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PM-9000 Portable Multi-Parameter Patient Monitor

1. Size No Limb perimeter PN Factory PN 1 3 1 5 7 cm 900E 10 04876 Pediatric PHILIPS M1866A 2 4 3 8 0cm_ 900E 10 04875 Pediatric PHILIPS M1868A 3 5 8 10 9cm 900E 10 04874 Pediatric PHILIPS M1870A 4 7 1 13 1cm 900E 10 04873 Pediatric PHILIPS M1872A 20 4 TEMP Accessories NAME YSI PN Application Temperature Probe YSI 401 0509 10 00095 Adult esophageal and rectal temperature measurements temperature measurements Skin TEMP probe YSI 409B 900E 10 04881 Can easily be taped to the skin to Adult give surface temperature readings Skin TEMP probe YSI 427 0010 10 12124 Can easily be taped to the skin to Pediatric give surface temperature readings 20 5 IBP Accessories ICP encephalic pressure transducer ICT B GADTEC P N 0010 10 12151 6PIN ICP cable assembly ver A P N 0010 21 12154 IBP cable PX1800 896019021 EDWARDS P N 0010 10 12177 IBP cable TC VTK OHMEDA or BD P N 6000 10 02106 Patient Monitor user s manual V 5 4 20 3 Accessories and Ordering Information Disposable IBP transducer DT 4812 OHMEDA or BD Reusable IBP transducer P23XL OHMEDA Disposable IBP pressure transducer PX260 EDWARDS Edwards two disposable IBP pressure transducer PX2X2 20 6 CO Accessories IT sensor OHMEDA P N SP4042 BD IT sensor cap OHMEDA P N SP5045 BD Anti pressure three circles injector 12CC 6PIN CO trunk cable assembly 20 7 CO2 Accessories 008 0781 00 EtCO
2. 9 4 Patient Monitor user s manual V 5 4 Chapter 10 Patient Safety The PM 9000 Portable Patient Monitor is designed to comply with the International National Safety requirements for medical electrical equipment This device has floating inputs and is protected against the effects of defibrillation and electrosurgery If the correct electrodes are used and applied in accordance with the manufacturer instructions the screen display will recover within 10 seconds after defibrillation Y This symbol indicates that the instrument is IEC 60601 1 Type CF equipment The unit displaying this symbol contains an F Type isolated floating patient applied part providing a high degree of protection against shock and is suitable for use during defibrillation A Warning A Do not touch the patient bed or instrument during defibrillation Environment Follow the instructions below to ensure a completely safe electrical installation The environment where the PM 9000 Portable Patient Monitor will be used should be reasonably free from vibration dust corrosive or explosive gases extremes of temperature humidity and so on For a cabinet mounted installation allow sufficient room at the front for operation and sufficient room at the rear for servicing with the cabinet access door open The PM 9000 Portable Patient Monitor operates within specifications at ambient temperatures between 0 C and 40 C Ambient t
3. Cleaning and reuse of Masimo LNOP sensors Reusable sensors can be cleaned per the following procedure E Remove the sensor from the patient m Disconnect the sensor from the monitor m Wipe the entire sensor clean with a 70 isopropy alcohol pad H Allow the sensor to air dry before returning it to operation Reattachment of single use adhesive sensors m LNOP single use sensors may be reapplied to the same patient if the emitter and detector windows are clear and the adhesive still adheres to the skin m The adhesive can be partially rejuvenated by wiping with a 70 isopropyl alcohol wipe Patient Monitor user s manual V 5 4 13 9 SpO2 Monitoring and allowing the sensor to thoroughly air dry prior to replacement on the patient AY Warning A To avoid cross contamination only use Masimo LNOP single use sensors on the same patient A Note If the sensor fails to track the pulse consistently the sensors may be incorrectly positioned Reposition the sensor or choose a different monitoring site A Caution A Do not reprocess any LNOP single use sensors m MASIMO SET PATIENT CABLES Reusable patient cables of various lengths are available All cables that display the Masimo SET logo are designed to work with any Masimo LNOP sensor and with any pulse oximeter or multiparameter instrument displaying the Masimo SET logo Only use Masimo oximetry patient cables for SoO2 measurements Other patient cables may cause imp
4. ST1 EXCEED Patient Monitor user s manual V 5 4 12 15 ECG RESP Monitoring ST measuring value of channel 2 exceeds the ST2 EXCEED measurement range HIGH 12 8 Arr Monitoring optional Arrhythmia Analysis The arrhythmia algorithm is used to monitor ECG of neonate and adult patient in clinical detect the changing of heart rate and ventricular rhythm and also save arrhythmia events and generate alarming information Arrhythmia algorithm can monitor paced and non paced patients Qualified personnel can use arrhythmia analysis to evaluate patient s condition Such as heart rate PVCs frequency rhythm and ectopic beat and decide the treatment Besides detecting changing of ECG arrhythmia algorithm can also monitor patients and give proper alarm for arrhythmia m The arrhythmia monitoring is shutoff by default You can enable it when necessary This function can call up the doctor s attention to the patient s heart rate by measuring and classifying the arrhythmia and abnormal heart beat and triggering the alarm m The monitor can conduct up to 13 different arrhythmia analyses mM The monitor can store the latest 60 alarm events when taking arrhythmia analysis to a peculiar buffer The operator can edit these arrhythmia events through the menu below Pick the item ARR ANALYSIS in ECG SETUP menu to access the ARR ANALYSIS sub menu ARR ANALYSIS Menu ARR ANALYSIS ARR ANAL OFF v ALM HI 10 PUCs AL
5. Patient Monitor user s manual V 5 4 CO2 Monitoring CO2 FORWARD FLOW HIGH CO2 MALFUNCTION HIGH CO2 BAROMETRIC HIGH HIGH CO2 BAROMETRIC LOW HIGH Stop using measuring function of CO2 CO2 COMM ERR CO2 module communication HIGH module notify failure biomedical engineer or Mindray service staff CO2 module is not properly Stop using measuring COR INITERR connected or failed aN function of CO2 module notify Measuring module failure or biomedical engineer E communication failure Hien or Mindray service staff CO2 ALM LMT ERR Functional safety failure HIGH Stop using measuring function of CO2 INS ALM LMT ERR Functional safety failure HIGH module notify biomedical engineer AWRR ALM LMT ERR Functional safety failure HIGH oF Mindray service staff Prompt message Message Cause Alarm Level Turn from measuring mode to CO2 STANDBY STATUS standby mode making the module No alarm in energy saving status CO2 WARM UP Shows that the sensor is in EES SE warming up stage CO2 SENSOR START UP Shows that the sensor has just No al rm entering start up stage 18 5 Maintenance and Cleaning H Care and Maintenance ech another patient Sample line is for one off use in SideStream module Do not sterilize or clean for reuse on 2 Airway adapter is for one off use in MainStream module Do not sterilize or clean for reuse on another patient ao When the sample system of S
6. 6PIN 3 lead ECG cable and lead wires assembly Deffibrilation IEC Mindray 6PIN separable ECG trunk cable assembly Mindray 6PIN separable ECG trunk cable assembly Defibrillation Mindray m Lead wires 3 lead ECG lead wire LL 22363 EURO 5 lead ECG lead wire KENDALL P N 0509 10 00093 P N 6000 10 02006 P N 6000 10 02007 P N 9000 10 05163 P N 9000 30 07339 P N 0010 30 12240 P N 0010 30 12241 P N 0010 30 12242 P N 0010 30 12243 P N 0010 30 12244 P N 0010 30 12245 P N 0010 30 12246 P N 0010 30 12247 P N 0010 30 12256 P N 0010 30 12257 P N 9000 10 07445 P N 9000 30 07338 Patient Monitor user s manual V 5 4 20 1 Accessories and Ordering Information 3 lead ECG lead wire EURO KENDALL 5 lead separable ECG lead wire AHA PINCH Mindray 3 lead separable ECG lead wire AHA PINCH Mindray 5 lead separable ECG lead wire IEC PINCH Mindray 3 lead separable ECG lead wire IEC PINCH Mindray 5 lead separable ECG lead wire AHA SNAP Mindray 3 lead separable ECG lead wire AHA SNAP Mindray 5 lead separable ECG lead wire IEC SNAP Mindray 3 lead separable ECG lead wire IEC SNAP Mindray m Electrodes ECG electrode Medi Trace 230 ECG electrode Medi Trace 210 KENDALL ECG electrode 2249 3M Pediatric ECG electrode 2248 3M Pediatric electrode 2258 3 3M 20 2 SpO Accessories m MASIMO ACCESSORIES 1269 LNOP DCI ADULT SENSOR KIT 1269 LNOP DCI ADULT REUSABLE SENS
7. menu the volume of PITCH TONE will be controlled by PR SOUND in SPO2 SETUP menu If other item than SPO2 is selected as HR SOURCE in ECG SETUP menu the volume of PITCH TONE will be consequently controlled by BEAT SOUND in ECG SETUP MENU A NoteA When SPO2 module is switched OFF PITCH TONE function will become disabled automatically 13 1 3 Sensors and Accessories Before use carefully read the LNOP sensor Directions for Use Use only Masimo oximetry sensors for SpO2 measurements Other oxygen transducers or sensors may cause improper Radical Pulse Oximeter performance Tissue damage can be caused by incorrect application or use of an LNOP sensor for example by wrapping the sensor too tightly Inspect he sensor site as directed in he sensor Directions for Use to ensure skin integrity and correct positioning and adhesion of he sensor AN Caution AN Do not use the damaged sensors Do not use a sensor with exposed optical components Do not immerse the sensor in water solvents or cleaning solutions the sensors and connectors are not waterproof Do not sterilize by irradiation 13 8 Patient Monitor user s manual V 5 4 SpO Monitoring steam or ethylene oxide AN Caution AN Do not use damaged patient cables Do not immerse the patient cables in water solvents or cleaning solutions the sensors and connectors are not waterproof Do not sterilize by irradiation steam
8. ARR RECALL 171 Puc 12 61 2061 BIGEMINY 12 01 2001 UFIBZUTAC 12 01 2001 ASYSTOLE 12 01 2001 BIGEMINY 12 01 2001 VFIB UTAC 12 61 2661 MISSED BEATS 12 01 2001 MISSED BEATS 12 01 2001 PUC 12 01 2001 TACHY 12 01 2001 UP DOUN CURSOR WAVE gt gt DELETE RENAME Back to the upper menu L o Figure 12 14 ARR RECALL Menu O UP DOWN Observe other event lists of other page o CURSOR Select the Arr event whose name is displayed in a protruding frame O DELETE Delete the selected Arr event O RENAME Rename the selected Arr event whose name is displayed in a sunken frame Switch the knob until the name you want appears o WAVE To display the Arrhythmia waveform time and parameter value o UP DOWN To observe waveforms of other Arrhythmia events o L RIGHT To observe 8 second waveform of Arrhythmia events o REC To print out displayed Arrhythmia event o EXIT To return to ARR RECALL menu of Arrhythmia event 12 18 Patient Monitor user s manual V 5 4 ECG RESP Monitoring ARR WAVE RECALL BIGEMINY ECG 276 0 00 29 12 01 2001 17 02 IBPA CH1 CH2 s 1712 IBPB CH1 CH2 SYS ER MEAN SP02 SPO2 PR L RIGHT REC NIBP Select previous or next Arr waveform AN Note A EXIT Figure 12 15 ARR WAVE RECALL Menu If there are more than 60 Arrhythmia events the latest will be retained ARR ALARM The alarm is triggered when an Arrhythmia occurs If the ALM is ON the alarm sounds
9. EEN 12 6 12 5 EGG MENU EE 12 7 12 6 ECG Alarm Information and Prompt 12 11 12 7 ST Segment Monitoring optional 12 12 12 8 Arr Monitoring optional 12 16 12 9 Measuring RESP orini araa aeiaai aa eaa aa aa er a ad aaae aea aa aaaea tis 12 20 12 10 Maintenance and Cleaning 12 24 Chapter 13 SpO2 Monitoring ccccccsccesseeeeseeeeeeeeeseaeenseeeeeeeeescaeseneeeeeseeeseneseseaeseeeeeeeeas 13 1 13 1 PART 1 MASIMO SpO2 board configuration cccccceeeeeteeceeeeseteeeeneeteeeeees 13 1 132127 ele 13 3 135172 Monitoring Procedure e sctiteceeccokie ce sceektey seth lege EEEa Aa EAER AE 13 5 13 1 3 Sensors and Accessories 0 cccceeececeeeeeceeeeeeaeeeeeeeeeeeeeeeaaeeeeeeeseaeeesaeeeeeeeeeeeees 13 8 13 1 4 Alarm Description and Prompt s AAA 13 11 13 1 5 Masimo Intormaion 13 13 13 2 PART 2 MINDRAY SpO2 board configuration ccccceceeeseeeeeeeeeeeeeeeneeeeees 13 14 13 2 1 What is SpO2 Monitortmg cee ceeeeeeeeeee cence eeaceeeeeeeceaeeeeaaeeeeaeeseeeeesiaaeeeeaeeeeaes 13 14 13 2 2 Precautions during SpO2 Pulse Monitoring cccccceseeeeeeeceeeeeeeseeeeeeesaees 13 15 13 2 3 Monitoring Proc dure cceeeceeeeeeeneeeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeenaaeeeeneaaes 13 16 2 Patient Monitor user s manual V 5 4 Content 13 2 4 Limitations for Measurement 13 18 1 3 2 5 Sp 2 Mem eege naa aa niacin aa a iaia 13 18 13 2 6 Alarm Description and Prompt 13 20 13
10. Verify that the transducer for CH1 does not fall off then execute zeroing If problem still exists contact the serviceman m IN DEMO FAIL Ensure that the monitor is not in DEMO mode Contact the serviceman if necessary m PRESSURE OVER RANGE FALL Ensure that the venting stopcock is opened to atmosphere then execute zeroing If the problem still exists replace the transducer and contact the serviceman m PULSATILE PRESSURE FALL Ensure that the transducer is not opened to the patient and the stopcock is vented to atmosphere Then execute zeroing If the problem still exists contact the serviceman IBP Calibration Pick IBP PRESSURE CALIBRATE in the IBP 1 2 SELECT menu to popup IBP PRESSURE CALIBRATE menu as shown below IBP PRESSURE CALIBRATE CH1 CAL VALUE 200 CALIBRATE 200 200 08 10 2001 00 07 00 CH2 CAL VALUE 200 CALIBRATE 200 144 08 10 2001 00 00 00 Back to the upper menu Figure 16 6 IBP Calibration Menu Calibrate the transducer Turn the knob to select the item CH1 CAL VALUE press and turn the knob to select the 16 6 Patient Monitor user s manual V 5 4 IBP Monitoring pressure value to be calibrated for channel 1 Then turn the knob to select CALIBRATE to start calibrating channel 1 Turn the knob to select the item CH2 CAL VALUE press and turn the knob to select the pressure value to be calibrated for channel 2 Then turn the knob to select CALIBRATE to start calibrating
11. dh ALM LEV MED AWRR ALM LO 8 gt ALM REC OFF APNEA ALM 20S c02 ALM HI 50 SWEEP FC EE c02 ALM LO 15 UNIT mmHg v INS ALM HI 4 Ka OTHER SETUP gt gt Open or close the COZ alarm EXIT Figure 18 3 COs Setup Menu Following functions can be realized via CO2 SETUP menu ALM select ON to enable and store alarm prompt when CO2 parameters have alarms Select OFF to disable alarm and display amp beside CO2 The default is ON ALM REC select ON to generate output from the recorder ever since CO2 parameter alarm occurs The default is OFF ALM LEV select from HIGH MED and LOW Level HIGH represents the most serious alarm followed by Level MED and Level LOW with a decrease of seriousness Change in ALM LEV can only affect the physiological alarm levels of CO2 parameters including EtCO2 upper limit EtCO2 lower limit InsCO2 upper limit AwRR upper limit and AwRR lower limit The default alarm level is MED CO2 ALM HI to adjust the upper alarm limit of EtCO2 If the measuring value is larger than CO2 upper alarm limit CO2 TOO HIGH appears on the screen After the measuring value returns to the normal one the information disappears CO2 ALM LO to adjust the lower alarm limit of EtCO2 If the measuring value is smaller than CO2 lower alarm limit CO2 TOO LOW appears on the screen After the measuring value returns to the normal one the information disappears INS
12. 12 9 4 RESP menu RESP SETUP Menu Pick RESP hot key on the screen to call up the following menu ALM SWEEP 12 5 ALM LEU MED v WAVE AMP 1 X ALM REC OFF 4 HOLD TYPE AUTO ALM HI 30 gt HOLD HI ALM LO 8 HOLD LO APNEA ALM 205 DEFAULT gt gt Open or close the RESP alarn EXIT Figure 12 17 RESP SETUP Menu RESP alarm setting e ALM pick ON to enable prompt message and data record during the RESP alarm pick OFF to disable the alarm function and there will be a 2 beside RESP e ALM REC pick ON to enable report printing upon RESP alarm e ALM LEV selectable from HIGH MED and LOW Level HIGH represents the most serious case e ALM HI used to set up the upper alarm limit e ALM LO used to set up the lower alarm limit RESP alarm is activated when the respiration rate exceeds set ALM HI value or falls below ALM LO value RESP alarm limits Max RR HI Min RR LO Step RESP ADU 120 0 1 RESP NEO PED 150 0 1 e APNEA ALM to set the standard of judging an apnea case It ranges from 10 to 40 seconds increases decreases by 5 e SWEEP Available options for RESP SWEEP are 6 25 12 5 and 25 0 mm s e WAVE AMP The user may set up the displaying amplitude of the RESP waveform The selections are 0 25 0 5 1 2 3 4 5 e HOLD TYPE AUTO MANUAL adjustable When it is AUTO mode HOLD HI and HOLD LO 12 22 Patient Monitor user s manual V 5 4 ECG RESP Monitoring menus cannot be used
13. DISPLAY WAY 1 GROUP ALM LEV MED UNIT mmHg ALM REC OFF INTERVAL MANUAL SYS ALM HI 160 RESET SYS ALM LO 900 CONT INUAL MEAN ALM HI 110 CALIBRATE MEAN ALM LO 60 PNEUMATIC DIA ALM HI gJ DEFAULT gt gt DIA ALM LO 50 Open or close the NIBP alarm EXIT Figure 14 2 NIBP SETUP Menu NIBP alarm setting e ALM pick ON to enable prompt message and data record during the NIBP alarm pick OFF to disable the alarm function and there will be a 28 beside NIBP Patient Monitor user s manual V 5 4 14 5 NIBP Monitoring e ALM LEV selectable from HIGH MED to LOW HIGH represents the most serious case e ALM REC pick ON to enable report printing upon NIBP alarm e SYS ALM HI SYS ALM LOW MEAN ALM HI MEAN ALM LO DIA ALM HI DIA ALM LO are for the user to set up the alarm limit for each type of pressure NIBP alarm is activated when the pressure exceeds set upper alarm limits or falls below lower alarm limits NIBP alarm limits Adult Mode SYS 40 270 mmHg DIA 10 210 mmHg Mean 20 230 mmHg Pediatric Mode SYS 40 200 mmHg DIA 10 150 mmHg Mean 20 165 mmHg Neonatal Mode SYS 40 135 mmHg DIA 10 95 mmHg Mean 20 105 mmHg RESET Restore measurement status Pick this item to restore initial settings of the pressure pump When the pressure does not work properly and the system fails to give message for the problem pick this item to activate self test procedure thus restore the system
14. Figure 12 8 ADJUST WAVE POS menu DEFAULT pick this item to access the ECG DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s confirmation A Warning A For pacemaker patient the pacing impulse analysis function must be switched on 12 10 Patient Monitor user s manual V 5 4 ECG RESP Monitoring otherwise the pacing impulse may be counted as normal QRS complex which results in failure of ECG LOST error detection WH For monitor with ST segment amp Arrhythmia analysis software refer to ST Segment Monitoring and Arrhythmia Analysis for details A Note A When Pacer Switch is On the Arrhythmia events related to PVCs will not be monitored At the same time the ST analysis will not be performed either 12 6 ECG Alarm Information and Prompt Alarm Message Alarms occurring in the process of ECG measurement contain two types physiological alarm and technical alarm Prompt message may also appear in the mean time For the audio and visual features during the appearance of these alarms and prompt messages in the process of ECG measurement please refer to the related description in Chapter Alarm In the screen physiological alarm messages and the prompt messages able to trigger alarms general alerts all displayed in
15. awRR 1 rpm Alarm range CO 0 10 0 76 mmHg awRR 2 100 rpm Suffocation Alarm Delay awRR 20 40 Sec Updating frequency once per second Calibrate no specified calibrate regulations AG calibrate stability after being used for consecutive 12 months the deviation from precision is lt 1 Rising time 240ms 10 90 Delay time 1 12 seconds maximum with 7 feet long sampling line and ID 0 055 inch Sample rate is 175 ml min Patient Monitor user s manual V 5 4 9 Appendix Ill EMC The monitor meets the requirements of EN 60601 1 2 2001 A Note A The monitor needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided below A Note A Portable and mobile RF communications equipment can affect this monitor See tables 1 2 3 and 4 below TABLE 1 Guidance and manufacturer s declaration electromagnetic emmissions The monitor is intended for use in the electromagnetic environment specified below The customer or the user of the monitor should assure that it is used in such an environment Emissions test Electromagnetic environment guidance The MONITOR uses RF energy only for its internal RF emissions Group function Therefore its RF emissions are very low and CISPR 11 H are not likely to cause any interference in nearby electronic equipment RF emissions The MONITOR is suitable for use in all establishments Harmonic
16. function is switched off at the same time 3 4 5 Recorder setup Select the RECORD in the SYSTEM SETUP menu to call up the following menu RECORD REC WAVE1 SP02 A REC WAVEZ IBP1 Se RT REC TIME 85 T TIMING REC TIME OFF z REC RATE 25 0 ki REC GRID ON CLEAR REC TASK Back to the upper menu Figure 3 11 Record Setup Patient Monitor user s manual V 5 4 3 7 System Menu A Note A In the USER MAINTAIN menu If the AUX OUTPUT item being selected with NURSE CALL the AUX OUTPUT port will be used to realize NURSE CALL function while ANALOG OUT function is switched off at the same time In this menu the user can set up to output two waveforms The waveforms that can be selected include ECG1 ECG6 SPO2 IBP1 IBP2 RESP CO2 AG The first to the seventh ECG waveform on the screen there are seven ECG waveforms in full leads display If no ECG waveform is currently displayed on the screen this item cannot be picked SpO2 Plethysmogram The first IBP waveform on the screen If no IBP waveform is currently displayed on the screen this item cannot be picked The second IBP waveform on the screen If less than two IBP waveforms are currently displayed on the screen this item cannot be picked RESP waveform If no RESP waveform is currently displayed on the screen this item cannot be picked Displayed waveform either of anesthetic gas or generated by CO2 module CO2 02 N2O anes
17. m Select trend parameter If multiple parameters are located at the same position on the trend graph by selecting the corresponding hot key of a parameter on the trend graph you can have the trend graph of this parameter displayed on the screen For example in ECG trend graph you can select hot keys such as HR ST or PVCs then the system will display their corresponding trend graphs respectively H Close trend screen In the FACE SELECT menu select options of other operating screens to close the Trend Screen oxyCRG Screen m Enter oxyCRG screen In the FACE SELECT menu select the oxyCRG SCREEN to enter the oxyCRG Screen BED No 1 ADU D nn Zhang shan M oxyGRG 805s RESP WAVE Figure 4 4 oxyCRG SCREEN H Trend graph of oxyCRG screen Located at the lower part of the screen oxyCRG screen consists of three trends HR Patient Monitor user s manual V 5 4 4 3 Face Select Trend SpO2 Trend and RR Trend or Compressed Resp Waveform H Select OxyCRG trend length Three are three hot keys at the bottom part of the oxyCRG Screen which are 4MIN 2MIN 1MIN RR RESP WAVE and REC By using hot keys for trend time you may select to display trend graphs of three different lengths i e 1 min 2 min and 4 min H Select RR trend or Compressed Resp Waveform By using the hot keys for RR RESP WAVE you may select either RR trend graph or compressed Resp Wave They occupy the same position Ther
18. 3 Production Specification Baseline Recovery ECG Signal Range Bandwidth Surgery Monitor Diagnostic Calibration Signal ST Segment Monitoring Range Measure and Alarm ARR Detecting Type Alarm Review 2 9 RESPARATION Method Differential input Impedance Measuring Impedance Range Base line Impedance Range Bandwidth Resp Rate Measuring and Alarm Range Adult Neo Ped Resolution Accuracy Apean Alarm 2 10 NIBP Method Mode Measuring Interval in AUTO Mode Measuring Period in STAT Mode Pulse Rate Range Alarm Type lt 3 S After Defi 8 mV p p 1 15 Hz 0 5 35 Hz 0 05 100 Hz 1 mV p p 5 Accuracy 2 0 2 0 mV ASYSTOLE VFIB VTAC COUPLET BIGEMINY TRIGEMINY R ON T VT gt 2 PVC TACHY BRADY MISSED BEATS PNP PNC Available Available Impedance between RA LL gt 2 5 MOhm 0 3 5 0Q 200Q 25000 0 2 2Hz 3 dB use 1kQ of ECG cable 0 120 rpm 0 150 rpm 1 rpm 2 rpm 10 40 s Oscillometric Manual Auto STAT 1 2 3 4 5 10 15 30 60 90 120 180 240 480 min 5 Min 40 240 bpm SYS DIA MEAN 4 Patient Monitor user s manual V 5 4 Measuring and alarm range Adult Mode SYS DIA MEAN Pediatric Mode SYS DIA MEAN Neonatal Mode SYS DIA MEAN Resolution Pressure Accuracy Pressure Maximum Mean error Production Specification 40 270 mmHg 10 210 mmHg 20 230 mmHg 40 200 mmHg 1
19. NET INIT ERR Ram NET INIT ERR Reg The network part in the system has failure The system cannot be linked to the net Contact the manufacturer for repair Patient Monitor user s manual V 5 4 System Alarm Prompt NET INIT ERR Mii NET INIT ERR Loop NET ERR Run1 NET ERR Run2 NET ERR Run3 5V TOO HIGH 5V TOO LOW POWER ERR3 POWER ERR4 12V TOO HIGH 12V TOO LOW POWER ERR7 POWER ERR8 3 3V TOO HIGH 3 3V TOO LOW The power part of the system has failure If the prompt repeatedly contact manufacturer for repair appears the CELL BAT TOO HIGH Cell battery has problem CELL BAT TOO LOW The cell battery has low capacity or the cell battery is not installed or the connection is loose Replace the battery If the failure still exists contact the manufacturer RECORDER SELFTEST During the selftest the system Execute Clear Record Task function in the recorder setup menu to re connect the host ERR fails connecting with the and the recorder If the failure recorder module i still exists contact the manufacturer for repair RECORDER VLT HIGH The recorder module has Contact the manufacturer for RECORDER VLT LOW voltage failure repair RECORDER HEAD HOT The continuous recording time may be too long After the
20. ON to enable report printing upon ECG alarm e ALM HI used to set up the upper limit of ECG alarm e ALM LO used to set up the lower limit of ECG alarm ECG alarm is activated when the heart beat exceeds set ALM HI value or falls below ALM LO value ECG alarm limits Max ALM HI Min ALM LO Step HR ADU 300 15 1 HR PED 350 15 1 HR NEO 350 15 1 A Note A Please set the alarm limits according to clinical condition of individual patient The upper limit shall not exceed 20 beat min higher than the patient s heart rate m HR FROM ECG SpO2 AUTO and BOTH may detect heart rate AUTO distinguishes heart rate source according to the quality of signal By picking ECG the monitor prompts HR and activates HR beep By picking SpO the monitor prompts PULSE and activates pulse beep BOTH mode displays HR and PR simultaneously when this item is picked PR parameter is displayed to the right side of SoO2 As for the sound of HR or PR in BOTH mode HR is given the priority i e if HR is available whose sound will be sent out but if HR is not available 12 8 Patient Monitor user s manual V 5 4 ECG RESP Monitoring then the sound will be for PR HR CHANNEL CH1 to count the heart rate by CH 1 waveform CH2 to count the heart rate by CH 2 waveform AUTO the monitor selects a channel automatically LEAD TYPE used to select either 5 LEADS or 3 LEADS SWEEP Available options for ECG SWEEP are 12 5 25 0 and 50 0 mm s
21. Optional Accessory 16 7 1 Introduction The ICT B is one of catheter tip transducers manufactured by Gaeltec It is designed for measuring intracranial pressure by the epidural method There are many advantages of catheter tip measurement including simplicity of use and excellent frequency response without artefacts 16 12 Patient Monitor user s manual V 5 4 IBP Monitoring The ICT B has an atmospheric reference pressure channel that connects the back of the sensing area to the ambient air pressure via the luer fitting on the connector All measurements are differential with respect to ambient air pressure SS Reference channel to Luer fitting for ambient air pressure Measured Calibration zero check by Extension pressure sleeve balloon inflation Y Transducer drive iH sensor Temperature compensation and Output signal bridge balance network Figure 16 9 ICT B transducer A significant feature of the ICT B is the ability to check the zero drift of the ICT B and pressure monitor in vivo Not only does this allow for accurate measurements but also allow moving the patient with the ICT B in the epidural space and reconnection to another monitor quickly and easily There is a flat silicone rubber membrane or balloon covering the pressure sensing diaphragm Two internal tubes connect the two sides of the diaphragm to a female luer fitting on the connector shell By introducing approximately 0 2 to 0 3ml of air f
22. SSS Figure 19 7 AG DEFAULT CONFIG m FACTORY DEFAULT CONFIG use the factory default configuration to initialize menu items m USER DEFAULT CONFIG use the user default configuration to initialize menu items m EXIT used to exit this menu 19 4 Alarm information and prompts When the alarm record switch in a related menu is on those physiological alarms caused by the parameter value exceeding the alarm limits will trigger the recorder to automatically output this parameter value and its related measured waveforms Physiological and technical alarms and prompts that may appear during AG monitoring are listed in following tables Physiological alarms Message Cause Alarm level The measured FiCO value exceeds FiCO2 HIGH the setup upper alarm limit User selectable FiCO2 LOW ee ee is below User selectable EtCO2 HIGH e See a bi EE User selectable EtCO2 LOW e in ms is below User selectable FiO2 HIGH e dare exceeds the User selectable FiO2 LOW ed is below the Leet selectable EtO2 HIGH ec Ee exceede User selectable EtO2 LOW as ieee hoa is below User selectable FiN20 HIGH The measured FiN O value exceeds User selectable Patient Monitor user s manual V 5 4 19 9 Anesthetic Gas Measurement the setup upper alarm limit FiN20 LOW The measured FiN2O value is below the setup lower alarm limit User selectable EtN20 HIGH The measured EtN2O value exceeds the setup upper alarm l
23. ST ANALYSIS Pick this item to access ST ANALYSIS menu the detailed information about the menu is to be discussed in the following section ARR ANALYSIS Pick this item to access ARR ANALYSIS menu the detailed information about the menu is to be discussed in the following section OTHER SETUP Pick this item to access ECG SETUP menu as shown below ECG DISPLAY HALF SCN FULL LEADS sl BEAT VOL 2 S ECG CAL PACE OFF ADJUST WAVE POS gt gt CASCADE OFF DEFAULT gt gt Select general or full lead ECG monitoring way EXIT Figure 12 7 ECG SETUP menu In the sub menu following functions are available ECG DISPLAY Select NORMAL DISPLAY to display 2 ECG waveforms for 5 lead for 3 lead only 1 ECG waveform is displayed Select MULTI LEADS DISPLAY the waveform area on the screen displays 6 ECG waveforms Select HALF SCAN MULTI LEADS there are 4 ECG waveforms are displayed on the screen Note If 3 LEADS is selected in the ECG SETUP menu only NORMAL DISPLAY can be selected for ECG DISPLAY item in the sub menu BEAT VOL The options are from 3 to 0 3 indicates the maximum volume while 0 the minimum A Note A PITCH TONE volume is controlled through adjusting the heart beat volume However if SPO2 is selected as HR FROM in ECG SETUP the PITCH TONE volume will accordingly controlled through adjusting PR SOUND in SPO2 SETUP menu Refer Patient Monitor user s manual V
24. SiS REVIGW AE A E E E E EAE 3 4 3 4 System Setup TEEN 3 4 EE ee EE 3 11 3 6 Monitor VErSION 20 EEN EES etna 3 12 327 Ri ie Ree le TEE 3 12 8 8 Maintenance x eevee cea te sees Qed Bechet vee Needed ea a a ae eae od 3 13 8 9 DEMO FUNCION E 3 16 Chapter 4 Face Geleet edu EE ENEE EEN EE eEe 4 1 4 1 Select Operating Screen 2 eeececec ceeeceeeececeeeeeeaeeeeaaeeeeneeecaaeseenaeseeeeseaeeeeaaeeseneeesaees 4 1 4 2 Standatd Re MEN 4 1 4 3 Trend SCL Mic sdassciess e die EAE NARESE AAA RARE E AAA A 4 2 4 4 E ER EE 4 3 4 5 Ee Sereen aars Reese eea n Ea RAEE eraa R ERa E RAE a Ra EARR E EERS eR 4 4 Chapter 5 Alati anini esga asoeio raaa aaar Aasaa da eCE 5 1 SPAM EE 5 1 5 2 Alarm verification during power on 5 4 RRE RT EE E 5 4 5 4 SILENCE and PAUSE ich acesial iva nite EENEG 5 5 5 5 lun EE 5 6 5 6 When an Alarm ICHTEN Ee ee AE dE 5 6 Chapter 6 Fre Ze a e ege ee ee Eed 6 1 Gl GEM OT al een E cede cle dee dEr asec Qiu dE dd geg 6 1 6 2 Enter Exit Freeze Gtaius erare tr nert tr rnst tntnnnttr annt tn anattar annt tn anneer aneren nnen 6 1 623 FroZe n Ment giia nnn uta e nannaa evento ad eaa aaea Bee ae ede 6 2 Patient Monitor user s manual V 5 4 1 Content 6 4 Reviewing Frozen Waveform ccccccececeececeeeeeeeceeeeeceaeeesaaeeesaaeseeeeeseaeeestaeeseneeenaees 6 3 6 5 Recording Frozen Waveform cccscccececceceeeeeeeeeceeeeeceeeesaaeessaaeseeeeeseaeeeseaeeseneeeeaees 6 3 Chapter 7 RECOrGIING eege EENS e errand
25. air way respiration rate respiring time per minute MAC minimum alveolar concentration Halothame HAL Isoflurane ISO Enflurane ENF Sevoflurane SEV Desflurane DES Patient Monitor user s manual V 5 4 19 1 Anesthetic Gas Measurement BED NO 1 ADU KEEN AG value Figure 19 1 AG measurement display A Note AN The system can only display the waveform and value of one anesthetic agent at one time 19 2 Measuring principle and operating process Principle for measuring anesthetic gas Anesthetic gas can absorb infrared ray By using this principle we can measure the concentration of anesthetic gas Gases that can be measured using AG module are all able to absorb infrared ray Besides each gas has it own absorption characteristic First the gas to be measured is driven into a sample cell Then optic infrared filter selects the infrared ray with special wavelength to penetrate this gas For a given volume the higher the gas concentration is the more infrared rays are absorbed This means that the higher the concentration of the absorbed infrared is the fewer infrared rays there are to have penetrated the gas We may first measure the quantity of the infrared rays that have penetrated the gas and then calculate the gas concentration via specialized formula If you desire to measure multiple gases you should install various infrared filters in the AG module Principle for measuring oxygen Within the r
26. level MED to level LOW Level HIGH represents the most serious case TB ALM HI and TB ALM LO used to set up the upper and lower alarm limit for TB Alarm occurs when the measured TB exceeds set alarm high limit or falls below alarm low limit TB alarm limits Max Alarm High Min Alarm Low Step TB 43 C 23 C 0 1 C m CO CONST It represents the computation constant related to the catheter and injectate volume After replacing the catheter you should adjust this constant according to the instruction A Warning A Make sure that the computational constant for the measurement is appropriate to the catheter used Patient Monitor user s manual V 5 4 17 7 CO Measuring INT TIME s It refers to the minimum time interval between two measurements It is in second unit The adjustment range is 5 to 300 seconds with the increment being 5 seconds INJ TEMP FROM Pick ON or OFF to select from two ways of obtaining the injectate temperature ON the system obtains the injectate temperature through sampling OFF directly display the injectate temperature obtains from the INJ TEMP item INJ TEMP When the INJ TEMP FROM is OFF the user can set the injectate temperature between 0 27 C with the increment being 0 1 C TEMP UNIT C for Celsius degree F for Fahrenheit degree m DEFAULT pick this item to access the CO DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT C
27. oscillometric method It is applicable for adult pediatric and neonatal usage There are three modes of measurement available manual automatic and continuous Each mode displays the diastolic systolic and mean blood pressure O Inthe MANUAL mode only one measurement is conducted for each time O In the AUTO mode the measurement is cycled you can set the interval time to 1 2 3 4 5 1 0 15 30 60 90 1 20 1 80 240 480 minutes O Inthe continuous mode the monitor measures the blood pressure as many times as possible in five minutes A Warning A 1 You must not perform NIBP measurements on patients with sickle cell disease or under any condition which the skin is damaged or expected to be damaged For a thrombasthemia patient it is important to determine whether measurement of the blood pressure shall be done automatically The determination should be based on the clinical evaluation Ensure that the correct setting is selected when performing measurements on children It may be dangerous for the children to use an over pressure level 14 2 NIBP Monitoring 14 2 1 NIBP Measuring A Warning A Before starting a measurement verify that you have selected a setting appropriate for your patient adult pediatric or neonate Do not apply the cuff to a limb that has an intravenous infusion or catheter in place This could cause tissue damage around the catheter when infusion is slowed or blocked during cuff inflation
28. 12 1 ECG RESP Monitoring Red R electrode Be placed near the right shoulder directly below the clavicle Yellow L electrode Be placed near the left shoulder directly below the clavicle Black N electrode Be placed on the right hypogastrium Green F electrode Be placed on the left hypogastrium White C electrode Be placed on the chest as illustrated in the F Figure 12 2 Note the following table gives the corresponding lead names used in Europe and America respectively Lead names are represented by R L N F and C respectively in Europe whose corresponding lead names in America are RA LA RL LL and V America Euro Lead names color Lead names color RA White R Red LA Black L Yellow LL Red F Green RL Green N Black V brown C White LA Black LL Red Figure 12 1 Electrode placement for 5 lead set A Note A Patient Monitor user s manual V 5 4 ECG RESP Monitoring To ensure patient safety all leads must be attached to the patient For 12 lead set attach the C electrode to one of the indicated positions as below Figure 12 2 gw Vi On the 4th intercostal space at the right sterna margin E V2 On the 4th intercostal space at the left sterna margin E V3 Midway between V2 and V4 electrodes mg V4 On the 5th intercostal space at the left clavicular line m V5 On the left anterior axillary line horizontal with V4 electrode E V6 On the left middle axillary line horizontal
29. 2 7 Maintenance and Cleaning 13 22 Chapter 14 NIBP Monitoring ccccseccsseeeeseeeeeeeeeesneeeeseeeeeeeeescaeseseeeeeeeeeeseaeseneenenseeeneas 14 1 E Ali tele ele EE 14 1 E Eelere WEE 14 1 14 3 NIBP SETUP men 14 5 14 4 NIBP Alarm Message ensten o rae Ra E R a E SAREES 14 8 14 5 Maintenance and Ceamimg 14 10 Chapter 15 TEMP Monitor inng cccccscccsseeeeeeeeeeeeeseneesnsneeeeeneescaeseseeenseeeseseseneenenseeeees 15 1 15 31 CEMP Monitoring is auras teenaged ioe aetna cae eee 15 1 15 2 TEMP SETUP En E 15 2 15 3 TEMP Alarm message 15 3 15 4 Care and Cleaning 0 cceescecececeeeeeceeeaeeeeneeceaeeesaaaeseneecaeeseaaeseeaaesseeeeseaeeesaeeseneees 15 4 Chapter 16 IBP Monitoring cccseecseseeesseeeeeeeeeeeeeeeseaeenseeeeeeeeeseaeseseeenseeeeseaesaseeeeneeeenes 16 1 1631 INtrOdUCtION 242 Aden et dane teat atari dat at dana 16 1 16 2 Precautions during IBP Monttormg 16 1 16 3 Monitoring ProCeCure A 16 2 16 4 IBP Meni oia raer ann tae eeh ennai inated 16 3 16 5 Alarm Information and Prompts cecsceceeececeeeeeeeeeeeeeeecaeeeeaaeseeeeeseaeeessaeeseneees 16 9 16 6 Maintenance and Ceanimg 16 11 16 7 ICP Transducer ICT B Optional Accessory cceccceseeeeeeseeeeeeeeeeaeeeeeeeeaees 16 12 Chapter 17 CO Measuring insisi eaoaai aoa aeeoa ea ea iaaea paean aeaaea 17 1 ORT E E 17 1 17 2 Monitoring Procedure AA 17 1 IAS CO ER BEE 17 6 17 4 Hemodynamic Calculaton 17 8 17 5 Alarm Informat
30. 3 2 cm 1 5mor 3 5 8 10 9 cm 4 3 cm 3m 4 7 1 13 1 cm 5 1 cm 14 2 Patient Monitor user s manual V 5 4 6 NIBP Monitoring Make sure that the cuff edge falls within the range of mark lt gt If it does not use a larger or smaller cuff that fits better Connect the cuff to the air hose The limb chosen for taking the measurement should be placed at the same level as the patient s heart If this is not possible you should apply the following corrections to the measured values If the cuff is placed higher than the heart level add 0 75 mmHg 0 10 kPa for each inch of difference If it is placed lower than the heart level deduct 0 75 mmHg 0 10 kPa for each inch of difference Check whether the patient mode is appropriately selected Access PATIENT SETUP menu from SYSTEM MENU and pick PAT TYPE item and turn the knob to select the required patient type Select a measurement mode in the NIBP SETUP menu Refer to the following paragraphs Operation Hints for details Press the START button on the front panel to start a measurement Operation Hints 1 To start auto measuring Access NIBP SETUP menu and pick the INTERVAL item in which the user may choose the selections other than MANUAL to set up the time interval for auto measurement After that press START button on the front panel to start the auto measuring according to the selected time interval A Warning A Prolonged non invasive blood pressure measurements
31. 30 rpm APNEA Time Selections are 10S to 40S Default 20S Work Mode MainStream Standby Measurement SideStream Standby Measurement Default Measurement Compensate Method MainStream General O2 N20 DES ALL SideStream General O2 N20 DES ALL Default Methods General Pump Rate 100 200 ml min Default 100 ml min Unit mmHg kPa Default mmHg Waveform Sweep 25 0 12 5 6 25 mm s Default 25 0 mm s Waveform Scale LOW HIGH Default LOW Besides for alarm function of CO2 module refer to Chapter Alarm for its recording function refer to Chapter Recording and for information about alarm event review graphic and tabular trend of CO2 parameters refer to Chapter Trend and Event 18 4 Alarm Information and Prompt Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during CO2 measurement Physiological alarms Message Cause Alarm Level CO2 TOO HIGH EtCo2 measuring value is above upper Debt alarm limit CO2 TOO LOW EtCO2 measuring value is below lower EE EE alarm limit Patient Monitor user s manual V 5 4 18 7 CO2 Monitoring INS TOO HIGH InsCO2 measuring value is abo
32. 93 42 EEC of 14 June 1993 concerning medical devices MDD 93 42 EEC Standards Harmonized Standards published in the Official Journal of the European Communities applicable to this product are ISO14971 2000 A1 2003 EN1041 1998 EN980 2003 IEC60878 2003 ISO1000 1992 A1 1998 ISO10993 1 2003 1ISO3744 1994 EN540 1993 EN60601 1 1990 A1 1993 A2 1995 A13 1996 EN60601 1 1 2001 EN60601 1 2 2001 EN60601 1 4 2000 EN60601 2 27 1994 EN60601 2 30 2000 EN60601 2 34 2000 EN475 1995 EN865 1997 EN864 1996 EN12470 4 2000 EN1060 1 1995 EN1060 3 1997 IEC60601 2 49 2001 ANSI AAMI SP 10 1996 Notified Body T V Product Service GmbH Ridlerstrasse 65 D 80339 Munich Germany 2 Patient Monitor user s manual V 5 4 Appendix Il Product Specification 1 Classification Anti electroshock type Anti electroshock degree EMC Harmful liquid proof degree Disinfection sterilizing method Working system 2 Specifications 2 1 Size and Weight Size Monitor Weight Monitor 2 2 Environment Temperature Working Welch Allyn Sidestream CO 5 C Welch Allyn Mainstream CO Artema AION Anesthesia Gases 10 C Storage Humidiity Working Storage Altitude Working Storage Class equipment with internal power supply ECG RESP SpO NIBP IBP TEMP CO CO CF AG BF Class A Ordinary equipment sealed equipment without liquid proof Refer to Operation manual for details Continuous running equipment 318 x
33. A Check alarm limits each time the monitor is used to ensure that they are appropriate for the patient being monitored SpO and PR alarm limits Max Upper Limit Min Lower Limit GC 100 0 1 PR 240 25 1 Patient Monitor user s manual V 5 4 13 7 SpO2 Monitoring m SWEEP Available options are 12 5 25 0 mm s m PRSOUND Pulse beep volume The options are from 3 to 0 3 indicates the maximum volume while 0 the minimum E AVG TIME 2 4S 4 6S 8S 10S 12S 14S 16S represent times that SpO average value is counted WH SENSITIVITY MODE Available options are normal and high m DEFAULT Pick this item to access the SoO2 DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s confirmation PITCH TONE function When SPO2 changes if the BEAT VOL in ECG SETUP menu is set to a value other than 0 which means BEAT VOL is switched ON the heart beat volume will change automatically according to SPO2 value This monitor has 20 kinds of PITCH TONE the higher the SPO2 value is the higher the PITCH TONE will be Although these 20 kinds of PITCH TONE could not be adjusted in menu their volume could be controlled For example when SPO2 is selected as HR SOURCE in ECG SETUP
34. ALM HI to adjust the upper alarm limit of InsCO2 If the measuring value is larger than InsCO2 upper alarm limit INS TOO HIGH appears on the screen After the measuring value returns to the normal one the information disappears Patient Monitor user s manual V 5 4 18 3 CO2 Monitoring m AWRR ALM HI to adjust the upper alarm limit of AWRR If the measuring value is larger than the upper alarm limit of AWRR AWRR TOO HIGH appears on the screen After the measuring value returns to the normal one the information disappears m AWRR ALM LO to adjust the lower alarm limit of AWRR If the measuring value is smaller than the lower alarm limit of AwRR AWRR TOO LOW appears on the screen After the measuring value returns to the normal one the information disappears WR UNIT to change the display units of CO2 and InsCO2 parameters mmHg and kPa are available for selection m APNEA ALM After selecting the alarm time for APNEA alarm having 7 levels which are 10S 15S 20S 25S 30S 35S and 40S the CO2 APNEA information will appear on the screen after the corresponding selected time The alarm level is HIGH m SWEEP to adjust the display rate of CO2 waveforms with 6 25 mm s 12 5 mm s or 25 0 mm s selectable gm Exit to close CO2 SETUP menu A Note A APNEA ALM cannot be closed When various alarms occur simultaneously the alarm information of highest level will be d
35. Alarm area Technical alarms related to NIBP measurement are displayed in the NIBP Technical Alarm area at the bottom of NIBP parameter area AN Note A The Physiological Alarm area is on the upper right part of the screen The Technical Alarm area is to the left side of the Physiological Alarm area A Note A If PM 9000 is connected to the external alarm prompt system e g the alarm speaker and indicator connected onto the rear panel of PM 9000 when alarm occurs the external alarm prompt system responds in the same way as the PM 9000 M Note A The concrete presentation of each alarm prompt is related to the alarm level Alarm prompt of the parameter exceeding the alarm limit When physiological alarm of the monitored parameter exceeds the alarm limit besides using the above mentioned three ways to give the alarm prompt the monitor also gives alarm by making the monitored parameter flash in the frequency of 1Hz If at this time the upper and lower limits of the parameter are displayed they will flash in the same frequency 1Hz Screen Display DEI When an alarm occurs the parameter triggering the alarm flashes signal appears on the Ok kk DEI screen indicating the occurrence of alarm Red DEI indicates high level alarm yellow indicates medium level alarm and yellow indicates low level alarm Technical alarm will not prompts signal Lamp light The high medium low level alarms are
36. Curve drawing will stop automatically when the measurement completes and then the C O Cardiac output and the C I Cardiac Index and in the Figure 17 2 will be calculated and displayed on the screen The monitor will also display the CO in the Parameter Area as well as the remaining time to the next measurement O in the Figure 17 2 To ensure the accuracy of the measurement it is suggested that a reasonable interval should take place between two consecutive measurements The length of the interval can be set in the C O SETUP menu Time unit second The interval time counter _ in the Figure 17 2 is displayed on the screen The next measurement can not be performed until the time reduces to zero and a prompt message Ready for new measurement appears A Note AS It is strongly recommended that the user must push the injector within four seconds after pressing the START button AN Note A It is strongly recommended that you wait at least 1 minute or longer depending on the patient s clinical condition before starting the next measurement Continue to repeat this procedure until you have completed the measurements you want to perform You can perform a maximum of 6 measurements before editing If you perform additional 17 4 Patient Monitor user s manual V 5 4 CO Measuring measurements the oldest measurement each time will be deleted If any of the curves in the edi
37. Device Configuration List 3 7 Drug Calculation You can use the drug calculation and titration table function of PM 9000 to calculate the concentration of 15 kinds of drugs Refer to Chapter Drug Calculation and Titration Table for detailed information 3 12 Patient Monitor user s manual V 5 4 System Menu 3 8 Maintenance Select the MAINTAIN item in the SYSTEM MENU to call up the ENTER MAINTAIN PASSWORD dialog box as shown below in which you can enter password and then customize maintenance settings You cannot execute factory maintenance function which is only available for the service engineers of MINDRAY company ENTER MAINTAIN PASSWORD USER KEY FACTORY KEY CONF IRM CONF IRM STATUS gt gt ABCDEFGHIJKLMNOPQRSTU VUXYZ01234567869 DEL OK EXIT Figure 3 19 Enter Maintain Password Input the password into the ENTER MAINTAIN PASSWORD box and press CONFIRM the USER MAINTAIN menu will pop up in which you can set up following items USER MAINTAIN LANGUAGE ENGLISH gt AUX OUTPUT NURSE CALL LEAD NAMING AHA S ALM SOUND ON z NET TYPE HYPER III LOCAL NET NO 1 Ka COLOR SELF DEFINE gt gt NURSE CALL SETUP gt gt Back to the upper menu Figure 3 20 User Maintain For the LANGUAGE language you can set the screen language which display on the screen For the AUX OUTPUT item there are two options available Patient Monitor user s manual V 5 4 3 13 Syste
38. FiN20O ALM HI used to adjust the upper alarm limit of PINO When the measured value is larger than FiN2O upper alarm limit the FiN2O HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit PINO ALM LO used to adjust the lower alarm limit of FiN20 When the measured value is smaller than PINO lower alarm limit the PINO LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit EtAA ALM HI used to adjust the upper alarm limit of EtAA When the measured value is larger than EtAA upper alarm limit the EtAA HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit EtAA ALM LO used to adjust the lower alarm limit of EtAA When the measured value is smaller than EtAA lower alarm limit the EtAA LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit FiIAA ALM HI used to adjust the upper alarm limit of FiAA When the measured value is larger than FiAA upper alarm limit the FiAA HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the Patient Monitor user s manual V 5 4 19 7 Anesthetic Gas Measurement measured value is below the upper ala
39. Follow the manufacturer s directions carefully to avoid damaging the monitor 3 Don t use the grinding material such as steel wool etc 4 Don t let the cleaning agent enter into the chassis of the system 5 Don t leave the cleaning agents at any part of the equipment 11 3 Cleaning Agents Examples of disinfectants that can be used on the instrument casing are listed below RW Diluted Ammonia Water RW Diluted Sodium Hyoichlo Bleaching agent A Note A The diluted sodium hyoichlo from 500ppm 1 100 diluted bleaching agent to 5000ppm 1 10 bleaching agents is very effective The concentration of the diluted sodium hyocihlo depends on how many organisms blood mucus on the surface of the chassis to be cleaned Diluted Formaldehyde 35 37 Hydrogen Peroxide 3 Alcohol isopropanol A Note A PM 9000 monitor and sensor surface can be cleaned with hospital grade ethanol and dried in air or with crisp and clean cloth 11 2 Patient Monitor user s manual V 5 4 Care Cleaning A Note A Mindray has no responsibility for the effectiveness of controlling infectious disease using these chemical agents Please contact infectious disease experts in your hospital for details 11 4 Sterilization To avoid extended damage to the equipment sterilization is only recommended when stipulated as necessary in the Hospital Maintenance Schedule Sterilization facilities should be cleaned first Recommended sterilization mat
40. IBP cable of channel IBP2SENSOROFF 2 falls off from Low Make sure that cable is properly monitor connected IBP 1 2 INIT ERR IBP 1 2 INIT ERR1 IBP 1 2 INIT ERR2 IBP 1 2 INIT ERR3 i i Stop using measuring function of IBP 1 2 INIT ERR4 IBP module failure HIGH IBP module notify biomedical IBP 1 2 INIT ERR5 engineer or Our service staff IBP 1 2 INIT ERR6 IBP 1 2 INIT ERR7 IBP 1 2 INIT ERR8 ER CONN rag dee Stop using ALARM function of IBP STOP EE HIGH module notify biomedical engineer Failure or Our service staff IBP 1 2 Stop using ALARM function of IBP IBP 1 2 COMM ERR communication Biror HIGH module notify biomedical engineer or Our service staff Functional safet Stop using ALARM function of IBP IBP1 ALM LMT ERR failure Y HIGH module notify biomedical engineer or Our service staff Functional safet Stop using ALARM function of IBP IBP2 ALM LMT ERR HTC Y HIGH module notify biomedical engineer or Our service staff 16 10 Patient Monitor user s manual V 5 4 IBP Monitoring Prompt message Alarm Message Cause EN IBP1 SYS EXCEED Systolic value of channel 1 is beyond HIGH measurement range IBP1 DIA EXCEED Diastolic measuring value of channel 1 is HIGH beyond measurement range IBP1 MEAN EXCEED Mean measuring value of channel 1 is HIGH beyond measurement range Systolic value of channel 2 is beyond HIGH IBP2 SYS EXCEED measurement range IBP2 DIA EXCEED Diastolic measuring
41. IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER WARRANTIES EXPRESSED OR IMPLIED INCLUDING WARRANTIES OF MERCHANT ABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE Exemptions Mindray s obligation or liability under this warranty does not include any transportation or other charges or liability for direct indirect or consequential damages or delay resulting from the improper use or application of the product or the substitution upon it of parts or accessories not approved by Mindray or repaired by anyone other than a Mindray authorized representative This warranty shall not extend to any instrument which has been subjected to misuse negligence or accident any instrument from which Mindray s original serial number tag or product identification markings have been altered or removed or any product of any other manufacturer Safety Reliability and Performance Mindray is not responsible for the effects on safety reliability and performance of the PM 9000 Portable Patient Monitor if M assembly operations extensions re adjusts modifications or repairs are carried out by persons other than those authorized by Mindray mM the PM 9000 Portable Patient Monitor is not used in accordance with the instructions for use or the electrical installation of the relevant room does not comply with NFPA 70 National Electric Code or NFPA 99 Standard for Health Care Facilities Outside the United States the relevant room must comply with all electrical installa
42. LIGHT tissue covering sensor d detector Reposition sensor SpO2 LOW l Ensure proper sensor Low signal quality application Mover sensor to a SIGNAL IQ l better perfused site i Stop using the measuring This message appears when function of SpO2 module SpO2 BOARD FAULT the Masimo Set board notify biomedical engineer or malfunctions our service staff This message is displayed when the front end module is Stop using the measuring SpO2 COMMUNICATION ERROR having problems communicating ie framing errors or bad checksums with the Masimo board function of SpO2 module notify biomedical engineer or our service staff SpO2 COMMUNICATION STOP This message is displayed when the host can not receive the data from Masimo board for 5 seconds Stop using the measuring function of SpO2 module notify biomedical engineer or our service staff SpO2 INIT ERR This message is displayed when the SpO2 module initialization error happened Stop using the measuring function of SpO2 module notify biomedical engineer or our service staff p x TEMP1 sensor is not Check the connection of ER connected correctly TEMP1 sensor TEMP2 sensor is not Check the connection of TEMP2 SENSOR OFF connected correctly TEMP2 sensor IBP1 LEAD OFF IBP1 sensor is not connected Check the connection of IBP1 correctly sensor IBP2 LEAD OFF IBP2 sensor is not connected Check the c
43. Nevertheless the Parameter area refreshes normally a In the Freeze status it does not affect the display and refresh of the Trend Graph area on the trend screen the display and refresh of oxyCRG on the Dynamic Refresh screen or the display and refresh of the Viewbed window on the Viewbed screen The frozen waveforms can be reviewed or recorded 6 2 Enter Exit Freeze Status Enter Freeze Status In the Non Freeze status press the FREEZE button on the front panel of the monitor to let the system exit the Menu being currently displayed if available then enter the Freeze status and display the popup FROZEN menu In the Freeze status except Viewbed waveforms all other waveforms are frozen In other words the system will no longer refresh all other waveforms Exit Freeze Status In the Freeze status executing any of the following operations will command the system to exit the Freeze status H Select the EXIT option on the FROZEN menu m Press the FREEZE button on the front panel again Patient Monitor user s manual V 5 4 6 1 Freeze m Press the non immediate to execute button such as a button once pressed a menu will pop up for you to further select an option on the front panel and system buttons of MAIN and MENU m Execute any operation that may trigger the adjustment of the screen or display of anew menu After exiting the Freeze status the system will discharge the Freeze stat
44. Patient Monitor user s manual V 5 4 14 1 NIBP Monitoring A Warning A Make sure that the air conduit connecting the blood pressure cuff and the monitor is neither blocked nor tangled 1 Plug in the air hose and switch on the system 2 Apply the blood pressure cuff to the patient s arm or leg following the instructions below Figure 14 1 WH Ensure that the cuff is completely deflated Apply the appropriate size cuff to the patient and make sure that the symbol is over the appropriate artery Ensure that the cuff is not wrapped too tightly around the limb Excessive tightness may cause discoloration and eventual ischemia of the extremities Si m de Q A J gt Ki Sd est Figure 14 1 Applying Cuff A Note A The width of the cuff should be either 40 of the limb circumference 50 for neonates or 2 3 of the upper arm length The inflatable part of the cuff should be long enough to encircle 50 80 of the limb The wrong size of cuff can cause erroneous readings H the cuff size is in question then use a larger cuff Size of reusable cuff for neonate children adult Patient Type Limb perimeter Cuff width Hose Infant 10 19 cm 8 cm Child 18 26 cm 10 6 cm 1 5 mor Adult 25 35 cm 14 cm 3m Large Adult 33 47 cm 17 cm Thigh 46 66 cm 21 cm Size of disposable cuff for neonate children adult Size No Limb perimeter Cuff width Hose 1 3 1 5 7 cm 2 5 cm 2 4 3 8 0 cm
45. TEMP LO Step T1 T2 50 0 0 1 TD 50 0 0 1 E UNIT To set temperature unit C or F m DEFAULT Pick this item to access the TEMP DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s confirmation 15 2 Patient Monitor user s manual V 5 4 NIBP Monitoring 15 3 TEMP Alarm message Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during TEMP measurement Physiological alarms Message Cause Alarm Level e Measuring value of channel 1 is above upper alarm limit User selectable TI TOO LOW Measuring value of channel 1 is below lower alarm limit User selectable ica Measuring value of channel 2 is above upper alarm limit User selectable T2 TOO LOW Measuring value of channel 2 is below lower alarm limit User selectable TD TOO Difference between two channels is larger than upper User s lectable HIGH limit Technical alarms Alarm Alarm Message Cause aval Remedy Temper
46. TOO LOW is below lower alarm limit User selectable ND TOO HIGH e measuring value User selectable above upper alarm limit ND TOO LOW NIBP DIA measuring value S User selectable below lower alarm limit NM TOO HIGN NIBP MAP measuring value User selectable is above upper alarm limit NM TOO LOW MBE May measuring value User selectable is below lower alarm limit Patient Monitor user s manual V 5 4 Technical alarms 1 display in information area NIBP Monitoring Alarm Message Cause Level Remedy Stop using alarming functions of PS ALMLMT Functional safety failure HIGH NIBP module and notify biomedical engineer or Mindray service staff Stop using alarming functions of NMALMLMT Functional safety failure HIGH NIBP module and notify biomedical engineer or Mindray service staff Stop using alarming functions of NO aE Functional safety failure HIGH NIBP module and notify biomedical engineer or Mindray service staff Technical alarms 2 display in the area below the NIBP value Alarm Message Cause Level Remedy Sensor or other Stop using measuring function of NIBP SELE TEST hardware of NIBP HIGH NIBP module notify biomedical module is incorrect engineer or Mindray service staff If failure persists stop using Communication with measuring function of NIBP module MBP COMM ERR NIBP module is failed HGN notify biomedical engineer or Mindray service staff Cuff is no pro
47. The user could select the function of this port in NURSE CALL SETUP menu of USER MAINTAIN menu Refer to the section about USER MAINTAIN menu to know the detailed information ANALOG OUTPUT connected to oscillograph and pen recorder BNC Jack NURSE CALL connected to the CALL system of the hospital by using dedicated NURSE CALL cable AN Note A The output terminal of NURSE CALL cable has two leads in free status e no distinction between positive or negative Before use the service engineer from MINDRAY or equipment engineer of the hospital must first install the accompanying connectors according to the real situation of the CALL system of the hospital m FUSE Socket T1 6A mM Network Interfaces Socket Standard RJ45 Socket When using wireless network module connect this part to the wireless network module RW Wireless network module The wireless network module is used to connect the monitor to the Central Monitoring System The Indicator lights and the meanings are 1 12 Patient Monitor user s manual V 5 4 Introduction Power green Indicates power when active GI Status amber Indicates the software has detected an abnormal condition See event log for status information Associated green Radio Activity amber A green LED indicates association between the CB 1000 and an AP or a MicroAP o
48. and the alarm indicator flashes If the REC is ON the alarm record will be printed out 4 seconds prior to and after the alarm with the ECG waveforms of analysis channel Physiological alarms Applicable Prompt Patient Occurring Condition Alarm Level Type ASYSTOL No QRS is detected for 4 consecutive E All patients seconds User selectable Fibrillatory wave for consecutive 4 seconds or VFIB Without The number of continuous Vent beats is NTAC pacemaker larger than the upper limit of cluster User selectable Vent beats gt 5 The RR interval is less than 600ms VT gt 2 Without 3 lt the number of cluster PVCs lt 5 User selectable pacemaker COUPLET Without 2 consecutive PVCs User selectable pacemaker BIGEMINY Without Vent Bigeminy User selectable pacemaker TE enor Vent Trigeminy User selectable Y pacemaker Patient Monitor user s manual V 5 4 12 19 ECG RESP Monitoring A type of single PVC under the condition that HR lt 100 R R interval is Without less than 1 3 the average interval RONT acemaker followed by a compensating pause of User selectable H 1 25X the average R R interval the next R wave advances onto the previous T wave Without Single PVCs not belonging to the type ENG pacemaker of above mentioned PVCs User selectable 5 consecutive QRS complex RR TACHY All patients interval is less than 500ms User selectable 5 consecutiv
49. and the monitor automatically calculates the RESP RATE e HOLD HI and HOLD LO When it is AUTO mode HOLD HI and HOLD LO menus cannot be used and the monitor automatically calculates the RESP RATE When the HOLD TYPE is MANUAL the user can use the knob to pick either HOLD HI or HOLD LO and turn the knob to adjust the two dashed lines in the RESP WAVEFORM area respectively The positions of the dashed lines will be used to calculate the upper and lower limits of RESP RATE by the monitor e DEFAULT pick this item to access the RESP DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s confirmation RESP Alarm Message Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during resp measurement Physiological alarms Message Cause Alarm Level RR TOO HIGH RESP measuring value is above upper alarm limit User selectable RRTOO LOW RESP measuring value is below lower alarm limit User selectable RESP APNEA E
50. anesthetics Explanation of Symbols in the Monitor e This symbol means BE CAREFUL Refer to the manual This symbol indicates that the instrument is IEC 60601 1 Type CF equipment The 10 2 Patient Monitor user s manual V 5 4 Patient Safety unit displaying this symbol contains an F Type isolated floating patient applied part providing a high degree of protection against shock and is suitable for use during defibrillation Equipotential grounding system Protective earth ground QO Partial On Off LE This item is compliant with Medical Device Directive 93 42 EEC of 14 June 1993 a directive of the European Economic Community Patient Monitor user s manual V 5 4 10 3 Chapter 11 Care Cleaning 11 1 System Check Before using the monitor do the following WH check if there is any mechanical damage WH check all the outer cables inserted modules and accessories WH check al the functions of the monitor to make sure that the monitor is in good condition If you find any damage on the monitor stop using the monitor on patient and contact the biomedical engineer of the hospital or Mindray Customer Service immediately The overall check of the monitor including the safety check should be performed only by qualified personnel once every 6 to 12 month and each time after fix up You should check the synchronism of the defibrillator in the frequency described in the hospital regul
51. as the length of the waveform displayed on the screen For example if the speed of a waveform is relatively fast then it needs shorter time to record it When recording frozen waveforms the system is still in the Freeze status After completion of recording if required you may select once more the waveform to be output and select REC option again to record the whole selected waveforms You may also record frozen waveforms by pressing the REC STOP button on the front panel If the recorder does not exist selecting the REC option can only call out the prompt Recorder does not exist in the STATUS bar For more detailed information about recording please refer to the chapter of Recording Patient Monitor user s manual V 5 4 6 3 Chapter 7 Recording WR General information on recording H Instructions for configuring and recording m Recording messages 7 1 General Information on Recording A thermal dot matrices recorder with 48mm wide printout paper is used for PM 9000 Portable Patient Monitor Performance of the Recorder Waveform record is printed out at a rate of 25 or 50 mm s It can record up to 2 waveforms Output with grid selectable English Chinese printout The real time recording time and waveform are user configurable Auto recording interval is set by the user the waveform is in accordance with the real time recording H The alarm recording waveform is automatically selected by
52. avoid the interference from the parameters that need not attention 3 4 7 Tracing Waveforms Selection Select the TRACE SETUP in the SYSTEM SETUP menu to call up the following menu TRACE SETUP v ECGi v RESP v ECG2 v SP02 v IBP1 v IBP2 v US WAVE SEQUENCE gt gt Back to the upper menu Figure 3 13 Tracing Waveforms Selection You can define the traces displayed on the screen in this menu The waveforms available for selection are those whose modules have been selected in MODULE SETUP menu This user can only decide the display sequence of the waveforms on the screen Select the WAVE SEQUENCE item in the menu to access the sub menu of the same name as shown in the figure below Patient Monitor user s manual V 5 4 3 9 System Menu WAVE SEQUENCE 1 first channel Z channel and so on EXIT Figure 3 14 Wave sequence 3 4 8 Event Setup The monitor has four types of events You can specify their representations by yourself Select the MARK EVENT item in the SYSTEM SETUP to call up the following menu MARK EVENT EVENT B EVENT C EVENT D A B C D are the symbols for operator def ined events EXIT Figure 3 15 MARK EVENT Menu How to mark the event Use the rotary knob to select one from event A B C and D The symbol will appear in the frame of the event being selected Once making a wrong selection you can push the knob on the event again to give up the sel
53. bed number name sex height weight date of birth admission date Parameter name and value Recording time Waveform name Waveform scale for ECG waveform ECG lead scale filter mode if having ECG waveforms it will be printed out within the first second or when changing the lead gain and filter mode during real time recording IBP scale the first second of IBP waveform CO2 scale the first second of CO2 waveform Date and time Company name 7 3 Recording Startup You can start the recording in the following ways Continuous real time recording Press REC STOP to start stop the recording 8 second real time recording Press REC STOP to start recording It will automatically stop in 8 seconds Auto recording Record the two waveforms selected in RECORD menu according to the setup time interval in RECORD menu Alarm recording When alarm recording is set ON it automatically starts when alarm occurs Frozen waveform recording After accessing FREEZE menu use knob to select two waveforms to be output Then press REC button in the menu to print out the waveforms FRULZER WAVE 1 ECG1 x WAVE 2 ECG2 be RECALL REC EXIT If two waveforms are off the measure parameters in frozen are printed out only Trend graph recording Pick REC button in the TREND GRAPH menu when viewing the trend graph to print out the currently displayed trend graph Trend table recording Pick REC button in the
54. channel 2 m The pressure calibration of the monitor Pressure Transducer T type Stopcock Pressure T type Transducer connector Interface cable he Hydrargyrum Pressure meter MOHITOR Figure 16 7 IBP Calibration Caution H Mercury calibration should be performed by the biomedical engineering department either whenever a new transducer is used or as periodically as requested by your Hospital regulation H The purpose of the calibration is to ensure that the system gives you accurate measurements H Before starting a mercury calibration a zero procedure must be performed m f you need to perform this procedure yourself you will need the following pieces of equipment e Standard sphygmomanometer e 3 way stopcock e Tubing approximately 25 cm long The Calibration Procedure SEE Figure 16 7 A Warning A You must never perform this procedure while patient is being monitored Patient Monitor user s manual V 5 4 16 7 IBP Monitoring Disconnect transducer with patient when patient is monitored By using of tube one end of T type connector links to 3 way stopcock of transducer another end links to inflation orb and the third end links to sohygmomanometer Vent the stopcock of transducer to atmosphere and run zeroing procedure Open the stopcock to the sohygmomanometer side after successful zeroing Select the calibrated channel in IBP calibration menu and preset the calibration pressure of t
55. connector to the appropriate parts of the cardiac output interface cable see the following figure 3 Pick the CO hot key in the parameter area on the screen to call up the C O SELECT menu and if necessary change the computation constant to the one appropriate to the catheter and volume of fluid used A Note A If to replace the Catheter thermistor please enter the catheter computation coefficient into the CO CONST item according to the instruction AT Pick C O MEASURE item in the C O SELECT menu to access the WINDOW FOR CO MEASUREMENT A Note A You should appropriately set the injectate switch because the CO calculation will be according to the ON or OFF of the injectate switch at the completion of measurement No change shall be made after the switch is set off Patient Monitor user s manual V 5 4 17 1 CO Measuring MONITOR CM Y A injectate i FN d RS ke een s t f Le Cardiac Output l E Cable f in ectale Sensor ZZ siectale Sensor y Delivery en WAN Tree Hausin Eh j T d sing Ay W System Thermoditution Y v L Catheter i Ki A Gi iAy A K WW Wi N W N q e Za T vA p a P i n line injectate e E T Temperature probe Figure 17 1 CO sensor connection o D You can perform more than one measurement as required D After completion of the measurement s access the WINDOW FOR CO EDIT to edit measured data The procedure in d
56. disposed of in compliance with the guidelines regulation the disposal of such products If you have questions concerning disposal of the product please contact MINDRAY or its representatives A Caution A If you have any doubt to the grounding layout and its performance you must use the built in battery to power the monitor 1 1 General Information Environment Temperature Working 0 40 C Transport and Storage 20 60 C Humidity Working 15 85 Transport and Storage 10 93 Altitude Working 500 to 4 600m 1 600 to 15 000ft Transport and Storage 500 to 13 100m 1 600 to 43 000ft Power Supply 100 250 V AC 50 60 Hz Pmax 110VA FUSE T1 6A General instruction PM 9000 is a Portable Patient Monitor that has abundant monitoring functions and is used for the clinical monitoring of adult pediatric and neonate In addition the user may select the different parameter configuration according to different requirements PM 9000 can be connected to the central monitoring system via the Mindray network so as to form a network monitoring system PM 9000 Figure 1 1 can monitor vital signals as ECG Respiratory Rate SpO2 NIBP Patient Monitor user s manual V 5 4 1 3 Introduction Dual TEMP Dual IBP CO CO2 and anesthetic gases It integrates parameter measuring modules display and recorder in one device featuring in compactness lightweight and portability Replaceable built in battery facilit
57. from abnormal performance CONTINUAL Start continuous measuring When this item is picked the menu will disappear automatically INTERVAL Interval time for automatic measuring Available selections 1 2 3 4 5 1 0 15 30 60 90 120 180 240 480 minutes Press START STOP button on the NIBP module to start the first auto measuring Pick MANUAL selection in INTERVAL item to set up the measuring mode to MANUAL UNIT Pick this item to set measurement unit Option mmHg or kPa CALIBRATE Calibrate the cuff pressure reading with a calibrated reference manometer Pick the CALIBRATE item to start the calibration and the item will change into STOP CAL which if picked the system will stop calibration DEFAULT Pick this item to access the NIBP DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up Patient Monitor user s manual V 5 4 NIBP Monitoring the dialog box asking for the user s confirmation A warning A The calibration of the NIBP measurement is necessary for every two years or as frequently as dictated by your Hospital Procedures Policy The performance should be checked according to the following details Procedure of the Pressure Transducer Calibration Replace the cuff of the device with a rigid metal vessel with a capacity of 500 ml 5 Connect a calibrated refe
58. from 25 C ambient 5W supplied to sensor heater Mainstream sensor temperature controlled to 42 C 100 msec 10 to 90 240 msec 10 to 90 1 12 seconds maximum with 7 feet length 0 055 inch ID Sampling line at 175 ml min Patient Monitor user s manual V 5 4 7 Production Specification CO2 Ins CO2 AwRR Suffocation Alarm Delay AwRR 2 16 AG Method Measuring mode Warm up time 0 99 mmHg 0 99 mmHg 0 150 rpm 10 40 Sec Infrared Absorption Technique Side stream 30 Sec 10 Min Side stream mode sampling gas flow rate Adult Neonate Gas Sort Measuring range CO2 N20 Des Sev Enf Iso Hal O2 awRR Resolution CO awRR Accuracy CO N O Des Sev 1000 150 Iso accuracy mode Full accuracy mode 200 ml min option 700 oO 120 ml min option COz2 N20 O2 Option Des Iso Enf Sev Hal 0 10 0 76 mmHg 0 100 0 18 0 8 0 5 0 100 Option 2 100 rpm 1 mmHg 1 rpm Accuracy 0 1 0 2 0 3 0 4 Unspecified 2 3 0 15 0 2 0 4 0 6 Unspecified 0 15 0 2 range 0 1 1 5 5 7 7 10 gt 10 0 20 20 100 0 1 1 5 5 10 10 18 gt 18 0 1 1 5 Patient Monitor user s manual V 5 4 Production Specification 0 4 5 8 Unspecified gt 8 Enf Iso Hal 0 15 0 1 0 2 1 5 Unspecified gt 5 O2 Option 1 0 25 2 25 80 3 80 100
59. in the ALM PAUSE TIME item in the SYSTEM MENU MAINTAIN After pushing the SILENCE button again the system will restore the normal status Besides the occurrence of any new technical alarm will also terminate the PAUSE status and let the system restore the normal status The 4 symbol disappears too AY Note A After the system goes back to the normal status the existence of alarm depends on whether the alarm condition is complied with After pushing the SILENCE button the system will permanently shut off the alarm sound for LEAD OFF SENSOR OFF alarm Patient Monitor user s manual V 5 4 5 5 Alarm 5 5 Parameter Alarm The setup for parameter alarms is in their menus In the menu for a specific parameter you can check and set the alarm limit alarm status The setup is isolated from each other When a parameter alarm is off a symbol amp displays near the parameter If the alarms are turned off individually they must be turned on individually For the parameters whose alarm is set to ON the alarm will be triggered when at least one of them exceeds alarm limit The following actions take place 1 Alarm message displays on the screen as described in alarm mode 2 The monitor beeps in its corresponding alarm class and volume 3 Alarm lamp flashes 4 Store all parameter values during the alarm and 4 8 or 16 second waveform prior to and after alarm 5 If alarm recording is on the recorder starts alarm
60. in Auto mode may be associated with purport ischemia and neuropathy in the limb wearing the cuff When monitoring a patient examine the extremities of the limb frequently for normal color warmth and sensitivity If any abnormality is observed stop the blood pressure measurements To stop auto measuring During auto measuring press START button on the front panel at any time to stop auto measurement To start a manual measuring H Access NIBP SETUP menu and pick the INTERVAL item Select the MANUAL selection Then press the START button on the front panel to start a manual measurement m During the idle period of auto measuring process press the START button on the front panel at any time to start a manual measurement Then press the START button on the front panel to stop manual measurement and the system continues executes auto measuring program according to selected time interval To start a manual measuring during the AUTO mode Press START button on the front panel To stop a manual measuring Patient Monitor user s manual V 5 4 14 3 NIBP Monitoring Repress the START button on the front panel again 6 To perform continuous measuring Access NIBP SETUP menu and pick the CONTINUAL item to start the continuous measurement The monitor will measure as many times of NIBP as possible within 5 minutes A Warning A Prolonged non invasive blood pressure measurements in continual mode may be associated with purport isch
61. indicated by the system in following different visual ways Alarm level Visual prompt High Alarm indicator flashes in red with high frequency Medium Alarm indicator flashes in yellow with low frequency Low Alarm indicator lights on in yellow Alarm Sound The high medium low level alarms are indicated by the system in following different audio 5 2 Patient Monitor user s manual V 5 4 Alarm ways Alarm level Audio prompt High Mode is DO DO DO DO DO DO DO DO DO DO which is g triggered once every 8 seconds Medium Mode is DO DO DO which is triggered once every 24 seconds Low Mode is DO which is triggered once every 24 seconds A Note A When alarms of different levels occur at the same time the monitor prompts the one of the highest level Alarm Setup The setup of the alarms can be realized in the alarm menu Press the ALARM SETUP button on the SYSTEM SETUP menu to call up ALARM SETUP menu default menu as shown below In the ALM SEL item the user may set up the information about common alarm setup represented by COMMON ALM SETUP and the alarm setup of each parameter ALARM SETUP ALM SEL COMMON ALM SETUP X7 ALARM VOL 2 z ALM REC TIME 8S ALM PAUSE TIME 2MIN 4 PARA ALM TYPE UNLATCH Back to the upper menu Figure 5 1 ALARM SETUP 4 COMMON ALM SETUP Select COMMON ALM SETUP selection in ALM SEL item This operation
62. instead of their real names The units for these five drugs are fixed The operator may select the appropriate units according to the convention of using these drugs The rules for expressing the units are mg series units are fixedly used for drug A B and C g mg mcg unit series units are fixedly used for drug D unit k unit m unit mEq is fixedly used for drug E 9 2 Patient Monitor user s manual V 5 4 Drug Calculation and Titration Table Patient weight After accessing the DRUG CALC window the operator should enter the patient weight into the first or the second item The entered weight will be used as the independent data only for the calculation of drug concentration A Note A This drug calculation function acts only as a calculator That means the patient weight in Drug Calculation menu and the patient weight in Patient Information menu are independent from each other Therefore if the Weight in Drug Calculation changes the Weight in Patient Information does not change In this way we can say the Drug Calculation menu is independent from other menus in the system Any change of it will not affect other information about the patient being currently monitored 9 2 Titration Table Access titration table Select TITRATION item in DRUG CALC menu to enter titration table display Titration table display for drug is as following TITRATION Drug A AMOUNT 400 0
63. interval time set in the TIMING REC TIME of the RECORDER menu Refer to Chapter 3 5 Recorder Setup for details Alarm Recording Parameter Alarm The monitor records waveforms 4 8 or 16 seconds prior to and after the alarm totally 8 16 or 32 seconds which can be selected in System Menu All parameter values during the alarm will also be recorded When parameter alarm occurs two recorded waveforms can be printed out In order to avoid repeated printout of alarm waveforms m f more than two parameter alarms are switched on and triggered simultaneously the recorder will print out those of the highest level If of the same alarm level the latest alarm will be printed out H f an alarm occurs during the alarm of another parameter it will be printed out after the current recording is finished m H many alarms occur at the same time some of waveforms will be stored for printout in turn ST Segment Alarm The monitor records 2 channel ECG waveforms 4 8 or 16 seconds prior to and after the alarm totally 8 16 or 32 seconds which can be selected in the ECG SETUP menu All parameter values during the alarm will also be recorded 7 2 Patient Monitor user s manual V 5 4 Recording Arrhythmia Alarm The monitor records 2 channel ECG waveforms 4 seconds prior to and after the alarm totally 8 seconds All measurement results during the alarm will also be recorded Freeze Waveform Recordi
64. measured value is below the upper alarm limit AwRR ALM LO used to adjust the lower alarm limit of AwRR When the measured value is smaller than AwRR lower alarm limit the AwRR LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit OTHER SETUP gt gt used to enter the other ALARM SETUP menus EXIT used to close this ALARM SETUP menu After selecting OTHER SETUP gt gt item in the ALARM SETUP menu the following ALARM SETUP menu pops up Patient Monitor user s manual V 5 4 Anesthetic Gas Measurement ALARM SETUP EtN20 ALM HI 55 EtAA ALM LO 0 0 EtN20 ALN LO o FiAA ALM HI 6 0 FiN20 ALM HI 53 FiAA ALM LO 0 0 FiN20 ALM LO o APNEA ALM 205 S EtAA ALM HI 8 0 gt Back to the upper menu a ae Figure 19 5 ALARM SETUP menu for other parameters EtN O ALM HI used to adjust the upper alarm limit of EtN2O When the measured value is larger than EtNsO upper alarm limit the EtN2O HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit N O ALM LO used to adjust the lower alarm limit of EtN20 When the measured value is smaller than EtN2O lower alarm limit the N O LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit
65. nere arr eraan aaa e a Enana ne sade anasan ina 7 1 7 1 General Information on Recording sessssseessseesresiesrirssirssrissrnnsrnnsrnnsrnnsrnnsennnsren 7 1 Te RECOGNI TYDE EE 7 1 73 Recording EE De DEE 7 4 7 4 Recorder Operations and Status Messages sessseesesseesietrieesetrirrrresrresre 7 5 Chapter 8 Trend and Event cccsceeseseeesneeeeseeeeeseeesnaeeeseeeeeeaeeesaesaseeeenseeeseeeseneanenseeeeesees 8 1 821 Trend Graphs ci 0t4 4 Set E E 8 1 8 2 Trend E LEE 8 3 EK HE EE 8 4 8 4 Alarm Event Recalls orire na a a AEA Naa E A E pains dee 8 5 Chapter 9 Drug Calculation and Titration Table ecccscessseesseeeeeeceesseeseseeeeneeeeeeeees 9 1 9 1 Drug Calculati Nesini iiia iia a vee Bee dl eae A 9 1 O22 IMATION abe a a ee geesde aa biayas tends 9 3 Chapter 10 Patient Safety anae ae aieeaa aaaea aaa ata aeaaea aeea neeaaeia aci naii 10 1 Chapter 11 Care Cleaning sssnsssnsuuneunnsunnnunnnuunnunnnunnnnnnnnunnnunnnunnnnnnnnnnnunnnnnnnnnnnnnn nnmnnn 11 1 21 System Gheck TT 11 1 11 2 General Cleanimg nenn nenn nnet 11 2 1123 Cleaning Age EE 11 2 PA EE e ET 11 3 dis Disintection giver ieee ae avi Ala hana Ada ih Anaad 11 3 Chapter 12 ECG RESP Monitoring c scccseeeeeseeseeeeeseeeeeeeeeseaeseseeeneeeeseneeeseaeeneeeeeeees 12 1 12 1 What Is ECG Montoring 12 1 12 2 Precautions during ECG Monitoring 12 1 12 3 Monitoring Procedure sosis asiata akaa aE NA AE iaa eia 12 2 12 4 ECG Screen Hot Keys
66. of CO CO COMM ERR communication HIGH module notify biomedical engineer or failure Mindray service staff TB ALM LMT Functional safet Stop using TB alarming function notify ERR failure Y HIGH biomedical engineer or Mindray service staff Prompt message general alerts Message Cause Alarm Level TB EXCEED TB measuring value is HIGH beyond measuring range 17 6 Maintenance and Cleaning Care and Maintenance A Warning A Before cleaning the monitor or the transducer make sure that the equipment is switched off and disconnected from the power line CO Cable Cleaning 1 If adhesive tape residue must be removed from the transducer cable double seal tape remover is effective and will cause a minimum of damage to the cable if used sparingly Acetone Alcohol Ammonia Chloroform or other strong solvents are not recommended because they will eventually damage the vinyl cabling 2 Sponge the cable with warm water and soap or another suitable cleaning solution and dry Do not immerse them in water 3 Check each cable for corrosion cracks and deterioration 4 Gas Sterilization For more complete asepsis use gas sterilization O Remove obvious contamination by using the cleaning procedure described previously To inhibit the formation of ethylene glycol when ethylene oxide gas is used as the disinfectant the transducer should be completely dry o Follow the operating instructions provided by the manufacturer of the ga
67. or Mindray service staff Patient Monitor user s manual V 5 4 13 21 SpO2 Monitoring Prompt message include general alerts Message Cause Alarm Level SPO2 EXCEED Sp measuring value exceeds the range HIGH PR EXCEED PR measuring value exceeds the range HIGH SEARCH PULSE SpO module is searching for pulse No alarm NO PULSE d module cannot detect Sp signal for a long HIGH 13 2 7 Maintenance and Cleaning Care and Cleaning A Warning A Turn of the monitor and disconnect the line power before cleaning the monitor or the sensor A Warning A Do not subject the sensor to autoclaving Do not immerse the sensor into any liquid Do not use any sensor or cable that may be damaged or deteriorated Cleaning m Use a cotton ball or a soft mull moistened with hospital grade ethanol to wipe the surface of the sensor and then dry it with a cloth This cleaning method can also be applied to the luminotron and receiving unit m The cable can be cleaned with 3 hydrogen dioxide 70 isopropanol or other active reagent However connector of the sensor shall not be subjected to such solution 13 22 Patient Monitor user s manual V 5 4 Chapter 14 NIBP Monitoring 14 1 Introduction Reference to the European standard EN 1060 1 Specification for Non invasive sphygmomanometers Part 1 General requirements The Non invasive Blood Pressure NIBP module measures the blood pressure using the
68. or ethylene oxide H Selecting a Masimo sensor When selecting a sensor consider the patient s weight the adequacy of perfusion the available sensor sites and the duration of monitoring For more information refer to the following table or contact Masimo Use only Masimo sensors and sensor cables Select an appropriate sensor apply it as directed and observe all warnings and cautions presented in the directions for use accompanying the sensor 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 SpO2 sensor To prevent interference from ambient light ensure that the sensor is properly applied and cover the sensor site with opaque material if required Failure to take this precaution in high ambient light conditions may result in inaccurate measurements LNOP ADT SINGLE USE ADULTS gt 30 kg LNOP PDT SINGLE USE Adults gt 10 kg and lt 50 kg LNOP NEO SINGLE USE _ Neonate lt 10 kg LNOP NEO PT SINGLE USE Neonate lt 1 kg or with poor skin integrity LNOP DCI REUSABLE Adults and Pediatrics gt 30 kg LNOP DCIP REUSABLE Pediatrics gt 10 kg and lt 50 kg LNOP DCSC REUSABLE Adult and Pediatrics gt 30 kg for spot check applications LNOP Ear sensor REUSABLE Adult Pediatric gt 30 kg LNOP YI Multi site REUSABLE Adult Pediatric Infant Neonatal gt 1 kg
69. patient Check the connection of the electrodes and lead wires MISSED BEATS Patient suffers from Arr of MISSED BEATS Check the current situation of the patient Check the connection of the electrodes and lead wires Check the connection of the pacemaker n i Check the connection of PNP The pacemaker is not paced electrodes Andi lead wits Check the current situation of the patient Check the connection of the pacemaker PNC No pacemaker signal is Check the connection of captured electrodes and lead wires Check the current situation of the patient ECG LEAD OFF ECG lead is not connected correctly Check the connection of ECG lead wire ECG V LEAD OFF The V lead wire of ECG is not connected correctly Check the connection of V lead wire ECG LL LEAD OFF ECG LA LEAD OFF The LL lead wire of ECG is not connected correctly The LA lead wire of ECG is not connected correctly Check the connection of LL lead wire Check the connection of LA lead wire ECG RA LEAD OFF The RA lead wire of ECG is not connected correctly Check the connection of RA lead wire ECG C LEAD OFF The C lead wire of ECG is not connected correctly Check the connection of C lead wire ECG F LEAD OFF The F lead wire of ECG is not connected correctly Check the connection of F lead wire ECG L LEAD OFF The L lead wire of
70. recording For further information on alarm recording please refer to Chapter Recording 5 6 When an Alarm Occurs A Note A When an alarm occurs you should always check the patient s condition first The alarm message appears at the top of the screen on the right side It is needed to identify the alarm and act appropriately according to the cause of the alarm 1 Check the patient s condition 2 Identify the cause of the alarm 3 Silence the alarm if necessary 4 When cause of alarm has been over check that the alarm is working properly You will find the alarm messages for the individual parameter in their appropriate parameter chapters of this manual 5 6 Patient Monitor user s manual V 5 4 Chapter6 Freeze E General m Freeze amp Unfreeze m Review amp Record Frozen Waveforms 6 1 General When monitoring a patient you may freeze the waveforms of interest so as to view them carefully Generally you can review maximally 40 seconds of a frozen waveform If required you may also use recorder to print out a frozen waveform The Freeze function of this monitor has following features a Freeze status can be activated on any operating screen a At the same time of entering the Freeze status the system exits all other operating menus Besides the system freezes all waveforms in the Waveform area of the Basic Screen or Full lead ECG waveforms and the extra waveform if available on the Full lead ECG screen
71. related chapter AN warning Always verify the self check function of audible and visual LED alarms when PM 9000 powers on 1 3 Button Functions All the operations to PM 9000 are through the buttons and a knob at the bottom of the screen The names of the buttons are above them They are from left to right Figure 1 3 AE 0 0 OQ Figure 1 3 PM 9000 Buttons and Knob MAIN Figure 1 30 Whatever levels of menu the system is in press the button and the system will always return to the main screen FREEZE Figure 1 30 Press this button and the system will access the FREEZE status In this status the user may review the waveform of 40 seconds Also the frozen waveform can be printed out In the 1 8 Patient Monitor user s manual V 5 4 Introduction FREEZE status press this button again to discharge the FREEZE status For detailed information refer to related chapter Freeze SILENCE Figure 1 30 Push this button to suspend alarm for maximum 3 minutes with 1 minute 2 minutes and 3 minutes selectable In Alarm PAUSE status a symbol appears in the Message Area Push this button for more than 1 second to mute all kinds of sounds including alarm sound heart beat pulse tone key sound At the same time a EZ symbol appears in the Message Area Push this button again to restore all kinds of sounds and the E symbol disappears from the screen AN Note A If new alarm occurs in Alarm
72. temperature alarm function will not work during the C O measurement When the measurement ends the function will automatically resume Patient Monitor user s manual V 5 4 17 5 CO Measuring WH The current blood temperature is displayed in the CO Parameter Area Thermodilutio Cathetern SS Pulmonary Artery Balloon Thermister Right Atrium Right Ventricle Figure 17 4 Thermodilutio Cathetern Site 17 3 C O SETUP Menu H CO Setup and Adjustment Pick the CO hot key on the screen to call up the C O SELECT menu as shown below GU SELECT GU SETUP C 0 MEASURE Back to the upper menu Figure 17 5 C O SELECT Menu Pick the C O SETUP button to access the submenu as shown below 17 6 Patient Monitor user s manual V 5 4 CO Measuring GU SETUP ALM ON INJ TEMP FROM ON A ALM LEV MED _ INJ TEMP 2 0 ALM REC OFF v TEMP UNIT L Z TB ALM HI 39 0 INT TIME s 30 ah TB ALM LO 36 0 DEFAULT gt gt CO CONST 0 542 Open or close the TB alarm EXIT Figure 17 6 C O SETUP Menu H TB Alarm setup ALM Select ON to enable alarm prompt and data storage during TB alarm Select OFF to disable audio alarm and prompt the 28 symbol beside TB numeric A Warning A During the cardiac output measurement procedure the blood temperature alarms will be inactive ALM REC Select ON to enable recording during the TB alarm ALM LEV selectable from level HIGH
73. the patient weight and drug name The system first gives a group of random initial values which cannot be used by the operator as the calculation reference Instead he should enter a new group of values at the doctor s instruction As Note A Each drug has its fixed unit or unit series Operator must select the proper unit at the doctor s instruction If the result exceeds the system defined range it will display A Note AY After entering a value a conspicuous prompt will appear in the menu warning the Operator to confirm the correctness of the entered value The correct value is the guaraniee for the reliability and safety of the calculated results AN Note A In neonate mode Drip Rate and Drop Size items are disabled A Note A For each entered value the system will always give a dialog box asking for the user s confirmation You must be careful when answering each box The calculated result is reliable only after the entered value is confirmed to be correct Select the drug name Turn the knob to pick the DRUG NAME item in DRUG CALC menu The user may select the drug name in the pull down list including AMINOPHYLLINE DOBUTAMINE DOPAMINE EPINEPHRINE HEPARIN ISUPREL LIDOCAINE NIPRIDE NITROGLYCERING PITOCIN Drug AQ Drug BI Drug C0 Drug D and Drug E Calculation for only one type can be generated each time NOTE AQBUCQDEE are only codes for drugs
74. the alarm area of the monitor while technical alarms and prompt messages unable to trigger alarms are then displayed in the information area of the monitor This section does not describe the content about Arr and ST analysis Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe respectively the possible various alarms those may occur during the measurement Physiological alarms Message Cause Alarm level ECG LOST No ECG signal of the patient is detected HIGH HR TOO HIGH HR measuring value is above the upper alarm limit User selectable HR TOO LOW HR measuring value is below the lower alarm limit User selectable Technical alarms Alarm EE EE ECG LEAD OFF ECG electrodes fall off LOW Make sure that all SAS the skin or ECG cables fall off electrodes leads and ECG V LEAD OFF or the monitor patient cables are properly connected ECG C LEAD OFF ECG LL LEAD OFF or ECG F LEAD OFF Patient Monitor user s manual V 5 4 12 11 ECG RESP Monitoring ECG LALEAD OFF or ECG LLEAD OFF ECG RALEAD OFF or ECG R LEAD OFF ECG INIT ERR ECG INIT ERR1 measuring function ECGINITERRS provided by ECG ECG INIT ERR4 ECG module failure HIGH module no
75. the patient receives treatment Patient No Patient bed number Range 1 100 Name of the doctor Patient name Valid characters A Z 0 9 and space bar Max length 12 characters Patient gender Available options F for Female M for Male Patient type Available options ADU PED and NEO Hospitalization starting date format year month day Patient date of birth format year month day Patient height turning the knob with the increase decrease of 0 5 cm inch each time The other HT unit in the other menus accord with the unit which you choosed here Patient weight turning the knob with the increase decrease of 0 5 kg Ib each time The other WT unit in the other menus accord with the unit which you choosed here Patient blood type Pick A B O AB or N N represents unknown blood type Admission of new patient 3 2 Patient Monitor user s manual V 5 4 System Menu Also in this menu you may select the NEW PATIENT item to access the CONFIRM TO UPDATE PATIENT dialog box as shown below in which you can decide whether to monitor a new patient CONFIRM TO UPDATE PATIENT All data of currently monitored patient will be deleted Yes YES Figure 3 3 Confirm To Update Patient Menu Pick YES to delete all information of the patient being currently monitored and exit the menu Pick NO to give up updating the patient and the system will keep the information of the current patient an
76. times minute NIBP From left to right there are Systolic pressure Mean pressure and Diastolic pressure unit mmHg or kPa SpO gt 2 SpO unit Pulse Rate unit beats minute When BOTH item is selected CO CO unit liter minute l TBE unit C or F IBP The blood pressure of channel 1 and 2 From left to right there are Systolic pressure Mean pressure and Diastolic pressure unit mmHg or kPa RESP Respiration Rate unit times minute CO2 EtCO2 unit mmHg or kPa INS CO2 unit mmHg or kPa AwRR times minute TEMP Temperature of channel 1 and 2 T1 T2 and the difference between them TD unit C or Pl Patient Monitor user s manual V 5 4 1 7 Introduction AG AwRR times minute MAC CO2 unit mmHg or kPa O2 unit or mmHg or kPa N2O unit or mmHg or kPa AdA unit or mmHg or kPa Alarm lamp and alarm status In normal status the alarm lamp is not on When alarm exists the alarm lamp flashes or lights on The color of the lamp corresponds to the alarm level Refer to related chapter Alarm For the details of alarm information and prompt information refer to the related content of each parameter in
77. value of channel 2 is HIGH beyond measurement range IBP2 MEAN EXCEED Mean measuring value of channel 2 is HIGH beyond measurement range IBP1 NEED ZERO CAL IBP channel 1 has not been zeroed LOW IBP2 NEED ZERO CAL IBP channel 2 has not been zeroed LOW 16 6 Maintenance and Cleaning 16 6 1 Care and cleaning A Warning A Before cleaning the monitor or the transducer turn off the power and disconnect from power line Cleaning of IBP Transducer Reusable After the IBP monitoring operation is completed remove the tubing and the dome from the transducer and wipe the transducer diaphragm with water To clean the transducer and the cable soak or wipe them by using soap or the detergents listed below Cetylcide Wavicide 01 Wescodyne Cidex Lysol Vesphene Do not immerse the connector in any liquid After cleaning dry the transducer thoroughly before storing Slight discoloration or temporary increase of surface stickiness of the cable should not be considered abnormal If adhesive tape residue must be removed from the transducer cable double seal tape remover is effective and will cause a minimum of damage to the cable if used sparingly Acetone Alcohol Ammonia and Chloroform or other strong solvents are not recommended because over time the vinyl cabling will be damaged by these Patient Monitor user s manual V 5 4 16 11 IBP Monitoring agents A Note A The disposable transducers or domes must not be re ster
78. will be a great deal of interference with the ECG signal WH Using 5 lead ECG set The default setting is ECG CH1 corresponding to Channel Il and ECG CH2 to Channel you can modify the setting to meet your needs You can set them to correspond to any two from Il Ill AVR AVL AVF and V If you set both to the same value one of them will be adjusted to another option automatically Figure 12 3 Figure 12 3 ECG lead A Note A If a ECG waveform is not accurate while the electrodes are tightly attached try to change the lead AN Note A Interference from a non grounded instrument near the patient and ESU interference can cause inaccuracy of the waveform Normal QRS complex should be o Tall and narrow with no notches o With tall R wave completely above or below the baseline Patient Monitor user s manual V 5 4 12 5 ECG RESP Monitoring o With pacer spike no higher than R wave height With T wave less than one third of the R wave height o o With P wave much smaller than the T wave For getting 1 mv calibrated ECG wave choose ECG CAL button in ECG SETUP menu A message when CAL can t monitor prompts on the screen Figure 12 4 Standard ECG Waveform AN Warning A Do not touch the patient table nearby or the equipment during defibrillation 12 4 ECG Screen Hot Keys the hot key for ECG Figure 12 5 O Leads of channel 1 10 The selectable leads are I Il III aVR aVL aVF V 20 When th
79. with V4 electrode m V3R V7R On the right side of the chest in positions corresponding to those on the left E VE Over the xiphoid position gm V7 On the 5th intercostal space at the left posterior axillary line of back mgm V7R On the 5th intercostal space at the right posterior axillary line of back Figure 12 2 C electrode placement for 12 lead set Recommended ECG Lead Placement for Surgical Patients A Warning A When using Electrosurgery equipment leads should be placed in a position in equal distance from Electrosurgery electrotome and the grounding plate to avoid cautery Electrosurgery equipment wire and ECG cable must not be tangled up The placing of the ECG leads will depend on the type of surgery that is being performed For example with open chest surgery the electrodes may be placed laterally on the chest or on the back In the operating room artifacts can sometimes affect the ECG waveform due to the use of ES Electrosurgery equipment To help reduce this you can place the electrodes on 12 4 Patient Monitor user s manual V 5 4 ECG RESP Monitoring the right and left shoulders the right and left sides near the stomach and the chest lead on the left side at mid chest Avoid placing the electrodes on the upper arms otherwise the ECG waveform will be too small A Warning AN When using Electrosurgery equipment never place an electrode near the grounding plate of the Electrosurgery device otherwise there
80. 0 150 mmHg 20 165 mmHg 40 135 mmHg 10 95 mmHg 20 105 mmHg 1mmHg 5mmHg Maximum Standard deviation Overpressure Protection Adult Mode Pediatric Mode Neonatal Mode 2 11 SpO2 Measuring Range Alarm Range Resolution Accuracy Actualization interval Alarm Delay Pulse Rate Measuring and Alarm Range Resolution Accuracy MASIMO Specification Range Saturation SpO2 Pulse Rate bmp 8mmHg 29743 mmHg 240 3 mmHg 14743 mmHg 0 100 0 100 1 70 100 0 69 about 1 Sec 10 Sec 2 unspecified 0 254bpm 1bpm 2bpm or 2 use the greater 1 100 25 240 Patient Monitor user s manual V 5 4 5 Production Specification Accuracy Saturation SpO2 Adults pediatric Neonates Saturation SpO2 During No Motion Conditions 70 1000 2 0 69 unspecified 70 100 3 0 69 unspecified During Motion Conditions Adults pediatric Neonates 70 100 3 0 69 unspecified Pulse bpm During No Motion Condition 25 to 240 3BPM Pulse bpm During Motion Condition Resolution Saturation SpO2 Pulse Rate bpm 2 12 TEMPERATURE Channel Measuring and Alarm Range Resolution Accuracy Actualization interval Average Time Constant 2 13 IBP Channel Label Measuring and alarm range ART PA CVP RAP LAP ICP P1 P2 Press Se
81. 0 mg VOLUME 250 00 ml DOSE hr 150 00 mg INF RATE 93 75 mlhr WEIGHT 70 0 kg DRIP RATE 31 25 GTTvmin DOSE INF RATE DOSE INF RATE DOSE INF RATE H 1 2 3 4 5 6 7 8 9 BASIC DOSE x STEP 1 DOSE TYPE DOSE hr Z UP DOUN REC Use one item as input calculate the other one EXIT Figure 9 2 TITRATION H Method to operate the titration table 1 In the TITRATION table turn the knob to pick BASIC item Press and turn the knob to select either FLOW RATE or DOSE or DROP RATE 2 Then turn the knob to pick STEP item Press and turn the knob to select step 1 10 are available for selection with the increment being 1 Patient Monitor user s manual V 5 4 9 3 Drug Calculation and Titration Table 3 Turn the knob to pick DOSE TYPE item Press and turn the knob to select the unit in the pull down list Use UP DOWN item in the table to view the data in previous or following pages Turn the knob to pick REC item After pressing the knob the recorder prints out the data displayed in the current titration table 6 Turn the knob to pick EXIT to return to DRUG CALC menu Total amount dose volume flow rate drop rate and patient weight and drug name are displayed on the top of the titration table Meaning of each English identifier is AMOUNT drug amount VOLUMEQ liquid volume DOSE min drug dose FLOW RATE flow rate DROP RATE drop rate WEIGHT patient weight
82. 144 x264 mm 5 5 kg 0 40 C 35 C 40 C 40 C 20 60 C 10 C 15 85 10 93 noncomdensing 500 to 4 600m 1 600 to 15 000ft 500 to 13 100m 1 600 to 43 000ft Patient Monitor user s manual V 5 4 Production Specification Power Supply 2 3 Display Device Messages 2 4 Signal Interface External display ECG Output Amplitude Accuracy Impedance Signal Delay NURSE CALL output 100 250 V AC 50 60 Hz Pmax 110VA FUSE T1 6 12 1 in Color TFT 800 x 600 Resolution 3 LED 8 Waveforms Maximum 1Alarm LED Yellow Red 1 Power LED Green 1 Charge LED Green 3 Sound Mode corresponding Alarm Mode Standard VGA BNC 1V lt 5 100 ohm lt 20 ms NURSE CALL function is realized through external NURSE CALL cable Output signal type Max voltage Max load current On resistance Isolation voltage 2 5 Battery Rechargeable Lead Acid Operating time under the normal condition NORMAL OPEN NORMAL CLOSE is software controlled 36V DC OR 25V AC 1A lt 10 1500VAC 2 3Ah 12V 100 minutes 2 batteries Operating time after the first alarm of low battery gt 5 minutes Maximum charging time of single battery is 4 hours Maximum charging time of two batteries is 8 hours 2 6 Recorder Option Record Width Paper Speed Trace Recording types 48 mm 25 50 mm s 2 Continuous real time recording 8 second real time re
83. 15 45 6 z0 01 15 44 6 2 01 15 43 6 2 01 15 42 EE 01 15 41 Soi An 01 15 40 EEN 01 15 39 cs E 01 15 38 E 01 15 37 EE RESOLUTION 1MIN x UP DOWN L RIGHT REC Select the time interval used to view the trend data of the parameter EXIT Figure 8 2 TREND TABLE Menu Time in response to each group of trend data is displayed at the leftmost list with date in bracket Marked event corresponds to marking time Trend data of each parameter is divided into 8 groups HR RR PVC ST1 ST2 TEMP1 TEMP2 TEMPD SPO2 PR NIBP NS ND NM IBP1 S D M IBP2 S D M CO2 INS AWRR TB NIBP trend data presents different specificity A certain NIBP measuring time is displayed below the TEST AT item as well as the measurement value For more than one measurement in one time it can display only one group and mark a on the MORE to indicate two and above measurement results To choose trend table of different resolution Pick the leftmost item and change the time interval of trend data To view other trend data When A appears on the upper part of the screen pick UP DOWN button and turn the knob clockwise to view later trend data When 4 appears on the lower part of the screen pick the Patient Monitor user s manual V 5 4 8 3 Trend and Event same item and turn the knob counterclockwise to view earlier trend data To obtain trend data of different parameter Pick L RIGHT to select one from the 8 groups of par
84. 2 DryerSample Line with TEE HH 008 0784 00 EtCO2 DryerSample Line HH No TEE 008 0780 00 EtCO2 DryerSample Line with TEE LH 008 0782 00 EtCO2 Dryer 008 0789 00 Adult Nasal Sampling Line soft 008 0786 00 Adult O2 Delivery Sampling Line 008 0790 00 Pediatric Nasal Sampling Line Soft 008 0785 00 Pediatric O2 Deliver Nasal SampleLine 008 0788 00 Infant EtCO2 Nasal Sampling Line Soft 008 0783 00 Infant O2 Deliver Nasal SampleLine 2 5mm 008 0766 00 InfantConnecter with Sideport 008 0779 00 Adult Pediatric Sampling TEE Sampling LineNeonate2 5m purchase Nol 60 15300 00 Sampling ELBOW BOX OF 50 P N 000 91167 Sampling SATRAIGHT CTEE connector DRYLINE WATER TRAP NEONATER 60 13200 00 MAINSTREAM SENSOR II P N 000 59000 AIRWAY ADAPTER ADULT BOX OF 10 P N 000 91060 AIRWAY ADAPTER LDS BOX OF 10 P N 000 91070 P N 6000 10 02107 P N 900E 10 04882 P N 0010 10 12176 P N 0010 10 12208 P N 6000 10 02079 P N 6000 10 02080 P N 6000 10 02081 P N 900E 30 04952 P N 0010 10 12082 P N 0010 10 12083 P N 0010 10 12084 P N 0010 10 12085 P N 0010 10 12086 P N 0010 10 12087 P N 0010 10 12088 P N 0010 10 12089 P N 0010 10 12090 P N 0010 10 12091 P N 0010 10 12092 P N 0010 10 12093 P N 9200 10 10555 P N 9000 10 07297 P N 9200 10 10593 P N 9200 10 10574 P N 9000 10 07299 P N 9000 10 07301 P N 9000 10 07302 20 4 Patient Monitor user s manual V 5 4 Accessories and Ordering Information 20 8 Anesthetic Gas Accessor
85. 250 VAC 50 60 Hz m Apply the power line provided with the monitor Plug the power line to INPUT interface of the monitor Socket in Figure 1 6 Connect the other end of the power line to a grounded 3 phase power output A Note A Connect the power line to the jack special for hospital usage A Note A Mindray does not provide MULTIPLE PORTABLE SOCKET OUTLETS IF use it please do not place it on the floor Mindray advises that every one monitor uses one MULTIPLE PORTABLE SOCKET OUTLETS m Connect to the ground line if necessary Refer to Chapter Patient Safety for details Patient Monitor user s manual V 5 4 2 1 Getting Started A Note AY Make sure that the POWER lamp now lights If it does not light check your local power supply If the problem still exists contact the local Customer Service Center A Note A The battery need to be charged after transportation or storage If the power supply is not properly connected before turning on the monitor it may not work properly because of insufficient power Connect the power supply to charge the battery 2 3 Power on the Monitor Press POWER in Figure 1 1 to power on the monitor Then a beep will be heard and at the same time the indicator will flash twice in yellow and red After 10 seconds or so the system will enter monitoring screen after self test and you can perform normal monitoring now During self test the software version
86. 4 Patient Monitor user s manual V 5 4 Chapter 13 SpO2 Monitoring 13 1 PART 1 MASIMO SpO2 board configuration OMAsiNo SEI General description SpO is a non invasive measurement of the functional oxygen saturation The measurement is taken by placing a sensor on a patient usually on the fingertip for adults and the hand or foot for neonates The sensor is connected to the patient monitor with pulse oximetry measurement module Masimo Set which is called MS 7 The monitor displays the calculated data from MS 7 in three ways 1 as a percent value for arterial oxygen saturation SpOz 2 as a pulse rate PR and 3 as a plethysmographic waveform on the screen Principles of Operation This MS 7 is based on three principles H Oxyhemoglobin and deoxyhemoglobin differ in their absorption of red and infrared light spectrophotometry m The volume of arterial blood in tissue and the light absorbed by the blood changes during the pulse plethysmography m Arterio venous shunting is highly variable and that fluctuating absorbance by venous blood is a major component of noise during the pulse This MS 7 determines SpO by passing red and infrared light into a capillary bed and measuring changes in light absorption during the pulsatile cycle Red and infrared light emitting diodes LEDs in oximetry sensors serve as the light sources a photodiode serves as the photodetector Traditional pulse oximeter assumes that all pulsatio
87. 5 4 12 9 ECG RESP Monitoring to the chapter about SPO2 to know the detailed information about PITCH TONE PACE ON detected signal will be marked by a above the ECG waveform OFF for non pacemaking patient AY Note AY If monitoring a patient with the pacemaker set PACE to On If monitoring a patient without pacemaker set PACE to Off If PACE is on the system will not perform some types of ARR analysis For detailed information please refer to the section ARR ALARM In the table the ARR type marked by All types applies to the analysis in all situations marked by Non paced applies only to the analysis in the situation when the patient does not use pacemaker CASCADE switch for ECG cascade CASCADE wave of each channel is displayed in two lines This function effects only when NORMAL DISPLAY is selected for ECG DISPLAY ECG CAL pick this item to start calibrating ECG The method to end CAL re select the CAL key in the menu or re select the lead name on the screen ADJUST WAVE POS used to adjust the position of the waveform on the screen Pick to access ADJUST WAVE POS dialog box The user may use CH NAME item to select the channel to be adjusted UP DOWN to adjust the position of the selected channel on the screen BACK TO DEFAULT to let the wave go back to the default position on the screen ADJUST WAVE POS CH NAME CH1 UP DOUN BACK TO DEFAULT Select the wave channel to be adjusted EXIT
88. AN Warning A ES Electrosurgery equipment wire and SpO cable must not be tangled up A Warning A Do not put the sensor on extremities with arterial catheter or venous syringe A Note A 13 14 Patient Monitor user s manual V 5 4 SpO Monitoring Do not perform SpO measuring and NIBP measuring on same arm at one time because obstruction of blood flow during NIBP measuring may adversely affect the reading of SpO value 13 2 2 Precautions during SpO2 Pulse Monitoring AN Note AN E Make sure the nail covers the light window E The wire should be on the backside of the hand AN Note A WE SpO value is always displayed at the same position m Pulse Rate will be displayed only under following situations Select HR FROM as SPO2 or BOTH in the ECG SETUP menu Select HR FROM as AUTO in the ECG SETUP menu and there is no ECG signal AN Note AY SpO waveform is not proportional to the pulse volume A Warning A Check if the sensor cable is in normal condition before monitoring After unplugging the SpO sensor cable from the socket the system shall display the error message SPO2 SENSOR OFF and give the audible alarm AN Warning AN Do not use the SpO2 sensor once the package or the sensor is found damaged Instead you shall return it to the vendor A Warning A Prolonged and continuous monitoring may increase jeopardy of unexpected change of dermal condition such as abnormal sensitivi
89. BP Channel 1 SYS DIA MAP Channel 2 SYS DIA MAP Dual IBP waveforms CO Blood Temperature TB Cardiac Output CO CO2 End Tidal CO2 EtCO2 0 Inspired Minimum CO2 InsCO2 1 4 Patient Monitor user s manual V 5 4 Introduction Air Way Respiration Rate AwRR AG Inhale and exhale CO2 FiCO2 EtCO2 Inhale and exhale N2O FiN2O EtN20 Inhale and Exhale O2 FiO2 EtO2 Inhale and exhale anesthetic agent FIAA ETAA Note AA refers to one of anesthetic agents listed below HAL Halothance ISO Isoflurance ENF Enflurance SEV Sevoflurance DES Desflurance Airway Respiration Rate respiratory times per minute unit rpm AwRR MAC Minimum alveolar concentration Waveforms of four anesthetic gases including CO2 N2O 02 AA PM 9000 provides extensive functions as visual amp audible alarm storage and report printout for trend data NIBP measurements and alarm events oxyCRG viewbed and drug dose calculation function is provided either 1 2 Screen Display The display of PM 9000 parameter monitor is a color LCD which can display the collected patient parameters waveforms alarm information as well as bed number time and monitor status etc The screen is divided into three areas Figure 1 2 Information area waveform areal parameter area EE e a SC ES d r Figure 1 2 PM 9000 Main Display Information Area The Message Area is at th
90. ECG is not connected correctly Check the connection of L lead wire ECG R LEAD OFF The R lead wire of ECG is not connected correctly Check the connection of R lead wire SPO2 SENSOR OFF SpO2 sensor may be disconnected from the patient or the monitor Make sure that the monitor and the patient are in correct connection with the cables Patient Monitor user s manual V 5 4 System Alarm Prompt SPO2 INIT ERR SPO2 INIT ERR 1 SPO2 INIT ERR 2 SPO2 INIT ERR 3 SPO2 INIT ERR 4 SPO2 INIT ERR 5 SPO2 INIT ERR 6 SPO2 INIT ERR 7 SPO2 INIT ERR 8 SpO module failure Stop using the measuring function of SpO module notify biomedical engineer or Our service staff SPO2 COMM STOP SpO2 module failure or communication error Stop using the measuring function of SpO module notify biomedical engineer or Our service staff SPO2 COMM ERR SpO2 module failure or communication error Stop using the measuring function of SpO module notify biomedical engineer or Our service staff SPO2 ALM LMT ERR Functional safety failure Stop using the measuring function of SpO module notify biomedical engineer or Our service staff PR ALM LMT ERR Functional safety failure Stop using the measuring function of SpO module notify biomedical engineer or Our service staff MASIMO Alarm information SpO2 NO SENSOR Sens
91. ER OUT OF PAPER alarm is displayed the recorder cannot start Please insert record paper properly Inserting Paper WH Open the recorder catch RW Pull down the switch on the left axis of the recorder WH Insert a new roll of paper into the paper cassette printing side facing the thermosensitive printhead m When the paper can be seen from the other side pull it out Ensure proper position and tidy margin m Pull back the switch on the left axis of the recorder RW Give out the paper from the recorder outlet mM Close the recorder catch A Note A Be careful when inserting paper Avoid damaging the thermosensitive printhead Unless when inserting paper or shooting troubles do not leave the recorder catch open Removing Paper Jam When the recorder functions or sounds improperly open the recorder catch to check for a paper jam Removing the paper jam in the following way Cut the record paper from the feeding edge Pull up the switch on the left axis of the recorder Pull the paper from below Re insert the paper Recorder Status Message Technical Alarms Message Cause Alarm Remedy Level RECORDER HEAD The thermal terminal is Stop operation HOT too hot ow The thermal head is not Push down the switch on Ee in recording place low the left axis of the recorder 7 6 Patient Monitor user s manual V 5 4 Recording RECORDER OUT OF Record paper ru
92. ES OCCURRING DURING SPO2 MEASUREMENT Physiological alarm Message Cause Alarm Level SPO TOO HIGH te ia value is above upper alarm Eerst SpO2 TOO LOW SpO2 measuring value is below lower alarm limit User selectable PR TOO HIGH PR measuring value is above upper alarm limit User selectable PR TOO LOW PR measuring value is below lower alarm limit User selectable Technical alarms Q ere Q May be an incorrect sensor or a defective sensor or cable Sensor not fully inserted MEEN a PENRO ato A LOW connector Disconnect and SpO2 NO DEER reconnect sensor Refer to the instructions for the sensor SENSOR being used Sencar inserted Disconnect and reconnect he ide dow LOW sensor with the logos ups matching SpO2 SENSOR SpO2 sensor may be Disconnect and reconnect the disconnected from the LOW sensor Patient Monitor user s manual V 5 4 13 11 SpO2 Monitoring Sp02 Stop using the measuring SE This message appears HIGH function of SpO2 module FAULT when the sensor is faulty notify biomedical engineer or our service staff SpO02 Make sure that the monitor UNRECOGNIZED M Liar ate de net LOW and the patient are in correct SENSOR cog connection with the cables Sp02 This message is displayed when the Make sure that the monitor pecan masimo sensor is finding Se use incompatible sensor incompatible sensor SpO2 Outside signal or energy
93. Electromagnetic propagation is affected by absorption and reflection from structures objects and people Patient Monitor user s manual V 5 4 3 Appendix IV System Alarm Prompt PROMPT CAUSE MEASURE n i XX value exceeds the higher EK alarm limit Check if the alarm limits are appropriate and the current XX TOO LOW XX value is below the lower situation of the patient alarm limit XX represents the value of parameter such as HR ST1 ST2 RR SpO2 IBP NIBP etc in the system The ECG signal of the patient Check if the electrodes and lead wires are connected ECG WEAK SIGNAL is too small so that the system correctly and the current can not perform ECG analysis Se situation of the patient The pulse signal of the patient Check the connection of the NO PULSE is too small so that the system sensor and the current can not perform pulse analysis situation of the patient The respiration Signal orahe Check the connection of the i i patient is too small so that the p RESP APNEA linking wire and the current system cannot perform RESP n o situation of the patient analysis ANG respiration signal or Ihe Check the connection of CO2 a i patient is too small so that the CO2 APNEA sensor and the current system cannot perform RESP gt lt situation of the patient analysis Check the current situation of i Patient suffers from Arr O
94. F surgical equipment do not let the transducer and cable contact the HF surgical equipment to prevent the patient from burning caused by leakage current Patient Monitor user s manual V 5 4 16 1 IBP Monitoring A Warning A Disposable IBP transducer or domes should not be reused A Note A Use only the pressure transducer specified in this operation manual The specified transducef except for ICT B transducer has the function of protecting against the electric shock especially the leakage current and the influence of cardiac defibrillator It can be used in surgical operation When the patient is in the defibrillation the pressure waveform may become temporarily distorted However the monitor will work normally after defibrillation with the operation mode and user configuration being not affected A Warning A Inspect the transducer cable is in normal condition before monitoring Unplug the transducer of the channel 1 the monitor should display the error message IBP SENSOR 1 OFF and trigger audible alarm The other channel should act the same A Note A Periodically calibrate the transducer either new or used according to the Hospital Regulation A Warning A If any kind of liquid other than the solution to be infused in the pressure line or transducer is splashed on the equipment or its accessories especially enters the transducer or the monitor contact the Service Center of the Hospital i
95. IEC 60601 Compliance Electromagnetic environment munity test Test level level guidance Conducted RF 3 Vrms 150kHz 3 Vrms Recommended separation distance IEC 61000 4 6 to 80MHz d 1 2x p 2 Patient Monitor user s manual V 5 4 EMC Recommended separation distance d 1 2xJP 80MHz to 800MHz d 2 3x p 800MHz to 2 5GHz Where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in meters Radiated RF 3 V m 80MHz 3 V m m IEC 61000 4 3 to 2 5 GHz Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range H Interference may occur in the vicinity of equipment marked with the following symbol Bei 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 an electromagnetic site survey should be considered If the measured field strength in the location in which the monitor is used exceeds the applicable RF compliance level above the monitor should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary
96. IMO SPOZ SETUP ALM PR ALM LO 5 s ALM LEV MED SWEEP 25 0 gt ALM REC OFF PR SOUND 2 X SP02 ALM HI 100 AVG TIME 8S v SP0Z ALM LO 90 gt SENSITIVITY MODE NORMAL PR ALM HI 126 DEFAULT gt gt Open or close the Sp02 alarm EXIT Figure 13 2 SpO2 SETUP menu A Warning A Setting the SpO upper alarm limit to 100 is equivalent to switching off the alarm on upper limit High oxygen levels may predispose a premature infant to retrolental fibroplasia Therefore the upper alarm limit for oxygen saturation must be carefully selected in accordance with commonly accepted clinical practices SpO gt alarm setting e ALM pick ON to enable prompt message and data record during the SpO alarm pick OFF to disable the alarm function and there will be a 4 beside SpO e ALM REC pick ON to enable report printing upon SpO alarm e ALM LEV used to set up alarm level selectable from HIGH MED and LOW HIGH represents the most serious case e SpO2 ALM HI and SpO2 ALM LO SpO2 alarm is activated when the result exceeds set SpO2 ALM HI value or falls below SpO2 ALM LO value Use the knob to pick the SpO2 ALM HI or SpO2 ALM LO item and turn the knob to select the desired alarm limit e PR ALM HI and PR ALM LO PR alarm is activated when the pulse rate exceeds set PR ALM HI value or falls below PR ALM LO value Use the knob to pick the PR ALM HI or PR ALM LO item and turn the knob to select the desired alarm limit A Warning
97. LL signal is synchronous with the alarm signal designated in the triggering condition m SIGNAL TYPE NORMAL OPEN or NORMAL CLOSE NORMAL OPEN select this item when the CALL system of the hospital is set to NORMAL OPEN NORMAL CLOSE select this item when the CALL system of the hospital is set to NORMAL CLOSE WH ALMLEV and ALM TYPE after NURSE CALL function is activated the monitor provides Patient Monitor user s manual V 5 4 3 15 System Menu the following combination options of alarm level and alarm type for the user to choose in order to trigger NURSE CALL signal ALM LEV provides three combination options i e NURSE CALL signal will be triggered when it is HIGH alarm MED alarm or LOW alarm ALM TYPE provides two combination options i e NURSE CALL signal will be triggered when it is TECH alarm or PHYS alarm AY Warning AY When no option in ALM TYPE is selected the NURSE CALL signal will not be triggered in whatever condition A Warning A When in ALARM SILENCE PAUSE status the monitor will automatically switch off NURSE CALL signal after discharging ALARM SILENCE PAUSE status the monitor will automatically return to the status before ALARM SILENCE PAUSE is activated If the user select CLOSE in the ALARM SOUND item of the USER MAINTAIN menu it will does not affect the function of NURSE CALL A Warning A The nurse call feature shou
98. M OFF opp RELEARN ALM LEU MED ARR ALARM gt gt ALM REC OFF ARR RECALL gt gt Perform Arr analysis only when the switch is On EXIT Figure 12 12 ARR ANALYSIS Menu m ARRANAL Pick ON during monitoring Default set is OFF m PVCs ALM pick ON to enable prompt message and data record when alarm occurs pick OFF to disable the alarm function and there will be a beside PVCs m ALM LEV selectable from HIGH MED LOW Level HIGH represents the most serious case m ALM REC pick ON to enable report printing upon PVCs alarm PVCs alarm is activated when the PVCs exceeds set PVCs ALM HI value 12 16 Patient Monitor user s manual V 5 4 ECG RESP Monitoring PVCs alarm upper limits Max Min Step PVCs 10 1 1 PVCs alarm and prompt message Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during pyvcs measurement Physiological alarms Message Cause Alarm Level PVCs TOO HIGH PVCs measuring value is above upper alarm User selectable limit Technical alarms Message Cause Alarm Level Remedy Stop using PVCs alarming Functional safety fu
99. OFF and enter Silence or Pause status A Note A After the alarm volume is set to OFF a al symbol will appear in the Technical Alarm Area AY Note AY Setting Alarm Volume to OFF is valid only when the monitor is turned on for this time After turning on the monitor next time this setup will restore its value of the previous time when the system is turned on COLOR SELF DEFINE is used by the user to define the color of the waveform displayed on the screen Five colors can be chosen from green cyan red yellow and white 3 14 Patient Monitor user s manual V 5 4 System Menu COLOR SELF DEF INE ECG WAVE amp PARA GREEN gt SPO02 WAVE amp PARA CYAN 4 IBP WAVE amp PARA RED v COZ WAVE amp PARA YELLOW 4 RESP WAVE amp PARA YELLOW 4 4 AG WAVE amp PARA YELLOW OTHER PARA WHITE Back to the upper menu Figure 3 21 Color Self define NURSE CALL SETUP If the NURSE CALL item in AUX OUTPUT being selected the NURSE CALL SETUP submenu will be available NURSE CALL SETUP 4 SIGNAL DURATION CONTINUUM gt SIGNAL TYPE NORMAL OPEN ALM LEV ALM TYPE v HIGH v TECH MED PHYS LOW Select Nurse call signal duration EXIT Figure 3 22 Nurse Call Setup m SIGNAL DURATION PULSE and CONTINUUM two types of signals are available Selecting PULSE indicates that the NURSE CALL is the pulse signal of 1s duration selecting CONTINUUM indicates that the NURSE CA
100. OH Tl Injectate Temperature If necessary change can be performed in the C O SETUP menu O Function keys START Start a measurement If the blood temperature cannot resume in a considerably long time STOP the measurement could not stop automatically Use this button to stop the measurement and display the C O C I calculation result Patient Monitor user s manual V 5 4 17 3 CO Measuring Cancel the processing measurement or cancel the result after CANGEE measurement REC Print out the curve Change the scale Y temperature value Three modes are Scale Y available 0 0 5 C 0 1 0 C and 0 2 0 C Adjust the scale by the temperature differences A smaller scale results in a larger curve Change the scale X time value Two modes are available 0 30s and 0 60s If you start measurement in the 0 30s mode it will be Scale X switched to 0 60s mode automatically if the measurement can not finish within 30 seconds After the switch no further adjustment can be made to the Scale X Edit Enter the WINDOW FOR C O EDIT Exit Press to exit the WINDOW FOR C O MEASUREMENT m Measuring the Cardiac Output Measurement should be taken when the message Ready for new measurement appears on the screen in the Figure 17 2 Press the START button and then start injection The thermodilution curve current blood temperature and the injectate temperature are displayed during the measurement
101. ONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s confirmation m EXIT used to exit the menu and return to the main screen 17 4 Hemodynamic Calculation m Hemocalculation Pick the HEMO CALCULATE in the WINDOWS FOR C O EDIT Window to display input parameter value and list calculation results HEMOD WINDOW RESULT CIC1 minsm 2 EFC SU m1 SUI m1m 2 SUR DS cm 5 SURI DSem 2 cm 5 PUR DS cm 5 PURI DScem 2 cm 5 LCW kg m LCWI Ckg m m 2 LUSU g m LUSUI g m7m 2 RCW Ckg m RCWI kg m7m 2 RUSU g m RUSY I g m7m 2 BSA m 2 1 811 INPUT VALUE Lu P 50 s PAUP mmHg 8 AP MAPcmmhg 93 CUP mmHg 12 PA MAP mmHhg COCl min HT cm 175 0 HR 60 UT Kg 70 0 CALCULATE REC EXIT Figure 17 7 HEMOD Windows Turn the rotary knob you can change the value of the parameter that the cursor appears on by picking it Pick CALCULATE after input of all parameter values the calculation results will 17 8 Patient Monitor user s manual V 5 4 CO Measuring be displayed in the window Pick REC can print out all the calculation results Input parameter value m PAWP Pulmonary Artery Wedge Pressure m CVP Central Venous Pressure E CO Cardiac Output m HR Heart Rate m AP MAP Mea
102. OR 6PIN SPO2 cable 6PIN SPO2 trunk cable KIT m NELLCO ACCESSORIES DS 100A finger sensor OXI P I pediatric sensor NELLCO Adult Neonate wrapping SPO2 sensor OXI A N m MINDRAY ACCESSORIES 512B finger SPO2 sensor Finger SPO2 sensor 518A multi function SPO2 sensor 6PIN SPO2 sensor trunk cable 6PIN SPO2 sensor trunk cable P N 9000 30 07470 P N 0010 30 12262 P N 0010 30 12263 P N 0010 30 12264 P N 0010 30 12265 P N 0010 30 12266 P N 0010 30 12267 P N 0010 30 12268 P N 0010 30 12269 P N 0010 10 12080 P N 0010 10 12304 P N 0509 10 00094 P N 900E 10 04879 P N 900E 10 04880 P N 0010 10 12274 P N 0010 10 12101 P N 9200 30 10682 P N 9200 30 10707 P N 9000 10 05161 P N 9000 10 07308 P N 9000 10 07336 P N 512B 30 90134 P N 512D 30 90200 P N 518A 30 90226 P N 0513 30 11220 P N 512D 30 16752 20 2 Patient Monitor user s manual V 5 4 Accessories and Ordering Information 20 3 NIBP Accessories m Reusable cuff Patient Type Limb perimeter PN Factory PN Infant 10 19 cm 0010 30 12157 CM1201 Child 18 26 cm 0010 30 12158 CM1202 Adult 25 35 cm 0010 30 12159 CM1203 Large Adult 33 47 cm 0010 30 12160 CM1204 Thigh 46 66 cm 0010 30 12161 CM1205 Adult 25 35 cm 0010 30 12059 W A BAUM Child 18 26 cm 0010 30 12060 W A BAUM Infant 10 19 cm 0010 30 12061 W A BAUM Pediatric 6 11 cm 0010 30 12067 W A BAUM Adult 25 35 cm 509B 30 08845 CM1203 1 m Disposable cuff
103. P is always displayed on the screen until the sensor reaches to the operating temperature After CO2 module is activated and enters the normal status for MainStream MAIN is displayed following CO2 waveform identifier and for SideStream the SIDE is displayed following CO2 waveform identifier Watertrap Nafion tube Mainstream 07 Sensor Airway SE Adapter Figure 18 1 Sidestream Connection Figure 18 2 Mainstram Connection E Do not use the sterile supplied CO2 Water trap set for side stream including water trap and sample line and cannula and Air adapter for main stream if the packaging or the sensor is damaged and return them to the vendor E CO2 WARM UP or CO2 SENSOR START UP displayed on the screen indicates that the sensor is in warm up or starting up After the information disappears from the screen the standard measurement can then be generated Monitor has water trap beside it which is used to prevent the moisture or water drops produced by patient s respiration from entering the module The sample line and the water trap are one off consumables that can not be repeatedly used by different patients 18 2 Patient Monitor user s manual V 5 4 CO2 Monitoring 18 3 CO2 Menu 18 3 1 Parameter Setup and Adjustment Turn the knob to select and press CO2 hot key on the screen to activate CO2 Setup menu as shown below c02 SETUP ALM ON AWRR ALM HI 30
104. PM 9000 Portable Multi parameter Patient Monitor Operation Manual Copyright SHENZHEN MINDRAY BIO MEDICAL ELECTRONICS CO LTD 2002 Version V5 4 Issued date 2004 08 08 Serial No PM 9000 Statement SHENZHEN MINDRAY BIO MEDICAL ELECTRONICS CO LTD hereinafter called Mindray owns all rights to this unpublished work and intends to maintain this work as confidential Mindray may also seek to maintain this work as an unpublished copyright This publication is to be used solely for the purposes of reference operation maintenance or repair of Mindray equipment No part of this can be disseminated for other purposes In the event of inadvertent or deliberate publication Mindray intends to enforce its rights to this work under copyright laws as a published work Those having access to this work may not copy use or disclose the information in this work unless expressly authorized by Mindray to do so All information contained in this publication is believed to be correct Mindray shall not be liable for errors contained herein nor for incidental or consequential damages in connection with the furnishing performance or use of this material This publication may refer to information and protected by copyrights or patents and does not convey any license under the patent rights of Mindray nor the rights of others Mindray does not assume any liability arising out of any infringements of patents or other rights of third parties Cont
105. Pause Silence status the system will discharge Pause Silence status automatically For specific rules see Chapter Alarm A Note A The system will begin to give alarm information again once there exist alarm triggering event Nevertheless remember pushing SILENCE button can permanently shut off audible alarm sound of ECG LEAD OFF and SPO2 SENSOR OFF alarms REC STOP Figure 1 3 Press to start a real time recording The recording time is set in REC TIME of RECORD SETUP submenu Press during recording to stop the recording For detailed information refer to related chapter START Figure 1 30 Press to inflate the cuff to start a blood pressure measurement When measuring press to cancel the measurement and deflate the cuff e MENU Figure 1 30 Press this button to call up the SYSTEM MENU in which the user may set up system information and perform review operation For detailed information refer to related chapter System Menu and related chapter Trend and Event Rotary knob Figure 1 30 The user may use the rotary knob to select the menu item and modify the setup It can be rotated clockwise or counter clockwise and pressed like other buttons The user may use the knob to realize the operations on the screen and in the system menu and parameter menu Method to use the knob to operate on the screen The rectangular mark on the screen that moves with the rotation of the
106. Procedure 12 3 1 Preparation 1 Prepare the patient s skin prior to placing the electrodes The skin is a poor conductor of electricity therefore preparation of the patient s skin is important to facilitate good electrode contact to skin WH Shave hair from sites if necessary m Wash sites thoroughly with soap and water Never use ether or pure alcohol because this increases skin impedance m Rub the skin briskly to increase capillary blood flow in the tissues and remove skin scurf and grease Attach clip or snap to electrodes prior to placement Put the electrodes on the patient Before attaching apply some conductive jelly on the electrodes if the electrodes are not electrolyte self supplied Connect the electrode lead to the patient s cable Make sure the monitor is ready with power supply A Warning A Check everyday whether there is skin irritation resulted from the ECG electrodes If so replace electrodes every 24 hours or change their sites A Note A For protecting environment the electrodes must be recycled or disposed of properly A Warning A Verify lead fault detection prior to the start of monitoring phase Unplug the ECG cable from the socket the screen will display the error message ECG LEAD OFF and the audible alarm is activated 12 2 Patient Monitor user s manual V 5 4 12 3 2 Installing ECG lead Placing the Electrodes for ECG Monitoring Electrode placement for 5 lead set Figure
107. RECALL The ALARM RECALL window is as shown below in which following data are displayed O Time span Format month day year hour minute month day year hour minute O Event type Patient Monitor user s manual V 5 4 8 5 Trend and Event O Serial number Format NO xx of XX O The value at the time of alarm NIBP result is with time O Two 8 16 32 second waveforms ALARM RECALL TIME SPAN 12 01 2001 15 04 CURRENT TIME O EVENT TYPE ALL IBP2 mmHg S 0 SPO2 98 IBP CH1 ART Page up down to view the previous or the following alarm event EXIT Figure 8 5 ALARM RECALL Menu To view all waveforms during the alarming process Pick L RIGHT and turn the knob to view all 8 16 32 second waveforms stored To view other alarm events Events of up to 60 are listed chronologically from the latest to the earliest Pick UP DOWN button and turn the knob to view later or earlier events Recording Pick REC to print our all data and waveform of this event 8 6 Patient Monitor user s manual V 5 4 Chapter 9 Drug Calculation and Titration Table PM 9000 Portable Patient Monitor provides Drug calculation and titration table display functions for fifteen drugs and outputs the content of titration table on the recorder 9 1 Drug Calculation The drug calculations that can be performed by the system are AMINOPHYLLINE DOBUTAMINE DOPAMINE EPINEPHRINE HEPARIN ISUPREL LIDOCAINE NIPRIDE NITROGLYCE
108. RIN and PITOCIN Besides DRUG A DRUG B DRUG C DRUG D and DRUG E are also provided to flexibly replace any of the drugs Select DRUG CALC in SYSTEM MENU the following DRUG CALC display appears DRUG NAME Drug A INF RATE 93 75 nl hr WEIGHT 70 0 4 kg DRIP RATE 31 25 GTT min AMOUNT 400 00 mg DROP SIZE 20 00 GTTvml VOLUME 250 00 ml DURATION 2 67 hr CONCENTRAT 1 60 gt mg ml DOSE min 2500 00 mcg Please carefully verify DOSEVhr 150 00 mg the input information DOSE kg min 35 71 mcg DOSE kg hr 2142 86 mcg TITRATION gt gt Patient weight in Kg EXIT Figure 9 1 DRUG CALC The following formulas are applied for dose calculation Concentrat Amount Volume INF Rate DOSE Concentrat Duration Amount Dose Dose Rate x Concentrat Operating method In the Drug Calculation window the operator should first select the name of the drug to be Patient Monitor user s manual V 5 4 9 1 Drug Calculation and Titration Table calculated and then confirm the patient weight Afterwards the operator should also enter other known values Turn the knob to select the value of the item to be calculated Turn the knob to change the value When it is the required value press the knob to view the calculation result Each item has its calculation range If the result exceeds the range display AN Note A For the drug calculation the prerequisite is that the operator must first of all enter
109. ROR AG module has communication failure High AG HARDWARE ERROR AG module has hardware failure High AG DATA LIMIT ERROR AG module failure High AG USA ERROR AG module failure High AG ZREF FAIL AG module fails to zero High AG CAL FAIL AG module fails to calibrate High FiCO2 ALM LMT ERR Functional safety failure High EtCO2 ALM LMT ERR Functional safety failure High FiO2 ALM LMT ERR Functional safety failure High EtO2ALMLMTERR Functional safety failure Hgh gt FINROALMLMTERR Functional safety failure Hgh EtN20ALMLMTERR Functional safety failure Hgh gt FIAAALMLMTERR Functional safety failure High gt Et AAALMLMTERR Functional safety failure High AWRRALMLMTERR Functional safety failure High Prompt Message Cause Alarm level AG IS STARTING Loading the AG module No alarm AG WARM UP E is operating in the Warm up No alarm AG STANDBY The AG module is operating in the Standby NolArm Patient Monitor user s manual V 5 4 19 11 Anesthetic Gas Measurement 19 5 Maintenance and cleaning AGmodule For detailed cleaning information about AG Module refer to the chapter of Maintenance and Cleaning in this operation manual H Bacteria filter The bacteria filter is one off type i e one bacteria filter can only be used by one patient m Sample line The sample line is one off type m Gas exhaust outlet The gas exhaust outlet is reusable You need to r
110. TREND TABLE menu when viewing the trend table to printout the currently displayed 7 4 Patient Monitor user s manual V 5 4 Arrhythmia review recording Alarm review recording NIBP review recording CO measurement curve record Hemodynamic Calculation result recording Monitor information recording Titration table recording OxyCRG recording A Note AY Recording trend table Access ARR RECALL window from ARR ANALYSIS of ECG SETUP menu and Pick WAVE button to access ARR WAVE RECALL menu Then press REC button to output the Arr Waveform and related information currently displayed on the screen Access the ALARM RECALL window from ALARM RECALL CONDITION menu from SYSTEM MENU and pick REC button to print out the alarm review waveform and related information currently displayed in the ALARM RECALL window Access the NIBP RECALL window from SYSTEM MENU and pick REC button to print out the NIBP information currently displayed in the window Press the MEASURE button on the CO module to call up the WINDOWS FOR CO MEASUREMENT window Pick REC button to print out the CO value and measurement curve Access the MEASURE button on the CO module to call up the WINDOWS FOR CO MEASUREMENT window Pick the EDIT button in the window to call up the WINDOWS FOR C O EDIT window in which pick the HEMO CALCULATE button to a
111. afety Consult the manufacturer of the monitoring equipment for questions relating to monitor safety Calibration The ICT B is supplied with minimal zero offset and the sensitivity is set at 5 uV V mmHg In order to set up the amplifier and recorder accurately the controls should be zeroed at ambient pressure and then a known pressure applied for instance using the calibration tube syringe and manometer or immersion to a known depth in a water column The gain of the system is then set to the required level The procedure should be repeated to check that the zero baseline has not changed due to the change in gain Manometer and syringe to apply ak nown pressure Patient Monitor Use a iml syringe to inflate the balloon for zero check Luer fitting must be open to ambient pressure during normal operation Calibration tube Figure 16 10 ICT B calibration Tightening the collet on calibration tube over the sliding calibration sleeve will seal around the ICT B catheter Using the male luer fitting a connection can be made to a reference pressure such as a syringe and manometer The output of the transducer and amplifier system can be reliably and quickly confirmed Zeroing H Checking the Zero when the ICT B is in the Epidural Space Patient Monitor user s manual V 5 4 16 15 IBP Monitoring Using a 1ml syringe inject approximately 0 3cc of air into the female luer connector on the proximal end of the ICT B Leave th
112. all sounds Push the SILENCE button again the system can exit the SILENCE status and restore the PAUSE status and accordingly suspend the alarm as per the previously defined time duration Push the SILENCE button for the third time the system will exit the PAUSE status and restore the normal alarm status by giving the alarm sound again When the system is in the SILENCE status any new alarm will terminate the SILENCE status and make the system restore the normal alarm status AN Note A When the lag symbol appears indicating the alarm sound is shut off and accordingly the system will not give alarm sound Therefore you must be very careful in using this function There are two methods to terminate this status One is to set the alarm volume to ON in the MAINTAIN menu The other method is to push the SILENCE button shortly to make the EJ symbol become 28 push the SILENCE button again and the system will restore the normal alarm status again Or you can push the SILENCE button for longer time to let the system restore the normal alarm status m PAUSE Push the SILENCE button on the panel shortly the system will shut off all alarm sound and visual prompt as well as description of physiological alarm and enter the PAUSE status The countdown of PAUSE status is displayed in the Physiological Alarm area in which area the x symbol is also displayed The time duration of the PAUSE status can be set to 1min 2min or 3min You can select
113. ameter name in the system such as HR ST1 ST2 RR SpO2 IBP NIBP etc CO2 NO WATERTRAP CO2 watertrap is not connected correctly Check the connection of CO2 watertrap Replace the filter net or CO2 CO2 WATERTRAP CO2 watertrap is clogged air hose Check if the water in OCCLUDE H Get the CO2 watertrap is too much CO2 SIGNAL LOW CO2 signals are poor Check for leaks in the airway Check if the airway is clogged Check if the watertrap is too old After excluding the above CO2 SIGNAL TOO LOW CO2 signals are too poor problems replace another CO2 air hose or watertrap If it still cannot work normally contact the manufacturer for repair CO2 BAROMETRIC TOO LARGE CO2 modules has failure CO2 PNEUMATIC LEAK CO2 SIGNAL NOISY CO2 SIGNAL SATURATE CO2 CALCULATION ERR CO2 PUMP FAULT CO2REVERSE FLOW CO2 FORWARD FLOW CO2 MALNUFUNCTION CO2 BAROMETRIC HIGH CO2 BAROMETRIC LOW CO2 WATCHDOG ERROR CO2 INT COMM ERR CO2 SYSTEM ROM ERR Contact the manufacturer for repair Patient Monitor user s manual V 5 4 5 System Alarm Prompt CO2 FLASH CRC ERR CO2 EXT RAM ERR CO2 INT RAM ERR CO2 FLASH CHECK ERR CO2 STACK OVER CO2 SENSOR FAULT CO2 SENSOR TEMP HIGH CO2 SENSOR TEMP LOW When the system di
114. ameters A gt by the rightmost item indicates following page available And lt by the leftmost item indicated previous page available To print out the trend data Pick REC to print out the trend data of current displayed parameter Mark event If an event is marked A B C or D the corresponding event type will display on the axis time of the trend table Operation example To view a NIBP trend table Pick MENU hot key lower right of the screen to access SYSTEM MENU Pick TREND TABLE Pick L RIGHT and switch to NIBP by turning the knob Pick the first item from the left and select requested time interval Pick UP DOWN and turn the knob to view NIBP trend data of different time For printout of trend table pick REC to start report printing of all trend data including NIBP of this time span m Pick EXIT to return to SYSTEM MENU 8 3 NIBP Recall PM 9000 can review the latest 400 NIBP measurement data Pick NIBP RECALL in the SYSTEM MENU to invoke the result and time of the latest 10 measurements as shown in the figure below NIBP RECALL KS HH HD TIHE 12 91 2091 15 13 50 NUM 1 UNIT UP DOUN REC Select the unit of the NIDP measured result EXIT Figure 8 3 NIBP RECALL 8 4 Patient Monitor user s manual V 5 4 Trend and Event Data is listed chronologically from the latest to the earliest 10 measurements can be displayed in one screen Pick UP DOWN to view other trend curve up to 400 result
115. an 60 and Oz is not being monitored turn on this switch SWEEP used to select the speed to scan the screen waveforms WORK MODE to monitor the anesthetic gas select the MEASURE option Otherwise select the STANDBY option ALARM SETUP gt gt used to enter the ALARM SETUP submenu CALIBRATE gt gt used to enter the CALIBRATE submenu O2 calibrate gt gt used to enter the O2 CALIBRATE submenu ADJUST WAVE AMP gt gt used to enter the ADJUST WAVE AMP submenu in which you may select the appropriate waveform amplitude for display DEFAULT gt gt used to enter the AG DEFAULT CONFIG submenu You can use the information in this submenu to initialize all menus Patient Monitor user s manual V 5 4 Anesthetic Gas Measurement 19 3 2 ALARM SETUP menu In the ALARM SETUP menu select the ALARM item to pop up the ALARM SETUP menu ALARM SETUP ALM ON v EZ ALM HI 684 ALM LEV MED EZ ALM LO 76 ALM REC OFF Fi02 ALM HI 669 EtcO2 ALM HI bp Fi02 ALM LO 7 EtcO2 ALM LO 15 AWRR ALM HI 30 FicO2 ALM HI 4 AURR ALN LO 8 Ka FicO2 ALM LO o gt OTHER SETUP gt gt Back to the upper menu DT Figure 19 4 ALARM SETUP menu ALM when this switch is ON if anesthetic gas has alarm the system will give alarm prompt and save the alarm information When this switch is OFF the system will not trigger alarm Instead it will display beside GAS in the Paramet
116. and output content Turn knob to select the MENU hot key on the lower right part of the screen to call up the SYSTEM MENU menu You can perform following operations in this menu SYSTEM MENU PATIENT SETUP gt gt SYSTEM SETUP gt gt DEFAULT gt gt SELECTION gt gt TREND GRAPH gt gt VERSION gt gt TREND TABLE gt gt DRUG CALC gt gt NIBP RECALL gt gt MAINTAIN gt gt ALARM RECALL gt gt DEMO gt gt Provide the DEMO data and display the DEMO waveform EXIT Figure 3 1 SYSTEM MENU Trend graph table review NIBP review and alarm review are discussed in Chapter Trend and Event 3 1 Patient Information Setup AN Note A To clear current patient data refer to New Patient for details Pick the PATIENT SETUP item in the SYSTEM MENU to call up the following menu Patient Monitor user s manual V 5 4 3 1 System Menu PATIENT SETUP DEPT ADMIT 20014 8 e 104 PAT NO 888 BIRTH 19514 8 e 104 BED NO 3 HEIGHT 175 0 cm DOCTOR CHEN WEIGHT 70 0 om NAME zg BLOOD A lt SEX M NEW PATIENT PAT TYPE ADU ABCDEFGHIJKLMNOPQRSTU VUXxYZ0123456789 DEL OK Enter max 12 characters DEL delete the current character OK confirm the entered information EXIT Figure 3 2 PATIENT SETUP You can setup following patient information DEPT PAT NO BED NO DOCTOR NAME SEX PAT TYPE ADMIT BIRTH HT cm inch WT kg lb BLOOD NEW PATIENT Department in which
117. ange of wavelengths mentioned above oxygen does not absorb infrared rays Therefore we have to measure oxygen concentration by taking advantage of its paramagnetic characteristic Inside the sensor of the oxygen module there are two glass balls filled up with 19 2 Patient Monitor user s manual V 5 4 Anesthetic Gas Measurement Nitrogen These two glass balls are suspended into symmetric non uniform magnetic field pointing into the direction away from the most intensive part of the field This device is surrounded by oxygen having paramagnetic characteristic By this means this device is actually further pushed out of the field by the oxygen having relatively more intensive paramagnetic characteristic The force moment acted on this device is proportional to the paramagnetic intensity of the surrounding gas and therefore also proportional to oxygen concentration t AG Mondule Patient monitor A Exhaust line to Scavenging System Patient sample line eg Airway Adapter e Endotracheal Tube Figure 19 2 connection diagram for measuring AG gas A warningA Ensure tight connection when installing the filter Any leakage in the system will result in incorrect reading because this leakage will make the surrounding environmental air mix up with patient gas A warningA To protect the module against contamination always use bacteria filter because without it bacteria and liquid may directly enter the AG modu
118. ates transportation of patient Large high resolution display provides clear view of 8 waveforms and full monitoring parameters The POWER switch is on the bottom left quarter of the front panel IT in Figure 1 1 It lights when the device is on The CHARGE indicator in Figure 1 1 is on the right side of the POWER switch It is used to indicate the AC Mains condition The ALARM indicator is on the upper side of the front panel The ALARM indicator flashes or lights when alarm occurs Q in Figure 1 1 The sockets of the sensors are at the left side The recorder socket is at the right side Other sockets and power plug in are at the rear panel PM 9000 is a user friendly device with operations conducted by a few buttons on the front panel TI in Figure 1 1 and a rotary knob Il in Figure 1 1 Refer to 1 3 Button Functions for details Figure 1 1 PM 9000 Portable Patient Monitor The visible LEDs are CLASS 1 LED PRODUCT according with EN 60825 1 A11 Oct 1996 PM 9000 Portable Patient Monitor performs monitoring of ECG Heart Rate HR 2 channel ECG waveforms Arrhythmia and S T segment analysis optional RESP Respiratory Rate RR Respiration Waveform SpO2 Oxygen Saturation SpO2 Pulse Rate PR SpO2 Plethysmogram NIBP Systolic Pressure NS Diastolic Pressure ND Mean Pressure NM TEMP Channel 1 Temperature T1 Channel 2 Temperature T2 Temperature Difference between two channels TD I
119. ations At least every 3 months it should be checked by a qualified customer service technician All the checks that need to open the monitor should be performed by qualified customer service technician The safety and maintenance check can be conducted by persons from Mindray You can obtain the material about the customer service contract from the local Mindray office A Warning A If the hospital or agency that is responding to using the monitor does not follow a satisfactory maintenance schedule the monitor may become invalid and the human health may be endangered A Note A To ensure maximum battery life it is recommended that at least once a month the monitor be run on battery until it turns itself off and then recharged A Warning A Refer the battery replacement only to Mindray service technician Patient Monitor user s manual V 5 4 11 1 Care Cleaning 11 2 General Cleaning A Warning A Before cleaning the monitor or the sensor make sure that the equipment is switched off and disconnected from the power line The PM 9000 Patient Monitor must be kept dust free Regular cleaning of the monitor shell and the screen is strongly recommended Use only non caustic detergents such as soap and water to clean the monitor shell A Note A Please pay special attention to the following items 1 Avoid using ammonia based or acetone based cleaners such as acetone 2 Most cleaning agents must be diluted before use
120. ations in the system will be replaced by default configurations 3 3 Trend Review Measurement Review and Alarm Event Review In the SYSTEM MENU there are TREND GRAPH TREND TABLE NIBP RECALL and ALARM RECALL items Please refer to Chapter 7 Trend and Event for detailed information 3 4 System Setup Select the system setup item in the system menu 3 4 Patient Monitor user s manual V 5 4 System Menu SYSTEM SETUP FACE SELECT gt gt ANALOG gt gt ALARM SETUP gt gt MODULE SETUP gt gt TIME SETUP gt gt TRACE SETUP gt gt RECORD gt gt MARK EVENT gt gt Back to the upper menu EE Figure 3 6 System setup In the System setup menu users can setup the following items 3 4 1 Face select Select FACE SELECT item in SYSTEM SETUP menu to access FACE SELECT dialog box as shown below in which four selections are available STANDARD SCREEN TREND SCREEN oxyCRG SCREEN and VIEWBED SCREEN Only one selection can be chosen for each time FACE SELECT STANDARD SCREEN TREND SCREEN oxyCRG SCREEN VIEWBED SCREEN Conventional monitor screen EXIT Figure 3 7 FACE SELECT 3 4 2 Alarm setup The system provides three levels of alarm volume You can select any of them as per the clinical requirement The procedures are Select the ALARM SETUP item in the SYSTEM SETUP sub menu of the SYSTEM SETUP menu The menu as shown below will pop up in whi
121. ature cable of T1 SENSOR OFF channel 1 may be LOW Make sure that the cable is disconnected from the properly connected monitor Temperature cable of channel T2 SENSOR OFF 2 may be disconnected from LOW Make sure that the cable is the monitor properly connected Stop using alarming T1 ALMLMT ERR Functional safety failure HIGH function of TEMP module notify biomedical engineer or Mindray service staff Stop using alarming T2ALMLMT ERR Functional safety failure HIGH function of TEMP module notify biomedical engineer or Mindray service staff Stop using alarming TD ALM LMT ERR Functional safety failure HIGH function of TEMP module notify biomedical engineer or Mindray service staff Prompt message Message Cause Alarm Level Measuring value of channel 1 is beyond measuring range Measuring value of channel 2 is beyond measuring range T1 EXCEED HIGH T2 EXCEED HIGH Patient Monitor user s manual V 5 4 15 3 TEMP Monitoring 15 4 Care and Cleaning AN Warning AN Before cleaning the monitor or the probe make sure that the equipment is switched off and disconnected from the power line Reusable TEMP Probes 1 The TEMP probe should not be heated above 100 C 212 F It should only be subjected briefly to temperatures between 80 C 176 F and 100 C 212 F 2 The probe must not be sterilized in steam 3 Only detergents containing no alcohol can be used for disaffection 4 The rec
122. ay a amp beside SpO m ALM REC pick ON the system will command the recorder to output alarm information when SpO alarm occurs m ALM LEV used to set up alarm level selectable from HIGH MED and LOW HIGH represents the most serious case mM SPO2 ALM HI and SPO2 ALM LO SpOz alarm is activated when the result exceeds set SPO2 ALM HI value or falls below SPO2 ALM LO value m PR ALM HI and PR ALM LO PR alarm is activated when the pulse rate exceeds set PR ALM HI value or falls below PR ALM LO value SpO2 and PR alarm limits Max Upper Limit Min Lower Limit Step SpO2 100 0 1 PR 254 0 1 The default SpO2 and PR alarm limits Parameters Max Upper Limit Min Lower Limit SpO2 Adult 100 90 Pediatric 100 90 Patient Monitor user s manual V 5 4 13 19 SpO2 Monitoring Neonatal 95 85 Adult 120 50 PR Pediatric 160 75 Neonatal 200 100 m SWEEP Available options are 12 5mm s 25 0 mm s m PRSOUND Pulse beep volume The options are from 3 to 0 3 indicates the maximum volume while 0 the minimum m AVG TIME 4S 8S 16S represent times that SpO average value is counted m DEFAULT Pick this item to access the SpoO2 DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s con
123. can not be measured within specific time HIGH Technical alarms Message Cause Alarm Level Remedy Stop using RESP alarming function HIGH notify biomedical engineer or Mindray service staff RESP ALM LMT Functional safety ERR failure Prompt message general alerts Message Cause Alarm Level RR measuring value exceeds HIGH RR EXCEED the measure range Patient Monitor user s manual V 5 4 12 23 ECG RESP Monitoring 12 10 Maintenance and Cleaning Care A and Cleaning Warning A Before cleaning the monitor or the sensor make sure that the equipment is switched off a nd disconnected from the power line If there is any sign that the ECG cable may be damaged or deteriorated replace it with a new one i nstead of continuing its application on the patient mM Cleaning Use fine hair cloth moistened in mild soap liquid or cleaning agent containing 70 ethanol to clean the equipment Sterilization To avoid extended damage to the equipment sterilization is only recommended when stipulated as necessary in the Hospital Maintenance Schedule Sterilization facilities should be cleaned first Recommended sterilization material e Ethylate 70 alcohol 70 isopropanol e Acetaldehyde Disinfection To avoid extended damage to the equipment disinfection is only recommended when stipulated as necessary in the Hospital Maintenance Schedule Disinfection facilities should be cleaned first 12 2
124. categories which are physiological alarm technical alarm and general alarm Physiological alarm refer to those alarms triggered by patient s physiological situation which could be considered dangerous to his or her life such as heart rate HR exceeding alarm limit parameter alarms Technical alarm refer to system failure which can make certain monitoring process technically impossible or make monitoring result unbelievable Technical alarm is also called System Error Message General alarm belongs to those situations that can not be categorized into these two cases but still need to pay some attention PM 9000 has preset the alarm level for the parameters You can also modify the alarm level using the method described in this chapter Alarm level of the System Error Message technical alarm is pre set in the system All technical alarm level and general alarm level some of the physiological alarm level are pre set in the system and can not be changed by user Patient Monitor user s manual V 5 4 5 1 Alarm 5 1 2 Alarm Modes When alarm occurs PM 9000 may raise the user s attention in at least three ways which are audio prompt visual prompt and description Audio and visual prompt is given by TFT display device the speaker on the display device and the alarm indicator Description is displayed on the screen Physiological alarm is displayed in the Physiological Alarm area Most of technical alarms are displayed in the Technical
125. ccess the HEMOD WINDOW window Then pick the REC button to print out the calculated result Access the ENTER MAINTAIN PASSWORD menu from the MAINTAIN menu Then pick the STATUS button to access the STATUS window Pick REC button to print out the status monitor information currently displayed in the window Access the DRUG CALC menu from the SYSTEM MENU menu Pick the TITRATION button in the menu to access the TITRATION window Pick the REC button to print out the titration currently displayed in the window In oxyCRG screen pick the REC button to print out oxyCRG currently displayed in the window You can press REC STOP button on the recorder to stop the current recording process Access the RECORD menu from the SYSTEM SETUP menu Then pick the CLEAR REC TASK button to stop all recording tasks 7 4 Recorder Operations and Status Messages Record Paper Requirement Only standard 50 0 1 mm thermosensitive record paper can be used otherwise the recorder may not function the recording quality may be poor and the thermosensitive Patient Monitor user s manual V 5 4 7 5 Recording printhead may be damaged Function Properly m When the recorder is working the record paper goes out steadily Do not pull the paper or the recorder will be damaged RW Do not operate the recorder without record paper Paper Out When RECORD
126. cement and move it when the skin deteriorates More frequent examinations may be required for different patients AN Note A Do not perform SpO measuring and NIBP measuring in same arm at one time because obstruction of blood flow during NIBP measuring may adversely affect the reading of SpO value A Note A Make sure the nail covers the light window The wire should be on the backside of the hand AN Note A SpO value always displays at the same position Pulse Rate will display when HR FROM is set at SpO2 BOTH in the ECG SETUP menu A Note A SpO waveform is not proportional to the pulse volume 13 1 2 Monitoring Procedure AN Note A This monitor with MS 7 is intended for continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin SpO2 and pulse rate measured by an SpO2 sensor for adult pediatric and neonatal patients in a hospital and mobile environment Limitations for Measurement If the accuracy of any measurement does not seem reasonable first check the patient s vital signs by alternate means and the check the instrument for proper functioning Inaccurate measurements may be caused by incorrect sensor application or use Patient Monitor user s manual V 5 4 13 5 SpO2 Monitoring significant levels of dysfunctional hemoglobins e g carboxyhemoglobin or methemoglobin intravascular dyes such as indocyanine green or methylene blue exposure to exce
127. ch you can set up the alarm volume and other alarm information For detailed information refer to Chapter Alarm Patient Monitor user s manual V 5 4 3 5 System Menu ALARM SETUP ALM SEL COMMON ALM SETUP ALARM VOL 5 x ALM REC TIME 8S x ALM PAUSE TIME 11MIN x PARA ALM TYPE UNLATCH Back to the upper menu Figure 3 8 Alarm Setup Pick ALARM VOL item turn the knob to set the volume The options are from 10 to 1 10 indicates the maximum volume while 1 the minimum 3 4 3 Time Setup Select the TIME SETUP item in the SYSTEM SETUP menu The menu as shown below will pop up System time is in the format of year month day hour minute and second Use cursor to highlight the item that you want to modify and turn the knob to select time Then select EXIT A Note A You shall set up the system time upon turning on the monitor if you need to set up the system time otherwise when you review the content with time information the system may not display the correct time wan Ter a MONTH 12 Ka DAY 1 Ka HOUR 15 Ka MINUTE 58 Ka SECOND 17 Ka Set the system time EXIT Figure 3 9 System Time Setup When this monitor is linked to the Central Station its system time will keep consistent with that of the Central Station Method to adjust time Once link is successfully established the Central Station will send its current time to the monitor The monitor will automatically adju
128. cording Auto 8 second recording Parameter alarm recording Patient Monitor user s manual V 5 4 2 7 Recall Trend Recall Short Long Alarm Event Recall NIBP Measurement Recall 2 8 ECG Lead Mode Lead selection Waveform Lead mode Lead selection Waveform Gain HR and Alarm Range Adult Neo Ped Accuracy Resolution Sensitivity Differential Input Impedance CMRR Monitor Surgery Diagnostic Electrode offset potential Leakage Current Production Specification Waveform freeze recording Trend graph table recording ARR events review recording Alarm event review recording NIBP review recording CO Measurement review recording AG Measurement review recording CO Measurement curve recording Hemodynamic Calculation result recording Drug Calculation and titration table recording Monitor information recording OxyCRG review recording 1 hour 1 second or 5 second Resolution 72 hrs 1 min 5min or 10 min Resolution 60 alarm events of all parameters and 8 16 or 32 seconds of corresponding waveform 400 NIBP measurement data 5 Leads R L F N C or RA LA LL RL V I Il III avR avL avF V CAL 2 ch 3 Leads R L F or RA LA LL 1 Ul Ul CAL 1 ch x0 25 x0 5 x1 x2 auto 15 300 bpm 15 350 bpm 1 or 1bpm use the greater 1 bpm gt 200 uV P P gt 5 Mohm gt 105 dB gt 105 dB gt 90 dB 300mV lt 10 uA Patient Monitor user s manual V 5 4
129. d exit the menu A Note A If you select YES the system will delete all information of the patient being currently monitored 3 2 Default Setup AN Note A After selecting any item in this sub menu the selected item will replace the current setup of the system and accordingly become the system default configuration DEFAULT FACTORY DEFAULT ADU CONFIG FACTORY DEFAULT PED CONFIG FACTORY DEFAULT NEO CONFIG USER DEFAULT ADU CONFIG USER DEFAULT PED CONFIG USER DEFAULT NEO CONFIG SAVE CURRENT AS USER CONFIG Back to the upper menu Figure 3 4 DEFAULT Menu Patient Monitor user s manual V 5 4 3 3 System Menu In this sub menu you can select both the factory default and the user defined default Also in this sub menu you can save the current system configuration as the user defined default configuration But at this time the system will automatically save all the setups in the parameter menu ECG gain and filter way as the user defined default configuration according to the patient type Also the dialog box as shown below will pop up CONFIRM SAVE DEFAULT CONFIG Old user defined config for this patient type will covered Yes Figure 3 5 CONFIRM DEFAULT CONFIG AN Note A After selecting any item in the DEFAULT menu and exiting the box the CONFIRM DEFAULT CONFIG Dialog box will pop up in which you can select YES to confirm your selection or NO to give up your selection A warning All configur
130. e INTERFERENCE preventing reading LOW Remove outside interference If values are not displayed within 30 seconds disconnect SpO2 PULSE Unit is searching for the LOW and reconnect sensor If pulse SEARCH patients pulse search continues remove sensor and replace on a better perfused site SpO2 LOW Move sensor to better PERFUSION signal tog smal OW perfused site Too much light on SpO2 TOO FE Remove or reduce lighting Inadequate tissue LOW Ges sensor from light MUCH LIGHT detector SpO2 LOW l l Ensure proper sensor Low signal quality LOW application Mover sensor to a SIGNAL IQ better perfused site Stop using the measuring spe Get ee Meda a eH EE EE module BOARD FAULT board malt netions notify biomedical engineer or our service staff This message is displayed when the front SpO2 end module is having Se Os ae COMMUNICATION problems communicating HIGH SE notify biomedical engineer or ERROR ie framing errors or bad GT EE checksums with the Masimo board This message is SpO02 displayed when the host oe Soe edie COMMUNICATION can not receive the data HIGH STOP from Masimo board for 5 seconds notify biomedical engineer or our service staff 13 12 Patient Monitor user s manual V 5 4 SpO Monitoring This message is Stop using the measuring displayed when the SpO2 function of SpO2 module SES ren module initialization error GC notify biomedical engineer or ha
131. e ECG is 5 lead the selectable leads are Il III aVR aVL aVF V when ECG is 3 lead the selectable leads are II Ill 30 Leads on the ECG wave must not have the same name Otherwise the system will Patient Monitor user s manual V 5 4 ECG RESP Monitoring automatically change the ECG waveform name that has the same name as the waveform being currently adjusted to another name Waveform gain of channel 1 used to adjust the size of ECG waveforms Select gain value for each channel from x 0 25 x 0 5 x 1 x 2 and auto Under auto mode the monitor chooses an appropriate level automatically A 1mv scale displays on each ECG channel s right side The height of 1mV bar is directly proportional to the waveform amplitude A Note A When the input signals are too large the peak of the waveform may be not able to be displayed In this case the user may manually change the setup method of ECG waveform according to the actual waveform so as to avoid the occurrence of the unfavorable phenomena Filter method used for displaying clearer and more detailed waveform There are three filter modes for selection DIAGNOSTI MONITOR and SURGERY modes may reduce perturbance and interference from Electrosurgery equipment The filter method is the item applicable for both channels which is always displayed at the waveform place of the channel 1 ECG waveform A Note A Only in Diagnosis mode the system can provide no
132. e QRS complex RR t BRADY Al patients interval is longer than 1 5s User selectable When HR is less than 100 beats min no heart beat is tested during the MISSED Without period 1 75 times of the average RR User selectable BEATS pacemaker interval or When HR is larger than 100 beats min no beat is tested with 1 second No QRS complex and pacing pulse are PNP With availabe during the period 1 75 times User selectable pacemaker of the average R R interval only considering patients with pacemaker When pacing pulse is available no With QRS exists during the period 1 75 times y SR pacemaker of the average RR interval only Userscleelable considering patients with pacemaker Patient type All patients refers to perform Arr analysis on patients either with pacemakers or without pacemakers Without pacemaker refers to perform Arr Analysis only on the patients without pacemakers With pacemaker refers to perform Arr Analysis only on the patients with pacemakers Prompt message Message ARR LEARNING A Note A Arrhythmia name displays in the Alarm Message Area Cause The QRS template building required for Arr Analysis is in process 12 9 Measuring RESP 12 9 1 How to measure RESP The monitor measures respiration from the amount of thoracic impedance between two ECG Alarm Level No alarm electrodes The change of impedance between the two electrodes due to the thoracic movement produces a respirator
133. e as the cursor moves here To print out the trend curve Press REC button to print out the trend curve of current selected parameter Mark event If an event is marked A B C or D then the corresponding event type will display on the axis time of the trend graph The event sign A B C or D is displayed in a frame Operation example To view the NIBP trend graph of the last 1 hour m Pick the MENU hot key lower right of the screen Pick TREND GRAPH item Pick the first item and switch to NIBP by turning the knob Adjust the second item to be 1 or 5 sec Pick the ZOOM button and turn the knob to view changes of the trend graph time and trend curve E Stop at requested trend time section for careful review Pick the ZOOM button to adjust the display scale if necessary E For measurement result of a specific time pick CURSOR to move the cursor to the point corresponding time and value will display on above and below respectively E For printout of trend graph pick REC to start report printing of NIBP trend of this hour H Pick EXIT to return to trend graph display 8 2 Patient Monitor user s manual V 5 4 Trend and Event 8 2 Trend Table H The latest 72 trend table data can be displayed at every 1 5 10 30 or 60 minutes Pick TREND TABLE in the SYSTEM MENU to call up the following menu TREND TABLE HR RR PUC gt TIHE EVENT BPH RPM min 01 15 48 59 20 01 15 47 6 20 01315 46 6 2 01
134. e in combination with air oxygen enriched environments or nitrous oxide A Warning A You must verify if the device and accessories can function safely and normally before use A Warning A You must customize the alarm setups according to individual patient situation and make sure that alarm sound can be activated when alarm occurs A Warning A Do not use cellular phone in the vicinity of this device High level electromagnetic radiation emitted from such devices may greatly affect the monitor performance Patient Monitor user s manual V 5 4 1 1 Introduction AN Warning A Do not touch the patient table or the device during defibrillation A Warning A Devices connected to the monitor shall form an equipotential system protectively earthed A Warning A When used with Electro surgery equipment you doctor or nurse must give top priority to the patient safety A Warning A Do not place the monitor or external power supply in any position that might cause it to fall on the patient Do not lift the monitor by the power supply cord or patient cable use only the handle on the monitor A Warning A Consult IEC 601 1 1 for system interconnection guidance The specific requirements for system interconnection are dependent upon the device connected to the monitor and the relative locations of each device from the patient and the relative location of the connected device to the medically used room containing the monitor I
135. e syringe attached and note the value on the pressure monitor or scope The ICP will decrease to zero or a value very close to it If the monitor transducer combination has drifted from zero reset the zero control to zero value on the meter Remove the syringe and the monitor will immediately begin to measure intracranial pressure A Warning A The total volume of air injected from a 1ml syringe to check the zero must not exceed 0 5ml or the membrane over the sensor may be ruptured H Connecting to a new monitor when the ICT B is in the Epidural Space v Set correct pressure range on monitor Inject 0 3cc of air from a 1ml syringe Adjust the monitor for zero reading With the air still injected set the calibration number on the monitor if applicable 2 SS S Remove the syringe and the ICP will be displayed immediately A Note A Always leave the luer fitting open to ambient pressure during measurement AY Warning A Disconnect the catheter from the monitor before defibrillation or electrosurgery 16 7 4 Practicing with the ICT B It is a good idea to obtain experience using the ICT B and monitor combination before actually using the device with a patient Set up the monitor and the ICT B as already described Use either a water column or the calibration tube to apply a known pressure of from 10 to 25mmHg to the ICT B Recall that 13 6cm of water is about equal to 10mmHg With the known pressure applied to the ICT B inject appro
136. e top part of the screen displaying the current status of both the monitor and the patient Patient information include BED NO Bed numbers of all patients under monitoring Patient type Three options Adult Pediatric Neonate 01 01 2000 Current date 130 510 32 Current date and time Patient Monitor user s manual V 5 4 1 5 Introduction Male Patient sex Male or Female ZHANG SHAN Patient name This item will display blank if the operator does not input patient name Other information in the Message Area will appear and disappear together with the reported status According to the content the information is divided into E Prompt information reporting the current status of the monitor or sensor probe which always appears to the right of the system time When this information appears it will cover patient sex and name E EI flag for alarm PAUSE Press SILENCE button once less than 1 second to mute all alarm sounds are muted for the time being and the flag appears at the same time Press the button again to terminate the PAUSE status The duration for PAUSE status can be 1 minute 2 minutes or 3 minutes EZ flag for alarm SILENCE Press SILENCE button once more than 1 second to manually mute the alarm sound and this flag appears at the same time The SILENCE status terminates when you discharge the status or new alarm occurs lag flag for Alarm Volume Off It appears indicating that you have c
137. eclaration of Conformance sss ssssssunseunseunnnunnnunnnnunnnunnnunnnunnnnnnnnnnnnnnnnnn enn Appendix ll Product Specification ccccseccseeeecesneeeeeeseseeeenseeeeseeeseseaeseseeeeeeeeeseeeseseeeeenseaes Appendix IIl EMC Appendix IV System Alarm Prompt scccseeeseeeeeeeeeseneeeseeeeneeeeeseaeeesaesnseeeeeeeeeseeseseneeenseees Patient Monitor user s manual V 5 4 Chapter 1 Introduction For an overall introduction to the monitor please refer to General Information For various messages displayed on the screen please refer to Screen Display For basic operating instructions please refer to Button Function For allocation of interface sockets please refer to Interfaces For important facts to be noted during the battery recharging procedure please refer to Built in Battery m For safety precautions of the monitor please refer to Patient Safety A Warning A PM 9000 Portable Multi Parameter Patient Monitor is intended for clinical monitoring application with operation only granted to appropriate medical staff A Warning AN Monitor can only monitoring one patient at a time AN Warning A There could be hazard of electrical shock by opening the monitor casing All servicing and future upgrading to this equipment must be carried out by personnel trained and authorized by Mindray A Warning A Possible explosion hazard if used in the presence of flammable anesthetics or other flammable substanc
138. ection Select EXIT to exit the menu and consequently the selection will come into effect Event function has following significance To classify the records into different categories such as those having influence on patients and those having influence on parameter monitoring including dose taking injection therapy status Event will be displayed on the trend graph table in order to assist the analysis on the patient parameters when the event happens 3 10 Patient Monitor user s manual V 5 4 System Menu 3 5 Selection Setup Select the SELECTION item in the SYSTEM SETUP to call up the following menu SELECTION KEY voL f5 HELP ON M SCAN TYPE REFRESH ALM LIMIT OFF M Select the appropriate key volume EXIT Figure 3 16 Selection Setup Key Volume Pick KEY VOL item in SELECTION menu turn the knob to set the volume The options are from 3 to 0 3 indicates the maximum volume while 0 the minimum Help Function The system provides On line Help to menu operations You can choose any help information as per your need The method is Select the SELECTION item in the SYSTEM MENU to access the SELECTION sub menu in which you can highlight the HELP item and turn the knob to select ON or OFF When it is ON you can browse the on line help information When it is OFF the system will turn off the on line help function Scan t
139. ed An example of a steady state measurement is measuring the CO2 content inside an incubator Calibration procedures use calibrated gas which is free of water vapor or dry as well The water vapor compensation is ON by default and may be enabled or disabled via a host system command H BTPS The end user may want choose whether to correct values for gas that is at body temperature ambient pressure and is saturated with water vapor BTPS or has that is at ambient temperature and pressure and is dry ATPD BTPS compensation Body Temperature and Pressure Saturated is a user selectable compensation that accounts for the differences between the airway sample and deep lung CO2 Since the intent is to Patient Monitor user s manual V 5 4 18 5 CO2 Monitoring report deep lung CO2 where the sample is at 37 C and fully saturated BTPS compensates for the variance of water vapor content due to temperature The BTPS compensation of CO2 module is on by default A Note A 1 If Compensate item is not correctly set as per the operation conditions the result will be far from the actual value thus leading to severe misdiagnosis 2 The default of Water Vapor Compensate is on Turn it off when measuring dry gas such as when performing regular maintenance or measurement validation by using dry calibrated gas 3 The default of BTPS is on Turn it on when measuring the VA saturated damp gas under the body temperat
140. eds the alarm limits an alarm will occur IBP alarm limits Pressure Label sig ee EN Es ow e ART 300 0 1 PA 120 6 1 CVP 40 10 1 RAP 40 10 1 LAP 40 10 1 ICP 40 10 1 P1 300 50 1 P2 300 50 1 IBP Zeroing Press the IBP PRESSURE ZERO button on the IBP SELECT menu to call up IBP PRESSURE ZERO menu as shown below IBP PRESSURE ZERO Being Prepared press ZERO key CH1 ZERO 00 00 0000 00 00 00 CH2 ZERO 00 00 0000 00 00 00 Back to the upper menu Figure 16 5 IBP PRESSURE ZERO A Note A User should ensure that the transducer has been zeroed before measurement Patient Monitor user s manual V 5 4 16 5 IBP Monitoring otherwise the device does not have valid zero value which may result in inaccurate measuring data Zero Transducer Select CH1 ZERO IBP1 is zeroed Select CH2 ZERO IBP2 is zeroed Cautions H Close the transducer stopcock to the patient before zeroing WR Open the venting stopcock to atmosphere m The transducer should be placed at the same level of the patient s heart approximately mid axillary line H Zero procedure should be performed before starting the monitoring or at least once a day or each time after connecting disconnecting the cable Information related to zero For this example CH1 is used m SUCCESSFUL ZERO Indicate the zero procedure has finished open the transducer stopcock to the patient and close the venting stopcock to atmosphere m SENSOR OFF FAIL
141. efore if select RR the position displays the dynamic trend of RR If select RESP WAVE the position displays the compressed Resp Wave H Record Select the REC hot key in the OxyCRG Screen you may use the recorder to output the three waveforms in the oxyCRG at the same time H Close OxyCRG In the FACE SELECT menu select options of other operating screens to close the OxyCRG Screen 4 5 Viewbed Screen If another monitor is connected on the same LAN of this monitor you can use this monitor to view any measured waveform and information about all measured parameters from another monitor m Enter Viewbed Screen Select the VIEWBED SCREEN option in the FACE SELECT menu Viewbed Screen window occupies the space of the bottom four waveforms 4 4 Patient Monitor user s manual V 5 4 Face Select BED No 1 ADU ee Zhang shan M VIEWBED NIBP mmHg uS wo WACNOSTIC Figure 4 5 VIEWBED SCREEN H Hot key of Viewbed There are two hot keys in the Viewbed Screen Select Bed Number and Select Waveform The hot key of Select Bed Number displays the bed numbers and patient names of other monitors currently connected on the LAN You can select a monitor to be monitored according to the patient name and bed number If at this time no other monitors are connected on the same LAN of this monitor the hot key of Bed Number will therefore display N A After you use this hot key to select a mon
142. elow There are four options in this dialog which are STANDARD SCREEN TREND SCREEN oxyCRG SCREEN and VIEWBED SCREEN Only one item can be selected at one time FACE SELECT Conventional monitor screen Figure 4 1 FACE SELECT 4 2 Standard Screen In the FACE SELECT menu Select the STANDARD SCREEN option to enter the Standard Screen The Standard Screen displays to us the parameters in the Parameter area and the waveforms being monitored This screen is the basic operating screen of the monitor Patient Monitor user s manual V 5 4 4 1 Face Select BED No 1 ADU Z nn Zhang shan M ek HR TOO HIGH DUACNOSTIC G POCE OF STI 000 1 00 die A rics O0 DI 21 08 EEN wn 98 x Figure 4 2 STANDARD SCREEN 4 3 Trend Screen H Enter TREND SCREEN In the FACE SELECT menu select the TREND SCREEN option to enter the Trend Screen BED No 1 ADU crorzmo Zhang shan M HR TOO HIGH 60 PWs OFF x NIBP 24 08 108 70 DIAGNOSTIC 98 Figure 4 3 TREND SCREEN H Position of trend graph 4 2 Patient Monitor user s manual V 5 4 4 4 Face Select Trend graph is located to the right of the corresponding waveform in the Waveform area Its color is the same as that of the corresponding parameter H Trend length Dynamic trend length is 2 hours On the trend graph the scale of the right end of the X axis is 0 hour while the left end is 2 hour
143. emaining part is displayed as a straight line Use the rotary snob on the front panel to move the cursor to the RECALL option on the FROZEN menu Press the knob the option displays L RIGHT By turning the knob left or right frozen waveforms on the screen will move left or right correspondingly There is an arrow indicating upward under the right side of the last waveform There is also a time scale beside the arrow OS is used to mark the moment when waveforms are frozen With waveforms moving right this time mark will in turn change into 1S 2S 3S These time marks are applied to all waveforms on the screen 6 5 Recording Frozen Waveform In the Freeze status you may output displayed frozen waveforms via the recorder Maximum 2 waveforms can be output at one time On the FROZEN menu the pull down lists of both WAVE 1 and WAVE 2 give you all names of frozen waveforms on the screen from which you may select two Select the REC option on the FROZEN menu to output parameters generated upon the freezing moment and the two selected frozen waveforms If one of the two selected waveforms is closed or not available only parameters and the other waveform are recorded If these two selected waveforms are all closed or not available only parameters are recorded As for the function of recording frozen waveforms you can only record the waveforms displayed upon the freezing moment The recording time length is the same
144. emia and neuropathy in the limb wearing the cuff When monitoring a patient examine the extremities of the limb frequently for normal color warmth and sensitivity If any abnormality is observed stop the blood pressure measurements 7 To stop continuous measuring During continuous measuring press START button on the front panel at any time to stop continuous measurement A Note A If you are in doubt about the accuracy of any reading s check the patient s vital signs by an alternative method before checking the functioning of the monitor A Warning A If liquid is inadvertently splashed on the equipment or its accessories or may enter the conduit or inside the monitor contact local Customer Service Center Measurement Limitations To different patient conditions the oscillometric measurement has certain limitations The measurement is in search of regular arterial pressure pulse In those circumstances when the patient s condition makes it difficult to detect the measurement becomes unreliable and measuring time increases The user should be aware that the following conditions could interfere with the measurement making the measurement unreliable or longer to derive In some cases the patient s condition will make a measurement impossible Patient Movement Measurements will be unreliable or may not be possible if the patient is moving shivering or having convulsions These motions may interfere with the detection of the arter
145. emperatures that exceed these limits could affect the accuracy of the instrument and cause damage to the modules and circuits Allow at least 2 inches 5cms clearance around the instrument for proper air circulation Power Source Requirements Refer to chapter Production Specification Grounding the PM 9000 Portable Patient Monitor To protect the patient and hospital personnel the cabinet of the PM 9000 Portable Patient Monitor must be grounded Accordingly the PM 9000 Portable Patient Monitor is equipped with a detachable 3 wire cable which grounds the instrument to the power line ground protective earth when plugged into an appropriate 3 wire receptacle If a 3 wire receptacle is not available consult the hospital electrician If completeness of the protective grounding wire is in doubt the equipment must be operated with internal power supply Patient Monitor user s manual V 5 4 10 1 Patient Safety AN Warning A Do not use a 3 wire to 2 wire adapter with this instrument Connect the grounding wire to the equipotential grounding terminal on the main system If it is not evident from the instrument specifications whether a particular instrument combination is hazardous or not for example due to summation of leakage currents the user should consult the manufacturers concerned or else an expert in the field to ensure that the necessary safety of all instruments concerned will not be impaired by the proposed combination Equip
146. en the sensor is facing in the proper direction The site of placement should be away from any craniotomy flap preferably via a contralateral burr hole The dura mater should be carefully stripped at least 2cm under the skull and 180 in arc before insertion Failure to do this will result in wedging of the pressure sensor and inaccurate readings Protect the catheter Use thick sutures and put tape around the catheter before suturing Remove all bone chips Use bone wax Use of a tunnel is recommended A short length of a large bore catheter can be passed first to act as a guide for the sensor tip Remove the guide from the burr hole end after the ICT B has been passed to the burr hole from the tunnel entrance Note that both edges are smoothed This will help to prevent damage to the catheter OOO se A Strip the dura at least 2 cm under the inner table of the skull Strip in an arc of at least 180 Figure 16 11 ICT B application Reseat the transducer tip after a few days since the dura may rapidly tighten and change its physical characteristics If possible round the bone at the point where the catheter makes its first bend into the burr hole and round the bone where the catheter makes the second bend under the cranium This Patient Monitor user s manual V 5 4 16 17 IBP Monitoring will help to prevent tearing the catheter or tip during insertion or removal A tear will require the device to be ret
147. ent of this manual is subject to changes without prior notice PROPERTY OF SHENZHEN MINDRAY BIO MEDICAL ELECTRONICS CO LTD 2002 ALL RIGHTS RESERVED Responsibility on the manufacturer party Mindray is responsible for safety reliability and performance of this equipment only in the condition that Patient Monitor user s manual V 5 4 l e all installation expansion change modification and repair of this equipment are conducted by Mindray qualified personnel and e applied electrical appliance is in compliance with relevant National Standards and e the monitor is operated under strict observance of this manual A Note A This equipment is not intended for family usage A Warning A This monitor is not a device for treatment purpose It is important for the hospital or organization that employs this equipment to carry out a reasonable maintenance schedule Neglect of this may result in machine breakdown or injury of human health II Patient Monitor user s manual V 5 4 Warranty Workmanship amp Materials Mindray guarantees new equipment other than accessories to be free from defects in workmanship and materials for a period of 18 months six months for multi site probes and SpO2 sensor from date of shipment under normal use and service Mindray s obligation under this warranty is limited to repairing at Mindray s option any part which upon Mindray s examination proves defective THIS WARRANTY
148. eplace it only when it is damaged or becomes loosely connected This tube can be cleaned and disinfected Cleaning use cloth moistened with warm soap water to clean the tube Do not immerse the tube into the liquid Disinfection use cloth moistened with cool chemical disinfector ramification mainly containing aldehyde ethanol or ramification mainly containing ethanol to clean the tube Do not immerse the tube into the liquid After cleaning use wet cloth to wipe off the disinfector and then use dry cloth to wipe the tube H Occlusion handling If the AG module passage is occluded the screen will display the message AG OCCLUSION Following are a few examples of occlusion which you may remove one by one until this message disappears Entrance Occlusion If the part at the entrance such as filter sample line or airway connector is occluded by condensed water the screen will display the message telling that the airway is occluded The optimal method to remove clogs of this kind is check for clogs in entrance parts a replace the bacteria filter at the entrance b check the sample pipe for clogs and or entangle If necessary replace it c Check the airway connector for water If necessary drain off the water and install the connector again Internal Occlusion If the interior of the AG module is contaminated by condensed water the screen will also display the message telling that the airway is occluded The optimal
149. er s manual V 5 4 13 17 SpO2 Monitoring peripheral circulation and the skin every 2 hours If any unfavorable changes take place you should change the measured position in time In the process of extended and continuous monitoring you should periodically check the position of the sensor In case that the position of the sensor moves during monitoring the measurement accuracy may be affected 13 2 4 Limitations for Measurement Measurement Limitations In operation the accuracy of oximetry readings can be affected by High frequency electrical noise including noise created by the host system or noise from external sources such as electrosurgical apparatus connected to the system Do not use oximeters and oximetry sensors during magnetic resonance imaging MRI scanning Induced current could potentially cause burns Intravascular dye injections Excessive patient movement External light radiation Improper sensor installation or incorrect contact position of the patient Sensor temperature optimal temperature between 28 C and 42 C Placement of the sensor on an extremity that has a blood pressure cuff arterial catheter or intravascular line Significant concentrations of dysfunctional hemoglobin such as carboxyhemoglobin and methemoglobin SpO too low Bad circular injection of the part being measured Shock anemia low temperature and application of vasomotor may all cause the arterial blood flow
150. er area ALM LEV there are three options HIGH MED and LOW HIGH refers to the most serious alarm followed by MED and LOW in the order of descending seriousness The default alarm level is MED ALM REC if it is ON when anesthetic gas parameter has alarm the recorder will output the alarm information The default is OFF EtCO2 ALM HI used to adjust the upper alarm limit of EtCO2 When the measured value is larger than ECO upper alarm limit the EtCO2 HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit EtCO2 ALM LO used to adjust the lower alarm limit of EtCO2 When the measured value is smaller than EtCO lower alarm limit the EtCO2 LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit FiCO ALM HI used to adjust the upper alarm limit of FiCO2 When the measured value is larger than FCO upper alarm limit the FiCO2 HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit FCO ALM LO used to adjust the lower alarm limit of FiCO2 When the measured Patient Monitor user s manual V 5 4 19 5 Anesthetic Gas Measurement value is smaller than FiCO2 lower alarm limit the FiCO2 LOW message is d
151. erial Ethylate and Acetaldehyde Appropriate sterilization materials for ECG lead blood pressure cuff are introduced in Chapters ECG RESP Monitoring Chapter NIBP Monitoring respectively A Caution A m Follow the manufacturer s instruction to dilute the solution or adopt the lowest possible density Do not let liquid enter the monitor No part of this monitor can be subjected to immersion in liquid Do not pour liquid onto the monitor during sterilization Use a moistened cloth to wipe up any agent remained on the monitor 11 5 Disinfection To avoid extended damage to the equipment disinfection is only recommended when stipulated as necessary in the Hospital Maintenance Schedule Disinfection facilities should be cleaned first Appropriate disinfection materials for ECG lead SpO2 sensor blood pressure cuff TEMP probe IBP sensor and CO cable are introduced in Chapters 12 18 respectively A Caution A Do not use EtO gas or formaldehyde to disinfect the monitor Patient Monitor user s manual V 5 4 11 3 Chapter 12 ECG RESP Monitoring 12 1 What Is ECG Monitoring Monitoring the ECG produces a continuous waveform of the patient s cardiac electric activity to enable an accurate assessment of his current physiological state Only proper connection of the ECG cables can ensure satisfactory measurement On the Normal Display PM 9000 provides display of 2 channel ECG waveforms m The patient cable consists of 2 part
152. es voltage variation in Uy for 5 cycle continued operation during on power supply 70 Ur 30 dip power mains interruptions it is input lines in Ur for 25 70 Ur 30 dip recommended that the monitor IEC 61000 4 11 cycle in U7 for 25 cycle be powered from an uninterruptible power supply or lt 5 Ur gt 95 lt 5 Us gt 95 dip a battery dip in U for 5 in U7 for 5 sec sec Power frequency magnetic eae Geier fields should be at levels 3 A m 3 A m characteristic of a typical magnetic field IEC 61000 4 8 location in a typical commercial of hospital environment NOTE Uzis the a c mains voltage prior to application of the test level TABLE 3 Guidance and manufacturer s declaration electromagnetic immunity Portable and mobile RF communications equipment should be used no closer to any part of the monitor including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter NOTE 1 A 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 The monitor is intended for use in the electromagnetic environment specified below The customer or the user of the monitor should assure that it is used in such an environment e
153. etail is described in the following pages ep AN Warning A Make sure that the computational constant for the measurement is appropriate to the catheter used A Note A The blood temperature alarm will not function during CO measurement It will resume automatically when the measurement is over 17 2 2 CO Measuring A Warning A Make sure that appurtenance applied is in conformity with relevant Medical Device Safety Requirements 17 2 Patient Monitor user s manual V 5 4 CO Measuring A Warning A Appurtenance should be avoided from contact with conductive metal body when being connected or applied C O Measurement Window Enter WINDOW FOR C O MEASUREMET and start C O measurement If CO transducer is not connected the monitor will prompt No Sensor unable to measure C O on the screen WINDOW FOR CO MEASUREMENT 2 0 C CO0Cl min o 2 49 CICl minsm 2 3 3 BSA m 2 0 743 em TECC 37 0 TICC 2 0 EH EI EI E o EE 1 s 20s 30s Ready for new measurement Measurement Time START STOP CANCEL REC g U 00 00 Scale X Scale Y EDIT gt gt Back to the upper menu Figure 17 2 Contents in C O Measurement Window H Contents displayed in the C O Window Measurement curve Prompt message refer to Measuring the Cardiac Ouput for details Start time of the measurement CO Cardiac Output Cl Cardiac Index BSA Body Surface Area TB Blood Temperature OOO
154. f the patient Check the ASS TOEE ASYSTOLE connection of the electrodes and lead wires Check the current situation of i i Patient suffers from Arr of the patient Check the KEE VFIB VTAC connection of the electrodes and lead wires Check the current situation of i i Patient suffers from Arr of the patient Check the COUPEET COUPLET connection of the electrodes and lead wires Check the current situation of i i Patient suffers from Arr Of the patient Check the BIGEMINY BIGEMINY connection of the electrodes and lead wires Check the current situation of n Patient suffers from Arr of the patient Check the EEN TRIGEMINY connection of the electrodes and lead wires RON T Patient suffers from Arr of R Check the current situation of Patient Monitor user s manual V 5 4 1 System Alarm Prompt ON T the patient Check the connection of the electrodes and lead wires PVC Patient suffers from Arr of PVC Check the current situation of the patient Check the connection of the electrodes and lead wires TACHY Patient suffers from TACHY Check the current situation of the patient Check the connection of the electrodes and lead wires BRADY Patient suffers from BRADY Check the current situation of the patient Check the connection of the electrodes and lead wires VT gt 2 Patient suffers from Arr of VT gt 2 Check the current situation of the
155. firmation PITCH TONE function When SPO2 changes if the BEAT VOL in ECG SETUP menu is set to a value other than 0 which means BEAT VOL is switched ON the heart beat volume will change automatically according to SPO2 value This monitor has 20 kinds of PITCH TONE the higher the SPO2 value is the higher the PITCH TONE will be Although these 20 kinds of PITCH TONE could not be adjusted in menu their volume could be controlled For example when SPO2 is selected as HR SOURCE in ECG SETUP menu the volume of PITCH TONE will be controlled by PR SOUND in SPO2 SETUP menu If other item than SPO2 is selected as HR SOURCE in ECG SETUP menu the volume of PITCH TONE will be consequently controlled by BEAT SOUND in ECG SETUP MENU A Note When SPO2 module is switched OFF PITCH TONE function will become disabled automatically 13 2 6 Alarm Description and Prompt SpO2 Alarm Message When the alarm switches are set to ON in relevant menus the physiological alarms caused by the parameter exceeding the alarm limit may possibly trigger the recorder to automatically output alarming parameter value and corresponding waveforms TABLES BELOW DESCRIBE THE POSSIBLE PHYSIOLOGICAL ALARMS TECHNICAL ALARMS AND PROMPT MESSAGES OCCURRING DURING SPO 13 20 Patient Monitor user s manual V 5 4 MEASUREMENT Physiological alarm Message SPO2 TOO HIGH Ca
156. foot Hold the sensor pull the belt and fit one of its sides with V edge into the V groove on the corresponding side of the sheath Appropriately elongate the belt about 20mm and fit the V edge of the other side of the belt into the V groove of the other side of the sheath and then loosen the belt After the V edges of the two sides of the belt fit well into the V grooves on the two sides of the sheath put the belt into the first lock bar to fasten the belt See figure 13 6 If the belt is too much long you may put it into the second lock bar You must position the SpO sensor in this way so as to make the photoelectric component face the correct position In the mean time note not to elongate the belt too much which may lead to inaccurate measurement and also blocking the blood circulation severely Figure 13 6 mounting of the neonate sensor AN Note AN If the sensor cannot be positioned accurately to the part to be measured it may result in inaccurate SpO reading or even that the SpO cannot be measured because no pulse is detected If this is true you must position the sensor again The excessive patient movement may result in inaccurate reading In this situation you must keep the patient quiet or change the part for monitoring to reduce the adverse influence of excessive movement AY Warning A In the process of extended and continuous monitoring you should check the Patient Monitor us
157. form is identical with that of this monitor The feature description of the displayed waveform is given above the waveform Sweep speed is also identical with that set up for the same waveform on this monitor H Technical Information area Technical Information area is to the right of patient name in Viewbed Screen This area displays related technical information to Viewbed such as due to network failure or network too busy Viewbed is disabled m Close Viewbed Screen In the FACE SELECT menu select options of other operating screens to close the Viewbed Screen H Rules for automatically selecting monitor to be viewed and waveform When you turn on the monitor or enter Viewbed Screen the system will automatically select a networked bedside monitor and a waveform of this monitor for you to view If the monitor being currently viewed is disconnected the viewed monitor will automatically close clear displays of all alarms parameters and waveforms However in this situation the Viewbed Screen still displays If you want to view another monitor you must select again through using hot keys If a measure module of the viewed monitor is plugged out or closed its corresponding waveform will disappear and the waveform in the Waveform area will not be refreshed Instead this Waveform area will display empty At this time if you want to view other waveforms of this monitor you need to select again A Note A When connecting by using wireles
158. front of the monitor Do not wipe the inner part of the connector socket when cleaning the monitor When the reusable cuff is not connected with the monitor or being cleaned always place the cover on the rubber tube to avoid liquid permeation Reusable Blood Pressure Cuff The cuff can be sterilized by means of conventional autoclaving gas or radiation sterilization in hot air ovens or disinfected by immersion in decontamination solutions but remember to remove the rubber bag if you use this method The cuff should not be dry cleaned 14 10 Patient Monitor user s manual V 5 4 NIBP Monitoring The cuff can also be machine washed or hand washed the latter method may prolong the service life of the cuff Before washing remove the latex rubber bag and for machine washing close the Velcro fastening Allow the cuff to dry thoroughly after washing then reinsert the rubber bag Tc LS gt aaveen Ss orel Szis INAY U OVE NOVINI Sa A Io omourmneg Eil XOTA Figure 14 5 Replace Rubber Bag in Cuff To replace the rubber bag in the cuff first place the bag on top of the cuff so that the rubber tubes line up with the large opening on the long side of the cuff Now roll the bag lengthwise and insert it into the opening on the long side of the cuff Hold the tubes and the cuff and shake the complete cuff until the bag is in position Thread the rubber tubes from inside the cuff and out through t
159. ge to the transducer may result A Warning A Do not immerse or soak the electrical connector end in any kind of fluid or liquid A Warning A The total volume of air injected to check the zero or baseline must not exceed 0 5ml or the membrane over the sensor may be ruptured A Warning A Do not press with thumb and forefinger on the tip of the ICT B Enormous pressures will be generated this way and the device will be subject to possible damage To see if the ICT B is operating gently touch the sensor tip A Note A Carefully check for cuts on the silicone of the catheter and sensor tip before use PLACING THE ICT B A Note A Burr hole edges must be rounded where the catheter makes an S bend into the epidural space Evacuate all bone chips A Note A The catheter should be protected by suitable means where sutures are placed This will prevent damage to the catheter when pulling sutures tight A Warning A Do not use haemostats or forceps as these will damage the device A Note A When removing the catheter care should be taken not to nick the device while cutting 16 14 Patient Monitor user s manual V 5 4 IBP Monitoring sutures Pull slowly on the catheter to remove the ICT B 16 7 3 Connection to the pressure monitor A Note A Although the catheter tip pressure transducer sensor is electrically isolated from the patient it is recommended that pressure monitors with patient isolation be used for s
160. h o indicates systolic value t indicates diastolic value and indicates mean value To select trend graph of a specific parameter Pick PARA SELECT item the first selection of the upper line and select a requested parameter name by turning the knob Patient Monitor user s manual V 5 4 8 1 Trend and Event To select 1 hour or 72 hour trend graph Pick RESOLUTION item the latter selection of the upper line choose 1 or 5 sec for 1 hour trend graph and 1 5 or 10 min for 72 hour trend graph To view other trend curves When appears on the right part of the screen pick L RIGHT the button at the extreme left of the lower line turn the knob clockwise to view later trend curves When r appears on the left part of the screen pick the same item turn the knob counterclockwise to view earlier trend curve To change the display scale Pick the ZOOM button in the lower line to adjust the y axis scale and thus change the trend curve in proportion The value beyond maximum value will be represented by the maximum value To obtain trend data of a specific time The time to which the cursor points will change as the knob is turned Parameter at this time is displayed below the x axis When fr appears on the right part of the screen the trend graph pages down for later trend curve as the cursor moves here When appears on the left part of the screen the trend graph pages up for earlier trend curv
161. he name of the waveform is displayed on the upper left part of the waveform The user may choose ECG lead based on the requirements The gain of the channel and the filter way are also displayed on each ECG waveform A 1mV scale bar is also displayed to the right side of ECG waveform The IBP waveform scale can also be selected according to the actual requirement Its range is described in the part Measure IBP In the IBP waveform area the waveform scale is displayed The three dotted lines for each IBP waveform form up to down represent respectively the upper limit scale reference scale and lower limit scale The values of these three scales can be set The specific method is given in the part Measure IBP When menu is wanted during screen operation the menu always occupies the fixed position in the middle part of the waveform area therefore part of waveform can not be viewed temporarily After exiting the menu the system will restores the original screen The user may set up the rate to refresh the waveform The method to adjust the refreshing rate of each waveform is discussed in the setup description of each parameter Parameter Area The parameter area lies to the right side of the waveform area whose position basically corresponds to the waveform The parameters displayed in the parameter area include ECG heart rate or pulse rate unit beats minute The ST analyzing result of channel 1 and 2 ST1 ST2 unit mV PVCs j unit
162. he setup lower alarm limit User selectable EtSEV HIGH The measured EtSEV value exceeds the setup upper alarm limit User selectable EtSEV LOW FIENF HIGH The measured EtSEV value is below the setup lower alarm limit The measured FiENF value exceeds the setup upper alarm limit User selectable User selectable FIENF LOW The measured FiIENF value is below the setup lower alarm limit User selectable EtENF HIGH The measured EtENF value exceeds the setup upper alarm limit User selectable EtENF LOW The measured EtENF value is below the setup lower alarm limit User selectable 19 10 Patient Monitor user s manual V 5 4 Anesthetic Gas Measurement The measured AwWRR value exceeds AwRR HIGH the setup upper alarm limit User selectable The measured AwRR value is below AwRR LOW the setup lower alarm limit KEES GAS APNEA ALM Respiration cannot be detected during HIGH specified time interval Technical alarms status Message Cause Alarm Level AG NO WATERTRAP The AG watertrap falls off from the monitor Medium CHANGE AG WATERTRAP Replace the AG watertrap Medium AG WATERTRAP TYPE The type of the AG watertrap being used is Medium WRONG not suitable AG INIT FAIL AG module has failure High AG COMM STOP GE failure or communication High AG OCCLUSION lt 2omimin which exceeds 1 seconds Hh AG COMM ER
163. he small hole under the internal flap Disposable Blood Pressure Cuffs Disposable cuffs are intended for one patient use only Do not use the same cuff on any other patient Do not sterilize or use autoclave on disposable cuffs Disposable cuffs can be cleaned using soap solution to prevent infection A Note AY For protecting environment the disposable blood pressure cuffs must be recycled or disposed of properly Patient Monitor user s manual V 5 4 14 11 Chapter 15 TEMP Monitoring 15 1 TEMP Monitoring Two TEMP probes can be used together to obtain 2 temperature data and compare them to work out the temperature difference TEMP monitoring setup m If you are using disposable TEMP probes you need to plug the TEMP cable into the monitor and then connect the probe to the cable With a reusable TEMP probe you can plug the probe directly into the monitor H Apply the TEMP probe s securely to the patient WR Switch on the system A Warning A Verify probe cables fault detection before beginning of monitoring phase Unplug the temperature probe cable of the channel 1 from the socket the screen will display the error message TEMP SENSOR1 OFF and the audible alarm is activated The other channel is the same AN warning If use two TEMP probes them must be made by the same manufacture A Note A Disposable TEMP probe can only be used once for one patient A warning The calibration of the temperature mea
164. his channel Inflate sphygmomanometer and obtain the value of pressure to preset value in menu Repeatedly adjust the calibrating pressure value in the menu or the pressure value of sphygmomanometer until they are equal Push CALIBRATION button the monitor starts calibrating process Wait for the result of calibration determine the action according to the prompt message After calibration disconnect the tube of sohygmomanometer and the T type connector then connect the transducer to the patient by following specified steps Related information to calibration for this example CH1 is used e SUCCESSFUL CALIBRATION CH1 work properly User could perform IBP monitoring via CH1 SENSOR OFF FALL Check the connection of CH1 transducer Ensure no SENSOR OFF FALL message prompts and Execute calibration If problem still exists contact serviceman IN DEMO FAIL Ensure that the monitor is not in DEMO mode Execute calibration If problem still exists contact serviceman PRESSURE OVER RANGE FAIL Make sure that you have selected transducer value in IBP CAL then proceed calibration PULSATILE PRESSURE FALL Ensure that the pressure value of the sphygmomanometer is constant Execute calibration If problem still exists contact serviceman IBP SCALE ADJUST submenu IBP SCALE ADJUST HI LO VAL CH1 ART Ise d o CH2 CVUP 40 0 20 Ad just the value of the upper scale the upper do
165. hown as below IBP 1 2 SELECT IBP SETUP IBP PRESSURE ZERO IBP PRESSURE CALIBRATE Access IBP setup menu EXIT Figure 16 2 IBP SELECT Menu Patient Monitor user s manual V 5 4 16 3 IBP Monitoring IBP 1 2 SETUP ALM FILTER NO FILTER ALM LEV MED ALM LIMIT SETUP gt gt ALM REC OFF z SCALE ADJUST gt gt AMP ADJUST MANUAL EXPAND PRESSURE gt gt SWEEP 25 0 DEFAULT gt gt UNIT mmHg e Open or close the IBP alarn EXIT Figure 16 3 IBP SETUP Menu Options that could be set up are ALM Select ON to enable alarm and data storage during IBP alarm Select OFF to disable physiological alarm and display the 2 symbol beside IBP numeric ALM LEV Set up the alarm level Three levels are available HIGH MED LOW ALM REC Select ON to enable recording once IBP alarm occurs Select OFF to disable recording function AMP ADJUST adjust waveform amplitude Two selections are available MANUAL AUTO Set it to AUTO the pressure names of IBP become P1 and P2 and the IBP scale is adjusted by system automatically Set it to MANUAL the pressure names of IBP can choose one of ART PA CVP RAP LAP ICP P1 P2 and the IBP scale is adjusted by the user via SCALE ADJUST item SWEEP Select the scanning speed of the IBP wave Two selections are available 12 5 mm s or 25 mm s UNIT Select the pressure unit mmHg or kPa FILTER Select filtering mode of system Three selections are ava
166. ial pressure pulses In addition the measurement time will be prolonged Cardiac Arrhythmia s Measurements will be unreliable and may not be possible if the patient s cardiac arrhythmia has caused an irregular heartbeat The measuring time thus will be prolonged Heart lung Machine 14 4 Patient Monitor user s manual V 5 4 NIBP Monitoring Measurements will not be possible if the patient is connected to a heart lung machine Pressure Changes Measurements will be unreliable and may not be possible if the patient s blood pressure is changing rapidly over the period of time during which the arterial pressure pulses are being analyzed to obtain the measurement Severe Shock If the patient is in severe shock or hypothermia measurements will be unreliable since reduced blood flow to the peripheries will cause reduced pulsation of the arteries Heart Rate Extremes Measurements can not be made at a heart rate of less than 40 bpm and greater than 240 bpm 14 2 2 NIBP monitoring screen NIBP measurement result and corresponding message are displayed as follows Time of measurement NIBP 16 50 mmHg gt BPuit NS M t val easurement value gt 108 84 70 160 gt NS Alarm limit Measurement mode gt MANUAL Jd Current cuff pressure Message gt Manual measure CUFF 100 14 3 NIBP SETUP menu Pick the NIBP hot key on the screen to call up the NIBP menu shown as below NIBP SETUP ALM ON gt
167. icone sealant to the damage The most common reason for failure of the ICT B pressure transducer is physical damage to the device s silicone catheter and or tip The cuts are usually caused by sharp bone segments and are not always visible to the naked eye If such damage remains undetected fluids may enter the device and damage the sensing element Check for damage as described in the Cleaning section of this manual 16 7 7 SOME COMMONLY ASKED QUESTIONS QUESTION ANSWER Is the ICT B a single use device No it is designed to be reused many times If it is damaged what shall we do Does the air used for checking the zero get into the patient Sterilize first Then obtain a purchase order for repair and send it back to Manufactory for repair No Air used for checking the zero stays in the fine lumens and tip of the ICT B until the syringe is removed What happens if we autoclave the ICT B It will have to be returned to Manufactory for repair We inject air to check the zero but the baseline on the scope always returns to ICP even if we leave the syringe attached What is wrong There is a leak in the catheter or sensor tip Remove wipe clean with alcohol and then sterilize Return the device to Manufactory for repair Readings were taken with the syringe left attached until we noticed it Can we rely on these readings No They are incorrect All pressure readings must be made with the p
168. idestream module occurring occlusion first check kinks for sampling line If no kinks are found then check water trap after disconnecting sample line from the Watertrap If the occlusion message on the screen disappears the sampling line must be replaced If the occlusion message on the screen remains the Watertrap must be replaced 4 No routine calibration required in both Mainstream and Sidestream CO2 module Patient Monitor user s manual V 5 4 Chapter 19 Anesthetic Gas Measurement 19 1 General AG module is used to measure respiratory and anesthetic gases of a patient during anesthesia This module provides et end tidal values and inspired values of various gases listed below E CO here it represents the measured EtCO2 value maximum expired gas value maximum expired gas value tested during expiring period E N20 nitrous oxide E O optional function m AwRR _ respiring time per minute The system can simultaneously display the waveforms of 4 anesthetic gases COs N20 O2 and an anesthetic waveform The default is to display CO2 waveform Parameters that can be displayed simultaneously are COs NO Oz and AA it refers to anesthetic DES ISO ENF SEV HAL In addition inspired and expired values are displayed at the same time plus MAC Minimal Alveolar Concentration or BAL Balance gas and AwRR Definitions of parameter COs carbon dioxide N O nitrous oxide O2 oxygen AwRR
169. ies DRYLINE Airway Adapter Straight P N 60 14100 00 P N 9000 10 07486 DRYLINE Airway Adapter Elbow P N 60 14200 00 P N 9000 10 07487 Aion DRYLINE Water Trap Adult purchase No 60 13100 00 P N 9200 10 10530 Sampling Line Adult 2 5m Adult purchase No 60 15200 00 P N 9200 10 10533 Patient Monitor user s manual V 5 4 20 5 Manufacturer Address European Representative Product Model Code Appendix EC Declaration of Conformance Shenzhen Mindray Bio Medical Electronics Co Ltd Mindray Building Keji 12 Road South Hi tech Industrial Park Nanshan Shenzhen 518057 P R China Shanghai International Holding Corp GmbH Europe Eiffestrasse 80 D 20537 Hamburg Germany Patient Monitor PM 9000 Standard Configuration including ECG RESP NIBP SpOs Battery Options Thermal Recorder 2 channel Temp 2 channel IBP EtCO2 Sidestream EtCO Mainstream Cardiac Output Anaesthetic Gases 12 1 in Color TFT 10 4 in Color TFT oO ON Oo Om FW DY Classification MDD Annex IX Ilb We herewith declare that the above mentioned products meet the provisions of the following EC Council Directives and Standards All supporting documentations are retained under the premises of the manufacturer and the notified body Patient Monitor user s manual V 5 4 1 EC Declaration of Conformance DIRECTIVES General applicable directives Medical Device Directive COUNCIL DIRECTIVE
170. ilable NORMAL filter the waveform at the frequency of 16Hz SMOOTH filter the waveform at the frequency of 8Hz and NO FILTER display the original waveform The default is NO FILTER ALM LIMIT SETUP Access the sub menu of IBP ALM LIMIT SETUP in which user may set up the upper and lower alarm limit of systolic pressure diastolic pressure and mean pressure respectively for channel 1 and channel 2 SCALE ADJUST Access the sub menu of IBP SCALE ADJUST in which user may adjust the position of the high reference and low scales for the two waveforms displayed on the screen EXPAND PRESSURE Access the sub menu of IBP EXPAND PRESSURE user could select the pressure type to be represented by P1 and P2 DEFAULT Access the IBP DEFAULT CONFIG dialog in which user could select FACTORY DEFAULT CONFIG or USER DEFAULT CONFIG After selecting an option and exiting the dialog the system will pop up a dialog asking for confirmation EXIT Exit the menu and return to the upper menu Patient Monitor user s manual V 5 4 IBP Monitoring A Warning A Before setting the alarm limits confirm to choose the correct label IBP ALM LIMIT SETUP SYS MEAN DIA CH1 ART ALM HI 110 CH1 ART ALM LO 390 70 50 CH2 CUP ALM HI 10 30 gt gt d ah ah CH2 CUP ALM LO 9 Al Set upper limit of IBP systolic pressure If above upper limit alarms occurs EXIT Figure 16 4 IBP ALM LIMIT SETUP When the value exce
171. ilized or re used A Note A For protecting environment the disposable transducers or domes must be reclaimed or disposed properly Sterilization H Chemical solution Sterilization Remove obvious contamination by using the cleaning procedure described previously Select a sterilant that has been found effective to your hospital or institution for chemical solution sterilization of operating room equipment Buffered glutaraldehyde e g Cidex or Hospisept has been found to be effective Do not use quaternary cationic detergents such as zephiran chloride If the whole unit is to be sterilized immerse the transducer but not the electrical connector into the sterilant for the recommended sterilizing period Ensure that the dome has been removed Then rinse all transducer parts except the electrical connector with sterilized water or saline The transducer must be thoroughly dried before storing mM Gas Sterilization For more complete asepsis use gas sterilization Remove obvious contamination by using the cleaning procedure described previously To inhibit the formation of ethylene glycol when ethylene oxide gas is used as the disinfectant the transducer should be completely dry Follow the operating instructions provided by the manufacturer of the gas disinfectant A Warning A The sterilize temperature must not exceed 70 C 158 F Plastics in the pressure transducer may deform or melt above this temperature 16 7 ICP Transducer ICT B
172. ill exists contact the manufacturer for repair NIBP RESET ILLEGALLY During NIBP measurement illegal reset occurs Check the airway of NIBP to see if there are clogs Then measure again if the failure still exists contact the manufacturer for repair NIBP COMM ERR The NIBP communication part has problem Execute the reset program in the NIBP menu If the failure still exists contact the manufacturer for repair The NIBP cuff is not connected LOOSE CUFF Re connect the NIBP cuff correctly Check the connection of each The NIBP cuff is not connected part or replace with a new AIR LEAK correctly or there are leaks in cuff If the failure still exists the airway contact the manufacturer for repair Problem happens when Check the connection of each AIR PRESSURE Measuring the curve The part or replace with a new i system cannot perform cuff If the failure still exists ERROR measurement analysis or contact the manufacturer for calculation repair Check if the setup of patient PrOD em happens when type is correct Check the E es scure TNE connection of each part or WEAK SIGNAL system cannot perform p replace with a new cuff If the measurement analysis or l e failure still exists contact the calculation manufacturer for repair Problem happens when Check the connection of each measuring the curve The part or replace with a new RANGE EXCEEDED sys
173. imit User selectable EtN20 LOW The measured N O value is below the setup lower alarm limit User selectable FIDES HIGH The measured FIDES value exceeds the setup upper alarm limit User selectable FIDES LOW EtDES HIGH The measured FIDES value is below the setup lower alarm limit The measured EtDES value exceeds the setup upper alarm limit User selectable User selectable EtDES LOW FIHAL HIGH The measured EtDES value is below the setup lower alarm limit The measured FiHAL value exceeds the setup upper alarm limit User selectable User selectable FIHAL LOW The measured FiHAL value is below the setup lower alarm limit User selectable EtHAL HIGH The measured EtHAL value exceeds the setup upper alarm limit User selectable EtHAL LOW The measured EtHAL value is below the setup lower alarm limit User selectable FiISO HIGH The measured FilSO value exceeds the setup upper alarm limit User selectable FiISO LOW The measured FilSO value is below the setup lower alarm limit User selectable EtISO HIGH The measured EtISO value exceeds the setup upper alarm limit User selectable EtISO LOW The measured EtISO value is below the setup lower alarm limit User selectable FISEV HIGH The measured FISEV value exceeds the setup upper alarm limit User selectable FISEV LOW The measured FiSEV value is below t
174. ineer or Mindray service staff CUFF TYPE ERR EE E a LOW Select appropriate cuff type comply with the Patient Monitor user s manual V 5 4 14 9 NIBP Monitoring patient type Measuring time has exceeded 120 seconds adult or 90 seconds neonatal Measure again or use other NIBP TIME OUT measuring method HIGH NIBP ILLEGALLY Abnormal module RESET reset HIGH Reset again Problem happens when measuring the curve The system Check the cuff Make sure that the MEASURE FAIL cannot perform HIGH patient under monitoring is measurement motionless Measure again analysis or calculation Prompt message display in the prompt area below NIBP value Message Cause Alarm Level Manual measure During manual measuring mode Cont measuring During continuous measuring mode Auto measuring During automatic measuring mode pigiea sian After selecting interval between measurements in MENU Press START STOP key during measuring Measurement over to stop measurement No alarm Calibrating During calibrating Calibration over Calibration over Pneum testing During pneumatic test Pneum test over pneumatic test over Resetting Reset failed NIBP module in resetting NIBP module reset failed 14 5 Maintenance and Cleaning A Warning A m Do not squeeze the rubber tube on the cuff Do not allow liquid to enter the connector socket at the
175. information of other parameters is the same as HR 5 2 Alarm verification during power on During PM 9000 power on audible and visual alarm capability will be tested by the system Every time when PM 9000 powers on alarm beeps DO and the LED indicator on the display device flashes yellow and red once If no beeps heard or no alarm indicator flashing viewed do not use this device to monitor any patient and notify Customer Service Center 5 3 Alarm Cause Alarm occurs when 1 Physiological alarm is evoked 2 Alarm for error of the system technical alarm is evoked 3 General alert occurs A Conditions that activate the parameter alarms When the measurement value exceeds the alarm limit and the alarm is set ON Alarm will not activate if the alarm is set OFF B Conditions that activate the system alarms technical alarm Upon the system error the monitor prompts alarm immediately and proceeds corresponding remedy stops all monitoring and eliminates the final results in order to avoid faulted treatment If more than one error occur they will be displayed by turns C General alert In some circumstances alerts will behave as physiological alarm but in normal sense we don t regard them as real patient health related items 5 4 Patient Monitor user s manual V 5 4 Alarm 5 4 SILENCE and PAUSE m SILENCE Push the SILENCE button on the panel for more than 1 second the system will shut off
176. ings The level of increase is approximately equal to the amount of carboxyhemoglobin present Dyes or any substance containing dyes that change usual arterial pigmentation may cause erroneous readings A Warning A Do not use this instrument and the sensors during magnetic resonance imaging MRI scanning Induced current could potentially cause burns The monitor may affect the MRI image and the MRI unit may affect the accuracy of the oximetry measurements A Warning A Pulse oximetry can overestimate the SpO2 value in the presence of Hb CO Met Hb or dye dilution chemicals AN Warning A Verify sensor cable fault detection before beginning of monitoring phase Unplug the SpO sensor cable from the socket the screen will display the error message SpO2 SENSOR OFF and the audible alarm is activated A Warning A Do not use the sterile supplied SpO sensors if the packaging or the sensor is damaged and return them to the vendor 13 4 Patient Monitor user s manual V 5 4 SpO Monitoring AN Warning A Prolonged and continuous monitoring may increase jeopardy of unexpected change of dermal condition such as abnormal sensitivity rubescence vesicle repressive putrescence and so on It is especially important to check the sensor placement of neonate and patient of poor perfusion or immature dermogram by light collimation and proper attaching strictly according to changes of the skin Check per 2 3 hours the sensor pla
177. ion and Prompt 17 9 17 6 Maintenance and Ceamimg 17 10 Chapter 18 CO2 Measuring cccccecesceeseeeeeeeeeeeeeeseaeseseneeeneneeseaesaseeeenseaeeeeeseseaeeeneeeeees 18 1 IBA Eeer ola et Aah eet EE ad 18 1 18 2 Monitoring Procedure aeiia aa a a a a a a a a 18 1 18 3 COZ ET 18 3 18 4 Alarm Information and Prompt 18 7 18 5 Maintenance and ClCaAning cccccceseceeeeeceeeeeceaeeeeeeeeceeeesaaeeeeaeeseeeeeseaeeesnaeeseenees 18 9 Chapter 19 AG Measuring i start ideana e Aere e aa aara aone ai daana ro caaeaae aaae naai 19 1 KREE EE 19 1 19 2 Measuring principle and operating PrOCeSS ce ee seceeceeeeeeeeeeeeneeeeeeeeneeeteees 19 2 TOS AG MOM eebe Eed coed tees dE ee iad estes 19 4 19 4 Alarm Information and Prompt 19 9 19 5 Maintenance and Ceamimg 19 12 Chapter 20 Accessories and Ordering Information ccccsccssseeeseeeseeeeeeseeeeeeeeenees 20 1 20 1 ECGiACCESSONOES EE 20 1 Patient Monitor user s manual V 5 4 3 Content 20 2 SPO2 Accessories ss ege nti ae EE leaden EE 20 2 20 3 NIBP Accessories gees eege AEN EEN 20 3 20 4 TEMP Accessortes aea aaea a a aaa aa araa aana TERA aae 20 3 20 5 IBP e EE 20 3 20 6 CO ACCOSSONIES eotia eseina enna ER E Ratan er RAT SESE REN aA ROER Aan er RATA ed M AEEA RE SEKERE ASN 20 4 207 COZ ACCESSOMNES as ea ee a E E e a e EE EE E E EE 20 4 20 8 Anesthetic Gas Accessories 0 cccccccccceeseececeesneeeeeeaeeeeeeaaaeeecseaaeeeeesaeeeseesaeeesenaas 20 5 Appendix EC D
178. iquids from entering the female luer on the electrical connector A male plug may be used to do this This plug must be removed during normal use and ETO sterilization 1 Rinse and cold soak the catheter transducer in a solution of glutaraldehyde such as Cidex following the chemical manufacturer s instructions Note that disinfecting does not equal sterilisation and the strength of the glutaraldehyde must be confirmed by the chemical manufacturer s instructions 2 After sterilisation of the catheter and just before use rinse the device with pyrogen free sterile distilled water or saline solution as recommended by the manufacturer of the 16 20 Patient Monitor user s manual V 5 4 IBP Monitoring sterilising agent K Care of the ICT B The metal sensor is very robust and can withstand severe shocks and vibrations It can be irreversibly damaged by contact with sharp objects or overpressure for instance by squeezing the tip between finger and thumb The silicone coating on the sensing area allows a small amount of water absorption During this process which may take an hour or more the baseline may drift a few mmHg The device should be allowed to stabilize in water or saline before use for a few hours Liquids entering the back of the sensor will cause damage to the sensor Cuts to the outer coating should be avoided and repaired immediately if any are found Return to manufactory or apply a temporary repair using a suitable sil
179. irically derived equation are based upon human blood studies against a laboratory co oximeter on healthy adult volunteers in induced hypoxia studies The above equations are combined and a noise reference N is determined N S 660 S 940 x R If there is no noise N 0 then S 660 S 940 x R which is the same relationship for the traditional pulse oximeter The equation for the noise reference is based on the value of R the value being seeked to determine the oC This instrument s software sweeps through possible values of R that correspond to SpO values between 1 and 100 and generates an N value for each of these R values The S 660 and S 940 signals are processed with each possible N noise reference through an adaptive correlation canceler ACC which yields an output power for each possible value of R i e each possible SpoO from 1 to 100 The result is a Discrete Saturation Transform DST plot of relative output power versus possible SpO value as shown in the following figure where R corresponds to SpO 97 13 2 Patient Monitor user s manual V 5 4 SpO Monitoring Discrete Saturation Transform _ DST Ei b S C O C Ss s5 DO 8 o e Zw r H MIN Ill cc oil Una iii 65 95 97 100 SpO The DST plot has two peaks the peak corresponding to the higher saturation is selected as the SpO gt 2 value This entire sequence is repeated once every t
180. isplayed on the screen m OTHER SETUP pick this item in the menu to call up CO2 more setup sub menu WAVE SCALE LOW WATERVAPOR ON WORK MODE STANDBY BTPS ON y PUMP RATE 100ml min v DEFAULT gt gt COMPENSATE GENERAL Select the displaying amplitude of the COZ wave EXIT Figure 18 4 CO2 More Setups Menu Now we introduce you to the functions of each item in CO2 SETUP submenu m WAVE SCALE to adjust full scale size of CO2 waveform display area with LOW or HIGH selectable The default value is LOW m PUMP RATE to adjust the pump rate of the air pump of CO2 module with 100ml min 150ml min or 200ml min selectable The default value is 100ml min NOTE This menu only functions to SideStream m WORK MODE to change the work mode of CO2 with MEASURE mode or STANDBY 18 4 Patient Monitor user s manual V 5 4 CO2 Monitoring mode selectable The default is STANDBY mode When it is required to monitor CO2 select MEASURE mode STANDBY mode disables the air pump in SideStream module the sensor and the IR infrared ray source in MainStream module thus decreases the power consumption and extends the life cycles of IR source and the whole CO2 module A Note A When not using CO2 monitoring function it is suggested not to connect MainStream sensor or SideStream water trap and to adjust to STANDBY mode m COMPENSATE to perform diffe
181. isplayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit EtO ALM HI used to adjust the upper alarm limit of EtO2 When the measured value is larger than EtO2 upper alarm limit the EtO2 HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit EtO2 ALM LO used to adjust the lower alarm limit of EtO2 When the measured value is smaller than EtO lower alarm limit the EtO LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit FiO2 ALM HI used to adjust the upper alarm limit of FiO2 When the measured value is larger than FiO2 upper alarm limit the FiO2 HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is below the upper alarm limit FCO ALM LO used to adjust the lower alarm limit of FiO2 When the measured value is smaller than EiO2 lower alarm limit the FiO2 LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit AwRR ALM HI used to adjust the upper alarm limit of AWRR When the measured value is larger than AwRR upper alarm limit the AwRR HIGH message is displayed on the screen In the UNLATCH mode this message disappears when the
182. itor to be viewed the system will toggle to the display of the selected monitor for your view The selected waveform is one of those listed in the hot key of Select Waveform The hot key of Select Waveform is used to select a waveform generated by the monitor being viewed If the hot key of Select Waveform displays N A it indicates that the bedside monitor being viewed has no waveforms You can use this hot key to select and therefore view different waveforms of the monitor being viewed E Alarm indicator of Viewbed On the upper right side of the Viewbed Screen there is an Alarm Indicator used to tell the alarm status of the monitor being viewed The activity of this alarm indicator is identical with that of the alarm lamp on the panel of the monitor being viewed That is to say if the monitor being viewed occurs medium low level alarm this alarm indicator illuminates yellow if it occurs high level alarm this alarm indicator illuminates red If the monitor being viewed has no alarm or the alarm is screened the icon for this alarm indicator will not be displayed E Parameter area of Viewbed Screen Under the hot key of Select Bed Number is the Parameter area in which parameters Patient Monitor user s manual V 5 4 4 5 Face Select of all monitors being viewed are displayed H Waveform area of Viewbed Screen Under the hot key of Select Waveform is the Waveform area The Sweep manner refreshing or scrolling of the wave
183. knob is called cursor Operation can be performed at any position at which the cursor can stay When the cursor is in the waveform area the user may immediately modify the current setup When the cursor is in the parameter area the user may open the setup menu of the corresponding parameter module so as to set up the menu items of the module Patient Monitor user s manual V 5 4 1 9 Introduction Operating method RW Move the cursor to the item where the operation is wanted WH Press the knob RW One of the following four situations may appear 1 4 10 The cursor with background color may become into the frame without background color which implies that the content in the frame can change with the rotation of the knob 20 Menu or measuring window may appear on the screen or the original menu is replaced by the new menu 30 A check mark V appears at the position indicating that the item is confirmed AT The system immediately executes a certain function Interfaces For the convenience of operation the different kinds of interfaces are in different parts of the monitor At the right side is AG watertrap Figure 1 4 and the recorder s paper inlet cover Figure 1 40 as shown in Figure 1 4 Figure 1 4 Right Side At the left side are the connectors to patient cables and the sensors as shown in Figure 1 5 O ad m SS ECKE EECH E Socket for CO2 sensor Socket for channel 1 TEMP
184. ld not be used as the primary source of alarm notification The audible and visual alarms of the monitor used in conjunction with clinical signs and symptoms are the primary source for notifying medical personnel that an alarm condition exists 3 9 DEMO function Select the DEMO item in the SYSTEM MENU to call up the ENTER DEMO PASSWORD After entering the password the system enters DEMO status The purpose of waveform demonstration is only to demonstrate the machine performance and for training purpose In clinical application this function is not forbidden because the DEMO will mislead the medical staff to treat the DEMO waveform and parameter as the actual data of the patient which may result in the delay of treatment or mistreatment Therefore before entering this menu you shall enter password INPUT DEMO KEY KEY 2080 4 Back to the upper menu Figure 3 23 Input Demo Key 3 16 Patient Monitor user s manual V 5 4 Chapter A Face Select 4 1 This monitor has four different operating screens which are Standard Screen Trend Screen oxyCRG Screen and Viewbed Screen When required you can select different operating screens for necessary information Let s probe into these four operating screens one by one Select Operating Screen In the SYSTEM MENU select the FACE SELECT option in the SYSTEM SETUP menu to call up the dialog box as shown in the figure b
185. le the CO2 concentration will compute from the detecting CO2 absorption intensity of patient sample The relation between partial pressure and percentage of CO2 concentration is given below P mmHg Percentage Pamp ambient pressure Of CO2 MainStream and CO2 SideStream modules whichever is selected by the user Autorun measuring mode is adopted Rate for waveform sampling is 31 msec time The operating series for the two modules are respectively MainStream work sequence After the system is powered on CO2 module automatically begins warming up for about 45S to 90S Then the sensor motor is activated After 5S to 10S the light source of infrared ray is opened After 10S the system enters the normal measuring status SideStream work sequence Except the procedures that after being powered on the system Patient Monitor user s manual V 5 4 18 1 CO2 Monitoring needs not warming up and the air pump should be activated other procedures are the same as those in MainStream sequence CO2 measurement setups 1 2 Verify the type of the configured CO2 module MainStream or SideStream For MainStream connect the sensor to the receptacle of CO2 module For SideStream plug the water trap onto its fixing chassis Add a permanently used nafion tube between the sampling line and the watertrap to further remove the influence of water vapor Power on the system For MainStream technical prompt information of CO2 WARM U
186. le and lead to system contamination clog or incorrect reading In order to prevent clog dispose the filter each time after it is used on a patient Do not try to disinfect or clean a used filter Only use the sample line recommended especially for the system Using other sample line may reduce the performance and reliability of the AG module If the sample line is tangled up do not use it because the line in this condition may have clog or leakage 19 3 Menus Patient Monitor user s manual V 5 4 19 3 Anesthetic Gas Measurement 19 3 1 AG SETUP menu Use the rotary knob to select the GAS hot key in the Parameter area to call out the AG SETUP menu AG SETUP AGENT v De COMPEN OFF k c02 UNIT mmHg SWEEP 123 g 02 UNIT mmHg WORK MODE STANDBY N20 UNIT z z ALARM SETUP gt gt AA UNIT z v ADJUST WAVE AMP gt gt PUMP RATE LOW DEFAULT gt gt Use the default configuration to initialize all the menus EXIT Figure 19 3 AG SETUP menu Detailed information about each item in the AG SETUP menu is AGENT used to select the name of the anesthetic to be monitored CO2 UNIT used to select the display unit of COs O2 UNIT used to select the display unit of O2 N20 UNIT used to select the display unit of N20 AA UNIT used to select the display unit of anesthetic PUMP RATE used to select the appropriate pump rate O2 COMPEN Oz compensation switch When the Oz concentration is larger th
187. losed the alarm sound permanently This status terminates when you discharges the status AN Note AY If lag symbol appears the system will no longer give audible alarm sound You must be very careful in using this function Two ways can be used to discharge this status One is set the alarm volume to an option other than OFF in the USER MAINTAIN menu The other method is to press SILENCE button to make the flag turn to 2 And then press SILENCE again and the system will restore the normal alarm status m Parameter alarm information is displayed always in the upper right corner of the screen m When the waveforms on the screen are frozen the FREEZE prompt will appear in the bottom part of the screen Waveform Menu Area The waveform area can maximally display 8 waveforms The displaying order of the waveforms on the screen can be adjusted For the maximum configuration the waveforms provided by the system for selection are 2 ECG waveforms SpO2 waveform 4 waveforms of IBP module IBP1 2 3 4 RESP waveform CO2 waveform and 4 waveforms of AG module CO2 N20 02 AA But CO2 waveforms and AG waveforms can t display at the same time All the waveforms in the system are listed out in the WAVEFORM SETUP menu The user may select the waveform to be displayed and adjust their displaying positions The specific 1 6 Patient Monitor user s manual V 5 4 Introduction method is illustrated in the part Set Up Screen Waveform T
188. m Menu m ANALOG OUT if being selected the AUX OUTPUT port will be used to realize ANANOG OUT function while NURSE CALL function is switched off at the same time And visually the NURSE CALL SETUP item in USER MAINTAIN menu will become gray indicating that the function is disabled m NURSE CALL if being selected the AUX OUTPUT port will be used to realize NURSE CALL function while ANALOG OUT function is switched off at the same time For the LEAD NAMING item you can select AHA or EURO To know the difference between these two styles refer to Chapter ECG RESP Monitoring For the ALM SOUND item you can set the alarm volume to ON or OFF For the NET TYPE item two selections are available HYPER III and CMS For the LOCAL NET NO item it refers to the net No A Note A When using the monitor with wireless network module do not change network bed number freely Contact the manufacturer in this case A Warning A When the alarm volume is set to OFF you will not hear the alarm sound if new alarm occurs Therefore you must be very careful in using this selection If setting the alarm volume to OFF when the system is in Silence or Pause status the system will automatically discharge Silence or Pause status If you select Silence or Pause when the alarm volume is set to OFF the system will restore the alarm volume before the alarm volume is set to
189. may call up the dialog box as the default one ALARM VOL The options are from 10 to 1 10 indicates the maximum volume while 1 the minimum ALM REC TIME which has three selections 8S 16S 32S ALM PAUSE TIME refers to the alarm suspension time span which has three selections 1MIN 2MIN 3MIN PARA ALM TYPE which has two selections LATCH UNLATCH LATCH refers to the situation once alarm occurs the system will alarm always until the intervention of the operator press SILENCE on the panel UNLATCH refers to the situation that once the Patient Monitor user s manual V 5 4 5 3 Alarm alarm condition is discharged the alarm will disappear automatically Alarm setup of each parameter In ALARM SETUP menu select ALM SEL item to set up the alarm information of following parameters They are HR ST PVC SPO2 NIBP IBP 1 2 RESP TEMP For example Method to set up alarm information of HR Step 1 Select HR ALM SETUP in ALM SEL item to call up the dialog box ALARM SETUP for HR only Step 2 Five items are available for the user to set up which are HR ALM on off of the alarm switch ALM LEV alarm level ALM REC alarm recording switch ALM HI higher limit of HR alarm ALM LO lower limit of HR alarm When use the knob to select each item and press the knob a pull down list appears for the user to choose his desired selection The method for setting the alarm
190. method to remove clogs of this kind is 19 12 Patient Monitor user s manual V 5 4 Anesthetic Gas Measurement Step 1 as usual check the entrance or the exit for clogs and remove them Step 2 if occlusion still persist after step 1 you should consider the existence of interior occlusion In this situation contact Mindray service engineer Patient Monitor user s manual V 5 4 19 13 Chapter 20 Accessories and Ordering Information This chapter lists the recommendation accessories used in this device A Warning A The accessories list below are specified to be used in this device of Shenzhen Mindray Bio Medical Electronics Co Ltd The device will be possibly damaged or lead some harm if any other accessories are used 20 1 ECG Accessories H Cables 6PIN 3 core ECG cable LL 2325TRONOMEDINC 5 lead ECG lead wire LL 22305TRONOMED 6PIN 5 lead ECG cable LL 2514TRONOM ED 6PIN 5 lead ECG cable LL 2540AAMI 6PIN 5 lead ECG cable EURO KENDALL 6PIN 5 lead ECG cable and lead wires assembly A 6PIN 5 lead ECG cable and lead wires assembly IEC Mindray 6PIN 3 lead ECG cable and lead wires assembly AHA Mindray 6PIN 3 lead ECG cable and lead wires assembly IEC Mindray 6PIN 5 lead ECG cable and lead wires assembly Deffibrilation AHA Mindray 6PIN 5 lead ECG cable and lead wires assembly Deffibrilation IEC Mindray 6PIN 3 lead ECG cable and lead wires assembly Deffibrilation AHA Mindray
191. mits ST Max ST HI Min ST LO Step 2 0 mv 2 0 mv 0 1 Patient Monitor user s manual V 5 4 12 13 ECG RESP Monitoring m DEF POINT pick this item to access the DEF POINT window in which the position of ISO and ST point can be set up o ISO Base point Default is 78 ms Oo ST Measurement point DEF POINT 180 ST Back to the upper menu Figure 12 10 DEF POINT window The operator can adjust the position of both ISO and ST measurement points The reference point is the position where the peak of R wave locates see Figure 12 11 R Wave ST Value 78 ms 109 ms Figure 12 11 DEF Point The ST measurement for each beat complex is the vertical difference between the two measurement points AN Note AY the ST measurement point should be adjusted if the patient s HR or ECG morphology changes significantly o Adjusting ISO ST 12 14 Patient Monitor user s manual V 5 4 ECG RESP Monitoring These two points can be adjusted turning the knob When adjusting ST measurement point the system will show the ST Measurement Point Window The QRS complex template displays in the window lf the template is not established a horizontal line will display If the channel is not at ON position a horizontal line will also display It is adjustable of the highlight bar in the window You may select ISO or ST then switch the knob left or right to move the cursor line When the cursor is at the required positio
192. mmediately 16 3 Monitoring Procedure Preparation before IBP measurement 10 Plug the pressure cable into corresponding socket and check that the monitor is switched on 20 Any entrapped air should be removed from the pressure system pressure line and transducer by filling with normal saline 30 Connect the arterial catheter to the pressure line ensure any entrapped air removed AY Warning A If any entrapped air in pressure system re fill system with normal saline 16 2 Patient Monitor user s manual V 5 4 IBP Monitoring AT Position the transducer at the same level of the patient s heart approximately mid axillary line HI Ensure the correct label name has been selected Refer to the next section for details 6 Zero the transducer Refer to the next section for details _ A _ y Leg l iV NAN Normal Saline if o Ki Y ith Te if 7 Pressure F Transducer PA IP j f j L j L a PATIENT a HA d j wee r MOHITOR s A Stopeok Drip Distal End j QI i hamber To Patient H j D f 7 VW j A Aw A Se SQ d ff NU d LL Pressure Transducer Interface Cable J Sh ot km d D i FH Figure 16 1 IBP Monitoring 16 4 IBP Menu Rotate the knob to move the cursor onto IBP hot key in the parameter area press the knob to popup IBP 1 2 SELECT menu shown as below Pick the IBP SETUP to popup IBP 1 2 SETUP menu s
193. n you may select the base point or the measurement point A Note A Abnormal QRS complex is not considered in ST segment analysis ST Alarm Message Note The alarm limits for two ST measurements are identical No setting of alarm limits can be made only for one channel Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages during ST measurement Physiological alarms Message Cause Alarm Level ST1 TOO HIGH ST measuring value of channel 1 is above the upper alarm limit SSES STITOO LOW ST measuring value of channel 1 is ee r sel below the lower alarm limit User selectable ST2 TOO HIGH ST measuring value of channel 2 is above the upper alarm limit weer selecienle ST2 TOO LOW ST measuring value of channel 2 is SL r sel below the lower alarm limit User selectable Technical alarms Stop using ST alarming STALMLMTERR Functional safety failure HIGH Mon notify biomedical engineer or Mindray service staff Prompt messages include general alerts Cause Alarm Level ST measuring value of channel 1 exceeds the measurement range Message
194. n Artery Pressure mE LVD Left Ventricular Diameter m PA MAP Mean Pulmonary Artery Pressure E HT Height E WT Weight 17 5 Alarm Information and Prompt CO Alarm Message Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during co measurement Physiological alarms Message Cause Alarm Level TB TOO HIGH E value is above upper alarm E TB TOO LOW ere value is below lower alarm User selectable Technical alarms Alarm Message Cause bevel Remedy TB SENSOR TB measuring cable LOW Make sure that cable is properly OFF falls off the monitor connected COINITERR CO module failure HIGH Stop using measuring function of CO module notify biomedical engineer or CO INIT ERR1 Mindray service staff CO INIT ERR2 CO INIT ERR3 CO INIT ERR4 CO INIT ERR5 CO INIT ERR6 CO INIT ERR7 Patient Monitor user s manual V 5 4 17 9 CO Measuring CO INIT ERR8 CO module failure or Stop using measuring function of CO CO COMM e ee communication HIGH module notify biomedical engineer or STOP failure Mindray service staff CO module failure or Stop using measuring function
195. n all circumstance the monitor must be connected to a grounded AC power supply The monitor is referred to as an IEC 601 F device in the summary of situations table contained in IEC 601 1 1 A Warning A Dispose of the packaging material observing the applicable waste control regulations and keeping it out of children s reach A Warning A This equipment is accord with the standard CISPR11 EN55011 class A A Warning A Grounding Connect the monitor only to a three wire grounded hospital grade receptacle The three conductor plug must be inserted into a properly wired three wire receptacle if a three wire receptacle is not available a qualified electrician must install one in accordance with the governing electrical code Do not under any circumstances remove the grounding conductor from the power plug Do not use extension cords or adapters of any type The power cord and plug must be intact and undamaged 1 2 Patient Monitor user s manual V 5 4 Introduction If there is any doubt about the integrity of the protective earth conductor arrangement operate the monitor on internal battery power until the AC power supply protective conductor is fully functional A Note A The software was developed per IEC601 1 4 The possibility of hazards arising from errors in the software program is minimized A Caution A At the end of its service life the product described in this manual as well as its accessories must be
196. n processed real signals In Monitor or Sugery mode ECG waveforms may have distortion of different extent In either of the latter two modes the system can only show the basic ECG and the results of ST analysis may also be greatly affected In Surgery mode results of ARR analysis may be somewhat affected Therefore it is suggested that in the environment having relative small interference you d better monitor a patient in Diagnosis mode Leads of channel 2 refer to for detailed information O0 Waveform gain of channel 2 refer to for detailed information AN Note A Pacemaking signal detected is marked by a above the ECG waveform 12 5 ECG Menu ECG SETUP Menu Pick the ECG hot key on the screen and the following menu will popup Patient Monitor user s manual V 5 4 12 7 ECG RESP Monitoring ECG SETUP HR ALM ON v HR CHANNEL CH1 ALM LEV MED v LEAD TYPE 5 LEADS ALM REC OFF v SWEEP 25 0 Z ALM HI 120 Ka ST ANALYSIS gt gt ALM LU 50 gt ARR ANALYSIS gt gt HR FROM ECG z OTHER SETUP gt gt Access the sub menu in which more items can be set EXIT Figure 12 6 ECG SETUP menu ECG alarm setting e HR ALM pick ON to enable prompt message and data record during the ECG alarm pick OFF to disable the alarm function and there will be a 28 beside ECG e ALM LEV selectable from HIGH MED LOW Level HIGH represents the most serious case e ALM REC pick
197. n thumb and forefinger 16 7 6 Cleaning and sterilization A Warning A Do not autoclave A Warning A Do not use radiation sterilization A Warning A Do not use ultrasonic cleaning A Warning A Do not use chlorinated hydrocarbons A Warning A Do not use toluene A Warning A Do not use sodium hypochlorite solution A Note A The ICT B is supplied non sterile It must be cleaned and sterilised before each use Inspect for cuts or damage to silicone coating before immersing in any liquid Be careful not to get liquid on the connector pins or inside the connector via the luer fitting Wash the catheter with soap solution being careful not to poke the sensing area Do not use synthetic detergents or oil based soaps as this may result in a foreign body reaction Transducers may be cleaned gently with alcohol wipes Do not soak in alcohol Sterilisation is by means of cold aqueous solutions of detergicide e g Cidex formalin or by ethylene oxide gas AY Warning A Do not use the sterilizing cap during ETO gas sterilizing A Note A Immediately after removal of the catheter from the patient Checking for cuts in the silicone rubber Use a 1ml syringe to inject 0 5cc of air into the luer and immerse the catheter in water If small bubbles are seen from any part of the catheter or tip wipe dry and sterilize Return to Patient Monitor user s manual V 5 4 16 19 IBP Monitoring Manufactory for repair A Note A It i
198. nction notify biomedical EECH failure SE engineer or Mindray service staff m ARRRELEARN Pick this item to start a learning procedure m ARRALARM Pick this item to access the ARR ALARM dialog box to set arrhythmia alarm parameters Set ALM to ON OFF to enable disable the alarm function Set REC to ON OFF to enable disable alarm record function turn the knob under LEV column to set alarm level to HIGH MED or LOW ARR ALARM ALM LEV REC ASYSTOLE ON v HIGH OFF UFIBVVTAC ON HIGH OFF R ON T ON MED OFF ALL ALM ON UT gt 2 ON MED OFF COUPLET ON MED OFF ALL ALM OFF PUC ON MED OFF BIGEMINY ON MED OFF v ALL REC ON TRIGEMINY ON MED OFF TACHY ON MED OFF v ALL REC OFF BRADY ON MED OFF PNC o dio cere e PNP o ome oo P S MISSED BEATS ON MED OFF Open or close the ASYSTOLE alarm EXIT Figure 12 13 ARR ALARM Menu Patient Monitor user s manual V 5 4 12 17 ECG RESP Monitoring You can pick ALL ALM ON to enable alarm function of all arrhythmia types and pick ALL ALM OFF to disable this function Likewise you can pick ALL REC ON to enable recording function for all arrhythmia types and pick ALL REC OFF to disable this function Changing the ALM LEV can reset alarm level of all arrhythmia types to the same value m ARRRECALL Pick this item to review and edit the ARR analysis result The latest arrhythmia events up to 60 are displayed
199. ng The monitor prints out the selected waveforms under the FREEZE mode In this way you can snap the abnormal waveforms on the screen and record it Trend Graph Table Recording The monitor can print out the trend graph and table in the current TREND GRAPH or TREND TABLE window Arrhythmia Review Recording The monitor can print out the alarm Arrhythmia event in the current ARR RECALL window Alarm Review Recording The monitor can print out the alarm events include waves and parameters in the current ALARM RECALL window NIBP Review Recording The monitor can print out all the NIBP review events in NIBP RECALL window CO Measurement Curve Recording The monitor can print out CO Measurement curve in WINDOWS FOR CO MEASUREMENT Hemodynamic Calculation result recording The monitor can print out parameters and results in HEMOD WINDOWS Monitor Information The monitor can print out messages in the current STATUS window Titration Table The monitor can print out the messages in the current TITRATION window Notes on Recording H Recording texts Real time Report Periodic Report Para Alarm Report XXX name of the alarm parameter Arrhythmia Report XXX Arrhythmia type Freeze Wave Report Trend Graph Trend Table Para Alarm Review NIBP Test Review Patient Monitor user s manual V 5 4 7 3 Recording CO Test Curve HEMOCAL PARAMETERS Status Report Titration Table Alarm parameters alarm time and freeze time Patient
200. ns in the light absorbance signal are caused by oscillations in the arterial blood volume This assumes that the blood flow in the region of the sensor passes entirely through the capillary bed rather than through any arterio venous shunts The traditional pulse oximeter calculates the ratio of pulsatile absorbance AC to the mean absorbance DC at each of two wavelengths 660 nm and 940 nm Patient Monitor user s manual V 5 4 13 1 SpO2 Monitoring S 660 AC 660 DC 660 S 940 AC 940 DC 940 This traditional instrument then calculates the ratio of these two arterial pulse added absorbance signals R S 660 S 940 This value of R is used to find the saturation SpOz in a look up table built into the instrument s software The values in the look up table are based upon human blood studies against a laboratory co oximeter on healthy adult volunteers in induced hypoxia studies This MS 7 assumes that arterio venous shunting is highly variable and that fluctuating absorbance by venous blood is the major component of noise during the pulse The MS 7 decomposes S 660 and S 940 into an arterial signal plus a noise component and calculates the ratio of the arterial signals without the noise S 660 S1 N1 S 940 S2 N2 R 1 S2 Again R is the ratio of two arterial pulse added absorbance signals and its value is used to find the saturation SpOz in an empirically derived equation into the software The values in the emp
201. ns out jovi Insert a new roll of PAPER record paper RECORDER COMM Operating status error Reset the recorder ow ERR RECORDER PAPER Recording continuously for iow Re insert paper JAM more than 30m RECORDER The recorder is in iw Wait for the completion INITIALIZING initialization process of initialization TOO MANY REC Too many alarm events eer Send recording order TASKS take place simultaneously after a while RECORDER PAPER The paper is in wrong iw Insert the record paper W P position again In the status of printing out Wait for the completion RECORDER BUSY low of printing out Recorder stops working Gives recording order after the recorder REC NOT AVAILABLE Low restores to the normal status or the failure is removed The voltage of the Stop recording until the RECORDER NET recorder is too high Low recorder restores normal HIGH status The voltage of the Stop recording until the RECORDER VLT LOW recorder is too low Low recorder restores normal status RECORDER S COMM Unrecoverable serial port L Shut down the monitor SE OW E ERR communication error and re start it again RECORDER Possibly caused a the i Reset the recorder SELFTEST ERR RAM ROM CPU or ow WATCHDOG Error occurs during Shutdown and re start RECORDER INIT ERR initialization low RECORDER INIT Error occurs during etc Shutdown and re start ERR1 initialization RECORDER INIT Error occurs during b Shutdown and re start ERR2 initialization RECORDER INIT Error occu
202. nsor Sensitivity Impedance Resolution Accuracy Actualization interval 2 14 CO Method Measuring range 25 to 240 5BPM 1 1 2 0 50 C 0 1 C 0 1 C 0 50 C exclusive of probe errors about 1 Sec lt 10 Sec 2 ART PA CVP RAP LAP ICP P1 P2 0 300 mmHg 6 120 mmHg 10 40 mmHg 50 300 mmHg D uV V mmHg 300 3000 Ohm 1 mmHg 2 or 1mmHg use the greater about 1 Sec Thermodilution Technique Patient Monitor user s manual V 5 4 CO TB Tl Resolution CO TB TI Accuracy CO TB TI Calculation Alarm Range 2 15 CO2 Method Measuring mode Production Specification 0 1 20 L min 23 43 C 0 27 C 0 1 L min 0 1 C 5 or 0 1L min 0 1 C 0 1 C CO Hemodynamic Calculation 23 43 C Infra red Absorbation Technique Sidestream or Mainstream optional Side stream mode sampling gas flow rate Measuring range CO2 INS CO AwRR Resolution CO INS CO AwRR Accuracy CO AwRR Actualization interval Start up Time Mainstream Response Time Sidestream Rise Time Sidestream Delay Time Alarm range 100 150 200 ml min option 0 99 mmHg 0 99 mmHg 0 150 bpm 1 mmHg 1mmHg 1 bpm 2 mmHg 0 40 mmHg 41 76 mmHg 77 99 mmHg 5 of reading 10 of reading 2 bpm about 1 Sec lt 30 sec typical in sidestream mode lt 80 seconds in mainstream mode
203. nt Physiological alarms Message Cause Alarm Level IS1 TOO HIGH SYS measuring value of channel 1 is above hie User selectable upper alarm limit IS1 TOO LOW SYS measuring value of channel 1 is below Ge User selectable lower alarm limit ID1 TOO HIGH DIA measuring value of channel 1 is above ee User selectable upper alarm limit ID1 TOO LOW DIA measuring value of channel 1 is below SC r sel lower alarm limit User selectable Patient Monitor user s manual V 5 4 16 9 IBP Monitoring IM1 TOO HIGH MAP measuring value of channel 1 is above User selectable upper alarm limit IM1 TOO LOW MAP measuring value of channel 1 is below Userselectabie lower alarm limit IS2 TOO HIGH SYS measuring value of channel 2 is above ser sdlectable upper alarm limit IS2 TOO LOW SYS measuring value of channel 2 is below User selectable lower alarm limit ID2 TOO HIGH DIA measuring value of channel 2 is above Userselectabi upper alarm limit ID2 TOO LOW DIA measuring value of channel 2 is below User selectable lower alarm limit IM2 TOO HIGH MAP measuring value of channel 2 is above ser selectabie upper alarm limit IM2 TOO LOW MAP measuring value of channel 2 is below s rselectable lower alarm limit Technical alarms Message Cause E Remedy IBP cable of channel Make sure that cable is properly IBP1 SENSOR OFF 1 falls off from LOW connected monitor
204. ntly near able to zero it but not obtain zero mmHg actual ICP readings We read negative ICP but get good Not proper zeroing The ICT B cannot read negative pressure Rezero the monitor 16 22 Patient Monitor user s manual V 5 4 IBP Monitoring waveforms on the monitor transducer combination Make sure that you are not plugging the female luer during readings The waveform on the monitor makes large cyclical swings If you are using a respirator or some device that applies pressure even indirectly it may affect ICP The transducer is responding normally by showing this accurately Patient Monitor user s manual V 5 4 16 23 Chapter 17 CO Measuring 17 1 General mM The Cardiac Output CO measurement is performed by using thermodilution method m The PM 9000 Portable Patient Monitor can determine blood temperature measure cardiac output and perform hemodynamic calculations mM You can have iced injectate using either the flow through system or individual syringes of injectate mM You can perform up to six measurements before editing the average cardiac output C O and cardiac index C I E Prompt message on the screen will tell you when to inject 17 2 Monitoring Procedure 17 2 1 C O Measurement Procedure Plug the C O interface cable into the C O socket in the front panel 2 Attach the injectate probe connector and catheter thermistor
205. o get familiar with the equipment and make the best out of it Following symbols indicates some important facts that you have to pay special attention to A Warning A Points to be noted to avoid injury to the patient and the operator A Caution A Points to be noted to avoid damage to the equipment A Note A Points to be noted This manual is intended for persons who are trained in the use of this field and have adequate experience in operation of monitoring equipment Patient Monitor user s manual V 5 4 V Content Content Chapter 1 Introducton ccccsecesseeeeeseeeeeeeenseeeeneeeessaaeeeseeeeeseeeseaeseseaesaseaeenseeeseaesaseaeeeeaes 1 1 1 1 General Information 1 3 1 2 Sereen Display EE 1 5 433 Buton FUNCONS eisa e AEE E AAE ESSEE EEEE 1 8 ER Blue 1 10 125 Bun Battery EE 1 14 Chapter 2 Getting Started csecccsseceseeesseeeeseeeeeseeeseaeseeseeeenseeeseaeseseeeseseeeenseeessaeseseaneneees 2 1 2 1 Open the Package and Check 2 1 2 2 Connect the Power Cales 2 1 2 3 Power On the Monitor cece ee eee eae aaaeeeeeeeeeseeaaaaeeeeeeeeeseeenneeeeeeeeeeee 2 2 2 4 Connect Patient Gensors nest ttn rnnt tnnnnttn anatta nnntnn ananman nenn nnn 2 3 25 Check the R cordet eeir uere kieten EEEREN K AARAA AEn ESERE AE EAR SERRATE RAN Ed 2 3 Chapter 3 System Menu sss sssnsesnseunneunneunneunnnunnnnnnnnnnnnunnnunnnnnnnnnnnnnnnnnnnnnnn nnne nnnn annene nnana 3 1 3 1 Patient Information Getup 3 1 32 Defaut e EE 3 3
206. onnection of IBP2 correctly sensor IBP1 NEED ZERO CAL Zero calibrating must be done before measuring in IBP1 Do zero calibrating for IBP1 IBP2 NEED ZERO CAL Zero calibrating must be done before measuring in IBP2 Do zero calibrating for IBP2 TB SENSOR OFF TB sensor is not connected correctly Check the connection of TB sensor CO2 SENSOR OFF CO2 sensor is not connected correctly Check the connection of CO2 sensor Patient Monitor user s manual V 5 4 System Alarm Prompt ECG NOISE XX INIT ERR X Rather large interference signals appear in the ECG signals XX has initialization error X during XX COMM STOP XX cannot communicate with the host XX COMM ERR XX cannot communicate normally with the host Check the connection of ECG lead wire Check the current situation of the patient Check if the patient moves a lot Re start up the monitor or re plug in out the module If the error still exists contact the manufacturer XX represents all the paramete r modules in the system such as ECG NIBP SpO2 IBP CO module etc XX ALM LMT ERR The alarm limit of XX parameter is modified by chance Contact the manufacturer for repair XX RANGE EXCEEDED The measured value of XX parameter has exceeded the measuring range of the system Contact the manufacturer for repair XX represents the par
207. or not fully inserted into the connector Sensor inserted upside down May be an incorrect sensor or a defective sensor or cable Insert sensor into the connector Disconnect and reconnect sensor Refer to the instructions for the sensor being used Disconnect and reconnect he sensor with the logos matching SpO2 SENSOR SpO2 sensor may _ be disconnected from the patient Disconnect and reconnect the sensor Orr or the monitor Reattach sensor Stop using the measuring SpO2 SENSOR This message appears when function of SpO2 module FAULT the sensor is faulty notify biomedical engineer or our service staff SpO2 Make sure that the monitor UNRECOGNIZED aua e S and the patient are in correct SENSOR g b connection with the cables SpO2 This message is displayed Make sure that the monitor Patient Monitor user s manual V 5 4 3 System Alarm Prompt INCOMPATIBLE when the masimo sensor is use incompatible sensor SENSOR finding incompatible sensor SpO02 Outside signal or energy d INTERFERENCE preventing reading ee If values are not displayed within 30 seconds disconnect SpO2 PULSE Unit is searching for the and reconnect sensor If pulse SEARCH patients pulse search continues remove sensor and replace on a better perfused site SpO2 LOW Signal too small Move sensor to better PERFUSTION 9 perfused site Too much light on Remove or reduce lighting MUCH
208. otential Grounding Protection class 1 instruments are already included in the protective grounding protective earth system of the room by way of grounding contacts in the power plug For internal examinations on the heart or the brain the PM 9000 Portable Patient Monitor must have a separate connection to the equipotential grounding system One end of the equipotential grounding cable potential equalization conductor is connected to the equipotential grounding terminal on the instrument rear panel and the other end to one point of the equipotential grounding system The equipotential grounding system assumes the safety function of the protective grounding conductor if ever there is a break in the protective grounding system Examinations in or on the heart or brain should only be carried out in medically used rooms incorporating an equipotential grounding system Check each time before use that the instrument is in perfect working order The cable connecting the patient to the instrument must be free of electrolyte A Warning A If the protective grounding protective earth system is doubtful the monitor must be supplied by inner power only Condensation Make sure that during operation the instrument is free of condensation Condensation can form when equipment is moved from one building to another thus being exposed to moisture and differences in temperature A Warning A Possible explosion hazard if used in the presence of flammable
209. other than domestic and those directly connected to Emissions IEC the public low voltage power supply network that Voltage supplies buildings used for domestic purposes Fluctuations Flicker Class A Emissions IEC 61000 3 3 TABLE 2 Guidance and manufacturer s declaration electromagnetic immunity The monitor is intended for use in the electromagnetic environment specified below The customer or the user of the monitor should assure that it is used in such an environment Immunity test IEC 60601 Compliance level Electromagnetic Test level environment guidance Patient Monitor user s manual V 5 4 1 EMC 7 SEN 2KV 4KV Floors should be ace contac concrete or ceramic tile a ES ev contact floors are covered with ENEE EE x pte mata te clave D fe 7 6KV 8KV air 30 air WW Electrical fast Mains power quality should be Transient burst Se Gg power okV that of a typical commercial or IEC 61000 4 4 SUPP nes hospital environment Surge Seen PE 1kV Mains power quality should be EC E 2 kV that of a typical commercial or Seng hospital environment mode Voltage dips Short lt 5 Ur gt 95 dip in Ur for 0 5 cycle 40 Ur 60 dip lt 5 Ur gt 95 dip in Ur for 0 5 cycle Mains power quality should be that of a typical commercial or hospital environment If the interruptions and in Uy for 5 cycle 40 Ur 60 dip user of the monitor requir
210. pO2 numeric shows the percentage of hemoglobin molecules which have combined with oxygen molecules to form oxyh pleth emoglobin The SpO2 PLETH parameter can also provide a pulse rate signal and a ysmogram wave How the SpO2 PLETH Parameter Works A Puls Arterial oxygen saturation is measured by a method called pulse oximetry It is a continuous non invasive method based on the different absorption spectra of reduced hemoglobin and oxyhemoglobin It measures how much light sent from light sources on one side of the sensor is transmitted through patient tissue such as a finger or an ear to a receiver on the other side The sensor measurement wavelengths are nominally 660nm for the Red LED and 940nm for Infrared LED Maximum optical power output for LED is 4 mW The amount of light transmitted depends on many factors most of which are constant However one of these factors the blood flow in the arteries varies with time because it is pulsating By measuring the light absorption during a pulsation it is possible to derive the oxygen saturation of the arterial blood Detecting the pulsation gives a PLETH waveform and pulse rate signal The SpO value and the PLETH waveform can be displayed on the main screen SPO2 is a non invasive measurement of the functional oxygen saturation Warning A e oximetry can overestimate the GpO value in the presence of Hb CO Met Hb or dye dilution chemicals SpO2 Pulse Monitoring
211. perating in the Spectrum24 Network Amber indicates Spectrum24 Radio traffic detected Wired LAN Attached green In Use amber A green LED indicates a connection between the CB 1000 and the wiredEthernet Lights amber to indicate activity is detected on the wired Ethernet Serial Activity Transmit LP green Receive amber A green LED indicates the CB 1000 is receiving data through the serial port and displays amber when the CB 1000 is transmitting data through theserial port AN Note A Monitor must be connected with specific network equipment such as Harb during using net function A Warning A Through network interface only MINDRAY Clinical Information Center can be connected in Patient Monitor user s manual V 5 4 1 13 Introduction A Warning A Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC standards e g IEC 60950 for data processing equipment and IEC 60601 1 for medical equipment Furthermore all configurations shall comply with the valid version of the system standard IEC 60601 1 1 Everybody who connects additional equipment to the signal input part or signal output part configures a medical system and is therefore responsible that the system complies with the requirements of the valid version of the system standard IEC 60601 1 1 If in doubt consult the technical service department or your local re
212. perly LOOSE CUFF wrapped or no cuff LOW Properly wrap the cuff exists Cuff hose or Check and replace the leaking parts AIR LEAK connector is LOW if required notify biomedical damaged engineer or Mindray service staff Stable pressure value Check if the hoses are tangled if AR oE is not available e g LOW failure persists notify biomedical hoses are tangled engineer or Mindray service staff Cuff is too loose or WEAK SIGNAL patient pulse is too LOW Use other method to measure blood Weak pressure Reset NIBP module if failure RANGE Measuring range persists stop using measuring EXCEEDED exceeds the specified HIGH function of NIBP module notify upper limit biomedical engineer or Mindray service staff Affected by arm EXCESSIVE motion signal noise is LOW Make sure that the patient under MOTION too large or pulse rate monitoring is motionless is not regular Pressure has Measure again if failure persists exceeded the stop using measuring function of OVER PRESSURE specified upper safety HIGH NIBP module and notify biomedical limit engineer or Mindray service staff SIGNAL STURATED Excessive motion LOW Stop the patient from moving Durin he matie Check and replace the leaking parts PNEUMATIC LEAK g P LOW if required notify biomedical test leak is detected f i engineer or Mindray service staff Operation of blood Stop using measuring function of a e pressure pump HIGH NIBP module notify biomedical system is failed eng
213. ppened our service staff Prompt message include general alerts Message Cause Alarm Level SpO2 EXCEED SpO2 measuring value exceeds the range HIGH PR EXCEED PR measuring value exceeds the range HIGH SEARCH PULSE SpO2 module is searching for pulse No alarm SpO2 module cannot detect SpO2 signal for a NO PULSE long time HIGH 13 1 5 Masimo Information The MASIMO SET Product Ihas El Masimo Patents This device is covered under one or more the following U S Patents 5 482 036 5 490 505 5 632 272 5 685 299 5 758 644 5 769 785 6 002 952 6 036 642 6 067 462 6 206 830 6 157 850 and international equivalents U S A and international patents pending No Implied License Possession or purchase of this device does not convey any express or implied license to use the device with replacement parts which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device Patient Monitor user s manual V 5 4 13 13 SpO2 Monitoring 13 2 PART 2 MINDRAY SpO2 board configuration 13 2 1 What is SpO2 Monitoring SpO2 Plethysmogram measurement is employed to determine the oxygen saturation of hemoglobin in the arterial blood If for example 97 hemoglobin molecules in the red blood cells of the arterial blood combine with oxygen then the blood has a SpOz oxygen saturation of 97 The SpOz numeric on the monitor will read 97 The S
214. presentative 1 5 Built in Battery PM 9000 Portable Patient Monitor is equipped with a rechargeable battery Figure 1 7 The battery in the Monitor can automatically recharge when connected to AC INPUT until it is full A symbol cam is displayed on the lower left quarter of the screen to indicate the status of recharging in which the CYAN part represents the relative electric energy of the battery This symbol will be covered when some information appears And if the battery is not installed in PM 9000 battery state will be displayed as aa under a cross to indicate that no battery is available There are two battery slots inside PM 9000 each can hold a battery and one battery can support PM 9000 working Battery can be installed into and pulled off from battery slot Under connectors to patient cables there are battery slots with cover See Figure 1 7 Battery Slot Cover A Warning A Don t pull off battery when the monitor is working When operating on battery the monitor will prompt alarm and shut off automatically when the energy is low When the electric energy is going out the monitor will sound continuous level 1 alarm beeping and display BATTERY LOW in the Message Area Connect the monitor to AC power at this moment can recharge the battery while operating If keep operating on the battery the monitor will shut off automatically more than 5 minutes since alarming upon exhaustion of the batter
215. probe Socket for channel 2 TEMP probe Socket for channel 1 IBP transducer Socket for channel 2 IBP transducer Socket for ECG cable Socket for Cardiac Output Socket for NIBP cuff Socket for Spo2 Sensor Patient Monitor user s manual V 5 4 Introduction Ee EI cE EI Figure 1 5 Left Side AN This symbol means BE CAREFUL Refer to the manual KA Indicates that the instrument is IEC 60601 1 Type CF equipment The unit displaying this symbol contains an F Type isolated floating patient applied part providing a high degree of protection against shock and is suitable for use during defibrillation Figure 1 6 Rear Panel RW Power Supply 100 250 VAC 50 60 Hz Socket J m VGA MONITOR Socket Monitor interface for external standard VGA color monitor Patient Monitor user s manual V 5 4 1 11 Introduction Appliance 1 Install the VGA monitor in the same room with the patient but keep away from the patient for more than 1 5m The monitor is intended to be used as an assistant monitoring device 2 Plug and insert the connection cable while the VGA monitor is in power off status 3 Power on at the same time or power on the PM 9000 patient monitor after VGA 4 Adjust brightness and contrast properly C C Socket Equipotential grounding terminal for connection with the hospital s grounding system m AUX OUTPUT socket This port is used for both Analog Output and NURSE CALL
216. r area indicating that the system has started performing pneumatic test 5 The system will automatically Inflate the pneumatic system to about 180mmHg 6 After 20 seconds or so the system will automatically open the deflating valve which marks the completion of a pneumatic measurement 7 no prompt appears on the bottom of the NIBP parameter area it indicates that the airway is in good situation and no air leaks exist However if the prompt PNEUMATIC LEAK appears in the place it indicates that the airway may have air leaks In this case the user should check for loose connection After confirming secure connections the user should re perform the pneumatic test If the failure prompt still appears please contact the manufacturer for repair monitor cylinder Cuff Figure 14 4 Diagram of NIBP air leakage test 14 4 NIBP Alarm Message Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during NIBP measurement Physiological alarms Message Cause Alarm Level NS TOO HIGH NIBP SYS measuring value User selectable is above upper alarm limit NIBP SYS measuring value NS
217. rate of the AG module is lt 20ml min which exceeds 1 second AG module communication failure has AG HARDWARE ERROR AG module has hardware failure AG DATA LIMIT ERROR AG module failure AG USA ERROR AG module failure AG ZREF FAIL AG module fails to zero AG CAL FAIL AG module fails to calibrate FiCO2 ALM LMT ERR Functional safety failure EtCO2 ALM LMT ERR Functional safety failure FiO2 ALM LMT ERR Functional safety failure EtO2 ALM LMT ERR Functional safety failure FiN20 ALM LMT ERR Functional safety failure EtN2O ALM LMT ERR Functional safety failure FiAA ALM LMT ERR Functional safety failure EtAA ALM LMT ERR Functional safety failure AwRR ALM LMT ERR Functional safety failure Maintenance and Cleaning of the Anesthetic Gas Measurement in this operation manual Check the connection of each part and the patient situation Measure again if the failure still exists contact the manufacturer for repair Patient Monitor user s manual V 5 4 9 P N 9200 20 10499
218. recorder becomes cool use the recorder for output again If the failure still exists contact the manufacturer for repair REC HEAD IN WRONG The handle for pressing the Press down the recorder POSITION paper is not pressed down handle for pressing the paper RECORDER OUT OF PAPER No paper is in the recorder Place the paper into the recorder RECORDER PAPER The paper in the recorder is Place the recorder correctly JAM jammed and try again RECORDER COMM In the recorder setup menu ERR execute the function of clearing record task The The communication of the function can make the host recorder is abnormal and the recorder connect RECORDER S COMM ERR again If the failure still exists contact the manufacturer for repair RECORDER W P PAPER The paper roll of the recorder is not placed in the correction position Place the paper roll in the correct position REC NOT AVAILABLE Cannot communicate with the recorder In the recorder setup menu execute the function of clearing record task The function can make the host and the recorder connect again If the failure still exists contact the manufacturer for Patient Monitor user s manual V 5 4 7 System Alarm Prompt repair NIBP INIT ERR NIBP SELFTEST ERR NIBP initialization error Execute the reset program in the NIBP menu If the failure st
219. rence manometer with an error less than 0 8 mmHg and a ball pump by means of a T piece connector and hoses to the pneumatic system Set the monitor in CALIBRATE mode Inflate the pneumatic system to 0 50 and 200 mmHg by ball pump separately The difference between the indicated pressure of the reference manometer and the indicated pressure of the monitor will not exceed 3 mmHg Otherwise please contact our customer service monitor Reference Manometer Ball Pump Metal Vessel Figure 14 3 Diagram of NIBP calibration m PNEUMATIC This item is used for air leakage test Turn the knob to pick the item to start the air leakage test Then the item will change into STOP PENUM which if picked the system will stop air leakage test A warning A This pneumatic test other than being specified in the EN 1060 1 standard is to be used by the user to simply determine whether there are air leaks in the NIBP airway If at the end of the test the system gives the prompt that the NIBP airway has air leaks please contact the manufacturer for repair Procedure of the air leakage test 1 Connect the cuff securely with the socket for NIBP air hole 2 Wrap the cuff around the cylinder of an appropriate size Patient Monitor user s manual V 5 4 14 7 NIBP Monitoring 3 Access the NIBP SETUP menu 4 Turn the knob to the PNEUMATIC item and press the knob Then the prompt Pneum testing will appear on the bottom of the NIBP paramete
220. rent compensate operations as per the selection of the user The selections are GENERAL O2 N2O DES and ALL Work conditions for calculating compensate are shown in following table Here is the operation method First select the gas compensates to be used including general compensate O2 compensate Desf compensate and full compensates Then determine whether to make VA compensate and BTPS compensate Work Conditions for CO Calculation Compensate Calculation O2 Modification N20 Desflurane Work Conditions Compensate Method Modification General OFF OFF O2 lt 60 no N20 02 ON OFF O2 gt 50 no N20 Desflurance OFF ON O2 lt 60 amp N20 Desflurane 12 Full ON ON O2 gt 60 amp N20 H WATERVAPOR determine whether to make watervapor compensate Water vapor compensation accounts for the effect of water vapor on the CO2 IR Infra Red absorption characteristics It is used in both mainstream and sidestream measurement modes The user may disable this compensation under certain situations During normal sidestream operation CO2 measurements are adjusted mathematically to compensation for this effect The host may choose to disable this compensation when performing dry gas meaasurements in which the gas does not contain water vapor Dry gas procedures may include steady state measurements and calibration procedures Steady state measurements are performed only when background CO2 or CO2 present in the immediate environment is measur
221. rically at ST1 and ST2 in the Parameter Area The trend can be viewed with table or graphic form Measurement unit of ST segment mv Measurement symbol of ST segment elevating depressing Measurement range of ST segment 2 0 mv 2 0 mv Pick the ST ANALYSIS item in the ECG SETUP menu to access the ST ANALYSIS sub menu as shown below ST ANALYSIS menu ST ANAL OFF M ALM HI 0 20 ST ALM OFF ALM LO 0 20 gt ALM LEY MED DEF POINT gt gt ALM REC OFF Perform the ST analysis only when switch is On EXIT Figure 12 9 ST ANALYSIS menu ST analysis alarm setting ST ANAL the switch for ST analysis Set it to ON to activate the ST analysis or OFF to disable the ST analysis ST ALM pick ON to enable prompt message and data record during the ST analysis alarm pick OFF to disable the alarm function and there will be a 4 amp beside ST ST alarm is activated when the result exceeds set ST HI value or falls below ST LO value ALM LEV used to set up the ST alarm level There are three selections HIGH MED and LOW ALM REC pick ON to enable report printing upon ST analysis alarm ALM HI used to set up the upper limit of ST alarm The max higher limit is 2 0 The minimum higher limit is 0 2 larger than the set lower limit ALM LOW used to set up the lower limit of ST alarm The minimum lower limit is 2 0 The max lower limit is 0 2 lower than the set higher limit ST analysis alarm li
222. rm limit m FiAA ALM LO used to adjust the lower alarm limit of FiAA When the measured value is smaller than FiAA lower alarm limit the FiAA LOW message is displayed on the screen In the UNLATCH mode this message disappears when the measured value is above the lower alarm limit H APNEAALM used to set up the apnea alarm time AN Note A Never turn off APNEA alarm When various alarms happen together the screen only displays the alarm message of the highest alarm level 19 3 3 ADJUST WAVE AMP menu In the AG SETUP menu select the ADJUST WAVE AMP gt gt item to pop up the ADJUST WAVE AMP menu as shown in the figure below ADJUST WAVE AMP COZ WAVE AMP 2 N20 WAVE AMP 2 02 WAVE AMP 2 AA WAVE AMP 2 Back to the upper menu ESES Figure 19 6 ADJUST WAVE AMP menu CO2 WAVE AMP used to adjust the display amplitude of CO waveform N20 WAVE AMP used to adjust the display amplitude of N O waveform O2 WAVE AMP used to adjust the display amplitude of O2 waveform AA WAVE AMP used to adjust the display amplitude of anesthetic waveform H EXIT used to exit this menu 19 3 4 DEFAULT menu In the AG SETUP menu select the DEFAULT item to pop up the AG DEFAULT CONFIG menu as shown in the figure below 19 8 Patient Monitor user s manual V 5 4 Anesthetic Gas Measurement AG DEFAULT CONFIG FACTORY DEFAULT CONFIG USER DEFAULT CONFIG Back to the upper menu
223. rom a 1ml syringe the pressure in these tubes will be greater than the ICP being measured The exact amount of air is not critical subject to the permitted maximum When this air is injected the pressure will cause the balloon to be lifted from the surface of the sensor and the same pressure will be applied to the back of the sensor The strain gauge senses equal pressure above and below which is equivalent to having zero pressure applied Thus by injecting a small volume of air one undeflects the pressure sensor and checks the zero of the transducer and amplifier 16 7 2 Cautions A Note A Gaeltec catheter tip pressure transducers are designed for use by trained physicians practicing a specialized branch of medicine Use of the transducers should be restricted to those trained to perform the procedures A Note A All pressure transducers must be used with patient monitors which meet the current safety standards for the country in which they are used and which are intended for use with strain gauge pressure transducers The PATIENT MONITOR must provide electrical isolation between the transducer and any mains powered equipment to which the monitor is connected Patient Monitor user s manual V 5 4 16 13 IBP Monitoring A Warning A Disconnect the catheter from the monitor before defibrillation or electrosurgery A Warning A Do not plug the female luer on the proximal end of the catheter during ethylene oxide sterilization or dama
224. roper Radical pulse oximeter performance AN CautionA Carefully route patient cables to reduce the possibility of patient entanglement or strangulation AN Caution Do not soak or immerse patient cables in any liquid solution Do not sterilize patient cables by irradiation steam or ethylene oxide see the cleaning instructions in the directions for use for reusable Masimo patient cables m Maintenance A Warning A Before cleaning the monitor or the sensor make sure that the equipment is switched off and disconnected from the power line For cleaning 13 10 Patient Monitor user s manual V 5 4 SpO Monitoring m Use a cotton ball or a soft mull moistened with hospital grade ethanol to wipe the surface of the sensor and then dry it with a cloth This cleaning method can also be applied to the luminotron and receiving unit m The cable can be cleaned with 3 hydrogen dioxide 70 isopropanol or other active reagent However connector of the sensor shall not be subjected to such solution 13 1 4 Alarm Description and Prompt SpO2 Alarm Message Among physiological alarms those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On TABLES BELOW DESCRIBE THE POSSIBLE PHYSIOLOGICAL ALARMS TECHNICAL ALARMS AND PROMPT MESSAG
225. roximal female luer open to atmosphere Someone new on the staff began injecting water into the luer but we caught it just as a little went into the ICT B Is the device ruined Probably not repair Return to Manufactory for Why will the ICT B be damaged if we ETO sterilize it with the luer plugged When you plug the luer you are sealing the internal lumens at normal atmospheric pressure Part of the ETO cycle is a partial Patient Monitor user s manual V 5 4 16 21 IBP Monitoring vacuum Thus the trapped air at atmospheric pressure will expand and rupture the balloon 16 7 8 TROUBLE SHOOTING baseline reappears with the waveform showing TROUBLE CAUSE REMEDY You inject air to The catheter or tip is cut and Readings cannot be trusted check the zero and cannot hold zero long enough Remove the ICT B and use a cal but the spare The waveforms will be accurate if that is all you need The indicates damaged gauge or over range and if you inject air or not you cannot see the waveform monitor Everything was alright for several hours and then the damaged gauge Either the tip is wedged or the tip sensor was overpressured against the dura during insertion Therefore the monitor is seeing a transducer that has a very high initial zero and finds this zero out of its range Although overpressured or wedged the sensor zero mu
226. rs during ioi Shutdown and re start ERR3 initialization RECORDER INIT Error occurs during low Shutdown and re start ERR4 initialization RECORDER INIT Error occurs during aw Shutdown and re start ERR7 initialization RECORDER INIT Error occurs during ian Shutdown and re start ERR8 initialization If after shutdown and re start error still exists contact out service engineers Patient Monitor user s manual V 5 4 7 7 Chapter 8 Trend and Event PM 9000 provides 72 hour trend data of all parameters storage of 400 NIBP measurement results and 60 alarm events This chapter gives detailed instruction for review of all data 8 1 Trend Graph WH The latest 1 hour trend is displayed every 1 or 5 seconds The latest 72 hour trend is displayed every 1 5 or 10 minutes Pick TREND GRAPH in the SYSTEM MENU to call up the following menu TREND GRAPH BPM 2661 12 61 15 48 11 166 r 80 60 40 20 Ae 111 15 44 Wei 15 46 11 15 48 11 o a PARA SELECT HR RESOLUTION 18 D L RIGHT 200M CURSOR REC Select the name of the parameter whose trend is to be selected EXIT Figure 8 1 TREND GRAPH Menu The uppermost part is the name of the parameter in which y axis stands for value and x axis time W Indicates the value of the parameter which it points to is below the x axis with corresponding time displayed beyond the trend graph Other trends except NIBP trend are displayed as continuous curves In NIBP trend grap
227. s Check the connection of each part or replace with a new cuff If the failure still exists contact the manufacturer for repair Problem happens when Check the connection of each measuring the curve The part and the patient situation MEASURE FAIL system cannot perform Measure again if the failure measurement analysis or still exists contact the calculation manufacturer for repair Problem happens when Check the connection of each measuring the curve The part and the patient situation NIBP SYSTEM FAILURE system cannot perform Measure again if the failure measurement analysis or still exists contact the calculation manufacturer for repair AG NO WATERTRAP The AG watertrap falls off from the monitor Check the connection of AG watertrap sensor CHANGE AG WATERTRAP Replace the AG watertrap AG WATERTRAP_ TYPE WRONG The type of the AG watertrap being used is not suitable Check if the watertrap type is correct Check the connection of each part or replace with a new watertrap If the failure still exists contact the manufacturer for repair AG INIT FAIL AG module has failure Check the connection of each part and the patient situation AG module failure or Measure again if the failure GE COMNISTOF communication failure still exists contact the manufacturer for repair Refer to the chapter of AG OCCLUSION AG COMM ERROR The actual PUMP
228. s Pick REC to print out all measurement data of NIBP RECALL 8 4 Alarm Event Recall PM 9000 can display the latest 60 alarm events m Select ALARM RECALL in the SYSTEM MENU to access ALARM RECALL CONDITION menu as shown below ALARM RECALL CONDITION ALARM RECALL TIME START 2001 gd 12 1 15 4 4 END CURRENT TIME SELF DEF INE ALARM RECALL EVENT ALL id ALARM RECALL gt gt Select the beginning time of the alarm concerned EXIT Figure 8 4 ALARM RECALL CONDITION Menu In this menu the user may select the conditions for alarm review including 1 Start and End time of review The user may select the start time of review in the item of START Then the user may select the end time of review Two selections are available current time and the user defined time For user defined end time the user can use the knob to select 2 ALARM RECALL EVENT In the pull down list of ALARM RECALL EVENT the user can select the parameter whose alarm events he wants to review The selections include ALL alarm events of all parameters ECG REST SPO2 NIBP IBP TEMP CO2 CO HR_H gt 180 the value of HR is higher than the upper alarm limit HR_L lt 60 the value of HR is below the lower alarm limit SPO2 lt 90 IBP_H gt 200mmHg IBP_L lt 40mmHg RR_H gt 40 RR_L lt 10 TEMP_H gt 40 C TEMP_L lt 34 C After setting up all the review conditions press the ALARM RECALL button to access ALARM RECALL window HR ALARM
229. s disinfectant A Warning A Do not autoclave the cable or heat it above 75 C 167 F The cable should be stored in an environmental temperature between 20 C to 75 C 68 F to 167 F It should be hung up or laid flat to prevent damage to the cable 17 10 Patient Monitor user s manual V 5 4 Chapter 18 CO2 Measuring 18 1 General This chapter offers some relevant data concerning CO2 monitoring PM 9000 provides two kinds of CO2 measuring methods as per the requirements of users which are MainStream and SideStream This module can be applied in operation room monitor units etc it can measure the CO2 partial pressure or concentration of patient Air Way obtain EtCO2 Inspired Maximum CO2 InsCO2 Air Way Respiration Rate AwRR and display CO2 concentration waveforms The parameter symbols displayed on the screen are defined as following CO2 EtCO INS InsCOz AWRR Air Way Respiration AwRR Resp times MIN A Note A Don t use the device in the environment with flammable anesthetic gas The device can only be operated by personnel having taken professional training and familiar with this manual A Warning A CO2 module shall be avoided from crash and vibration 18 2 Monitoring Procedure Principle of CO2 measurement is primarily based on the fact that CO2 molecule can absorb 4 3um infrared ray Absorption intensity is proportional to CO2 concentration of patient samp
230. s See Chapter Accessories and Ordering Information for detail information of the ECG accessories The cable that connects to the monitor The lead set that connects to the patient m Using a 5 lead set the ECG can derive up to two waveforms from two different leads For requested lead you may choose from the left side of ECG waveform m The monitor displays the Heart Rate HR ST segment and Arrhythmia analysis WH Allof the parameters above can be set as alarm parameters A Note A In the default settings of PM 9000 the ECG waveforms are the first two waveforms from top in the Waveform Area 12 2 Precautions during ECG Monitoring AY Warning A Do not touch the patient table nearby or the equipment during defibrillation A Warning A Use only the original PM 9000 ECG cable for monitoring A Warning A When connecting the cables and electrodes make sure no conductive part is in contact with the ground Verify that all ECG electrodes including neutral electrodes are securely attached to the patient Patient Monitor user s manual V 5 4 12 1 ECG RESP Monitoring AY Warning A When apply the ECG cable with no resistances to Mindray patient monitor or other patient monitors which themselves with no current limit resistance it can t be applied to defibrillation A Note A Interference from a non grounded instrument near the patient and ESU interference can cause inaccuracy of the waveform 12 3 Monitoring
231. s net card Viewbed function is disabled Patient Monitor user s manual V 5 4 Chapter 5 Alarm This chapter gives general information about the alarm and corresponding remedies Alarm setup and prompt messages are provided in respective parameter setup sections A Warning A When PM 9000 is powered on the system may verify the audio and visual alarm function Upon turning on the monitor a Dang will be heard and at the same time the indicator will flash twice in yellow and red This is used to verify the audio and visual alarm function of the system Therefore the user should be carefully observe the status If the audio and visual alarm function is not normal it indicates that the monitor cannot be used to monitor a patient Please contact Mindray Company or service center 5 1 Alarm Modes 5 1 1 Alarm Level Each alarm either technical or physiological has its own level For alarm of higher level when it occurs the system will give prompt in a more alert way Some alarm s level can be set by the user via software Others can not by changed once defined by the system Alarms in PM 9000 are divided into three levels that is high medium and low High level alarm indicates the patient s life is in danger or the monitor under using has serious problem in technical respect It is the most serious alarm Medium level alarm means serious warning Low level alarm is a general warning Alarms are classified into three
232. s recommended that each institution establish the efficacy of its sterilization procedure by a method which includes the sterilization of an intentionally contaminated product A Note A There are only two chemical sterilization techniques recognized by the U S Department of Agriculture as effective and truly sporicidal gas sterilization by ethylene oxide and liquid sterilization by a glutaraldehyde e Ethylene oxide ETO Procedure Unplug the female luer on the proximal connector before the ETO sterilization cycle Failure to do this will result in damage to the ICT B and render it unusable The luer must be open to allow free passage of ETO gas both internally and externally E Package the ICT B in a coil in disposable ETO packaging Include an approved sterilization indicator E Sterilize Normal Cycle in an accepted commercially available hospital sterilizer Follow the manufacturer s instructions for the sterilizer Use the following as a guide only In an actual hospital sterilization facility the following parameters were found to provide acceptable sterilization via ETO Sterilizer make and model AMSCO Eagle 2000 Prevacuum 15 minutes 24 inches Hg Relative humidity 40 Temperature 140 F ETO mix 12 88 Gas pressure 8 psi Exposure time 1 hour 45 minutes Post Vacuum 15 minutes 24 inches Hg Aeration Cycle 12 hours Calculated ETO Concentration 600 mg l e Liquid Sterilization Procedure Prevent l
233. splays 2000 1 1 the system gives this Re set up the system time It is better to set up the time just after the start up and prior to REAL CLOCK RO reminding the Wachahat monitoring the patient After NEEDSET aes Dees modifying the time the user the current system time is not had better re start up the right monitor to avoid storing error time S The system has no cell battery REAL CLOCK NOT Install or replace the EXIST ofthe Batlety Nas TN Ouro rechargeable battery the capacity SYSTEM WD FAILURE SYSTEM SOFTWARE ERR SYSTEM CMOS FULL SYSTEM CMOS ERR SYSTEM EPGA FAILURE SYSTEM FAILURE2 SYSTEM FAILURE3 SYSTEM FAILURE4 SYSTEM FAILURES SYSTEM FAILURE6 SYSTEM FAILURE SYSTEM FAILURE8 SYSTEM FAILURE9 SYSTEM FAILURE10 SYSTEM FAILURE11 SYSTEM FAILURE12 The system has serious error Re start up the system If the failure still exists contact the manufacturer KEYBOARD NOT AVAILABLE KEYBOARD COMM ERR KEBOARD ERROR KEYBOARD ERR1 KEYBOARD ERR2 The keys on the keyboard cannot be used The keyboard has which cannot be used failure Check the keys to see whether it is pressed manually or by other object If the key is not pressed abnormally contact the manufacturer for repair Contact the manufacturer for repair NET INIT ERR G
234. ssive illumination such as surgical lamps especially ones with a xenon light source bilirubin lamps fluorescent lights infrared heating lamps or direct sunlight exposure to excessive illumination can be corrected by covering the sensor with a dark or opaque material excessive patient movement venous pulsations placement of a sensor on an extremity with a blood pressure cuff arterial catheter or intravascular line the monitor can be used during defibrillation but the readings may be inaccurate for a short time Loss of pulse signal can occur in any of the following situation the sensor is too tight there is excessive illumination from light sources such as a surgical lamp a bilirubin lamp or sunlight a blood pressure cuff is inflated on the same extremity as the one with a SpO2 sensor attached the patient has hypotension severe vasoconstriction severe anemia or hypothermia there is arterial occlusion proximal to the sensor the patient is in cardiac arrest or is in shock SpO gt 2 plethysmogram measurement MASIMO SET ONLY 1 Switch on the monitor 2 Attach the sensor to the appropriate site of the patient finger 3 Plug the connector of the sensor extension cable into the SpO socket on the PM 9000 Figure 13 1 mounting of the sensor SpO2 SETUP Menu Pick the SpO2 hot key on the screen to call up the SoO2 SETUP menu as shown below Patient Monitor user s manual V 5 4 SpO2 Monitoring MAS
235. st have been just within the range of the monitor As conditions If the tip is wedged pull back a few millimeters to free it This will allow the monitor to be zeroed If this does not help the transducer has been strained and must come out and be returned for repair Sometimes raising the scale on the monitor will allow it to manage a transducer with a high zero offset Try raising the pressure scale to 90 120 or 300mmHg and then setting zero If this works the only thing that you will sacrifice is the waveform resolution Return the catheter for repair when the measurement is finished Try raising the pressure scale to 90 120 or 300mmHg and then setting zero If indeed placed properly the brain may have moved away from the skull substantially enough so that there is poor contact between the skull transducer and the dura This may happen soon after the transducer is placed but may correct itself in a short time or over range changed the total pressure light came on zero amount ICP pushed the monitor beyond its capabilities The transducer The sensor face must be flat It is important that the transducer can be zeroed and planar against the dura If its face be placed against an intact we have good facing the inner table of the section of dura pressure waves skull for example then you will If required use a contralateral burr but the ICP reads get pressure waves and be hole consta
236. st its system time accordingly Besides the Central Station will keep on sending its current time 3 6 Patient Monitor user s manual V 5 4 System Menu to the monitor once per hour to maintain consistent time between them However the monitor will not adjust its time if it is different from the Central Station only in second Please note that if you are setting up the system time when link is just established successfully the monitor will immediately close the setup menu of system time The setup button of system time in the system setup menu is disabled when the monitor is linked to the Central Station That means you cannot open the setup menu of system time If the Central Station has no this function you can skip over this paragraph 3 4 4 Analog The monitor can output an analog waveform whose time delay is less than 30ms The output terminal is on the rear panel Select ANALOG item in SYSTEM SETUP menu to call up the ANALOG menu The first item is for setting up On Off of the switch of the analog output The second item is for selecting the waveform name to be output Select EXIT item to return to the previous menu ANALOG OUT ANALOG WAVE ECG1 v Open close analog output On outputing analog wave EXIT Figure 3 10 ANALOG AN Note A In the USER MAINTAIN menu If the AUX OUTPUT item being selected with NURSE CALL the AUX OUTPUT port will be used to realize NURSE CALL function while ANALOG OUT
237. such as reorienting or relocating the monitor Over the frequency range 150kHz to 80 MHz field strengths should be less than 3V m TABLE 4 Recommended separation distances between portable and mobile RF communications equipment and the monitor The monitor is intended for user in an electromagnetic environment in which radiated RF disturbance are controlled The customer or the user of the monitor can help prevent electromagnetic interference by maintain a minimum distance between portable and mobile RF communication equipment transmitters and the monitor as recommended below according to the maximum output power of the communication equipment Rated maximum output Separation distance according to frequency of transmitter power of transmitter m Ww 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 d 1 2x P d 1 2x P GHz d 2 3x VP 0 01 0 12 0 12 0 23 0 1 0 38 0 38 0 73 1 1 2 1 2 2 3 10 3 8 3 8 7 3 100 12 12 23 For transmitters rated at a maximum output power not listed above the recommended separation distanced d in meters m can be estimated 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 guidelines may not apply in all situations
238. surement is necessary for every two years or as frequently as dictated by your Hospital Procedures Policy When you need calibrate the temperature measurement contact the manufacture please AN Note A The self test of the temperature measurement is performed automatically once per hour during the monitoring The test procedure lasts about 2 seconds and does not affect the normal measurement of the temperature monitoring Patient Monitor user s manual V 5 4 15 1 TEMP Monitoring 15 2 TEMP SETUP Menu Pick the TEMP hot key on the screen to call up the TEMP SETUP menu shown as below TEMP SETUP ALM ON LZ ALM HI 39 0 ALM LEU MED T2 ALM LO 36 0 ALM REC OFF TDALM HI 2 0 Ti ALM HI 39 0 Ss TEMP UNIT z Ti ALM LO 36 0 DEFAULT gt gt EXIT Figure 15 1 TEMP SETUP Menu TEMP alarm setting m ALM pick ON to enable prompt message and data record during the TEMP alarm pick OFF to disable the alarm function and prompt the 2 symbol beside TEMP numeric m ALM LEV used to set up the alarm level selectable from HIGH MED or LOW m ALM REC used to start stop recording TEMP alarms Pick ON to enable report printing upon TEMP alarm m Alarm for T1 T2 and TD occurs when the measured temperature exceeds set alarm high limit or falls below alarm low limit T1 is Channel 1 temperature T2 is Channel 2 temperature TD is the temperature difference between the above two TEMP alarm limits Max TEMP HI Min
239. tal probes should be used if possible in conjunction with a protective rubber cover 5 To clean the probe hold the tip with one hand and with the other hand rubbing the probe down in the direction of the connector using a moist lint free cloth A Note A Disposable TEMP probe must not be re sterilized or reused A Note A For protecting environment the disposable TEMP probe must be recycled or disposed of properly 15 4 Patient Monitor user s manual V 5 4 Chapter 16 IBP Monitoring 16 1 Introduction This chapter introduces IBP measurement maintenance and cleaning of relevant accessories The Monitor measures direct blood pressure SYS DIA and MAP of one selected blood vessel through two channels and displays two BP waveforms measures direct blood pressure SYS DIA and MAP The available pressure labels are Label Definition ART Arterial Blood Pressure PA Pulmonary Arterial Pressure CVP Center Venous Pressure RAP Right Atrial Pressure LAP Left Atrial Pressure Intracranial Pressure ICT B Transducer information Refer to 16 7 P1 P2 Expand Pressure ICP 16 2 Precautions during IBP Monitoring A Warning A Parts and accessories used must meet the safety requirements of the medical electrical equipment standards A Warning A Do not contact the metal part connected to the electrical appliance when connecting or using the accessory A Warning A When the monitor is used with H
240. ted do not use the catheter and return it to Manufactory for repair Proper function before insertion into the epidural space should be confirmed by gently touching the tip of the transducer and observing a deflection on the operating room pressure monitor Once the ICT B has been inserted into the epidural space the physician should check the proper function again by injecting 0 3cc of air to check the zero of the ICT B The monitor should respond correctly as previously described J Review of techniques to prevent damage to the catheter 1 In preparing the burr hole it is imperative that the hole be rounded at the edges where the catheter makes an S bend into the epidural space 2 Evacuate all bone chips 3 A small pledgelet of woven bandage should be placed around the catheter where sutures will be placed This will prevent damage to the catheter when pulling sutures tight Otherwise you may cut the catheter 4 Use some bone wax on the edges of bone where the catheter and tip make contact with bone 5 When removing the catheter care should be taken not to cut the device while cutting sutures Remove the ICT B by pulling slowly on the catheter 6 The dura mater should be stripped sufficiently so that the tip of the sensor is not forced or wedged into place 7 Do not use haemostats or forceps they will damage the device Do not squeeze the 16 18 Patient Monitor user s manual V 5 4 IBP Monitoring sensor betwee
241. tem cannot perform cuff If the failure still exists measurement analysis or contact the manufacturer for calculation repair EXCESSIVE MOTION The patient arm moves Check the connection of each part and the patient situation Measure again if the failure still exists contact the manufacturer for repair Check for the smoothness in a the airway and patient OVER PRESSURE SE folds exis inthe situation Measure again if airway the failure still exists contact the manufacturer for repair Problem happens when Check the connection of each measuring the curve The part and the patient situation SIGNAL SATURATED system cannot perform Measure again if the failure measurement analysis or still exists contact the calculation manufacturer for repair Problem happens when Check the connection of each measuring the curve The part and the patient situation NIBP TIME OUT system cannot perform Measure again if the failure measurement analysis or still exists contact the calculation manufacturer for repair 8 Patient Monitor user s manual V 5 4 System Alarm Prompt CUFF TYPE ERR Perhaps the used cuff does not fit the setup patient type Check if the patient type is set up correctly Check the connection of each part or replace with a new cuff If the failure still exists contact the manufacturer for repair PNEUMATIC LEAK NIBP airway has leak
242. the monitor 7 2 Recording Type PM 9000 provides several stripe recording types Continuous real time recording 8 second real time recording Auto 8 second recording Alarm recording Waveform freeze recording Trend graph table recording ARR events review recording Alarm event recording NIBP review recording CO2 Measurement review recording AG Measurement review recording CO Measurement curve recording Hemodynamic Calculation result recording Monitor information recording Patient Monitor user s manual V 5 4 7 1 Recording WR Drug calculation titration recording WR OxyCRG recording Real time Recording Real time recording starts as you press the REC STOP button on the recorder The waveforms for continuous real time recording and continuous 8 second recording are automatically set by the monitor usually the first two waveforms displayed on the screen You can also configure it through the menu Refer to related section for details In RECORD menu the user can choose two waveforms to be printed out The User can setup one waveform off Thus the real time record will print out one waveform If two waveforms are off the real time record will print out measure parameters only A Note A If certain recording is in process and another parameter demands alarm recording it will only be executed after the earlier recording is finished Auto recording The monitor starts the recorder for 8 seconds according to
243. thetic gas generated by AG module RT REC TIME this item has two options CONTINUAL and 8s CONTINUAL means once pushing the REC STOP button on the recorder panel or the monitor panel the recorder will continuously print out the waveform or parameter until this button is pushed again TIMING REC TIME OFF used to set up the time interval between two recordings 10 selections are available OFF 10min 20min 30min 40min 50min 1hour 2hours 3hours and 4hours The system will start the recording process according to the selected time interval The recording time is always 8 seconds A Note A RT REC TIME takes priority over TIMING REC TIME OFF REC RATE this item has two options 25 0 and 50 0 mm s REC GRID used to decide output format OFF is without grid and ON is with grid CLEAR REC TASK used to clear the alarm event that has been generated and is waiting for recording out A Note A H two same waveforms are selected the system will automatically change one of the waveform to a different one 3 4 6 Module Setup Select the MODULE SETUP item in the SYSTEM SETUP menu to call up the following menu 3 8 Patient Monitor user s manual V 5 4 System Menu MODULE SETUP v ECG v IBP 1 2 RESP v c02 TEMP v CO v SP02 NIBP Back to the upper menu EES Figure 3 12 Module Setup You can choose the parameters to be monitored in this menu This can
244. tifies biomedical engineer ECGINITERRS or Mindray service ECG INIT ERR6 staff ECG INIT ERR7 ECG INIT ERR8 If failure persists ECG COMM STOP Occasional communication HIGH notify biomedical failure engineer or Mindray service staff If failure persists ECG COMM ERR Occasional communication HIGH notify biomedical failure engineer or Mindray service staff Stop using HR alarm function notify HR ALM LMT ERR Functional safety failure HIGH biomedical engineer or Mindray service staff Make sure the patient is quiet the electrodes are LOW properly connected and AC power system is well grounded ECG measuring signal is ECG NOISE greatly interfered Prompt messages include general alerts Message Cause Alarm Level HR EXCEED HR measuring value exceeds the HIGH measurement range 12 7 ST Segment Monitoring optional ST Segment Monitoring Optional WH ST segment monitoring function is shutoff by default You can switch it to ON when necessary 12 12 Patient Monitor user s manual V 5 4 ECG RESP Monitoring NOTE When setting ST ANALYSIS on the monitor will select DIAGNOSTIC mode You can set it to MONITOR mode or OPERATE mode as required However at this time ST value has been severely distorted It is available to measure the variance of ST segment with ST analysis at the waveform tracks for selected lead The corresponding ST measurement result displays nume
245. ting window is not selected for calculation excluded from the averaging calculations the place will be taken by the new measurement E Editing the CO measurement Pick the EDIT button to access the WINDOWS FOR C O EDIT as shown below WINDOW FOR CO EDIT 0 AVERAGE COC l min 2 49 HEMO CALCULATE gt gt 0 o CICl minzm 2 3 3 Back to the upper menu O Figure 17 3 CO Edit Windows Contents displayed in the window O Six curves of the six measurements and C O value Average value of cardiac output D Average value of cardiac index Function button in the edit window Editing operation Values of selected measurements can be averaged and stored in the CO item in the HEMOD menu as the basis for Hemodynamic calculations When first enter the EDIT Window curves and CO values of valid measurements are highlighted indicating these values are to be averaged You can move the cursor to the curve of questionable measurements and press the rotary knob dis highlighted waveforms and CO values will be excluded from the averaging calculation A Note A Dis highlighted curves can be picked and included into the averaging calculation 17 2 3 Blood Temperature Monitoring Blood temperature monitoring can function when C O measurement is not taken The blood temperature is measured by the thermistor situated in the distal end of the flotation catheter in the pulmonary artery See the diagram below WH The blood
246. tion regulations mandated by the local and regional bodies of government Patient Monitor user s manual V 5 4 Ul Return Policy Return Procedure In the event that it becomes necessary to return a unit to Mindray the following procedure should be followed 1 Obtain return authorization Contact the Mindray Service Department and obtain a Customer Service Authorization Mindray number The Mindray number must appear on the outside of the shipping container Return shipments will not be accepted if the Mindray number is not clearly visible Please provide the model number serial number and a brief description of the reason for return 2 Freight policy The customer is responsible for freight charges when equipment is shipped to Mindray for service this includes customs charges Company Contact Address Mindray Building Keji 12th Road South Hi tech Industrial Park Nanshan Shenzhen P R China 518057 Phone 86 755 2658 2888 Fax 86 755 2658 2680 Free hot line 86 800 830 3312 EC Representative Name Shanghai International Holding Corp GmbH Europe Address Eiffestrasse 80 D 20537 Hamburg Germany Phone 49 40 2513174 Fax 49 40 255726 IV Patient Monitor user s manual V 5 4 Preface This manual gives detailed description to PM 9000 Portable Patient Monitor concerning its performance operation and other safety information Reading through this manual is the first step for the user t
247. to reduce and hence make the measurement impossible The absorption of oxyhemoglobin HbO2 and deoxyhemoglobin to the light of special wavelength may also affect SoO2 measurement If there exist other objects carbon hemoglobin methemoglobin methylene blue and indigo carmine absorbing the light of the same wavelength they may result in false or low SpOz value Itis recommended to use SpOz sensors described in chapter Accessories and Ordering Information 13 2 5 SpO2 Menu SPO2 SETUP Menu Turn the knob to move the cursor onto the SPO2 hot key in the Parameter area push the knob to access the SPO2 SETUP menu 13 18 Patient Monitor user s manual V 5 4 SpO2 Monitoring SPOZ SETUP ALM PR ALM LO 50 ALM LEU MED SWEEP 25 0 ALM REC OFF PR SOUND 2 SPOZ ALM HI 100 AVG TIME 45 s SP02 ALM LO 90 gt DEFAULT gt gt PR ALM HI 120 Open or close the Sp02Z alarn EXIT Figure 13 7 SPO2 SETUP menu A Warning A Setting the SpO upper alarm limit to 100 is equivalent to switching off the alarm on upper limit High oxygen levels may predispose a premature infant to retrolental fibroplasia Therefore the upper alarm limit for oxygen saturation must be carefully selected in accordance with commonly accepted clinical practices SpO alarm setting m ALM pick ON the system will give alarm prompt and store alarm information when SpO2 alarm occurs pick OFF the system will not give alarm and instead displ
248. tted line EXIT 75 gt gt gt Figure 16 8 IBP SCALE ADJUST Menu Patient Monitor user s manual V 5 4 IBP Monitoring The waveform and corresponding scale appears in the IBP Waveform Area with 3 dotted lines representing Higher Scale Reference Scale and Lower Scale from the top to the bottom Values of the three scales can be set according to the instruction given below WH IBP label Selectable from ART PA CVP RAP LAP ICP P1 P2 WH HI IBP value of Higher scale the range of which is the measurable range of current pressure AY Note A The HI value must be higher than the LO value m LO IBP value of Lower scale the range of which is the measurable range of current pressure A Note A The LO value must be lower than the HI value VAL IBP value of Reference scale between HI and LO A Note A HI scale LO scale Reference scale and IBP waveform are displayed simultaneously on the screen user could obviously view the change of the waveform after the scale has been adjusted 16 5 Alarm Information and Prompts Alarm Messages Physiological alarm caused by the parameter value exceeds the limits will activate the recorder to automatically outputting the parameters and related measuring waveforms once the alarm occur while ALARM REC in related menu switch ON Tables below describe the possible physiological alarms technical alarms and prompt messages occurring during IBP measureme
249. ty rubescence vesicle repressive putrescence and so on It is especially important to check the sensor placement of neonate and patient of poor perfusion or immature dermogram by light collimation and proper attaching strictly according to changes of the skin Check per 2 3 hours the sensor placement and move it when the skin deteriorates More frequent examinations may be required for different patients Patient Monitor user s manual V 5 4 13 15 SpO2 Monitoring 13 2 3 Monitoring Procedure SpO plethysmogram measurement 1 Switch on the monitor 2 Attach the sensor to the appropriate site of the patient finger 3 Plug the connector of the sensor extension cable into the SpO socket on the SpO2 module Figure 13 3 Mounting of the sensor m Neonate SpO Measurement The process of measuring neonate SpO is similar to that of measuring adult SpO2 Below is the description of neonate SpO sensor and its installation 1 Neonate SpO sensor Neonate SpOz sensor consists of Y form SpOz2 sensor and its sheath Insert the LED and PD ends of the Y form SpO sensor respectively into the upper and lower grooves on the sheath figure 13 4 Figure 13 5 shows us the neonate SpO gt z sensor after insertion Figure 13 4 Neonate SpO sensor 1 13 16 Patient Monitor user s manual V 5 4 SpO Monitoring Figure 13 5 Neonate SpO gt sensor 2 2 Attaching Neonate SpO sensor Wind the SpO sensor around a hand or
250. ure and ambient pressure and turn it off when measuring the dry gas under the ambient temperature and pressure 4 Operate by strictly observing the Compensate operation method m DEFAULT pick this item to access the CO2 DEFAULT CONFIG dialog box in which the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used After selecting any of the items and exiting the dialog box the system will pop up the dialog box asking for the user s confirmation EtCO2 upper alarm limit when parameter value exceeds this limit there will be alarm for exceeding the upper limit Default Adult 50 mmHg Pediatric 50 mmHg Neonatal 45 mmHg EtCO2 lower alarm limit when parameter value is smaller than the lower limit there will be alarm for exceeding lower limit Default Adult 15 mmHg Pediatric 20 mmHg Neonatal 30 mmHg InsCO2 upper alarm limit when parameter value exceeds this limit there will be alarm for exceeding upper limit Default Adult 4 mmHg Pediatric 4 mmHg Neonatal 4 mmHg AwRR upper alarm limit when parameter value exceeds this limit there will be alarm for exceeding upper limit Default Adult 30 rpm 18 6 Patient Monitor user s manual V 5 4 CO2 Monitoring Pediatric 30 rpm Neonatal 100 rpm AwRR lower alarm limit when parameter value is smaller than the limit there will be alarm for exceeding lower limit Default Adult 8 rpm Pediatric 8 rpm Neonatal
251. urned for repair an inconvenience that may be avoided by smoothing areas of bone in contact with the catheter transducer The catheter is led out through the wound in the manner of a drain It may make sharp bends without disturbing the operation of the ICT B Care should be taken though not to pinch the catheter by bending onto itself at acute angles for this will seal and possibly damage the internal lumens required for proper operation The catheter should be restrained from moving once the tip is in place It may be fixed to the scalp by encircling sutures or with a silicone rubber suture collar available from manufacturers of such items as peritoneal shunt systems The latter method is preferred as it will help prevent damage to the catheter by sutures or during removal of sutures Another method is by first approaching the burr hole through a tunnel under the skin entering the tunnel from a point distal to the burr hole by making a small incision in the skin The ICT B can be guided in the tunnel by using a disposable tube removable from the burr hole side This latter method is to be preferred from both a mechanical stability point of view and from the reported low incidence of infection The catheter can then be led out in the manner of a drain and the burr hole incision sutured The physician is urged to examine the ICT B for physical damage to the silicone rubber covering anywhere on the tip or catheter before use If damage is suspec
252. us clear screen waveforms and resume to display real time waveforms In the Screen Refresh mode the system begins scanning waveforms from the extreme left one In the Screen Scroll mode the system begins displaying and scrolling waveforms from the extreme right one 6 3 FROZEN Menu Press the FREEZE button on the button module the FROZEN menu will appear on the bottom part of the screen At the same time the system enters the Freeze status WAVE 1 WAVE 2 ECG2 RECALL REC EXIT Figure 6 1 FROZEN menu m WAVE 1 used to select the first frozen waveform to record The pull down list of this item gives you the names of all frozen waveforms displayed on the screen m WAVE 2 used to select the second frozen waveform to record The pull down list of this item gives you the names of all waveforms displayed on the screen H RECALL used to review frozen waveforms m REC after selected the system begins recording the frozen waveforms selected in WAVE 1 and WAVE 2 H EXIT after pressed the system closes the FROZEN menu and exits the Freeze status AN Note A Pressing the FREEZE button repeatedly in short time period may result in discontinuous waveforms on the screen 6 2 Patient Monitor user s manual V 5 4 Freeze 6 4 Reviewing Frozen Waveform By moving the waveform you may review a waveform of 40 seconds before the moment when it is frozen For a waveform less than 40 seconds the r
253. use SpO measuring value is above upper alarm limit SpO2 Monitoring Alarm Level User selectable SpO2 TOO LOW SpO2 measuring value is below lower alarm limit User selectable PR TOO HIGH PR measuring value is above upper alarm limit User selectable PR TOO LOW PR measuring value is below lower alarm limit User selectable Technical alarms Alarm failure Message Cause level Remedy Make sure that the SE monitor and the patient SPO2 SENSOR OFF fom dhe patient LOW are in correct orhe eer connection with the cables SPO2 INIT ERR SPO2 INIT ERR 1 SPO2 INIT ERR 2 SPO2 INIT ERR 3 Stop using the SpO m d l measuring function of SPO2 INIT ERR 4 failure HIGH SpO gt module notify biomedical engineer or SPO2 INIT ERR 5 Mindray service staff SPO2 INIT ERR 6 SPO2 INIT ERR 7 SPO2 INIT ERR 8 Stop using the ae ae measuring function of SPO2 COMM STOP ae HIGH SpO gt module notify communication l Sirr biomedical engineer or Mindray service staff Stop using the P a measuring function of SPO2 COMM ERR Be E EE HIGH SpO2 module notify error biomedical engineer or Mindray service staff Stop using the measuring function of SPO2 ALM LMT ERR Fri SEH HIGH SpO module notify biomedical engineer or Mindray service staff Stop using the measuring function of PR ALM LMT ERR ee HIGH SpO gt module notify biomedical engineer
254. ve alarm limits User selectable AWRR TOO HIGH AwRR measuring value is above upper alarm limit User selectable AWRR TOO LOW AwRR measuring value is below lower alarm limit User selectable In specific time interval no RESP can be Ee detected using CO2 module GE Technical alarms Alarm Message Cause Level Remedy Mainstream sensor is not Make sure that CO2 SENSOR OFF properly connected or has LOW mainstream sensor is fallen off properly connected CO2 NO Sidestream water trap is not Make sure that WATERTRAP properly connected or has LOW sidestream water trap fallen off is soundly connected CO2 WATERTRAP Sidestream water trap is Low FER E Sie OCCLUDE occluded H functions smoothly CO2 SIGNAL LOW Measuring module technical LOW If necessary re start failure the monitor If failure CO2 SIGNAL TOO LOW persists stop using LOW measuring function of CO2 BAROMTRC MED CO2 module notify TOO LARGE biomedical engineer CO2 PNEUMATIC MED or Mindray service LEAK staff CO2 SIGNAL NOISY LOW CO2 SIGNAL SATURATE SEH CO2 CALCULATION ERR HIGH CO2 SENSOR FAULT HIGH CO2 SENSOR TEMP HIGH HIGH CO2 SENSOR TEMP LOW HIGH CO2 WATCHDOG TIMEOUT PGR CO2 INT COMM ERR HIGH CO2 SYSTEM ROM ERR HIGH CO2 FLASH CRC ERR HIGH CO2 INT RAM ERR HIGH CO2 FLASH CHECK ERR HIGH CO2 EXT RAM ERR HIGH CO2 STACK OVER HIGH CO2 PUMP FAULT HIGH CO2 REVERSE HIGH FLOW
255. will display A Note A If the monitor finds any fatal error during self test it will alarm A Note A Check all the functions that may be used to monitor and make sure that the monitor is in good status A Note A The battery must be recharged to the full electricity after each use to ensure adequate electricity reserve A Warning A If any sign of damage is detected or the monitor displays some error messages do not use it on any patient Contact biomedical engineer in the hospital or Mindray Customer Service Center immediately A Note A The interval between twice press of POWER should be more than 1 minute 2 2 Patient Monitor user s manual V 5 4 Getting Started 2 4 Connect Patient Sensors Connect all the necessary patient sensors between the monitor and the patient A Note A For information on correct connection refer to related chapter 12 19 2 5 Check the Recorder If your monitor is equipped with a recorder open the recorder door to check if paper is properly installed in the output slot If no paper present refer to Chapter Recording for details Patient Monitor user s manual V 5 4 2 3 Chapter 3 System Menu New patient enrolment Recording Trend Graph Table and Alarm Review System Setup Drug Calculation Maintenance PM 9000 Portable Multi Parameter Patient Monitor features flexible configurations You can customize monitoring content waveform sweep speed sound volume
256. wo seconds on the most recent four seconds of raw data The SpOz value therefore corresponds to a running average of arterial hemoglobin saturation that is updated every two seconds 13 1 1 Precautions A Warning AN This pulse wave from M 7 should NOT be used as an apnea monitoring AY Warning AN This monitor with M 7 should be considered an early warning device for SpO2 As a trend towards patient deoxygenation is indicated blood samples should be analyzed by a laboratory co oximeter to completely understand the patient s condition AN Warning AN If an alarm condition other than exceptions listed herein occurs while the alarm silence period is set to off the only alarm indications will be visual displays and symbols related to the alarm condition A Warning AY Measure the monitor s leakage current whenever an external device is connected to Patient Monitor user s manual V 5 4 13 3 SpO2 Monitoring the serial port Leakage current must not exceed 100 microamperes AN Warning A To ensure patient electrical isolation connect only to other equipment with electronically isolated circuits A Warning A Do not connect to an electrical outlet controlled by a wall switch or dimmer A Warning A As with all medical equipment carefully route patient cabling to reduce the possibility of patient entanglement or strangulation A Warning A Interfering Substances Carboxyhemoglobin may erroneously increase read
257. ximately 0 3cc of air into the female luer using a 1ml syringe and note that the monitor does indeed immediately go to zero Also note that if the ICT B is moved rapidly up and down in a column of water pressure waves of high fidelity are seen The ICT B has a very high frequency response and you will observe excellent pressure waves in actual practice It can also be confirmed that the exact amount of air injected to check the zero is not important 16 7 5 Note to the neurosuregeon The ICT B is intended for the measurement of epidural pressures Use of the transducer for the measurement of intraventricular pressures is not recommended The ICT B is designed for the measurement of positive pressures only 16 16 Patient Monitor user s manual V 5 4 IBP Monitoring A Note A Catheter Tip Pressure Transducers must be used under the supervision of a suitably qualified Physician Method of Application of the ICT B The application of the ICT B may be accomplished through a variety of surgical techniques Therefore the surgeon is best advised to use the method which his own practice and discretion dictate to be best for the patient The following are some general guidelines The ICT B may be inserted during surgery or through a burr hole When in place the catheter tip transducer should have its pressure sensing surface facing against the dura under the cranium There are 2 5cm marks on the back of the catheter and these are visible wh
258. y 1 14 Patient Monitor user s manual V 5 4 Introduction Figure 1 7 Battery Slot Cover A Warning A After the patient monitor has been placed unused for a long time the battery must be recharged before use again When not using the patient monitor for a long time without charging the battery the battery capacity will decrease Connect the patient monitor to appropriate AC mains to charge the battery Mindray recommends replace the sealed Lead Acid battery once per year Dispose or recycle the battery and other parts of the patient monitor by following local government regulations Patient Monitor user s manual V 5 4 1 15 Chapter 2 Getting Started Open the package and check Connect the power cables Power on the monitor Connect patient sensors Check the recorder A Note A To ensure that the monitor works properly please read Chapter Patient Safety and follow the steps before using the monitor 2 1 Open the Package and Check Open the package and take out the monitor and accessories carefully Keep the package for possible future transportation or storage Check the components according to the packing list mM Check for any mechanical damage WH Check all the cables modules and accessories If there is any problem contact the distributor immediately 2 2 Connect the Power Cables Connection procedure of the AC power line H Make sure the AC power supply complies with following specification 100
259. y waveform on the screen 12 20 Patient Monitor user s manual V 5 4 ECG RESP Monitoring 12 9 2 Setting Up RESP measurement For RESP monitoring it is not necessary for additional electrodes however the placing of electrodes is important Some patients due to their clinical condition expand their chest laterally causing a negative intrathoracic pressure In these cases it is better to place the two RESP electrodes laterally in the right axillary and left lateral chest areas at the maximum point of breathing movement to optimize the respiratory waveform A Note A The RESP monitoring is not recommended to be used on patients who are very active as this can cause false alarms Checklist for RESP Monitoring 1 Prepare the patient s skin prior to placing the electrodes 2 Attach snap or clip to the electrodes and attach the electrodes to the patient as described below 3 Switch on the monitor 12 9 3 Installing electrode for RESP measurement Placing the Electrodes for Respiratory Monitoring Figure 12 16 Electrodes placement 5 lead A Note A Place the red and green electrodes diagonally to optimize the respiration waveform Avoid the liver area and the ventricles of the heart in the line between the RESP electrodes so as to avoid cardiac overlay or artifacts from pulsating blood flow This is Patient Monitor user s manual V 5 4 12 21 ECG RESP Monitoring particularly important for neonates
260. ype The system can display all waveforms about monitored patient on the screen either in Refresh or Scroll way The method is Select SELECTION item in SYSTEM MENU to access SELECTION sub menu in which there is the item SCAN TYPE The user may decide the way to display the waveform by choosing either REFRESH or SCROLL Alarm Limits The system can display the alarm limits You can choose this function as per your need The method is Select the SELECTION in the SYSTEM MENU to call up the SELECTION menu You can set the ALM LIMIT switch to ON or OFF Patient Monitor user s manual V 5 4 3 11 System Menu 3 6 Monitor Version Select the VERSION item in the SYSTEM MENU to know the software version of the monitor VERSION Version 05 08 00 07 31 2001 Copyright c Mindray Co Ltd Compile Time Apr 16 2003 DEVICE CONFIG LIST gt gt Back to the upper menu Figure 3 17 Monitor Version Select the DEVICE CONFIG LIST to know the configuration of the monitor DEVICE CONFIG LIST DYNAMIC TREND MODULE v oxyCRG ECG VIEWBED RESP WAVE SCROLL DISPLAY TEMP PARA ALARM LIMIT DISPLAY SPOZ DRUG CALC amp TITRATION v NIBP ARR amp ST ANALYSIS IBP ECG LEAD TYPE 5 LEADS v CO ECG MULTI LEADS DISPLAY C02 NIBP LIST DISPLAY GAS POWER OFF DATA STORAGE RECORDER Back to the upper menu Figure 3 18

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