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Cardell®MAX-12 DUO HD

1. 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 Dn 27 on 27 on 21 Dn 21 Dn Dn Dn Cardell MAX 12 DUO HD User s Manual Trend data can also be found in the monitor under the Data Manager gt Trend Display menu When downloading to the USB storage device the latest 24 hours of data is organized into an excel file Each row of data 1s separated by 18 seconds hs B c D E F G H J K L M N 1 Nickname Species RecordNo 2 Oliver Dog 16 3 Date Time HR Spo2 NIBP SYS RESP ETCO2 TEMP1 TEMP2 Innarco_AIBP1 SYS 1IBP2 SYS DIA MAP 4 9 Feb 4 17 33 60 98 20 32 370 380 160 120 85 95 120 85 95 5 9 Feb 4 17 51 60 98 20 32 370 380 160 120 85 95 120 85 95 6 9 Feb 4 18 09 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 7 9 Feb 4 18 27 60 98 20 32 370 380 160 120 85 95 120 85 95 8 9 Feb 4 18 45 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 9 Feb 4 19 03 60 98 20 32 370 380 160 120 85 95 120 85 95 10 9 Feb 4 19 21 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 11 9 Feb 4 19 39 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 12 9 Feb 4 19
2. Cardell MAX 12 DUO HD Veterinary Vital Signs Monitor User s Manual 4 850 35m 60 207 850 395 m MIDNDMARIL For Veterinary Use Only 003 2423 00 Rev E 4 3 13 Cardell MAX 12 DUO HD User s Manual TABLE OF CONTENTS SECTION 1 INTRODUCTION ail 5 MSE NER nia 5 I 2 PRODUGISUPPORT Glielo ei 5 13 IMPORTANT INFORMATION Ss dadas 6 SECTION 2 SABE EY tccncetsesasccsetcctcccschecccsuvasadeseapanecacscctuassecenecaatsuaceneenceecaate 7 a ESA A eil 7 22 SAFETY REQUIREMENTS aaraa e ar a a RR A owen eimenes 8 ASSAT ONE O oa catalani 10 Pa AAE E TON EEA EAA iaia 11 SECTION 3 DEVICE DESCRIPTION cccccccccccccccccccccccccccccccccccccccs 13 Bw FRONT PANEL E E E E S E A ta 13 3 2 REAR PAN E aaa 16 SIDE PANEL iolanda 17 3 4 BEFORE MONITORING onuraren OAA iaa 19 3 5 DISPLA VU RAIN e lla aL 20 eE SAh N U cieli 22 SECTION 4 ALARM SETUP 2 22 cccccccccsccccccsccsccccccncccsccccccccenseccccvcssccencers 24 AABRIEFINTRODU CTO Nao 24 NO A ey ee ae OnE A II A mee Re ena ee 25 A 3 AFARVEUIMIFSSETUP esca dis 26 4 4 ALARM SOUND VOLUME da 27 AS DEFAULT ALARM LIMITS ca ria 27 AG ALARM MODE zarien ai 28 A F ALARM EVENT REVIEW dada 29 SECTIONS MONITORING SYSTEM SETUP cccccccccccccccccccccccccccccs 30 SYSTEMS E FUP elabora 31 5 ZECGAVAVEFORM REGAL iii 31 DS TRENDS PU las alado 33 SAD MO IN ODE da a 35 Cardell MAX 12 DUO HD User s Manual SS CHANNEL SE WOR acacia 35 Sio PATI
3. 2 3 Make sure monitor is set to Large Small corresponding to cuff used 4 To ensure the patient s safety never use cuff on the same limb where an infusion is going on Do not measure SpO2 or other parameters on the same limb where blood pressure is measured Do not apply cuff on an injured limb Do not measure a patient s blood pressure continuously or repetitively for a long time 10 Use only accessories recommended by the manufacturer 11 Remove the cuff after turning the power off 10 5 Alarm Setup 10 5 1 NIBP alarm ON OFF and alarm limits setup User can activate alarm function and setup alarm limits one by one Main Menu gt Rotate the knob NIBPi Press the knob Rotate the knob gt SYS DIA alarmi gt Press the knob Rotate the knob Press the knob Adjust parameter range Parameter Alarm range SYS Upper Limit lower limit 254 mmHg SYS Lower Limit 30 upper limit mmHg DIA Upper Limit lower limit 220 mmHg DIA Lower Limit 10 upper limit mmHg SI Cardell MAX 12 DUO HD User s Manual SYS DIA Alarm 0 40 mmHg The Alarm trigger when the following abnormal events occur and messages will be displayed in the NIBP parameter area Cuff loose Cuff not connected Cuff position error Overpressure protection Measurement out of limits or Measurement error Take the following steps after seeing the messages 1 Cuff is too loose not connected or
4. 50Hz 60Hz Input Power lt 150VA Battery Capacity 12V 4 6 Ah Charging time28 hours Battery backup working time 21 5 hours per battery Charging mode Automatically charged with charge protection feature While the device is powered by AC power mains Discharge Protection When powered by battery the device will be automatically powered off when the battery power is almost used up III Performance Specifications 1 ECG CMRR 260dB Heart Rate Measurement and Alarm Range 15 300bpm Accuracy bpm Heart Rate Average 8 beats 123 Cardell MAX 12 DUO HD User s Manual ECG Display Channel Pacemaker detection rejection Input voltage range Input pulse width Interface Lead selection Lead fault alarm Input QRS indicator Waveform memory Sweep speed Amplitude selection Trend Frequency response Heart rate alarm duration Defibrillation protection Recovery after defibrillation 2 RESPIRATION Measurement method Respiration rate measurement and alarm range Waveform speed Respiration asphyxy alarm 124 channels 2mV to 700mV 0 2ms to 2 0ms AAMI 6 pin I IL III V avR avL avF 5 lead mode Audible and visual indication 3 or 5 lead ECG cable Audible and visual heart mark flashes 12 minutes 12 5 25 50 mm s X 1 4 X1 2 X1 X2 X4 Auto 2 hours gt 4 hours gt 8 hours gt 24 hours gt 48 hours s gt 72 hours gt 96 hours gt 120 hours Monitoring 0 5 3
5. 9 11 Alarm LED 12 Handle to stop printing Start Stop NIBP Press the key to start blood pressure measurement press it again to stop blood pressure measurement System Setup Menu Press the key and the system setup menu will be displayed on the screen Press it again the menu will disappear Power indicator AC indicator When the monitor is connected to AC power the yellow indicator will remain on When the patient monitor turned on the indicator becomes green Flashing red indicates a high priority alarm or life threatening situation Flashing yellow indicates a medium priority alarm Steady yellow indicates a low priority alarm 15 Cardell MAX 12 DUO HD User s Manual 3 2 Rear Panel The rear panel of MAX 12HD multi parameter patient monitor is as shown in Fig 3 2 1 2 34 2 6 7 8 Fig 3 2 MAX 12HD Rear Panel 1 Fan For heat dissipation 2 Speaker 3 Ethernet port 4 Video Out VGA port 5 USB 6 Label 7 Equipotentiality Ground Post 8 AC power supply socket External display port connect standard color VGA monitor Cardell MAX 12 DUO HD User s Manual 3 3 Side Panel There are eight receptacles on the side panel See Fig 3 4 Fig 3 4 MAX 12HD Side Panel 1 CO C Stat CO cable connection 2 ECG RESP ECG cable connection 3 NIBP Cuff hose connection 4 SpO SpO extension cable connection 5 6 IBP 1 amp 2 IBP cable optional connections 7 8 TE
6. General supplies such as elasticized and regular tape suture scrub solution and assorted needles should be available Local anesthesia 2 lidocaine HCI may be injected in the vicinity of the artery to reduce vasospasm during the procedure Catheter selection Either short or long catheters may be successfully used for direct blood pressure measurement The preferred biomaterials for arterial catheters are either PFE Teflone or polyurethane In most cases short length catheters 2 3 are used in patients who require short term blood pressure monitoring 1 e anesthesia short term procedures or are relatively immobile Long length indwelling catheters 4 are preferred for long term monitoring or in mobile patients The gauge of catheter is based on vessel diameter at the placement site In dogs 20 24 G x 2 3 over the needle catheters are used in the dorsal pedal metatarsal and popliteal arteries In cats a 22 24G x 2 catheter is selected for the same arterial sites Large diameter arterial segments femoral and brachial a may accommodate a 20 G x 2 3 over the needle catheter in the dog and a 22 G x 2 3 catheter in the cat Several manufacturers Arrow BD offer an over the needle catheter system with a built in guide wire that is intended to facilitate arterial catheter placement In these systems the guide wire 1s first advanced and the catheter is then placed over the guide wire This system is helpful when chal
7. MAX 12 DUO HD User s Manual the original date and time Date and Time Year Hour 12 Month 10 Min 39 Day 31 sec 1z OK Cancel Fig 5 6 Date and Time 5 9 Volume and Brightness Setup Volume amp Brightness Setup menu can also be displayed when the knob is pressed at the following hot keys Exit Alarm Volume HR Volume Brightness Big Number Night Mode GOYA Vda tel 7 ECG The Alarm and Heart Rate volumes have 7 levels The Brightness adjustment is used to adjust the screen brightness When Standard is selected the screen is bright suitable for monitoring in daytime When Soft is selected the screen is slightly dark suitable for monitoring during nighttime 42 Cardell MAX 12 DUO HD User s Manual WARNING If you select Night mode the monitor display screen becomes dark and all volumes turn off Before selecting please consider your patient s Status NOTE Night Mode cannot be selected during alarm status Press any button except knob on front panel to exit Nights Mode When a new alarm event occurs the monitor automatically exits this mode 5 10 HR PR Priority Setup gt Rotate the knob gt HR PR Priority Press the knob gt First Priority 2 Priority gt Rotate the knob Press the knob First priority includes ECG SpOy IBP and 2 priority includes SpO ECG IBP When First priority 1s selected heart rate HR is first displayed in the
8. 2 ECG Waveform Recall Waveform Recall The past 12 minutes of ECG waveforms can be recalled When a patient s ECG waveform is abnormal it can be used to review the waveform The ECG data comes from the channel where heart rate 1s detected ECG Recall 6006 10 31 11 Of 40 006 10 31 11 086 52 006 10 31 11 10 04 2006 10 31 11 11 16 ZOO06 10 31 11 12 28 No Signal Received 006 10 31 11 07 40 2006 10 31 11 07 45 age Up Down L R Scan Analysis Exit Fig 5 2 ECG Recall 31 Cardell MAX 12 DUO HD User s Manual Display Screen In the above figure you can see ECG recall on the top of the screen The status bar at the right side indicates the position and length of the waveform recall The five time stamps at the left side are the start times of every three lines of recalled waveforms The first line is 24 seconds including 4 segments and each segment is 6 seconds A segment in red at the bottom of the screen see next page is magnified with lead mode and amplitude marked out The two times at the bottom indicate the start and end time of ECG waveform recall respectively NOTE The ECG waveform recall speed does not change with the current sweep speed In the process of ECG waveform recall rotate the knob and you can scroll up and down the ECG waveform in memory Press ECG Analysis and an ECG segment analysis can be done using electronic calipers See figure
9. Limbs should be perpendicular to the spine and parallel with their opposite member In awake cats and dogs it is best to have the patient held by a veterinary technician or veterinary assistant One lead should be applied first to determine comfort level and adjustment made as needed Then the other clamps can be placed in position It is important that the patient be kept still A moving patient may cause clips to saw into skin tissue leading to discomfort and change in position of electrodes 7 4 ECG Setup Ar Press the waveform button then rotate the knob and select ECG knob finally select required item to setup Exit ECG Lead ECG Gain Wavetorm Speed ImV Cal Lead Mode ECG Mode HR Upper Limit HR Lower Limit HR Alarm Color Setup Baseline Setting Fig 7 3 ECG Menu User may select and confirm by rotating and pressing the knob 53 Cardell MAX 12 DUO HD User s Manual ECG Lead Select different leads to display different ECG waveforms of a patient ECG Gain Select different waveform gain User may select x1 4 x1 2 x1 x2 x4 or Auto Waveform Speed Waveform speed options 12 5 25 0 50 0mm s ImV CAL When it is pressed a ImV square wave will be displayed on the ECG waveform for user calibration PaceMaker Detect VIVIIWV Off HR Source each ECG channel ECG Mode operation monitoring diagnosis Alarm Limit set the upper limit and lower limit of parameters Alarm Sound On Off ECG S
10. The individual or at least breed specific value must be known to most accurately determine whether a given patient s blood pressure deviates from normal Breed Systolic Diastolic Pulse Rate fing mig GUIDELINES Mean Arterial Pressure MAP Minimum to adequately perfuse all peripheral tissue beds 60 70 mmHg Hypertension Suspect with systolic pressure greater than 150 mmHg affirmed when 2 Info per Dr Donald Sawyer Michigan State University 131 Cardell MAX 12 DUO HD User s Manual above 160 170 mmHg also affirmed in cats when diastolic pressure is above 100 mmHg Hypotension During anesthesia generally maintain systolic pressure above 80 mmHg 132 Cardell MAX 12 DUO HD User s Manual APPENDIX 3 DEAD SPACE Cause Effect amp Control in Small Animal Anesthesia Robert M Stein D V M DAAPM Founder www VASG org Dead space is an often misunderstood and overlooked aspect of veterinary anesthesia patient management Dead space is always present as a component of the patient s airway and to a variable degree as a component of the anesthetic system Ignoring the harmful consequences of system dead space can lead to potentially fatal patient outcomes This is especially worrisome when managing small patients There are three different types of dead space anatomic alveolar and mechanical equipment Dead space ventilation involves that component of the respiratory gases that does not participate in
11. channel there is a scale line on the top and bottom At the right end of each line there is an IBP value corresponding to the level The difference between the two IBP values is the selected gain value 20 40 60 80 120 180 240 330 Auto 98 Cardell MAX 12 DUO HD User s Manual NOTE Each time the machine is turned on IBP is set to be manual zeroing and gain is set to be 330 The setting can be changed but will not be saved after power off To set the gain Main Menu gt Rotate the knob IBP1 2 gt Press the knob Rotate the knob IBP Gain Press the knob gt 20 40 60 80 120 180 240 330 Auto Rotate the knob Press the knob Zeroing Mode Zeroing has auto and manual modes Main Menu gt Rotate the knob gt HIBP1 2 gt Press the knob Rotate the knob gt Zeroing Mode gt Press the knob gt Auto Manuall gt Rotate the knob gt Press the knob Manual Zeroing If zeroing mode is set to be Manual then the system will automatically enter IBP Setup Menu and IBP Zeroing Yes status Press the knob and the system will start zeroing Auto Zeroing When the screen prompts Press Zeroing Key if the zeroing mode is set to be Auto then the system will automatically give the command and start 99 Cardell MAX 12 DUO HD User s Manual zeroing and the user does not need to confirm Enforced Zeroing When the transducer needs to be calibrated please enter IBP Setup Menu and
12. decrease risk in these patients In recent years closed tubing systems which isolate operator maintenance functions from the primary system have become popular in human medicine 141 Cardell MAX 12 DUO HD User s Manual References Ahrens TS Taylor LA Hemodynamic Waveform Analysis St Louis MO WB Saunders 1992 pp 91 120 Lake CL Hines RL Blitt CD Clinical Monitoring Practical Applications for Anesthesia and Critical Care Philadelphia PA WB Saunders 2001 pp 181 204 Macintire DK Drobatz KJ Haskins SC Saxon WD Manual of Small Animal Emergency and Critical Care Medicine Philadelphia PA Lippincott Williams and Wilkins 2005 pp 73 74 Parbrook GD Davis PD Parbrook EO Basic Physics and Measurement in Anaesthesia 3rd ed Oxford UK Butterworths 1990 pp 218 231 3 Reprinted with permission from IVECCS APPENDIX 5 ACCESSORIES The following items are included in the standard monitor kit and can be reordered from your distributor or directly from Midmark using the associated reorder codes l l 5 l l l 2 The accessories associated with the optional invasive blood pressure monitoring configuration MAX 12 DUO HDi and MAX 12 Hdim are as follows 650 208 Invasive Blood Pressure IBP Interface cable 016 1587 00 IPB Transducer kit 142 Cardell MAX 12 DUO HD User s Manual The following are optional accessories for use with the MAX 12HD series EP XS MAX 12 9500 series extra sm
13. ejection of blood from the ventricle during systole fills out or sustains the pulse waveform As pressure 139 Cardell MAX 12 DUO HD User s Manual and flow reach their maximum values the curve flattens and reaches peak pressure The rounded sustained portion of the pressure wave represents a combined effect of ventricular volume ejection distention of the entire aorta and runoff into aortic branches Following this point the curve begins to descend until a defined upstroke or notch on the downside of the pressure curve 1s noted This notch referred to as the dicrotic notch represents closure of the aortic valve and secondary pressure generation that occurs by distention and compression of the aortic root following valve closure As pressure falls further during run off of blood into the arterial ranches the pressure curve descends to its lowest pressure point just prior to the next cardiac cycle The arterial waveform varies with the site of catheter placement and its distance from the aortic root The further the distance from the heart the more tented or peaked the waveform appears This is accompanied by a narrower base or distance from the beginning to end of the waveform This appearance change is due to several factors including pressure drop and diameter of blood vessel The important point is that the waveform change reflects a lower mean arterial pressure which is essential for forward blood flow to a
14. monitor will stop the measurement and display in the parameter area but without an audible alarm It 1s recommended to check the connection of the temperature probe regularly 87 Cardell MAX 12 DUO HD User s Manual SECTION 12 CO MONITORING Optional 12 1 General Information The MAX 12 HD includes the capability to monitor end tidal CO using the optional Capnostat CO sensor This measures CO by using the infrared absorption technique which has endured and evolved in the clinical setting for over two decades and remains the most popular and versatile technique today The principle is based on the fact that CO molecules absorb infrared IR light energy of specific wavelengths with the amount of energy absorbed being directly related to the CO concentration When an IR beam is passed through a gas sample containing CO the electronic signal from the photodector which measures the remaining light energy can be obtained This signal is then compared to the energy of the IR source and calibrated to accurately reflect CO concentration in the sample To calibrate the photodetector s response to a known concentration of CO is stored in the monitor s memory A reference channel accounts for optical changes in the sensor allowing the system to remain in calibration without user intervention 12 2 Capnostat 5 Sensor Mainstream The CAPNOSTAT 5 CO Sensor is a mainstream CO sensor It is factory calibra
15. must be in conformity with IEC 60601 standards The system configuration of monitor must be in conformity with IEC 60601 1 1 medical electric standard otherwise it will reduce the safety of monitor e Even while not being used the battery may also discharge So check battery level every month e ECG cable socket is for connecting ECG lead wires only Please do not connect it to any other signal source Pay attention to the color label and marks of ECG lead wires e Please clean the monitor and accessories according to instructions Always unplug the power cord before cleaning e EMC The device is in conformity with the requirements of IEC 60601 1 2 and related EMC standards But when electromagnetic power is extremely high it may cause interference Please ensure any device close to the monitor meets the related EMC requirements Do not use cell phone or personal telecommunication devices next to the monitor e Unknown EMI may be caused by radio transmitter or TV Please remove Cardell MAX 12 DUO HD User s Manual the patient monitor or add shielding materials INSTRUCTIONS FOR USE For continued safe use of this equipment it is necessary that the instructions are followed However instructions listed in this manual in no way supersede established medical practices concerning patient care Loss of data When the device accidentally loses data please keep patient under close attention until the device returns to no
16. skin temperature with an external probe Temperature monitoring provides numerical information only no waveform As with other parameters data is displayed in the temperature parameter window on the right side of the screen A TEMP 4 TEMP2 ZA The signal input is insulated and it is defibrillator proof The insulated input ensures patient safety and protects the device during defibrillation and electrosurgery 85 Cardell MAX 12 DUO HD User s Manual 11 2 Temperature Setup Temperature monitoring results are displayed in numeric form only without a waveform A Connect temperature probe to patient and make sure the other end of the cable is firmly inserted into the socket in the device The screen will then display the temperature reading Main Menu gt Rotate the knob TEMP I gt Press Er pper Limit 42 TZ Lower Limit 30 the knob Then you can enter the temperature setup 14 alarm menu as shown in the right figure To set the alarm Te Upper Limit 42 limits and temperature units please operate the knob TZ Lower Limit 30 v TZ Alarm through rotating and pressing it Unit Fig 11 1 Temperature Setup Menu For example to set the temperature unit Main Menu gt Rotate the knob gt TEMP gt Press the knob Rotate the knob gt Unit Setup gt Press the knob gt C F gt Rotate the knob Press the knob To set the temperature channel and alarm limits Main Menu Rotate the kno
17. the adapter ensure the windows are dry residue free and that the adapter has not been damaged during handling or the cleaning disinfecting process CAUTION Do not insert any object such as a brush into the CAPNOSTAT 5 CO airway adapter Irreparable damage may occur to the CO windows 95 Cardell MAX 12 DUO HD User s Manual SECTION 13 IBP MONITORING Optional 13 1 General Information The device displays the maximum systolic pressure minimum diastolic pressure mean pressure and an IBP waveform The IBP waveform can be observed in different channels and the waveform speed is the same as that of the ECG waveform In the IBP waveform channel there is a scale on the top and at the bottom and at the right end of the line the IBP reading 1s displayed NOTE For a thorough discussion see Appendix 4 Direct Blood Pressure Monitoring by Marc R Raffe DVM MS DACVA DACVECC IVECCS proceedings 13 2 Transducer IBP transducers provided are in conformity with ANSI AAMIBP23 1986 standards and with sensitivity 5uV V mmHg Check transducer cable before connecting it to the device WARNING The disposable transducer is for single use only Never attempt to reuse the parts Discard the used transducers properly Transducer zeroing is very important for accurate measurement So zeroing should be performed regularly 1 When the screen prompts Please do calibration user may enter to give command Main Me
18. the fully encircling bladder design Hair need not be clipped except when heavily matted In cats less than five 5 pounds when measurements are difficult to obtain place the cuff around the leg above the elbow to obtain measurements from the brachial artery Measurements from the coccygeal artery may be used by placing the cuff around the base of the tail but not in anesthetized patients Cat Cuff Placement Cuff placement for a dog For measurements in dogs it is preferable to use the right lateral sternal or dorsal recumbent positions That is not a problem in anesthetized patients but it may be difficult to get large dogs to cooperate for proper positioning If the dog is in a sitting position place the front paw on the operator s knee and take measurements from the metacarpus Sites for cuff placement are the 75 Cardell MAX 12 DUO HD User s Manual metacarpus metatarsus and anterior tibial In anesthetized patients most surgeries are done on the posterior part of the body so the metacarpal area of the forelimb is most convenient In situations where this is not possible the cuff should be wrapped around the metatarsus just proximal to the tarsal pad or around the hind leg just distal to the hock The tail site should not be used for cuff placement during anesthesia It is not necessary to center the cuff over the artery because of the fully encircling bladder design If the hair over the artery site is too thick or mat
19. the sensor cable independently from the sensor 8 Connect the sensor assembly to the Interface Cable a Place the plastic hinged cover in the unlocked position perpendicular to the connector b Connect the sensor assembly to the Interface Cable c Lock the plastic hinged cover to prevent accidental cable disconnection Figure 10 Sensor to Interface Cable 9 Plug the Interface Cable into the SpO connector on the side panel of the monitor Push the cable in until you hear an audible click WARNING The indicates that the SpO2 sensor connector is insulated and defibrillation proof which can ensure patient and monitor safety during defibrillation and electrosurgery 10 Press the ON STANDBY pushbutton to turn ON the monitor 67 Cardell MAX 12 DUO HD User s Manual 11 Verify that the sensor is properly positioned by observing at least ten seconds of a continuous pleth waveform being displayed across the screen When a valid signal is detected the monitor displays the SpO gt and Pulse Rate values Should the perfusion light be at a low level reposition the sensor or try a different sensor If normal operation cannot be achieved call a Midmark representative for assistance NOTE In addition to the V SAT sensor and clips that are included with the monitor there is an optional reflectance sensor the MAXFAST 1 that can be used on the base of the tail This is mainly used as an alternat
20. using it Anesthetic gas exhaust tube Cleaning Wipe the tube with a piece of soft cloth damped in mild soap water then wipe it with a piece of dry cloth Do not immerse it in any liquid Disinfecting Wipe the tube with a piece of soft cloth damped in cold chemical disinfectant Do not immerse it in the liquid After disinfecting remove the disinfectant residue with a piece of cloth and keep it dry Solution for Occlusion Entrance Occlusion When entrance accessories water trap sampling line standard gas tube connector are occluded or entangled 1 Replace the water trap 2 Check the sampling line for occlusion entanglement and replace it when necessary 3 Check the gas channel connector to see if water is accumulated If necessary remove the liquid and change the connector position Make sure the gas channel is connected correctly Exhaust System Occlusion When the exhaust accessories sealing rings or exhaust gas tube are occluded or entangled please 1 Check the exhaust system accessories for occlusion or entanglement If necessary replace it 2 Start Zeroing 116 Cardell MAX 12 DUO HD User s Manual NOTE When the gas inlet or outlet system accessories become occluded or entangled first check the exhaust system accessories for occlusion If necessary replace them If after exhaust accessories are replaced and occlusion still exists please check the gas inlet accessories for occlusion and r
21. warranty does not apply if the product e has been damaged from improper operation misuse e has been damaged because of improper connection to other devices e has been damaged by accident e has been modified without written authorization of the Company e has had the serial number removed or defaced 1 2 2 After sale service To obtain service or product support please contact Midmark in Tampa Florida at 800 643 6275 or visit the website at www Midmark com Have the following information available e model and serial number of the equipment e date of purchase and distributor name 1 3 Important Information e The product is made under the ISO9001 2000 and ISO13485 2003 quality system e Manufacturer address Midmark 10008 N Dale Mabry Hwy Suite 110 Tampa FL 33618 e Phone 800 643 6275 Fax 813 264 6218 Cardell MAX 12 DUO HD User s Manual SECTION 2 SAFETY 2 1 Safety Notice 2 1 1 Intended Use The Cardell MAX 12 HD is used to provide continuous monitoring display and recording of physiological parameters such as ECG non invasive blood pressure SpO2 CO respiration and temperature 2 1 2 Application Environment This device 1s for use by trained veterinary personnel in veterinary centers The device is restricted to be used on one patient at a time 2 1 3 Operator Requirements Only veterinary personnel who have read the Operator s Manual should use this monitor 2 1 4 Terminology The terms d
22. 3 1 Front Panel The front panel of MAX 12HD multi parameter patient monitor is as shown in Fig 3 1 ame oz mur rene fon 2002 01 28 11 44 57 CI 51410 5171 als 10 Fig 3 1 MA X 12HD Front Panel 13 Cardell MAX 12 DUO HD User s Manual 1 Display Color TFT LCD display for displaying waveform menu alarm status and vital signs 2 Power button When the patient monitor is connected to A C power or there is enough battery power press this button until the monitor turns on or off 3 n a Paremeter Setup Menus Press this key to setup each parameter 4 ok Freeze Restore Press this key to freeze unfreeze the waveform Note During waveform freeze status the monitor will automatically restore waveform sweep after 30 seconds 5 Silence Press the key to enable disable the alarm sound When alarm is off the icon at left will appear When pressed the alarm will be silenced for 2 e BE minutes Knob When in a menu rotate the knob to scroll through choices and press the knob to make a 6 selection From the main display rotating the knob will scroll through the NIBP history Pressing the knob from the main display will enter the short cut menu to adjust alarm volume HR volume brightness Big Font Night Mode and Work Mode 7 Start Stop Printing Press the key to start printing will automatically print 90 seconds Press 1t again Cardell MAX 12 DUO HD User s Manual a Y
23. 5 Hz Diagnosis 0 05 100 Hz Less than 7 seconds Tested with 5kV Less than 5 seconds Thoracic impedance or direct with CO 0 150 brpm 2brpm 6 25 12 5 25mm s 0 120s Cardell MAX 12 DUO HD User s Manual Respiration lead selection 3 IBP Optional Measurement and alarm range Scale Channel Resolution Trend storage time Waveform speed Transducer sensitivity Transducer type Update time 4 SpO RA LA RA LL RL LL RL LA 30 300 mmHg mmHg kPa single channels or double channels 1 mmHg 120 hours 12 5 25 50mm s 10 SuV V mmHg Disposable Approx 1 second SpO Measurement and Alarm range SpO Average SpO Accuracy SpO Pulse rate SpO Pulse rate average SpO Pulse rate accuracy Update time Pulse rate alarm limits Pulse sound Sensor type Internal LED waveform 0 100 8 beats 2 70 100 3 50 69 30 250bpm 8 seconds 2bpm Approx 1 seconds 0 240bpm Pulse sound indication Finger tip universal Y wrap Infrared 940nm Red light 660nm 125 Cardell MAX 12 DUO HD User s Manual Light power dissipation Pulse rate indication 5 NIBP Method Parameters Scale Operation mode Repeat cycle Measurement and alarm range Systolic Diastolic Pulse rate range Measurement time Pressure display accuracy NIBP pulse rate accuracy Infrared light 22 5 mW Red light lt 30mW Digital Auto oscilloscope SYS DI
24. 57 60 98 20 32 370 380 160 120 85 95 120 85 95 13 9 Feb 4 20 15 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 14 9 Feb 4 20 33 60 98 20 32 370 380 160 120 85 95 120 85 95 15 9 Feb 4 20 51 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 16 9 Feb 4 21 09 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 17 9 Feb 4 21 27 60 98 20 32 370 380 160 120 85 95 120 85 95 18 9 Feb 4 21 45 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 19 9 Feb 4 22 03 60 98 20 32 370 380 160 120 85 95 120 85 95 20 9 Feb 4 22 21 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 21 9 Feb 4 22 39 60 98 20 32 370 380 160 120 85 95 120 85 95 22 9 Feb 4 22 57 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 23 9 Feb 4 23 15 60 98 120 85 95 20 32 370 380 160 120 85 95 120 85 95 24 5 8 Date and Time Setup The device displays the real date and time Each time the device is turned on 1t will display the current date and time To enter time setup D gt Rotate knob Date and Time gt Press knob Rotate the knob and press the knob and you can change the date and time When the date and time are set please rotate to OK and press the knob to exit the setup 1f OK is not selected the change will be regarded as canceled If a change is completed and you want to cancel it then rotate the knob to Cancel press the knob and exit Then the screen will still display 41 Cardell
25. 60 minutes depending upon the relative humidity For monitoring during longer periods an electrode paste should be used It is best to first wet the hair at the lead attachment site with alcohol then place paste on the moistened hair and skin It is important that the paste be in direct contact with skin For patients with dense undercoat rub paste with fingers to assure that it has made contact with skin Crocodile clips are supplied with this monitor and they must opened wide enough to firmly but gently grasp the skin 7 3 Attaching ECG Electrodes 7 3 1 Leadwires and Color Table 7 1 5 Lead Color and Coding USA Standard International Standard LA black Left Foreleg L yellow Left Foreleg RA white Right Foreleg R red Right Foreleg RL green Right Hind Leg N black Right Hind Leg LL red Left Hind Leg F green Left Hind Leg V brown explore C white common Table 7 2 3 Lead Color and Coding USA Standard International Standard LA black Left Foreleg L yellow Left Foreleg RA white Right Foreleg R red Right Foreleg LL red Left Hind Leg F green Left Hind Leg 51 Cardell MAX 12 DUO HD User s Manual 7 3 2 Lead placement Figure 7 1 5 Lead Placement For a 5 lead system four limb leads can be applied RA LA RL and LL with the exploring lead brown used for diagnostic purposes as needed Otherwise the exploring lead may be left unplugged Refer to Figure 7 1
26. A MAP Pulse rate mmHg kPa Manual Auto Stat 1 10 15 30 60 90 120 240 480 minutes 20 265mmHg 15 220mmHg 0 300 bpm Typical measurement time is 20 seconds STAT Typical measurement time 1s 20 seconds 5mmHg 2 or 2bpm whichever is greater 6 TEMPERATURE 2 channel Measurement and Alarm range Probe Unit Accuracy 126 0 50 C Rectal Esophageal Celsius Fahrenheit 0 1 C Cardell MAX 12 DUO HD User s Manual Resolution Update time 0 1 C Approx 1 second 7 CO EtCO amp InCQ Optional Working mode Measurement range Scale Accuracy Resolution CO Respiration Waveform speed Measurement standby 8 Multi gas Optional Measure range and accuracy O CO j N30 HAL ISO ENF 5 0 100 Vol 0 10 0 Vol 0 100 Vol 0 8 5 Vol 0 8 5 Vol 0 10 0 Vol 0 99 mmHg mmHg kPa 2 mmHg 0 39 mmHg 5 40 99 mmHg 0 08 for every 1mmHg above 38 1 mmHg 0 150 brpm 2brpm 6 25 12 5 25mm s 3Vol 0 5 Vol or 12 rel 2 00 Vol 8 rel 0 15 Vol 15 rel 0 15 Vol 15 rel 0 15 Vol 15 rel I 127 Cardell MAX 12 DUO HD User s Manual SEV 0 10 0 Vol 0 15 Vol 15 rel DES 0 20 0 Vol 0 15 Vol 15 rel Unit mmHg kPa IV Display Display Color TFT LCD Size 2a Display Channel 6 or 8 V Recorder Type Thermal recorder Printing mode R
27. ECG 4 signals ECG Lead Mode Three lead and Five lead are options standard configuration 1s three lead Five Lead Three Lead When selecting Five Lead the ECG leads you can choose are 1 11 11 IVIaWR aVL aVF and the RESP leads you can choose are RA LA RA LL LA RL LL RL When selecting Three Lead the ECG leads you can choose are VIVII and the RESP leads you can choose are RA LA RA LL Work Mode Monitoring Operation Diagnosis mode is for the needs of different circumstances User may set in accordance with the actual needs v Monitor Operation Diagnosis Diagnosis Mode To display the original ECG waveform which is not filtered 56 Cardell MAX 12 DUO HD User s Manual Monitoring Mode To display the waveform where interference has been filtered Operation Mode This is only for the circumstances where there are significant interferences outside and ECG waveform has significant distortion for example operating room It is not calibration significant Alarm sound On Off To turn the ECG alarm sound on or off 7 5 Preparation for monitoring 1 Select correct electrodes 2 Connect electrodes to lead wires 3 Attach electrodes to the patient correctly WARNING When connecting the electrodes or patient cable make sure that they do not come in contact with any other conductive material or object a metal exam table for instance 4 Plug the ECG cable into the ECG
28. ENT Se MUP da I rta 37 5 7 ECG AND TREND DATA EXPORTATION ccscecsecececcececcccececececscecececeacecsaeeceacecsaeeceueeceeeceueess 37 O DATE AND MME SETUP ai calco 41 5 9 VOLUME AND BRIGHTNESS SETUP edad 42 S IOHRIPR PRIORITY SETUP nn A 43 5 11 DISPLAY INTERFACE SELECTION di 44 SR ARE 45 5 13 CHOOSE LANGUAGE redada 45 SECTION G PRINTING ueleabicnicia zola antenata 46 6 LPRINTER INTRODUCTION Abr a 46 622 PRINTING OE TU Piti o air ia 46 SECTION 7 ECG MONITORING ccccccccccccccccccccccccccccccccccsccccccccccces 50 7 1 GENERALINEORMATION asa 50 7 2 PREPARATIONS icau rici 50 7 3 ATTACHING EGG ELECTRODES wa inline 51 PAE CG SE MUP dard an O N NRE EARE NEE EAEE EEN EERENS AEE EN EEEE EE OOE 53 Ao PREPARATION FOR MONO R G ld isa 57 FO FURR e TP dd 57 Pil PRECAUTIONS a ed A E E PAT i e A 58 7 6 CLEANING AND IVIBINTENANGE EENEN EEE EE EREE AEE EEN EAE EE EEEREN 59 TI ON EEO EE E EE EEEE EEEE lee EEE 59 SECTION 8 RESPIRATION MONITORING cccccccccccccccccccccccccccccces 61 8 1 GENERAL INFORMATION ccececcececceccccacccecccceacececcecenceceaceceacsceucecenceceaceceaceeeacecenceeeaceeeaceneas 61 8 2 RESPIRATION SETUP wvscavivaiadievaaucadvseadsdacexeuduavavetadeervoncudeawalsdeavecetuaverels dem enuasdeivalelisisamaavieels 61 8 3 RESPIRATION MONITORING PREPARATION cccececcecccccccccaceceaceceaceceacsceacscenceeeacseenceeeaceeenseneas 64 SALA iii 64 SECTION 9 SPO gt MONITORING ccc
29. General Information The multi gas module measures CO N30 and one of the five anesthesia gases Halothane Isoflurane Enflurane Sevoflurane Desflurane Each gas is displayed in a monitoring channel with waveforms showing minimum inhalation volume and maximum exhalation volume NOTE Each channel displays only one gas at a time Gas Measurement The infrared method is used in the multi gas measurement 14 2 Installation and Connection Parts Multi gas module Multi gas module connecting cable Water trap filter Gas sampling line Standard gas tube connector t tube with sampling line connector port Gas evacuation line Anesthesia machine gas tube connector CAUTION In order to protect the module from contamination and for the accuracy of data measurement a water trap for filtering out the moisture and bacteria must be used Without the filter bacteria and moisture may enter the Multi gas module directly resulting in contamination of the system occlusion faulty reading and damage to the module itself Empty the water trap before it fills and replace it regularly to avoid contamination Installation Procedures 107 Cardell MAX 12 DUO HD User s Manual The multi gas module is an external and independent part of the Cardell MAX12 HD patient monitor CAUTION In order to ensure good ventilation of the module please keep minimum Scm from each side from the wall or cabinet NOTE Do not let conden
30. IBP channel will display No transducer and alarm sound can be heard 2 Plug transducer cable into the IBP or IBP2 socket and alarm will stop indicating the connection is correct The other end of the transducer cable is connected as follows 1 2 3 4 5 Fig 13 4 IBP Transducer Connection Diagram Y The T 1 is used to make 2 to be open to the air 2 The T 3 is used to block 2 from 3 and 4 The pressure monitoring tube 4 is to ensure the accuracy of the measurement 4 The 5 in the above diagram is to connect patient catheter 1 Fill in the catheter system from T 3 and make sure there is no bubble in the system 2 Connect patient catheter to pressure monitoring tube make sure there is no air in catheter pressure monitoring tube or transducer 103 Cardell MAX 12 DUO HD User s Manual 13 5 Alarm Setup IBP monitoring alarm includes parameter limit alarm and abnormal status alarm Alarm is to give alert when the monitoring results are abnormal It 1s audible and visual with LED indicators and flashing readings Note Adjust default alarm limits according to the circumstances and the patient status Parameter Limit Range Parameter Range SYS Upper Limit lower limit 300 mmHg SYS Lower Limit 30 upper limit mmHg DIA Upper Limit lower limit 300 mmHg DIA Lower Limit 30 upper limit mmHg MAP Upper Limit lower limit 300 mmHg MAP Lower Limit 30 upper limit mmHg NO
31. MP 1 amp 2 Temperature probe extension cable connection 17 Cardell MAX 12 DUO HD User s Manual A Please check precautions of each parameter in the related sections IBP 1 amp 2 is an optional parameter On the right side panel is the built in printer on the left side panel the two rechargeable batteries are housed A To load thermal paper To install the paper roll in the printer first lift the smoke colored latch on the printer compartment Place the roll of paper between the two round tabs of the paper holder with the paper coming off of the bottom of the roll Pull enough paper from the roll so 1t hangs over the door when closed Do not thread paper under black bar You are now ready to print MAX 12 HD is Class I device with internal power and complies with IEC60601 EN60601 requirements A Devices connecting to the patient monitor should meet IEC standards Data processing device should meet IEC950 and medical devices should meet IEC60601 1 The complete system should meet the latest valid standards of IEC60601 1 1 BATTERY Battery Power Supply 12V 4 6Ah Whenever the device is plugged into AC power the two batteries will automatically be charged They should be charged at least for 8 hours before they become full To ensure batteries are fully charged it is recommended to plug the device in AC power even when the device is not being used Note Before the first use the batteries must be charged Note When the d
32. Maintenance menu then here only English can be selected The system display interface will be the English version 45 Cardell MAX 12 DUO HD User s Manual SECTION 6 PRINTING 6 1 Printer Introduction Printer Type The device uses a built in thermal array recorder and the width of recording waveform is 50mm Printer Function Adjust waveform speed Record waveforms on 3 channels Record current parameters and waveforms User can set real time recorded time waveform and delay time User can set timing print interval User can select Alarm triggered printing User can select required printing mode which includes real time waveform printing tabular printing delayed printing alarm triggered printing and automatic printing 6 2 Printing Setup In Printing Setup the user can select the print content print speed print channel printing mode alarm triggered printing On Off printing length previous time and auto print time interval Exit Print Content Print speed Channel 1 Waveform Channel 2 Waveform Channel 3 Waveform Single ECG PRT Print Mode Alarm Trigger Print Time Length Previous Time Setup Timing Printing 46 Cardell MAX 12 DUO HD User s Manual Print content It is possible to print tabular data or up to three channels of monitoring waveforms When selecting waveform you can start real time waveform printing through alarm triggered printing timing printi
33. NFORMATION pill iii iooad 96 ES 2 TRANSDUCER ir dia 96 A O 97 13 4 TRANSDUCER CONNECTION aida 103 IS ALARTE UP aaa acido 104 TS 6 PRECAUTION Sta id 104 TIT TROUBLESHOOTING uccisi 105 SECTION 14 MULTI GAS MONITORING OPTIONAL oooococcococoocooooo 107 IA SIGENERALINFORMATION aldo 107 14 2 INSTALLATION AND CONNECTION a da as 107 Cardell MAX 12 DUO HD User s Manual A iii iii li A 109 14 4MONITORINGzgo nl ai ai ian e ra ica 110 AS DEPA oa ii hide lia 111 14 6 PRECAUTIONS isa ooo e eo asa 112 A ae ae ene ee ee 113 14 8 CLEANING AND MAINTENANCE ccccececececscscscscscscesscccecscecesececscecseeeeeseseeeseeeeeeeaveseeeeeees 115 SECTION 15 CLEANING AND MAINTENANCE ccccccccccccccccccccccecs 118 VRTECCANIN Ge lo 118 152 SYSTEM CALIBRATION ea e Le 122 APPENDIX 1 PRODUCT SPECIFICATIONS ccccscccccccccccccccccccecs 123 APPENDIX 2 BP REFERENCE VALUEG cccccccccccccccccccccccccccccecs 130 APPENDIX 3 DEAD SPACE CAUSE EFFECT amp CONTROL IN SMALL ANIMAL ANESTHESIA sile 133 APPENDIX 4 DIRECT BP MONITORING ccccccccecccceccccccccccecs 136 APPENDIX 5 ACCESSORIES sii eee 142 Cardell MAX 12 DUO HD User s Manual SECTION 1 INTRODUCTION 1 1 General Welcome to the Cardell MAX 12 HD Multiparameter Monitor for use on small and large animals It continuously monitors and displays the following physiological parameters blood pressure ECG respiration arter
34. TE If CVP mode is selected there is no SYS and DIA alarm 13 6 Precautions WARNING If liquid enters the monitor turn 1t off immediately and contact Midmark WARNING When the monitor is connected to electrosurgical units make sure the transducers and cables do not contact the electrosurgical unit The patient lead and conducting wire must be far away from the operating table and other devices Electrosurgical unit should be properly grounded 104 Cardell MAX 12 DUO HD User s Manual WARNING When a defibrillator 1s used make sure patient cable has no contact with metal or other conductor or device grounding part During defibrillation do not touch the patient table or device 13 7 Troubleshooting If the IBP waveform channel displays Calibration Error please re enter the IBP Setupimenu and press the Zeroing key If the Calibration Error prompt still exists replace the transducer If the IBP waveform channel displays No signal received please turn off the machine and turn it on again If the prompt still exists please contact Midmark for help If the IBP value has a big difference from your expected value please perform zeroing again by following the steps in section 13 3 describing Transducer Zeroing before performing IBP measurement 105 106 Cardell MAX 12 DUO HD User s Manual Cardell MAX 12 DUO HD User s Manual SECTION 14 MULTI GAS MONITORING Optional 14 1
35. adwires using a soft cloth dampened with a germicidal solution CUFFS Prior to each patient use inspect the blood pressure cuff and its hose for damage 119 Cardell MAX 12 DUO HD User s Manual REUSABLE NYLON CUFFS As necessary for normal cleaning with mild detergents dilute bleach solution 1 2 wipe the cuff with the cleaning solution rinse with water and dry NOTE Midmark does not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use DISPOSABLE VINYL CUFFS In certain situations the cuff may become soiled during its use In these situations a water based detergent is suitable for wiping the cuff As necessary the preferred method for cleaning the cuff is to wipe it down with a damp soapy cloth A damp detergent free cloth should then be used to rinse the cuff NOTE Midmark does not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use PNEUMATIC TUBING Prior to each patient use inspect the NIBP Inflation Hose for proper connection cracks and kinks As necessary clean the pneumatic tubing using a soft cloth dampened with a germicidal solution CO CONSUMABLES LoFlo and CStat5 CO consumables are intended for single patient use in
36. after each use 3 Open the clip by pressing with the thumb and forefinger 4 Slide one of the sensor s alignment buttons along the clip slot until the sensor pad is fully engaged in the clip 5 Slide the second sensor button along the other clip slot until the second sensor pad is fully engaged in its side of the clip NOTE Check that the VetSat optical sensor pads are facing each other 6 The sensor is now ready to be applied to the patient The preferred sensor application site for canine feline and equine animals is on the tongue with the sensor s optical components positioned on the center of the tongue Alternatively the sensor and clip may be applied to the animal s lip toe ear prepuce or vulva NOTE If the sensor does not track the pulse reliably it may be incorrectly positioned or the sensor site may be too thick thin or deeply pigmented to permit appropriate light transmission If any of these situations occur reposition the sensor or try another sensor site If the sensor site is covered with fur try shaving the site and reapplying the sensor 66 Cardell MAX 12 DUO HD User s Manual 7 Be sure that the sensor cable 1s positioned along the side of the animal s face and body to avoid entanglement with the animal WARNING Do not use supplemental tape to adhere the clip and sensor directly to the site this can restrict blood flow and cause inaccurate measurements For best results secure
37. al 7 9 2 No ECG waveform After leadwires are connected but there is no ECG waveform and the screen shows lead off or no signal received 1 Check 1f the electrodes are in good contact with the patient and 1f the leadwires are open 2 Check all the external connections of the ECG leadwires 3 Check the ECG electrodes Prolonged placement of electrodes may result in polarized voltage and the electrodes should be replaced 4 If no signal received is displayed on the ECG channel then the ECG module has communication problem with the main unit Turn off the machine and turn it on again If problem still remains contact Midmark 7 9 3 ECG baseline shift ECG scan baseline is not stable on the display 1 Check if the working environment is too humid and if the machine has moisture inside If yes keep the machine on for 24 hours and keep the ambient environment dry 2 Check the electrode quality and whether the skin is clean where the electrode is placed 60 Cardell MAX 12 DUO HD User s Manual SECTION 8 RESPIRATION MONITORING 8 1 General Information The monitor provides two respiration monitoring methods thoracic impedance indirect and through the CO2 microstream sampline line direct NOTE If the patient is intubated direct respiration monitoring through the CO2 sample line is recommended If you choose to monitor respiration using the thoracic impedance method place the ECG electrodes
38. alarm has the following 4 statuses Alarm sound is on Alarm sound is off Must be done in the alarm setup menu Alarm sound is turned off for 2 minutes The time is counted BEBE 2 00 down But new alarm event may turn the alarm on again Note Press the Silence key on the front panel and at the same time pay attention to the time display at the lower part of the status area until the desired time duration of silence 1s reached The alarm for different parameters may be turned off on in the parameter setup menus During the silence a new alarm event may trigger the alarm sound and Silence will become invalid The low battery power alarm is not affected by Silence key It will always alarm whenever battery power 1s low 25 Cardell MAX 12 DUO HD User s Manual 2 To turn on or off alarm sound operate the knob as follows O gt Rotate the Knob gt Alarm Setup gt Press the Knob Alarm on off gt Press the Knob On Off Rotate the Knob gt Press the Knob When alarm is off disabled you will not hear any sound when new alarm events occur Alarm can be enabled through the alarm setup menu or pressing the Silence key on the front panel 4 3 Alarm Limits Setup Alarm limits include upper and lower limits that are user adjustable The alarm setup for each parameter can be found in the respective parameter setup menus In the main menu rotate the knob to select the parameter and press the kn
39. all esophageal probe ecg temp resp CD 0019 FLAT ECG CLIPS PKG OF 5 143 144 Cardell MAX 12 DUO HD User s Manual
40. an audible alarm the power is being used up and the monitor will be powered off within five minutes 1f not recharged c When AC power plug icon appears in the position of the battery it indicates that the monitor is being powered by AC power and the internal battery is being charged Parameter Area In the parameter area the real time data of the following parameters are displayed Y HR PR SpO Respiration Rate NIBP IBP1 IBP2 CO Templ and Temp2 NIBP parameters displayed are the systolic and diastolic values and mean value At the right side of SpO data display area there is a red bar indicating the signal strength of SpO When an artery pressure 1s measured IBP parameter area displays the systolic and diastolic readings in red color mean pressure in blue color When VCP is measured in IBP parameter area mean pressure is displayed in red color and its systolic and diastolic pressure readings are displayed in blue The display position can also be exchanged 21 Cardell MAX 12 DUO HD User s Manual 3 6 Menu Menu offers different selections The key O is used to activate the main menu of the device The contents of the menu change with the channel setup In the main menu line rotate the knob to point to a key see above IBP2 and press the knob to enter the sub menu operations After entering sub menu rotate the knob to point to a key and press the knob You can enter the next menu or
41. and Table 7 1 for more information Figure 7 2 3 Lead Placement For a 3 lead system leads should be attached just below the elbow on the front leg and just above the stifle on the hind leg The following lead sequence should be applied for a 3 lead system Right Foreleg RA white Left Foreleg LA black Left Hind Leg LL red Refer to Figure 7 2 and Table 7 2 for more information POSITIONING ANESTHETIZED PATIENTS For ECG monitoring during anesthesia it 1s most important to position patients properly on the table for the procedure If standard lead placement as described below 1s not possible leads should be attached to the body where they will be least subject to movement and away from the surgical site It is preferable to view an upright QRS complex for monitoring ECG A heart base to apex lead arrangement will be best if the negative lead is DZ Cardell MAX 12 DUO HD User s Manual placed at the base point of right shoulder at thoracic inlet and the positive lead at the apex low on caudal left thorax Standard right forelimb lead is negative and standard left hind leg is positive in lead two so if these leads are properly placed and the machine is set to Lead II an upright complex should be the result POSITIONING CONSCIOUS PATIENTS Standard position for recording diagnostic ECG in dogs is right lateral recumbency Diagnostic tracings can be obtained in cats in either right lateral or sternal position
42. anger warning and caution are used throughout this manual to point out hazards and to designate a degree or level of seriousness Please familiarize yourself with their definitions and significance DANGER is defined as a source of potential injury to an animal WARNING indicates a potential hazard or unsafe practice which if not avoided could result in death or serious injury CAUTION indicates a potential hazard or unsafe practice which 1f not avoided could result in minor personal injury or product property damage Cardell MAX 12 DUO HD User s Manual NOTE provides application tips or other useful information to assure that you get the most from your equipment 2 1 5 Monitor Safety The safety statements presented in this chapter refer to the equipment in general and in most cases apply to all aspects of the monitor There are additional safety statements in the parameter chapters that are specific to that monitored parameter The order in which safety statements are presented in no way implies order of importance There are no dangers that refer to the equipment in general Specific Danger statements may be given in the respective sections of this manual 2 2 Safety Requirements WARNING e The Cardell MAX 12 HD is not intended to be used as an apnea monitor e Do not use it during MRI scans e Please do not rely on the alarm functions of the patient monitor The alarm limits may have been improperly set o
43. aning and Maintenance Multi gas Module NOTE Prevent disinfectant or its fumes from entering into the gas module through the tubing Otherwise the module performance may be degraded or damaged Accessories Replacement Procedures Water trap Empty before it is full using a syringe Replace 1f contaminated or occluded Gas sampling line Reusable Standard gas tube connector Disposable Anesthetic gas exhaust tube Reusable only needs to be replaced when broken Make sure the connection is tight when doing replacement Cleaning Procedures Water trap Do not attempt to sterilize or clean it Empty it before it fills and replace when contaminated or occluded Gas sampling line and standard gas tube connector Before cleaning the sampling line and gas tube connector please get the following ready Distilled water Citric acid compound liquid Container big enough to immerse the tube Injector Steps 1 Flush out any granule residue in the tube with distilled water 2 Then wash the tube with citric acid compound liquid immerse the tube in 115 Cardell MAX 12 DUO HD User s Manual citric acid for 20 minutes Make sure that the tube is fully immersed 3 Wash the tube with citric acid compound liquid again 4 Flush out the citric acid residue with distilled water 5 Inject air into the tube with the injector to remove the remaining water Do not use compressed air 6 Make sure the tube is completely dry before
44. applied to a wrong position If the NIBP parameter area displays Cuff loose or Cuff not connected or Cuff position error please check the position of the cuff first and check whether the inflation hose is damaged 2 Overpressure Protection If the NIBP parameter area displays Overpressure protection it indicates that the internal inflation circuit results in an NIBP measurement failure Please contact Midmark for service 3 Measurement Pressure out of Limit If the NIBP parameter area displays Measurement Pressure out of limit it is because the patient s blood pressure is extremely high and out of the measurement range of the patient monitor Calm the patient down and perform the measurement again 4 Measurement Error If the NIBP parameter area displays Measurement Error it may be the result of a system self test error the patient being over excited trembling or air leakage Calm the patient down and perform the measurement again If the message persists please contact Midmark Alarm Sound On Off Turn the alarm sound on or off 82 Cardell MAX 12 DUO HD User s Manual 10 6 Precautions The following circumstances may affect the measurement results 1 patient motion 2 rapid change in pressure 3 shock or hypothermia 10 7 Maintenance CUFFS Prior to each patient use inspect the blood pressure cuff and its hose for damage REUSABLE NYLON CUFFS As necessary for n
45. apy water or mild detergent saline 1 or one of the following solutions Microzid pure Mucocit 4 Incidin 10 Cidex pure Sporicidin 1 16 Mucaso 3 Buraton pure alcohol pure Alconox 1 84 Cetylcide 1 63 2 Clean the sensor surface with soft cloth and let it dry completely 3 Wipe the receiving part and flashing part of the sensor with soft cloth immersed in the detergent or alcohol 4 Check the sensor and cable each time before use If any damage is found please replace them immediately 9 8 Troubleshooting 9 8 1 No SpO2 data Failure Phenomenon During monitoring process there is no SpO2 waveform or data Inspection Method Check if there the red light on the sensor is on Solution If there is no red light inside the sensor the wiring connectors may have 72 Cardell MAX 12 DUO HD User s Manual become loose or the wire inside the cable may have grown frayed over time Try it on your finger or earlobe and if no reading is obtained it may indicate that the V SAT sensor must be replaced If No signal received is displayed on the screen then there is a communication problem between the SpO2 module and the host Turn off the machine and turn it on again If the problem still remains consult Midmark CAUTION Certain drugs including alpha 2s are vaso constrictive and may cause difficulty in obtaining readings on patient extremities Moving the sensor further back on the p
46. at the same time Set up alarm limits Different parameters have different limits Parameter Range Parameter Adjustment Range Respiration upper limit Low limit to 150 bpm Respiration lower limit 1 to upper limit Apnea Alarm Time 5 120 seconds Alarm for abnormal status electrode off 64 Cardell MAX 12 DUO HD User s Manual SECTION 9 SpO MONITORING 9 1 Introduction The MAX 12HD continuously monitors and displays arterial blood oxygen saturation SpO and pulse rate The monitor beeps with each pulse beat It allows you to choose alarm limits and audible tone volumes You can select the high and low alarm limits for SpO and pulse rate and independently choose the volume for alarm and pulse beep tones The MAX 12HD determines SpO and pulse rate by passing two wavelengths of light one red 660nm and the other infrared 940nm through body tissue to a photo detector Pulse identification is accomplished by using plethysmographic techniques and oxygen saturation measurements are determined using spectrophotometric oximetry principles During measurement the signal strength resulting from each light source depends on the color and thickness of the body tissue the sensor placement the intensity of the light sources and the absorption of the arterial and venous blood including the time varying effects of the pulse in the body tissues The monitor processes these signals separating the time invariant parameter
47. ates name of Animal ECG Waveform The ECG waveform shows twelve minute continuous waveforms The excel sheet is capable of storing 120 columns with 3000 groups of data in each column for this data Each data column corresponds to 6 seconds of ECG waveform namely 6 500 sampling rate 3000 groups totaling 3000 120 360000 groups They are organized in chronological order with the first column storing the first 5 seconds of data This data can also be found in the monitor under Data Manager gt ECG Recall Menu The last minute of data is converted into a CSV file and stored in the USB storage device It is composed of two parts an information area and a data area To see the actual ECG waveforms highlight all the ECG data and click on Chart Wizard on the excel tool bar Depending on your excel version you may need to use another graphing tool that came with your excel software woman cn Wl amp pad fa eee OiU ie iu fu lel 17 B C D E F G H J K Date Time Nickname Species RecordNcECG LeadECG Gain 9 Feb 4 23 33 Oliver Dog 16 Ill X 1 2 0 second 6second 12 seconc 18 seconc 24 seconc 30 seconc 36 seconc 42 seconc 48 seconc 54 seconc 60 seconcf 16 32 32 32 32 2 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32 32
48. atient s tongue or exploring alternate sites lip ear toe webbing prepuce vulva may restore the readings 9 8 2 Intermittent SpO2 value Failure Phenomenon When patient SpO2 is measured the SpO2 value is not continuous Inspection method 1 Patient motion 2 SpO2 extension cable connection or V SAT sensor Solution Keep the patient as still as possible Value loss caused by patient motion can be considered normal 73 Cardell MAX 12 DUO HD User s Manual SECTION 10 NIBP MONITORING 10 1 General Information The MAX 12HD uses oscillometric principles to calculate the systolic diastolic and mean arterial pressure MAP values The MAP is calculated as the lowest cuff pressure that provides the maximum cuff oscillations Therefore MAP is the largest signal received and 1s the most accurate reading using oscillometric methods Systolic pressure is calculated as the cuff pressure at which an increase in cuff oscillations is perceived The diastolic pressure is the cuff pressure when oscillations are no longer decreasing as pressure is released from the cuff Special veterinary specific algorithms have been designed to ensure reliable and accurate measurements from kittens to horses The patient monitor first inflates the cuff to a pressure of around 20mmHg higher than the systolic pressure then slowly deflates the cuff When the cuff pressure is higher than systolic pressure the artery is blocked and the
49. b gt TEMPi Press the knob Rotate the knob gt T1 Upper Limit Press the knob Rotate the knob Increase or decrease the value gt Press the knob 86 Cardell MAX 12 DUO HD User s Manual 11 3 Temperature Monitoring 1 Select temperature probe WARNING Skin surface and rectal probes are not exchangeable 2 Probe may be used either in the esophagus or the rectum of the patient CAUTION To avoid cross contamination we suggest you label the probe with tape indicating which way it s been used 3 Insert the temperature probe into the temperature socket in the side panel WARNING Connect temperature probe with patient and insert the other end of the cable into the temperature socket of the monitor completely The screen will display the temperature reading 4 Set temperature alarm limits WARNING Before performing temperature measurement do not get the temperature probe close to a heat source If it has been close to a heat source then let 1t cool down for 5 minutes before performing measurement 5 Start to monitor patient s temperature CAUTION It takes 10 seconds for the patient monitor to display stable reading CAUTION The patient monitor performs an auto temperature calibration every hour Should the Temperature calibration error message will appear please contact Midmark WARNING When temperature probe is not connected or temperature probe 99 falls off the
50. be 5 Connect anesthetic gas exhaust tube to the rear panel of module and connect anesthesia loop or evacuation pipe 6 Start Anesthetic Agent Monitoring 1 Select corresponding display channel in setup menu 2 From the display mode the module will enter Standby mode in about 2 3 minutes 3 If inhaled anesthetic gas is to be measured please select the 110 Cardell MAX 12 DUO HD User s Manual corresponding anesthetic gas in menu 4 Select Measurement mode from the work mode menu and in a few seconds Zeroing will be displayed Zeroing takes about 2 minutes then it automatically enter s Measurement mode 5 In Measurement mode the channels of the waveform and parameter display the measured results of the current sampling gas 6 When standby mode is selected the multi gas module will stop the measurement NOTE After powering on or the first time switching from Standby to Measurement mode zeroing is required The channel will display Zeroing for 4 seconds and then start zeroing which lasts for 2 minutes After zeroing is completed it will automatically enter into measurement mode 14 5 Display Anesthetic gas parameter display consists of Waveform CO N O anesthetic agents Parameter The inhaled amp exhaled CO2 N20 five anesthetic agents one anesthetic agent at a time Gas Channel Window Each gas has its own window with the following items being d
51. before the monitor is turned on it will not be recognized by the monitor 3 Turn the monitor on for monitoring Use monitor as normal until you are ready to download the data 37 38 Cardell MAX 12 DUO HD User s Manual 4 When ready to download the data select the System menu Scroll down and select USB Export This will allow you to record the data taken from the last patient Exit EC61 SPOZ Imri 1BPZ coz Nispe tene SUSE 2010 02 08 17 09 31 5 It takes about 3 5 seconds to copy the data onto the USB storage device During this process the waveform and alarm sounds may be interrupted due to the heavy CPU usage Once the exporting is complete the monitor will display a message that will indicate if the export was successful or not Export Trend amp ECG Wave Successful means that the data has been exported successfully Exit ECG Recall Trend Display Dena Channel Setup Patient Setup 1 Mato and Time Export ECG amp Trend Files to USI Export Trend 4 ECGWave Successful Exit EOG1 SPOZ IBPi NOTE DO NOT remove the USB storage device TURN OFF THE MONITOR FIRST Removing the USB device without first turning off the monitor can damage the USB device and corrupt the data Cardell MAX 12 DUO HD User s Manual NOTE If exporting of data is used frequently please keep the USB storage device plugged into the monitor at all times Since all data stored on the monito
52. below ECG Analysis de Amplitude Asystole 2006 10 31 11 10 10 ee loi TO pia 2006 10 31 11 10 10 2006 10 31 11 10 15 Fig 5 3 ECG Analysis 32 Cardell MAX 12 DUO HD User s Manual Press Position and a base point can be set on the magnified ECG waveform Then rotate the knob and the cursor will move along the waveform displaying measurement information Move the cursor to change the relative time and amplitude of the point and measure the EGC segment Press to select ECG Analysis waveform 5 3 Trend Display The device provides up to 120 hour monitoring history data which can be displayed through trend display function Follow the steps below to enter trend display D Rotate the knob Trend Display Press the knob Trend Display Disp Time 2HourOhin Work Time OHourbMin HR PR bpm 00 407120 6 50 0 8 10 31 12 15 20 ate Up Down Page Zoom Fig 5 4 Trend Display In the Trend Display the texts at the left side are monitoring parameter and 1ts upper and lower alarm limits 33 Cardell MAX 12 DUO HD User s Manual In the time status box under graph the time stamps on the left and right sides indicate the start and end time of the trend The time in the middle indicates the time where the cursor is When the actual monitoring time is not enough to be displayed in the full screen the time at the right side indicates the last trend record ti
53. bral blood flow and intracranial pressure o Tachypnea and an increased work of breathing which can negatively impact a debilitated patient e Arterial O levels may eventually decrease enough to cause hypoxemia especially in a patient breathing room air e Inadequate ventilation interferes with adjustments in anesthetic levels Controlling mechanical dead space is a simple matter 134 Cardell MAX 12 DUO HD User s Manual e Mechanical dead space is most concerning for patients under 6 kg body weight o Minimize the connectors attached to the endotracheal tube particularly in small patients For example in a 6 kg patient under anesthesia the patient s alveolar ventilation volume would be 31 5 ml Using a pediatric F circuit with adult EtCO monitor and right angle adaptor or apnea alert adaptor could create 30 ml of mechanical dead space effectively eliminating 95 of normal spontaneous alveolar ventilation e Make sure you regularly inspect all anesthetic machines and systems paying particular attention to valve function and inner hose integrity e Make sure that the ET tube is not excessively long e Select your anesthetic system carefully o Do not use a pediatric F circuit as a substitute for conventional pediatric circle hoses or a noncircle system e Using no more than one monitor adaptor o Make sure it is a pediatric low volume adaptor for smaller patients to avoid any significant impact on total mechanical dead space e Avoid th
54. button will stop the NIBP measurement immediately 79 Cardell MAX 12 DUO HD User s Manual STAT Continuously measure patient s NIBP for 5 minutes The mode is mainly used to closely monitor a patient s blood pressure changes in emergency situations During the STAT measurement press the NIBP Start Stop button on the front panel and the measurement will immediately stop Select time interval Select time interval in AUTO displays behind the mode Adjustable ranges in minutes are 1 10 15 30 60 90 120 180 240 480 The time interval means the time between the last NIBP measurement start to the next NIBP measurement start Change NIBP measurement scale Use this to change the NIBP measurement scale between mmHg and kPa 10 4 Preparations before NIBP Monitoring 1 Use cuffs of proper sizes 2 Ensure the cuff has been completely deflated 3 Place the cuff on the patient s limb 4 Install the cuff hose to the NIBP connector of the patient monitor 5 Make sure there is no block between the monitor and the hose 6 Set blood pressure measurement correctly in the setup menu 7 The cuff on the patient s limb should be at the same level as the heart 8 Press the blood pressure start key and start measuring blood pressure 80 Cardell MAX 12 DUO HD User s Manual WARNINGS 1 Make sure there is no other pressure on the cuff Wrong cuff size may result in inaccurate measurements
55. ccccccccccccccccccccccccccccccccccecccecs 65 A A A A O A AN 65 al E A II A he 66 ed SPO SEW A elle 68 9 4 PREPARATION FOR MONITORING Ca is 69 SS YAA A A A A A E eater 71 Cardell MAX 12 DUO HD User s Manual 9 6 PRECAUTION Salle 71 9 7 CLEANING AND MAINTENANCE cccccceccccececcccccecceccacscenceceacececceceacecencecsaceeeacesenceseaceceaceneas 72 9 8 TROUBLESHOOTING aa aliante 72 SECTION 10 NIBP MONITORING ccccccccccccccccccccccccccccccccccccccccces 74 TOI GENERALCINFORMATION siaa araa Aaa a Aca uaieloe 74 EOZ CUFEPEACEMEN Ti Slds 75 TOS NIBP lui 78 10 4 PREPARATIONS BEFORE NIBP MONITORING ccececcecececccceccccecececcecscecscecscececcecsaceceeesss 80 TOS ALARM SETUP a ee CO 81 I0 6 PRECAUTIONS licei aa 83 IO 7 MAINTENANCE sierras alle 83 SECTION 11 TEMPERATURE MONITORING ccccccccccccccccccccccccccces 85 EL 1GENERALINFORMATIONiisialunel lalla 85 EZ TEMPERATURE ET a o aia 86 11 3 TEMPERATURE MONITORING is 87 SECTION 12 CO MONITORING OPTIONAL ccccccsssscscsccsccccscessscees 88 1201 GENERAL INFORMATI N secoli dilatare 88 12 2 CAPNOSTAT 5 SENSOR MAINSTREAM cccececscccceccececccceacecsacececcecencecsacecsacecsaceceacecsuceceacenss 88 12 3 LOFO CO gt SENSOR SIDEST REAM den 90 LZA MENU SEM UP toda a 91 125 CLEANING amp E MAINTENANCE sus e el non ot odorant ee ainda eee ol 94 SECTION 13 IBP MONITORING OPTIONAL cecsccsssscscsccsccccscessecess 96 TS GENERAL I
56. cons Rotate the knob to CO and press the knob to enter the CO Menu 91 Cardell MAX 12 DUO HD User s Manual Exit Work Mode Unit Wavetorm Speed Waveform Fill Zerome EtCO2 Lower Limit EtCO 2 Alarm 1102 Upper Limit 11002 Lower Limit InCO Alarm RR Upper Limit RR Lower Limit RR Alarm Apnea Alarm Apnea Alarm lime Color Setup Work Mode Choose from Standby or Work Mode The monitor will be in Standby Mode when the CO is not in operation Whenever the CO probe or module is connected the monitor will default to Work Mode If not monitoring CO disconnect the cable to slow down the rate of battery depletion Unit Choose from mmHg or kPa Waveform Speed Choose from 6 25 12 5 25 0mm s The waveform speed represents the sweep speed The faster the sweep moves across the screen the more detail will be drawn out So you will get a bigger waveform that will take up more space on the screen The slower the sweep moves across the screen the more waveform gets drawn This will give the viewer a wider sample of waveforms Waveform Fill Standard waveform is the default for the monitor Fill is 92 Cardell MAX 12 DUO HD User s Manual an option that will color in the waveform instead of displaying it as a line Zeroing Zeroing is required each time a new type of airway adapter is used or when a sensor is used for the first time Generally after an airway adapter is installed it is
57. dle and cap the catheter hub with the adapter An initial aspiration should easily produce a blood flash into the saline solution Flush in 2 3 cc of heparinized saline solution to clear blood from the catheter lumen Secure the catheter in place prior to proceeding further Connection to BP monitor Flush the connecting tubing with saline using the flush device embedded in the disposable transducer or by using a saline filled syringe attached to the stopcock immediately adjacent to the extension tubing Be sure that there are no visible air bubbles following the flush procedure Attach the connecting tubing to the catheter adapter extension You should see a pressure waveform on the monitor screen after opening the stopcocks to the system Level the transducer at the estimated base of the heart point of the shoulder Close the line to the patient and open it up to room air using the stopcock Press the zero button again to recalibrate the system to the patient Close the stopcock to air and open the line to the patient You are now measuring direct blood pressure Blood pressure waveform Arterial waveforms emanate from the pulse pressure created by ventricular systole and diastole The arterial pulse pressure wave begins as left ventricular contraction and forward blood flow stroke volume creates aortic distention within the closed vascular system Peak aortic blood flow produces the initial upstroke in the pressure pulse while continuous
58. e password 8727 then choose ok to enter Demo mode Loggin On cdefghi jklmn opqrstuvuxyz Demo All data will be deleted continue Blank a an Del Caps OK Cancel OK Cancel When the device is in Demo mode you will see DEMO MODE on the screen Press Demo mode again to return to normal monitoring mode 5 5 Channel Setup The channel setup menu can be entered from the system main menu and is used to change the channel mode and the parameters of the channels Waveform Channel 1 displays ECGI ECG waveform and indicates ECG waveform speed and ECG mode Waveform Channels 2 8 can be selected to display parameters or waveform 35 Cardell MAX 12 DUO HD User s Manual If Expand is selected on the Channel Setup menu the height of the channel above it increases Selecting None displays a blank channel in the parameter area The Temperature parameter is displayed at the bottom of the parameter area NOTE If you do not select NIBP channel the monitor cannot measure NIBP Setup Channel Setup can be set to display parameters on 6 channels or 8 channels Step 1 Press knob to enter Channel Setup press knob to enter channel selection mode and use dial to highlight 6 or 8 press knob to confirm click on OK Step 2 Rotate knob to select a waveform channel number Press the knob to enter the parameter selection menu and turn the knob to highlight the preferred parameter for t
59. e kept in a cool and dry place away from direct sunlight high temperature and humidity 48 Cardell MAX 12 DUO HD User s Manual 49 Cardell MAX 12 DUO HD User s Manual SECTION 7 ECG MONITORING 7 1 General Information The Cardell MAX 12HD Monitor records heart rate with electrode clips attached to the patient Electrodes detect signals caused by changes of electrical conduction in the heart during the cardiac cycle Heart rate is computed on a beat to beat basis using the R R interval of the QRS complex It is necessary to make sufficient preparations before monitoring in order to get accurate readings Patient Cable The patient cables consist of the main cable connected to the patient monitor and the leadwires connected to the patient WARNING At ECG receptacle you can see 0 label which indicates that the signal input part is highly insulated and defibrillator proof In addition it is guaranteed that the monitor will not be damaged during defibrillation and HF surgical operation 7 2 Preparations 7 2 1 Skin Preparation and Lead Contact Sites where leads are attached to the body must be properly prepared to optimize contact Dogs and cats have enough electrolyte material on their skin and hair so that merely moistening lead sites with 70 isopropyl alcohol is appropriate This will usually be sufficient for ECG recording monitoring 50 Cardell MAX 12 DUO HD User s Manual for a short time 30 to
60. e knob to navigate through the parameters EtCO2 Upper Limit EtCO2 Lower Limit EtCO2 Alarm InCO2 Upper Limit InCO2 Lower Limit InCO2 Alarm PR Upper Limit PR Lower Limit RR Alarm Color Setup This menu allows you to allocate the color of your choice to the waveforms and displays for each parameter 12 5 Cleaning amp Maintenance CAPNOSTAT 5 CO Sensor Cleaning the outside of the CAPNOSTAT 5 CO2 Sensor 1 Use a cloth dampened with isopropyl alcohol 70 a 10 aqueous solution of sodium hypochlorite bleach disinfectant spray cleaner such as Steris Coverage Spray HB ammonia or mild soap 2 Wipe down with a clean water dampened cloth to rinse and dry before use Make certain that the sensor windows are clean and dry before reuse Airway Adapters 1 Clean by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant such as isopropyl alcohol 70 a 10 aqueous solution of 94 Cardell MAX 12 DUO HD User s Manual sodium hypochlorite bleach a gluteraldehyde 2 4 solution such as Cidex Steris System 1 or ammonia It should then be rinsed out with sterile water and dried 2 May be disinfected using the methods listed below a Immerse and soak in Cidex or equivalent 2 4 glutaraldehyde solution for a 10 hour soak b Immerse and soak in Perasafe or equivalent peracetic acid 26 solution for a 10 minutes Cidex OPA follow the manufacturer s instructions for use 3 Before reusing
61. e use of positional right angle adaptors in smaller patients e Avoid maintaining anesthesia with a facemask Simply put anesthetized patients should have their end tidal CO monitored for maximal patient safety 135 Cardell MAX 12 DUO HD User s Manual APPENDIX 4 DIRECT BP MONITORING Marc R Raffe DVM MS DACVA DACVECC Pfizer Inc St Paul MN Blood pressure is considered an important component of patient monitoring in emergency and critical care medicine Blood pressure is a product of several cardiovascular parameters including cardiac output stroke volume x heart rate volumetric compliance of peripheral blood vessels systemic vascular resistance and effective circulating blood volume Veterinary medicine has embraced blood pressure measurement as an important monitoring tool for a variety of medical and surgical situations In most cases current clinical practice measures blood pressure by an indirect technique which relies on surface pressure occlusion of a superficial artery using a pneumatic cuff and a method to detect blood flow distal to the site of cuff occlusion Accepted detection methods to identify blood flow include auscultation oscillometry palpation ultrasonic and photoelectric methods Although valuable it has long been recognized that all indirect methods have limitations in accurate measurement associated with both patient and operator factors Also indirect blood pressure measurement is not robust m
62. eal time amp alarm triggered printing of waveform and text Printing channel 2 3 channels Printing speed Auto 12 5 25 0mm s VI Physical Specifications Net Weight 15 8 lbs 6 5 kg Gross Weight 19 8 lbs 9 0 kg Dimensions 450x380x390 mm VII Environmental Specifications Temperature Working 0 40 C Storage and Transportation 20 55 C 128 Cardell MAX 12 DUO HD User s Manual Relative Humidity Working lt 80 non condensing Storage and Transportation lt 95 non condensing Barometric pressure Working 86 106 kPa Storage and Transportation 50 106 kPa Specifications subject to change without prior notice 129 Cardell MAX 12 DUO HD User s Manual APPENDIX 2 BP REFERENCE VALUES Which Blood Pressure is Normal in Dogs or Cats It is essential to know the reference range of blood pressure in a given species in order to properly evaluate the animal s blood pressure and detect hypertension or hypotension When using different measurement techniques oscillometry or direct blood pressure measurements one must also remember that methodological factors influence results Therefore technique specific reference values should be known Species specific breed specific and individual differences in normal blood pressure ranges can be observed The most accurate assessments are made by comparing different blood pressure readings over time using serial measurements made at regular intervals a
63. eaning that it cannot be accurately measured during low pressure and vasoconstricted states Because there are limits to indirect blood pressure measurement there is increased interest in direct blood pressure monitoring in patients demonstrating abnormal physiology that may render indirect measurement techniques inaccurate or impossible Direct blood pressure measurement requires introduction of a catheter into an arterial or venous lumen and equipment and supplies to transfer pressure from the catheter tip to a measurement device For this reason direct measurement is technically more demanding than indirect techniques but less prone to measurement error The purpose of this presentation is to review the theory practice and techniques for direct arterial blood pressure measurement in dogs and cats Equipment needed for direct blood pressure measurement Equipment and supplies Essential equipment and supplies needed for direct blood pressure monitoring include arterial catheters see below side port catheter adapter low compliance extension tubing three way stopcocks 136 Cardell MAX 12 DUO HD User s Manual pressure measurement device transducer pressure analysis and display device ECG BP monitor heparinized saline and syringes needles For long term placement a constant flush device Intraflowe IV tubing 1L normal saline heparin and pressure infuser device permits continuous flush infusion to prevent clot formation
64. ensor from its proper position NOTE If defects are noted do not use the sensor or clip Refer to the Directions For Use pamphlet enclosed with the sensor for more information TEMPERATURE PROBES As necessary the probes should be cleaned with a mild detergent and water to remove excess bioburden When necessary the probes may be disinfected 121 Cardell MAX 12 DUO HD User s Manual using a soft cloth saturated with a 10 1 10 solution of chlorine bleach in tap water or 70 isopropyl alcohol When all of the surfaces have been disinfected wipe the entire surface of the monitor using a soft cloth dampened with fresh water to remove any trace amounts of residue and or fumes 15 2 System Calibration Besides the routine cleaning of the monitor and accessories outlined in the previous section and replacement of accessories due to normal wear and tear calibration of the monitor should not be necessary during the warranty period If the monitor is in need of repair it must be referred to the appropriate service personnel Service performed by unauthorized personnel could be detrimental to the monitor and may void the warranty For service contact Midmark 122 Cardell MAX 12 DUO HD User s Manual Appendix 1 Product Specifications I Safety Safety Class Classl with internal power supply Device Continuous working non AP APG device II Power Supply Requirements Input Power Supply Voltage a c 100V a c 242V
65. ent monitor are as follows SpO2 NIBP SYS mmHg NIBP DIA 2 Cardell MAX 12 DUO HD User s Manual SYS DIA Lower 20 20 20 mp NI a pm Temp Lower 36 0 36 0 36 0 CC IBP SYS mmHg IBP DIA mmHg Lower 40 40 4 EtCO2 Upper 60 60 60 mmHg Lower InCO2 mmHg 4 6 Alarm Mode The device provides two alarm modes standard and auto which can be set in the alarm setup menu Di Rotate the knob gt System Alarm Setup Press the knob Rotate the knob Alarm Mode gt Press the knob Rotate the knob IStd Auto gt Press the knob 1 Standard Alarm Mode When abnormal event happens and all alarm functions are on alarm will persist until a response is received 2 Auto Alarm Mode 28 Cardell MAX 12 DUO HD User s Manual When abnormal event happens and all alarm functions are on alarm will last for 30 seconds and display alert message in a proper position When blood pressure and temperature values are abnormal out of limits and all the alarm functions are on the alarm sound will last for 30 seconds and automatically turn off but the readings will continue flashing When HR PR SpO gt or respiration readings are abnormal out of limits and all alarm functions are on the device will give real time sound and flashing visual alarm After all alarm setup is completed rotate the knob to Exit and press the knob to exit alarm setup 4 7 Alarm Eve
66. eplace them if necessary 117 Cardell MAX 12 DUO HD User s Manual SECTION 15 CLEANING AND MAINTENANCE 15 1 Cleaning WARNING Do not under any circumstances perform any testing or maintenance on the monitor while the monitor is being used to monitor a patient The monitor must be turned OFF Unplug the monitor from the AC power source and remove the internal battery CAUTION Do not open the monitor to clean or repair it Contact Midmark for service needs CAUTION Disconnect all accessories from the monitor before cleaning Do not immerse any part of the electrical connector of the cable or accessories in the cleaning or disinfection solution at any time Do not use an abrasive cloth or cleaner on the accessories Immersing the patient cable or lead wires in any liquid may result in moisture entering This may cause internal damage and reduce the product life Alcohol and organic solvents may cause stiffness and brittleness THE MONITOR On a daily basis examine the monitor s case for damage and check the AC power cord for bent or broken prongs cracks or fraying Neither the monitor nor the power cord should be used if damaged If any damage is noted contact the appropriate service personnel CAUTION Do not spray or pour any water or cleaning solution directly onto the monitor 118 Cardell MAX 12 DUO HD User s Manual As needed clean the monitor using a soft cloth dampened with a mild dishwa
67. ery 10 seconds red LED flashing second Medium Priority Single medium volume beep 3 times every 25 seconds yellow LED flashing every 2 seconds Low priority single low volume beep every 30 seconds steady yellow LED High priority Alarm Asystole SYS DIA is too low Apnea Alarm Medium priority Alarm Parameter values exceed set limits equipment alarms Low priority Alarm Low battery power Medium Priority alarm equipment conditions are as follows LEAD OFF LOOSE CUFF PROBE OFF AIR LEAK CUFF POSITION ERROR OVERPRESSURE RANGE EXCEEDED OTHER ERROR NO WATERTRAP Optional Multi gas FILTER OCCLUSION CALIBRATION ERROR OCCLUSION LOW SIGNAL When sensors or probes are unplugged the screen will display Probe off or No sensor and alarm Note When Asystole is displayed on the screen please check for the ECG Gain of the relative channel to see if it 1s too low to detect heart rate If so user can switch the ECG lead or change the source channel for the alarm 24 Cardell MAX 12 DUO HD User s Manual To effectively control the system alarm function the monitor has alarm ON OFF and sound volume selection which can be set through Setup Rotate the knob in main menu and when the arrow points to Alarm Setup press the knob to enter alarm setup menu 4 2 Alarm On Off 1 Press the key Xon the front panel to turn on the system alarm sound or silence the alarm within a period of time The
68. etup Procedures Rotate the knob to select and press the knob to confirm For example Rotate the knob to highlight Lead Press the knob and select the desired item Press the knob to confirm After setup rotate the knob to the EXIT icon the last one press the knob and exit Lead selection Lead selection is used to select different leads to display different ECG waveforms User may select I II III V aVR aVL aVF 54 Cardell MAX 12 DUO HD User s Manual Where I II III are bipolar extremity leads and aVR aVL aVF are voltage added extremity leads The positive and negative polarities of the leads are as follows aVR aVL aVF ECG Gain To change the ECG waveform amplitude user may select x4 x2 x1 x1 2 x1 4 and Auto The selected gain is displayed above the waveform channel and the selected value 1s the amplitude value Waveform speed Exit Y 50 mm s 25 mm s 12 5 mm s 6 25 mm s Select ECG waveform display speed User may select 12 5 25 0 50 0 mm s according to the specific needs ImV CAL When it is pressed a 1ImV square wave will be displayed on the ECG 55 Cardell MAX 12 DUO HD User s Manual wavetorm for user calibration HR source User may select ECGI or ECG 2 or ECG3 or ECG4 ECG1 ECG 1 to detect heart rate based on ECG signals ECG 2 to detect heart rate based on ECG 2 signals ECG 3 to detect heart rate based on ECG 3 signals ECG 4 to detect heart rate based on
69. evice is being stored for a long time make sure the batteries are full Check the battery status at least every month and recharge them Cardell MAX 12 DUO HD User s Manual Each fully charged battery can support the device continuously working for 1 5 hours however NIBP measurement and printing may accelerate the consumption of battery power When the battery power is almost used up the battery mark at the lower right corner of the screen will flash alerting user to plug the device in AC power as soon as possible When battery power is not enough to support normal operation of the device the device will be turned off automatically and will not start to work until being turned on after it is plugged into AC power WARNING Even when the device is not on battery power will be discharged slowly 3 4 Before Monitoring Before monitoring a patient please check the following Check if there is any mechanical damage Check the external connections Check if the patient monitor is in good working condition Warning If anything is found abnormal or mechanical damage is apparent please don t use it and contact Midmark Step 1 After power on the system will start self test If the self test is successful then start monitoring your patient If changes are to be made in the operation or settings see the Operation Procedures Step 2 Make sure the patient monitor is connected to the patient through the accessories Step 3 A
70. g or kPa Press Test test static press Dynamic Blood Pressure Start Stop dynamic blood pressure monitoring Alarm limit adjust alarm upper and lower limits Alarm On Off Turn on or off NIBP alarm sound 78 Cardell MAX 12 DUO HD User s Manual Operation Method Rotate the knob to select required function then confirm by pressing the knob Select cuff size The current cuff size is displayed near the blood pressure value on the screen Large or small can be selected corresponding to the type of cuff selected for your patient When using one of the two large nylon cuffs SV8 or SV10 select Large Otherwise the cuff size should be set to Small corresponding to the white cuffs sizes SV1 SV5 CAUTION Before measurement make sure you have chosen the right cuff size on the monitor Select measurement mode MANU AUTO STAT NOTE The current NIBP Measurement Mode will display to the upper right of NIBP parameter Manual MANU Press NIBP Start Stop button on the front panel and the NIBP measurement will start immediately NOTE During an NIBP measurement if the NIBP Start Stop button is pressed again the measurement will be stopped immediately CAUTION The initial inflation pressure is 150 mmHg Automatic AUTO The patient monitor will inflate the cuff at the start of each automatic measurement cycle NOTE Anytime during NIBP measurement pressing the NIBP Start Stop
71. gas exchange Simply said there is no patient benefit from dead space ventilation If mechanical dead space volume equals or exceeds alveolar ventilation volume the patient will not be able to clear carbon dioxide at all Ideally your goal should be to minimize dead space through proper patient planning and to detect excess dead space consequences through end tidal CO2 monitoring Anatomic dead space is comprised of the upper airway structures that do not participate in gas exchange This includes the gases in the nasal passages nasopharynx larynx trachea and in the larger airways Alveolar dead space represents those alveoli that are ventilated with fresh gas but not perfused by the pulmonary circulation Mechanical or equipment dead space is made up of any portion of the endotracheal tube extending beyond the patient s incisors patient monitor adaptors ETCO2 apnea alert etc any adaptors used to facilitate patient system positioning right angle or swivel adaptors used to reduce the risk of tracheal trauma during patient rotation the pace within a mask not occupied by the patient s nose humidification management exchangers HME and the Y piece defined as the terminal end of an F circuit or noncircle system and the inhalation exhalation hose connector in a circle system Exhausted soda lime or malfunctioning one way valves can also contribute to increasing mechanical dead space Dead space also increases in a non rebreath
72. hat channel Then press knob to select parameter Step 3 Press OK The waveforms and parameters will be displayed on screen according to order Channel Setup Channel Mode 8 chamel ECG1 Chamel 2 ECG2 Channel 3 ECG3 Channel 4 SPOZ Chamel 5 NONE Chamel 6 Channel 7 NONE Chamel 8 NONE TEMP Cancel Fig 5 3 Channel Setup 36 Cardell MAX 12 DUO HD User s Manual 5 6 Patient Setup In the monitoring process patient information can be entered for the ease of observation To enter the patient setup dialog box I Rotate the knob Patient Setup gt Press the Knob Patient Information Nickname 10 1 34567Y89ab Record No ofc cdefghijklnn Location Sex Male Opqreztuvuwxuz Species Cat Blank p A New Record No Select Yes to clear patient data D el Caps OK Cancel Patient name Record number and Location ID can be entered through rotating and pressing the knob Then select sex species and whether it s a new patient to clear old data These steps are required if downloading to USB for each patient and must be done prior to beginning new case 5 7 ECG and Trend Data Exportation I Exporting Trend Data and ECG Waveform Data Monitoring data that can be exported are Trend Data and ECG Waveform Data Exporting data 1 Make sure the monitor is turned off 2 Insert the USB storage device into the USB port on the back of the monitor NOTE If the USB device is not inserted
73. human medicine but in the veterinary setting may be reused as long as any moisture is allowed to dry between uses It is estimated that with fairly regular use the sampling lines should be replaced every 60 to 90 days Do not attempt to disinfect or flush the FilterLine as the monitor can be damaged Refer to the manufacturer s instructions enclosed with each sensor for more information 120 Cardell MAX 12 DUO HD User s Manual SpO INTERCONNECT CABLE Prior to each patient use inspect the SpO Interconnect cable for damage As necessary clean the cable using a soft cloth dampened with a germicidal solution SENSOR AND CLIPS CAUTION To avoid damage to the VetSat sensor remove it from the clip before cleaning either piece CAUTION Do not sterilize the sensor or clips by irradiation steam or ethylene oxide Do not immerse the sensors in water or cleaning solution When necessary the sensor may be surface cleaned by wiping it with an agent such as 70 Isopropyl Alcohol The clip may be cleaned by either wiping it with or soaking it for ten 10 minutes in 70 Isopropyl Alcohol If the clip is soaked be sure to rinse it with water and air dry it prior to use on the next patient After each cleaning and prior to each use inspect the sensor and cable for fraying cracking breakage or other damage Inspect the clip for cracking or breakage or loss of spring tension that would allow slippage or movement of the s
74. ial blood oxygen saturation of arterial hemoglobin SpO carbon dioxide CO2 and temperature Some versions include invasive BP and or multigas monitoring It converts the various physiological changes into data and calculates analyzes the data and then displays the data on the screen When the monitored data exceed the preset limits an alarm system activates and sends a signal to alert the staff s attention The Cardell MAX 12 HD Multiparameter Monitor uses internal battery power or AC power Before using the patient monitor please read this manual thoroughly in order to use the monitor correctly and to ensure the monitor performs according to the specifications and in conformity with the safety standards This manual is an integral part of the product and describes its intended use It should always be kept with the monitor Observance of the manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety 1 2 Product Support 1 2 1 Warranty Please register your warranty either using the post card included or online if indicated After unpacking the system you may want to keep the packing materials for future return for service if necessary The manufacturer is responsible for the safety reliability and performance of the monitor Cardell MAX 12 DUO HD User s Manual The warranty applies if the product is used according to the operator s manual instruction The
75. ients requiring an airway adapter install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y section 6 For intubated patients with an integrated airway adapter in the breathing circuit connect the mail luer connector on the straight sample line to the female port on the airway adapter WARNING Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit In reverse always remove the airway adapter from the breathing circuit before removing the sensor 90 Cardell MAX 12 DUO HD User s Manual Using the Sidestream Sensor Holder The sidestream sensor holder can be used to clamp the sensor onto an IV pole or a Shelf 1 Push the sensor into the holder until it clicks into position 2 Clamp the holder onto an IV pole a shelf or another appropriate location 3 To remove the sensor from the holder release the clip and pull the sensor out of the holder Removing Exhaust Gases from the System WARNING Regarding Anesthetics When using the sidestream CO measurement on patients who are receiving or have recently received anesthetics connect the outlet to a scavenging system to avoid exposing the veterinary staff to anesthetics Use an exhaust tube to remove the sample gas to a scavenging system Attach it to the sidestream sensor at the outlet connector 12 4 Menu Setup Push the Menu button to access the parameter i
76. ing system when fresh gas flows are inadequate or when certain defects are present in the system for instance when the center tube of a Bain system or F circuit is cracked or broken These dead space contributors can all be controlled through proper system inspection and 133 Cardell MAX 12 DUO HD User s Manual maintenance Mechanical dead space gas is the first gas inhaled at the beginning of the each respiratory cycle As the mechanical dead space volume increases less fresh gas moves into the patient s alveoli limiting gas exchange Anesthetic System The consequences of excessive mechanical dead space can be substantial and potentially fatal As dead space volume from any cause increases effective alveolar ventilation decreases In patients breathing 100 oxygen there may be negligible initial effect on arterial oxygen tension Arterial CO2 however can reach impressive levels It is possible to have an end tidal CO level greater than 110 mmHg in patients with a normal pulse oximeter reading e Increased arterial CO gt causes o Respiratory acidosis o Sympathetic stimulation o Cardiac arrhythmias A mix of sympathetic stimulation and hypoxemic effects o Variable peripheral vasoconstriction sympathetic effect followed by peripheral vasodilation as a direct effect on peripheral vessels o CNS depressant effect and eventually narcosis PaCO levels above 100 mmHg have an anesthetic effect o Increased cere
77. ircumference Width Range sve00 kity includes alloftheabove o Large Animal Cuff Selection Cuff Model Number Bladder Size Limb Circumference idth Range SV10 References Pedersen KM Butler MA Ersboll AK Pedersen HD 2002 Evaluation of an oscillometric blood pressure monitor for use in anesthetized cats JAVMA 221 646 650 Sawyer DC Guikema AH Siegel EM 2004 Evaluation of a new oscillometric blood pressure monitor in isoflurane anesthetized dogs Vet Anaesth Analg 31 27 39 11 Cardell MAX 12 DUO HD User s Manual 10 3 NIBP Setup NIBP setup includes select measurement work mode select cuff size select auto measurement time interval change NIBP measurement scale pressure compensation dynamic blood pressure adjust alarm limit and turn the alarm sound on or off Enter NIBP setup Press the Parameter Setup button ANA and press knob to confirm Rotate to NIBP press knob to confirm Users can rotate the knob to select items shown in the following figure and press the knob to confirm Exit Work Mode Cuff Setting Unit Pressure Test Dynamic Blood Pressure SYS DIA Alarm SYS Upper Limit SYS Lower Limit DIA Upper Limit DIA Lower Limit MAP Upper Limit MAP Lower Limit NIBP Alarm Fig 10 1 NIBP Setup Menu Select cuff size Large Small Select work mode Manual Auto and Stat Select time interval for auto NIBP measurement Change NIBP measurement scale mmH
78. isplayed Waveform reading of in and et Gas Channel Parameter Window The gas parameter window displays measured parameters of CO N 0 and anesthetic agents 111 Cardell MAX 12 DUO HD User s Manual NOTE If you have any doubt as to the accuracy of the displayed value check for leakage or occlusion in the water trap and exhaust tube NOTE If the waveform seems to be abnormally flat check the water trap and sampling line for any leakage or occlusion Replace the water trap or sam 14 6 Precautions The measurement range and accuracy of each gas are as follows O 5 0 100 Vol 3 Vol CO 0 10 0 Vol 0 5 Vol or 12 rel N O 0 100 Vol 2 00 Vol 8 rel Anesthetic Agents HAL 0 8 5 Vol 0 15 Vol 15 rel ISO 0 8 5 Vol 0 15 Vol 15 rel ENF 0 10 0 Vol 0 15 Vol 15 rel SEV 0 10 0 Vol 0 15 Vol 15 rel DES 0 20 0 Vol 0 15 Vol 15 rel During measurement only the selected anesthetic agent is displayed NOTE In order to assure the gas measurement accuracy the module will automatically start calibration after continuous operation for more than 2 hours The calibration takes about ten seconds The channel will display 66 29 After zeroing 1s Zeromg and the parameter box will display completed it will return to normal measurement status 112 Cardell MAX 12 DUO HD User s Manual 14 7 Alarm The multi gas modu
79. ive when head neck dental procedures are being performed 9 3 SpO Setup To enter SpO Setup menu Main Menu gt Rotate the knob gt SPO gt Press the knob See the menu on the right Enter waveform speed setup By rotating the knob and pressing you can set the sweep speed the SpO alarm limits and pulse rate alarm limits and turn the alarm on or off For example to set the SpO2 waveform speed Exit Waveform Speed SPO2 Upper Limit SPO Lower Limit SPO Alarm PR On Color Setup Fig 10 1 SpO Setup Menu 68 Cardell MAX 12 DUO HD User s Manual Main Menul gt Rotate the knob gt SPO1 gt Press the knob Rotate the knob gt Waveform Speedi gt Press the knob gt 112 5 25 0 50 0mm Si gt Rotate the knob Press the knob Alarm sound On Off To select On Off On To turn on SpO alarm sound Off To turn off SpO alarm sound To set SpO alarm limits Main Menu Rotate the knob gt SPO gt Press the knob Rotate the knob gt SPO Upper Limit Press the knob Rotate the knob increase or decrease the value gt Press the knob For alarm limit default setting see Alarm Setup 9 4 Preparation for Monitoring 1 Select the proper size sensor 2 Apply the sensor to a proper position on the patient If possible keep the sensor at the same level of the patient s heart 69 Cardell MAX 12 DUO HD User s Manual WARNINGS eDo not apply the SpO2 sensor
80. le are not in contact with metal or other conductor surface or grounding devices During defibrillation do not touch patient table or instrument 58 Cardell MAX 12 DUO HD User s Manual WARNING Ensure conductive parts including electrodes of the patient cable do not come into contact with any conductive surfaces WARNING Do not use the patient monitor during MRI or CT scan CAUTION Leads and cables should be away from patient s neck 7 8 Cleaning and Maintenance CAUTION Please always obey the detailed instructions supplied together with the transducer which are more updated than the information here The following instructions shall be treated as general guidance when there is no specific method When the cable is found worn out or damaged please replace the cable at once 7 8 1 ECG cable cleaning In order to keep the cable dust free please clean it with clean cloth with soapy water or a mild detergent 7 8 2 ECG cable disinfection In order to avoid long term damage to the cable we recommend that you only disinfect the cable when it s necessary according to your hospital regulations CAUTION Do not autoclave the cable 7 9 Troubleshooting 7 9 1 Inaccurate Heart Rate 1 check patient s ECG signal a check adjust lead placement 59 Cardell MAX 12 DUO HD User s Manual b check clean the patient s skin c check replace ECG electrodes 2 check if ECG waveform amplitude is norm
81. le has alarms for values exceeding the preset limits apnea and for abnormal status NOTE Alarm can be turned off in the menu Alarm for Parameters Exceeding Preset Limits Alarm will be activated when the measured parameter exceeds the preset parameter alarm limits CO alarm limit setup Default ET 8 50 IN 0 8 Range 0 76mmHg NO alarm limit setup Default IN 50 80 Range 0 100 O alarm limit setup Default ET 30 70 IN 20 80 Range 5 100 Anesthetic agent alarm parameter setup HAL Default ET 1 0 3 0 IN 1 0 3 0 Range 0 8 5 113 Cardell MAX 12 DUO HD User s Manual ISO Default ET 1 0 3 0 IN 1 0 3 0 Range 0 8 5 ENF Default ET 1 0 3 0 IN 1 0 3 0 Range 0 10 0 SEV Default ET 1 0 3 0 IN 1 0 3 0 Range 0 10 0 DES Default ET 1 0 3 0 IN 1 0 3 0 Range 0 20 0 Apnea Alarm When apnea alarm is on if no breath is detected for the preset period the apnea alarm will be activated NOTE The Multi gas module and the patient monitor system have a smart apnea alarm function That is there will be no alarm during the period when the patient monitor is just powered on It will only activate the apnea alarm after it has detected respiration and later it identifies there is an apnea Abnormal Status Abnormal status refers to sampling line occlusion or water trap error 114 Cardell MAX 12 DUO HD User s Manual 14 8 Cle
82. lenging cases are encountered Long catheters are generally selected in large bore femoral and brachial a arteries where stabilization is challenging The additional length of the catheter allows the catheter tip to be located in a more central arterial location and adds additional length that reduces accidental catheter dislodgment Technique for setting up direct blood pressure monitoring Equipment set up and preparation Prior to beginning the procedure all equipment and supplies should be assembled and be ready to use The first step is to attach the pressure transducer to the patient monitor at the appropriate plug site Following attachment connect three way stopcocks to the luer adapters in the transducer housing In permanent transducers two stopcocks 137 Cardell MAX 12 DUO HD User s Manual are required in disposable units only one may be necessary Leave one stopcock open to room air and fill the chamber with heparinized saline being sure that ALL air bubbles are removed After filling leave the stopcock open and zero the transducer to the machine by pressing the zero control button on the monitor panel This adjusts the electronics to provide accurate measurement This step will be repeated after patient attachment occurs After filling and zeroing the transducer a flush infusion device is attached to one stopcock unless it is embedded in the transducer device An IV bag with heparinzed saline is placed in a
83. ll tissues and organs When concurrently monitoring electrocardiogram ECG and arterial blood pressure one notes a slight delay between the ECG signal and blood pressure waveform during a cardiac cycle This delay represents the time required to produce electromechanical coupling and isometric ventricular contraction prior to forward blood flow and pressure wave generation Factors affecting measurement Direct blood pressure measurement is affected by both patient and technical factors Physiologic status of the patient including circulating blood volume cardiac contractility neuroendocrine status and peripheral vascular state all contribute to blood pressure values Support measures such as mechanical ventilation or other procedures which impact on cardiovascular physiology also contribute to accurate measurement The reader is referred to reference material for further discussion of these issues Technical issues also affect accurate measurement Technical issues generally fall into three categories catheter management appropriate set up and management of the measurement apparatus and operator error Arterial catheter management is a critical issue in success Placement should be on a flat surface away from joints or other 140 Cardell MAX 12 DUO HD User s Manual structures which may intermittently occlude the catheter lumen due to position or movement Continuous flushing of the catheter to avoid intraluminal clots i
84. me and the time at the left side indicates the start time of monitoring The display status bar at the right side of the trend graph indicates whether all of the trend is displayed on the single page If it is the status bar is full If not 1t indicates that the trend is not completely displayed and you can press to display the trend in the next page Note In the Temp trend display Templ is displayed in blue Temp2 in green In the IBP trend display the blue line indicates SYS the green line indicates DIA and the pink line indicates MEAN Note Except for NIBP TEMP CO and IBP all other parameters have two horizontal lines respectively indicating the high and low alarm limits The functions of the menu items are as follows Move scale To move the scale and observe different time Up Downl To move the trend up and down L R To display previous or next trend Zoom To set the time duration of trend display 2 hours gt 4 hours gt 8 hours gt 24 hours 48 hours gt 72 hours 96 hours gt 120 hours When finished press the Main Menu key on the front panel to exit the trend display and return to the main menu screen 34 Cardell MAX 12 DUO HD User s Manual 5 4 Demo Mode For the purpose of training the device provides a Demo mode function To enter demo mode Press fo gt Rotate knob gt Demo Mode gt Press knob A dialog box will pop up at this time as follows you should input th
85. mity to the vessel to reduce vasospasm and desensitize the area for catheter placement Do not remove the filter cap from the needle hub prior to placement You will be entering a high pressure vessel and will have a sudden burst of blood back through the catheter hub if it is uncovered The catheter is initially introduced through the skin In some cases a pilot wound is created if skin is tough and may damage initial catheter 138 Cardell MAX 12 DUO HD User s Manual insertion Once the catheter is inserted through the skin it is SLOWLY advanced while a finger is kept over the artery to feel when the catheter intersects the vessel You can feel the vessel wall because it is a muscular structure and may actually feel a pulsation as the needle tip engages the arterial wall At this point a flash may be noted in the needle hub Once the flash is noted stabilize the catheter unit If you are using a guide wire catheter slowly advance the wire stylette It should move easily or only encounter slight resistance if you are in the vessel lumen Once the guide wire is inserted full length slowly advance the catheter until the catheter hub is at the skin surface If using a standard catheter slowly advance the catheter There should be slight resistance due to tissue drag but the catheter should go smoothly After catheter placement is confirmed gently compress over the vessel at the catheter tip remove the stylette and nee
86. ng or by pressing the print button on the monitor s front panel Exit v Waveform Data Tabular data printing is limited to the last 20 data sets at 4 minute intervals totals 80 minutes Print Speed Auto 12 5 25 0 50 00 mm s Print Mode Auto Default Exit v Auto Default In auto mode when alarm is triggered the alarming parameter waveform will be printed regardless of parameters selected in print waveform channel setup In default mode regardless of the alarm only parameters selected in waveform channel setup will be printed Alarm Trigger printing When this function is turned ON whenever there is an alarm the monitor will automatically print the data and waveform according to the time selections below Advanced Time Setup means it will print data that led up to the alarm event in the interval chosen 47 Cardell MAX 12 DUO HD User s Manual Alarm Print Time 10seconds 15seconds 20seconds 30seconds Advanced Time Setup 3s 2s 1s 0s Exit v None 1 Second 2 Seconds 3 Seconds Timed Printing Monitor will automatically print at the interval selected Fxit VA OFF 5 Minutes 10 Minutes 15 Minutes 30 Minutes 1 Hour Printing Report Head Each time a waveform is printed a header is automatically printed including the date time print speed and parameter values including blood pressure units Printing Paper The printing paper width is 50mm The paper should b
87. nt Review oy gt Rotate the knob Alarm Event Review gt Press the knob The content of alarm event review includes Data Time HR SpO2 EtCO SYS DIA MAP m PR RESP TEMP1 Alarm description Alarm Event Review Press OK to exit Press Clear to delete all of alarm events 29 Cardell MAX 12 DUO HD User s Manual SECTIONS MONITORING SYSTEM SETUP Patient monitor setup includes ECG waveform recall Trend display Demo mode Channel setup Patient information setup Date and time setting Print setup Volume and brightness setting Cardiac measurement Alarm event review Default setup System alarm setup HR PR priority Select interface ECG output channel setup Network connection setup About software version Choose language Data manager USB data manager USB export function and System maintenance The system setup menu is as follows Exit ECG Recall Trend Display Demo Channel Setup Patient Setup Date and Time Print Setup Volume amp Brightness Cardiac Measurement Alarm Event Review Default Setup System Alarm Setup HR PR Pri rity Select Interface ECG Output Channel Network Connection About Choose Language Data Manager USB Data Manager USB Export System Maintenance Fig 5 1 System Setup Menu 30 Cardell MAX 12 DUO HD User s Manual 5 1 System Setup Step 1 Press O to enter main menu as Fig 5 1 Step 2 Choose required item to set 5
88. nu gt Rotate the knob gt IBP1 2 gt Press the knob Zeroing 96 Cardell MAX 12 DUO HD User s Manual Model gt Press the knob If the zeroing mode is set to Manual after the system prompts zeroing 1s correct it will pop out Zeroing Mode Now press the knob and you will enter IBP measurement status If the zeroing mode is set to Auto after the system prompts that zeroing is correct it will automatically enter IBP measurement status without necessity for the user to confirm 13 3 IBP Setup Before IBP monitoring make the following preparations Set IBP channel and labels Select IBP waveform display scale Set alarm limits Connect transducer Zero the transducer The IBP Setup function is mainly used to set the IBP gain IBP label alarm limits and IBP zeroing The IBP Setup menu is as follows 97 Cardell MAX 12 DUO HD User s Manual Exit IBP Gain Label Setup Zeroing Mode IBP Calibration Unit Wavetorm Speed SYS Upper Limit SYS Lower Limit DIA Upper Limit DIA Lower Limit MAP Upper Limit MAP Lower Limit IBP Alarm PR On Color Setup Fig 13 1 IBP Setup Menu Ext w IP ART AG FA R PA Fig 13 2 Label Setup Manual Auto Fig 13 3 Zeroing Mode IBP Gain Different IBP gains correspond to different waveform display scales The device provides auto selection of optimal waveform gain Auto and manual waveform gain Manual In the IBP waveform
89. ob to confirm Rotate the knob again to look for the soft key and press the knob The original alarm reading turns into yellow Now turn the knob left or right you may increase or decrease the limit until desired limit is obtained Then press the knob to confirm In the NIBP setup menu there is SYS DIA Alarm limit with range from 0 to 40mmHg The system default is 20 mmHg and will be saved after power off If the monitor detects that the difference between the SYS and DIA values are lower than this limit the system will give a high priority alarm Note After parameter alarm limits are set they will remain in the system after power off until next setup 26 Cardell MAX 12 DUO HD User s Manual 4 4 Alarm Sound Volume To meet the needs of different users the main menu offers selection of Volume amp Brightness las follows gt Rotate the knob Volume amp Brightness Press the knob Alarm Volume Press the knob Rotate the knob 1 2 3 4 5 6 7 gt Press the knob Or directly press the knob and enter Volume amp Brightness menu to adjust the alarm volume 4 5 Default Alarm Limits To return to the factory alarm setting 1 e default alarm limits follow these steps to return to the factory alarm limits for dogs cats or horses Y gt Rotate the knob gt Default Setup Press the knob Rotate the knob Dog Cat Horse Other Default gt Press the knob The default alarm limits of the pati
90. on the patient s trunk for more reliable readings 8 2 Respiration Setup To enter respiration setup menu Exit RESP Lead RESP Gain Wavetorm Speed Waveform Fill Apnea Alarm Apnea Alarm Time RR Upper Limit RR Lower Limit RR Alarm Color Setup Fig 8 1 Respiration Setup Menu da Press the waveform button Rotate the knob gt RESPI gt Press the knob 61 Cardell MAX 12 DUO HD User s Manual RESP Lead While ECG is in Three Lead mode the lead selections available are RA LA RA LL if ECG is in Five Lead mode RA LA RA LL RL LA RL LL are available for selection RESP Gain xV2 x1 2 are available for selection Through selecting respiration gain the respiration waveform can be zoomed in or out for convenient observation Waveform Speed 6 25 12 5 25 0mm S are available for selection Exit 25 mm s v 12 5 mm s 6 25 mm s Main Menu gt Rotate the knob gt RESPI gt Press the knob Rotate the knob gt Waveform Speedi gt Press the knob gt 16 25 12 5 25 0 gt Rotate the knob gt Press the knob To fill up RESP waveform Main Menu gt Rotate the knob gt RESPi gt Press the knob Rotate the Cardell MAX 12 DUO HD User s Manual Waveform Filling gt Press the knob Apnea Alarm Operator can turn on off Apnea Alarm as follows a 3 JE gt gt Main Menu gt Rotate the knob RESP Press the knob Rotate
91. only required to be zeroed once Please note that additional adapter zeroing is required only when prompted by the sensor module To perform zeroing oe a Turn the monitor on Plug the Respironics CO module into the monitor Verify that Work Mode has changed from Standby to Work Mode You will notice that that Zeroing option on the menu has now been grayed out not allowing you to select it This is because the module needs time to connect with the monitor The monitor will connect with the CO module It takes approximately 5 seconds for the Respironics CO module to perform internal initialization and another minute to warm up Once the module is warmed up and ready the Zeroing option will light up again Click on the Zeroing option to Zero the module The menu will go away and you will be returned to the main screen There will be a message where the CO waveform would be flashing 9 Zeroing The values to the right side of the waveform will display a horizontal bar indicating that there is no value available When Zeroing is complete the flashing Zeroing message will disappear The values to the right side of the waveform will display a 0 in each column 93 Cardell MAX 12 DUO HD User s Manual 9 The module is now ready for use EtCQ InCO RR Setup The monitor user can set upper and lower limits for these parameters depending on the patient s circumstances Rotate and press th
92. ormal cleaning with mild detergents dilute bleach solution 1 2 wipe the cuff with the cleaning solution rinse with water and dry NOTE We do not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use DISPOSABLE VINYL CUFFS In certain situations the cuff may become soiled during its use In these situations a water based detergent is suitable for wiping the cuff As necessary the preferred method for cleaning the cuff is to wipe it down with a damp soapy cloth A damp detergent free cloth should then be used to rinse the cuff 83 Cardell MAX 12 DUO HD User s Manual NOTE We do not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use 84 Cardell MAX 12 DUO HD User s Manual SECTION 11 TEMPERATURE MONITORING 11 1 General Information A continuous temperature monitor is used to measure a patient s core body temperature during the administration of general anesthesia detection and treatment of hyperthermia post surgical recovery and other various cases that may require constant body temperature monitoring The monitor will display continuous electronic temperature readings or the core body temperature via either a rectal esophagel probe or
93. parameter area in priority When ECG is not detected the parameter area displays SpO gt pulse rate PR or IBP pulse rate PR When no heart rate or pulse rate is detected the parameter area displays When 2 priority is selected the parameter area first displays SpO pulse rate PR When SpO sensor is not connected the parameter area will display heart rate HR or IBP pulse rate PR When no heart rate or pulse rate is 3 detected the parameter area will display 43 Cardell MAX 12 DUO HD User s Manual 5 11 Display Interface Selection P Rotate the knob gt Select interface Press the knob Rotate the 2011 09 03 02 26 08 Fig 5 9 Big Font From the display interface one can select Enhanced Waveform Big font shown as above and Grid On these two kinds of displays are convenient for observing the screen from a long distance User can select both or neither The other method to setup Big Font interface Press the knob the menu as follow shown will pop up in the screen rotate the knob and select Big Font Exit Alarm Volume alili HR Volume 01111 Brightness Std Nights Mode 44 Cardell MAX 12 DUO HD User s Manual 9 12 About About Wersiom v11 06 Fig 5 10 About Enter About from the system setup menu the screen will display software version 5 13 Choose Language If you have set English as the Language from the System
94. pressure sleeve and an IV infusion set microdrip is attached to the flush device and the bag pressurized to 300 mm Hg A 6 12 length of low compliance IV tubing is attached to a stopcock to interface the catheter to the transducer This tubing is flushed and filled with heparinzed saline The stopcock is turned off to prevent fluid drainage once the tubing is filled A catheter adapter with a side port is flushed with heparinized saline filled syringe with the syringe attached after flushing The catheter catheter supplies and prep solution are assembled and organized on a work surface for easy access Catheter placement sites A superficial artery amenable to catheter placement is identified Reported sites for arterial catheter placement in dogs and cats include the dorsal pedal metatarsal popliteal and femoral arteries in the hind limb and the brachial artery in the forelimb In general distal rear limb sites are selected based on ease of identification catheter placement and stabilization following catheter insertion The selected site must be clipped and surgically prepped prior to catheter placement Failure to aseptically prepare the area can lead to systemic infection Catheterization technique The artery is palpated for pulse quality In hypotensive patients peripheral arterial sites may not be detectable due to low blood flow and poor pulse quality Following identification a small amount of 2 lidocaine is infiltrated in proxi
95. r is purged when power is lost or the monitor 1s turned off be sure to download the case data before powering down or if running on battery power and a low battery status message appears Since you cannot plug in the USB device while the monitor is on keeping the USB storage device plugged in at all times will allow you to download information when you need to TIP Use the Patient Setup menu to clear the data before the start of the case and enter the patient s name and ID After the case is complete download the data to the USB device and then clear the data prior to starting anew case Doing this will create separate data files on the USB device separated by time and unique to each case and patient Transferring data to your PC Plug the USB storage device into your PC 2 Select the USB storage device and navigate to the MAX12 folder Double click to open it 3 Select the saved data that you wish to view The data is saved in Excel format To view ECG data select ECGWAVE To view all other parameters select TREND Il Data Format Data that 1s downloaded to the USB storage device are saved in excel format They are also automatically dated and timed and includes the animal name For example 39 Cardell MAX 12 DUO HD User s Manual 20091120_140004_Oliver_TREND xIs 20091120 indicates date of download Year 2009 November 20 140004 indicates time of download 14 00 04 Oliver indic
96. r the alarm may have been disabled e Alarm functions of the patient monitor must be checked regularly e Before using the cables please check the cable and connectors If any damage 1s found replace 1t immediately e Electro surgery circuit must be connected properly to prevent burns or even death e When several devices are used on the same patient leakage current may increase and lead to danger to the patient Before using please consult a professional to do a leakage current test and make sure the leakage current 1s within safety limits e When a defibrillator is used make sure patient will not touch the ground Cardell MAX 12 DUO HD User s Manual metal or other conductor or device During defibrillation never touch the patient table or the device e When electrosurgery unit is used make sure the patient lead and cable are far away from the operating table to reduce the risk of burns caused by poor connection e Before using on another patient make sure previous monitoring data is cleared e Before using the monitor make sure it is in normal working condition CAUTION e Use properly grounded power sockets and ensure adequate grounding If there is any doubt about the grounding please use battery operation e Check accessories on regular basis and discard damaged accessories properly e To ensure patient s safety and performance of the product use only the manufacturer recommended accessories e Service parts
97. re are small amplitude oscillometric waveforms When the cuff pressure is equal to the systolic pressure the oscillometric amplitude increases With the decrease of the cuff pressure the oscillometric amplitude increases When the cuff pressure reaches a certain value the oscillometric amplitude reaches a maximum value then the cuff pressure is mean arterial pressure It uses the changes of the oscillometric amplitude under different cuff pressures to identify mean pressure and calculate the systolic and diastolic pressure On the NIBP socket mark indicates the signal input part is insulated and defibrillation protected and patient safety can be ensured In defibrillation and electrosurgical procedures the device will not be damaged 74 Cardell MAX 12 DUO HD User s Manual 10 2 Cuff Placement Cuff placement for a cat A cat may be left in its owner s lap to keep it calm Measurements are best done in an area of the hospital away from noise and bright lights The animal may be held so that the front limbs are free for cuff placement In conscious patients the tail may be the most appropriate location for placement of the cuff Cats may be most comfortable in sternal recumbency making the tail a more preferable site For the median artery on the foreleg place the cuff around the forelimb between the elbow and carpus It 1s not necessary to center the cuff over the artery which is on the medial side of the leg because of
98. receptacle on the side panel of the monitor 5 When necessary adjust the ECG setup 6 Set the ECG alarm limits 7 6 Alarm Setup ECG monitoring alarms include parameters out of limit alarms and abnormal status alarms When the monitored parameters are out of the preset limits the monitor will give an audible and visible alarm 7 6 1 Alarm Limit Setup 57 Cardell MAX 12 DUO HD User s Manual Different parameters have different alarm limits For different patients different limits may be required 1 Rotate the knob in ECG menu 2 Enter the alarm limit setup menu 3 Select the alarm limit of the corresponding parameter WARNING The default alarm limits are designed as general guidelines and for convenience so that values can be reset automatically to common starting points but these should be adjusted with each patient according to their individual circumstances 7 6 2 Parameter Adjustment Range Parameter Adjustment Range HR Limit 15 300 bpm 7 6 3 Abnormal Status Alarm Abnormal Status alarm includes Asystole and lead off CAUTION When ECG amplitude is too low it may result in inaccurate heart rate or Pseudo asystole We suggest when ECG waveform is too low change the lead and adjust to the ECG lead which has maximum amplitude Otherwise the monitor may give Asystole alarm 7 7 Precautions WARNING When using defibrillator make sure the electrode and patient cab
99. rmal Other devices connecting to the device should meet IEC standards for example data processing device should meet IEC 950 and medical device should meet IEC60601 1 and the whole system should meet the latest version of IEC60601 1 1 standards Plastic bags and other packaging materials should be disposed of in accordance with related regulations After the device or the accessories are at the end of their life cycle please dispose of them according to local laws and regulations 2 3 Safety Symbols Note Depending on the configuration of your monitor it may or may not have the following labels ES BF applied part Type F applied part meet the requirements of EC60601 1 standards Shock protection level is higher than Type B applied part 9 Defibrillation protection Type CF applied part Type F applied part in conformity with IEC 60601 1 standards Shock protection level higher than BF applied part A Note Please check accompanying documents E Fuse Cardell MAX 12 DUO HD User s Manual Equipotentiality 4 cl Power ON OFF Press Press AC 2 Protective Ground 2 4 Installation 2 4 1 Unpacking and Check When you unpack monitor and accessories check accessories according to the packing list Check for any damage to the equipment or the external lead wires and accessories In case you have any other questions please contact Midmark at 800 643 6275 2 4 2 Environmental Requirements To ens
100. s tissue thickness skin color light intensity and venous blood from the time variant parameters arterial volume and SpO to identify the pulse and calculate oxygen saturation Oxygen saturation calculations can be performed because blood saturated with oxygen predictably absorbs less red light than oxygen depleted blood Since measurement of SpO depends on a pulsating vascular bed any condition that restricts blood flow such as use of a blood pressure cuff or extremes in systemic vascular resistance may cause an inability to determine accurate pulse and SpO readings CAUTION SpO sensors are fragile and should be handled with great care 65 Cardell MAX 12 DUO HD User s Manual 9 2 SpO2 Sensor WARNING Use only Nellcor veterinary oxygen transducers Use of other oxygen transducers may cause improper performance INSTRUCTIONS FOR USE NOTE Reusable sensors may be used on the same site for a maximum of four 4 hours provided the site is inspected routinely to ensure skin integrity and correct positioning Because individual skin condition affects the ability of the skin to tolerate sensor placement 1t may be necessary to change the sensor site more frequently with some patients 1 Select a sensor and clip that is appropriate for the patient There are two 2 sizes of VetSat veterinary sensor clips model VSC S small and model VSC L large 2 Clean the VetSat sensor and clip separately before and
101. s essential for long term patency and accuracy of measurement Ensuring an uninterrupted fluid interface between the catheter and transducer device is essential Air bubbles in the transducer or extension tubing may dampen the signal producing errors Correct procedural set up with zeroing the system is critical to ensure accurate values are measured Attention to detail of the catheter and operating system by personnel is important to avoid errors and complications Any break in the protocol may contribute to inaccurate measurement and increased patient risk Complications Reported hazards of invasive arterial pressure monitoring include vascular injury disconnection accidental injection of drugs infection and damage to nearby nerves In the author s experience accidental disconnection and infection are two most common complications Accidental disconnection can produce rapid exsanguination with the risk of hypotension shock and death is possible if not immediately identified Constant monitoring of the extension tubing and connection points is important to avoid this complication Nosocomial infection may lead to bacteremia and sepsis Sources of infection include catheter wound site contamination of tubing and stopcocks during routine maintenance procedures and reuse of non sterile transducers Attention to standard protocols targeted to reduce introduction of pathogens at tubing connection sites or ports is also important to
102. s the clip open and remove When the probe is removed from the patient the message SpO2 Probe OFF is displayed and an audible alarm sounds indicating a connection has been lost To acknowledge the alarm press the SILENCE RESET pushbutton The monitor silences the audible and visual alarms and the message SpO2 Probe OFF remains on the display 70 Cardell MAX 12 DUO HD User s Manual To remove the sensor from the clip grasp the end of each sensor pad and pull it through to the inside of the clip The sensor should pop out of the clip easily DO NOT pull on the cable 9 5 Alarm Setup The SpO2 alarm is for parameter out of limit or abnormal status When the parameter exceeds the limit the monitor will give both visual and audio alarms Alarm Range Parameter Range Spo2 upper limit lower limit to 100 SpO2 lower limit 0 to upper limit Pulse rate upper limit Lower limit to 250 bpm Pulse rate lower limit 30 to upper limit Abnormal Status Alarm Probe Off alarm 9 6 Precautions WARNING Prolonged use or the patient s condition may require changing the sensor site periodically Change sensor site and check skin integrity circulatory status and correct alignment every 2 3 hours If there is any change move the sensor to another site 71 Cardell MAX 12 DUO HD User s Manual 9 7 Cleaning and Maintenance 9 7 1 Clean the sensor 1 Clean the sensor with a soft cloth moistened in so
103. sed water accumulate on Gas sampling line or water trap It is recommended to place the Multi gas module in a place higher or in the same level of patient position Connect multi gas module to the UT4000F PRO patient monitor enclosure Multi gas Exhaust If N30 and or other inspired anesthetic gas are used make sure to avoid operating room pollution Once a gas sample is passing through the multi gas module it must be sent to the anesthesia circuit Otherwise it must be removed from the anesthesia circuit Sending anesthetic gas to anesthesia circuit To send anesthetic gas to anesthesia circuit the following accessories are required An anesthetic gas exhaust tube Anesthesia machine gas circuit connector 1 Connect one end of anesthetic gas exhaust tube to Anesthetic gas exhaust outlet 2 Connect anesthesia machine gas tube connector to anesthesia machine patient circuit exhalation 3 Connect the other end of anesthetic gas exhaust tube to the anesthesia machine gas tube connector Exhausting Anesthetic gas 108 Cardell MAX 12 DUO HD User s Manual To exhaust anesthetic gas from anesthesia circuit please connect exhaust gas clearing system to the multi gas module The following accessories are required to be connected An anesthetic gas exhaust tube A ventilator gas storage box with inhalation pressure no higher than 0 3 0 4mmHg or an exhaust gas clearing connector 14 3 Menu Multi gas Meas
104. select a function directly and press the knob to confirm the selection When finished rotate the knob to BACK and press the knob to confirm to exit Then the setting 1s saved Volume and Brightness menu may also be displayed by directly pressing the hot key as follows Exit Alarm Volume HR Volume Brightness Night mode on CFR Big Number Night Mode CO2 Work Mode 7 ECG Alarm sound volume has 7 selections Heart rate sound volume has 7 selections Display brightness can be adjusted Under Normal mode the screen is bright suitable for monitoring in daytime When Night mode is selected the screen 1s darker suitable for monitoring at night NOTE If any alarm occurs the Night mode will be exited NOTE System prevents entering Night mode during alarms 1 In system setup menu press to return to the normal monitoring screen E 2 In sub menu mode press 4 to return to the normal monitoring screen When user has not performed any operations for over 30 seconds the menu display will automatically disappear and return to full screen 22 Cardell MAX 12 DUO HD User s Manual 23 Cardell MAX 12 DUO HD User s Manual SECTION 4 ALARM SETUP 4 1 Brief Introduction Alarms are designed to give an alert when the monitoring results are abnormal It 1s rendered with audible sounds visual LED indicators and flashing readings Alarms have three degrees High priority Double high volume beeps 5 times ev
105. set IBP1 2 Zeroing status to be YES Such manual zeroing mode 1s also called Enforced Zeroing Follow the steps below Main Menu gt Rotate the knob IBP1 2 Press the knob gt IBP Zeroing Press the knob IBP Labeling IBP Labels IP ART AO RA FA PA CVP ICP IP Invasive blood pressure default label ART Artery Pressure 1 e the arterial blood pressure being monitored AO Aorta Pressure RA Radial Artery Pressure FA Femoral Artery Pressure PA Pulmonary Artery Pressure CVP Central Vein Pressure ICP Intracranial pressure 100 Cardell MAX 12 DUO HD User s Manual When a waveform channel is set to display IBP in the Display Channel Setup Max 2 channels for IBP you may select the labels in LabellSetup so as to identify the measurement location The IBP labeling methods are as follows Main Menu gt Rotate the konb gt IBP1 P gt Press the knob Rotate the knob IBPLabelingt gt Press the knob IP ART AO RA FA PA CVP ICP Rotate the knob gt Press the knob NOTE When an artery pressure is selected to be measured the IBP parameter area mainly displays the SYS and DIA displayed in red letters and the mean pressure displayed in blue letters When CVP is measured IBP parameter area mainly displays the mean pressure displayed in red letters and the values of its SYS and DIA are displayed in blue letters IBP Unit The device provides two units for displa
106. shing detergent solution and gently rub the soiled area until clean Use a clean soft cloth to dry the monitor Do not use abrasive cleaners on the monitor Do not use either isopropyl alcohol or solvent to clean the monitor Use of these cleaners can cause damage to the monitor s surface Do not immerse the monitor or power cord in the cleaning solution When necessary the monitor surfaces may be disinfected using a soft cloth saturated with a 10 1 10 solution of chlorine bleach in tap water When all of the surfaces have been disinfected wipe the entire surface of the monitor using a soft cloth dampened with fresh water to remove any trace amounts of residue and or fumes NOTE Thoroughly wipe off any excess cleaning solutions Care should be taken to prevent water or cleaning solution to run into connector openings or crevices THE DISPLAY CAUTION Use care when cleaning the display Do not use a paper towel to clean the display as this may cause scratches Occasionally as needed clean the display window using a soft lint free cloth sprayed with an alcohol free glass cleaner Do not use either isopropyl alcohol or solvent to clean the display Use of these cleaners can cause damage to the display The use of paper towels is not recommended as it may scratch the surface PATIENT CABLE AND LEADWIRES Prior to each patient use inspect the patient cable and leadwires for damage As necessary clean the patient cable and le
107. t least once yearly This makes 1t possible to detect the initial signs of related disease e g cardiovascular and renal disease more sensitively and at an earlier stage The normal values for dogs and cats are not identical FELINE NORMAL VALUES The blood pressure values for cats are not breed specific However the most sensitive way to detect changes in feline blood pressure is also by comparing individual blood pressure readings taken over time Normal feline blood pressure 124 84 Other investigators have reported comparable reference values Feline Reference Values Systolic Diastolic mmHg mmHg 125 11 Brown et al 1997 123 14 88 15 Curtet 2001 125 12 86 15 Weber et al 2002 CANINE NORMAL VALUES The normal values for dogs are breed specific Those for Golden Retrievers Labradors 1 Adapted from Essential Facts of Blood Pressure in Dogs and Cats Egner Carr amp Brown 2003 130 Cardell MAX 12 DUO HD User s Manual and giant breeds tend to be lower than the overall average and those for greyhounds and in general racing hounds tend to be higher The table that follows lists the normal values for common dog breeds using oscillometric blood pressure monitors Average canine blood pressure 133 75 This figure was calculated as the mean of 1782 oscillometric measurement in clinically healthy dogs of different breeds The overall average is therefore serves as a point of reference only
108. ted and does not require further calibration CAPNOSTAT 5 CO Sensor Figure 9 1 88 Cardell MAX 12 DUO HD User s Manual Connecting the CAPNOSTAT 5 CO Sensor to the Monitor 1 Insert the CAPNOSTAT 5 CO Sensor connector into the receptacle of the MAX 12 HD 2 Make sure the arrows on the connector are at the top of the connector and line up the two keys of the connector with the receptacle and insert 3 To remove the connector grab the body portion of the connector and pull back Do not grab the cord Shown below is the CAPNOSTAT 5 CO Sensor connection to a Respironics Novametrix CO adapter CAPNOSTAT 5 CO Sensor Connect Slides on Clicks into place Remove Slides off Window Figure 9 2 Shown below is the CAPNOSTAT 5 CO Sensor with a patient circuit CAPNOSTAT 5 CO sensor Elbow Airway adapter Patient connector pediatric adult Figure 9 3 89 Cardell MAX 12 DUO HD User s Manual 12 3 LoFlo CO Sensor Sidestream For Sidestream CO the LoFlo CO sensor is provided for your use Comnecting the LoFlo CO Sensor to the Monitor 1 Plug the sensor cable into the monitor s CO input receptacle 2 Wait two minutes to allow the sensor to warm up 3 Connect the airway adapter or sample line to the sensor It will click into place when seated correctly 4 Make sure to Zero your sensor before use See section 9 4 5 For intubated pat
109. ted for good contact it should be clipped NOTE Use metacarpus or metatarsus NOTE To achieve the most accurate readings it is important to keep the cuff on a horizontal plane with the heart Large animals A large animal such as a horse should be in a stock standing still or lying down For horses and cows the cuff can be wrapped around the base of the tail using the coccygeal artery on the ventral surface WARNING When monitoring over an extended period of time or at frequent intervals periodically observe the patient s limb to make sure that the circulation is not impaired for a prolonged period of time Cuff size selections The widest cuff that can be placed on the patient without extending beyond the joint should be selected Appropriate sized cuffs may be selected based on 76 Cardell MAX 12 DUO HD User s Manual published guidelines that cuff width should be 40 60 of limb circumference The cuff should be wrapped for a snug fit Overlapping the cuff will not affect measurement results Make sure the hook and loop sections of the cuff are fully engaged when it is wrapped around the limb If not fully engaged the cuff will detach during bladder inflation If that happens select the next size bigger cuff Adhesive tape or other material should not be used to secure the cuff Use the following table as a guide to select the correct size Small Animal Cuff Selection Reorder Number Bladder Size Limb C
110. the knob Apnea Alarm Press the knob Apnea Alarm Time 5 10 15 20 120 seconds are available for Apnea Alarm Time selection Main Menu gt Rotate the knob RESP Press the knob Rotate the knob Apnea Alarm Time Press the knob Rotate the knob Press the knob If Apnea Alarm is ON Apnea alarm will be triggered when the system detects an abnormity according to the Apnea Alarm Time setup An Apnea Alarm 1s classified as a high priority alarm To set RESP alarm limits Main Menui gt Rotate the knob gt RESPi gt Press the knob Rotate the knob gt RR Upper Limit jor RR Lower Limit Press the knob Rotate the knob Press the knob RR Alarm Operator can turn on off the RESP Alarm as follows Main Menu gt Rotate the knob gt 1RESPi gt Press the knob Rotate the knob gt RR Alarm Press the knob 63 Cardell MAX 12 DUO HD User s Manual 8 3 Respiration Monitoring Preparation 1 Place electrodes in proper positions 2 Select proper respiration lead combination 3 Set respiration alarm limits NOTE Electrodes must be placed in proper positions CAUTION Patient motion may result in a respiration measurement error 8 4 Alarm Setup The respiration temperature alarm includes a parameter out of limit alarm and an abnormal status alarm When the parameter 1s out of limit the monitor will give an alarm sound automatically and the value displayed on the screen flashes
111. to an extremity where there is arterial catheter blood pressure cuff or injection tube e Make sure the light emitting part and light detecting part face each other e Make sure the sensor is applied to a region of arterial blood flow e Make sure there is no extreme motion e Make sure skin where the sensor is applied is neither too thick nor too thin e Make sure there is no strong ambient light coming into the sensor Cover the site with opaque material 3 Plug the sensor into the SpO2 connector on the patient monitor 4 Set the upper and lower limits of SpO2 CAUTION Handle the sensor and the wiring with care There are sensitive electrical parts in the sensor that can be damaged by negligent treatment Keep the wiring away from pointed things Normal wear and tear caused by patient motion or sensor cleaning will limit the life of the probe Longevity can be extended by careful treatment WARNING During prolonged monitoring check and change the sensor position regularly in order to avoid damage to the patient s skin Special patients need special treatment SENSOR REMOVAL CAUTION For the comfort of the patient and to avoid damaging the sensor do not pull on the cable when removing the sensor and clip from the sensor site but rather unclip the sensor and remove from placement site When SpO2 monitoring is completed remove the sensor from the patient To remove the sensor and clip from the patient pres
112. ttach probe and transducer to the patient Note The monitor can be used for a single patient at one time 19 Cardell MAX 12 DUO HD User s Manual 3 5 Display illustrations Under normal working conditions the display screen is as shown in Figure 3 5 j f f 1 j 01 28 11 43 60 TAREA MEAT AI 2M ie 01 28 11 44 60 120 85 95 m 60 20 37 0 38 0 C q tS L ree A 01 28 11 44 60 120 85 95 m 60 20 37 0 38 0 C AT 1 Exit ECG1 ECG2 ECG3 ECG4 SPOZ COZ NIBP TEMP Setup 2002 01 28 11 44 57 Fig 3 5 Display Screen The display screen is composed of data area parameter area and waveform area Data Area shows the data about patient and monitor such as patient no location sex and patient mode Parameter Area shows monitoring physiological parameters Waveform Area shows monitoring waveform on each channel and alarm events Note The patient mode includes cat dog horse and other Date and time are displayed on the bottom right of screen 20 Cardell MAX 12 DUO HD User s Manual In the Status Area you can see battery power status AC power and alarm Status Battery power status The mark I is used to indicate the battery power The more segments the more power remains a When only two segments remain the mark m F starts flashing and an audio alarm indicates battery power is low b When only one or no segment remains the mark WEF turns to red and flashes with
113. ure electric installation safety the environment should be reasonably dust free without corrosive or combustible gas or extreme temperature or humidity Keep the monitor at least 2 from the wall to ensure good air ventilation behind it 2 4 3 Power Supply Requirements The Cardell MAX 12 HD Multiparameter Monitor is a Class I device with internal power supply in conformity with IEC60601 EN60601 requirements It can use AC power or its internal battery Connect AC Power When using AC power the MAX 12 HD may be turned on at any time Before plugging it into the outlet check outlet s power output with the 11 Cardell MAX 12 DUO HD User s Manual requirements of the device Once plugged in power is indicated on the front panel by a yellow light This shows the monitor is in standby condition and the battery is charging 2 4 4 Combination Of Equipment Both medical and non medical equipment must comply with IEC60601 1 1 standard Warning The use of many devices together can increase the leakage current which may injure the patient and personnel 2 4 5 Operation Press and hold the power button until the monitor turns on The system will start self test and then start the monitoring screen If the power indicator on the front panel is green it shows that the device is in normal working condition and can be used for vital sign monitoring Cardell MAX 12 DUO HD User s Manual SECTION 3 DEVICE DESCRIPTION
114. urement Menu Exit Work Mode Waveform Speed Y Wave Filling Apnea Alarm Apnea Alarm Time Unit Co2 N20 02 Choose Monitor Gas HAL ISO ENF SEV DES WwW N VV N N VV Y Work mode Select Standby mode or Measurement mode Waveform speed Set the speed of waveform Wave filling Select to fill in the waveform or not Apnea alarm Apnea alarm On Off Apnea alarm time Setup apnea alarm time 109 Cardell MAX 12 DUO HD User s Manual NOTE The patient monitor has a smart alarm function It will not activate alarm during the period when the patient monitor is just powered up Instead it will only activate alarm after it has detected breath and there is a stop in the breath later Unit Select mmHg or kPa Alarm limit Set parameter alarm limits Choose Anesthetic Gas Select HAL ISO ENF SEV DES 14 4 Monitoring 1 When the patient monitor is powered on the multi gas module will be powered on automatically Then connect patient and warm up the module 2 Install the water trap in the water trap holder in the front panel of multi gas module 3 Connect one end of gas sampling line to the water trap turn it clockwise to make sure it is connected tightly To disconnect the water trap from gas entrance of multi gas module turn the connector at the top of gas sampling line counterclockwise 4 Connect the other end of gas sampling line to patient loop with standard gas tube connector t tu
115. ying IBP measurements e g mmHg or kPa default is mmHg The unit can be set in Scale Setup Main Menul gt Rotate the knob IBPI1 2 Press the knob Rotate the knob lunit gt Press the knob mmH g kPal Rotate the knob gt Press the knob The change in IBP units will be displayed in all the IBP areas e g parameter area and trend graph 101 Cardell MAX 12 DUO HD User s Manual Alarm Setup and Printing Setup After the above setup is completed the alarm limits for the SYS and DIA of IBP1 2 need to be set Main Menul gt Rotate the knob gt IBP1 2 gt Press the knob Rotate the knob gt SYS Upper Limit Press the knob Rotate the knob Adjust the value gt Press the knob For the defaults of IBP alarm limits see Section 4 Alarm Setup IBP Alarm can be turned On or Off separately Main Menu gt Rotate the knob IBPI1 2 Press the knob Rotate the knob gt IBP Alarmi gt Press the knob To print set the No 2 channel to be IBP1 or IBP2 in the Printing Setup Main Menu gt Rotate the knob System Setup gt Press the knob Rotate the knob Printing Setup gt Press the knob Rotate the knob gt Channel 2 Waveforml gt Press the knob gt SPO2 IBP1 IBP2 CO2 RESP gt Rotate the knob Press the knob The above setup will remain after power off 102 Cardell MAX 12 DUO HD User s Manual 13 4 Transducer Connection 1 When the device 1s turned on the

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