click Setup Patient ID The Patient ID Setup window appears Admit Clear Al Confirm Undo Close Patient Note Adult Reed Erlandson To Radiology 3 Add or remove a note e To add a note scan or type up to 20 characters on the Patient Note line Carefully check your note Note Patient notes that are entered when the monitor is not connected to the network will not be displayed on secondary or remote Virtual Monitors Only the most recent patient note will be displayed when the monitor reconnects to the network e To remove a note use the Backspace key on your keyboard 4 Click Confirm The information is stored 5 Click Close 82 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System 83 Respond to alarms and alerts Overview of central station alarm and alert indications e Alarms indicate patient vital sign violations by showing red window borders icons and vital sign highlights All alarms are associated with audible tones e Alerts indi
119. he window click or in the upper left corner of the Acuity System screen to change the screen view Directions for use Chapter 6 Review or print patient data 107 Review arrhythmia events Arrhythmia Analysis option In the Arrhythmia Events Review window you can review and print arrhythmia events in these ways e List arrhythmia events and event counts by type e Review ECG waveforms associated with arrhythmia events e View normal and ventricular ECG beat labels e Jump to the next or previous alarm or arrhythmia event e Jump to the next or previous alarm or arrhythmia event of the same type as the one currently shown e Advanced Arrhythmia Analysis option Delete or undelete an arrhythmia event marker from review windows and printouts If your window appears abbreviated your system includes the Lethal Arrhythmia Analysis option lethal arrhythmia detection only 108 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Open an Arrhythmia Events Review window To open an Arrhythmia Events Review window 1 Open the window for one of these types of patients e Current patient in local unit Ad it Abigail Watson SHR In the patient s Waveform Window click vl e Non monitored patient or patient in a networked Acuity System unit a Inthe Acuity Central Station screen s lower left corner click a b Fora patient in the listed unit click the patient s name and w For a patient in ano
120. heck the Irregular Limit box Directions for use Chapter 10 Troubleshooting and maintenance 163 Printing Table 18 Troubleshooting printing Problem Explanation There is a delay in the Virtual Monitor or No data is lost Waveform Window data display when a printout takes place Is any data lost Although a Virtual Monitor can show up to three waveforms at once if additional waveforms are turned on for display all are printed In snapshots or alarm prints sometimes four or five waveforms are printed and sometimes three waveforms are printed When over three waveforms are printed on an alarm print or snapshot there is no room left on the printout for a vital signs summary An alarm print or snapshot doesn t include a vital signs summary even though an NIBP measurement was taken within the last eight hours If you prefer to receive a vital signs summary turn off additional waveforms in the Virtual Monitor by clicking MAIN MENU MORE WAVE SEL NEXT if necessary CHANGE Check for various causes 1 Ensure that the printer is turned on and supplied with paper and toner expected a printout to occur at the central station but it did not occur Or 2 Ensure that the printer s On Line light is illuminated 3 Click or ig on the map at the central station location to open the Central Station Printers window appears on the map at the central station area 4 If any print job has besid
121. hes the monitored patient s age Adult Pediatric or Neonate If it does not match take these steps a Select the current patient mode b Select the appropriate patient mode and then follow the prompts Optional Customize alarm limits using patient monitor keys or the Alarms Setup window at the Acuity Central Station See Adjust a patient s alarm limits on page 46 A WARNING When a patient is connected to a monitor ensure that the default alarm limits are appropriate for the patient The system uses Acuity System Presets values for Arrhythmia Analysis and ST Analysis limits and monitor default values for all other limits if the monitor can save default values Before you set customized alarm limits for a patient confirm the patient s ID and room number Otherwise customized limits might be lost Directions for use Wireless Propag CS monitor Chapter 3 Admit and begin monitoring 35 To start wireless Propag CS monitor communication with the system 1 Use a Propag CS monitor that is designated for use within the Acuity System network in which the patient will be monitored Verify that the Acuity System network cable is not plugged into the Acuity System network connector on the monitor If the monitor is on take one of these steps e If it was not monitoring this patient turn it off and on again to clear prior trends and alarm limits e If it was monitoring this patient and you want to save this pati
122. hythm An irregularity in the R to R interval over a series of at least 16 non ventricular beats Waveform example NonCapture pacemaker noncapture For pacemaker patients with the Analyze Pacers option enabled a beat does not directly follow a pacer 58 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Open an Arrhythmia Alarms Setup window In the Arrhythmia Alarms Setup window you can adjust some or all these preferences for a patient depending on your Arrhythmia Analysis option Turn off alarming for all arrhythmia types except the lethal arrhythmias VFib asystole and VTach Adjust alarm limits for one arrhythmia type at a time or set all arrhythmia limits to Presets values Adjust alarming preferences alarming level priority minimum duration that an irregular rhythm arrhythmia must occur for alarming and Print on Alarm Set special preferences for patients with pacemakers Initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses WARNING Before you set customized alarm limits for a patient confirm the patient s ID and room number Otherwise customized limits might be lost To open an Arrhythmia Alarms Setup window In the patient s Virtual Monitor click Setup Arrhythmia Alarms The Arrhythmia Alarms Setup window appears If your window appears abbreviated your system includes the Lethal Arrhythmia Analysis opt
123. ications 195 Tabular Trends Events 101 Waveforms 104 Room number enter from a Virtual Monitor 40 S Safety check equipment 172 standards 3 7 Scanning patient ID information 40 Screen view 17 change 18 Screen view buttons 17 Search for patient by unit 12 97 121 Secondary Acuity System recommended for safety 3 Setup window Alarms 46 Arrhythmia Alarms 58 Central Station Printer 50 opening 23 Printouts 49 specifications 190 Waveform Window 51 Show Deleted button 111 Sidestream C02 indicator 23 Signal interruption C02 159 SIQ indicator 17 23 100 105 114 Snapshot printout from Waveform Window 22 Software monitor compatibility with Acuity System 175 Sort Windows button 19 Source troubleshooting 160 208 Index Specifications 175 alarm and alert 179 EMC 184 factory defaults 188 general monitoring 175 heart rate calculation 177 pacemaker 178 Patient List 188 printing 188 Setup windows 190 system compatibility 175 Virtual Monitor 189 Sp02 114 false alarms 158 Masimo PI and SIQ indicators 17 23 100 105 114 OxyCRG print setup 49 response time 44 troubleshooting 159 ST Analysis alarms off 71 check leads for 73 detection and ECG electrodes 77 disabled when 69 dismiss alarm 90 reference beat 70 set preferences for 73 Setup window specifications 193 ST RELEARN button 76 ST Arr Relearn button 65 Standards interconnection 3 Stat Set button 46 STATSCALE button 44 Status icons 20 24 Summary bu
124. indow 96 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System 97 Review or print patient data Review patient data If your Acuity System includes the Full Disclosure option waveforms and trend information for all patients are stored for a configurable period up to 96 hours Locate patient data This section describes how to locate data for a patient in any unit within your Acuity System or networked Acuity System To locate a patient 1 In the lower left corner of the Acuity Central Station screen click ge The Patient List window appears Scroll the patient list e fthe patient is listed proceed to Step 4 e fthe patient is not listed click Other Patients to view networked Acuity System units The Other Patients Lists window appears List patients by one of these criteria e Click Unit and then select the unit name from the list in the box on the right networked Acuity System e Click Last Name or First Name and then click the first letter of the name Click a column heading to sort the list by name location or ID Actively monitored patients are listed at the top Locate the patient name in the list 98 Chapter 6 Review or print patient data Welch Allyn Acuity Central Monitoring System To view the patient s data 1 In the Patient List window or Other Patients Lists window click a patient s name in the list Click one of these buttons Click Summar
125. ines Surge 1 kV differential mode 1 kV differential Mains power quality should be that of a IEC 61000 4 5 2 kV common mode mode typical commercial or hospital environment 2 kV common mode Voltage dips short interruptions and voltage variations on power supply input lines IEC 61000 4 11 Power frequency 50 60 Hz magnetic field lt 5 U gt 95 dip in U for 0 5 cycle 40 U 60 dip in U for 5 cycles 70 U 30 dip in U for 25 cycles lt 5 U gt 95 dip in U for 5 sec 3 A m lt 5 U gt 95 dip in U or 0 5 cycle 40 U 60 dip in U or 5 cycles 70 U 30 dip in U or 25 cycles lt 5 U gt 95 dip or 5 sec in U 3 A m Mains power quality should be that of a typical commercial or hospital environment If the user of the Acuity System requires continued operation during power mains interruption it is recommended that the monitor be powered with reliable AC power Power frequency magnetic fields should be at levels characteristic of a typical location in IEC 61000 4 8 a typical commercial or hospital environment Note U is the AC mains voltage prior to application of the test level 186 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Guidance and Manufacturer s Declaration Electromagnetic Immunity The Acuity System is intended for use in the electromagnetic environment specified below The customer or the user of the Acui
126. intout occurs at the Acuity System printer 122 Chapter 6 Review or print patient data Welch Allyn Acuity Central Monitoring System 12 lead printouts You can perform 12 lead ECG interpretation and create printouts through the Welch Allyn 1500 Patient Monitor Note The 12 lead ECG interpretation measurements are not saved on the monitor and are printed out at the Acuity System printer However Acuity will support re printing of the 12 lead reports Files are saved for 96 hours Types of 12 lead printouts e Average beats 3x4 plus rhythm strip e Average beats 6x2 plus snippets for V1 through V6 e Automatic sequential 3x4 plus rhythm strip e Automatic sequential 6x2 e Automatic simultaneous 3x4 plus rhythm strip e Automatic simultaneous 6x2 Note The 12 Lead printouts in the 6x2 formats can print both Standard lead sequences and Cabrera lead sequences The 3x4 format always prints a Standard lead sequence Print a 12 lead ECG printout To print a 12 lead printout 1 Runa 12 lead analysis using the Welch Allyn 1500 Patient Monitor Once the analysis is completed the 12 lead report automatically prints at the Acuity System printer 2 If are print of the last 12 lead analysis is needed place the cursor under printer icon at the Waveform Review Window or the Graphical Trends Review Window Click Print and select Print Report A printout occurs at the Acuity System printer Directions for use Chapter 6 Review or
127. iom PVRI 4144 vsmiem PAd 26 mmHg LCW 4 7 kgm LCWI 2 6 kgm PAm 30 mmHg LVSW 58 5 gm LVSWI 0 97 gmim CVPm 14 mmHg RCW 1 74 kgm RCWI 12 09 kg mm PAWP 22 mmHg RVSW 21 76 om RVSWI 21 76 gmim Height 75 n Weight 125 0 wb BSA 1 80 m A Patient information appears if the patient is confirmed in the Acuity System B Henodynamic calculations This area displays the information generated by the Welch Allyn 1500 Patient Monitor regarding the hemodynamic calculations 125 l Move a monitored patient You can move a monitored patient in these ways e Move a patient and monitor to a new room within the unit or transfer to a new unit within the same Acuity System network e Move a patient to a different monitor anywhere within the same Acuity System network If the patient s original Acuity System review information is still available within the Acuity System network 24 to 96 hours after disconnect it is available in the new location after the move Patient data collected on the patient monitor during the move might transfer to the Acuity System depending upon the monitor For information about patient monitors that are part of your Acuity System but are not shown in this chapter consult the patient monitor manufacturer s literature Move the patient and monitor to a new location You can arrange to move a patient and monitor to a new location in these ways e From the Acuity Central Station e From a hardwired or wireless
128. ion lethal arrhythmia detection only Setup Arrhythmia Alarms Shelly F Phelps LETHAL Pause LETHAL Irregular 125 im LETHAL 3 6 v T OFF RonCapture v OFF OFF Options OFF Pause Limit OFF Irregular Limit r OFF Single ECG OFF Pacer Display OFF Analyze Pacers r Ga a Alarms Set ST Arr Relearn Undo Close These open the Alarms Printouts Waveform Window Undoes what has been done since the Arrhythmia Alarms and ST Analysis Setup windows window was opened except relearn Directions for use Chapter 4 Adjust monitoring settings and patient information 59 Turn off alarming for all arrhythmia types except lethal arrhythmias A WARNING Turning off alarming for arrhythmia types and ST Analysis disables both audio and visual alarm indicators Although alarming for lethal arrhythmias cannot be turned off patients susceptible to arrhythmias must be kept under close physical surveillance if their alarming has been turned off for any arrhythmia types To turn off alarming for all arrhythmia types except lethal arrhythmias VFib asystole and VTach 1 Inthe patient s Virtual Monitor click Setup Arrhythmia Alarms If your window appears abbreviated your system detects lethal arrhythmias only Alarming for lethal arrhythmia types cannot be turned off Setup Arrhythmia Alarms Alarm Limit Lavel LETHAL LETHAL LETHAL OFF OFF vj OFF OFF OFF OFF OFF OFF Ald a Se
129. ions for use Chapter 4 Adjust monitoring settings and patient information 69 ST Analysis option The Acuity System ST Analysis option analyzes the ST segment of current ECG beats relative to the ST segment of a reference beat Specifically the system reports mm or mV of deviation between the current beat s ST segment offset and the reference beat s ST segment offset The system learns the reference beats when a learning or relearn function occurs For a listing of when learning or relearn functions occur see When ST relearn occurs for a patient on page 75 In the ST Analysis Setup window you can do the following things e Specify analysis preferences e Set alarm limits e Set ST alarming priority level e Set Print on Alarm e View current beats and reference beats e View current deviation values including alarm values e Initiate relearn of a patient s reference beats for ST analysis only ST analysis is not performed in these circumstances e f Analyze Pacers is set on in the patient s Arrhythmia Alarms Setup window e f the patient monitor is set in neonate mode e During the occurrence of arrhythmia events 70 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Examine the ST Analysis Setup window The ST Analysis Setup windows in this section are shown in alarm To open an ST Analysis Setup window e In the patient s Virtual Monitor click Setup
130. is noisy reduce patient movement and increase distance from other electrical devices Correct patient mode for the patient e Virtual Monitor ECG 1 and ECG 2 display these things ECG waveform Waveform amplitude at least 160 uV peak to peak ORS complex amplitude at least twice the P or T wave amplitude 78 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System A WARNING In Acuity Systems that include an Arrhythmia option a relearn function causes the system to learn a patient s normal ECG rhythm If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as a normal Thereafter rhythms of this type might not trigger an alarm A relearn event can be initiated by a user or by the system System relearns are in response to these circumstances e Patient connection e Lead change or failure e System restart During an arrhythmia relearn event the system posts a RELEARN alert in the patient s Virtual Monitor and Waveform Window Carefully observe a patient during an Acuity System learning period During learning the system detects only VFib and asystole arrhythmias After a relearn event Relearn and Learning Done event markers W appear in most of the patient s review windows and some printouts After relearn carefully evaluate the new ECG rhythm and the current ST segment for all active leads to ensure that the system learned an a
131. it box The default when Pause Limit is not checked is the R to R interval that is greater than or equal to two times the average R to R e Irregular limit under Options To adjust the minimum duration that an irregular rhythm arrhythmia must occur before the Acuity System alarms click an arrow to specify seconds and then check the Irregular Limit box 62 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System e Print on Alarm To specify that central station alarm printouts occur for a specific arrhythmia type alarm check the Print on Alarm box next to the arrhythmia type If the patient has a pacemaker see To set additional arrhythmia analysis preferences for a pacemaker patient on page 62 Set additional arrhythmia analysis preferences for a pacemaker patient A WARNING Always turn on Analyze Pacers for paced patients and always turn off Analyze Pacers for non paced patients The Acuity System analyzes arrhythmias based on whether the Analyze Pacers setting is on or off The Analyze Pacers setting is Off by default To set additional arrhythmia analysis preferences for a pacemaker patient In the patient s Virtual Monitor click Setup Arrhythmia Alarms Setup Arrhythmia Alarms Shelly F Phelps Alarm Print on Alarm Print on Limit Level Alarm Arrhythmia Level Alarm Pause MED ZI Irregular OFF zj Non Capture Z HIGH Options Pause Limit x Irregu
132. it www welchallyn com patents C LOCK and Nellcor are registered trademarks of Nellcor Puritan Bennett Masimo and Signal IQ are registered trademarks of Masimo Corporation Software in this product is copyrighted by Welch Allyn or its vendors All rights are reserved The software is protected by United States of America copyright laws and international treaty provisions applicable worldwide Under such laws the licensee is entitled to use the copy of the software incorporated with this instrument as intended in the operation of the product in which it is embedded The software may not be copied decompiled reverse engineered disassembled or otherwise reduced to human perceivable form This is not a sale of the software or any copy of the software all right title and ownership of the software remain with Welch Allyn or its vendors For information about any Welch Allyn product visit www welchallyn com about company locations htm Manual DIR 80018355 Ver A eal Welch Allyn Protocol Inc 8500 SW Creekside Place Beaverton Oregon 97008 7101 USA EC REP Regulatory Affairs Representative Welch Allyn Limited Navan Business Park Dublin Road Navan County Meath Republic of Ireland www welchallyn com Yso El Mortara C oss WelchAllyn Contents 1 General information wis acca dd wade os Phe boom Gadakea ake Choe ees 1 Indications FOFUSE 22 00 ek cer kee Ya Sake ka nd Pe ee ee ees 1 General descriptions i
133. ity Central Station screen s lower left corner click E For a patient in the listed unit click the patient s name and as For a patient in another unit Click Other Patients the patient s name and aK The Waveforms Review window appears Waves ECG _ aVR Ji Lat u aVF Amv R view Waveforms 1I a Rna T Ub E ABCA A L a A A aE Aia an aan lans a AA n AE A A A A 625 A 200 mm min 100 mm min 50 mm min ma Ia P 9 A 0 7 7 7 i ine it Miko 3008 mj va r Print Close These open the Graphical Trends Tabular Trends Events Prints a Review Print that covers the Waveforms Arrhythmia Events and OxyCRG Review Windows time span shown in the window Directions for use Chapter 6 Review or print patient data 105 Display waveforms and events Beat labels Normal and ventricular V 13080 To select and adjust waveforms 1 2 3 Check up to five boxes to display waveforms for corresponding vital signs and ECG lead sources If the patient monitor includes SpO gt Signal IQ detection and you check SpO gt SIO occupies a waveform slot in the display Click Scales and then make a selection Click under mm sec to adjust sweep speeds To adjust the period shown in the window 1 Click on the time line to display waveforms from a different time period Along the time line patient alarms are red Scroll the waveforms
134. kward Click 4 or to jump to the next or previous alarm The associated event is highlighted in the list To select and adjust the waveform s 1 Check one or two boxes under Waves to view waveforms for corresponding vital signs or ECG lead sources If you see only one waveform and you prefer two click in the upper left corner of the Acuity System screen to change to the full screen view Click Scales and then make a selection 104 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Review waveforms Full Disclosure option In the Waveforms Review window you can review and print the waveforms in these ways Scroll up to five vital sign waveforms at once Arrhythmia option View normal and ventricular ECG beat labels along the waves Click graphs to identify event markers above the waveforms Jump to the next or previous alarm or arrhythmia event or next previous alarm or event of the same type as the one currently shown Open a Waveforms Review window To open a Waveforms Review window 1 Optional In the upper left corner of the Acuity Central Station screen click or to change the screen view to see a larger review window Open the window for one of these types of patients Current patient in local unit In the patient s Virtual Monitor click Review Waveforms Non monitored patient or patient in a networked Acuity System unit a b In the Acu
135. l Station Verify that the patient s ECG leads are effectively applied 160 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System CO Sp0 IPI and NIBP displays Table 16 Troubleshooting CO SpO IPI and NIBP displays Problem When try to change CO units at the patient monitor a message says must use the Acuity System units Explanation CO units are an Acuity System installation choice set by your system administrator Acuity System requires a single CO unit to ensure that the CO units are displayed correctly When select SpO as the pulse rate source ECG remains the source When ECG is monitored and C LOCK is on ECG is chosen as the heart rate source SpO or NIBP are not displayed in the Virtual Monitor when try to turn on either for display A connected monitor equipped with IPI does not display an IPI value in the Virtual Monitor You can select up to three waveforms for display If you select more than three the three highest priority waveforms are displayed ECG is always displayed when it is monitored and P1 P2 P3 P4 and CO take priority over other selections If you want to display SpO or NIBP turn off P1 P2 P3 P4 and CO In addition NIBP numerics display for only one hour after an NIBP measurement is taken This occurs under these circumstances e The monitor s Patent Mode is set to neonate Make sure that the monitor is s
136. l interruption is occurring The Virtual Monitor shows the same lead for ECG1 and ECG2 Explanation WARNING All heart rate alarms are valid even if the HR value at the A central station differs from that at the monitor If your system includes an Arrhythmia Analysis option the Acuity System heart rates for adult and pediatric patients are a result of system software analysis The HR PR numeric changes to in the Virtual Monitor Waveform Window review windows and system printouts when the system detects ventricular fibrillation or asystole However an apparently valid heart rate numeric might show in the patient monitor Unsupported or stressed ECG cables or electrodes can result in movement artifact In addition if the patient is monitored by a wireless monitor various environmental variables can interfere with wireless signal transmission WARNING Use wireless monitors only on patients who can tolerate intermittent monitoring interruptions All wireless systems are prone to intermittent signal dropout During signal dropout periods arrhythmia and ST segment analyses cannot be performed and the Acuity System does not show alarms or alerts WARNING Always replace disconnected lead wires immediately If a lead wire becomes disconnected and a second lead is not available the Virtual Monitor might show the same lead for ECG1 and ECG2 A patient s HR numerics and ECG waveform are not displayed at the Acuity Centra
137. lar Limit Single ECG Pacer Display 4 Analyze Pacers aaja Alarms Set ST Arr Relearn Undo Close 4 A js Carefully evaluate the patient s current rhythm to ensure that you want the Acuity System to relearn it as the patient s normal ECG rhythm A relearn occurs in the next step Check the Analyze Pacers box to enable specialized arrhythmia analysis Pacer Display is turned on also If you prefer not to view the pacer display clear the Pacer Display box A RELEARN alert occurs at the patient s Virtual Monitor and Waveform Window The alert remains until relearn is finished Carefully evaluate the new ECG rhythm to ensure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 If Noncapture is listed in the arrhythmia list set an Alarm Level and Print on Alarm for pacemaker noncapture WARNING Keep all pacemaker patients under close observation Rate meters might continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely solely upon rate meter alarms Directions for use Chapter 4 Adjust monitoring settings and patient information 63 Initiate relearn of a patient s ECG rhythm Description of the relearn function Relearn is an Arrhythmia Analysis function that causes the Acuity system to relearn a patient s normal ECG rhythm The Acuity System uses the relearned
138. larms and alerts and how to respond to them Respond to a DROPOUT alert When there is a loss of bi directional communication between a wireless monitor and the Acuity System an audible DROPOUT equipment alert occurs at the monitor and at the Acuity Central Station The monitor continues to provide local alarms and alerts but alarms generated by the Acuity System such as arrhythmia or ST analysis alarms are not indicated and you cannot access any Acuity System windows related to the patient To respond to a DROPOUT alert EQUIPMENT ALERT TELEMETRY DROPOUT SUSPEND RESET _ENDTELE fan Review T J Suspend Snapshot Close Take one of these steps e Click SUSPEND The audible tone is suspended for 90 seconds e Click RESET Alert indications stop and the Virtual Monitor is in the blue patient intentionally disconnected state If the monitor resumes communication with the Acuity System the Virtual Monitor Waveform Window and patient icon return to the green patient monitoring OK state A WARNING Auto reboots occur and wireless connection is occasionally disrupted During this period the bedside monitors continue to provide their primary alarming functions Auto reboots occur infrequently due to poor environmental conditions Failure to perform preventative maintenance can increase the frequency of occurrence Directions for use Chapter 5 Respond to alarms and alerts 89 Dismiss a CHECK
139. lead for ECG1 and ECG2 WARNING Carefully monitor lead wire connections of patients prone to arrhythmia events If a lead wire disconnects during an event the Acuity System s ability to accurately detect the event can be compromised WARNING f your system includes arrhythmia analysis and if you connect change or move an electrode ensure that a RELEARN alert occurs at the patient monitor and the virtual monitor Moving or changing an electrode can change the beat morphology If the system does not learn the new morphology it might not alarm or it might cause false alarms The relearn process establishes the new morphology as the normal ECG rhythm for arrhythmia and ST segment analyses e fa RELEARN alert occurs after changing or moving an electrode carefully evaluate the new ECG rhythm and the current ST segment for all active leads to make sure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 e fa RELEARN alert does not occur after changing or moving an electrode initiate a relearn event For instructions see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses on page 65 WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of thi
140. lick Review Tabular Trends Events Non monitored patient or patient in a networked Acuity System unit a Inthe Acuity Central Station screen s lower left corner click a b Fora patient in the listed unit click the patient s name and For a patient in another unit click Other Patients the patient s name and The Tabular Trends Events Review window appears Paul Erlandson j EEY eh PSO EBA BATA EAS i AAT TES AED A EMI AA List Type Tabular Events ESE Duration HR PR IRR ER Tabufer DAY hain si s Ien Zain Interval gt 6 13 Limit HR 12 jet40e 1 1y teres j tain ue 14 30 io 1 2 A HRR Sain Limit IR 208 16136 J spor nar Biter 14 49 08 Lede iR 337 Jel 1 AR ER a Tue 15 00 00 1m 2 coe 1h Bile 15 04 12 Limit IR 4h Tue 15 12 55 Livit IR Lait ik APNEA Limit RR Tue 5 400 Te 200r COl laog ee ee al oaao oadd ioo Ae a fae 72 96 Delete cianta scales r Print Clese These open the Graphical Trends Tabular Trends Events Prints a Review Print that covers the time Waveforms Arrhythmia Events and OxyCRG Review Windows span shown in the window 102 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Adjust the content of the tabular list Review Tabular Trends Events a odiati J y REA TAES YT GFE ETA i a D a Tine Event Duration IHR PR IRR ER List Type Tabular Evants Batty DAY hrators si
141. lt A mode might be suppressed by the Acuity System for up to four minutes and 15 seconds depending on choices made during Acuity System installation For further information see the monitor directions for use Visual indications at the patient monitor are not suppressed After an audible alarm tone is suspended and another vital sign alarm occurs for the same patient a new tone does not occur until the original 90 seconds has lapsed Patient status icon does not change to wv when a patient alarm is suspended WARNING During an alarm or alert suspension period be aware of new visual alarm indications that might occur on the patient monitor or Virtual Monitor During a suspension period these things occur at the Virtual Monitor and patient monitor e Audible tones are suspended for 90 seconds unless RESUME is clicked at the central station or the alarm tone is reset at the patient monitor e Alarms for lethal events apnea asystole ventricular tachycardia and ventricular fibrillation override the suspend state e All other new alarms for the same patient are indicated only visually by additional red numeric highlights and arrhythmia or ST status messages e New equipment alerts are indicated only after the first alarm and alert conditions are corrected A Additionally these indications occur e On hallway message panels and in the message window at the top of the Acuity System screen if a new alarm is higher pri
142. ludes Arrhythmia Analysis option beat labels appear Directions for use Chapter 11 Specifications 197 Table 41 Review window Waveforms Features Factory default Display priority of waveforms Period displayed Up to five ten in the full screen review view monitored within the last 24 hours in following order of priority ECG Oe Oe ee uU S 25 mm s period depends on sweep speed The most recent seconds monitored appear at the right side of the window or if another review window was viewed first the period is centered around the cursor bar position in the first viewed review window ECG lead RESP lead and CO labels to the right of the waveform display Reflect labels selected at the monitor during the current time position of the cursor bar Propaq LT monitor lead selections are independent from Acuity System lead selections Presets values ECG scale 1 mV Sweep speed 25 mm s P1 range 30 mmHg to 180 mmHg P2 range 0 mmHg to 50 mmHg P3 range 0 mmHg to 50 mmHg P4 range 0 mmHg to 50 mmHg CO range 0 mmHg to 60 mmHg Sp0 scale 1x RESP scale 2x Blue cursor bar shows Event types Event markers are arrhythmia types Arrhythmia and ST Relearn or Learning Done and snapshot print ECG beat labels 24 hour or up to 96 hour time line indicates patient or equipment state Printouts Normal and ventricular V If Acuity System includes Arrhythmia Analysis option beat l
143. m Patient List Review PLR Acuity Central Station Duplicate Acuity Central Station that derives information from the primary Acuity System Ability to select from the Patient List which patients are viewed View Waveform Windows and Virtual Y Y Y Monitors View real time vital signs Y Y Y Print records and specify auto printing for Y Y Y a patient Review graphical trends tabular trends Y Y Y events waveforms OxyCRG information arrhythmia events and ST analysis information Coordinate central station printers and Y Y Y print jobs Print a patient summary from the patient Y Y Y list Open a Waveform Window by clickinga Y Y Y map icon Admit and readmit patients Y Y N Transfer patients Y Y N Discharge patients Y Y N Enter and change patient information and Y Y N add a patient note Change alarm limits and settings Y Y N Set up Arrhythmia Analysis and ST Y Y N Analysis Waveform Windows and Virtual Y Y N Monitors auto open on alarm Suspend alarms or alerts Y Y N High Availability HA Paired Systems Y N N supported For details see Flexible patient access FPA using virtual network computing VNC on page 13 Directions for use Acuity System heart rate Chapter 11 Specifications 177 Table 22 Acuity System heart rate calculation Acuity System configuration Acuity System with Arrhythmia Analysis module Method of HR calculation Acuity Central
144. m includes multiple screens the additional screens show Waveform Windows or Virtual Monitors Button Description Expands the map to cover most of the Acuity Central Station screen Map shows room locations and status icons of all monitored patients One Virtual Monitor and review window cover part of the map Map View 4 Waveforms 2 Utilities View View The 4 waveforms view shows four Waveform Windows two utility windows and one Virtual Monitor A utility window can cover the map If your system includes multiple screens this view can show two utility windows and one Virtual Monitor E ES 8 Waveforms View 12 Waveforms View Shows eight Waveform Windows and one Virtual Monitor A utility window can cover the map Shows 12 Waveform Windows A Virtual Monitor can cover the map and can be replaced by a utility window Half Screen Review View Full Screen Review View The top half of this view shows a review window and the bottom right quarter of the screen shows four Waveform Windows The map in the bottom left quarter might be covered by a Virtual Monitor or utility window If your system includes multiple screens a Virtual Monitor replaces the Waveform Windows Shows one review window for one patient Aal All Monitors View Shows three Virtual Monitors and one utility window that can cover the map shows no Waveform Windows Directions for use System buttons Chapter 2 Acuit
145. mia Alarms Setup Arrhythmia Alarms Alarm Printon Alarm Printon Level Alarm Arrhythmia Level Alarm LETHAL _J Pause LETHAL Irregular 125 m LETHAL 3 6 r OFF OFF OFF OFF OFF OFF 182 r v OFF 3 A al OrE aaja S Alarms set ST Arr Relearn Undo Close NonCapture Options Pause Limit Irregular Limit Single ECG Pacer Display Analyze Pacers E OL A a E E 2 Set alarm limits in one of these ways e Inthe Limit column click the arrows next to the arrhythmia type to set alarm limits for one arrhythmia type at a time e Click Alarms Set Presets to set all arrhythmia limits to preset values For Presets values see Table 35 on page 191 3 Ifthe patient has a pacemaker see To set additional arrhythmia analysis preferences for a pacemaker patient on page 62 Directions for use Chapter 4 Adjust monitoring settings and patient information 61 Adjust preferences for a patient s arrhythmia alarming To adjust preferences for a patient s arrhythmia alarming 1 In the patient s Virtual Monitor click Setup Arrhythmia Alarms Setup Arrhythmia Alarms Shelly F Phelps Arrhythmia Saree ooncon Single ECG enables you to select one lead for EAD arrhythmia analysis This is useful if false alarms TE A ETRS ae occur because of a 3 6_ T T OFF af RonCapture c SFE patient s unique beat OFF nf morphology For details vl OFF J Options see Table 14 on
146. most recent highest priority arrhythmia alarm latches in the Waveform Window even after alarm condition ceases Can be configured to apply to lethal high level or lethal high level medium level arrhythmia alarms Audible latching Lethal arrhythmia events can be configured to also latch audibly Audio tone latching default is off Table 26 Alarm and alert indications at the Acuity Central Station Alarms red Monitor equipment alerts System wide Patient yellow equipment information alerts alerts yellow yellow Duration Indications remain until Indications remain until the Indications remain until condition condition is cleared or condition is cleared or the is cleared except Disk Failure alarm is turned off alert is acknowledged equipment alert is displayed for disabled at the patient two minutes four times an hour If latched alarm monitor some alerts do not capability is enabled allow acknowledgement lethal and high level arrhythmia alarms and Certain wireless alerts can medium levelarrhythmia be RESET at the Acuity alarms if so configured Central Station persist in Waveform Windows until cleared at Central 180 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Table 26 Alarm and alert indications at the Acuity Central Station continued Alarms red Monitor equipment alerts System wide yellow equipment alerts yellow Patient information alerts
147. most reliable for arrhythmia analysis 4 Click Setup Arrhythmia Alarms The Arrhythmia Alarms Setup window appears 5 Under Options locate the Single ECG box 6 Next to the Single ECG box click the arrow and select the most reliable lead for arrhythmia analysis A relearn occurs in the next step 7 Check the Single ECG box A RELEARN alert occurs at the patient s Virtual Monitor and Waveform Window The alert remains until relearn is finished 8 Carefully evaluate the new ECG rhythm to ensure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 oo WARNING If you turn on Single ECG in response to false lethal arrhythmia alarming for example due to bundle branch block or irregular rate arrhythmia analysis is limited to one lead Typically 3 lead analysis via a 5 wire cable is optimal Acuity Systems that include an Arrhythmia Analysis option measure HR using arrhythmia algorithms whereas the monitor uses a single lead Thus the patient monitor can display a higher heart rate perhaps due to noise or artifact which can result in more frequent HR alarms than the Acuity Central Station displays If the patient monitor is a Propaq LT CS or Encore and if the patient has a high quality pulse oximetry waveform you can attempt to reduce HR alarming by changing the HR source to Sp0 For example from the Propag monitor s main menu press
148. mponent that the icon represents Table 7 Colors of Acuity System status icons Icon color Gray Blue Green Yellow Red Meaning of icon color Acuity System is not receiving patient information from this site because no communication is established When the icon represents Acuity System components the components are operating successfully When the icon represents an individual monitor Acuity System is not receiving continuous heart rate or pulse rate information from it This patient is successfully monitored The patient and monitor are not in an alarm or alert state Alert When the icon represents an Acuity System component the component is in an alert state When the icon represents an individual patient monitor there is a monitor problem or there is a setup problem with Patient ID room number or alarm limits Alarm Surveillance is lost for this patient or an alarm limit is violated 138 Chapter 9 Status icons Welch Allyn Acuity Central Monitoring System Patient monitor status icons Patient Monitor status icons show status and act as buttons to open patient Virtual Monitors and Waveform Windows Locations of patient monitor status icons Patient monitor status icons appear on the Acuity Central Station screen in these locations e On the map at patient locations e Inthe corresponding Waveform Window e In the corresponding Virtual Monitor Gh Wess 12528 Le SENE E EE ae KELI Eaa S wr
149. n page 65 WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move Check the Alarms Setup window to see if some limits have been turned off A WARNING Patients for whom alarming has been turned off must be kept under close physical surveillance Turning off alarming disables both audio and visual alarm indicators WARNING Do not use Stat Set or Auto Set for a patient in an alarm state Use these buttons only when your patient s vital sign values are in an acceptable range The buttons adjust alarm limits based on the patient s current vital sign values 158 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Table 14 Troubleshooting patient alarm indications Problem Explanation Audible alarm or alert tones are delayed at the patient monitor However visual indications at the patient monitor and Acuity Central Station occur at the same time To minimize disturbance to patients a 10 second delay occurs before an alarm or alert tone sounds at most patient monitors connected to the Acuity System network WARNING Audio tones at a patient monitor in pediatric or adu
150. n to mobile devices running Clinician Notifier software Note Some patient monitors that can communicate within the Acuity System might not be represented in this diagram Directions for use Chapter 2 Acuity System overview 11 Networked Acuity System features Networked Acuity Systems include various features This section presents these network features e Remote Patient List Review PLR station e Paired system CPUs high availability pairs Remote Patient List Review PLR station Networked Acuity System with a remote Patient List Review PLR station Some networked Acuity Systems include one or more remote Patient List Review stations Clinicians can do these things at a PLR station e Open Waveform Windows e Open a Virtual Monitor e View realtime vital signs in all relevant windows e Open review windows e Print records and specify auto printing for a patient WARNING f you view an Acuity System display remotely and its primary Acuity System fails you lose all access to the remote display Monitoring a patient at an Auto Open Secondary AOS or Patient List Review PLR remote station is not a substitute for monitoring a patient at the primary Acuity Central Station 12 Chapter 2 Acuity System overview Welch Allyn Acuity Central Monitoring System To open a Waveform Window on a PLR station screen PLR stations are typically part of an extended Acuity System network To open a patient s Waveform Window from
151. nd to achieve optimal event detection and analysis e ECG cable lead wires and electrodes are undamaged Patient s skin is properly prepared e Electrodes are placed using standard good practices e5 wire ECG cable is used A 3 wire cable limits arrhythmia and ST segment analyses to a single lead and ST analysis is disabled when a lead failure occurs LL electrode is connected Otherwise only one ECG lead is available and arrhythmia and ST segment analyses are effected e Patient monitor and Virtual Monitor display these things HR numeric and ECG waveform Non noisy signal If signal is noisy reduce patient movement and increase distance from other electrical devices Correct patient mode for the patient eVirtual Monitor ECG 1 and ECG 2 display these things ECG waveform Waveform amplitude at least 160 uV peak to peak ORS complex amplitude at least twice the P or T wave amplitude WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move 46 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Adjust a patient s alarm limits In the Alarms Setup wind
152. ndows and some printouts After relearn carefully evaluate the new ECG rhythm and the current ST segment for all active leads to ensure that the system learned an appropriate rhythm WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move 92 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System To respond to a RELEARN alert RELEARN VERIFY THAT LEARNING RHYTHM IS NOISE FREE pan zl Setup F J Review Suspend Snapshot Close 1 Inthe patient s Virtual Monitor carefully evaluate the new ECG rhythm to ensure that the Acuity System has learned an appropriate rhythm 2 Check the relearned ECG rhythm in the Waveforms Review window a Click Review Waveforms The Waveforms Review window appears b Click the Arrhythmia Relearn event marker W shown at the time of the Relearn event c Examine the rhythm that the system learned to ensure that it appropriate 3 If your Acuity System includes the ST Analysis option examine the ST segment a Click Setup ST Analysis The ST Analysis Setup window appears b Examine the current ST segment for all active leads to ensure t
153. ndows for Patient ID Alarms Printouts Waveform Window Arrhythmia Alarms and ST Analysis e Review Opens review windows for Graphical Trends Tabular Trends Events Waveforms Arrhythmia Events and OxyCRG e Suspend Suspends an audible alarm tone for 90 seconds e Snapshot Prints a snapshot at the Acuity Central Station printer E Patient mode messages Alarm and alert messages replace patient mode indicator F Patient monitor status icon Patient monitor status icon For details about all status icons see Status icons on page 137 G Waveforms Up to three waveform display areas For patient monitors that include Masimo Sp0 measurement capabilities indicator beneath SpO wave is Signal IQ For more information refer to Masimo Corporation literature 24 Chapter 2 Acuity System overview Welch Allyn Acuity Central Monitoring System H ECG lead The adjacent waveform is derived from this ECG lead If you want to review waveforms from a leads click Review Waveforms to open the Waveforms Review window Color indicates status Red patient alarm Yellow equipment or patient alert Green patient vital signs within limits and normal equipment operation Blue intentional disconnection To open a patient s Virtual Monitor Take one of these steps at the Acuity Central Station screen Adult Reed Erlandson HRI RR e Click the status icon in the patient s Waveform Window e Click the patient s map icon
154. nitor the information is stored at the Acuity Central Station and the patient map icon remains in the original position and state until the move takes place If the patient is connected to a wireless patient monitor and transferred to a new unit the patient map icon appears at the new central station If you did not enter the room number the icon remains in the yellow RM unconfirmed state until the room is confirmed Directions for use Chapter 7 Move a monitored patient 127 Move patients and their hardwired monitors mee Propag CS monitor mE Propaq Encore monitor Welch Allyn 1500 Patient Monitor To disconnect move and reconnect a hardwired monitor to a new network connector Throughout this procedure and the move leave the monitor turned on 1 Ona Propaq CS monitor Press NET OFF in the top left corner of the screen On a Propaq Encore monitor Press NET OFF on the top right corner of the casing On a Welch Allyn 1500 Patient Monitor Press the Standby key and select Discontinue Monitoring 2 Within 15 seconds remove the Acuity System network cable from the monitor The monitor should disconnect from the Acuity System If it does not begin again at Step 1 3 Inthe new location connect the Acuity System network cable to the Acuity System network connector on the bedside monitor The CONFIRM PATIENT prompt appears 4 Take one of these steps e If the information in the CONFIRM PATIENT prompt is
155. nitoring a patient You can either temporarily interrupt or permanently stop patient monitoring For information about patient monitors that are part of your Acuity System but are not shown in this chapter consult the patient monitor manufacturer s literature Temporarily interrupt monitoring To temporarily interrupt monitoring a patient 1 Disconnect sensor cables from the monitor Leave the monitor turned on Equipment alert s appear Acknowledge Disable all equipment alerts At the central station the patient s map icon and windows are in the blue patient intentionally disconnected state Optional Disconnect lead wires from patient electrodes and disconnect electrodes from the patient When ready to resume normal monitoring reconnect sensor cables to the monitor If necessary apply lead wires to electrodes and apply electrodes to the patient The CONFIRM PATIENT prompt appears Take one of these steps e If the information in the CONFIRM PATIENT prompt is correct click YES At the central station the patient s windows return to the state that they were in before the disconnect e If the information in the CONFIRM PATIENT prompt is not correct click NO and see To respond to the CONFIRM PATIENT prompt on page 29 134 Chapter 8 Discontinue Acuity System monitoring Welch Allyn Acuity Central Monitoring System A WARNING f your system includes arrhythmia analysis and if you connect
156. ntral Monitoring System 4 Enter your VNC client password If you are using the VNC Enterprise Edition Server enter your user name and password 5 Press OK The Remote Patient List Review window appears For more information see Remote Patient List Review PLR station on page 11 Y SAND 3 617 Victor N Christensen u SIMULATING w s Note FPA connections are not shared between individual client connections The Acuity Central Station allows only one client to connect to each display session When you disconnect from a remote viewing session the windows and views are not reset It is recommended that you close all patient windows on the viewing client before disconnecting Directions for use Chapter 2 Acuity System overview 15 Paired system CPUs High availability pairs and switchovers Acuity Systems that typically support at least 29 patients include a high availability HA central processing unit CPU The HA CPU is a redundant Acuity System CPU An HA CPU assumes control if the Acuity System CPU s operation is interrupted An HA CPU switchover occurs to ensure minimal loss of Acuity Central Station monitoring capability Historical data that had been gathered by the non operational CPU before the switchover might not be available for some patients until that CPU becomes operational At any one time displays in a paired CPU system should all receive input from either the Acuity System CPU or the HA CPU
157. ntricular fibrillation override the suspend state e All other new alarms for the same patient are indicated only visually by additional red numeric highlights and arrhythmia or ST status messages e New equipment alerts are indicated only after the first alarm and alert conditions are corrected WARNING If an Acuity Central Station display is intentionally or inadvertently muted alarm and alert tones do not occur at the display If your central station display includes audible tones remain aware of whether they are occurring If they appear to have stopped ensure that tones are restored WARNING False alarms may occur in some situations You must understand and address the cause of the false alarms whenever possible to eliminate the possibility of repeated false alarms and alarm fatigue which might result in a failure to respond to an actual alarm situation WARNING Central station alarms alerts and other events can go unnoticed if clinical personnel are not present at the central station or if interruptions occur in power or system operations WARNING The leading cause of patient death or serious injury reported with the use of patient monitoring equipment is failure to respond to alarms notifying the user of an adverse change in patient condition If you are relying on visual alarm notifications maintain a clear line of sight and remain within 4 meters of the central station If you are relying on audio alarm notifications make su
158. nts section Events list section Numbers of arrhythmia events that occurred in All events checked in the event counts section the selected time span are listed here left are listed and described here To delete an event from review windows and printouts 1 In the event counts section check boxes next to event types that you would like to delete 2 Inthe events list section click the arrhythmia that you would like to delete 3 Click Delete ARR Events and then click Delete Selected The event is deleted To undelete an event fro review windows and printouts 1 Inthe event counts section check the Show Deleted box to show italicized deleted events in the events list section The number of deleted events in the displayed time span appears to the left of the box 2 Inthe events list section click the italicized event that you would like to undelete 3 Click Delete ARR Events and then click Undelete Selected The event is restored 112 Chapter 6 Review or print patient data Welch Allyn Acuity Central Monitoring System Review ST analysis information This section explains how to review ST analysis review information In the ST Analysis Setup window you can do these things e View current beats for specific leads e View current ST segment deviation values including alarm values If you are would like information about setting up ST segment analysis see ST Analysis option on page 69 To view current beats and ST
159. o a monitor ensure that the default alarm limits are appropriate for the patient The system uses Acuity System Presets values for Arrhythmia Analysis and ST Analysis limits and monitor default values for all other limits if the monitor can save default values Before you set customized alarm limits for a patient confirm the patient s ID and room number Otherwise customized limits might be lost Directions for use Chapter 3 Admit and begin monitoring 33 Propaq LT monitor N s ETT wM oTo SE To start Propaq LT monitor communication with the Acuity System and connect the patient to the monitor 1 Use a Propag LT monitor that is designated for use within the Acuity System network in which the patient will be monitored Turn on the monitor In the top right area of the Propag LT monitor screen verify that the battery icon is green which indicates that the battery is fully charged If it is not green monitor the patient with another fully charged monitor Attach the lead wires to the electrodes Apply the electrodes to the patient Attach the cables to the monitor last to optimize waveform interpretation during the initial Acuity System learning phase Look for a steady green light at the top of the monitor to confirm that the monitor is communicating with the Acuity System If the monitor is not communicating with the Acuity System use another monitor 34 Chapter 3 Admit and begin monitoring Welch All
160. o count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely solely upon rate meter alarms WARNING Central station alarms and other events can go unnoticed if clinical personnel are not present at the central station or if interruptions occur in power or system operations WARNING The leading cause of patient death or serious injury reported with the use of patient monitoring equipment is failure to respond to alarms notifying the user of an adverse change in patient condition If you are relying on visual alarm notifications maintain a clear line of sight and remain within 4 meters of the central station If you are relying on audio alarm notifications make sure that you can hear audio alarms from where you are Set the volume as needed considering the environment and ambient noise levels Verify that the alarm is audible to a clinician working at the maximum distance from the central station Related to monitoring interruption A A WARNING f you view an Acuity System display remotely and its primary Acuity System fails you lose all access to the remote display Monitoring a patient at an Auto Open Secondary AOS or Patient List Review PLR remote station is not a substitute for monitoring a patient at the primary Acuity Central Station WARNING Use wireless monitors only on patients who can tolerate intermittent monitoring interruptions All wireless systems are prone to intermittent signal dropou
161. occasionally disrupted During this period the bedside monitors continue to provide their primary alarming functions Caution U S Federal law restricts this device to sale by or on the order of a physician Caution Make sure that your barcode scanner is properly configured by Welch Allyn before use Directions for use Chapter 1 General information Acuity System compliance with safety standards C 0297 Table 1 Acuity System compliance with safety standards The CE Mark and Notified Body Registration Number signify that the product meets all essential requirements of European Medical Device Directive 93 42 EEC Acuity System component s Product category Organization and standard Propaq Encore Propag CS Propag LT Welch Allyn 1500 Patient Monitor and Micropag monitors Wireless Micropag Propag LT and Propaq CS monitors Medical Equipment EN 60601 1 1990 A1 1992 A2 1995 IEEE 802 11 Wireless LAN Medium Access Control MAC and Physical Layer PHY Specifications IEEE 802 11a 802 11e 802 1 1h 802 1X 5 GHz All components operating together as a system All components operating together as a system Electromagnetic compatibility for Medical Equipment Medical Systems IEC 60601 1 2 2007 IEC 60601 1 1 2000 All information systems components Acuity System cordless receiver cabinet nformation Technology Equipment Electromagnetic compatibility EN 60950 1994 FCC
162. ogy If the system does not learn the new morphology it might not alarm or it might cause false alarms The relearn process establishes the new morphology as the normal ECG rhythm for arrhythmia and ST segment analyses elf a RELEARN alert occurs after changing or moving an electrode carefully evaluate the new ECG rhythm and the current ST segment for all active leads to make sure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 elf a RELEARN alert does not occur after changing or moving an electrode initiate a relearn event For instructions see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses on page 65 WARNING If you turn on Single ECG in response to false lethal arrhythmia alarming for A example due to bundle branch block or irregular rate arrhythmia analysis is limited to one lead Typically 3 lead analysis via a 5 wire cable is optimal WARNING In some clinical environments and due to some physiologic differences among patients the Acuity System might not alarm for occurrences of ventricular tachycardia ventricular fibrillation or asystole For instance asystole is defined as an absence of any detected beat for four or more seconds Patient pathologies where indications of electrical activity continue to exist without adequate cardiac function might not be recognized as asystole gt W
163. om Acuity System monitoring on page 136 Discharge a patient from Acuity System monitoring A patient s waveform and trend information is available for review and printing for 24 to 96 hours after Acuity System monitoring has stopped for the patient After the information is no longer available the patient s name remains in the Patient List window until the patient is discharged from the Acuity System Discharge patients when the need for monitoring has passed If a discharged patient s waveform and trend information remain in the system it is still available for review and printing You cannot discharge a patient who is currently monitored by the Acuity System Note Ona Welch Allyn 1500 Patient Monitor selecting Discharge Patient from the Standby menu discharges the patient at the Acuity System To discharge a patient from Acuity System monitoring 1 At the Acuity Central Station from which the patient was monitored in the lower left corner of the Acuity Central Station screen click E 2 Click the patient s name 3 Click Discharge The Discharge Patient window appears 4 Verify that this patient is to be discharged 5 Click Discharge The patient is removed from the Patient List when the patient s waveform and trend information no longer remain in the Acuity System 137 9 Status icons Status icon colors The color of a status icon conveys the status of the patient patient monitor or Central Station co
164. on 170 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Power outages To turn off the Acuity System 1 Notify staff members so that procedural changes in patient care can be put into place It is not necessary to disconnect monitors from bedside network connectors 2 On the Acuity System screen move the pointer into the gray area of the upper right corner 3 Open the System menu For an Acuity System Hold down the key on your keyboard and press the right trackball or mouse key For a Mobile Acuity LT System Hold down the ae key on your laptop computer keyboard and press the right mouse key The System menu appears in the upper right corner of the screen 4 Click Shutdown Workstation A confirmation prompt appears 5 Click Confirm 6 Wait a few minutes for the computer to turn off 7 Turn off power to these system components A A Central Station display s Acuity System laser printer s Terminal servers Caution Do not simply turn off power to the Acuity Central Station An orderly shutdown allows proper storage of patient information WARNING f normal central processing unit CPU operation is interrupted for example during CPU maintenance scheduled and unscheduled reboots power loss or a high availability HA CPU switchover period central station monitoring and analysis temporarily stop The Acuity System cannot collect patient review data during
165. on your computer is not set too low or is not set to mute as this may cause you to miss audible alarms generated from the Acuity System WARNING Replace central station hardware within the the lesser of 3 years or the original equipment manufacturer s specification Failure to perform preventative maintenance can impact system performance and availability WARNING The bedside patient monitor is the primary alarming source for the patient and the central station is a backup alarm source The central station is only as reliable as its network and should be relied on only as a backup alarming device WARNING Lethal arrhythmia LTA analysis by the central station is only as reliable as the connection to the bedside monitor With the exception of the Welch Allyn 1500 monitor in a disconnected state which provides its own LTA analysis and alarm the central station is the primary source for LTA analysis LTA alarms will occur at the central station and will also be communicated to the bedside monitor for annunciation Thus in a central station workflow LTA analysis and alarming will only be as reliable as the network WARNING A paired system CPU high availability pair is strongly recommended to provide system redundancy WARNING The electronic medical record system EMR is not intended to serve as a primary monitoring system for alarms or as an exclusive source for patient data in determining patient care The Acuity System is capable of trans
166. ond to alarms and alerts 87 Remove a latched arrhythmia alarm If your Acuity System is configured to allow latched alarms indications for certain arrhythmia alarms remain or latch in the Waveform Window even after the alarm condition has ceased e Depending on configuration lethal high level and possibly medium level arrhythmia alarms visually latch in Waveform Windows For details about arrhythmia alarm levels see To adjust preferences for a patient s arrhythmia alarming on page 61 e After the alarm condition becomes inactive latching indications remain until you clear the latched alarm or until the alarm is replaced by another latched alarm of equal or higher priority e lf you attempt to remove a latch for an alarm condition that is still active the visual latch remains To remove a latched arrhythmia alarm The latched alarm Abigail Watson 7 80 S OFF u Pde z Red bar Lethal or high level arrhythmia alarm Red and yellow bar medium level arrhythmia alarm Take one of these steps e Click the colored bar to remove the latching indication s e Click to remove the latching indication s and review the event The Arrhythmia Events Review window appears The cursor clears the text and bar as it sweeps across the window 88 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System Respond to specific alarms and alerts This section describes a few of the Acuity System a
167. onitor manufacturer s literature Note f a wireless patient monitor operates outside of its wireless communication area the monitor aggressively searches for connection with the central station and depletes its battery life at a faster rate If it searches for an extended period of time typically more than four hours it can display a system fault error that necessitates turning the monitor off and on again Micropag monitor A WARNING Do not attempt to monitor neonatal patients ECGs using a Micropaq monitor Micropaq monitors are intended for use with adult and pediatric patients only To start Micropaq monitor communication with the Acuity System and connect the patient to the monitor Perform steps in the following order to ensure that both the monitor and the Acuity Central Station display the default ECG leads 1 Use a Micropag monitor that is designated for use within the Acuity System network in which the patient will be monitored 2 Install a newly charged battery in the battery compartment at the back of the Micropag monitor using a bottom to top approach 3 Immediately determine the patient mode which appears briefly on the first Micropaq monitor screen If the patient mode does not match the patient age change the mode at the Acuity Central Station See Change the Patient Mode in Table 2 on page 43 4 Attach the lead wires to the electrodes 5 Apply the electrodes to the patient 6 Attach the cabl
168. or use Chapter 9 Status icons Table 8 Icons and messages that represent patient and monitor status Patient monitor status icon C Patient Alarm or Telemetry Dropout Icon display priority Take priority over alerts Icon location on map Locations representing monitors that are audibly alarming in response to one of these conditions e Patient vital sign limit violations e Patient monitor is not communicating with the Acuity System Messages in hallway message panels and at top of Acuity Central Station screen room VT ASYS VF APNEA Limit vital sign 0 room Dropout Recommended action Patient Alarm Attend to the patient and suspend or silence the alarm tone You can turn off or reset alarm limits also at the central station Then click the Silence Reset key at the patient monitor or Resume at the central station Virtual Monitor Telemetry Dropout During this state Arrhythmia and ST alarms are not indicated 1 Click one of these buttons e SUSPEND to suspend the alarm tone for 90 seconds e RESET to stop the alert and put the monitor in the blue patient intentionally disconnected state 2 Bring the wireless monitor within range of a wireless access point 3 If the problem persists contact qualified service personnel Yel Take priority Locations representing room Reconnect the HR PR over alerts monitors that no longer
169. ority than one already shown on the panels it replaces the first alarm e At the patient monitor a short blip tone can occur if a new arrhythmia alarm is a higher level than a suspended alarm WARNING Always identify the source of an alarm before you suspend it When an NIBP alarm is suspended or silenced the window borders and icon colors at the central station are the pre alarm color instead of the typical red Alarm Suspended status A The patient alarm might have been an NIBP alarm When an NIBP alarm is suspended changes color to reflect the patient status before the alarm When click the bar in a Waveform Window to remove a latched alarm the alarm remains SpO false alarms are occurring If you attempt to remove a latch for an alarm condition that is still active the visual latch remains Poor sensor placement a patient s poor circulation frequent arrhythmias or excessive patient movement can increase the frequency of false alarms If the problem persists after you have corrected sensor placement try changing the SpO RESPONSE time to SLOW and C LOCK to OFF Directions for use Heart rate and ECG displays Chapter 10 Troubleshooting and maintenance 159 Table 15 Troubleshooting heart rate and ECG displays Problem Heart rate values on the patient monitor differ from HR values at the Acuity Central Station or appears instead of the HR PR numeric reading ECG signa
170. oses the patient s 1 2 Waveform Window Select Waveforms or NIBP only to display on the Acuity Central Station screen w Enti I ART 1 PA co2 LJ RESP 3j Spo j REP Note If you need to s close a Waveform aaoh ae Close Waveform Window Close Window from a Patient List Review PLR station see These open the Alarms Printouts Waveform Window Arrhythmia page 12 Alarms and ST Analysis Setup windows 2 Click 1 or 2 to select the number of waveforms to display in the Waveform Window 3 Check a vital sign box to display a waveform If ECG is monitored ECG1 is always displayed and cannot be deselected NIBP is selected for display if it is the only vital sign monitored 52 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Arrhythmia Analysis option The Acuity System Arrhythmia Analysis module analyzes patient ECG data to detect specific changes in cardiac rhythms The system uses up to three ECG leads to detect normal beats ventricular beats and to analyze arrhythmias The Arrhythmia Analysis options are not intended for use on neonatal patients and arrhythmia analysis is disabled in the Neonate mode Arrhythmia Analysis terms These terms are used throughout this section alarm level A setting that indicates an individual arrhythmia type s priority and associated audible alarm tone Alarm level designations can be lethal high medium low or off
171. ow you can adjust a patient s alarm limits individually or as a group WARNING Before you set customized alarm limits for a patient confirm the patient s ID and room number Otherwise customized limits might be lost To adjust a patient s alarm limits 1 In the patient s Virtual Monitor click Setup Alarms The Alarms Setup window appears Patient s measured value Limits Limits pair Slider head aarm set Suspen Clos Ped These open the Alarms Printouts Waveform Window Arrhythmia Alarms and ST Analysis Setup windows 2 Check vital sign boxes along the bottom of the screen to view corresponding alarm limits 3 Adjust alarm limits in one of these ways e Adjust limits for one vital sign at a time Click On or Off next to the limits pair to adjust the pair Click On to turn the alarm limits on and click Off to turn the alarm limits off Click and move a slider head to set or turn off a lower or upper limit Click Auto Set to set a limits pair close to the patient s current vital sign values e Reset limits for all vital signs at once Click Alarm Set and then click one of these options Stat Set sets all limits based on the patient s current vital sign values Presets sets all limits to preset values For details see Table 34 on page 190 All Alarms On turns on any limits that are off with the values that they last held Directions for use Chapter 4 Adjust monitoring settings and patient info
172. patients e ST analysis module provides real time monitoring and alarms for ST segment deviations from a reference beat for patients with suspected heart disease and anomalies The clinician is responsible for determining the clinical significance of each selected ST segment deviation or alarm The ST analysis module is not intended for use with neonatal patients General description The Acuity Central Monitoring System Acuity System is Welch Allyn s central monitoring solution It consists of a central monitoring station Acuity System software and a collection of other commercially available networking products The Acuity System is available in multiple product configurations Acuity Systems can be customized to meet a customer s unique needs based on hospital policy health care facility size and patient census and floor layout In all cases the user must carefully review the features and functionality of the Acuity System to ensure that selected configurations meet specific clinical needs The Acuity System supports patient information management patient vital sign alarm and equipment alert management patient data and waveform monitoring and review system administration and ongoing service The Welch Allyn Connectivity Server WACS module consists of a server platform on which one or more of the following software options are installed Web Server Acuity System patient printout files available on Web browsers AcuityLink Ac
173. placed using standard good practices e 5 wire ECG cable is used A 3 wire cable limits arrhythmia and ST segment analyses to a single lead and ST analysis is disabled when a lead failure occurs e LL electrode is connected Otherwise only one ECG lead is available and arrhythmia and ST segment analyses are effected e Patient monitor and Virtual Monitor display these things HR numeric and ECG waveform Non noisy signal If signal is noisy reduce patient movement and increase distance from other electrical devices Correct patient mode for the patient e Virtual Monitor ECG 1 and ECG 2 display these things ECG waveform Waveform amplitude at least 160 uV peak to peak ORS complex amplitude at least twice the P or T wave amplitude 68 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System A A WARNING Carefully monitor lead wire connections of patients prone to arrhythmia events If a lead wire disconnects during an event the Acuity System s ability to accurately detect the event can be compromised WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move Direct
174. ppropriate rhythm For evaluation instructions see To respond to a RELEARN alert on page 92 WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move Directions for use Chapter 4 Adjust monitoring settings and patient information 79 Edit patient information You can revise information within the Acuity System as follows e Edita patient name e Edit clinical information e Edit a patient ID Add an amended patient ID e Add a note to a patient s Waveform Window If you want to change a patient s room number see Arrange a patient move from the patient monitor on page 129 Edit any patient information except a patient ID Sometimes it is necessary to change or correct patient information You might wish to correct the spelling of the name or change clinical information If you are monitoring a patient with a Propaq LT monitor you can edit this information at the monitor instead if you like To edit any patient information except a patient ID gt i a 1 At the Acuity Central Station click Sap The Patient List window appears 2 Click the patient s name to highlight it and then click Edit
175. print patient data 123 Review a 12 lead report PATIENT RECORDING oxra B INTERPRETATION WelchAltyn Patient Name Peter Muster Date of Report oO 0 Uncesfemed interpretation MD SHOULD REVIEW Patient ID 173 300107 09 Time of Report 16 46 01 SINUS RHYTHM Date of Birth 1962 09 03 Recorded by EMR1 LEFT ATRIAL 1730m Referring physici INCOMPLETE RIGHT BUNDLE BRANCH BLOCK Weight ag Ordering physician LVH WITH REPOLARIZA Ethnicity Caucasian Lomi RULE OUT ANTEROSEPTAL MYOCARDIAL DAMAGE PIPR 96 ms 160 me Medion 578 UNCONFIRMED REPORT QRS dur S4 ms Anti errhythmic QT QTe 348 ms 389 me Beta Blocker PQRS T axis 28 46 39 Digitalis Heertrate bpm c p Patient anxious 2an a Ss aSe aege alete SSREr eRe ae L a ee a ERS IRAs EPPEN BEESS BEF Es eal beet se Rk EAER E i z EA Fa fE iz i E 333 Fa its HEH E iad HBH ja HH E iiz EA EE H ne ra 333 E E 32 EH En E jz pz HE ni HM Eii i Eii HH BIH Bihi jz AA Hal E HE fz Eta B E Eih SSSR REESE g Pe sists balsam SERE eiee ee eee EE E E poreaaeeeee EBF ES A Patient information appears if patient is confirmed in the Acuity System This data includes extended demographics such as date of birth height weight gender ethnicity and other measurements B Print information This data includes when the report was printed clinician and physician information
176. r by clicking the patient s map icon once or twice Open the patient list show patients who are connected to wireless monitors open system administration windows and sort the order of Waveform Windows Displays the patient s vital signs information and status Directions for use Chapter 2 Acuity System overview 17 F Screen view buttons Change the overall Acuity System screen view They vary in appearance according to your system configuration G Message window Displays the date and time or the location of alarms and alerts It matches optional hallway message panel messages Note Welch Allyn Acuity Systems communicate with some patient monitors that include Masimo Corporation SoO2 measurement capabilities If a monitor communicating with your Acuity System has such capabilities the monitor s corresponding Acuity System Virtual Monitor Waveform Window some review windows and some printouts include SpO Perfusion Index PI and Signal O indicators and numerics For more information regarding Perfusion Index PI and Signal O please refer to Masimo Corporation literature or http www masimo com 18 Chapter 2 Acuity System overview System screen views Welch Allyn Acuity Central Monitoring System You can change the screen view of the Acuity Central Station display by clicking these buttons along the top left of the Acuity Central Station screen Your system includes some or all of these choices If your syste
177. r the time line to adjust the line s scope in hours 2 On the time line click an area in which you are interested Events are red The blue box moves The box indicates the time span covered in both sections 3 Under Time Span click to specify the number of hours spanned in both list sections In the event counts section the number of events beside each box is updated to reflect the current time span In the events list section the listings change To specify the content of the events list 1 Inthe event counts section check any of these things to list them in the events list section a Check arrhythmia types b Check these boxes to further refine the listings e Lethal and High Arr Alarms List only lethal events and events that were set to high priority in the Arrhythmia Alarms Setup window All Arr Alarms List all events that alarmed All Arr Events List all events that occurred whether or not they were set to alarm 110 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Adjust the waveform display Beat labels Normal and ventricular v Arrhythmia event marker Carl R Keyes HGERUDERERERERERML AD AAAAILADAAAAAAAAAAAAAAAAD DRsereoenmeneee SLU VUUUUUUUUUUUUUUUUUUVUVVUN Eo D gt ivt Priority Tise lethal Fri 09 29 51 Lethal Fri 09 30 01 Lethal Fri 09 30 35 Fret 10 52 04 Fri 10 54 07 Fri 10 54 24 2 Shov Deleted Lethal and Wigh Arr Alaras 0
178. rates derived from CO 50 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Coordinate system print jobs and central station printers This section presents the Acuity Central Station Printer window from which you can coordinate printers and pending print jobs for the entire Acuity System To coordinate print jobs 1 On the Acuity Central Station map where the Acuity Central Station icon is located click w The Print Jobs view of the Central Station Printer window appears Processing the request Print ren DK Print Jobs Alarm print cf 05 02 14 59 AUTO CcU West 13248 John Henry M05 02 14 56 ALARM CCU Hest 1324A Bun Keat Heng 05 02 07 30 TREND CCU West 1322A Leo Deffenbacher 05 02 14 54 SNAPSHOT CCU West 13284 James V Grizzell 05 02 07 30 TREND CcU West 1324A Bun Keat Heng 05 02 15 00 SNAPSHOT CCU West 13198 Mackenzie E Stokes 05 02 14 59 AUTO CcU West 1328A James V Grizzell 05 02 14 58 REVIEW ccU West 13244 Bun Keat Heng mail Printer status kJ a eer D E Printing 89 Tatal Jobs 9 2 Click a print job to highlight it 3 Click any of these buttons e Click Print Next to print the job next e Click Delete and then Delete Selection to delete the print job Note f appears beside a print job see Table 18 on page 163 for troubleshooting information To coordinate printers 1 Click E The Printers View appears 2 Doany of these things e Read mes
179. rchased VNC license allows one VNC client to view real time and full disclosure data on monitored patients The Acuity Central Station supports two editions of the VNC server however these two editions cannot be mixed on a single Patient List Remote The VNC Free Edition Server is pre installed as a part of the Acuity System however a license must be purchased in order to use FPA The VNC Enterprise Edition Server offers features not included in the free edition and can be purchased for an additional fee There are three screen resolutions available for the VNC connection Resolution View type Standard port number 1280 x 1024 Standard resolution 5 1680 x 1050 Widescreen resolution 6 1024 x 704 Single patient view 7 To log on to flexible patient access using VNC 1 Ensure that you have installed a version of the VNC client application 2 Launch your VNC client application The VNC connection screen appears 3 Enter the IP address or host name a colon and the port number of the VNC server and press OK Do not add spaces between your entries Note Itis recommended that your biomedical engineer work with your facility s IT department and add the host name of your VNC port forwarder to the domain name server DNS so that changes to the port forwarder IP address do not affect VNC users It is also recommended that you use acuity as the host name of the port forwarder 14 Chapter 2 Acuity System overview Welch Allyn Acuity Ce
180. re If the prompt information is correct click Accept and other information fills in 4 If necessary scan or type the patient s name and press Tab or Enter to advance 5 If necessary scan or type the room number Up to five characters including numbers letters and dashes are accepted 6 Check the listed patient monitor model and serial number to ensure that they indicate your patient s monitor Directions for use Chapter 3 Admit and begin monitoring 41 Click Next Page to enter additional patient demographics such as date of birth gender height weight ethnicity and medications The second page of the Patient ID setup window appears Patient Identification Year Month Day Date of Birth 1380 i eo Height 65 0 in Gender Male Weight 170 0 Ib Ethnicity Other Medications _ Anti arrhythmic _ BetaBlocker _ Digitalis a Prev Page Clear All Confirm Undo Patient ID window 2 To confirm the patient 1 2 Carefully review your entries for accuracy Click Confirm If a prompt appears telling you that the same ID number has been previously used carefully review the ID number and then take one of these steps e Click Do Anyway to confirm the ID with the name that you have entered Review data is combined e Click Go Back to return to the Patient ID Setup window revise the ID or name and then click Confirm again You have completed the patient ID confirmation process The Ac
181. re that you can hear audio alarms from where you are Set the volume as needed considering the environment and ambient noise levels Verify that the alarm is audible to a clinician working at the maximum distance from the central station 86 Chapter 5 Respond to alarms and alerts Welch Allyn Acuity Central Monitoring System Related to heart rate HR and arrhythmia alarms A WARNING All heart rate alarms are valid even if the HR value at the central station differs from that at the monitor If your system includes an Arrhythmia Analysis option the Acuity System heart rates for adult and pediatric patients are a result of system software analysis The HR PR numeric changes to in the Virtual Monitor Waveform Window review windows and system printouts when the system detects ventricular fibrillation or asystole However an apparently valid heart rate numeric might show in the patient monitor Related to NIBP alarms A A WARNING Always identify the source of an alarm before you suspend or silence it When an NIBP alarm is suspended the window borders and icon colors at the central station are the pre alarm color instead of the typical red Alarm Suspended status WARNING f a noninvasive blood pressure reading is suspect repeat the measurement watching a manometer if the monitor has one to verify the reading If you are still uncertain about the reading use another method Directions for use Chapter 5 Resp
182. res Customizable Factory default default Number of vital signs checked at once Up to two but only one ECG at once Priority order of displayed vital sign boxes 1 ECG 1 4 P3 7 RESP 2 P1 5 P4 8 Sp0 3 P2 6 CO 9 NIBP Directions for use Review windows Table 39 Review window Graphical Trends Chapter 11 Specifications 195 Features Frequency of trend data sampling and storage by Acuity System Customizable default Factory default Sampled and stored once per second Frequency of patient monitor data storage and transfer to Acuity System Data is stored at the monitor every two minutes one minute for Propaq LT and then transferred to Acuity System Time delay from Virtual Monitor display to Graphical Trends Review window display Less than one minute updated continuously Display priority of trends Up to five vital signs ten in the full screen review view that have been active within last 24 hours in following order of priority HR PR Time span Cursor bar position Eight hours The most recent time monitored appears at the right edge of the window or if another review window was viewed first the period is centered around the cursor bar position in the first viewed window HR PR RR BR P1 P2 P3 P4 and CO labels to the right of the Graphical Trend Display Reflect labels selected at the monitor during the current time position of the cursor bar Presets value
183. rhythm A run of successive ventricular beats that is less than the V Tach alarm limit and the number of successive ventricular beats is greater than or equal to three Couplet Two consecutive ventricular beats that are preceded and followed by a normal beat PVC min Premature ventricular beats that are greater or equal to the patient s PVC min alarm limit Bigeminy Three or more successive cycles consisting of a normal beat followed by a premature ventricular beat Bigeminy is independent of the average heart rate Trigeminy Three or more successive cycles of two normal beats followed by a premature ventricular beat Trigeminy is independent of the average heart rate Tachycardia A HR greater than or equal to the patient s tachycardia alarm limit If the tachycardia limit is decreased past the HR high limit the HR high limit will decrease to a value equal to the tachycardia limit Directions for use Chapter 4 Adjust monitoring settings and patient information 57 Table 5 Full Arrhythmia Analysis option events detected in addition to lethal events Arrhythmia event and definition Bradycardia A HR less than or equal to the patient s bradycardia alarm limit If the bradycardia limit is increased past the HR low limit the HR low limit will increase to a value equal to the bradycardia limit Pause The R to R interval that is greater than or equal to two times the average R to R Irregular irregular r
184. rhythm as a guideline to identify arrhythmia events arrhythmia relearn and to analyze deviation of the ECG ST segment offset ST relearn When relearn occurs for a patient Both arrhythmia and ST relearn events occur after these things e ST Arr Relearn is clicked in the Arrhythmia Alarms Setup window e Single ECG is clicked in the Arrhythmia Alarms Setup window e Patient connection some lead changes or lead failures system restart Only an arrhythmia relearn event occurs after these things e RELEARN is clicked in the Arrhythmia Alarms Setup window A RELEARN button instead of an ST Arr Relearn button indicates that the system does not include the ST Analysis option e Analyze Pacers is clicked in the Arrhythmia Alarms Setup window ST Analysis is disabled when Analyze Pacers is enabled What occurs in a patient s windows during and after a relearn event e Virtual Monitor and Waveform Window A visual RELEARN alert occurs HR is taken from the patient monitor instead of from the arrhythmia software and real time waveforms display as usual e ST Analysis Setup window The waveform slice displays NO VALID BEATS and the Acuity System can take up to 30 seconds to update the waveform e Most review windows and some printouts Relearn and Learning Done event markers V appear A WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a
185. rm but was not notified WARNING During an alarm or alert suspension period be aware of new visual alarm indications that might occur on the patient monitor or Virtual Monitor During a suspension period these things occur at the Virtual Monitor and patient monitor e Audible tones are suspended for 90 seconds unless RESUME is clicked at the central station or the alarm tone is reset at the patient monitor e Alarms for lethal events apnea asystole ventricular tachycardia and ventricular fibrillation override the suspend state e AIl other new alarms for the same patient are indicated only visually by additional red numeric highlights and arrhythmia or ST status messages e New equipment alerts are indicated only after the first alarm and alert conditions are corrected A Directions for use Chapter 10 Troubleshooting and maintenance 155 Table 12 Troubleshooting equipment alerts Problem Explanation A Cuff Not Detected or a No Pulses Detected equipment alert is occurring at both the patient monitor and Virtual Monitor but NIBP is not being monitored This condition usually occurs for one of these reasons e The monitor wasn t turned off and on again to clear settings including Auto NIBP before the new patient was connected to it e The monitor was turned off but CURRENT SETTINGS including Auto NIBP were saved via the monitor s SYSTEM Menu When a patient monitor is set in the auto NIBP mode
186. rmation 41 Important considerations adjusting alarm limits A A WARNING Patients for whom alarming has been turned off must be kept under close physical surveillance Turning off alarming disables both audio and visual alarm indicators WARNING Do not use Stat Set or Auto Set for a patient in an alarm state Use these buttons only when your patient s vital sign values are in an acceptable range The buttons adjust alarm limits based on the patient s current vital sign values WARNING Always check alarm limits when a monitor reestablishes communication with the Acuity System If you change limits at a monitor while it is not communicating with the Acuity System for example during transport or signal dropout when you reestablish communication with the system the limits might change to Acuity System Presets values WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move WARNING False alarms may occur in some situations You must understand and address the cause of the false alarms whenever possible to eliminate the possibility of repeated false alarms and alarm fatigue which might result in a failure to respond to an a
187. rrhythmia and ST segment analyses are effected ePatient monitor and Virtual Monitor display these things HR numeric and ECG waveform Non noisy signal If signal is noisy reduce patient movement and increase distance from other electrical devices Correct patient mode for the patient e Virtual Monitor ECG 1 and ECG 2 display these things ECG waveform Waveform amplitude at least 160 uV peak to peak ORS complex amplitude at least twice the P or T wave amplitude WARNING If your system includes arrhythmia analysis and if you connect change or move an electrode ensure that a RELEARN alert occurs at the patient monitor and the virtual monitor Moving or changing an electrode can change the beat morphology If the system does not learn the new morphology it might not alarm or it might cause false alarms The relearn process establishes the new morphology as the normal ECG rhythm for arrhythmia and ST segment analyses e f a RELEARN alert occurs after changing or moving an electrode carefully evaluate the new ECG rhythm and the current ST segment for all active leads to make sure that the Acuity System has learned an appropriate rhythm For evaluation instructions see Respond to a RELEARN alert on page 91 elf a RELEARN alert does not occur after changing or moving an electrode initiate a relearn event For instructions see To initiate relearn of a patient s ECG rhythm for arrhythmia and ST segment analyses o
188. rs Unrecognized Unconfirmed Patient Arrhythmias with alarm levels set KJ Networked Acuity ID to high System ST segment offset if alarm level set to high Apnea alarms RMI High level alarm tone Monitor Central Printer Problem Unconfirmed Room BEEP BEEP BEEP Communication Lost Number Three loud beeps followed by a pause Medium level alarms bel E These alerts are not Arrhythmias with alarm levels set 9 Monitor Problem Swap Space Low secon ied win to medium audible tones ST segment offset if alarm level set to medium a Alert Tone Patient vital sign alarms p Network Problem A soft beep followed Medium level alarm tone by a long pause BEEP beep Connectivity Server One loud and one softer beep followed Note Some Monitor Unavailable by a brief pause Problem alerts are not associated with Low level alarms NN Vv audible tones No Continuous Heart Some Connectivity Pulse Rate alarms Services Unavailable Arrhythmias with alarm levels set to low ST Analysis with alarm level set to low ey Low level alarm tone Devices Running beep beep beep Clinician Notifier are Three spaced soft beeps followed by a Not Reachable pause These alerts are not associated with audible tones a Arrhythmia alarm levels are set in the Arrhythmia Alarms Setup window Arrhythmia alarms are further prioritized by list order in this window b ST alarm levels are set in the ST Analysis Setup w
189. rval 3 4 previous average interval 1 4 latest interval Transition rates for choice of formula include hysteresis and are 70 and 80 beats per minute Table 23 Acuity System heart rate trending Heart rate trends Heart rate information is available in the trend data which can be viewed on the display or printed The operator can inspect the trend data to see the lowest highest and median averaged heart rates Trend data also includes the total beats per range of time Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Acuity System pacemaker detection Table 24 Pacemaker detection with the Acuity System Arrhythmia Analysis module Monitor Characteristic Specification Micropaq Acuity System Pacer indicator shown on screen if PACER display turned ON pacer spike Virtual Monitor always shown if of sufficient amplitude Pacer Pulse Pacer detection range i e shows the dashed vertical marker for 3 mV to Detection 700 mV 0 1 ms width 2 mV to 700 mV 0 2 to 2 ms pulse width in Rejection electrically quiet environment Thresholds adjust to reject repetitive ambient noise Pacer detector influences ORS picking even while pacer indication is disabled Does not count as heartbeats approximately 95 of pacemaker pulses within pacer detection range with or without AAMI EC13 1992 tails of 4 25 50 75 or 100 ms decay time constant whose tail amplitudes are up to 25 2 mV maximum whether
190. s Blue cursor bar shows P1 is 30 mmHg to 180 mmHg P2 P3 and P4 are 0 mmHg to 50 mmHg all others similar to monitor factory Trend Graphs values For further information see the monitor directions for use Vital sign numerics and event types Event markers are arrhythmia types Arrhythmia and ST Relearn or Learning Done and snapshot print 24 hour or up to 96 hour time line indicates patient and equipment state Time line color matches icon color at all points in time Printouts Graph Table Summary 196 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Table 40 Review window Tabular Trends Events Features Factory default Frequency of trend data sampling and storage by Sampled and stored once per second Acuity System List type Both Tabular interval 15 minutes Vital sign boxes that are checked None Acuity System screen views that support this Full screen and half screen views window Number of waveforms viewed simultaneously Half screen view 1 Full screen view 2 24 hour or up to 96 hour time line indicates Time line color matches icon color at all points in time patient and equipment state Printouts Tabular Trends Events Data Median value over the last minute Trends downloaded from the patient monitor are Italicized Trends corresponding to events are bold with bell icon ECG beat labels Normal and ventricular V If Acuity System inc
191. s being monitored for arrhythmias the HR value is derived from the arrhythmia library instead of from the patient monitor Table 33 Waveform Window Features Factory default Waveform Window auto open In waveforms views 1 Upon monitor connection to Acuity System if empty window 2 Upon alarm if open space is available OR replaces a non alarming Waveform Window Number of waveforms Up to two displayed simultaneously Display priority of 1 ECG 3 P2 5 P4 7 RESP 9 NIBP waveforms 2 P1 4 P3 6 CO 8 Sp0 Number of vital sign numerics displayed Display priority of numerics Heart rate HR Setup windows Up to four If four or more monitored at once the third and fourth alternate in the same zone others appear if they alarm 1 HR PR 4 P2 7 CO 10 NIBP 2 Sp02 5 P3 8 RR BR 11 Temperature 3 P1 6 P4 9 IPI For patients being monitored for arrhythmias the HR value is derived from the arrhythmia library instead of from the patient monitor Table 34 Setup window Alarms Features Display priority of vital signs Alarm limits Customizable default Factory default Up to three vital signs in this order of priority 1 Vital signs in alarm 2 Active vital signs in the order listed in window Presets values Presets values Stat Set values Auto Set values Micropag monitor HR 50 to 120 bpm Sp0z 90 to 100 For all monitors except the Micropag monitor Presets ar
192. s type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move Directions for use A Chapter 3 Admit and begin monitoring 39 WARNING Ensure these things to minimize false HR Arrhythmia Analysis and ST Analysis alarms and to achieve optimal event detection and analysis ECG cable lead wires and electrodes are undamaged Patient s skin is properly prepared Electrodes are placed using standard good practices 5 wire ECG cable is used A 3 wire cable limits arrhythmia and ST segment analyses to a single lead and ST analysis is disabled when a lead failure occurs LL electrode is connected Otherwise only one ECG lead is available and arrhythmia and ST segment analyses are effected Patient monitor and Virtual Monitor display these things HR numeric and ECG waveform Non noisy signal If signal is noisy reduce patient movement and increase distance from other electrical devices Correct patient mode for the patient Virtual Monitor ECG 1 and 2 display these things ECG waveform Waveform amplitude at least 160 uV peak to peak ORS complex amplitude at least twice the P or T wave amplitude 40 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System Enter and confirm a patient s ID or room at the central station A patient s Acuity System window borders and icons are in a yellow alert state if the patient s ID
193. sages to check printer status e Clicka printer to highlight it and then click Disable to disable the printer or Enable to enable the printer Directions for use Chapter 4 Adjust monitoring settings and patient information 51 Adjust a patient s waveform displays You can select waveforms for display in a patient s Virtual Monitor and Waveform Window Note Only three waveforms can be displayed at a time in the Virtual Monitor These waveforms are displayed based on their priority Make sure you turn off all waveforms you do not want displayed For a list of waveform priorities see Virtual Monitor on page 189 or Waveform Window on page 190 To adjust waveform displays for a patient s Virtual Monitor You can select or deselect up to three vital sign waveforms for viewing 1 Inthe patient s Virtual Monitor click MAIN MENU MORE WAVE SEL 2 Click NEXT to highlight a waveform 3 Click ON OFF To adjust waveform displays for a patient s Waveform Window 1 In the patient s Virtual Monitor click Setup Waveform Window The Waveform Window Setup window appears Copy of the Waveform Window 1320A Setup Waveform Window Jeffery J 80 danda adad i TEFA 80 5 it pue 97 199 Click anywhere in this area to print waveforms Click anywhere in this area to suspend Click in icon to open monitor Click in gray area above icon to close Waveform Window Select Maximum number of waveforms to display Cl
194. ssage When you suspend an arrhythmia or ST alarm the audible alarm tone is suspended for 90 seconds as usual However the Acuity System Virtual Monitor displays a visual message to call attention to the alarm To dismiss an arrhythmia or ST alarm message ASYSTOLE ARRHYTHMIA IN PROGRESS DISMISS Review T _ Resume Snapshot Close Alarms Suspended e Click DISMISS The border remains red but the message is dismissed and you can see the waveforms Directions for use Chapter 5 Respond to alarms and alerts 91 Respond to a RELEARN alert A WARNING In Acuity Systems that include an Arrhythmia option a relearn function causes the system to relearn a patient s normal ECG rhythm If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm A relearn event can be initiated by a user or by the system System relearns are in response to these circumstances e Patient connection e Lead change or failure e System restart During an arrhythmia relearn event the system posts a RELEARN alert in the patient s Virtual Monitor and Waveform Window Carefully observe a patient during an Acuity System learning period During learning the system detects only VFib and asystole arrhythmias After a relearn event Relearn and Learning Done event markers V appear in most of the patient s review wi
195. ssage for each patient monitor is displayed Lethal alarms take priority over all other alarms If more than one patient has an alarm or alert at one time the messages rotate in and out New alarms appear before new alerts Messages appear only when no alarms or monitor equipment alerts are occurring Duration Messages appear for at least five seconds and then other active messages reappear one by one The Disk Failure equipment alert is displayed for two minutes four times an hour No messages 184 Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Electromagnetic standards compliance The Acuity Central Monitoring System complies with all applicable and required standards for electromagnetic interference e t does not normally affect nearby equipment and devices e It is not normally affected by nearby equipment and devices e Itis safe to operate the Acuity System in the presence of high frequency surgical equipment e However it is good practice to avoid using the Acuity System in extremely close proximity to other equipment Guidance and Manufacturer s Declaration Electromagnetic Emissions The Acuity System is intended for use in the electromagnetic environment specified below The customer or the user of the Acuity System should assure that it is used in such an environment Emissions test Compliance Electromagnetic Environment Guidance RF emissions
196. t During signal dropout periods arrhythmia and ST segment analyses cannot be performed and the Acuity System does not show alarms or alerts WARNING f an Acuity Central Station display is intentionally or inadvertently muted alarm and alert tones do not occur at the display If your central station display includes audible tones remain aware of whether they are occurring If they appear to have stopped ensure that tones are restored WARNING f normal central processing unit CPU operation is interrupted for example during CPU maintenance scheduled and unscheduled reboots power loss or a high availability HA CPU switchover period central station monitoring and analysis temporarily stop The Acuity System cannot collect patient review data during the interruption period That data becomes permanently unavailable Auto reboots and HA CPU switchovers occur infrequently but poor environmental conditions and failure to perform preventative maintenance can increase frequency of occurrence 6 Chapter 1 General information Welch Allyn Acuity Central Monitoring System Cautions A A AN A WARNING Whenever an interruption in Acuity System CPU operation occurs please contact Welch Allyn Technical Service soon to ensure that your entire system has returned to normal operating condition and that it does not require further service WARNING Auto reboots can occur during internal software checks and wireless connection can be
197. t data becomes permanently unavailable Auto reboots and HA CPU switchovers occur infrequently but poor environmental conditions and failure to perform preventative maintenance can increase frequency of occurrence Whenever an interruption in Acuity System CPU operation occurs please contact Welch Allyn Technical Service soon to ensure that your entire system has returned to normal operating condition and that it does not require further service 152 Chapter 10 Troubleshooting and maintenance Welch Allyn Acuity Central Monitoring System Table 10 Troubleshooting the central station display Problem Explanation No audible alarm or alert tones are coming from the central station display Look for a mute button on the display and push it to restore sound Contact your Biomedical Engineering department if tones are not restored inadvertently muted alarm and alert tones do not occur at the display If your central station display includes audible tones remain aware of whether they are occurring If they appear to have stopped ensure that tones are restored A WARNING If an Acuity Central Station display is intentionally or WARNING Ensure that nothing is connected into the headphone jack A of the central station computer A connection in this jack will mute any audible tones from the display or the computer A menu that do not recognize appears on the Acuity Central Station screen Acuity System Engineering menus are l
198. t patient in local unit In the patient s Virtual Monitor click Review OxyCRG Non monitored patient or patient in a networked Acuity System unit a Inthe Acuity Central Station screen s lower left corner click a b Fora patient in the listed unit Click the patient s name and then click ers For a patient in another unit Click Other Patients the patient s name and Es The OxyCRG Review window appears 10 3430 103500 10 35 30 10 36 00 Wave isj y Resp SpO2 PI Prints a Review Print that covers the time span shown in the window Scales Print Close These open the Graphical Trends Tabular Trends Events Waveforms Arrhythmia Events and OxyCRG Review Windows 114 Chapter 6 Review or print patient data Welch Allyn Acuity Central Monitoring System Adjust the OxyCRG display and locate alarms Time marker 10 3430 103500 10 35 30 7 HR and Sp0 lines are ua connected trend values Red lines indicate alarms Perfusion Index PI For information refer to Masimo Corporation literature To adjust the time period shown in the display area of the window 1 Under Time Span click a button Time markers show along the top of the graphs area 2 Click on the time line to display data from a different time period Along the time line patient alarms are red 3 Scroll the display Click or to scroll the display forward or backward Click D gt or
199. ted 3 Measurement Offset Click to set the offset from the J point This is the point at which the ST measurement is made If you click Auto the Acuity System selects the offset based on the patient s heart rate 74 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System Set alarm preferences for ST Analysis A WARNING Turning off alarming for arrhythmia types and ST Analysis disables both audio and visual alarm indicators Although alarming for lethal arrhythmias cannot be turned off patients susceptible to arrhythmias must be kept under close physical surveillance if their alarming has been turned off for any arrhythmia types To set ST analysis alarm preferences 1 Inthe patient s Virtual Monitor click Setup ST Analysis The ST Analysis Setup window appears ST Analysis Deviation on off fon Measurement Offset ms 60 80 Auto Print on Alarm On Off Alarm Limits mm Alarm Level Lower 2 0 lt Upper 2 0 lt HIGH MED LOW OFF ala aly _ST RELEARN Undo Close 2 Set alarm limits in one of these ways e In the Alarm Limits area click the arrows to set the lower and upper limits for deviation from the reference beat e Click Presets to select preset ST Analysis settings Clicking Presets resets alarm limits alarm level measurement offset and Print on Alarm For ST Analysis Presets values see Table 36 on page 193 3
200. the Acuity System adjusts the HR lower limit to the new bradycardia limit If you set the tachycardia limit lower than the HR upper limit the Acuity System sets the HR upper limit to the new tachycardia limit In either case a message appears in the upper border of the Arrhythmia Alarms Setup window telling you HR alarm limits have changed 156 Chapter 10 Troubleshooting and maintenance Patient alarm indications Welch Allyn Acuity Central Monitoring System Table 14 Troubleshooting patient alarm indications Problem Explanation False arrhythmia alarms are occurring because of a patient s abnormal beat morphology HR alarms are occurring at an unusually high level at the patient monitor sometimes erroneously and the Acuity Central Station doesn t show some or all of the HR alarms The system includes Arrhythmia Analysis The Acuity System analyzes patient ECG data to detect specific changes in cardiac rhythms The system uses up to three ECG leads to detect normal beats ventricular beats and to analyze arrhythmias If false arrhythmia alarms are occurring due to a patient s unique beat morphology and if you are using a 5 wire ECG cable you can direct the Acuity System to analyze arrhythmias using one reliable lead 1 In the patient s Virtual Monitor click Review Waveforms The Waveforms Review window appears 2 Check all of the lead boxes to view waveforms shown from each lead Note the lead that is
201. the interruption period That data becomes permanently unavailable Auto reboots and HA CPU switchovers occur infrequently but poor environmental conditions and failure to perform preventative maintenance can increase frequency of occurrence Whenever an interruption in Acuity System CPU operation occurs please contact Welch Allyn Technical Service soon to ensure that your entire system has returned to normal operating condition and that it does not require further service Directions for use Chapter 10 Troubleshooting and maintenance 171 To turn on the Acuity System 1 Turnon the power to these components in this sequence a b C d Acuity System laser printer s Terminal server located in the equipment room Acuity Central Station display s Acuity Central Station computer The computer power up process takes several minutes and several system messages appear on the screen The Acuity System logs in and starts up the Acuity System screen The map appears and all connected monitors map icons show Unconfirmed Patient ID status or Alarm s Off status 2 For each patient take these steps a b A Verify patient information and then click YES Check patient alarm limits WARNING In Acuity Systems that include an Arrhythmia option a relearn function causes the system to learn a patient s normal ECG rhythm If the system learns an abnormal rhythm or learns a rhythm during noise it designates the le
202. ther unit Click Other Patients the patient s name and w The Arrhythmia Events Review window appears Roview Arrhythmia Events Carl R Keyes 105200 165201 105202 105293 305204 105225 105206 105297 10STD 105209 Vrach pepe lee pe botewe rept else vi dw bebop ir giieha ie bag ge Hele haee VY 2 Shov Deleted 11 Lethal and High Arr Alaras Viach Fri 13 02 12 AN Arr Alaras Fri 15146126 12 AN Arr Events Fri 15 47 15 I 00 00 r ii 00 Jaa 42 72 96 Delete ARR Events Scales r Print Close These open the Graphical Trends Tabular Trends Events rints a Review Print that covers the time Waveforms Arrhythmia Events and OxyCRG Review Windows span shown in the window Directions for use Chapter 6 Review or print patient data 109 Adjust the content of both list sections Rovinw Arrhythmia Events 105283 105204 vr ch Sah A i lm A aa D Pa a d E ia A el A Aaa E E A BAN A ua A ES aaa aa ana TATT nAn nnna pp PDI PTI DD DIT DIS IDA 2 Shov Deleted 11 Lethal and Wigh Arr Alaras 12 AN Arr Alaras 12 i AN Arr Events SRRIBPTRSEL ESE EEN Delete ARR Eventyr v Printer Close Event counts section Events list section Numbers of arrhythmia events that occurred in All events checked in the event counts section left the selected time span are listed here are listed and described here To adjust the time period covered in both list sections 1 Click a number unde
203. thmia Alarms and ST Analysis Setup windows Directions for use Measurement offset J J points green Turn on or off ST analysis Chapter 4 Adjust monitoring settings and patient information 71 The point at which the ST segment analysis is performed as determined by the number of ms or mV after the J point Vertical green reference line intersects each beat at the J point the end of ORS and the start of the ST segment If a patient s ST analysis is turned off the patient s ECG is not A WARNING analyzed for ST segment deviations ST alerts or alarms are not generated and ST information is not stored as graphical trends The Acuity System can be configured to set ST analysis to Off as a default setting For further information see your system administrator To turn on or off ST analysis 1 Inthe patient s Virtual Monitor click Setup ST Analysis The ST Analysis Setup window appears Pa ST Analysis fon or Measurement Offset ms 60 80 Auto Print on Alarm On Off yii if ETIN 5 Lead Il Alarm Limits mm Lower 2 0 lt Upper 2 0 lt alg A ie Presets ST RELEARN Click On or Off in the ST Analysis area Alarm Level HIGH MED Low OFF Undo Close 72 Chapter 4 Adjust monitoring settings and patient information Welch Allyn Acuity Central Monitoring System View current beats and ST segment deviation values To view current beats and
204. tient s central station printouts on page 49 116 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Print a Snapshot printout on demand To print a snapshot from a Waveform Window Reed Erlandson To Radiology Print Area e Bring your pointer into the window and click PRINT or click anywhere in the Waveform Area A printout occurs at the Acuity System printer To print a snapshot from a Virtual Monitor Exam Edd bode e Click Snapshot A printout occurs at the Acuity System printer Directions for use Chapter 6 Review or print patient data 117 Review printouts Review printouts capture information shown in a current or non monitored patient s review window Information in a review printout e The information displayed in a review window e Information formatted uniquely for each type of review window Availability of review printouts for different types of patients e Current patients e Discharged or non monitored patients Patients who have been monitored by the Acuity System in the last 24 to 96 hours depending upon your system configuration Print a review printout To print a review printout 1 Open a review window for one of these types of patients e Current patient in local unit In the patient s Virtual Monitor click Review and then select a review window e Non monitored patient or patient in a networked Acuity System unit a In the Acuity Central Sta
205. tient during an Acuity System learning period During learning the system detects only VFib and asystole arrhythmias After a relearn event Relearn and Learning Done event markers W appear in most of the patient s review windows and some printouts After relearn carefully evaluate the new reference ECG rhythm and the current ST segment for all active leads to ensure that the system learned an appropriate rhythm For evaluation instructions see To respond to a RELEARN alert on page 92 WARNING Minimize patient movement during a RELEARN as movement creates noise during the reading If the system learns an abnormal rhythm or learns a rhythm during noise it designates the learned rhythm as normal Thereafter rhythms of this type might not trigger an alarm Ensure that the patient remains still for 5 minutes after the RELEARN before allowing them to move When l m monitoring a neonate any buttons related to Arrhythmia Analysis and ST Analysis are grayed out The Arrhythmia Analysis and ST Analysis options are not intended for neonatal patients When patient mode is set to Neonate Arrhythmia Analysis and ST Analysis buttons are disabled A large number of irregular rhythm alarms are occurring You can adjust the minimum duration that an irregular rhythm must occur before the Acuity System alarms for a patient In the Arrhythmia Alarms Setup window under Options click an arrow to specify up to 120 seconds and then c
206. tion screen s lower left corner click b Fora patient in the listed unit Click the patient s name and then click one of these review window buttons For a patient in another unit Click Other Patients the patient s name and then click one of these review window buttons Graphical Tabular Trends Waveforms OxyCRG Arrhythmia Trends Events Events 2 Inthe review window click Print and then click one of these printout types Review window Review printout choices Graphical Trends Graph Table Summary Tabular Trends Events Tabular Trends Events no selection is offered Tabular Trends Events is printed Waveforms Waveforms Custom All leads Arrhythmia Events Waveforms Event List OxyCRG Graph no selection is offered Graph is printed 118 Chapter6 Review or print patient data Read a review printout To read a review printout A Type of printout B Number of deleted events C Deleted event D Included events A Type of printout B Number of deleted events C Deleted event D Included events day 13 October 2005 04 00 00 Welch Allyn Acuity Central Monitoring System WelchAllyn Medical Center h Katarina Watson 2002 YZONE 1 1334B Patient ID Amended ID Location Hour Arrhythmia Event Review Adult 16 00 Selected Events for Review w VFib 1 w Pause w Asystole 2 w Irregular a VTach a NonCapture PVC Run PVC min Bigeminy Trigeminy Tachycardia
207. to clear prior trends and alarm limits If it was monitoring this patient and you want to save this patient s trends and alarm limits keep it turned on 3 If the monitor is off turn on the monitor A Caution Make sure you acknowledge the Confirm Patient prompt on your monitor before switching the monitor from a wireless connection to a hardwired connection or vice versa Failure to confirm the patient can result in a licensing error To connect the patient to the monitor 1 Attach the lead wires to the electrodes 2 Apply the electrodes to the patient Directions for use Chapter 3 Admit and begin monitoring 29 3 Attach the cables to the monitor last to optimize waveform interpretation during the initial Acuity System learning phase To respond to the CONFIRM PATIENT prompt 1 If you see the CONFIRM PATIENT prompt respond as follows CONFIRM PATIENT IS THIS MONITOR STILL CONNECTED TO ID 458214 Jeffery J Mellinger YES 3 NO mY Setup N Review T Suspend Snapshot Close A WARNING Carefully verify the patient s ID and name before you respond to the CONFIRM PATIENT prompt If you assign another patient s ID number the Acuity System could combine patients Full Disclosure review information e f the indicated patient is the correct patient press YES The patient is confirmed at the Acuity Central Station The Acuity System sends unit default alarm limits and unit settings to the pati
208. tric or neonate mode depending upon setting at patient monitor Display settings Acuity System utilizes monitor factory default settings For further information see the monitor directions for use Lead selections Micropag and Propag LT monitors 5 wire cable ECG1 LEAD is Lead II ECG2 LEAD is Lead V RESP LEAD is Lead III 3 wire cable ECG1 LEAD is Lead II Propaq CS and Propag Encore monitors 5 wire cable ECG1 LEAD is Lead II ECG2 LEAD is Lead V 3 wire cable ECG1 LEAD is Lead II n Welch Allyn 1500 Patient Monitor 10 wire cable ECG1 LEAD is Lead II ECG2 LEAD is Lead V 5 wire cable ECG1 LEAD is Lead II ECG2 LEAD is Lead V 3 wire cable ECG1 LEAD is Lead I n n Number of waveforms Up to three displayed simultaneously Display priority of All waveforms on ECG always displayed if waveforms monitored 1 ECG 1 5 P2 9 RESP 2 ECG 2 6 P3 10 Sp05 3 ECG 3 7 P4 11 NIBP 4 P1 8 CO Number of vital sign Eight if six or more are monitored at once numerics displayed Temperature and NIBP values alternate in the simultaneously same space If CO is active and turned on at the patient monitor BR numerics are shown second choice is RR numerics when impedance pneumography is active Chapter 11 Specifications Welch Allyn Acuity Central Monitoring System Table 32 Virtual Monitor Features Customizable default Factory default Heart rate HR For patient
209. tton 98 Summary information from Patient List 98 SUSPEND alarm and alert tones temporarily 43 Alarm or alert 84 new alarms during 85 154 158 Symbol Numeric display 181 182 Numeric display 181 182 222 Numeric display 181 182 System Administration button 16 19 System buttons 19 T Tabular Trends Events Review window 101 specifications 196 Technical Service Welch Allyn 149 Temperature units set system 165 Time adjust Acuity System 164 zone set system 165 Welch Allyn Acuity Central Monitoring System Tones alarm and alert 95 179 Transfer patient wireless 129 Transport changing alarm limits during 37 47 125 155 Trends clear for new patient 37 clearing or saving 28 35 of patients on networked Acuity Systems 121 OxyCRG Sp02 112 review graphical 99 tabular and events review 101 Trigeminy definition 56 Troubleshooting Acuity System 151 alarms and alerts 156 and Maintenance 149 Arrhythmia Analysis 161 connecting and disconnecting 151 NIBP 160 U Undelete Selected button 111 Unit name set for display 169 search for patient by 12 97 121 Unit button 12 97 121 Utility window Acuity Central Station screen 16 V Ventricular fibrillation definition 55 Ventricular rhythm definition 56 Ventricular run definition 56 Ventricular tachycardia definition 55 VFib definition 55 View Wireless button 19 patients 19 View change screen 18 Virtual Monitor Acuity Central Station screen 16 alarms and
210. twork the alarms could be occurring at another Acuity System Contact your Biomedical Engineering department If you are a biomedical engineer see Identify or change a monitor s network name ESSID on page 165 154 Chapter 10 Troubleshooting and maintenance Equipment alerts Welch Allyn Acuity Central Monitoring System Table 12 Troubleshooting equipment alerts Problem When connect a monitor to the Acuity System a Communication Alert message occurs Explanation Only monitors with Acuity System network connectors on their sides with Acuity System authorization and with software versions indicated in Table 19 on page 175 can communicate with the Acuity System For compatibility with other monitors contact your Welch Allyn representative Confirm the monitor s software version by reading the start up screen when the monitor is turned on There is no visual indication that the monitor has Acuity System authorization If this problem continues contact qualified service personnel The patient monitor displays a Network Fault message after press NET OFF and disconnect from the Acuity System At the Acuity Central Station a patient s Virtual Monitor is in the yellow alert state or red alarm state and it shows a CHECK WIRELESS or TELEMETRY DROPOUT message While an alert is occurring at the Acuity Central Station one or more hallway message panels are displaying a different message Wh
211. ty System should assure that it is used in such an environment Immunity Test IEC 60601 Test Level Compliance Electromagnetic Environment Guidance Level Portable and mobile RF communications equipment should be used no closer to any part of the Acuity System including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended Separation Distance Conducted RF ch pe 3 Vims d 1 2 JP IEC 61000 4 6 150 kHz to 80 MHz Radiated RF 3 V m 3 V m d 1 2 JP 80 MHz to 800 MHz IEC 61000 4 3 80 MHz to 2 5 GHz d 23 P 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts according to the transmitter manufacturer and d is the recommended separation distance in meters Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference might occur in the vicinity of equipment marked with this symbol gt A Note 1 At 80 MHz and 800 MHz the higher frequency range applies Note 2 These guidelines might not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadc
212. tyLink Clinician Notifier software installation instructions English Welch Allyn patient monitors Micropaq Monitor directions for use CD ROM multilanguage Propag LT Monitor directions for use CD ROM multilanguage Propaq CS Monitor directions for use CD ROM multilanguage Propag Encore Monitor directions for use CD ROM multilanguage Welch Allyn 1500 Patient Monitor directions for use CD ROM multilanguage 2 Acuity System overview System configurations E h m a si T y J Acuity Central Monitoring System Mobile Acuity LT System The Acuity System consists of an Acuity Central Station that receives displays and analyzes information from various wireless and hardwired monitoring devices Mobile Acuity LT Central Stations are laptop computers Some Acuity Systems can send patient data to Internet browsers and hospital information systems HISs via the optional Welch Allyn Connectivity Server WACS The systems can receive patient information also from HISs The FlexNet concept allows several Acuity Systems to centrally monitor groups of patients resident on local Acuity Systems within a hospital and on networked Acuity Systems in smaller clinics or hospitals Transfers can occur from system to system and remote viewing of real time and historical Full Disclosure data is available for consultation from any of the Acuity Systems Chapter 2 Acuity System overview Diagram of the System
213. u take these steps For Propaq CS and Encore monitors a Inthe top left or right corner of the monitor press NET OFF The monitor disconnects from the Acuity System b Turn off the monitor The trend information for this patient is erased from the monitor For a Micropaq monitor a Press to highlight ACUITY and then press X to select it b Select END TELE The monitor disconnects from the Acuity System c Remove the battery from the Micropag monitor For a Propag LT monitor a Press the arrow keys to underline Y at the top of the screen and then press e to select it b Select Acuity menu c Select END TELE The monitor disconnects from the Acuity System d Turn off the monitor e Select Delete amp Shut Down The trend information for this patient is erased from the monitor For a Welch Allyn 1500 Patient Monitor a Press the Standby key and select Discontinue Monitoring FF a in The patient is discharged from the Acuity System and the monitor enters standby mode b Turn off the monitor or c At Acuity select END TELE Note Turning off the monitor is optional and not required when selecting END TELE In either case the trend information for this patient is erased from the monitor 2 Discharge the patient from Acuity System monitoring 136 Chapter 8 Discontinue Acuity System monitoring Welch Allyn Acuity Central Monitoring System For instructions see Discharge a patient fr
214. uctions see Enter and confirm a patient s ID or room at the central station on page 40 To move a patient from a Propaq LT monitor to a different monitor 1 On the Propaq LT monitor press the arrow keys to underline Y at the top of the screen and then press e to select it NI a Select Acuity menu Select END TELE The monitor disconnects from the Acuity System Turn off the monitor Select Delete amp Shut Down The trend information for this patient is erased from the monitor Connect the patient to a new monitor and connect the monitor to the Acuity System At the central station the patient s yellow icon appears in an unconfirmed state on the map Enter or confirm the patient information For instructions see Enter and confirm a patient s ID or room at the central station on page 40 To move a patient from a wireless Propaq CS monitor to a different monitor 1 2 On the Propag CS monitor touch NET OFF Turn off the monitor cA The trend information for this patient is erased from the monitor Connect the patient to a new monitor and connect the monitor to the Acuity System At the central station the patient s yellow icon appears in an unconfirmed state on the map Enter or confirm the patient information For instructions see Enter and confirm a patient s ID or room at the central station on page 40 133 Discontinue Acuity System monitoring Stop mo
215. uity Central Station e Patient monitor e Optional Mobile device running AcuityLink Clinician Notifier software To suspend an audible alarm or alert tone from a Waveform Window 13284 Limit HR Linen gt James Grizzell Suspend Area 1 Bring your pointer into the Waveform Window 2 Click in the numerics area to the right of the word SUSPND Tones are suspended for 90 seconds To suspend an audible alarm or alert tone from a Virtual Monitor 1318B Mackenzie E Stokes Tey zauong eT ere 80 eet G 1 nv 1 18 a lera hae Inv PE Oe E 3 OF Re a a Sp02 STAT SET SUSPEND ALL APM LIMITS 1 MAN 9 Setup T Review T Suspend J Snapshot close Limit PA 1 Bring your pointer into the Virtual Monitor 2 Click Suspend Tones are suspended for 90 seconds Directions for use Chapter 5 Respond to alarms and alerts 85 Important considerations suspending an audible alarm or alert tone Related to indications A WARNING During an alarm or alert suspension period be aware of new visual alarm indications that might occur on the patient monitor or Virtual Monitor During a suspension period these things occur at the Virtual Monitor and patient monitor e Audible tones are suspended for 90 seconds unless RESUME is clicked at the central station or the alarm tone is reset at the patient monitor e Alarms for lethal events apnea asystole ventricular tachycardia and ve
216. uity System patient information delivered to mobile devices HL7 Interface options Third Party Data Stream Interface and Clinician Notifier Barcode Interface 2 Chapter 1 General information Welch Allyn Acuity Central Monitoring System Acuity System software further processes data acquired from patient monitors Acuity Systems with the Arrhythmia Analysis module calculate heart rate using multiple ECG leads and arrhythmia analysis algorithms The Acuity System is not directly connected to patients It is designed to be used as a central monitoring system for a set of patient monitors that support both continuously and intermittently acquired data Supported monitors include but are not limited to the following Welch Allyn devices Propag Encore Propag CS Propag LT Micropag and Welch Allyn 1500 Patient Monitor as configured to interface with the Acuity System The Acuity System and distributed monitoring devices are prescription devices to be used by authorized health care professionals using standard institutional procedures and standards of care for patient monitoring Staff training in the operation of the Acuity System and the patient monitoring devices connected to it is essential for optimal use Users should be skilled at the level of a technician nurse physician health care provider or medical specialist with the knowledge and experience to acquire and interpret patients vital signs data Individuals using the Acuity
217. uity System sends unit default alarm limits and settings to the patient monitor Optional Customize alarm limits For details see Adjust a patient s alarm limits on page 46 42 Chapter 3 Admit and begin monitoring Welch Allyn Acuity Central Monitoring System 43 Adjust monitoring settings and patient information Set up typical monitoring at the Virtual Monitor This table presents typical monitoring functions that you can set up at the Acuity Central Station using the Virtual Monitor Note When a patient is intentionally disconnected from the central station or a patient connected to the Welch Allyn 1500 Patient Monitor is in Standby mode the patient s waveform display resets to the default view when reconnected to the central station Table 2 Typical monitoring functions at the Virtual Monitor NIBP and SpO spot checks Task Clicks at Virtual Monitor Notes Start an NIBP 1 NIBP Can be started also at the patient monitor measurement except for 2 START a Micropag monitor Propag LT monitor Start 1 Sp0 SpO Spot Mode must be turned on at the monitor an Sp02 spot check 2 START measurement Patient mode and alarms Micropaq monitor 1 MAIN MENU You can change a Micropaq monitor s patient mode only at Change the patient mode 2 MORE the Acuity Central Station For all other patient monitors you 3 MORE can change patient mode only at the patient monitor 4 NEXT 5 CHA
218. until the correct mode is shown For a Welch Allyn 1500 Patient Monitor If the mode shown in the Information field is incorrect press the Menu key use the trim knob to scroll to Patient Mode press the trim knob to enter the menu and select the appropriate mode 2 If the patient is not confirmed write down the patient s name ID and room number and ensure that the information is delivered to the Acuity Central Station for patient confirmation At the central station the patient map icon remains in the yellow ID or RM unconfirmed state until the ID and room are confirmed 3 Optional Customize alarm limits using patient monitor keys or the Alarms Setup window at the Acuity Central Station See Adjust a patient s alarm limits on page 46 A WARNING When a patient is connected to a monitor ensure that the default alarm limits are appropriate for the patient The system uses Acuity System Presets values for Arrhythmia Analysis and ST Analysis limits and monitor default values for all other limits if the monitor can save default values Before you set customized alarm limits for a patient confirm the patient s ID and room number Otherwise customized limits might be lost Directions for use Chapter 3 Admit and begin monitoring 31 Start communication between a wireless monitor and the system For information about patient monitors that are part of your Acuity System but are not shown in this chapter consult the patient m
219. ured modified adjusted or repaired other than by Welch Allyn or by persons expressly authorized by Welch Allyn or in accordance with written instructions provided by Welch Allyn g the product has not been subject to misuse negligence or accident Welch Allyn s sole and exclusive obligation and buyer s sole and exclusive remedy under the above warranties is limited to repairing or replacing free of charge a product that is reported to Welch Allyn at one of the telephone numbers listed below not later than seven days after the expiration of the warranty Welch Allyn 8500 S W Creekside Place Beaverton Oregon 97008 7107 USA Telephone 503 530 7500 or 800 289 2500 Facsimile 503 526 4200 WELCH ALLYN SHALL NOT BE OTHERWISE LIABLE FOR ANY DAMAGES INCLUDING BUT NOT LIMITED TO INCIDENTAL CONSEQUENTIAL OR SPECIAL DAMAGES THERE ARE NO EXPRESS OR IMPLIED WARRANTIES THAT EXTEND BEYOND THE WARRANTIES IN THIS DOCUMENT WELCH ALLYN MAKES NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE 202 Warranty Welch Allyn Acuity Central Monitoring System Index 203 A Access point ethernet 10 Acuity System adjust time 164 Central Station 10 Central Station screen 16 compatibility with monitors 175 components 10 components don t change 3 components inspect 172 discontinue monitoring 133 documents 8 general information 1 heart rate calculation 177 if inoperable 4 Intended Use 1 networked or remote 11
220. utton sorts all Waveform Windows and any open Virtual Monitor windows by room number in alphanumeric order The sorting only applies to the current screen view e Waveform Windows for monitors without confirmed patient IDs are located at the end e For networked Acuity Systems with more than one Acuity System unit rooms are grouped together according to Acuity System unit e The order in which windows are displayed depends on how your system has been configured Generally windows are displayed from top to bottom and left to right If the Sort Windows button is grayed out your system is not configured to sort windows In this case each Waveform Window space is assigned to a particular room and unassigned wireless monitors occupy unoccupied Waveform Window spaces Wireless monitors are bumped out to different unoccupied spaces if their spaces become occupied by hardwired monitors 20 Chapter 2 Acuity System overview Welch Allyn Acuity Central Monitoring System Central station map and status icons Your system includes a map that is similar to one of these examples An Acuity Central Station map shows status icons for these things e System components e Each patient monitor and associated patient that is communicating with the Acuity System For a complete description of all Acuity status icons see Status icons on page 137 Wireless Monitor F Room assigned G No room assigned A Networked Acuity Systems B No
221. ventricular only or A V sequential pulses 150 and 250 ms separation all per AAMI 1992 tests 3 1 4 1 and 3 1 4 2 Propag CS Acuity System Pacer indicator shown on screen if PACER display turned ON pacer spike Propag Encore Virtual Monitor always shown if of sufficient amplitude Pacer Pulse Pacer detection range i e shows the dashed vertical marker for 0 1 ms Detection pulses is 3 mV to 700 mV and drops linearly to 2 mV to 700 mV for 0 2 Rejection to 2 ms pulses Pacer detector influences ORS picking even while pacer indication is disabled Does not count as heartbeats approximately 95 of pacemaker pulses that are within pacer detection range with or without AAMI EC13 1992 tails of 4 25 or 50 75 or 100 ms decay time constant whose tail amplitudes are 2 5 or 25 2 mV maximum whether ventricular only or A V sequential pulses all per AAMI 1992 tests 3 1 4 1 and 3 1 4 2 Propaq LT Acuity System Pacer indicator shown on screen if PACER display turned ON pacer spike Virtual Monitor always shown if of sufficient amplitude Pacer Pulse Pacer detection range 3 2 mV to 700 mV 0 1 ms width 2 mV to 700 Detection mV 0 2 to 2 ms pulse width all with or without overshoot in electrically Rejection quiet environment Thresholds adjust to reject repetitive ambient noise Pacer detector influences ORS picking even while pacer display indication is disabled Does not count as heartbeats approximately 95 of pacemaker pulses within
222. view or print patient 97 Defaults factory 188 Delete ARR Events button 111 Delete arrhythmia event marker 111 Delete Selected button 111 Delete Selection button 50 Discharge a patient 136 Disconnecting troubleshooting 151 DISMISS button 89 90 Display appearance differences 23 bell symbol in 23 message window 83 select waveforms 51 set unit name for 169 p02 or NIBP not showing 160 Disposal of equipment 173 Documents Acuity System 8 Dropout alert 88 154 be cautious 5 159 E ECG electrodes and ST Analysis 77 false alarms 159 label leads 45 lead display 22 leads displayed 38 159 leads select change and view 45 numerics not showing 159 pacer turn on off display 44 set filter 169 signal interruption 159 troubleshooting 159 Edit a patient ID 80 patient information except ID 79 Electromagnetic compliance EMC specifications 184 EN1060 compliance set 165 Equipment Directions for use check periodically 172 ESSID identifying or changing a 165 Ethernet access point 10 Event definitions Arrhythmia 54 Event marker definition of 52 delete arrhythmia 111 list and counts 109 111 Event definition of 52 Events tabular trends review 101 F Factory defaults and specifications 188 False alarms ECG and arrhythmia 159 Sp02 158 FlexNet 9 G General information 1 Glossary of arrhythmia terms 52 Graphical Trends Review window 99 113 117 specifications 195 H Hallway message p
223. y System overview 19 The system buttons in the lower left corner of the Acuity Central Station screen provide quick access to frequently used system wide functions ABB Ch es YASDA Lea Derren RIOT cae EA Ws 12000 Afte veitan Lots 34 Parir P Oea Fa E Select iok to velere or Print west brad dk The Patient List button opens the Patient List window which enables you to preadmit readmit transfer and discharge patients in your Acuity System You can also view and print stored waveforms and trends of patients who have not been monitored by the Acuity System for up to 96 hours If your Acuity System is connected within a network of Acuity Systems depending upon the type of network you can perform the above functions for networked patients You can also locate networked patients edit their patient information change their alarm limits and suspend their alarms and alerts A Patient List button is displayed also in review windows that have been opened by way of the Patient List window When you click and hold the View Wireless button the map icons of all patients that are connected to wireless monitors change to Wireless icons other patient icons become gray boxes The map returns to normal when you release the button on your mouse or trackball The System Administration button opens a window that allows designated system administrators to create new user identifications and to adjust system time The Sort Windows b
224. y System unit a Inthe Acuity Central Station screen s lower left corner click E b Fora patient in the listed unit Click the patient s name and then click z For a patient in another unit Click Other Patients the patient s name and Eaj The Graphical Trends Review window appears Trends wf HR PR J PVE SG wv Spo2 y Spo2 Pi J 3 ime Span ism 30 m Prints a Review Print that covers the time span shown in the window Scales Print Close These open the Graphical Trends Tabular Trends Events Waveforms Arrhythmia Events and OxyCRG Review Windows 100 Chapter6 Review or print patient data Welch Allyn Acuity Central Monitoring System Adjust the graphical trends display and locate events pS 1035 Va KAA V MoS era Y Event marker Sbo2 pl z y Arrhythmia event marker Sp0 Perfusion Index PI For more information refer to Masimo Corporation literature Cursor bar 4 f gt Oe ee BAA r Seales gt Print Close To adjust the time period shown in the graphs area of the window 1 Under Time Span click a button Time markers show along the top of the graphs area Click on the time line to display data from a different time period Along the time line patient alarms are red Click or to scroll the display forward or backward Click A or 4 to page the display forward or backward To select and adjust the tr
225. y to view a summary of the patient s monitoring history Summary is not available in the Other Patient List screen Click to view the patient s Graphical Trends Review window Click to view the patient s Tabular Trends Events Review window Click to view the patient s Waveforms Review window Click to view the patient s OxyCRG Review window Click v to view the patient s Arrhythmia Events Review window Click to view a current patient s Virtual Monitor If the review icons for a patient are grayed out the patient s review information is no longer stored by the Acuity System Directions for use Chapter 6 Review or print patient data 99 Review graphical trends In the Graphical Trends Review window you can review and print data in these ways Scroll graphical trend data for up to five vital signs at once Locate red alarm periods along the trend graphs View event markers above the top graph Click graphs to see numeric values and event identifiers Jump to the next or previous alarm Open a Graphical Trends Review window To open a Graphical Trends Review window 1 Optional In the upper left corner of the Acuity Central Station screen click or to change the screen view to see a larger review window Open the window for one of these types of patients Current patient in local unit In the patient s Virtual Monitor click Review Graphical Trends Non monitored patient or patient in a networked Acuit
226. yn Acuity Central Monitoring System To enter patient information 1 Specify whether existing patient data will be saved e If the patient matches the name on the Propag LT monitor screen press an arrow key to highlight Continue Patient and then press e to select it The patient s data is saved and a unit list appears e f the patient does not match the name on the Propaq LT monitor screen press an arrow key to highlight Start New Patient and then press e to select it Patient data is cleared and a unit list appears If the keypad display or backlight is locked simultaneously press 4 and gt Select the unit in which your patient will be monitored A patient list appears Scroll the patient list and take one of these steps If you see the patient s ID name take these steps a Select the ID name A room list appears b Select the patient s room The patient is confirmed at the Acuity Central Station If you do not see the patient s ID name take these steps a Write down the patient s name ID room number and the last four digits of the serial number that is on the back of the Propag LT monitor b Ensure that the information is delivered to the Acuity Central Station for patient confirmation At the central station the patient map icon remains in the yellow ID or RM unconfirmed state until the ID and room are confirmed Along the top of the Propaq LT monitor screen verify that the patient mode matc
227. ystem network cable from the Acuity System network connector on the Propag monitor and then reconnect If the icon still does not appear call Welch Allyn Technical Services department When reconnect a wireless monitor This is normal in this circumstance Simply wait the 20 seconds or so until the patient to the Acuity System the Unconfirmed Patient ID icon appears patient s map icon disappears for a few seconds before the jum icon appears ID Directions for use Chapter 10 Troubleshooting and maintenance 153 Table 11 Troubleshooting connection patient room and patient ID Problem Explanation Sometimes patients are assigned an ID number that didn t give them A patient is being monitored with a wireless monitor and can t find the patient s data on the central monitor Alarms are occurring for the patient at the patient monitor but not at my unit s Acuity Central Station If you do not enter a patient ID number after up to five minutes the Acuity System might generate an automatic patient ID number for you The number is created from the room number or for wireless monitors part of the serial number of the monitor and the time If you want to change the ID number see Edit a patient ID number add an amended revised patient ID on page 80 A network name is specified for all wireless patient monitors If the network name does not match the network name of your Acuity System ne
228. ythmia analysis packages are unable to achieve 100 percent accuracy for all morphologies and occurrences of ORS and PVC detection Thus close physical surveillance and clinical interpretation of cardiac data must still be an integral part of every patient s care Clinicians must review all data obtained from the Acuity System before implementing therapy based on the data WARNING The Welch Allyn 1500 Patient Monitor provides primary alarming including LTAs The central station provides a secondary alarm and is only as reliable as its network When connection to the central station is lost the Welch Allyn 1500 Patient Monitor acts as a standalone monitor and provides the primary alarm When connected to the central station the monitor provides the primary alarm based on a signal from the central station WARNING Do not use Arrhythmia Analysis or ST Analysis on networks with heavy Class 1 services such as voice over IP VOIP Directions for use Chapter 4 Adjust monitoring settings and patient information 67 Related to patient monitor heart rate indications A WARNING All heart rate alarms are valid even if the HR value at the central station differs from that at the monitor If your system includes an Arrhythmia Analysis option the Acuity System heart rates for adult and pediatric patients are a result of system software analysis The HR PR numeric changes to in the Virtual Monitor Waveform Window review windows an
229. yze arrhythmia because of excessive electrical noise The Acuity System invalidates individual noisy leads and then re validates them when noise is no longer detected At the Acuity Central Station there is no heart rate reading during this alert but the patient monitor might present a heart rate To respond to an arrhythmia NOISE alert NOISE ARTIFACT DETECTED UNABLE TO ANALYZE paiay ga Review T Suspend Snapshot Close 1 Verify that the patient s lead wires and electrodes are in good condition 2 Verify that the electrodes were placed using standard good practices Directions for use Chapter 5 Respond to alarms and alerts 95 Summary of Acuity System alarm and alert levels Alarm and alert levels determine which alarms or alerts are indicated if multiple alarms or alerts occur for a patient This table shows a summary of alarm and alert levels For a complete list of icons see Status icons on page 137 Table 6 Summary of alarm and alert levels at the Acuity System Alarms red Monitor equipment System equipment Patient information alerts yellow alerts yellow alerts yellow Lethal arrhythmia alarms Alerts Low level alerts Low level alerts Ventricular fibrillation asystole and a ventricular tachycardia x Monitor Cannot Lethal level alarm tone Communicate ee Manne yett BEEP BEEP BEEP BEEP ree Four loud beeps followed by a pause N ID High level alarms Too Many Monito

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