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Chapter 5 CO2 Monitoring

1. PROBE OFF LEADS OFF LEARNING DEMO cuff is not wrapped correctly or is not connected Air moving part tube or the cuff leak air Unstable cuff pressure or tangled cuff tubing Very weak signal because of the cuff or the patient has very weak pulse The measurement range exceeds 255 mmHg Infant patient over 135 mmHg The repeated measurement due to moving excessive noise during the stepping inflation and measuring pressure and pulse e g during patient shaking motion Blood pressure amplifier overflow due to excessive movement Leaking during the pneumatic device testing Abnormal condition of CPU such as register overflow divided by zero The blood pressure measuring now is in adult mode In this case it is not allowed to monitoring infant or neonatal patient Otherwise there may be serious danger to the infant monitored The blood pressure module is now worked in infant measuring mode SpO gt probe fell off The ECG electrodes or cable fell off Learning arrhythmia for 15 seconds The monitor is displaying the demo waveforms which are generated by the monitor itself 81 User Manual for Patient Monitor 12 5 Status Error during CO Monitoring Suggested Message Response Sensor Over Temp Make sure sensor is not exposed to extreme heat heat lamp etc If error persists return sensor to factory for servicing Sensor Faulty
2. ococcccccccnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnos 67 TF PGS 67 User Manual for Patient Monitor NENNE NNN 68 9 3 SPO5 MONITORING ii ANG 70 DA RESPIRATION MONITORING SN 71 DAA Measure Pda dye aE Ned Seed ee Ce et ee a te 71 9 4 2 Factors affecting respiration monitoring ccc cece cece a 72 DS TEMPERATURE MONITORING ve 72 TG NNN 72 9 6 1 Measarine Pr 72 62 Wiaims ican Vs ES eal SAMPO iO ed 12 CHAPTER 10 TROUBEESHOOTING used 73 LO INO DISPEAY ON TENNE 73 10 2 EXCESSIVE ECG SIGNAL INTERFERENCE OR TOO THICK BASELINE 00111 73 10 3 NO BLOOD PRESSURE AND PULSE OXYGEN MEASURES cccccesccceseccececcescscesssceusecesecsuecseecseesens 73 VASSNES 73 CHAPTER T MAINTENANCE sp 74 Il ERVICEAND EXAMINATION NG 74 UV BATTERY MAINTENANCE ui AS AA A AA AN Ta 74 11 3 CLEANING STERILIZATION AND DISINFECTION ccssccssccssccssccssccsccesscscesscesscesccesscesseescescesccesces 75 11 4 CLEANING STERILIZATION AND DISINFECTION OF ACCESSORIES cccccsssccssccsccessceesccessceusceeseees 76 MD LOR A GE SAA AA edge 76 TIR NOT 76 CHAPTER 1 2APPENDIUN nes 77 IZ AAR ME INFORMATION SA A AA cau doa AA AA seen 77 12 2 DEFAULT ALARMING VALUES AND SETUP RANGE ccccccccscccsescesescesescuceceecucsseusssenessusessueeseueusess 78 TA ABBREVIATION FART TN 80 12 4 STATUS ERROR DURING NIBP MONITORING ccccccceccccceeccccesscsceeccecescceeescsseuessseusesseeesseeueseseees 81 12 6 TYPICAL PRESSURES AND CO READINGS AT ALTITU
3. Check that the sensor 1s properly plugged in Reinsert or reset the sensor if necessary If error persists return sensor to factory for servicing No Parameter Message The host must set the Barometric Pressure and compensations to clear this error no user intervention should be required The sensor temperature is greater than 40 C One of the following conditions exist Source Current Failure EEPROM Checksum Faulty Hardware Error Barometric Pressure and or gas compensations have not been set since power on For CO to be calculated with the stated accuracy these values should be set whenever the sensor 1s plugged in Module in Sleep Mode This bit is set when sensor has been placed in sleep mode Zero In Progress A Module Zero is currently in progress Sensor Warm Up This error condition is normal at startup This error should clear when the warm up is complete Check Sampling Line Check that the sampling line is not occluded or kinked Zero Required To clear check airway adapter and clean if necessary If this does not correct the error perform an adapter zero If you must adapter zero more than once a possible hardware error may exist CO Out of Range If error persists perform a zero Check Airway Adapter To clear clean airway adapter if mucus or moisture 1s seen If the adapter is clean perform a Capnostat zero The Sensor not Ready One o
4. ETA User Manual for Patient Monitor lt gt Gain The ECG gain 6 options x1 4 x1 2 x1 x2 x4 and Auto Auto is for automatic gain control The factory default is x1 lt gt HR Hi High limit of heart rate alarm Lo Low limit of heart rate alarm The adjustable range and the factory default value can be found in chapter 3 9 lt gt Speed ECG waveform sweeping speed 4 options 6 25 12 5 25 50 mm s The factory default is 25 mm s lt gt Mode ECG filter mode Three options MON DIA and OPE MON Monitoring mode Moderate filtering that can filter out interference and present good ECG waves DIA Diagnosis mode No filtering represent the true ECG without filtering OPE Operation mode Deep filtering filter out strong interference The factory default 1s MON lt gt BtSnd Heart beat sound The synchronous heart beat sound during monitoring 0 7 level adjustable lt 1mV Generating the 1mV signal This signal is used to test the function of the machine It is not used during normal operation Factory default 1s OFF lt gt 50H7 frequency filter It means turning on or turning off the 50Hz frequency filter lt gt Pace Pace detecting switch The default is OFF When the option is on the mark will be made in the first ECG channel of any screen if pace is detected as shown below Figure 4 32 Heart Beat Detection Screen lt gt S T Hi The high limit value of S T
5. 2 With the Korotkoff Sound Method the measure is taken on the basis of appearance and disappearance of heart sound The air release speed and heart rate may have direct effect on the measurement accuracy It also has the disadvantages of rapid air release and poor accuracy In the contrast with the oscillating method the 68 User Manual for Patient Monitor determination is calculated on the basis of cuff pressure oscillatory Waveform envelope and the air release speed and heart rate has little effect on the measurement accuracy 3 Statistics show that when measuring the hypertension the measure taken by the oscillating method is likely to be lower than that taken by the Korotkoff Sound Method When measuring the hypotension the measure taken by the oscillating method is likely to be higher than that by the Korotkoff Sound Method But it doesn t mean the advantages or disadvantages between the oscillating method and the Korotkoff Sound Method Comparison with the results taken by more accurate method let s say comparison of the invasive pressure result with the output value by the blood pressure measuring simulator will show which method has more accurate results In addition higher or lower value should be a statistical concept It is recommended those used to adopt the Korotkoff Sound Method use different physiological calibration for values determined by the oscillating method 4 The studies have shown that the Korotkoff Sound M
6. 3 3 4 TEMP Transducer Connection Patient Monitor has two TEMP transducers to measure different body temperature Connecting methods 1 Attach the transducers to the patient firmly 2 Connect them to TEMP 1 or TEMP on the right panel Note When unplugging the probe be sure to hold the head of the connector and pull it out 3 3 5 Battery Installation 1 Make sure that monitor doesn t connect to mains power supply and stays in switch off status 2 Open the battery cover insert the battery into any slot of battery compartment and pay attention to the instruction of polarity direction in the compartment Do not reverse the battery 3 Move baffle plate with hand to fasten the battery 4 Remove the battery cover According to your need you can insert one more storage battery to prolong using time Please take out the battery from battery compartment if it won t be used for a long time 15 User Manual for Patient Monitor 3 3 6 Loading Printing Paper This description 1s for loading paper for the built in printer Operation procedures 1 Press both OPEN notches with force on printer shield with two thumbs to open tt 2 Move the tab of rubber roller lock at the left 90 upwards to unlock tt 3 Cut one end of the paper into triangle and load the paper from the underside of the rubber roller 4 Turn the roller clockwise to get the paper rolled and put the paper roll into the compartment 5 Pull the p
7. the transmitter Conducted RF Recommended separation distance IEC 61000 4 6 3 Vrms vg 150 kHz to 80 MHz d 12P Radiated RF d 12 JP 80 MHzt0 800 MHz IEC 61000 4 3 3 V m 20 MHz to 2 5 GHz d 234P 800 MHz to 2 5 GHz Where P 1s the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in metres m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Ni Interference may occur in the vicinity of equipment marked with the following symbol NOTE 1 At 80 MHz and 800 MHz the higher frequency range applies NOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters and electromagnetic site survey should be considered If the measured field strength in the location in which Patient Monitor is used exceeds the applicable RF compliance level above Patient Monitor should be observed to verify normal operation If abnormal p
8. 3 If the following situations occur the network cable is disconnected suddenly or the software running on the work station 1s closed accidentially but the bedside monitor is under normal monitoring state the user should re connect the network or re run the software on the work station to enable the network re connection automatically at this time please be patient to wait as the network searching time can be up to 2 minutes 4 13 oxy CRG Screen In the mode selection screen move the gray cursor to OXY and press the Navigation Knob to enter oxyCRG screen shown in Figure 4 39 1 or 2 This screen displays the value or waveform of HR SpO and Respiration waveform or Respiration Rate in selected time The time can be set as I minute 2 minutes and 4 minutes by the lower left button Press the middle button to set the third channel waveform display Respiration waveform Fig 4 39 or Respiration Rate Fig 4 39 2 Press Exit button or Display key to exit from this screen Figure 4 39 oxyCRG Screen 2 AO User Manual for Patient Monitor 4 14 MC Calculator In the mode selection screen move the gray cursor to MC and press the Navigation Knob to enter MC analysis screen shown in Figure 4 40 This series monitor supplies 10 kinds of medicine calculation and titration display function Medicine AMINOPHYLLINE Weight 70 00kg Gross Le Cubage o MC D m D fh Diam Deg TS D
9. C3 V3 The electrodes are placed in different places the different Chest C4 V4 lead forms will display electrode C5 V5 C6 V6 Safety Instructions for ECG Monitoring LA LA A UP 9000 Patient Monitor can only be equipped with ECG leads provided by our company using ECG leads supplied by other companies may cause improper performance or poor protection while using defibrillator Flectric parts of electrodes leads and cables are forbidden to contact any other electric parts including ground UP 9000 Patient Monitor can resist against defibrillator and electrosurgical unit Readings may be inaccurate for a short time after or during using defibrillator or electrosurgical unit Transient caused by cable circuitry blocks while monitoring may be similar to the real heartbeat waveform as a result resistance heart rate alarm rings If the electrodes and cable are placed proper positions according to this manual s instructions and the instructions for using electrode the chance to occur this transient will be decreased To the patient with pacemaker because this device has been designed to resist against the interference of pacemaker generally the pacemaker pulse 1s not counted in heart rate measurement and calculation unless the cycle time of pacemaker pulse is over 2ms In order to reduce this possibility observe the ECG waveforms on the screen carefully and do NOT rely entirely on the heart rate display and alarm system
10. Do wipe off the remained alcohol or ispropanol on the accessories after disinfection for good maintenance can extend the life of accessories 11 5 Storage If the equipment will not be used for long period of time wipe it clean and keep it in the packaging which shall be kept in a dry and good ventilation place free from dust and corrosive gases Storage environment ambient temperature 20 60 C relative humidity 1046 9546 atmospheric pressure 53kPa 106kPa 11 6 Transportation This monitor should be transported by land vehicle or railway or air in accordance with the contractual terms Do not hit or drop it with force 2165 User Manual for Patient Monitor Chapter 12 Appendix 12 1 Alarm Information Hi are The related parameter value exceeds the preset high low l limit Over NIBP DIA limit alarm limit Over NIBP MAP limit Over S T limit Over NIBP PR limit Unable to detect HR ECG cable and leads are connected to monitor and patient well but HR is unable to be detected It may caused by inconformity HR signal Unable to detect SpO SpO probe is connected to monitor and patient well but SpO is unable to be detected It may be caused by inconformity SpO signal The battery capacity will exhaust Low battery voltage Lead Off The ECG electrodes or cable fell off Probe Off SpO probe fell off Ba kg User Manual for Patient Monitor 12 2 Default Alarming Values and Setup Range The default alarmin
11. ES Make sure that the monitor 1s grounded properly Pay close attention to the fluctuation of the local power supply voltage A manostat is recommended when necessary In case any indication of damage about the function of the monitor is detected and proven it is not allowed to apply it to the patient for any monitoring Please contact the local dealer or our company and we are to offer the best solution as soon as possible for your satisfaction 11 1 2 Routine Maintenance After each maintenance or the yearly maintenance the monitor can be thoroughly inspected by qualified personnel including function and safety examinations The designed life of this monitor is 5 years In order to ensure its long service life please pay attention to the maintenance 6 If the hospital fails to carry out a satisfactory maintenance program about the monitor it may get disabled and harm the patient s safety and health 6 In case of ECG leads damage or aging please replace the lead 6 If there is any indication of cable and transducer damage or they deteriorate they are prohibited from any further use A The adjustable units in the monitor such as potentiometer are not allowed to adjust without permission to avoid unnecessary failures that affect normal application A It is recommended to use the battery once a month to ensure its strong power supply capacity and long service life and recharge it after run out of the power volume 11 2 Battery
12. Save The operator can choose how much of the data that needs to be saved The unit is hour Once the time 1s chosen the system starts to save data from the current time If OFF is selected 1t means that the data will not be saved The system will determine the time range according to the disk space available If no disk space available SAVE will be displayed as OFF When the user intends to save the current ECG waveform permanently please delete the history files Net Type The type of network connection to the central monitoring system There are three selectable options OFF NET and COM The option OFF means no data transmission at all that 1s to say disconnection to the outside world The option NET means the network 1s Ethernet for data transmission by TCP IP data packet The option COM means the network 1s RS 232 for data transmission When the option of Net Type is not NET the field of HostIP and PORT will represent gray which tells the user these fields are inactivated and there no need to set them If the option 1s OFF press Exit to end the data transmission therefore the data communication is terminated Similarly if the option is NET or COM pressing Exit to activate the data communication But the change of current Net Type needs hardware initialization so if the users want to change Net Type they should exit from the setting scree
13. set ambient atmospheric pressure It can be determined by barometer or the ambient altitude Altitude can be used to determine the typical barometric pressure 1f a barometer is not available refer to Appendix Typical Pressures and CO Readings at Altitudes for details lt gt Zero The method to calibrate CO Zero calibration Calibration must be carried out in a drafty place and the CO module must have worked continuously for 5 minutes to ensure an accurate calibration or the calibration will not work The information promoted for Zero calibration is as follows Do you want to do zero calibration Apply reference air with 0 5 CO Please apply the reference air with 0 COs the air in the drafty room usually can be regarded as the air with 0 CO Press OK and the result will be displayed on the screen several seconds later lt gt Flow CO flow It is flow rate of the CO sampling Its value is 50m1 min lt gt Apnea display time of the respiration rate value in data area when the previous respiration has been detected while the next one is not meanwhile the device will prompt apnea information The setting range is 10s 60s the default is 20s For example if 20 seconds is set here it means the respiration rate value will disappear after 1t has been shown for 20 seconds in the data area if on respiration 1s detected during this period lt gt Period setting the calculation cycle of EtCO value there are thr
14. A Attention must be followed to avoid causing damage to the monitor 3502 2580001 Ti User Manual for Patient Monitor Instructions to User Dear Users Thank you very much for purchasing our product Please read the following information very carefully before using this device Read these instructions carefully before using this monitor These instructions describe the operating procedures to be followed strictly Failure to follow these instructions can cause monitoring abnormity equipment damage and personal injury The manufacturer is NOT responsible for the safety reliability and performance issues and any monitoring abnormality personal injury and equipment damage due to user s negligence of the operation instructions The manufacturers warranty service does not cover such faults NZ WARNING PACEMAKER PATIENTS Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely entirely upon rate meter ALARMS Keep pacemaker patients under close surveillance See this manual for disclosure of the pacemaker pulse rejection capability of this instrument Monitoring a single person at a time The monitor is defibrillator proof Verify that the accessories can function safely and normally and the monitor is grounded properly before conducting defibrillation Disconnect the monitor and sensors before MRI scanning Use during MRI could cause burns or adversely affec
15. Module Module Pressure Module Saturation Module Respiratory rate ECG RESP TEMP NIBP Spo2 PR Ela nata ECG leads MIBP cuff Spe Sensor sampling tube Figure 2 1 2 2 Composition 1 The monitor consists of the main units and the corresponding functional components ECG leads non invasive blood pressure cuff SpO probe temperature transducer appendix of invasive blood pressure and side stream CO 2 The patient monitor has 6 measurement channels the ECG and respiration channel the NIBP channel the SpO pulse channel the temperature channel IBP channel and EtCO InsCO channel 3 The patient monitor has two output channels the networking communication port and the printer 4 Basic parameters include heart rate respiration rate EtCO InsCO temperature SpO NIBP and pulse 2 3 Working Theories UP 9000 Patient Monitor which performs physiological parameter measurement through different modules is a product of module design It consists of six modules ECG module NIBP module SpO module IBP module CO module and the main unit 1 The ECG module collects the heart rate respiration waveforms through the ECG leads and collects the temperature data through the temperature probes as well User Manual for Patient Monitor The SpO module collects the data of pulse rate pulse oxygen saturation SpO and SpO volume waveform via the SpO probe The NIBP module collects the
16. ON the learn key 1s disabled Press this key and the system enters learning mode The Start changes to End Press 1t again to end the learning When Learn key change to yellow from gray 1t indicates the learning has finished After the arrhythmia detection begins the system will automatically detect the arrhythmia waveforms If arrhythmia 1s detected the arrhythmia waveform will be displayed in the 3 ECG channel shown in Figure 4 28 When the system get reset or the patient has changed the arrhythmia needs to be re learned Learn Because the arrhythmia detection is based on the normal ECG waveform at the same speed and same amplitude when the patient changes or the arrhythmia detection is incorrect the arrhythmia needs re learn To better use the learn function 1t 1s recommended to use a good ECG waveform to learn during the monitoring View Press this key and the selected record in the ARR list which 1s to be reviewed becomes green Rotate the Navigation Knob to choose the record and display the corresponding waveform in the 3 ECG channel Press the knob again to exit Exit press this key to exit the arrhythmia detection screen and return to the system menu During monitoring 1f arrhythmia is detected the system will alarm The ARR alarm is system default and does not need setup ETR User Manual for Patient Monitor During arrhythmia detection incorrect detection might occur if the non ECG waveforms e g square wave
17. Press the Current the recall list on the left side displays the current one When entering the recall screen the system defaults the current one Delete Press this key and the selected record in the recall list becomes green Rotate the Navigation knob to choose the reviewed record that is to be detected press it release 1t 2 seconds later and then the record is deleted The current record cannot be deleted or system will exit Delete screen Exit Press this key to return to the system setup menu In this screen the system can print the recalled data list or the recalled waveform 33 User Manual for Patient Monitor 4 9 ARR Screen Move the gray cursor to ARR and press Navigation Knob to enter ARR screen shown in Figure 4 28 The structure is similar to recall screen We will cover each function key below Alarm x ADU MON TITT 011 08 00 39 lal ST 40 098 MY x1 Ni XI TEMP 12 TD 36 5 37 5 1 1 rd 120 VE EARLY 08 58 59 II X1 MON HR 60 86 98 ADUL MANU PR Spo2 Pleth WINK DEMI AR PRA T Time VPC Type Lead Gain 08 59 33 VE EARLY T XI 08 59 21 VE EARLY T XI 08 59 10 VE EARLY T XI X1 08 58 59 VE EARLY T XI 08 58 48 VE EARLY T XI TD TEMP 1 2 End Learn View Exit View YPC detected graph a ID MONITOR Figure 4 28 ARR Screen End This button is used to start and end the system arrhythmia detection The default is End When the ARR is not
18. 38 User Manual for Patient Monitor lt gt Gas Leak For professional person to test gas leak on blood pressure A WARNING STAT can only be used for Adult Using this mode to Infant Neonatal patient can cause serious injury Limits setup Move the gray cursor to the upper or lower limits of the alarm settings and press the Alarm silence key to turn ON or OFF the alarm for the setting Yellow color shows ON status and gray color show the OFF status SPO PARAMETER SETTINGS 5p0 2 Hi 100 Pulse Hi 180 Lo 90 a Lo 40 SYS Print ECG TEMP NIBP Spo2 gt gt Figure 4 35 SpO settings lt gt SpO Hi Lo High and Low limits of SpO alarm lt gt Pulse Hi Lo High and Low limits of pulse rate alarm RESPIRATION PARAMETER SETTINGS Gain AZ RR HI opeed 12 5 Apnea OFF Lo Type RES lt lt TEMP NIBP 5p RESP DEF Exit Figure 4 36 Respiration Settings lt gt Gain Respiration amplification gain 4 options x1 2 x1 x2 and x4 The default is x2 lt gt Apnea The timeout for apnea alarm in second The timeout setting range is 5 120 or the alarm is disabled When the patient stop breathing for the time longer than the set period the Respiration display channel display warning Apnea xxx second The default is OFF lt gt RR Hi High limit of respiration rate alarm Lo Low limit of respiration rate alarm lt gt Speed Respiration display speed 2 op
19. Graphic Trend Screen for detailed instructions and operations gt Date HR 2009 05 19 EtCO Graphic Trend 54 User Manual for Patient Monitor Chapter 6 Alarm 6 1 Alarm Priority High Priority Over FR Imit Over RR limit Over TEMPI limit Over TEMP2 limit Over SpO limit Over PR limit Over NIBP SYS limit Over NIBP DIA limit Over NIBP MAP limit Over EtCO limit Over InsCO limit Over TD limit Over S T limit Over NIBP PR limit ECG ARREST Unable to detect HR Unable to detect SpO The battery capacity will exhaust Medium Priority VE RONT SVE RONT Lead Off Probe Off Sensor Over Temp Sensor Faulty Zero Required CO Out of Range Check Airway Adapter Check Sampling Line The Sensor Off Low Priority Other arrhythmia phenomenon Except ECG ARREST VE RONT and SVE RONT refer to 12 3 Abbreviation of arrhythmia for details 55 User Manual for Patient Monitor 6 2 Alarm modes When an alarm occurs the monitor responds with visual alarm indications which are shown by two ways alarm indicator and alarm message description and audible alarm indications Visual Alarm Indicators The flashing rates for the three categories of alarms are shown in the table below Indicator Color Alarm Caregory Flashing Rate Red flashing High priority alarm 2 Hz Yellow flashing Medium priority aarm 0 5 Hz Yellow light Low priority alarm Constant on non flashing Audible Alarm Indications
20. IBP2 mmHg 20 100 60 82 NG IRR EtCO2 Ins x 1639 0 3 4 Push knob for system menu AD MON TOR Waveform area 5 trace CO waveform It can be respiration waveform or CO waveform Data area RR ETCO Ins 16 39 0 3 4 RR EtCO and Ins Data Area x EtCO 39 0 The label and the value will become gray when CO is turned off RR Respiration Rate The rpm after that is the unit of the respiration 1 e respiration per min lt V Ins The label of the minimal inhalational CO the label and the value will become gray when CO is turned off lt gt 16 Respiration rate It will display the respiration rate of CO when the switch is turned on lt gt XI Respiration gain amplification 5 4 User Manual for Patient Monitor x1 2 Waveform scaled with half of the base gain xI Waveform scaled with base gain x2 Waveform scaled with twice of the base gain x4 Waveform scaled with four times of the base gain Observing Screen 7 Leads on the Same Screen and other display screen will display CO monitoring data as well besides Main Screen Note CO monitoring function can be effective only when the setting item System Menu SETUP 5CO 5Switch 1s set as ON 5 4 CO Graphic Trend On Graphic Trend screen rotate the knob and move the cursor to CO then press the knob to enter EtCO Graphic Trend Refer to Chapter 4 5
21. Maintenance Please pay attention to the polarity of battery do NOT insert it into battery compartment with reversed polarities 6 Do NOT use the batteries manufactured by other companies if being inserted the device will may be damaged 6 In order to avoid damaging the battery do NOT use other power supply device to charge the battery After battery ageing phenomenon occurring do NOT throw the battery into fire to avoid explosion risk 74 is 4 4 gt 7 VIN WIN WIN WIN User Manual for Patient Monitor Do not hit or strike it with force Do not use this battery on other devices Do not use this battery below 10 C or above 40 C Dispose of the battery the local law should be followed In order to maintain battery supply time and prolong battery lifetime please charge the battery every one or two months if don t use battery for a long time And do charge battery at least 12 15 hours every time Before connect to AC do start monitor with battery s power supply until battery power is used up and monitor turn off automatically then connect monitor to AC and have it charged for 12 15 hours continuously The speed of charge will be the same no matter whether the monitor is working or not The reason why discharge the battery before charge is to avoid the decrease of capacity caused by battery s memory effect If the monitor won t be used for a long time do have it charged fully before conservation A When st
22. The audible alarm has different tone pitch and on off beep patterns for each priority category These are summarized in the Table below Alarm Category High priority alarm 500Hz 2 beeps per 7 sec Medium priority alarm 700Hz 4 beeps per 9 sec Low priority alarm 600Hz 20 beeps per 13 sec 300 Note Visual alarm indicators can not be suspended or removed Audible alarms may be decreased in volume or silenced 6 3 Alarm Silence Press x key to set or activate the system alarm In the monitoring screen press Alarm to set the alarm timer There are four options of alarm silent time 2 minutes 5 minutes 10 minutes and 20 minutes The time shows up on the upper left corner of the screen When the alarm timer is activated the system begins to count down If alarm occurs during that period the system alarm will be activated automatically and the monitor will give alarm If there is no alarm during that period when the set time has passed the system alarm will be activated as well When the monitor alarms press X key to suspend the alarm and set the alarm silence time 6 DO NOT silence the audible alarm or decrease its volume if patient safety could be compromised 6 4 Alarm Setting In the Mode Selection screen move the cursor to the SETUP and press it to enter system setup screen 157 Limits setup Move the gray cursor to the High or Low limits of the alarm settings and press the Alarm key to turn ON or OF
23. There are three selectable patient types Adult Infant and Neonate lt gt MON ECG Filter type There are three types Diagnosis Monitor and Operation The option can be set in the system menu TT battery power indicator When the indicator is yellow and displays only one grid it means there is a little battery power left When the indicator turns red and blinks as well as less than one grid displays the system alarm will be on to remind the battery shortage Please connect the device to the mains power supply in time to ensure the normal use of monitor and the battery will be recharged When the battery power is full battery power indicator displays full grid During recharging the grids in the battery indicator are rolling circularly lt gt 2011 06 20 16 36 04 Current calendar time and date The system time and date can be set during the system start up when the screen displays the time and data setups The current figure shows the time and date June 20 16 36 04 2011 lt gt Push Display changing interface System prompt or description for the current status 19 User Manual for Patient Monitor lt gt ID The patient ID It can be entered or changed in the archive management window Waveform area lt gt 1 trace The first trace is ECG waveform for lead II The left side of the ECG shows the sign I which indicates the ECG scale The
24. and triangle wave appear During arrhythmia detection the arrhythmia module is very important The system requires a group of stable ECG waveforms If the system detects the arrhythmia incorrectly please re learn arrhythmia by pressing Learn button and capture correct template 4 10 System Setup Screen 4 10 1 Screen Description In the Mode Selection screen move the cursor to the SETUP and press it to enter system setup screen shown in Figure 4 29 To set up the system parameter rotate the Navigation knob to move the cursor to the corresponding button and press it to perform corresponding settings At the same time the DEF button returns the settings to the default value but the patient document and the recalled data will not be changed We will cover the functions of each button SYSTEM PARAMETER SETTINGS Type ADUL Mode Demo Lang ENG Fill OFF Frze ECG Disp2 7ECG AlmY ol 5 Key ON Beep 5 NetType NET IBP OFF SYS Print ECG TEMP NIBP Spo gt gt Figure 4 29 System Parameter Settings lt gt Type The object being monitored this can be selected among Adult Infant and Neonate Adult the object 1s adult Infant the object 1s pediatric Neonate the object 1s neonate The default is Adult When changing the patient type the system will perform the alarm settings NIBP settings initializations Please pay special attention to the patient type before star
25. apply tape to secure the sensor in place or to tape it shut venous pulsation may lead to inaccurate saturation measurements 5 Do not immerse sensor as it causes short 6 Do not use NIBP or other constructing instruments on same appendage as sensor for blood flow interrupted by NIBP cuff or circulatory patient condition will result in no pulse found or loss of pulse 7 Do not use the sensor or other oximetry sensors during MRI scanning 8 Carefully route cables to reduce the possibility of patient entanglement or strangulation 9 Do not alter or modify the sensor Alterations or modifications may affect performance or accuracy 10 Do not use the sensor if the sensor or the sensor cable appears damaged Creative offers a 6 momth warranty against manufacturing defects for the SpO sensors mentioned above in its undamaged condition If you have any question regarding any of SpO sensor instructions please contact market O creative sz com your local dealer 87 User Manual for Patient Monitor L 1141 Budapest Fogarasi t 77 1095 Budapest Mester u 34 Tel 220 7940 220 8881 220 7959 Tel 218 5542 215 9771 215 7550 220 7814 364 3428 Fax 220 7940 216 7017 216 7018 Fax 218 5542 Mobil 30 531 5454 30 939 9989 Mobil 30 940 1970 20 949 2688 E mail delton delton hu Web www delton hu www medipek hu 88
26. dual ruby light infrared heater and direct sunlight etc Strenuous action of the subject or extreme electrosurgical interference may also affect the accuracy Please do not use the SpO sensor when having the MRI or burn may be caused by faradism Always observe the plethysmogram waveform which is auto scaled within the range of 100 The SpO gt reading may be unlikely true when the waveform is not smooth or irregular If in doubt rely on your clinical judgment rather than the monitor readout 10 A functional tester can not be used to assess the accuracy of the pulse oximeter monitor or a SpO sensor However a functional tester such as SpO simulator can be used to check how accurately a particular pulse oximeter is reproducing the given calibration curve Before testing the oximeter by a functional tester please firstly ask the manufacturer which calibration curve 1s used if necessary request the manufacturer for its dedicated calibration curve and download it into the tester Clinical Limit l As the measure is taken on the basis of arteriole pulse substantial pulsating blood stream of subject is required For a subject with weak pulse due to shock low ambient body temperature major bleeding or use of vascular contracting drug the SpO waveform PLETH will decrease In this case the measurement will be more sensitive to interference For those with a substantial amount of staining dilution drug such as methylene bl
27. from xx minutes automatically when starting blood cuff inflation After ending counting down it will deflate automatically The default value is 40 minutes lt gt Alarm the time of alarm 1 to 60 minutes continuous adjusting range If the set is xx minutes the system will alarm until ending deflation when the time reaches ending deflation is xx minutes and the alarm type is high priority alarm The default value is 5 minutes For example the duration is 40 minutes the alarm set 1s 5 minutes the alarm will ring when the duration countdown left time is 5 minutes lt gt Start Press it with the Navigation knob the blood cuff starts being inflated after inflating this field displays AG User Manual for Patient Monitor End then press End button to perform deflation lt gt Exit Press it with the Navigation knob to return to Mode Selection Screen Note In CUFF status after pressing Start to start CUFF function if monitored object and inflating mode are modified the CUFF function will be stopped 46 User Manual for Patient Monitor Chapter 5 CO Monitoring If your monitor has CO monitoring function please follow the instructions in this chapter to perform CO monitoring on patient 5 1 CO Parameter Settings 1 On Main Screen press the knob to enter System Menu Screen Then choose SETUP gt C0 to enter CO Parameter Settings screen switch WOFEW Gai
28. gain x2 Waveform scaled with twice of the base gain x4 Waveform scaled with four times of the base gain TEMP1 2 36 71 37 5 Figure 4 4 TEMP Data Area lt gt TEMP 1 2 Temperature label The values 36 7 and 37 5 are the temperature values lt CC Body temperature unit C is Celsius and F is Fahrenheit lt gt TD the absolute value in temperature between TEMP 1 and TEMP 2 20 User Manual for Patient Monitor NIBP Mark and Unit Time of NIBP Measurinc PR Mark and Value i Value of Systolic Pressure Value of MAP Value of Diastolic Pressure ADUL MANU NIBP Measuring Style Mode of NIBP Figure 4 5 Blood Pressure Data Area NIBP The blood pressure type labels and the measured value PR pulse rate value measured by NIBP measurement 63 pulse rate value mmHg NIBP unit mmHg and kPa ADUL NIBP measurement mode The object is adult MANU The NIBP measurement mode manual 17 43 NIBP measuring time Mark and Value of SpO Mark and Value of PR Histogram of SpO Indensity Figure 4 6 SpO and Pulse Rate Area SpO SpO label 98 on the right side is the current SpO value lt gt PR Pulse rate label 61 on the lower left shows the pulse rate value gt SpO strength bar Absolute value TEMP Label Value of TEMP 36 5 1 0 37 5 value of TEMP diff
29. it shut venous pulsation may lead to inaccurate saturation measurements 5 Do not immerse sensor as it causes short 6 Do not use NIBP or other constructing instruments on same appendage as sensor for blood flow interrupted by NIBP cuff or circulatory patient condition will result in no pulse found or loss of pulse 7 Do not use the sensor or other oximetry sensors during MRI scanning 8 Carefully route cables to reduce the possibility of patient entanglement or strangulation 9 Do not alter or modify the sensor Alterations or modifications may affect performance or accuracy 10 Do not use the sensor if the sensor or the sensor cable appears damaged 85 User Manual for Patient Monitor Instructions for Adult SpO Finger Rubber Sensor Intended Use When used with a compatible patient monitor or a pulse oximeter device this SpO sensor is intended to be used for continuous non invasive functional arterial oxygen saturation SpO gt and pulse rate monitoring for patients weighing greater than 50kg Contraindications This sensor is contraindicated for use on active patients or for prolonged use Instructions for Use 1 Hold the sensor with its opening towards the patient s index finger A The sensor should be oriented in such a way that the sensor side with a finger tip sign is positioned on the top 2 Insert the patient s index finger into the sensor until the fingernail tip rests against the stop at the end of t
30. listing screen please refer to the previous chapter 28 User Manual for Patient Monitor 4 7 Trend Graph Screen 4 7 1 Screen Description Move the gray cursor to the TREND button press the knob and you will get the screen as shown in Figure 4 17 Time HR RR SpO2 TEMPI TEMPI s7 09 17 51 60 14 98 86 6 87 7 ECG s TEMP NIBP Spo2 RESP gt gt Figure 4 17 Trend Menu Screen This 1s the graphic trend selection screen 1 e Trend Menu screen If you want to enter one of the trend graphs the procedures are rotate the Navigation knob move the cursor to one of the parameter For example from the left to right we can view ECG S T Temperature NIBP SpO IBP1 IBP2 Respiration and EtCO trend graphs The corresponding screens are described in the following figures Time HR RR SpO2 TEMPI TEMPI ST 08 17 51 60 114 98 36 6 87 7 eco s r TEMP NIBP Spo2 RESP gt gt Figure 4 18 ECG Trend Graph Figure 4 18 is the ECG trend graph There are 3 options on the right of the graph as described below The 8 on the top shows the trend graph time Move the cursor to the trend time press the knob and rotate it and the trend graph time will change to 24 or 120 which changes the horizontal axis to be 24 hours or 120 hours The corresponding trend graph also changes to 24 hour trend or 120 ho
31. scale sign changes its length according to the ECG gains All ECG waveforms have their own scale When the third measured trace change to lead II the first trace will automatically change to lead I lt gt 2 Trace The second trace is for the ECG waveform of lead III When the third measured trace displays the ECG for the lead III this waveform automatically changes to the ECG for lead I lt gt 3 trace The third trace is the measurable ECG channel Its lead can be adjusted and will not repeat the 1st and 2nd traces 3 4 trace SpO waveform lt 5 trace Respiration waveform or CO waveform Data area Heart Rate Mark and Unit b m Heart Rate Value Heart Beating Symbol ECG Waveform Value of ST Segment ___ ST 0 098mv A Gain XV Measuring mV Figure 4 3 Heart Rate Area lt gt HR The currently displayed heart rate 60 on the right side is the heart rate lt gt bpm The heart rate unit bom beat per minute pp The heart beating symbol Its flashing corresponds to the R wave of the ECG waveform The speed is the same with the heart rate lt gt S T 0 098mv The measured mili volts value during S T measurement lt gt XI ECG waveform gain amplification 6 options available Auto Automatic scaled waveform x1 4 Waveform scaled with 1 4 of the base gain x1 2 Waveform scaled with half of the base gain x1 Waveform scaled with base
32. to select functions or parameters Press and release it to shift the screen and to confirm the function or other operating tips The majority operations of this system are finished by navigation knob 11 Alarm indicator Indicator Color Alarm Level Alarm Event o Exceeding the limits pulse stop suffocation or low Red flashing High priority alarm battery power Yellow flashing Middle priority alarm Leads and probe off VE RONT and SVE RONT Yellow light Low priority alarm Other arrhythmia phenomenon 3 2 2 Left and Right Panel Figure 3 2 the Left Panel Figure 3 3 the Right Panel Different ports are located in different positions of the monitor for operating convenience The bullt in printer is at the left panel shown as Figure 3 2 The cable and transducer ports are at the right panel shown as Figure 3 3 1 TEMP1 TEMP2 TEMP probe connector 2 NIBP NIBP hose connector 3 SpO SpO sensor connector User Manual for Patient Monitor 4 ECG RESP ECG cable connector 5 CO CO sensor connector 6 Battery cover remove the cover to install or change rechargeable battery Factory default two rechargeable batteries 12V 2 3 Ah battery specification FB 12V 2300mAh ZA TO AVOID BATTERY DAMAGE ALWAYS REMOVE BATTERY S BEFORE SHIPPING OR STORAGE Type BF Je Type CF and applicable during the defibrillator is used AN Caution Please read the manual for detalls 3 2 3 Rear Panel Figure 3 4 Rea
33. type net or COM gt gt gt Beep The synchronous heart beat sound The range of setting is 0 7 The factory default is 5 lt gt IBP turn on or turn off the IBP function PRINTER SETTINGS Printer OFF Timer OFF Way Pleth ARR OFF OFF Way 3 SYS Print ECG TEMP NIBP Spo2 gt Figure 4 30 Printer Settings lt gt Printer the switch of printer setting the printer can be used if you choose ON This parameter does not have default but the choice can be stored lt gt Timer if Print is ON rotate navigation knob to set on the Timer to enable timed print and set the value of printing intervals in the cycle category When the time set 1s reached the system will automatically take the record The interval is 1 2 3 to 240 minutes The default is OFF lt gt Wave2 when built in printer is selected you can choose SpO respiration I III AVR AVL AVF or V to be printed with II lead ECG waveform The default setting is SpO lt ARR ARR triggering print If the printer option is ON it means once ARR occurs the printer will be triggered for recording the ARR waveform information The default is OFF ECG PARAMETER SETTINGS HR Hi 180 Lo 40 S T Hi 68 Lo 68 ECG TEMP NIBP Spo2 gt gt Figure 4 31 ECG Parameter Settings lt gt Lead Can choose from I II III aVR aVL aVF V V1 V6 The default is I
34. when the groups of data are less than 13 the Navigation Knob can not be used to scroll up or down the listing Up to 13 groups of the latest data can be printed each time when printing SpO list and the printing data is the SpO list on current screen Rotate the knob to display the next screen and then press the Print key to perform printing the next page of SpO list will be printed All the parameters in the SpO trend list are corresponding to the time when the SpO measurements were taken There 1s only one record every 4 seconds 4 6 Blood Pressure Trend List Screen 4 6 1 Screen Description Move the gray cursor to NIBP List in the mode selection screen and press Navigation Knob to enter into NIBP trend list screen displays in the same position shown as Figure 4 16 128 80 92 122 87 93 120 88 90 128 81 95 126 82 94 124 87 99 Figure 4 16 NIBP List 4 6 2 Operation Introduction The NIBP list screen is similar with the SpO gt trend listing screen The difference is the title bar colors In the NIBP list title bar the font color of NIBP is the same with NIBP parameters and other titles font color is white All the parameters in the NIBP list are corresponding to the time when the NIBP measurements were taken When the NIBP measurement is taken successfully each time the NIBP list will be updated and the latest measured data is in front of the list All the operations is similar to the SpO gt trend
35. 0 15 00 15 00 Cubage 500 00mi 6 00 6 00 16 00 16 00 7 00 7 00 17 00 17 00 D yh 60 00mg 8 00 8 00 18 00 18 00 9 00 3 00 19 00 19 00 TS 60 00ml fh DS 20 00GTT m Dose 1 m 2c Mo Titration Exit Figure 4 42Titration Screen The parameters on the left of titration screen are the MC analyzed parameter values the right is comparison table The four options Dose 1 h and lt gt bellow the table will be covered in turn lt gt Dose Medicine dose DS and TS are selectable if the option is DS the comparison table will be Dose DS table if the option is TS the comparison table will be Dose TS table The operator will 44 User Manual for Patient Monitor choose the value of TS and DS according to this table lt gt 1 means step is has relation with Dose option 1 10 adjustable if the former option selects Dose the dose step will can be changed in compression table 1f selects TS the TS step will can be changed 1f selects DS the DS step will can be changed lt gt h Dose unit h m Kg h and Kg m selectable when the unit is changed the TS or DS are changed correspondingly according to the former formula lt gt lt gt Turn to another page move the gray cursor to this button and press it with the Navigation knob the cursor ch
36. 00000000 00000 0 aaa 2 A EEE E E 3 CHAPTER 2 WORKING THEORIES sj 4 JORN NN 4 2 2 COMPOSITION NA AS Sa 4 2 WORKING TER AN 4 CHAPTER 3 INSTALLATION AND CONNECTION ccscccsssccscsccccccccsccccsccccssccccsccccsccccsccccscccess 6 TEN 6 Ca aa AA 6 TE ENE Power ES 6 TS SAS AA 6 NENNE i 2 Front Pd AA AAA tutus SA A AA AAA A 7 DR 8 PN 9 I3 CONNECTION seede bed 10 TEGE NNN NG 10 35 2 Blood Pressure Cul Connec UO o 11 DJ To COMMECE NG SINN 14 3 34 TEMP Transducer Connection aaa aa aa ea a haaa 15 Dd BER he a 15 3 300 Loading Printing Papapk 16 CHAPTER 4 MONITORING SCREEN oran id 18 DAD SS 18 Ay del Date and Time SPAR 18 4 12 SCREEN Descrip UON AA AT 19 A DISPLAY SEN 23 27 IV SEN 23 12 2 Seven ECG Wave OMS OR tie Se SEN SSS 24 4 2 3 Fight Channels Real time Waveforms and Trends on the Same Screen cccccccccccnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnos 25 42 4 Operauin O O A ON 25 4 3 FREEZE AND S T SEGMENT ANALYSIS SCREEN ccccsssssseccccessseccccccenseeeccceaanseseccceeaasescecesaaseseeeseenaes 26 E SA O 26 AD i se 27 24 MODE SELECHON SCREEN dd A A 27 4 I PS TREND LIST SCREEN NN 27 TS DENN 28 4 06 BLOOD PRESSURE TREND LIST SCREEN 0 28 a BA ENE 28 16 OA 28 2 TREND GIR PSN 29 Al Screen BA EE smaueans 29 User Manual for Patient Monitor 212 Op sd sprer 32 FS ROLLS ae 32 FR SEN NNN NNN 34 AA AUP AS 35 AA Ba ree Go 00 EN A A A 35 HO Rome BG AA APP eee 40 42 COLOR SETTINGS SCREEN er 40 4 12 FILE ARC
37. DES ssvevvrnernnnvvnnevnnnvnnnnvnnnvnnnnvnnnvnnnvnnnnvennsnnnesene 83 12 ACCESSORIES LNR 84 12S INSTRUCTIONS FOR SPOJ PROBE SN 85 VII User Manual for Patient Monitor Chapter 1 Overview 1 1 Features UP 9000 Patient Monitor is the combination of the functions of patient monitor which can be used to monitor patient s 6 physiological parameters ECG respiratory rate body temperature non invasive blood pressure NIBP pulse oxygen saturation SpO gt and pulse rate lt gt lt gt lt gt 2 15 high resolution color LCD to display patient ECG waveform respiration waveform SpO gt cubage waveform NIBP waveform and CO waveform User friendly and intuitive display interface multiple configuration of ECG waveform display Default screen view displays the information of all the waveforms and parameters visually Observing screen view heart rate value and SpO value display in big fonts Seven lead waveforms on one screen view displays the information of 7 ECG lead waveforms and different monitoring parameters on one screen Eight channel real time waveforms and two hours trends screen view intuitionistic knowing the physiological status of patient Battery power indicator which enables real time battery power detection and displays the battery power The cuff can be also used as a tourniquet which is convenient and practical in use as an additional function and different cuff pressure
38. DUL MANU Name Start End NoName 08 55 57 08 59 59 TD TEMP1 2 36 6 1 0 37 7 MONITOR Recall HIST Delete Exit Figure 4 25 Waveform Recall Screen In this screen ECG waveform recall can be selected we will cover the each button function in the recall list screen Rotate the Navigation knob to move forward or backward to review the waveform Press the Navigation knob to exit the waveform recall and return to the initial waveform recall screen EYA User Manual for Patient Monitor ID Name Start End t 000001 NoName 08 55 57 08 59 59 Recall HIST Delete Exit Figure 4 26 ECG Recall List During waveform recall the system not only displays the current recalled waveform but also displays the lead status gain and filter type of the waveform and time as shown in Figure 4 27 Waveform Recall Recall HR 60 a4 Time 09 01 14 oo Figure 4 27 Waveform Recall Rotate the Navigation Knob to move forward or backward to review the waveform Press the Navigation Knob to exit the waveform recall and return to the initial waveform recall screen Recall press the recall button the first record of recall list turns to green rotate the knob to select a record and then press the knob to perform data recall the recalled waveform and data will be displayed in the third channel HIST Press the key to shift between the History key and Current key Press HIST and the recall list on the left displays the history data list
39. EMPI TEMPI ST 09 12 61 60 14 99 86 7 975 Time HR RR Sp02 TEMPITEMPII EtCO2 ST 09 26 41 00 14 98 86 7 87 7 20 20 008 ca TEMP NIBP spo2 RESP CO Exit Figure 4 24 EtCO Trend graph ETP User Manual for Patient Monitor 4 7 2 Operating Instructions Rotate the knob choose the parameter and press the knob to review the trend graph and move the cursor to the Exit press it to exit the trend graph Note In the temperature trend graph the Temperature 1 is dotted in white and Temperature 2 is dotted in green 2 The EtCO trend graph can be viewed only when the CO measurement function is activated through the setting System menu SETUP CO Switch ON 4 8 Recall Screen Move the gray cursor to RCALL in the mode selection screen and press Navigation Knob to enter into Recall trend screen displays in the same position shown as Figure 4 25 The recall waveform is the selected lead waveform and displayed in third channel Generally a piece of recall record is saved every one hour 1f the time is less than one hour when the patient 1s changed this record will be separately saved as a piece of recall record Leads and gain etc parameters of saved ECG always keep in accordance with the settings of system parameter Alarm i 2007 08 15 17 50 46 HR bpm x1 ST 40 098 mv TEMP1 2 TD 36 6 I 37 6 1 0 NIBP mmHg PR Recall aa Time 08 56 28 pp Bo D 1 20 91 86 A
40. F the alarm for the setting Yellow color shows ON status and gray color shows the OFF status Refer to Chapter 12 2 for detailed Default Alarming Values of All Parameters and Setup Range 6 Whenever the monitor is used check the alarm limits to ensure that they are appropriate for the patient being monitored 56 User Manual for Patient Monitor 6 5 Verify Adjustable Alarm Function To verify adjustable alarm function select Demo for the item of Mode in system parameter settings menu and adjust alarm limits or change alarm setting then pay a close attention to the alarm If the alarm is sent out according to your setting it means the alarm function is effective 57 User Manual for Patient Monitor Chapter 7 Technical Specifications 7 1 ECG Monitoring 1 Input signals range in amplitude 0 5 mVp 5 mVp 2 Heart rate display range 15 bpm 350 bpm 3 Heart rate display accuracy 1 or 2 bpm whichever is greater 4 Heart rate averaging Averages the recent eight beats having RR intervals falling within the acceptable limits 5 Heart rate alarm delay time lt 10s 6 Response time to change in heart rate Change from 80 bpm to 120 bpm lt 8 sec Change from 80 bpm to 40 bpm 8 sec 7 Tall T wave rejection Rejects all T wave less than or equal to 120 of ImV QRS 8 Pacemaker pulse rejection Rejects all pulses of amplitude 2mV to 700mV and duration 0 1 to 2 ms without overshoot Rejects all pulses of
41. HIVE MANAGEMENT SCREEN seeererevnnnvnvnnnnnvnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnennnene 40 ALOE TS REE PT 42 EME CALCULATOR ios 43 4 14 1 Medicme Dosave Cal o ed Da E 43 FT Te 44 STONE ee 45 TTS ENDR 45 CHAPTER 5 CO MONITORING NG 47 tek CO PARAMETERS SEIN se NG 47 5 2 COs SENSOR CONNECTION a sculls gayang nalabag dd JANDA LAN abah a is 49 Na Lo ES ES ACOSO ta 49 5 2 2 Mainstream CO Sensor Connection 1 000000000100 NN 51 SC MONITORING SCREEN ger 53 EIA E REN D aA a AN 54 CHAPTER GALARM BANAAG NGANGA AT a a aaa aeiaai 55 OPNE 55 02 AARNE MODE In AAA A a e 56 Od TN 56 EMNENE 56 6 5 VERFYADIUS PE BEE AAR FUNCTION GN 57 CHAPTER 7 TECHNICAL SPECIFICATIONS Lassen 58 IS PEG NON TORING SS 58 TATA AN KN KINAPA 59 TO EEPMP MONITORING aaa ales sak Aa UNA AN 59 LANIBP UNIREA 59 LO SPD MONITORING NG 60 TO PULSE RATE MONITORING see 60 TONN 60 TS PATARECORDING a a NA AA ana a AN bada 60 7 9 ORION SPINN 61 GS SS ON NE ANA NAG NONA An ALONA ARI RE EE 61 7 11 GUIDANCE AND MANUFACTURER S DECLARATION ELECTROMAGNETIC COMPATIBILITY 62 CHAPTER 8 PACKAGING AND ACCESSORIES eseeesovsessvnserevnnsvnensevnnnnenennnenenenssnnennenennnennnenssnsenseee 66 Dal PACKAGING 2 66 0 NESSE ica 66 CHAPTER 9 PARAMETERS MONITORING ccssscccssscccsssscccssscccscscccsssscccssscccscsccccsssccessscoesess 67 BES MONITO ING asics tddi 67 9 1 1 How to Obtain High Quality ECG and Accurate Heart Rate Value
42. IR light beam is passed through a gas sample containing CO the electronic signal from a photodetector 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 calibrated the photodetector s response to a known concentration of CO is stored in the monitor s memory The monitor determines CO concentration in the breathing gases by measuring the amount of light absorbed by these gases EtCO is display as a numerical value in millimeters of mercury mmHg percent or kilopascals kPa In addition a CO waveform capnogram may be displayed which is a valuable clinical tool that can be used to assess patient airway integrity and proper endotracheal tube placement Respiration rate is calculated by measuring the time interval between detected breaths 9 6 2 Mainstream vs Sidestream Sampling Mainstream CO sensors are placed at the airway of an intubated patient allowing the inspired and expired gas to pass directly across the IR light path The major advantages of mainstream sensors are fast response time and elimination of water traps Sidestream CO sensors are located away from the airway requiring a gas sample to be continuously aspirated from the breathing circuit and transported to the sensor by means of a pump This type of system is needed for non intubated patients When using mainstream C
43. O sensors check the window for the patient secretions pooled on periodically Because that condition may affect the accuracy of the measurement or even make the sensor not work When using sidestream CO sensors there is a water trap or a part of the sampling tube with dehumidifying function Please periodically check the flow sensor and tubing for excessive moisture or secretion buildup AX C 5k Q User Manual for Patient Monitor Chapter 10 Troubleshooting Note In case of trouble of this machine in service follow the instructions below to eliminate the problem first If the attempt fails contact the dealer in your local area or the manufacturer A Do NOT open the monitor cabinet without permission 10 1 No Display on the Screen Shut down the machine and unplug the power cable Use a universal meter to check if the outlet has proper voltage if the power cable is in good condition and if the power cable is properly connected with this apparatus or outlet Remove the fuse from the back cover of this machine and make sure it is in good condition 10 2 Excessive ECG Signal Interference or too Thick Baseline 1 Check if the plate electrodes are properly located and if valid plate electrodes are used 2 Check whether the lead wires are properly inserted If no ECG curve displayed check if the ECG lead wires are broken 3 Make sure the mains outlet has standard grounding wire 4 Check if the grounding wire of the apparatu
44. P setting select Mode option and set it as MANU and then press the NIBP key on the front panel to start measure If press the NIBP key again the measurement will be stopped 9 During the automatic measurement interval when no NIBP measurement is taken press the NIBP key a measurement in manual mode will be taken If at this time press the NIBP key again the manual mode will be stopped and continue the automatic mode 2 Take a measurement in automatic mode Enter into the screen of NIBP setting select Cycle option and select time interval according needs then press the NIBP key on the front panel to start the automatic measurement at a certain interval 3 Stop automatic measurement In the procedure of automatic measurement press the NIBP key at any time the measurement will be stopped 4 STAT measurement Enter into the screen of NIBP settings select Cycle option and set as STAT the STAT measurement will be taken This procedure will last for 5 minutes 5 Stop STAT measurement on the halfway In the procedure of STAT measurement press the NIBP key at any time the measurement will be stopped 9 3 SpO Monitoring 9 3 1 Measuring Principle Based on Lamber Beer law the light absorbance of a given substance is directly proportional with its density or concentration When the light with certain wavelength emits on human tissue the measured intensity of light after absorption reflecting and attenuation in t
45. S 7 Drop a Duration Po MG Titration Exit Figure 4 40 Medicine Dosage Calculator Screen 4 14 1 Medicine Dosage Calculator Medicine types which can perform drug dosage calculation AMINOPHYLLINE DOBUTAMINE DOPAMINE EPINEPHRINE HEPARIN ISUPREL LIDOCAINE NIPRIDE NITROGLY CERIN and PITOCIN Drug Dosage Calculation adopts the following formula Medicine Consistency MC Medicine Gross Cubage Dose minute Dose hour 60 Dose Kg m Dose m Weight Dose Kg h Dose h Weight Transfusion Speed TS Dose h MC Drop Speed TS Cubage drop Duration Medicine Gross Dose h Formula Introduction Names in formula are the same with the names in Figure 4 44 Dose m Dose per minute Dose h Dose per hour Dose Kg m Dose per Kg per minute Dose Kg h Dose per Kg per hour On medicine calculation screen first the operator should move the gray cursor to Medicine to select the calculated medicine name and then move the cursor to Weight to select and confirm patient weight at this time MC analysis screen 1s shown as Figure 4 41 Medicine AMINOPHYLLINE Weight 70 00kg Gross 5oo 0omg Cubage 500 00mi MC 1 00m9 m Dym 1 00m9 D fh s0 00mg Dykgym 1429me9 D kgrh 85714meg TS soomi DS zorr Drop EI Duration 034 MC Titration Exit Figure 4 41MC Analysis Screen NT User Manual for Patient Monitor Rotate the Navi
46. Segment Lo The low limit value of S T Segment gt Limits setup Move the gray cursor to the High or Low limits of the alarm settings and press the Alarm silence key to turn ON or OFF the alarm for the setting Yellow color shows ON status and gray color shows the OFF status amp Before start 1mV testing please turn off the ARR detection TEMPERATURE PARAMETER SETTINGS TEMPTHI 39 0 TEMP2HI 39 0 Lo 35 0 a Lo 35 0 STS Print ECG TEMP NIBP Spo2 gt gt Figure 4 33 Temperature settings 37 User Manual for Patient Monitor lt gt TEMP Hi High limit of temperature 1 alarm Lo Low limit of temperature 1 alarm lt gt TEMP3 Hi High limit of temperature 2 alarm Lo Low limit of temperature 2 alarm gt Limits setup Move the gray cursor to the High or Low limits of the alarm settings and press the Alarm silence key to turn ON or OFF the alarm for the setting Yellow color shows ON status and gray color shows the OFF status lt gt Unit Temperature unit The default is C Celsius and it can be set to F Fahrenheit lt gt TD Temperature difference value When the TD value is higher than the set value the alarm will ring NIBP PARAMETER SETTINGS sys Hi 800 DIA Hil 90 MAP Hil 110 P JET bo oa oa o a o Unit Mode Cycle InitP Ge 7 80 68 6 NG Figure 4 34 NIBP Settings SYS Hi Lo High and Low limits of systolic pressure alarm DIA Hi Lo High and Low limits of dia
47. T CREATIVE MEDICAL Patient Monitor UP 9000 User Manual Version 1 0 User Manual for Patient Monitor This Manual is written and compiled in accordance with the IEC 60601 1 Medical electrical equipment Part1 General requirements for safety and MDD 93 42 EEC It complies with both international and enterprise standards and is also approved by State Technological Supervision Bureau The Manual is written for the current UP 9000 Patient Monitor The Manual describes in accordance with the UP 9000 Patient Monitor s features and requirements main structure functions specifications correct methods for transportation installation usage operation repair maintenance and storage etc as well as the safety procedures to protect both the user and equipment Refer to the respective chapters for details The Manual is published in English and we have the ultimate right to explain the Manual No part of this manual may be photocopied reproduced or translated into another language without the prior written consent We reserve the right to improve and amend it at any time without prior notice Amendments will however be published in a new edition of this manual Version of This Manual Ver 1 0 Revised date October 22 2012 All rights reserved Marks in the Manual 6 Warning must be followed to avoid endangering the operator and the patient o Note contains some important information and tips about operations and application
48. The inflation can be activated by Monitor so the pressure will increase automatically untill it exceeds the limit value specified in table A This pressure limit value depends on the patient type selection as shown in table A Child 200mmHg Table A During the inflation the Monitor will close the deflating valve and the pressure value will be shown during the process If there 1s no manual deflation operation the pressure will persist until deflation by manual operation so it is necessary to use a manual valve for doing adequate deflation in several steps to verify the pressure accuracy in the full scale of measurement range Mode 2 No automatic inflation by Monitor during the pressure accuracy verification Increase the pressure manually by the pumping balloon and the verification can be done by applying different pressure value manually If the increased pressure exceeds the given limit as shown in table B the Monitor will deflate automatically because of over pressure protection Adult 300mmHg Child 240mmHg Table B A After the verification do press the button again to return to normal working mode then continue other operation or the NIBP key will be invalid A Pressure accuracy verification must be operated by technician or equipment manager Doctor or nurse is not allowed to do the verification it is very dangerous especially when the pressure cuff is still on patients gt Air Leakage Check In order to avoid sign
49. amplitude 2mV to 400mV and duration 0 1 to 2 ms with overshoot 9 Sensitivity selection AUTO Automatic scaled waveform x1 4 2 5mm mV tolerance 5 x1 2 5mm mV tolerance 5 xl 10mm mV tolerance 5 x2 20mm mV tolerance 5 x4 40mm mV tolerance 5 10 Sweeping speed 6 25mm s 12 5mm s 25mm s 50mm s tolerance 10 11 ECG noise level lt 30uVp p 12 ECG input loop current lt 0 1 uA 13 Differential input impedance gt SMQ 14 Common mode rejection ratio CMRR Diagnostic mode gt 90dB Operation monitoring mode gt 105dB 15 Time constant Monitoring mode gt 0 3s Diagnostic mode gt 3 2s 16 Frequency response Monitoring mode 0 67 Hz 40 Ha T pa ee Ao 3 0dB Diagnostic mode 0 05 Hz 150 HAT a CN 3 0dB 58 User Manual for Patient Monitor Additional declarations to conform the particular standard of IEC 60601 2 27 Medical electrical equipment Part 2 27 Particular requirements for the safety including essential performance of electrocardiographic monitoring equipment Direct current for Applied current less than 0 1 microamperes respiration leads off sensing and active noise suppression Response to irregular A1 Ventricular bigeminy 80BPM rhythm A2 Slow alternating ventricular bigeminy 60BPM A3 Rapid alternating ventricular bigeminy 120BPM A4 Bidirectional systoles 90BPM Time to ALARM for Waveform B1 Amplitude Average Time to Alarm tachycardia 0 5 mV lt 8 s
50. ange into yellow rotate knob to right to turn to the page forward rotate knob to left to turn to the page backward When shift to the first page or the last page rotate the knob in reverse turning to the page forward or turning to the page backward will can be performed Move gray cursor to MC Button and press it with the Navigation knob to return to MC analysis screen Move the gray cursor to Exit and press it with the Navigation knob to return to mode selection screen 4 15 Tourniquet Cuff In the mode selection screen move the gray cursor to CUFF and press the Navigation Knob to enter Cuff screen shown in Figure 4 43 Pressure Duration 40 Alarm Figure 4 43Tourniquet Cuff 4 15 1 Screen Description lt gt Pressure For setting the high limit of cuff pressure when inflating When cuff pressure exceeds this value it will stop inflating Adjusting rage Under Neonate mode 70 110 Under Infant mode 80 130 Under Adult mode 80 180 Step 5 Unit mmHg The default value for neonate is 90 for infant is 110 and for adult is 140 Note If in blood parameter setting option on system parameter settings screen the blood unit option is kPa the unit of cuff pressure here also 1s kPa lt gt Duration After inflation the continuous time when cuff pressure is an invariableness pressure 5 6 7 120 minutes adjustable When the set 1s xx minutes the system will count down
51. aper out of paper slot on the shield 6 Move the tab of the rubber roller lock 90 downwards to lock it 7 Put the shield back in position and secure it Operation procedures for taking out printing paper roll 1 2 steps are the same with the 1 2 steps mentioned above for loading printing paper 3 Roll the loading roller anti clockwise and pull the paper out 4 5 steps are the same with the 6 7 steps mentioned above for loading printing paper i T Li LI LI Figure 3 9 Loading and taking out printing paper 16 User Manual for Patient Monitor P8 printer may be used due to the different configuration P8 printer operation instruction Power indicator green light shows the power is on while the monitor is out of power the green light is off Error indicator red light is constant which shows the printer is out of paper or the printing paper does not install well When the printer installs normally the red light is off Power Indicator Open button Error Indicator Paper cartridge Figure 3 10 P8 printer Loading printing paper Step 1 press and hold down the cartridge button to open the paper cartridge Step 2 Install the paper to the printer properly pull the paper out of the printer for 2 cm as shown in figure 3 11 Step 3 Close the printer cover along the direction of arrow as shown in figure 3 11 Figure 3 11 printing paper ECA User Manual for Pa
52. arting the monitor by battery power only which is short of supply monitor will turn off automatically In order to avoid the damage to battery caused by excessive discharge please pay attention to following After monitor turns off automatically there is still small drain current inside battery so it is suggested that user should press the power button again to cut off the power supply If battery keeps in a state of small drain current battery will be damaged and can t be repaired because of excessive discharged A If battery is damaged please replace with same type and specification battery marked by CCC or CE in time or contact the company directly 11 3 Cleaning Sterilization and Disinfection NZ D DO bDb6b6bbHb 2 2 nn Switch off the monitor and disconnect the power cable before cleaning Kept the monitor from dust It is recommended to clean the outer shell and screen of the monitor to keep it clean Only non corrosive cleanser such as clear water is permitted Wipe the surface of the monitor and transducers with an alcohol impregnated wipe and dry it with dry and clean wipe or simply air dry This monitor can be disinfected and sterilized please clear the monitor first Do not let the liquid cleanser flow into the connector jack of the monitor to avoid damage Clean the exterior of the connector only Dilute the cleanser Do not use scrub materials Do not let any liquid flow into the shell or any p
53. arts of the monitor Do not let the cleanser and disinfectant stay on its surface Do not perform high pressure sterilization to the monitor Do not put any parts of the monitor or its accessories in the liquid Do not pour the disinfector on its surface while sterilization If the monitor is accidentally wetted it should be thoroughly dried before use The rear cover can be removed by qualified service technician to verify absence of water Never use this machine in an environment with inflammable gas Avoid being hit by lightning The power cable should be plugged into an outlet with grounding wire Do not use an outlet with poor condition If possible use power supply system with regulator It must be used in a clean environment protected against shock Keep it away from corrosive substances TS User Manual for Patient Monitor explosive substances high temperature and dampness A If it is installed in a cabinet make sure the installation allows for good ventilation and easy maintenance observation and operation 11 4 Cleaning Sterilization and Disinfection of Accessories It is recommended to clean the accessories including sensor leads and plugs with a piece of gauze which has been soaked in 75 Alcohol or 70 Ispropanol before use 6 Do not use damaged accessories Accessories cannot be entirely immerged into water liquor or cleanser 6 Do not use radial steam or epoxyethane to disinfect accessories
54. ation Support the airway adapter to prevent stress on the ET tube Reuse disassembly cleaning disinfecting or sterilizing the single patient use CO airway adapters may compromise functionality and system performance leading to a user or patient hazard Performance is not guaranteed if an item labeled as single patient use is reused 51 User Manual for Patient Monitor Inspect the sidestream on airway adapters and sidestream sampling kits for damage prior to use DO NOT use the sidestream on airway adapters and sidestream sampling kits if they appear to be damaged or broken If the CO waveform Capnogram appears abnormal inspect the CO airway adapters and replace if needed Periodically check the CQ Flow sensor and tubing for excessive moisture or secretion buildup Do not use them if there is excessive moisture or exterior condensation Electric Shock Hazard The CO Sensor contains no user serviceable parts Refer service to qualified service personnel Do not open the sensor cabinet at will as electric shock hazard may occur Place the exhaust vent of the CO Sensor in drafty ambient and do not let anything block the exhaust vent Always disconnect the CO Sensor before cleaning Do NOT use if it appears to have been damaged Refer servicing to qualified service personnel DO NOT sterilize or immerse the CO Sensor in liquids Replace the sidestream on airway adapters and sidestream sampling kits if excessive secre
55. blood pressure data including the diastolic systolic and mean arterial pressure through the NIBP cuff The cuffs are designed for adult infant and neonate respectively and the NIBP measurement has three modes adult infant and neonate The IBP module collects the data and the waveforms of invasive blood pressure through the IBP cable The CO module collects the data of respiration rate FtCO InsCO through the sampling tube The main unit consists of main board multi function board and the keyboard The multi function board performs the data communication among the main board ECG module SpO module NIBP module IBP module and CO module User Manual for Patient Monitor Chapter 3 Installation and Connection 3 1 Installation 3 1 1 Opening the Box and Check 1 Open the packaging take out the monitor accessories from the box carefully and place it in a safe stable and easy to watch position 2 Open the users manual to sort the accessories according to the packing list Inspect the accessories for any mechanical damages Check all the exposed leads and inserted accessories Please contact the local dealer or our company in case of any problems We are to offer you the best solution for your satisfaction 3 1 2 Connecting the AC Power Cable Connecting procedures Make sure that the AC power supply is 100 240VAC 50 60Hz 6 Use the power cable prepared by the manufacturer Insert one end of it to the power port of
56. both of AC indicator and DC indicator are on it means that this device is using mains power supply and the battery is being recharged 4 ECG Lead Click it to shift the ECG monitoring circulatory among I II and III aVR aVL aVF and V 5 Alarm silence Press this key to set or activate the system alarm silence function In the monitoring screen press lt 3 Alarm to set the alarm silent time The time shows up on the lower left corner of the screen When the alarm timer is activated the system begins to count down and alarm when the set time has passed The alarm silent time has four options 2 minutes 5 minutes 10 minutes and 20 minutes or the system alarm is in the alarm status 6 Freeze Press this key to freeze ECG waveforms or the waveforms of ECG SpO and RESP for S T segment analysis according to system setting User Manual for Patient Monitor Ta NIBP Press it to start or stop NIBP measure 8 Print Press it to print different waveforms of different status according to system setups In the main menu print lead IECG waveform and the second waveform this can be selected in the system menu 9 Display Click it to shift the display modes Press it to shift the main screen list screen viewing screen and the seven leads on the same screen and return to the main screen from other screens 10 Navigation knob It is the major operating key of the system Rotate it to the left or right
57. can be set according to patient s condition Up to 20 types of arrhythmia can be analyzed automatically waveform freezing is available and automatic S T segment measurement 8 24 120 480 hours trend graph analysis function under working status up to 120 hours trend data can be stored including HR Temp SpO RR IBP and NIBP etc trends Up to 100 groups of arrhythmia events data can be stored as well as the corresponding ECG Temp SpO RESP and pulse value of each case Up to 1000 groups of NIBP measurement can be stored as well as the corresponding HR Temp RR SpO and PR while the blood pressure measurement is taken 1t can be recalled by list table or graphic trend Up to 14 hours store and recall ECG waveform data eternally even if the device is out of power Unique file management which enables recording modifying deleting and saving operation of patient s information Displays heart rate trend SpO trend respiration trend or waveform simultaneously on oxyCRG screen to know the instantaneous condition change of neonate Accurate NIBP measurement with over pressure protection Software and hardware dual excessive air pressure protection function Unique pulse oximetry technique achieves accurate SpO and pulse rate measurement Multiple interface monitoring which enables simultaneous monitoring of several ECG waveforms Precise alarm system different alarm events adopt different alarm degrees 3 degr
58. cer One piece 5 Rectal temperature probe optional One piece 6 Power cable One piece 7 Grounding wire One piece 8 Disposable electrode Ten pieces 9 IBP transducers Dual optional One set 10 Sidestream Mainstream CO accessories One set 11 Printing paper optional Ten rolls 12 User manual One copy 13 Warranty One copy 14 Packing list One piece Note The accessories are subject to change Detailed items and quantity see the Packing List 84 User Manual for Patient Monitor 12 8 Instructions for SpO Probe Instructions for Pediatric SpO Finger Clip Sensor Intended Use When used with a compatible patient monitor or a pulse oximeter device the sensor is intended to be used for continuous non invasive functional arterial oxygen saturation SpO and pulse rate monitoring for pediatric patients weighing between 10 40kg Contraindications This sensor is contraindicated for use on active patients or for prolonged use Instructions for Use 1 2 3 4 5 6 7 With the upper and lower jaws open place an index finger evenly on the base of the clip Push the finger tip against the stop so that it is over the sensor window A If an index finger cannot be positioned correctly or is not available other fingers can be used Note When selecting a sensor site priority should be given to an extremity free of an arterial catheter blood pressure cuff or intravascular infusion line Spread
59. cillating method is mature In practice however various problems are encountered such as why the measures taken by the oscillating method is lower or higher than those taken by Korotkoff Sound Method Why the measures are inclined to decline Why in some cases no result is obtained in spite of the inflation actions Why the measure values have big discreteness and even abnormal data in some cases Why the SpO waveforms may disappear suddenly and so on The following explanations are devised to give the answers The Oscillating method vs the Korotkoff Sound Method Blood pressure measurement by the oscillating method and Korotkoff Sound Method has good correlation with the invasive measurement Notwithstanding any of the non invasive blood pressure measurements has its one sidedness when it is compared to the invasive measurement The oscillating method has its advantages over the Korotkoff Sound Method in less error higher reliability and stability Their differences may be reflected in the following aspects 1 The measures by the Korotkoff Sound Method are liable to effect of human factors For example different people may have different sound judging ability or different reactivity when listening to heart sound and reading mercury meter The air release speed and subjectivity may also affect the judgment By the oscillating method the computation is accomplished by the computer thus relieving the possibility of effect due to human factor
60. cument archive management screen can be used to manage information about the patient In the screen the operator can enter and modify the patient ID name Bed number Sex and Age The operator can also choose to save the patient data in the permanent storage lt gt ID or Patient ID To enter patient ID choose the patient ID field using the Navigation Knob Press it to enter 40 lt gt User Manual for Patient Monitor the text entry box Rotate the knob to choose the letter and press the knob to enter the letter To delete the letter move the cursor to the letter to be deleted and rotate the knob to enter spaces after the H Use the spaces to replace the letters After finishing entering the patient ID choose Exit button and press the knob to exit the text entry The patient ID is the unique identifier for the patient When the patient ID changes the system considers the patient has changed Name Enter the patient s name Bed Enter the patient s bed number Sex Choose between M or F for male and female Age Choose the age field and use the rotate knob to select an age Synchro Selecting Synchro can upload the current patient file to patient archive screen of center unit for management and also can send patient archive of center unit to bedside unit for management Note The function of Synchro ONLY can be performed in communication of bedside unit and center unit with dual screen center system
61. cursor to Medicine rotate Navigation knob to perform selection Ten options AMINOPHYLLINE DOBUTAMINE DOPAMINE EPINEPHRINE HEPARIN ISUPREL LIDOCAINE NIPRIDE NITROGLYCERIN and PITOCIN The default medicine is AMINOPHYLLINE Weight when entering into medicine calculating window the operator should enter patient s weight the weight is used for MC calculation only weight 0 5Kg to 300Kg selectable step 0 5Kg default 70 Kg for adult 20Kg for infant 3 0 Kg for neonate A Medicine calculation function just supplies a medicine calculator function The values in table can have no relation with the monitored patient so the weight in this menu and the weight in system are two different values When update a patient in system operation the value in this menu will not be affected 4 14 2 Titration When entering medicine name and weight again MC analysis screen displays as Figure 4 38 and then move the gray cursor to Titration button and press it with the Navigation knob the titration screen will display on screen as shown in Figure 4 42 Medicine AMINOPHYLLINE Dose TS Dose TS 0 00 0 00 10 00 10 00 Weight 70 00kg 1 00 1 00 11 00 11 00 2 00 2 00 12 00 12 00 Gross 500 00mq 3 00 3 00 13 00 13 00 4 00 4 00 14 00 14 00 5 00 5 0
62. e The value is displayed after the measure on S T 0 000 mV The operation is carried out in 4 steps First rotate the Navigation Knob to move the base point the red cross horizontally to baseline point the baseline is between the Q wave and the P wave At this point the frozen screen shows S T 0 xxx mV Set Base DIRC HOR Second press the Navigation Knob The screen shows S T 0 xxx mV Set Base DIRC VER Then rotate the knob to move the base point vertically to the baseline point Third press the Navigation Knob again The screen shows S T 0 xxx mV Set S T DIRC HOR Rotate the knob to move the S T point the yellow cross horizontally to the point to be measured on the S T segment Last press the Navigation Knob again The screen shows S T 0 xxx mV Set S T DIRC VER Rotate the knob to move the S T point vertically to the point to be measured on the S T segment One the main screen allows pressing the Freeze key to enter the S T segment analysis screen NOTE The S point is the end point of S wave and the T point is the start point of T wave 4 4 Mode Selection Screen Press the Navigation Knob in the main screen as shown in Figure 4 2 the operating area shows the mode selection screen as shown in Figure 4 14 System Menu Figure 4 14 Mode Selection Screen In the mode selection screen rotate the knob to move the gray cursor to the corresponding screen Press the knob to enter the scree
63. e always use valid plate electrodes 9 1 2 Factors affecting ECG signal Interference from Electrosurgical Unit Doesn t filter the interference waveform Poor grounding Flectrodes are not placed properly Use expired electrode or use disposable electrode repeatedly The skin placed electrode is uncleaned or poor contract caused by scurf and hair CLEE ES Flectrode long time used NIA User Manual for Patient Monitor 9 2 NIBP Monitoring 9 2 1 Measuring Principle Blood pressure may be measured in an invasive way whereby the sensor will be inserted into blood vessel directly or a non invasive way The non invasive way includes several methodologies such as the Korotkoff Sound Method and oscillating method The Korotkoff Sound Method is used as a conventional way whereby stethoscope is used to measure the blood pressure By the oscillating method an inflation pump will fill the air and release it slowly A computer will record change of the cuff pressure when the air is released With this record the blood pressure value will be determined First of all make sure the signal quality judgment by computer meets the requirements of accurate calculation such as sudden limb movement or cuff being hit during the measurement If the answer is negative give up the calculation If the answer is positive proceed with calculation of the blood pressure value As change of the blood pressure is recorded by electric sensor which sensitivi
64. e measurement when the subject is connected with an artificial heart lung machine 4 Do not take the measurement when the subject uses diuresis or vasodilator 5 When the subject is suffering from major hemorrhage hypovolemic shock and other conditions with rapid blood pressure change or when the subject has too low body temperature the reading will not be reliable for reduced peripheral blood flow will lead to reduced arterial pulsation 6 Subject with hyperadiposis In addition statistics show that 37 people report blood pressure difference of no less than 0 80kPa 6mmHg between the left and right arms and 13 people report difference of no less than 1 47kPa 11mmHg Note Some practitioners may report big discreteness or abnormal value of the blood pressure measures when the oscillating method is used As a matter of fact the so called big discreteness must be a term in the sense of Statistical significance of mass data Abnormal data may be observed in some individual cases It is normal in the scientific experiments It may be caused by an apparent reason or by an unknown factor in some cases Such individual doubtful experimental data may be identified and eliminated using the special statistical technique It is not a part of this manual The practitioner may eliminate the apparently unreasonable data according to the experience Operation Introduction 1 Take a measurement in manual mode Enter into the screen of NIB
65. easurement from a limb receiving ongoing transfusion or intubations or skin lesion area otherwise damages may be caused to the limb Continuous use of SpO2 sensor may result in discomfort or pain especially for those with microcirculatory problem It is recommended that the sensor should NOT be applied to the same place for over two hours change the measuring site periodically if necessary SpO measuring position must be examined more carefully for some special patient Do NOT install the SpO sensor on the finger with edema or vulnerable tissue To prevent the risk of the short circuit and to ensure the ECG signal quality the equipment must be properly grounded Although biocompatibility tests have been performed on all the applied parts some exceptional allergic patients may still have anaphylaxis Do NOT apply to those who have anaphylaxis All the connecting cables and rubber tubes of the applying parts should be kept away from the patient s cervix to prevent any possible suffocation of the patient All the parts of the monitor should NOT be replaced at will If necessary please use the components provided by the manufacturer or those that are of the same model and standards as the accessories along with the monitor which are provided by the same factory otherwise negative effects concerning safety and biocompatibility etc may be caused DO NOT stare at the infrared light of SpO sensor when switch it on for the infrared may d
66. ec I mV lt 8 sec 2mV lt 8 sec Waveform B2 Amplitude Average Time to Alarm ImV lt 8 sec 2mV lt 8 sec 4mV lt 8 sec 7 2 RESP Monitoring 1 RESP rate measuring range Orpm 120rpm 2 RESP rate accuracy 5 or 2 rpm whichever is greater 3 RESP rate alarm limit setting range Orpm 120rpm 4 Alarm tolerance 5 or 2 rpm whichever is greater 7 3 TEMP Monitoring 1 TEMP measuring range 25 0 45 0 C 2 TEMP measuring accuracy 0 2 C 3 TEMP responding time lt 150s 7 4 NIBP Monitoring 1 Measuring method Oscillometric Technique 2 Pneumatic pressure measuring range O mmHg 300mmHg 3 Accuracy of pressure measurement 3 mmHg 4 Cuff inflation time lt 10 seconds typical adult cuff 5 Measurement time on the average lt 90 seconds 6 Air release time while the measurement is canceled lt 2 seconds typical adult cuff 7 Initial cuff inflation pressure Adult 175 mmHg Infant 135 mmHg Neonate 65 mmHg 8 Overpressure protection limit Adult lt 300 mmHg Infant lt 240mmHg Neonate lt 150 mm 59 User Manual for Patient Monitor 9 NIBP measurement range mmHg 40 275 40 200 40 135 MAP mmHg 20 230 20 165 20 110 DIA mmHg 10 210 10 150 10 95 10 NIBP accuracy Maximum mean difference 5 mmHg Maximum standard deviation 8 mmHg 11 Measurement mode Manual Auto STAT 7 5 SpO Monitoring 1 Probe dual wavelength LED Wavelength Red light 660 nm Infrared light 905 nm Maximal
67. ee selectable options 1b 10s and 20s 1b means the EtCO value will be calculated once every respiration cycle 10s means the EtCO value will be calculated once every 10s and the maximum EtCO value measured during this 10s will be displayed on data area 20s means the EtCO value will be calculated once every 20s and the maximum EtCO value measured during this 20s will be displayed on data area lt gt TEMP setting the temperature value of the current measured air flow For instance the temperature is usually set as 37 C while measuring the patient s respiration by air flow However if the air flow to be measured is the reference gas the temperature is set as 25 C The setting range 0 50 Unit Q Default value 35 0 lt gt 02 Compen adjusting the concentration of compensating gas in patient s respiration air flow Generally the compensating gas is oxygen so it can be called oxygen compensation concentration The unit Setting range 0 100 Default value 16 lt gt Balance setting the balance gas in patient s respiration air flow There are three kinds of selectable balance gas Air N2O and He namely air nitrous oxide and helium If no specific balance gas is given the balance gas can be set as Air 48 User Manual for Patient Monitor lt gt Agent setting whether adding the anesthetic gas to patient s respiration air flow and the concent
68. een press the Display key to switch the ECG lead or press the Print key to print the ECG waveform and the second waveform The second waveform can be selected in the System menu GEN User Manual for Patient Monitor 4 2 2 Seven ECG Waveforms on the Same Screen Choose 7 ECG of Disp2 on system setup screen press the Display key the system enters the 7 ECG waveform screen In this screen the operator can simultaneously view 9 waveforms the ECG waveform for 7 leads I II III AVR AVL AVF and V the SpO Waveform and the RESP Waveform as shown in Figure 4 10 Alarm ADUL MON 2012 01 12 17 12 29 NIBP mmHg III PR 17 12 4 27 AVR AVL AVF Pletp TEMP1 2 36 5 RESP i 37 7 Figure 4 10 7 Leads on the Same Screen In this screen rotate the Navigation Knob to adjust the ECG gain The ECG gain includes 6 options Auto X1 4 X1 2 X1 X2 X4 Rotate the knob to adjust the gain for all 7 ECG waveforms Press the freeze button to freeze all 9 waveforms including 7 ECG waveforms SpO2 waveform and respiration waveform or CO2 waveform 24 User Manual for Patient Monitor 4 2 3 Eight Channels Real time Waveforms and Trends on the Same Screen When the Disp2 option 1s Trend on system menu screen press the Display key on the main screen then the system will enter the trend screen as shown in Figure 4 11 Fight channel real time waveforms and trend graph can be viewed on th
69. ees visual and audible alarm function User Manual for Patient Monitor lt gt Flexible high and low alarm limits setting function lt gt Easy to color code and change the color of the font background and waveforms if needed lt Cardiac pacemaker restraining function enables to be used along with cardiac pacemaker lt gt Protection against defibrillator and resistance against the interference from electrosurgical unit lt Blood pressure may be measured in the mode of adult infant neonate which may be selected via the menu to better suit the adult infant and neonatal patient lt gt CO and IBP measuring functions are optional lt gt Built in printer to output waveforms and text 1 2 Product Name and Model Product name Patient Monitor Model UP 9000 1 3 Scope of Application UP 9000 Patient Monitor is designed for monitoring patient s ECG respiration value body temperature value non invasive blood pressure value pulse oxygen saturation value pulse rate and other physiological parameters This equipment is applicable for use in major medium and small sized hospitals clinics and health practitioner s office etc medical unit The operation should be performed by qualified professionals only 1 4 Operating Environment 1 Ambient temperature range 5 40 C Relative humidity 30 80 Atmospheric pressure 70kPa 106kPa Power supply 100 240VAC Power frequency 50 60Hz This device should be s
70. elines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 65 User Manual for Patient Monitor Chapter 8 Packaging and Accessories 8 1 Packaging The product is packed in high quality corrugated cartons with foam inside to protect the apparatus against damage in the handling process Gross weight Details see the indication on the outer package Dimension 500 L x320 W x460 H mm 8 2 Accessories 1 ECG lead cable One set 2 NIBP cuff One set 3 SpO probe One piece 4 Body temperature probe One piece 5 Power supply cable One piece 6 Equipotential grounding wire One piece 7 Disposable electrode Ten pieces 8 User Manual One copy 9 Warranty One copy 10 Quality certificate One copy 11 Assembly report Two copies 12 Dustproof mantle One set 13 Printing paper optional Ten rolls 14 CO accessories optional For Mainstream For Sidestream Mainstream sensor One set Sidestream Sensor One set CAPNOSTAT 5 LoFlo C5 Airway adapter One piece Sampling Line Kit One set Note The accessories are subject to change Detailed items and quantity see the Packing List 66 User Manual for Patient Monitor Chapter 9 Parameters Monitoring 9 1 ECG Monitoring 9 1 1 How to Obtain High Quality ECG and Accurate Heart Rate Value The electrocardiogram ECG or EKG is primarily a tool for evaluati
71. erence Value of TEMP II Figure 4 7 TEMP Data Area lt TEMP 1 2 TEMP label 1 TEMP I 2 TEMP II lt gt 36 5 37 5 the value of temperature lt gt TD the label of temperature difference lt gt 1 0 Absolute value of TEMP I and TEMP II 2 1 gt gt lt gt User Manual for Patient Monitor RR E1C07 Ins AI Figure 4 7 Respiration Data Area RR Respiration Rate The bpm after that is the unit of the respiration 1 e beat per min 14 Respiration rate value ae Respiratory Sync Mark EtCO2 The label and the value will become gray when CO is turned off 39 4 is EtCO2 value Ins The label of the minimal inhalational CO the label and the value will become gray when CO is turned off 2 9 is InsCO2 value X1 Respiration waveform gain amplification x1 2 Waveform scaled with half of the base gain I Waveform scaled with base gain x2 Waveform scaled with twice of the base gain x4 Waveform scaled with four times of the base gain a7 User Manual for Patient Monitor 4 2 Display2 Screen 4 2 1 Viewing Screen Choose Obser of Disp2 on system setup screen press the Display key to enter the monitoring screen as shown in Figure 4 9 Alarm LE HR SpQ2 RR NIBP mmHg PR 37 6 44 126 85 92 63 Pleth RESP x Push Display to exit BD gt VER3 16 1 15 gt Figure 4 9 Viewing Screen In this scr
72. erformance is observed additional measures may be necessary such as re orienting or relocating Patient Monitor b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3V m 64 User Manual for Patient Monitor Table 4 Recommended separation distances between portable and mobile RF communications equipment and The equipment or system for EQUIPMENT and SYSTEM that are not LIFE SUPPORTING Patient Monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the equipment or system can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the equipment or system as recommended below according to the maximum output power of the communications equipment Separation distance according to frequency of transmitter Rated maximum output power of 150kHz to 80MH 80MH7 to 800MHz 80MHz to 2 5GHz transmitter For transmitters rated at a maximum output power not listed above the recommended separation distance d in metres m can be determined using the equation applicable to the frequency of the transmitter where p is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer NOTE 1 At 80 MHz and 800 MHz the separation distance for the higher frequency range applies NOTE 2 These guid
73. ethod has the worst accuracy when it comes to measurement of hypotension while the oscillating method has worse accuracy when it comes to measurement of controlled hypertension relief 9 2 2 Factors affecting NIBP measuring Like common non invasive blood pressure measurement improper operation may cause inaccurate or blank result or misunderstanding of the measuring information when the oscillating method is used to take the measure of blood pressure This point needs particular attention of the operators 1 Requirements of the cuff 1 Appropriate cuff should be selected according to the age of the subject For more information see Chapter 3 2 Remember to empty the residual air in the cuff before the measurement is commenced 66 99 3 Locate the cuff in such a way that the q mark is at a location where the clearest pulsation of brachial artery is observed 4 The cuff should be tightened to a degree where insertion of one finger is allowed 5 The lower end of the cuff should be 2cm above the elbow joint 2 The subject should lie on the back so that the cuff and the heart are in a horizontal position and the most accurate measure 1s taken Other postures may lead to inaccurate measurement 3 Do not speak or move before or during the measurement Care should be taken so that the cuff will not be hit or touched by other objects 4 The measures should be taken at appropriate intervals Continuous measurement at too short i
74. f the following conditions exist Sensor under temperature Temperature not stable Source Current unstable This error occurs whenever the pneumatic pressure is outside the expected range One of the following conditions exist Zero Required Zero Required Zero Error The value being calculated is greater than the upper CO limit 150 mmHg 20 0 kPa or 19 7 The maximum value output is the upper CO limit Usually caused when the airway adapter is removed from the sensor or when there is an optical blockage on the windows of the airway adapter May also be caused by failure to perform sensor zero to when adapter type is changed This is prompted if the CO sensor is not ready for a Capnostat Zero If the Zero Required and this massage both prompt message both promptone or more of the following conditions may exist e Breaths detected e Temperature is not stable e Source Current unstable e In sleep mode Zero in already progress Normal zero calibration is in already progress Zero Fault and Breaths Detected Zero attempted and breaths have been detected in the last 20 seconds Zero calibration is successful 82 User Manual for Patient Monitor 12 6 Typical Pressures and CO Readings at Altitudes Barometric Pressure mmHg 83 User Manual for Patient Monitor 12 7 Accessories List 1 ECG cable One set 2 NIBP cuff One piece 3 SpO probe One piece 4 Body surface temperature transdu
75. g value o Moe aqu ttt Neonate AA PAMPANG 10 mmHg sai 00 mme ma acre High limit 200mmHg 160mmHg 140mmHg aan l 10mmHg High limit i 40mmhe Pressure l ni l ni l on High Timi l ni ni l r High limit 50mmiig i l ni Sat 10mmHg Pulmonary 00mm Preso omg er 10mmHg High limit 90mmHg gt l So 10mmHg sys High limit 30mmHg 30mmHg 30mmHg KI High limit 30mmHg 30mmHg 30mmHg Venous DIA High binan 30mmHg 30mmHg 30mmHg Pressure High bung 30mmHg 30mmHg 30mmHg Respiration High limit Rate re SIR User Manual for Patient Monitor The high and low limits setting range Tow limit _ Respiration ER Pulse Rate TEE MATTER Temperature Ditorenee 00500 0050c osso Na Venous Diastolic a Artery Central 79 User Manual for Patient Monitor 12 3 Abbreviation of Arrhythmia NE NN NG Ng ho ua 2 a A A A A a a gt O N AMA Se O ECG TACHY ECG BRADY ECG ARREST MISS BEAT VE EARLY SVE EARLY VE COUPLET SVE COUPLET VE RUN SVE RUN VE SHORT RUN SVE SHORT RUN VE BIGEMINY SVE BIGEMINY VE TRIGEMINY SVE TRIGEMINY VE INSERT SVE INSERT VE RONT SVE RONT 80 User Manual for Patient Monitor 12 4 Status Error during NIBP Monitoring Cuff error Air leak Pressure error Signal weak Over extent Over motion Signal overflow Leak in gas run System error Adult Infant
76. gation knob to move the cursor to the option which needs to be calculated press the knob and rotate it to obtain calculating value When the calculating value is selected the calculated value will be displayed in corresponding position Each calculating option has limit range if the result exceeds range it will display LA LA ja gt On MC analysis screen other menu options cannot enter value unless entering patients weight and medicine name again in default status it is no effective The values in system is a group of stochastic initial values the operator should not consider it as calculating standard please follow doctor s device enter a group values which are suitable for patient The unit of every medicine is settled unit or unit series The operator must select the appropriate unit according to doctor s device In a unit series unit carry performs automatic adjustment along with the current entering value When exceeding the range of this unit expression the system will display When the operator finishes one option entering the system will give visible indication in menu to remind operator to check the correctness of entering value Under neonate mode DS and Drop are useless For every new entering value please perform confirming The operator should take it seriously only when the entering is correct the calculating result is believable and reliable Select Medicine Type Move the
77. he sensor Adjust the finger to be placed evenly on the middle base of the sensor Direct the cable along the top of the patient s hand Apply adhesive tape to secure the cable B If an index finger cannot be positioned correctly or 1s not available other fingers mac a e can be used Xy Fn pa TY HUN 3 Plug the sensor into the PRE gg Y oximeter and verify F See ng proper operation as 7 Ss described in the user manual A dl 4 Inspect the monitoring site every 1 2 hours for skin integrity Cleaning amp Disinfection Unplug the sensor before cleaning or disinfecting Surface clean sensor and cable with a soft gauze pad by saturating it with a solution such as 70 isopropyl alcohol If low level disinfection is required use a 1 10 bleach solution Caution Do not sterilize by irradiation steam or ethylene oxide Warnings 1 This sensor is for use only with compatible patient monitors or pulse oximeter devices Use of this sensor with instruments other than compatibles may result in improper performance 2 Some factors may affect the accuracy of saturation measurements Such factors include excessive patient motion fingernail polish use of intravascular dyes excessive light poorly perfused finger extreme finger sizes or improper placement of the sensor 3 The sensor site must be checked for skin integrity at least every 1 2 hours Because individual skin condition affects the ability of the skin to
78. iance level guidance Floors should be wood concrete or ceramic tile 1f floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment If the user of the equipment or system requires continued operation during power mains interruptions it is recommended that the equipment or system be powered from an uninterruptible power supply or a battery Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment User Manual for Patient Monitor Table 3 Guidance and manufacturer s declaration electromagnetic immunity for EQUIPMENT and SYSTEM that are not LIFE SUPPORTING Patient Monitor is intended for use in the electromagnetic environment specified below The customer or the user of Patient Monitor should assure that it is used in such an electromagnetic environment IMMUNITY test IEC 60601 test level a Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to any part of Patient Monitor including cables than the recommended separation distance calculated from the equation applicable to the frequency of
79. ificant error of blood pressure measurement or even no measurement result caused by air leakage in the pneumatic system including the cuff during measuring it 1s recommended to check if there is leak in the pneumatic system as well LA Please remove the cuff from patient while performing the leakage check Safety Instructions for NIBP Monitoring 6 When taking the measure of an infant or neonate s less than 10 years old blood pressure do NOT operate in the adult mode The high inflation pressure may cause lesion or even body putrescence It is recommended to take the blood pressure measurement manually Automatic or continuous measurement should be taken at the presence of a doctor nurse NIBP monitoring is prohibited to those who have severe hemorrhagic tendency or with sickle cell disease or partial bleeding will appear Do NOT bind NIBP cuff on limbs with transfusion tube or intubations or skin lesion area otherwise damages may be caused to the limbs Pay attention to the color and sensitivity of the limb when measuring NIBP make sure the blood circulation is not blocked If blocked the limb will discolor please stop measuring or move the cuff to other positions Doctor should examine this timely The time of the automatic pattern noninvasive blood pressure measurement pulls too long then the body connected with the cuff possibly have the purpura lack the blood and the neuralgia When guarding patient it is a m
80. is screen Alarm FE 150 HR CAS Time 17 14 35 o Il 45 0 TEMP CAS 25 0 Il 100 spo CAS 80 Pleth ka TEMP 1 NORR RESP FAST A a 0 9 05h 1 n Figure 4 11 Eight Channel Real time Waveforms and Two Hours Trends On this screen the first channel waveform is ECG waveform of Lead Il the second CAS one is the continued ECG for the first channel waveform the third one is ECG waveform of Lead I the fourth one is the continued ECG for the third channel waveform the fifth one is IBP1 waveform the sixth one is IBP2 waveform the seventh one 1s SpO waveform the last channel is respiration waveform On the right of waveform area from the top down respectively is heart rate temperature SpO2 IBP1 IBP2 EtCO trend graph the abscissa of trend graph 2h 0 means various trend of every parameter value from now on to two hours before waveform in trend graph shifts from right to left On this screen press Lead key can perform switching ECG Lead status the changing regulation of leads is the same with the leads operation on the main screen 4 2 4 Operating Instructions In the above monitoring screens the operator can perform freeze normal print and the blood pressure etc measurement in addition print and blood pressure measurement can be operated at the same time When pressing the Display key again on the front panel the system returns to the main screen 25 User Manual for Patient Monitor 4 3 Freeze a
81. issue can reflect the structure character of the tissue by which the light passes Due to that oxygenated hemoglobin HbO gt and deoxygenated hemoglobin Hb have different absorption character in the spectrum range from red to infrared light 600nm 1000nm wavelength by using these characteristics SpO can be determined SpO measured by this monitor is the functional oxygen saturation a 70 User Manual for Patient Monitor percentage of the hemoglobin that can transport oxygen In contrast hemoximeters report fractional oxygen saturation a percentage of all measured hemoglobin including dysfunctional hemoglobin such as carboxyhemoglobin or metahemoglobin 9 3 2 SpO Measurement Restrictions interference reason l The fingers should be properly placed see the attached illustration of this instruction manual or else it may cause inaccurate measurement result Make sure that capillary arterial vessel beneath the finger is penetrated through by red and infrared lights The SpO sensor should not be used at a location or limb tied with arterial or blood pressure cuff or receiving intravenous injection Do not fix the SpO sensor with adhesive tape or else it may result in venous pulsation and consequential inaccurate measurement result of SpO Make sure the optical path is free from any optical obstacles like adhesive tape Excessive ambient light may affect the measuring result It includes fluorescent lamp
82. ituated in a place protected against direct sunlight so as to prevent overheat inside it Do not use this device in an environment with toxic or inflammable gas This device should be fixed on a stand so as to prevent possible shock Do not use with any equipment other than those expressly permitted in these instructions Ph MINE a NO When using this device with electrosurgical equipment the user doctor or nurse should pay attention to the safety of patient 7 Make sure that the equal potential grounding terminal is grounded correctly 8 Do not use mobile phone nearby so as to avoid strong radiant field interference 1 5 Impact on the Environment and Resources Low EI User Manual for Patient Monitor 1 6 Safety a This device conforms to IEC60601 1 electric safety classification Class I with Type BF and CF applied parts b This device can resist against the discharge of defibrillator and the interference of electro surgical unit c This device can monitor the patients with pace maker d DO NOT use this device while the patient 1s under MRI scanning User Manual for Patient Monitor Chapter 2 Working Theories 2 1 Overall Structure The overall structure of the monitor 1s shown as Fig 2 1 20100240 Operation buttons rer Power Supplycincluding Buttons LCD Display EG battery supports each 1 7 j part s power Central Processing o l Electrocardiogram 4 Non invasive Blood Pulse Oxyen CO
83. la kits 1 T connector sampling cannula kits Adapter 2 Nasal Sidestream Cannula Kits ne AA Y 3 Oral Sidestream Cannula Kits 50 User Manual for Patient Monitor 5 2 2 Mainstream CO Sensor Connection Sensor cable AD a Adapter 9 i CO sensor Demonstration for Mainstream CO Sensor Connection 1 Take out the CO Sensor and insert the CO Sensor Cable into the connector labeled CO on the connector panel of the monitor 2 Snap the CO sensor onto the airway adapter as shown in Figure 6 9 A click will be heard when the airway adapter is properly inserted 3 Position the airway adapter in the patient s respiratory circuit as close to the patient as possible between the endotracheal tube and the ventilator circuit Next turn on the CO switch at CO Setup Screen and then wait 2 minutes for the sensor warm up Safety Introductions for CO Monitoring Sensor Cable Mainstream A CO Sensor CO Sensor is a precision measuring part please use it correctly and store it properly Precautions for electrostatic discharge ESD and electromagnetic interference EMI to and from other equipment Failure of Operation If the CO Sensor fails to respond as described in this user manual DO NOT use it until approved for use by qualified personnel DO NOT position the sensor cables or tubing in any manner that may cause entanglement or strangul
84. ling tube with the tubes upward to avoid the affects of excessive moisture Altitudes are different in different area so set the Barometric Pressure setting value as the ambient barometric pressure Use only our company approved accessories While using the CO sensor a system leak that may be caused by an uncuffed endotracheal tube or a damaged CO sensor may significantly affect flow related readings These include flow volume pressure and other respiratory parameters When stopping CO monitor please disconnected the CQ sensor from the patient monitor 52 User Manual for Patient Monitor Disposal of the CO Sensor and its accessories should comply with national and or local requirements In the presence of electromagnetic devices i e electrocautery patient monitoring may be interrupted due to electromagnetic interference Electromagnetic fields up to 20 V m will not adversely affect system performance Nitrous oxide elevated levels of oxygen helium and halogenated hydrocarbons can influence the CO measurement Excessive moisture in the CO may affect the accuracy of the flow measurement 5 3 CO Monitoring Screen Alarm 19 19 ADUL MON 2009 05 19 1 14 32 00 ST 0 039 mY x 1 TEMP 1 2 TD 36 6 37 0 0 4 NIBP mmHg 17 28 PR 127 85 98 62 ADUL MANU R Spo2 ECG XI Crt Hi Pletha AG SINE WO Mei ART a ge ye 50 162 120 141 DJ A Y di
85. n XI Unit RR Hi EtCO2Hi 70 0 ins Hi Lo Lo Lo Baro Zero OFF Flow gt Le 888 ORG 1886 BF 402 CO Parameter Settings 1 ty hy Apnea Period 105 TEMP 35 0 02 Compen Balance Air Agent LE PA 11 1 80 LAF 88 9 7 CO Parameter Settings 2 NOTE CO parameter setting screen will be displayed in two pages Focus the gray cursor on gt then press the navigation knob to enter the second page where the operator can set some other parameters about CO as shown in above figures lt gt Switch choosing the mode of CO It is recommended that the switch is turned on only when there is a need to monitor CO parameter This can not only reduce the power consumption and also extend the life of the CO module In order to maintain the monitor please set CO switch at OFF state in system setup when CO function is not used lt gt Gain the CO waveform gain lt P Unit Choosing the EtCO and the minimum InsCO It can be set up as kPa mmHg and 47 User Manual for Patient Monitor lt gt Respiration Rate High Setting the upper alarm limit of CO respiration rate Low Setting the lower alarm limit of CO respiration rate lt gt EtCO High Setting the upper alarm limit of EtCO Low Setting the lower alarm limit of EtCO lt gt InsCO High Setting the upper alarm limit of InsCO Low Setting the lower alarm limit of InsCO lt gt Baro Barometric pressure
86. n firstly then manually turn off the device and reboot 1t to make the new setting effective Note The Net Type will remain the last setting when the monitor is restarted lt gt Host IP The users should set the host IP IP number of the work station in the central monitoring system when the option of Net Type 1s NET If it is necessary to change the IP number as mentioned above the user should turn off the monitor manually and reboot 1t to make the new setting effective Port The port number to which the monitor will connect to the work station in the central monitoring system It can also be used to represent the patient bed number which can be set in the range from 6001 to 6064 e g the port number 6002 means the monitor 1s assigned to the bed number 2 in the CSM It is known that the work station can connect to up to 64 bedside monitors In order to make the new setting effective as mentioned above the user should power off and reboot monitor after change the port number Note 1 Make sure the work station and patient monitors are in the same local domain when using NET type network connection different monitor should be set to unique port number in case causing repeated bed number and failing to connect with the work station 2 Help symbol on monitor will give corresponding information prompts during the process of detecting and establishing network connection 4 User Manual for Patient Monitor
87. n of SpO List NIBP List TREND RCALL ARR SETUP COLOR FILE OXY MC and CUFF Start from Chapter 4 5 these modes are described in turn Press Display Key Exit to exit from this screen 4 5 SpO Trend List Screen Move the gray cursor to SpO gt List in the mode selection screen and press Navigation Knob to enter into SpO trend list screen displays in the same position shown as Figure 4 15 Time HR EtCO2 Ins RR TEMPI TEMP2 SpO2 PR 08 57 60 38 03 18 36 7 37 6 99 60 08 56 60 39 02 18 36 7 37 6 98 61 08 56 60 39 02 18 36 6 37 5 98 60 08 56 60 38 04 18 36 7 37 5 98 62 08 56 60 38 04 18 36 7 37 5 99 60 08 56 60 38 04 18 36 7 37 7 98 60 08 56 60 38 03 18 36 5 37 6 99 61 08 56 60 39 03 18 36 7 37 5 98 61 08 56 60 39 03 18 36 6 37 6 99 60 08 56 60 39 04 18 36 5 37 7 99 60 08 56 60 39 02 18 36 5 37 6 98 60 08 56 60 40 03 18 36 5 37 6 99 60 08 56 58 40 03 18 36 6 37 7 99 62 bh Figure 4 15 SpO List ETA User Manual for Patient Monitor 4 5 1 Screen Description In the SpQ list title bar the front color of SpO PR is the same with SpO gt parameters and other front color is white The operation on the trend listing is simple Using the Navigation Knob allows the user to scroll the list up and down When rotating the knob anti clockwise the list scrolls upward 1 e use the arrow to scroll the data When rotating knob clockwise the list scrolls down 1 e use the arrow to scroll the data Please note that
88. nd S T Segment Analysis Screen In the main screen press the Freeze key to freeze three channel ECG waveforms or all the waveforms on the screen as shown in Figure 4 12 warm I III II ST 0 000mv Set Base DIRC HOR Pleth RESP Time NIBP PR HR RR Spo2 PR TEMP1 2 p1 12 17 13 124 84 91 63 60 14 99 61 36 6 37 5 Ne p1 12 17 12 126 85 92 63 60 14 99 60 36 5 37 5 b1 12 17 12 129 88 95 60 60 14 100 61 36 5 37 7 TEMP1j2 b1 12 17 12 127 80 93 60 60 14 100 61 36 5 37 7 11 1217 12 124 81 98 63 60 15 99 60 36 5 37 6 p1 12 17 11 129 87 91 61 60 17 100 60 36 6 37 6 Figure 4 12 Frozen Screen 4 3 1 Screen Description Freezing S T segment analysis screen 1s similar with the main screen except the waveforms are frozen For example the Figure 4 13 1s a portion of the frozen waveform The symbols on the screen were described briefly on the screen Base Point Orientation l T a Lengthways Difference between set the shifted point to be set the direction Base Point and ST Point Base Point or ST Point horizontal or vertical AI Point Orientation Figure 4 13 Frozen Waveform A When the system setting for the freezing waveform is ALL the Freeze key will freeze all the waveforms 96 User Manual for Patient Monitor 4 3 2 Operation Instruction The operator can use the Navigation Knob to analyze the S T segment waveform 1 e measuring the difference between the S T segment value and the referenced valu
89. ng the electrical events within the heart The action potentials of cardiac muscle cells can be viewed as batteries that cause charge to move throughout the body fluids These currents represent the sum of the action potentials occurring simultaneously in many individual cells and can be detected by recording electrodes at the surface of the skin The figure below shows the system of the heart Sinoatrial Node p p ii Left Atrium ISAN en TE i C HIS Bundle Right Atrium F Naia Ja ae Left Bundle i Po Branch LBB Atrioventricular Node PA Pa y Left Posterior AVN 2 A Ca BP u Fascicle LPS Right Bundle mag Branch RBB Left Ventricle Left Anterior Fascicle LAF Right Ventricle Purkinje Fibers PF First of all the hospital should be equipped with a 100 250V power supply system with a typical grounding wire If big interference in ECG continues connect one end of the grounding wire provided with this equipment to the grounding wire on the back panel of this monitor and the other end to the special grounding wire water pipe or radiator A common ECG plate electrode used together with this monitor has short shelf life Generally the shelf life 1s only one month after the package is opened When outdated plate electrode is used due to skin s contact impedance and big electrode potential the chance of interference will be increased and the ECG baseline will have an unstable inclination Therefor
90. nstructions 4 Skin clean gt Clean and dry abrade skin to ensure low sensor impedance Mild soap and Water is recommended as a skin cleanser Note Alcohol is not recommended as a skin cleanser for it leaves a film layer that may cause high sensor impedance If alcohol 1s used ensure 30 second dry time gt Dry abrading the skin gently with a dry wash cloth gauze for skin preparation is helpful to remove the 19 The locations of the electrode are in the following Figure non conductive skin layer The symbol indicates that the cable and accessories are designed to have special protection against electric shocks and 1s defibrillator proof Figure 3 5 Electrode Location Note If skin rash or other unusual symptoms develop remove electrodes from patient 5 After starting the monitor 1f the electrodes become loose or disconnected during monitoring the system will display LEAD OFF on the screen to alarm the operator 4A It might not display ECG wave with 3 leads Five leads should be used to have ECG wave 10 User Manual for Patient Monitor 6 The ECG leads and their corresponding locations are as follows Symbol Position RA The intersection between the centerline of the right clavicle and Rib 2 The intersection between the centerline of the left clavicle LA l and Rib 2 LL Left part of the upper abdomen RL Right part of the upper abdomen C1 V1 C V C2 V2
91. nt Monitor 4 1 2 Screen Description Alarm KC 16 16 ADUL MON 2011 06 20 16 36 04 1 Il S T 0 098 my NIBP mmHg pi PR a 16 29 4 22 97 28 ln da dn sn Ja da da ad Au MANO PR 5p02 60 98 pol UA A Va J N A N 1 i A f f A a j Ny J h N f N N a N Wg 7 nn ma hv 7 gt Nad 2 Mud A Time NIBP PR HR RR SP02 PR TEMP1 2 06 20 16 35 127 80 99 61 60 15 100 62 36 5 37 5 0 06 20 16 34 121 84 90 63 62 15 99 62 36 7137 7 06 20 16 33 124 81 90 60 62 14 99 60 36 7 37 5 TD TEMP 1 2 06 20 16 32 126 85 91 60 62 14 100 60 36 5 37 6 36 5 06 20 16 31 128 85 94 64 62 14 99 62 36 5 37 6 06 20 16 30 129 83 95 63 60 15 100 62 36 5 37 6 1 0 37 5 Figure 4 2 Main Screen Navigation knob has two functions in main menu screen 1 Long time press the navigation knob about 3 seconds to enter system menu screen 2 Rotate navigation knob to choose corresponding parameter area circularly in data area short time press navigation knob about 1 second to enter corresponding parameter setting screen That is to say adding the shortcut operation on the main screen it is convenient to set each parameter s menu Border area Alarm 225 22 shows the alarm is ON and Lt shows the alarm is OFF the numbers after CA ig the time when the alarm will on The alarm will be activated automatically after the system finishes counting down lt gt ADUL The patient type
92. ntervals may lead to pressed arm reduced blood flow and lower blood pressure and resulting inaccurate measure of blood pressure It is recommended the measure be taken at intervals of more than two minutes 5 With the oscillating method when blood pressure is measured the inflation pressure of the cuff will be automatically adjusted according to the previous measure Generally the initial inflation pressure is 180mmHg for the adult mode or 100mmHg for the infant mode or 80 mmHg for the neonate mode when it is powered on Following that 50mmHg for the adult mode or 30mmHg for infant mode or 1OmmHg for the neonate mode will be added on the basis of the last measurement of systolic pressure In this way when the blood pressure rises or the subject is changed the blood pressure meter may fail in giving the result after the first time inflation This monitor will automatically adjust the inflation pressure until the measure is taken after that up to four measures will be allowed 6 When an adult subject is monitored the machine may fail in giving the blood pressure measure 1f the infant or neonate mode is selected 69 User Manual for Patient Monitor 9 2 3 Clinical Limitations 1 Serious angiospasm vasoconstriction or too weak pulse 2 When extremely low or high heart rate or serious arrhythmia of the subject occurs Especially auricular fibrillation will lead to unreliable or impossible measurement 3 Do not take th
93. o harm to the eye If the monitor falls off accidentally please do NOT operate it before its safety and technical indexes have been tested minutely and positive testing results obtained It is recommended to take the blood pressure measurement manually The automatic or continuous mode should be used at the presence of a doctor nurse Reuse disassembly cleaning disinfecting or sterilizing the single patient use CO cannula kits and on airway adapters may compromise functionality and system performance leading to a user or patient hazard Performance is not guaranteed if an item labeled as single patient use is reused Electrical Shock Hazard Always disconnect the CO Sensor before cleaning Do NOT use if it appears to have been damaged Refer servicing to qualified service personnel Electrical Shock Hazard No user serviceable parts inside the CO Sensor After the life cycle of the Sidestream CO Sensor and its accessories has been met disposal should be accomplished following national and or local requirements Please peruse the relative content about the clinical restrictions and contraindication When disposing of the monitor and its accessories the local law should be followed TV User Manual for Patient Monitor Table of Contents CHAPTER LOVERVIE W TN 1 NN 1 PRODUCT NAMBAND MODELA AAA AAA 2 LS SCOPE OF APPLICATION A al 2 EOP RATING ENY RONMENT a ANA AA AN 2 1 5 IMPACT ON THE ENVIRONMENT AND RESOURCES 00000
94. od pressure cuff or intravascular infusion line 3 Spread open the rear tabs of the sensor to provide even force over the length of the pads B 4 The sensor should be oriented in such a way N that the cable is a LAG En positioned along the top of the hand C 5 Plug the sensor into the oximeter and verify proper operation as described in the user manual C 6 Inspect the monitoring site every 1 2 hours for skin integrity 7 Before each use surface clean sensor and cable with a soft gauze pad by saturating it with a solution such as 70 isopropyl alcohol If low level disinfection is required use a 1 10 bleach solution Caution Do not sterilize by irradiation steam or ethylene oxide Warnings 1 Some factors may affect the accuracy of saturation measurements Such factors include excessive patient motion fingernail polish use of intravascular dyes excessive light poorly perfused finger extreme finger sizes or improper placement of the sensor 2 Using the sensor in the presence of bright lights may result in inaccurate measurements In such cases cover the sensor site with an opaque material 3 The sensor must be moved to a new site at least every 3 hours Because individual skin condition affects the ability of the skin to tolerate sensor placement it may be necessary to change the sensor site more frequently with some patients If skin integrity changes move the sensor to another site 4 Do not
95. of this monitor when monitoring this kind of patients The improper connection with electrosurgical unit may not only cause burns but also damage or arouse deviations of measurement You can take some steps to avoid this situation such as do NOT use small ECG electrodes choosing the position which is far away from the estimated Hertzian waves route using larger electrosurgical return electrodes and connecting with the patient properly No predictable hazard will be caused by the summation of leakage currents when several items of monitor are interconnected ECG leads may be damaged while using defibrillator If the leads are used again please do the functional check first 3 3 2 Blood Pressure Cuff Connection 1 Connect the cable to the right panel connector marked with the NIBP icon 2 Unveil and wrap the cuff around patient s upper arm Requirements of the cuff 1 Appropriate cuff should be selected according to the age of the subject Its width should be 2 3 of the length of the upper arm The cuff inflation part should be long enough to permit wrapping 50 80 of the limb concerned See the table below for the dimensions Note The size of the cuff selected should suit the subjects while measuring EHE User Manual for Patient Monitor Cuff Model Cuff Width Neonate Cuff 6 0cm 9 5cm Middle sized Infant Cuff 10cm 19cm Large sized Infant Cuff 18cm 26cm 2 When putting on the cuff unveil and wrap it around the u
96. open the rear tabs of the sensor to provide even force over the length of the pads B The sensor should be oriented in such a way that the cable is positioned along the top of the hand C Plug the sensor into the ETT ert oximeter and verify proper ca Ea gr operation as described in va Fed 2 the user manual Inspect the monitoring site B LC every 1 2 hours for skin integrity Before each use surface clean sensor and cable with a soft gauze pad by saturating it with a solution such as 70 isopropyl alcohol If low level disinfection is required use a 1 10 bleach solution Caution Do not sterilize by irradiation steam or ethylene oxide Warnings 1 Some factors may affect the accuracy of saturation measurements Such factors include excessive patient motion fingernail polish use of intravascular dyes excessive light poor blood perfusion in the finger extreme finger sizes or improper placement of the sensor 2 Using the sensor in the presence of bright lights may result in inaccurate measurements In such cases cover the sensor site with an opaque material 3 The sensor must be moved to a new site at least every 3 hours Because individual skin condition affects the ability of the skin to tolerate sensor placement it may be necessary to change the sensor site more frequently with some patients If skin integrity changes move the sensor to another site 4 Do not apply tape to secure the sensor in place or to tape
97. optical output power less than 2mW maximum average 2 SpO measuring range 35 100 3 SpO measuring accuracy not greater than 3 for SpO range from 70 to 100 NOTE accuracy defined as root mean square value of deviation according to ISO 9919 4 Low perfusion performance the declared accuracy is sustained when the pulse amplitude modulation ratio is as low as 0 4 7 6 Pulse Rate Monitoring 1 Pulse rate measuring range 30bpm 240bpm 2 Pulse rate measurement accuracy 2bpm or 2 whichever is greater 7 7 CO Monitoring 1 Technology Infrared absorption method 2 Mode of Sampling Sidestream or Mainstream 3 CO Response Time Sidestream lt 3seconds including transport time and rise time Mainstream lt 60ms rise time 4 Warm up Time Not less than two minutes 5 CO measurement range 0 150mmHg 6 CO Accuracy 0 40mmHg 2mmHg 41 70mmHg 5 of reading 71 100mmHg 8 of reading 101 150mmHg 10 of reading NOTE Gas temperature at 25 C for Sidestream Gas temperature at 35 C for Mainstream 7 Flow rate S0ml min 10 ml min Sidestream 7 8 Data Recording 1 Sensitivity selection tolerance 5 60 User Manual for Patient Monitor 2 Recording speed 25 mm s 3 Recording speed accuracy 10 4 Hysteresis 0 5mm 5 Frequency response Monitoring mode 0 5 40Hz Diagnostic mode 0 05 75Hz 6 Time constant Monitoring mode gt 0 3s Diagnostic mode gt 3 2s 7 9 Other Technical Specifica
98. pper arm evenly to appropriate tightness 3 Remember to empty the residual air in the cuff before the measurement is commenced 4 Locate the cuff in such a way that the q mark is at a location where the clearest pulsation of brachial artery is observed 5 The cuff should be tightened to a degree where insertion of one finger is allowed 6 The lower end of the cuff should be 2cm above the elbow joint Figure 3 6 Cuff Position gt Pressure Accuracy Verification Pressure Accuracy Verification is a function to inspect the accuracy of pressure measurement by the NIBP module inside the device Technician or equipment manager should do pressure accuracy verification every half year or year in order to check 1f the pressure measurement still conforms to the requirement of product performance If the deviation is beyond the declared specification it is permitted to return it to factory for repair or calibration Before verification please connect the monitor to a standard pressure meter as the reference equipment like a mercury pressure meter 133901 91055910 poojq Amasa NIBP cuff with dual air tuhe Air tube Agr vert module testing NIBP module software inside of UP 9000 Manual valve A Inflatable balloon Figure 3 7 Connection of Pressure calibration fixture Increase the pressure manually through the inflatable balloon EC User Manual for Patient Monitor Mode 1
99. r e Complies emissions IEC61000 3 3 62 User Manual for Patient Monitor Table 2 Guidance and manufacturer s declaration electromagnetic immunity for all EQUIPMENT AND SYSTEMS Patient Monttor 1s intended for use in the electromagnetic environment specified below The customer or the user of the equipment or system should assure that it is used in such an environment Immunity test Flectrostatic discharge ESD IEC61000 4 2 Electrical fast transient burst IEC61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and voltage variations on power supply input lines IEC61000 4 11 Power frequency 50Hz 60Hz magnetic field IEC61000 4 8 IEC60601 test level 6 kV contact 8kV air 2kV for power Supply lines 1 kV for input output lines 1kV line s to line s 2kV line s to earth lt 5 Ur gt 95 dip in LU for 0 5 cycle 40 Ur 60 36 dip in Ur for 5 cycles 70 Ur 30 36 dip in Ur for 25 cycles lt 5 Ur gt 95 dip in Ur for s 6 kV contact 8kV air 2kV for power Supply lines 1 kV for input output lines 1kV differential mode 2kV common mode lt 5 Ur gt 95 dip in LU for 0 5 cycle 40 Ur 60 36 dip in Ur for 5 cycles 70 Ur 30 36 dip in Ur for 25 cycles lt 5 Ur gt 95 dip in Ur for s NOTE Uris the a c mains voltage prior to application of the test level re Electromagnetic environment Compl
100. r panel The following ports are at the rear panel of the monitor 1 MONITOR External display port 2 NET serial communication port which 1s used to network with central monitoring system 3 Y Equipotential ground port 4 FUSE 2XT3 15 A fuse holders fuse specification T3 15AL 250V P5 X20mm 5 AC100 240V Power supply socket 6 S N Serial number 7 Nameplate S N CIS EC REP Authorised representative in the European community FET Manufacturer including address and date Disposal of this device according to WEEE regulations ES 9 User Manual for Patient Monitor 3 3 Connection 3 3 1 ECG Connection ECG measurement is to collect the ECG signal via the ECG electrodes Electrode connects the patient and the lead The lead connects the monitor The locations of the electrodes are very important for obtaining accurate ECG signals 1 Connect the cable to the right panel connector marked with the ECG icon 2 Select electrodes to be used Use only one type of electrode on the same patient to avoid variations in electrical resistance For ECG monitoring it is strongly recommended to use silver silver chloride electrodes When dissimilar metals are used for different electrodes the electrodes may be subject to large offset potentials due to polarization Recovery time after application of defibrillator pulses may be especially compromised 3 Prepare the electrode sites according to the electrode manufacturer s i
101. ration of anesthetic gas The setting range 1s 0 0 20 0 the default status 1s not adding anesthetic gas that s to say the concentration 1s 0 0 2 To set the color of CO parameters on Color Settings screen 5 2 CO Sensor Connection 5 2 1 Sidestream CO Sensor Connection ue Pa 3 ven AN EN S s sample cell 2 52 CO Receptacle A Sensor Cable os Sidestream CO Sensor Sample cell Demonstration for Sidestream CO Sensor Connection 1 Take out the CO Sensor and insert the CO Sensor Cable into the connector labeled CO on the connector panel of the monitor 2 The sample cell of the sampling cannula must be inserted into the sample cell receptacle of the CO Sensor A click will be heard when the sample cell is properly inserted Then connect to airway tube After finishing sensor connection and make sure that the air input end is exposed to room air and away from all sources of CO including the ventilator the patient s breath and your own Next turn on the CO switch at CO Setup Screen and then wait 2 minutes for the sensor warm up 3 Default Tubing Configuration sampling dehumidification sampling sample jadapter tubing tubing filter Cell j f Adapter and Sampling tube Single patient use Extending airway tube for connecting to sampling tube Single patient use 49 User Manual for Patient Monitor Wye Connector 4 Optional sampling cannu
102. res in operating it Failure to operate it correctly can cause damage to the SpO probe Operation procedure 1 Connect the SpO probe to the right panel s jack labeled SpO When unplugging the probe be sure to hold the head of the connector and pull it out 2 Insert one finger into the probe index finger middle finger or ring finger with proper nail length according to the finger mark on the probe shown as below Figure 3 8 Demonstration for SpO probe When selecting a sensor do consider the patient s category adequacy of perfusion availability of probe site and anticipated monitoring duration Use only SpO gt probes provided by our company with this monitor Read the following table for SpO probe information Refer to Chapter 12 8 for the detailed instructions of each SpO probe SpO2 Probe Patient Category SpO2 Finger clip Sensor reusable Pediatric SpO2 Finger rubber Sensor reusable Adult SpO2 Finger clip Sensor reusable Adult 14 User Manual for Patient Monitor High ambient light sources such as surgical lights especially those with a xenon light source bilirubin lamps fluorescent lights infrared heating lamps and direct sunlight can interfere with the performance of an SpO sensor To prevent interference from ambient light ensure that the sensor is properly applied and cover the sensor site with opaque material Failure to take this action in high ambient light conditions may res
103. s properly grounded 10 3 No Blood Pressure and Pulse Oxygen Measures 1 Check if the blood pressure cuff is properly wrapped around the arm according to the operating instructions if the cuff leaks and if the inlet is closely connected with the NIBP jack on the side panel Check 1f the indicator of the pulse oxygen sensor flashes and if the pulse oxygen probe is properly connected to the SpO jack on the side panel 2 Tfthe problems still ex1st please contact the manufacturer 10 4 System Alarm 1 When the parameter value is higher or lower than the alarm limits the alarm will ring Please check whether the alarm limit value is proper or the condition of the patient 2 Leads off Please check the connection of the leads 3 Probe off Please check the connection of the probes Ea User Manual for Patient Monitor Chapter 11 Maintenance In case of trouble of this machine in the service follow the instructions below to eliminate the problem first If the attempt fails refer to the dealer in your local area or the manufacturer 11 1 Service and Examination 11 1 1 Daily Examination Before using the monitor the checks below should be carried out E Check the monitor for any mechanical damage E Inspect the exposed parts and the inserted parts of all the leads and the accessories Examine all the functions of the monitor that are likely to be used for patient monitoring and ensure that it 1s in good working condition
104. stolic pressure alarm MAP Hi Lo High and Low limits of mean arterial pressure alarm PR Hi Lo High and Low limits of mean arterial pressure alarm Unit The pressure unit mmHg and kPa can be selected The factory default is mmHg Mode The cuff inflation mode manual or automatic The factory default is manual The operator needs to press the NIBP button to perform NIBP measurement If the Auto mode is chosen the operator needs to set an interval cycle as well lt gt Cycle The inflation interval when the NIBP measurement is set to Auto The options are STAT 1 min 2 min 240 min Press NIBP and the system begins to count down It takes blood pressure measurement automatically after finishing counting down If STAT is selected press NIBP to take 5 minutes measurement lt Initial inflation pressure setting Cuff pressure to be inflated initially its options are different depending on patient type for neonate initial inflation pressure can be 60 70 80mmHg default setting 70 mmHg for infant initial inflation pressure can be 80 100 120 140 mmHg default setting 100 mmHg for adult initial inflation pressure can be 80 100 120 140 160 180 200mmHg default setting 150 mmHg lt gt NIBP Cali The NIBP Cali has three options NIBP Cali Mode 1 NIBP Cali Mode 2 and OFF Make sure the key is off with manual after the NIBP calibration or the user could not do other operations The factory default 1s OFF
105. t Monitor 9 4 2 Factors affecting respiration monitoring lt Place the white RA and red LL electrodes on the cross if the line between two electrodes in liver area or heart area the artificial error may occur lt Respiration monitoring doesn t support monitoring the patient who do much movement or may lead to wrong alarm 9 5 Temperature Monitoring The sensor is thermo resistor type 25 temperature of measured part through measuring the voltage There is a period responding time so the accurate temperature value display after a while The temperature monitoring can be divided into two measuring method measure through body surface temperature and through the temperature inside the body cavity placed in mouth or anus Normal value body surface 36 5 30 BTC inside body cavity 36 5 C Notes gt Attach the TEMP transducer to the patient generally if the TEMP transducer and skin doesn t contact closely the measured value becomes lower so for those who have requirement for temperature add a proper martial to transducer and fix it with adhesive tape to make them contact firmly gt Especially for pediatric patient they like sports pay more attention to the transducer fixing 9 6 CO Monitoring 9 6 1 Measuring Principle The principle is based on the fact that CO molecules absorb infrared light energy of specific wavelengths with the amount of energy absorbed being directly related to the CO concentration When an
106. t or the patient ID is changed the vertical axis will return to its original value of O 75 and 150 Other changes of vertical axis value in other trend graph are similar to that of ECG The Trend graph shows parameter value of the current time For example in the 8 hours trend graph when the monitoring time exceeds 8 hours the data 8 hours ago will be move out of the graph This ensures the screen always display the current data for review The data moved out of the graph is not deleted but is just hidden temporarily When the time frame changes from 8 hours to 24 hours while the monitoring time is less than 24 hours the complete set of data will display Other trend graphs follow the same rule The S T segment respiration rate body temperature and other trend graph are similar to that of ECG s and we will not cover them in detail again Please note that for those trend graphs the horizontal axis is the number of times the blood pressure measured instead of time Time HR RR SpO2 TEMPI TEMPI sT 09 12 51 60 14 99 86 7 875 TEMP35 0 25 0 09 03 Time HR RR po2 TEMPI TEMPI s7 09 12 57 60 14 99 36 7 975 ECG ST TEMP NIBP 5p 2 RESP gt gt Figure 4 20 Body Temperature Trend Graph 30 User Manual for Patient Monitor ST TEMP NIBP SpO RESP gt gt Time HR RR Sp02 TEMPITEMPI st 09 17 67 60 14 98 36 6 377 Time HR RR SpO2 T
107. t the MRI image or the monitor s accuracy If you have any doubt to the grounding layout and its performance you must use the built in battery to power the monitor All combinations of equipment must be in compliance with standard of IEC 60601 1 1 medical and electric system requirements Check SpO gt probe application site periodically every 30 minutes to determine circulation positioning and skin sensitivity The SpO measurement of this monitor may not work for all testees If stable readings cannot be obtained at any time discontinue using Do not immerse the monitor or its accessories in liquid to clean Do not use accessories other than those provided recommended by the manufacturer Each time the monitor is used check the alarm limits to ensure that they are appropriate for the patient being monitored The monitor is intended only as an adjunct in patient assessment It must be used in conjunction with clinical signs and symptoms When taking the measure of a pediatric or neonate s less than 10 years old blood pressure do NOT operate in the adult mode The high inflation pressure may cause lesion or even body putrescence The monitor is prohibited from applying to those who have severe hemorrhagic tendency or II User Manual for Patient Monitor who are with sickle cell disease for they may develop partial bleeding when this monitor is used to take the blood pressure measurement DO NOT take blood pressure m
108. the monitor and the other end to the grounded three phase power Jack 9 Connect the monitor to the grounding port with the provided ground cable Caution ensure that the monitor is grounded correctly A The provided battery of the monitor must be recharged after transportation or storage So if the monitor is switched on without being connected to the AC power socket it may not work properly due to insufficient power supply 3 1 3 Starting the Monitor The system performs self detection and enters initial display after switch on the monitor and the orange alarm indicator blinks to inform that the user can begin operating it Check all the applicable functions to make sure that the monitor works normally If the built in battery is applied please recharge it after the monitor is used to ensure sufficient power storage 6 Do not use the device to monitor the patient if the device appears obvious damage or indication of fault Please contact the local dealer or our company A After the monitor is switched off it s recommended to delay 1 minute to restart it Pa User Manual for Patient Monitor 3 2 Appearance 3 2 1 Front Panel Figure 3 1 Front Panel 1 Power switch Press it for 3 seconds to turn on or turn off the monitor 2 AC indicator When AC indicator is on it means this device is using mains power supply 3 Built in DC power indicator When DC indicator is on it means the battery is used when
109. tient Monitor Chapter 4 Monitoring Screen 4 1 Main Screen 4 1 1 Date and Time Setup Instead of entering into monitoring screen it shows the date and time setting screen immediately after the monitor is started shown as Figure 4 1 Time Setup pate 2006 08 17 Time 16 s 16 92 Figure 4 1 Date and Time Setup The system will stay on this screen for 10 seconds If you do not rotate the navigation knob within this period the screen will enter into the Main Screen Follow the steps below to set date and time Step 1 Rotate Navigation Knob move the gray cursor to Edit Step 2 Press the knob and then gray cursor stays on the Year of the date Press the knob again and the gray cursor becomes highlighted Rotate the knob left or right to increase or decrease the year value Step 3 When the Year is set press the knob to move the gray cursor to the Month of the date Step 4 Repeat Step 2 and Step3 to adjust the Year Month Date Hour and Minute Step 5 If you have finished adjusting the date and time press the knob and rotate the knob to move the cursor to Save press it to save the settings Then move the cursor to Exit press it to exit the date and time setting screen meanwhile enter into the main screen shown in Figure 4 2 The system is initialized and enters into Main Screen where monitoring and system operation are performed as shown in Figure 4 2 18 User Manual for Patie
110. ting the monitoring It is forbidden to use Adult type on the infant and neonatal patient or 1t can cause serious Injury lt gt Mode Monitor mode selection The Real Time shows the real time waveform i e normal monitoring state The Demo shows the demo waveforms In the demo state all the signals and data are generated from the patient monitor for demo and testing purpose The default is Real Time lt gt LANG The current language used which can be selected by the user There is no default for this setting However the setting can be saved lt gt Fill When the fill setting is ON the display fills the volume for the SpO and Respiration When it is OFF the system displays the line graph The default is OFF 35 User Manual for Patient Monitor lt gt Frze Pressed the key to freeze the selected waveform The options are All and ECG When ECG is selected the system only freezes ECG waveforms When All is selected the system freezes all the waveforms including ECG SpO and Respiration The factory default is ECG Disp2 The display 2 Three options Trend Obser Observation and 7 ECG 7 ECG lead can be selected The factory default is Observation lt gt VOL The sound volume The maximum volume is 7 and minimum is 0 i e no sound The default is 5 Key If the setting is ON the press of the button will generate a keystroke sound The factory is ON Net Type select net
111. tions 1 Power supply 100 240VAC 50 60Hz 2 Power consumption see the nameplate on the monitor 3 Display mode 12 1 inches TFT color LCD 4 Alarming mode Audible amp visible alarm 5 Communication Ethernet port 7 10 Classification Safety standard IEC 60601 1 The type of protection against electric shock Class I equipment The degree of protection against electric shock Type BF CF applied parts Electro Magnetic Compatibility Group I Class A 61 User Manual for Patient Monitor 7 11 Guidance and manufacturer s declaration Electromagnetic compatibility Table 1 Guidance and manufacturer s declaration electromagnetic emission for all EQUIPMENT AND SYSTEMS Patient Monitor is intended for use in the electromagnetic environment specified below The customer or the user of the equipment or system should assure that it is used in such an environment Emissions test Compliance Electromagnetic environment guidance RF emissions Patient Monitor uses RF energy only for its internal CISPR 11 function Therefore its RF emissions are very low and are Group 1 l not likely to cause any interference in nearby electronic equipment RF emissions Patient Monitor is suitable for use in all establishments CISPR 11 Class A other than domestic and those directly connected to the H public low voltage power supply network that supplies pe ford buildings used for domestic purposes Voltage fluctuations flicke
112. tions are observed Do not operate the CO Sensor when it is wet or has exterior condensation Monitor the CO waveform Capnogram If you see changes or abnormal appearance check the patient and the sampling line Replace line if needed DO NOT use device on patients that cannot tolerate the withdrawal of 50 ml min 10 ml min from the airway or patients that cannot tolerate the added dead space to the airway Do not apply excessive tension to any sensor cable or pneumatic tubing Explosion Hazard DO NOT use in the presence of flammable anesthetics or other flammable gasses Use of the CO Sensor in such environment may present an explosion hazard The power voltage over monitor working voltage may cause damage to CO sensor Likewise too low power voltage may affect the CO measuring accuracy or even make the CO sensor not work When changing sampling tube it is suggested to choose the default sampling tube with dehumidifying function The sampling tube without dehumidifying function may be easily blocked by excessive moisture Use life ordinary sampling tube 6 12 hours the sampling tube with dehumidifying function about 120 hours If the measurement appears abnormity caused by sampling tube block please replace it The total length of the sampling tube and extending airway tube shouldn t be longer than 3 meters too long may cause measurement abnormity If using T connector sampling cannula kits please insert the samp
113. tions 6 25mm s and 12 5 mm s The default is 12 5 mm s lt gt Type Respiration impedance gt Limits setup Move the gray cursor to the High or Low limits of the alarm settings and press the Alarm silence key to turn ON or OFF the alarm for the setting Yellow color shows ON status and gray color shows the OFF status 39 User Manual for Patient Monitor 4 10 2 Resume Default System parameters default key Move the cursor to DEF press the Navigation knob for 2seconds all the value of parameters will resume default except the setting of language and printer type 4 11 Color Settings screen In the mode selection screen move the gray cursor to COLOR and press the Navigation Knob to enter color setting screen shown in Figure 4 37 SPO NIBP H ime RESP TEMP BACK Figure 4 37 Color Settings In this screen rotate the knob to choose the color press and rotate it to change the color When the appropriate color is chosen press the knob again to save it Press the Exit to exit from this color settings screen 4 12 File Archive Management Screen In the mode selection screen move the gray cursor to FILE and press the Navigation Knob to enter document management screen shown in Figure 4 38 Patient Setup Device Setup ID Sex M Save OFF NetType prao Bed Age 30 Port Bee arene rovers OK The net type effected after reboot Do Figure 4 38 Document Management Screen The do
114. tolerate sensor placement 1t may be necessary to change the sensor to another finger 4 Do not use NIBP or other constructing instruments on same appendage as sensor for blood flow interrupted by NIBP cuff or circulatory patient condition will result in no pulse found or loss of pulse Do not use the sensor during MRI scanning 5 Carefully route cables to reduce the possibility of patient entanglement or strangulation 6 Do not alter or modify the sensor Alterations or modifications may affect performance or accuracy 7 Do not use the sensor if the sensor or the sensor cable appears damaged 86 User Manual for Patient Monitor Instructions for Adult SpO Finger Clip Sensor Intended Use When used with a compatible patient monitor or a pulse oximeter device the sensor is intended to be used for continuous non invasive functional arterial oxygen saturation SpO gt and pulse rate monitoring for patients weighing greater than 40kg Contraindications This sensor is contraindicated for use on active patients or for prolonged use Instructions for Use 1 With the upper and lower jaws open place an index finger evenly on the base of the clip Push the finger tip against the stop so that it 1s over the sensor window A If an index finger cannot be positioned correctly or 1s not available other fingers can be used 2 Note When selecting a sensor site priority should be given to an extremity free of an arterial catheter blo
115. ty is much higher than that of human ears the oscillating method uses different definitions for measurement of diastolic pressure mean arterial pressure and systolic pressure from the Korotkoff Sound Method When the oscillating method is used the circuit in the measuring apparatus will separate the amplitude of the cuff pressure from its change with pulsation With the oscillating method the blood pressure at the maximum amplitude of cuff pressure is defined as the mean arterial pressure The blood pressure at amplitude of cuff pressure forward reduced according to proper proportion is defined as systolic pressure while the blood pressure at amplitude of cuff pressure backward reduced according to proper proportion is defined as diastolic pressure The maximum change of pulse pressure occurs at these two points They are equivalent to the point with pulse sound and the point without pulse sound respectively in the Korotkoff Sound Method When the risk of invasive monitoring method outweighs its advantage of accuracy non invasive monitoring method shall be used Comparison between blood pressure measuring methods To overcome the effect of human hearing variation and air release speed on measurement accuracy when the conventional Korotkoff Sound Method is used to take measure of blood pressure people have been dedicated to study of automatic measurement of blood pressure By now automatic blood pressure measuring system based on the principle of os
116. ue indigo green and acid indigo blue or carbon monoxide hemoglobin COHb or methionine Me Hb or thiosalicylic hemoglobin and some with icterus problem the SpO determination by this monitor may be inaccurate The drugs such as dopamine procaine prilocaine lidocaine and butacaine may also be a major factor blamed for serious error of SpO measurements As the SpO value serves as a reference value for Judgment of anemic anoxia and toxic anoxia the measurement result of some patients with serious anemia may also present as good SpO value 9 4 Respiration Monitoring 9 4 1 Measuring Principle The air will be filled into alveolus or be expelled during respiration and the chest s volume changes with this process Because the conductivity of air is lower than body tissues the chest s impedance will be changed by the inflation With this specialization the respiration can be monitored through putting safe current into body and measuring the change of voltage between the electrodes The product will transmit the high frequency current whose frequency is much higher than ECG frequency but with the safe current limit to the ECG electrodes placed at the both sides of chest which can be detect ECG signal and chest s impedance at the same time and the respiratory rate will be measured through impedance method by the software So the additional electrodes for respiratory measurement are unnecessary Af User Manual for Patien
117. ult in inaccurate measurements If patient movement presents a problem verify that the sensor is properly and securely applied move the sensor to a less active site use an adhesive sensor that tolerates some patient motion or use a new sensor with fresh adhesive backing For reusable sensors follow the sensor directions for use for cleaning and reuse For single patient use sensors use a new sensor for each patient Do not sterilize any sensor by irradiation steam or ethylene oxide Safety Introductions for SpO Monitoring Continuous use of fingertip SpO sensor may result in discomfort or pain especially for those patients with microcirculatory problem It is recommended that the sensor should NOT be applied to the same finger for over two hours SpO measuring position must be examined more carefully for some special patient Do NOT install the SpO sensor on the finger with edema or fragile tissue pr WIN Do NOT put the SpO sensor and pressure cuff on the same limb otherwise the NIBP measuring will affect SpO measuring and cause the alarm error Do NOT use the damaged SpO sensor Please do not allow the cable to be twisted or bended Please do not use nail polisher or other cosmetic product on the nail The fingernail should be of normal length PD b Bb p The SpO sensor cannot be immerged into water liquor or cleanser completely because the sensor has no capability to resist the harmful ingress of water
118. ur trend After choosing Scan the trend graph display a triangle and a vertical line a moving ruler mark that can be moved by rotating the knob As shown in the figure when you move the mark to a specific point the data area below the graph will display the time and its corresponding heart rate respiration rate SpO gt temperature Itemperature I Wher rotating Navigation knob key to move the mark the moving interval is a changing value The rule is that the initial step is 1 after moving it towards the same direction 5 times the interval becomes 5 and with 5 more steps the interval becomes 10 then 20 and 40 No matter what the interval is as long as you move towards the other direction the interval becomes 1 of the other direction Therefore it is very easy to find the time you are looking for The last option on the right is Exit Move the cursor to the Exit and press the Navigation knob to return to the previous screen The screen returned to is the Mode Selection screen 29 User Manual for Patient Monitor Please note that the maximum value on the vertical axis of the ECG is 150 not the value of ECG upper limit 300 The graph is scaled down for better view of the waveforms When the ECG value exceeds 150 the vertical axis s maximum value will automatically change to 300 That is to say the vertical axis value 0 75 150 will change to 0 150 300 if ECG value exceeds 120 automatically When system gets rese
119. ust to inspect the luster the warmth and the sensitivity of the body far end SEE User Manual for Patient Monitor frequently Once any exception is observed please stop the blood pressure measurement immediately The subject should lie on the back so that the cuff and the heart are in a horizontal position and the most accurate measure will be taken Other postures may lead to inaccurate measurement Do not speak or move before or during the measurement Take care to avoid that the cuff will not be hit or touched by other objects The measurements should be taken at appropriate intervals Continuous measurement at too short intervals may lead to pressed arm reduced blood flow and lower blood pressure and resulting in inaccurate measure of blood pressure It 1s recommended the measure be taken at intervals of more than two minutes When an adult subject is monitored the machine may fail in giving the blood pressure measure if the infant mode is selected Prior to use of the cuff empty the cuff until there is no residual air inside it to ensure accurate measurement Do NOT twist the cuff tube or put heavy things on it When unplugging the cuff hold the head of the connector and pull it out The symbol indicates that the cable and accessories are designed to have special protection against electric shocks and is defibrillator proof 3 3 3 To connect the SpO SpO probe is very delicate equipment Please follow the steps and procedu

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